BMJ Open (Dec 2021)
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
- Shan Wang,
- Zheng Liu,
- Ling Zhang,
- Peng Liu,
- Wei Wei,
- Dongsheng Wang,
- Yi Yang,
- Chuanyu Gao,
- Na Sun,
- Haiyan Sun,
- Haitao Wang,
- Lianjie Li,
- Shengli Li,
- Xinyuan Yang,
- You Zhang,
- Xiaowen Ma,
- Pingshuan Dong,
- Yanhui Gao,
- Junhui Zhang,
- Hongxia Zhang,
- Dayi Hu,
- Xiaoli Ji,
- Shuhong Su,
- Qianqian Cheng,
- Datun Qi,
- Xianpei Wang,
- Zhongyu Zhu,
- Muwei Li,
- Zhifang Wang,
- Xuming Yang,
- Hualing Xia,
- Wuxing Li,
- Shuiyin Ding,
- Baoqiang Bai,
- Changming Tian,
- Jinbo Li,
- Chuntong Wang,
- Jixia Yan,
- Heping Li,
- Wanke Li,
- Zhenfu Zhao,
- Huading Zhou,
- Chuanqian Zhang,
- Hengliang Wang,
- Dequan Jing,
- Suxia Chen,
- Haijun Zheng,
- Fengxian Lin,
- Guiye Zhao,
- Yanggui Liu,
- Xiangyang Cheng,
- Chengwen Zhang,
- Liangping Wang,
- Changgang Tong,
- Huihui Lang,
- Haojie Xu,
- Hengshan Wei,
- Ruilu Xue,
- Hongxu Geng,
- Yonghong Shi,
- Qiwei Tang,
- Yuchun Li,
- Yonggang Liu,
- Jianbo Jia,
- Xianzhang Li,
- Xinling Deng,
- Qinghua Xu,
- Linming Zhao,
- Lipeng Li,
- Suqin Chen,
- Keqi Liang,
- Linwu Zhang,
- Jiandang Jiang,
- Weitian Xiao,
- Hongwen Zhang,
- Shengke Zhu,
- Baofu Liu,
- Chengxuan Pan,
- Fengyun Lu,
- Yaoze Li,
- Qingchun Zhang,
- Yintao Qiao
Affiliations
- Shan Wang
- 3 Department of Biology and Biochemistry, University of Houston, Houston, TX, USA
- Zheng Liu
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Ling Zhang
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Peng Liu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Wei Wei
- Department of Anaesthesiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong, China
- Dongsheng Wang
- Yi Yang
- 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chuanyu Gao
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
- Na Sun
- Department of Epidemiology and Biostatistics, Soochow University Medical College, Suzhou, China
- Haiyan Sun
- Biostatistics Core, Geisinger, Danville, Pennsylvania, USA
- Haitao Wang
- Thoracic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Lianjie Li
- Shengli Li
- 5 State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, Beijing, China
- Xinyuan Yang
- You Zhang
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Xiaowen Ma
- 1 Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
- Pingshuan Dong
- Yanhui Gao
- Junhui Zhang
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
- Hongxia Zhang
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
- Dayi Hu
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan, China
- Xiaoli Ji
- 1 Department of Human Microbiome, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China
- Shuhong Su
- Qianqian Cheng
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, China
- Datun Qi
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, China
- Xianpei Wang
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, China
- Zhongyu Zhu
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, China
- Muwei Li
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, China
- Zhifang Wang
- Xuming Yang
- Hualing Xia
- Wuxing Li
- Shuiyin Ding
- Baoqiang Bai
- Changming Tian
- Jinbo Li
- 2 School of Public Health, Kunming Medical University, Kunming, China
- Chuntong Wang
- Jixia Yan
- Heping Li
- Wanke Li
- Zhenfu Zhao
- Huading Zhou
- Chuanqian Zhang
- Hengliang Wang
- Dequan Jing
- Suxia Chen
- Haijun Zheng
- Fengxian Lin
- Guiye Zhao
- Yanggui Liu
- Xiangyang Cheng
- Chengwen Zhang
- Liangping Wang
- Changgang Tong
- Huihui Lang
- Haojie Xu
- Department of Rheumatology, Peking Union Medical College Hospital, China
- Hengshan Wei
- Ruilu Xue
- Hongxu Geng
- Yonghong Shi
- Qiwei Tang
- Yuchun Li
- Yonggang Liu
- Graduate school, China Medical University, Shenyang, China
- Jianbo Jia
- Xianzhang Li
- Xinling Deng
- Qinghua Xu
- Linming Zhao
- Lipeng Li
- Suqin Chen
- Keqi Liang
- Linwu Zhang
- Jiandang Jiang
- Weitian Xiao
- Hongwen Zhang
- Shengke Zhu
- Baofu Liu
- Chengxuan Pan
- Fengyun Lu
- Yaoze Li
- Qingchun Zhang
- Yintao Qiao
- DOI
- https://doi.org/10.1136/bmjopen-2021-053510
- Journal volume & issue
-
Vol. 11,
no. 12
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.
