Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China.
Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan, China.
BMJ Open. 2021 Dec 20;11(12):e053510. doi: 10.1136/bmjopen-2021-053510.
To assess differences in reperfusion treatment and outcomes between secondary and tertiary hospitals in predominantly rural central China.
Multicentre, prospective and observational study.
Sixty-six (50 secondary and 16 tertiary) hospitals in Henan province, central China.
Patients with ST elevation myocardial infarction (STEMI) within 30 days of symptom onset during 2016-2018.
In-hospital mortality, and in-hospital death or treatment withdrawal.
Among 5063 patients of STEMI, 2553 were treated at secondary hospitals. Reperfusion (82.0% vs 73.0%, p<0.001) including fibrinolytic therapy (70.3% vs 4.4%, p<0.001) were more preformed, whereas primary percutaneous coronary intervention (11.7% vs 68.6%, p<0.001) were less frequent at secondary hospitals. In secondary hospitals, 53% received fibrinolytic therapy 3 hours after onset, and 5.8% underwent coronary angiography 2-24 hours after fibrinolysis. Secondary hospitals had a shorter onset-to-first-medical-contact time (176 min vs 270 min, p<0.001). Adjusted in-hospital mortality (adjusted OR 1.23, 95% CI 0.89 to 1.70, p=0.210) and in-hospital death or treatment withdrawal (adjusted OR 1.18, 95% CI 0.82 to 1.70, p=0.361) were similar between secondary and tertiary hospitals.
With fibrinolytic therapy as the main reperfusion strategy, the reperfusion rate was higher in secondary hospitals, whereas in-hospital outcomes were similar compared with tertiary hospitals. Public awareness, capacity of primary and secondary care institutes to treat STEMI, and establishment of deeper cooperation among different-level healthcare institutes need to further improve.
NCT02641262.
评估在中国中部主要农村地区的二级和三级医院之间再灌注治疗和结局的差异。
多中心、前瞻性和观察性研究。
中国中部河南省的 66 家（50 家二级和 16 家三级）医院。
2016 年至 2018 年期间症状发作后 30 天内的 ST 段抬高型心肌梗死（STEMI）患者。
院内死亡率以及院内死亡或治疗退出。
在 5063 例 STEMI 患者中，有 2553 例在二级医院接受治疗。再灌注（82.0%对 73.0%，p<0.001），包括溶栓治疗（70.3%对 4.4%，p<0.001）更常见，而直接经皮冠状动脉介入治疗（11.7%对 68.6%，p<0.001）则较少见。在二级医院，53%的患者在发病后 3 小时内接受溶栓治疗，5.8%的患者在溶栓后 2-24 小时内进行冠状动脉造影。二级医院的发病至首次医疗接触时间更短（176 分钟对 270 分钟，p<0.001）。调整后的院内死亡率（调整后的 OR 1.23，95%CI 0.89 至 1.70，p=0.210）和院内死亡或治疗退出（调整后的 OR 1.18，95%CI 0.82 至 1.70，p=0.361）在二级和三级医院之间相似。
以溶栓治疗为主要再灌注策略，二级医院的再灌注率较高，而与三级医院相比，院内结局相似。需要进一步提高公众意识、初级和二级医疗机构治疗 STEMI 的能力以及不同级别医疗机构之间的深入合作。
NCT02641262。
