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Treatment delay and reperfusion management of acute ST-segment elevation myocardial infarction: analysis of the China
1Department of Cardiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
Insights
The China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP) found that while delays persist, primary percutaneous coronary intervention (PCI) use is increasing. This trend correlates with lower in-hospital mortality for STEMI patients in China.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- The China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP) was initiated in 2011 to address critical issues in STEMI care within China, including inadequate reperfusion rates and prolonged treatment delays.
- STEMI remains a significant public health concern, necessitating improved emergency response and treatment protocols.
Purpose of the Study:
- To evaluate the baseline characteristics and emergency care status of STEMI patients in tertiary hospitals across China.
- To analyze treatment pathways and outcomes within the initial phase of the CSCAP registry (CSCAP-1).
Main Methods:
- CSCAP-1 is a prospective, multi-center registry involving 53 tertiary PCI hospitals across 14 Chinese provinces.
- Data were collected from 4191 patients experiencing STEMI symptom onset within 12 or 12-36 hours, requiring primary PCI.
Main Results:
- Nearly half of STEMI patients (49.0%) self-transported to the hospital; 83.2% of those with symptom onset within 12 hours received primary PCI.
- Median door-to-balloon time was 115 minutes. In-hospital all-cause mortality was 2.4%, significantly lower in the reperfusion group (2.1%) compared to the non-reperfusion group (5.3%).
Conclusions:
- Despite challenges like treatment delays and self-transportation, tertiary hospitals in China show positive trends in adopting primary PCI for STEMI.
- The findings underscore the need for integrated STEMI networks to further enhance emergency care and reduce mortality in China.
Background:
The China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP) was launched in 2011 to address the problems of insufficient reperfusion and long treatment delay in STEMI care in China.
Aim:
To describe the baseline status of STEMI emergency care in Tertiary PCI Hospitals using Phase 1 (CSCAP-1) data.
Design:
CSCAP-1 is a prospective multi-center STEMI registry.
Methods And Results:
A total of 4191 patients with symptom onset within 12 or 12-36 h requiring primary percutaneous coronary intervention (PCI), were enrolled from 53 tertiary PCI hospitals in 14 provinces, municipalities, and autonomous regions of China in CSCAP-1. Among them, 49.0% were self-transported to the hospital, 26.5% were transferred to the hospital by calling the emergency medical services directly, and 24.5% were transferred from other hospitals. In patients with symptom onset within 12 h, 83.2% received primary PCI, 5.9% received thrombolysis and 10.9% received conservative medications. The median door-to-balloon time was 115 (85-170) min and the median door-to-needle time for in-hospital thrombolysis was 80 (50-135) min. The overall in-hospital all-cause mortality was 2.4%, while it was 5.3% in the non-reperfusion group and 2.1% in the reperfusion group (P < 0.001).
Conclusion:
Although a long treatment delay and a high proportion of patients transporting themselves to the hospital were observed, trends were positive with greater adoption of primary PCI and lower in-hospital mortality in tertiary hospitals in China. Our results provided important information for further integrated STEMI network construction in China.
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