Clinical characteristics and in-hospital management strategies in patients with acute coronary syndrome: results from 2,096 accredited Chest Pain Centers in China from 2016 to 2021

Background and purpose: The Chest Pain Center accreditation project was launched in 2011 in China as a nationwide effort to improve clinical management of acute chest pain patients. In this study, we summarize the clinical characteristics and in-hospital outcomes of patients undergoing treatment for acute coronary syndrome (ACS) in Chest Pain Centers in China. Methods: Data were based on the Chinese Cardiovascular Association (CCA) Database-Chest Pain Center of 1,745,118 ACS patients admitted at 2,096 accredited Chest Pain Center between January 1, 2016, and December 31, 2021. Patient characteristics, time delays, treatment, and outcomes were analyzed using descriptive analysis. Results: The final analysis included a total of 1,745,118 patients, 699,476 patients (40.1%) with ST segment elevation myocardial infarction (STEMI), 349,572 (20.0%) with non-ST segment elevation myocardial infarction (NSTEMI), and 696,070 (39.9%) with unstable angina (UA). Electrocardiogram (ECG) was conducted in 89.4% of the patients within 10 min after first medical contact. For STEMI patients, the median door-to-wire crossing time was 72.1 (53.1 to 91.9) min and the median first medical contact-to-needle time was 32.3 (23.8 to 58.6) min. In-hospital mortality was 2.0% in the overall analysis, 3.6% for STEMI, 2.1% for NSTEMI, and 0.3% for UA. Primary percutaneous coronary intervention (PCI) was conducted in 62.8% of STEMI patients, with increasing rate in grade I and II hospitals over the 6-year study period. Patients treated with thrombolysis had significantly higher mortality than those treated with PCI and thrombolysis combined with PCI. The development of Chest Pain Centers varied substantially across geographic regions. Conclusions: Based on CCA Database-Chest Pain Center, the current study provided an overall description of the clinical characteristics of ACS patients in China. The results on management pattern and in-hospital outcomes of STEMI patients identified important areas for further improvement in ACS patient management in China.