Long-Term Prognosis of Different Reperfusion Strategies for ST-Segment Elevation Myocardial Infarction in Chinese
Chao Wu1, Qiong Yu Zhang2, Ling Li3
1Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing 100037, China.
Insights
Reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) in Chinese county hospitals significantly reduces 2-year mortality. However, prehospital delays limit treatment, and failed fibrinolysis requires prompt rescue percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- ST-segment elevation myocardial infarction (STEMI) remains a leading cause of mortality worldwide.
- Reperfusion therapy is critical for improving outcomes in STEMI patients.
- The effectiveness of different reperfusion strategies in resource-limited settings like Chinese county-level hospitals requires evaluation.
Purpose of the Study:
- To assess the long-term prognosis of STEMI patients treated with various reperfusion strategies.
- To identify factors influencing reperfusion therapy uptake and outcomes in Chinese county-level hospitals.
- To compare the 2-year mortality rates associated with fibrinolysis, primary percutaneous coronary intervention (PCI), and no reperfusion therapy.
Main Methods:
- Analysis of 2,514 STEMI patients from the China Acute Myocardial Infarction registry (January 2013-September 2014).
- Evaluation of reperfusion strategies including fibrinolysis and primary PCI.
- Assessment of 2-year mortality as the primary outcome, with secondary analysis of reperfusion success and rescue PCI rates.
Main Results:
- Only 42.9% of STEMI patients received reperfusion therapy, primarily due to prehospital delays exceeding 12 hours.
- Both fibrinolysis (14.5% mortality) and primary PCI (6.8% mortality) were associated with significantly lower 2-year mortality compared to no reperfusion (28.5%).
- Successful fibrinolysis showed no significant difference in mortality compared to primary PCI, while failed fibrinolysis had similar poor outcomes to no reperfusion.
Conclusions:
- Reperfusion therapy, particularly primary PCI, significantly improves survival in STEMI patients in Chinese county-level hospitals.
- Prehospital delays and limited access to timely reperfusion are major barriers to optimal STEMI care.
- Quality improvement initiatives focusing on public education and efficient referral for mechanical revascularization after failed fibrinolysis are crucial.
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 initiativesare warranted, especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.
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