Reperfusion strategy and in-hospital outcomes for ST elevation myocardial infarction in secondary and tertiary hospitals in predominantly rural central China: a multicentre, prospective and observational study. Issue 12 (20th December 2021)

• Record Type: Journal Article
• Authors: Zhang, You; Wang, Shan; Cheng, Qianqian; Zhang, Junhui; Qi, Datun; Wang, Xianpei; Zhu, Zhongyu; Li, Muwei; Hu, Dayi; Gao, Chuanyu
• Other Names: author non-byline.; Gao Chuanyu author non-byline.; Wang Zhifang author non-byline.; Su Shuhong author non-byline.; Dong Pingshuan author non-byline.; Yang Xuming author non-byline.; Li Shengli author non-byline.; Xia Hualing author non-byline.; Li Wuxing author non-byline.; Ding Shuiyin author non-byline.; Bai Baoqiang author non-byline.; Yang Xinyuan author non-byline.; Tian Changming author non-byline.; Li Jinbo author non-byline.; Wang Chuntong author non-byline.; Yang Yi author non-byline.; Gao Yanhui author non-byline.; Sun Haiyan author non-byline.; Yan Jixia author non-byline.; Li Heping author non-byline.; Li Wanke author non-byline.; Zhao Zhenfu author non-byline.; Zhou Huading author non-byline.; Zhang Chuanqian author non-byline.; Wang Hengliang author non-byline.; Jing Dequan author non-byline.; Chen Suxia author non-byline.; Ji Xiaoli author non-byline.; Zheng Haijun author non-byline.; Lin Fengxian author non-byline.; Zhao Guiye author non-byline.; Wei Wei author non-byline.; Liu Peng author non-byline.; Liu Yanggui author non-byline.; Cheng Xiangyang author non-byline.; Ma Xiaowen author non-byline.; Zhang Chengwen author non-byline.; Wang Liangping author non-byline.; Tong Changgang author non-byline.; Zhang Ling author non-byline.; Lang Huihui author non-byline.; Xu Haojie author non-byline.; Wei Hengshan author non-byline.; Wang Haitao author non-byline.; Xue Ruilu author non-byline.; Geng Hongxu author non-byline.; Shi Yonghong author non-byline.; Tang Qiwei author non-byline.; Li Yuchun author non-byline.; Liu Yonggang author non-byline.; Wang Dongsheng author non-byline.; Jia Jianbo author non-byline.; Li Xianzhang author non-byline.; Deng Xinling author non-byline.; Xu Qinghua author non-byline.; Zhao Linming author non-byline.; Zhang Hongxia author non-byline.; Li Lipeng author non-byline.; Chen Suqin author non-byline.; Liang Keqi author non-byline.; Zhang Linwu author non-byline.; Jiang Jiandang author non-byline.; Xiao Weitian author non-byline.; Zhang Hongwen author non-byline.; Zhu Shengke author non-byline.; Liu Baofu author non-byline.; Pan Chengxuan author non-byline.; Lu Fengyun author non-byline.; Yang Jie author non-byline.; Li Yaoze author non-byline.; Liu Zheng author non-byline.; Zhang Qingchun author non-byline.; Qiao Yintao author non-byline.; Sun Na author non-byline.; Li Lianjie author non-byline.;
• Is Part Of: BMJ open. Volume 11:Issue 12(2021)
• Publication Date: 2021-12-20
• Subjects: myocardial infarction -- quality in health care -- adult intensive & critical care -- coronary intervention -- coronary heart disease; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2021-053510
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To assess differences in reperfusion treatment and outcomes between secondary and tertiary hospitals in predominantly rural central China. Design: Multicentre, prospective and observational study. Setting: Sixty-six (50 secondary and 16 tertiary) hospitals in Henan province, central China. Participants: Patients with ST elevation myocardial infarction (STEMI) within 30 days of symptom onset during 2016–2018. Primary outcome measures: In-hospital mortality, and in-hospital death or treatment withdrawal. Results: 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. Conclusions: 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. Trial registration number: NCT02641262 .