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Multicenter Study
. 2021 Sep;8(2):e001666.
doi: 10.1136/openhrt-2021-001666.

Changes in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015

Tianna Zhou #  1 , Xi Li #  2   3 , Yuan Lu  1 , Karthik Murugiah  1 , Xueke Bai  4 , Shuang Hu  4 , Yan Gao  4 , Frederick A Masoudi  5   6 , Harlan M Krumholz  1 , Jing Li  2 ; China Patient-Centered Evaluative Assessment of Cardiac Events Collaborative Group
Affiliations
Multicenter Study

Changes in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015

Tianna Zhou et al. Open Heart. 2021 Sep.

Abstract

Objective: Access to acute cardiovascular care has improved and health services capacity has increased over the past decades. We assessed national changes in (1) patient characteristics, (2) in-hospital management and (3) patient outcomes among patients presenting with ST segment elevation myocardial infarction (STEMI) in 2011-2015 in China.

Methods: In a nationally representative sample of hospitals in China, we created two random cohorts of patients in 2011 and 2015 separately. We weighted our findings to estimate nationally representative numbers and assessed changes from 2011 to 2015. Data were abstracted from medical charts centrally using standardised definitions.

Results: While the proportion of patients with STEMI among all patients with acute myocardial infarction decreased over time from 82.5% (95% CI 81.7 to 83.3) in 2011 to 68.5% (95% CI 67.7 to 69.3) in 2015 (p<0.0001), the weighted national estimate of patients with STEMI increased from 210 000 to 380 000. The rate of reperfusion eligibility among patients with STEMI decreased from 49.3% (95% CI 48.1 to 50.5) to 42.2% (95% CI 41.1 to 43.4) in 2015 (p<0.0001); ineligibility was principally driven by larger proportions with prehospital delay exceeding 12 hours (67.4%-76.7%, p<0.0001). Among eligible patients, the proportion receiving reperfusion therapies increased from 54% (95% CI 52.3 to 55.7) to 59.7% (95% CI 57.9 to 61.4) (p<0.0001). Crude and risk-adjusted rates of in-hospital death did not differ significantly between 2011 and 2015.

Conclusions: In this most recent nationally representative study of STEMI in China, the use of acute reperfusion increased, but no significant improvement occurred in outcomes. There is a need to continue efforts to prevent cardiovascular diseases, to monitor changes in in-hospital treatments and outcomes, and to reduce prehospital delay.

Keywords: delivery of health care; epidemiology; health care; myocardial infarction; outcome assessment; percutaneous coronary intervention.

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Conflict of interest statement

Competing interests: JL reported receiving research grants, through Fuwai Hospital, from the People’s Republic of China for work to improve the management of hypertension and blood lipids and to improve care quality and patient outcomes of cardiovascular disease; receiving research agreements, through the National Center for Cardiovascular Diseases and Fuwai Hospital, from Amgen for a multicentre clinical trial assessing the efficacy and safety of omecamtiv mecarbil and for dyslipidaemic patient registration; receiving a research agreement, through Fuwai Hospital, from Sanofi for a multicentre clinical trial on the effects of sotagliflozin; receiving a research agreement, through Fuwai Hospital, with the University of Oxford for a multicentre clinical trial of empagliflozin; receiving a research agreement, through the National Center for Cardiovascular Diseases, from AstraZeneca for clinical research methods training, outside the submitted work; and receiving a research agreement, through the National Center for Cardiovascular Diseases, from Lilly for physician training, outside the submitted work. HK works under contract with the Centers for Medicare & Medicaid Services to support quality measurement programmes; was a recipient of a research grant, through Yale, from Medtronic and the US Food and Drug Administration to develop methods for postmarket surveillance of medical devices; was a recipient of a research grant with Medtronic and is the recipient of a research grant from Johnson & Johnson, through Yale University, to support clinical trial data sharing; was a recipient of a research agreement, through Yale University, from the Shenzhen Center for Health Information for work to advance intelligent disease prevention and health promotion; collaborates with the National Center for Cardiovascular Diseases in Beijing; receives payment from the Arnold & Porter law firm for work related to the Sanofi clopidogrel litigation, from the Martin/Baughman law firm for work related to the Cook IVC filter litigation, and from the Siegfried and Jensen law firm for work related to Vioxx litigation; chairs a Cardiac Scientific Advisory Board for UnitedHealth; was a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science, the Advisory Board for Facebook and the Physician Advisory Board for Aetna; and is the founder of Hugo Health, a personal health information platform, and cofounder of Refactor Health, an enterprise healthcare AI-augmented data management company. FM has a contract with the American College of Cardiology as the Chief Scientific Advisor for the NCDR and has received travel expenses from the Fuwai Hospital. YL is supported by the National Heart, Lung, and Blood Institute (K12HL138037) and was a recipient of a research agreement, through Yale, from the Shenzhen Center for Health Information for work to advance intelligent disease prevention and health promotion.

Figures

Figure 1
Figure 1
Number of patients by year and condition. (A) Number of patients in PEACE-Retrospective AMI Study. (B) Weighted number of patients in China. To estimate nationally representative numbers of hospitalisations for 2011 and 2015, we applied sampling weights proportional to the inverse sampling fraction of hospitals within each stratum and the sampling fraction of patients within each hospital to account for differences in the sampling fraction for 2011 in all analyses. AMI, acute myocardial infarction; NSTEMI, non-ST segment elevation myocardial infarction; PEACE, China Patient-Centered Evaluative Assessment of Cardiac Events; STEMI, ST segment elevation myocardial infarction.
Figure 2
Figure 2
Adjusted in-hospital outcomes for patients with STEMI. Adjusted OR of 1 shows no difference from year 2011. We included 12 764 patients (6472 in year 2011 and 6292 in year 2015). We excluded 630 patients transferred in from other facilities, 2281 patients transferred out to other hospitals at any timepoint and 132 patients discharged alive within 24 hours. C=0.774 for mortality, C=0.793 for death or treatment withdrawal, and C=0.694 for composite complications. STEMI, ST segment elevation myocardial infarction.
Figure 3
Figure 3
Adjusted 7-day outcomes among patients with STEMI. Adjusted OR of 1 shows no difference from year 2011. We included 13 518 patients (6715 in year 2011 and 6803 in year 2015). We excluded 630 patients transferred in from other facilities, 1527 patients transferred out to other hospitals within 7 days of admission and 132 patients discharged alive within 24 hours. C=0.773 for mortality and C=0.791 for death or treatment withdrawal. STEMI, ST segment elevation myocardial infarction.
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