Hospital admissions for STEMI increased in China during past decade

The estimated national rate of hospital admissions for STEMI in China increased from 3.7 per 100,000 people in 2001 to 15.8 per 100,000 people in 2011.

Jing Li, PhD, of the National Clinical Research Center of Cardiovascular Diseases, Beijing, and colleagues analyzed STEMI admission in a nationally representative sample of patients in China in 2001, 2006 and 2011 for the China PEACE–Retrospective Acute Myocardial Infarction Study. They used a systematic sampling approach to analyze rates of STEMI, treatments and baseline characteristics. The researchers sampled 175 hospitals and 13,815 STEMI admissions. For the analysis of treatments, procedures and tests, 12,264 patients were included; for the analysis of in-hospital outcomes, 11,986 patients were included.

STEMI admission rates up

Besides the significantly increased national rate of STEMI admissions (P<.0001), the prevalence of risk factors such as smoking, diabetes, hypertension and dyslipidemia also increased from 2001 to 2011.

For patients without documented contraindications, use of aspirin within 24 hours and use of clopidogrel rose during the study period. Use of aspirin within 24 hours rose from 79.3% (95% CI, 77.3-81.3) in 2011 to 91.2% (95% CI, 90.5-91.9), whereas use of clopidogrel rose from 1.5% (95% CI, 0.9-2.1) in 2001 to 80.7% (95% CI, 79.8-81.6), according to the results.

The use of primary PCI also increased during the study period, from 10.2% in 2001 to 27.6% in 2011; P<.0001). However, the researchers found no change in the rate of patients who did not receive reperfusion (44.8% in 2011; 45% in 2011; P=.82).

Median length of hospital stay decreased from 13 days (interquartile range, 7-18) in 2001 to 11 days (interquartile range, 7-14) in 2011 (P <.0001), the researchers found.

Li and colleagues determined that adjusted in-hospital mortality did not significantly change between 2001 and 2011 (OR=0.84; 95% CI, 0.62-1.12).

“Quality of care has improved for some treatments, but important gaps persist and in-hospital mortality has not decreased,” the researchers wrote. “National efforts are needed to improve the care and outcomes for patients with STEMI in China.”

Important step

Ajay J. Kirtane

In an invited commentary, Ajay J. Kirtane, MD, SM, and Gregg W. Stone, MD, both from the Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center at Columbia University Medical Center/New York Presbyterian Hospital, noted that until now, very little was known about the care of patients with acute MI in China. “Publication of these data is an important step towards improving health care in China, and should be cherished as an opportunity that could translate into saving hundreds of thousands of lives,” they wrote.

Gregg W. Stone

Kirtane and Stone, both members of the Cardiology Today’s Intervention Editorial Board, stressed that emphasis must be placed on early identification of symptoms, rapid diagnosis and reperfusion therapy in all appropriate patients, establishment of high-quality continuity of care and efforts at secondary prevention after discharge.

“Addressing the identified gaps in widespread access to timely reperfusion and administration of adjunctive medical therapies alone is a proven paradigm with the greatest potential to improve [CV] survival, especially in rural areas that have a very low density of hospitals,” they wrote.

For more information:

Kirtane AJ. Lancet. 2014;doi:10.1016/S0140-6736(14)61033-3.

Li J. Lancet. 2014;doi:10.1016/S0140-6736(14)60921-1.

Disclosure: The researchers report no relevant financial disclosures. Kirtane reports receiving research grants to his institution from Abbott Vascular, Abiomed, Boston Scientific, Eli Lilly, Medtronic CardioVascular, St. Jude Medical and Vascular Dynamics. Stone reports consulting for Abbott Vascular, Boston Scientific and Medtronic.