Anticoagulant therapy for non-ST-segment elevation acute coronary syndrome in China: A multi-center observational
Xiao-Huan Gong1, Jin-Ming Yu1, Yong Mao1
1Key Laboratory of Public Health Safety, Ministry of Education, Centre for Clinical Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China.
Insights
In China, anticoagulant therapy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) primarily uses single medications like low-molecular-weight heparin (LMWH) and percutaneous coronary intervention (PCI). Unstable angina (UA) shows better outcomes than non-ST-segment elevation myocardial infarction (NSTE-MI), yet treatments remain similar.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) requires effective anticoagulant therapy.
- Understanding current treatment strategies in China is crucial for improving patient prognosis.
- Variations in treatment approaches for unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTE-MI) warrant investigation.
Purpose of the Study:
- To evaluate current anticoagulant therapy practices for NSTE-ACS in China.
- To identify disparities in treatment between UA and NSTE-MI.
- To provide evidence-based recommendations for optimizing NSTE-ACS management and patient outcomes.
Main Methods:
- A cohort of 1,502 NSTE-ACS patients was analyzed from 28 hospitals across China (2009-2011).
- Treatment strategies, including medication and percutaneous coronary intervention (PCI), were assessed.
- Efficacy and safety endpoints were evaluated at 9 and 30 days post-PCI.
Main Results:
- Patients with UA demonstrated significantly better efficacy and safety outcomes compared to NSTE-MI (P < 0.05).
- The use of low-molecular-weight heparin (LMWH) was 66.42%, fondaparinux 30.61%, and unfractionated heparin (UFH) 0.61%.
- Percutaneous coronary intervention (PCI) was performed in 69.64% of patients, with single medication use at 70.74%.
Conclusions:
- Unstable angina (UA) has a better prognosis than non-ST-segment elevation myocardial infarction (NSTE-MI), yet clinical management shows no differentiation.
- The predominant anticoagulant therapies for NSTE-ACS in China involve single medications, primarily LMWH, alongside PCI.
- Clinical practice highlights a need for tailored therapeutic strategies for UA and NSTE-MI to improve patient outcomes.
Objective:
To assess the anticoagulant therapy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in China and to offer the rationale for establishing reasonable strategies to improve the prognosis of NSTE-ACS.
Methods:
A total of 1,502 patients with NSTE-ACS were recruited from 28 third-grade hospitals distributed in 14 provinces and cities in China from December 2009 to December 2011. The strategies for diagnosis and treatment, decided by each hospital respectively, were used for further analysis and comparison of medication, percutaneous coronary intervention (PCI), and end points for efficacy and safety assessment at 9 and 30 days following PCI.
Results:
A lower incidence rate (P < 0.05) was noted for efficacy and safety in patients with unstable angina (UA) than those with non-ST-segment elevation myocardial infarction (NSTE-MI). The prescription rate of unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux, PCI, and single medication was 0.61%, 66.42%, 30.61%, 69.64%, and 70.74%, respectively.
Conclusion:
Compared with NSTE-MI, UA is featured with better prognosis, less severity, and different outcome. However, in clinical practice, the therapies for NSTE-MI and UA show no differences, which deserves great attention. In China, the most common anticoagulant therapies for NSTE-ACS are single medication, mainly based on LMWH and PCI.
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