Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan 451464, China.
Chin Med J (Engl). 2023 Sep 20;136(18):2203-2209. doi: 10.1097/CM9.0000000000002698. Epub 2023 Aug 4.
Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. This study aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018.
We compared the data from the Henan STEMI survey conducted in 2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment.
STEMI patients in 2016-2018 were younger (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and β-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after adjustment.
Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.
从 2009 年到 2020 年，中国医疗体系改革期间，关于 ST 段抬高型心肌梗死（STEMI）治疗质量变化的数据有限。本研究旨在评估中国中部河南省 2011 年至 2018 年期间 STEMI 患者治疗过程和结局的变化。
我们比较了 2011-2012 年河南省 STEMI 调查（n=1548，横断面研究）和 2016-2018 年河南省 STEMI 登记（n=4748，多中心前瞻性观察研究）的数据。确定了治疗过程和院内死亡率的变化。治疗过程措施包括再灌注治疗、阿司匹林、P2Y12 拮抗剂、β 受体阻滞剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂和他汀类药物。在考虑治疗的理想候选患者中分析了治疗药物的使用情况。
2016-2018 年的 STEMI 患者比 2011-2012 年更年轻（中位数年龄：63.1 岁比 63.8 岁），女性比例更低（24.4%[1156/4748]比 28.2%[437/1548]）。指南推荐治疗的综合使用率从 2011 年显著增加到 2018 年（60.9%[5424/8901]比 82.7%[22,439/27,129]，P<0.001）。12 小时内接受再灌注治疗的患者比例从 44.1%（546/1237）增加到 78.4%（2698/3440）（P<0.001），中位发病至首次医疗接触时间延长（从 144 分钟到 210 分钟，P<0.001）。抗血小板药物、他汀类药物和β受体阻滞剂的使用显著增加。调整后，院内死亡率随时间显著降低（6.1%[95/1548]比 4.2%[198/4748]，比值比[OR]：0.67，95%置信区间[CI]：0.50-0.88，P=0.005）。
2011 年至 2018 年，STEMI 患者逐渐实施指南推荐的治疗方法，与院内死亡率降低相关。然而，临床实践与指南建议之间仍存在差距。需要进一步强调中国中部地区公众意识、再灌注策略和胸痛中心建设。
