Liu Jiamin, Masoudi Frederick A, Spertus John A, Wang Qing, Murugiah Karthik, Spatz Erica S, Li Jing, Li Xi, Ross Joseph S, Krumholz Harlan M, Jiang Lixin
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (J.L., Q.W., J.L., X.L., L.J.).
Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.).
J Am Heart Assoc. 2015 Feb 23;4(2):e001343. doi: 10.1161/JAHA.114.001343.
Chinese and U.S. guidelines recommend angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) for all patients with acute myocardial infarction (AMI) in the absence of contraindications as either a Class I or Class IIa recommendation. Little is known about the use and trends of ACEI/ARB therapy in China over the past decade.
Using nationally representative data from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction (China PEACE-Retrospective AMI Study), we assessed use of ACEI/ARB therapy in 2001, 2006, and 2011, overall and across geographic regions and strata of estimated mortality risk, and predictors of ACEI/ARB therapy, among patients with Class I indication by Chinese guidelines. The weighted rate of ACEI/ARB therapy increased from 62.0% in 2001 to 71.4% in 2006, decreasing to 67.6% in 2011. Use was low across all 5 geographic regions. By strata of estimated mortality risk, in 2001, rates of therapy increased with increasing risk; however, by 2011, this reversed and those at higher risk were less likely to be treated (70.7% in lowest-risk quintile vs. 63.5% in the highest-risk quintile; P<0.001).
One third of Chinese AMI patients with Class I indications do not receive ACEI/ARB therapy during hospitalization, with little improvement in rates over time. Patients at higher mortality risk in 2011 were less likely to be treated, highlighting important opportunities to optimize the use of this cost-effective therapy.
ClinicalTrials.gov. Unique identifier: NCT01624883.
中国和美国的指南推荐，对于所有无禁忌证的急性心肌梗死（AMI）患者，应使用血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB），这是I类或IIa类推荐。过去十年中，中国ACEI/ARB治疗的使用情况和趋势鲜为人知。
利用中国急性心肌梗死患者中心评估心脏事件回顾性研究（China PEACE-回顾性AMI研究）的全国代表性数据，我们评估了2001年、2006年和2011年ACEI/ARB治疗的使用情况，包括总体情况、不同地理区域以及估计死亡风险分层情况，还评估了中国指南中I类适应证患者接受ACEI/ARB治疗的预测因素。ACEI/ARB治疗的加权率从2001年的62.0%增至2006年的71.4%，2011年又降至67.6%。所有5个地理区域的使用率都较低。按估计死亡风险分层，2001年，治疗率随风险增加而升高；然而，到2011年，情况逆转，高风险患者接受治疗的可能性降低（最低风险五分位数组为70.7%，最高风险五分位数组为63.5%；P<0.001）。
三分之一有I类适应证的中国AMI患者住院期间未接受ACEI/ARB治疗，且随着时间推移治疗率几乎没有改善。2011年死亡风险较高的患者接受治疗的可能性较小，这凸显了优化使用这种具有成本效益疗法的重要机会。
ClinicalTrials.gov。唯一标识符：NCT01624883。
