Long-Term Prognosis of Different Reperfusion Strategies for ST-Segment Elevation Myocardial Infarction in Chinese County-Level Hospitals: Insight from China Acute Myocardial Infarction Registry

IF 3 3区医学 Q2 ENVIRONMENTAL SCIENCES

Biomedical and Environmental Sciences Pub Date : 2023-09-01 DOI:10.3967/bes2023.110

Chao WU , Qiong Yu ZHANG , Ling LI , Xu Xia ZHANG , Yong Chen CAI , Jin Gang YANG , Hai Yan XU , Yan Yan ZHAO , Yang WANG , Wei LI , Chen JIN , Xiao Jin GAO , Yue Jin YANG , Shu Bin QIAO

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引用次数: 0

Abstract

Objective

To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) treated with different reperfusion strategies in Chinese county-level hospitals

Methods

A total of 2,514 patients with STEMI from 32 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. The success of fibrinolysis was assessed according to indirect measures of vascular recanalization. The primary outcome was 2-year mortality.

Results

Reperfusion therapy was used in 1,080 patients (42.9%): fibrinolysis (n = 664, 61.5%) and primary percutaneous coronary intervention (PCI) (n = 416, 38.5%). The most common reason for missing reperfusion therapy was a prehospital delay > 12 h (43%). Fibrinolysis [14.5%, hazard ratio (HR): 0.59, 95% confidence interval (CI) 0.44–0.80] and primary PCI (6.8%, HR = 0.32, 95% CI: 0.22–0.48) were associated with lower 2-year mortality than those with no reperfusion (28.5%). Among fibrinolysis-treated patients, 510 (76.8%) achieved successful clinical reperfusion; only 17.0% of those with failed fibrinolysis underwent rescue PCI. There was no difference in 2-year mortality between successful fibrinolysis and primary PCI (8.8% vs. 6.8%, HR = 1.53, 95% CI: 0.85–2.73). Failed fibrinolysis predicted a similar mortality (33.1%) to no reperfusion (33.1% vs. 28.5%, HR = 1.30, 95% CI: 0.93–1.81).

Conclusion

In Chinese county-level hospitals, only approximately 2/5 of patients with STEMI underwent reperfusion therapy, largely due to prehospital delay. Approximately 30% of patients with failed fibrinolysis and no reperfusion therapy did not survive at 2 years. Quality improvement initiatives are warranted, especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.

查看原文本刊更多论文

中国县级医院ST段抬高型心肌梗死不同再灌注策略的远期预后：来自中国急性心肌梗死登记处的见解。

目的：评价我国县级医院采用不同再灌注策略治疗ST段抬高型心肌梗死（STEMI）患者的长期预后。方法：2013年1月至2014年9月，来自32家医院的2514名STEMI患者参加了中国急性心肌梗死登记。根据血管再通的间接测量来评估纤维蛋白溶解的成功率。主要结果为2年死亡率。结果：1080例（42.9%）患者采用了再灌注治疗：纤溶（n=664，61.5%）和经皮冠状动脉介入治疗（n=416，38.5%）。错过再灌注治疗的最常见原因是院前延迟>12h（43%）。纤溶[14.5%，危险比（HR）:0.59，95%置信区间（CI）0.44-0.80]和初次PCI（6.8%，HR=0.32，95%CI:0.22-0.48）与未再灌注患者（28.5%）相比，2年死亡率较低；只有17.0%的纤维蛋白溶解失败的患者接受了抢救性PCI。纤维蛋白溶解成功和初次PCI的2年死亡率没有差异（8.8%vs.6.8%，HR=1.53，95%CI:0.85-2.73）。纤维蛋白溶解失败预测的死亡率（33.1%）与无再灌注（33.1%vs.28.5%，HR=1.30，95%CI:0.93-1.81）相似。结论：在中国县级医院，只有大约2/5的STEMI患者接受了再灌注治疗，主要是由于院前延迟。大约30%的纤维蛋白溶解失败且没有再灌注治疗的患者在2年时没有存活下来。质量改进举措是有必要的，特别是在公共卫生教育和纤维蛋白溶解失败的情况下机械血运重建的快速转诊方面。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Biomedical and Environmental Sciences 环境科学-公共卫生、环境卫生与职业卫生

CiteScore

2.60

自引率

8.60%

发文量

2170

审稿时长

1.0 months

期刊介绍： Biomedical and Environmental Sciences (BES) is a peer-reviewed journal jointly established by the Chinese Center for Disease Control and Prevention (China CDC) and the Coulston International Corporation (CIC), USA in 1988, and is published monthly by Elsevier. It is indexed by SCI, PubMed, and CA. Topics covered by BES include infectious disease prevention, chronic and non-communicable disease prevention, disease control based on preventive medicine, and public health theories. It also focuses on the health impacts of environmental factors in people''s daily lives and work, including air quality, occupational hazards, and radiation hazards. Article types considered for publication include original articles, letters to the editor, reviews, research highlights, and policy forum.