Journal Article

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

Li, Wuxing, Pan, Chengxuan, Ding, Shuiyin, Li, Xianzhang, Xu, Haojie, Deng, Xinling, Yang, Xuming, Jia, Jianbo, Gao, Chuanyu, Chen, Suqin, Zhang, Hongxia, Liu, Baofu, Lu, Fengyun, Zhang, Junhui, Liu, Peng, Li, Lipeng, Liu, Yanggui, Sun, Na, Bai, Baoqiang, Wei, Hengshan, Zhang, You, Cheng, Qianqian, Zhao, Zhenfu, Zhang, Hongwen, Qiao, Yintao, Xu, Qinghua, Wang, Zhifang, Dong, Pingshuan, Wang, Dongsheng, Li, Muwei, Liang, Keqi, Su, Shuhong, Li, Lianjie, Wang, Hengliang, Wang, Haitao, Jing, Dequan, Shi, Yonghong, Zheng, Haijun, Ma, Xiaowen, Li, Wanke, Zhao, Linming, Yang, Xinyuan, Qi, Datun, Zhang, Chengwen, Wang, Liangping, Wang, Chuntong, Hu, Dayi, Jiang, Jiandang, Zhang, Qingchun, Chen, Suxia, Liu, Yonggang, Gao, Yanhui, Xue, Ruilu, Li, Yuchun, Lang, Huihui, Li, Jinbo, Cheng, Xiangyang, Li, Shengli, Li, Heping, Tang, Qiwei, Zhang, Ling, Tong, Changgang, Zhu, Shengke, Zhang, Chuanqian, Zhou, Huading, Sun, Haiyan, Ji, Xiaoli, Wei, Wei, Li, Yaoze, Xia, Hualing, Lin, Fengxian, Zhao, Guiye, Xiao, Weitian, Zhang, Linwu, Wang, Xianpei, Zhu, Zhongyu, Tian, Changming, Geng, Hongxu, Yang, Jie, Yan, Jixia, Liu, Zheng, Wang, Shan, Yang, Yi

2021

Overview

ObjectivesTo assess differences in reperfusion treatment and outcomes between secondary and tertiary hospitals in predominantly rural central China.DesignMulticentre, prospective and observational study.SettingSixty-six (50 secondary and 16 tertiary) hospitals in Henan province, central China.ParticipantsPatients with ST elevation myocardial infarction (STEMI) within 30 days of symptom onset during 2016–2018.Primary outcome measuresIn-hospital mortality, and in-hospital death or treatment withdrawal.ResultsAmong 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.ConclusionsWith 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 numberNCT02641262.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: adult intensive & critical care / Angioplasty / Blood pressure / Cardiovascular disease / Cardiovascular Medicine / Clinical medicine / coronary heart disease / coronary intervention / Coronary vessels / Data collection / Diabetes / Heart attacks / Heart rate / Hospital Mortality / Hospitals / Humans / Hypertension / Ischemia / Mortality / myocardial infarction / Observational studies / Patients / Percutaneous Coronary Intervention / Prospective Studies / quality in health care / Reperfusion / Risk factors / Rural areas / ST Elevation Myocardial Infarction / Stroke / Tertiary Care Centers / Thrombolytic drugs / Thrombolytic Therapy / Treatment Outcome / Variables / Veins & arteries