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
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.Par...
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2021-12-01
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| author | 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 |
| author_facet | 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 |
| author_sort | Shan Wang |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-156d92baf5a3457ea9f6bc643e1c2811 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-156d92baf5a3457ea9f6bc643e1c28112024-12-10T22:45:09ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2021-053510Reperfusion 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 studyShan Wang0Zheng Liu1Ling Zhang2Peng Liu3Wei Wei4Dongsheng WangYi Yang5Chuanyu Gao6Na Sun7Haiyan Sun8Haitao Wang9Lianjie LiShengli Li10Xinyuan YangYou Zhang11Xiaowen Ma12Pingshuan DongYanhui GaoJunhui Zhang13Hongxia Zhang14Dayi Hu15Xiaoli Ji16Shuhong SuQianqian Cheng17Datun Qi18Xianpei Wang19Zhongyu Zhu20Muwei Li21Zhifang WangXuming YangHualing XiaWuxing LiShuiyin DingBaoqiang BaiChangming TianJinbo Li22Chuntong WangJixia YanHeping LiWanke LiZhenfu ZhaoHuading ZhouChuanqian ZhangHengliang WangDequan JingSuxia ChenHaijun ZhengFengxian LinGuiye ZhaoYanggui LiuXiangyang ChengChengwen ZhangLiangping WangChanggang TongHuihui LangHaojie Xu23Hengshan WeiRuilu XueHongxu GengYonghong ShiQiwei TangYuchun LiYonggang Liu24Jianbo JiaXianzhang LiXinling DengQinghua XuLinming ZhaoLipeng LiSuqin ChenKeqi LiangLinwu ZhangJiandang JiangWeitian XiaoHongwen ZhangShengke ZhuBaofu LiuChengxuan PanFengyun LuYaoze LiQingchun ZhangYintao Qiao3 Department of Biology and Biochemistry, University of Houston, Houston, TX, USADepartment of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, ChinaCenter for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USADepartment of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Anaesthesiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong, China1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, ChinaDepartment of Epidemiology and Biostatistics, Soochow University Medical College, Suzhou, ChinaBiostatistics Core, Geisinger, Danville, Pennsylvania, USAThoracic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA5 State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, Beijing, ChinaDepartment of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China1 Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USASchool of Public Health, Southwest Medical University, Luzhou, Sichuan, ChinaResearch Division, Joslin Diabetes Center, Boston, Massachusetts, USAHenan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan, China1 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, ChinaDepartment of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, ChinaDepartment of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, ChinaDepartment of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, ChinaDepartment of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, ChinaDepartment of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People`s Hospital Heart Center, Zhengzhou, Henan, China2 School of Public Health, Kunming Medical University, Kunming, ChinaDepartment of Rheumatology, Peking Union Medical College Hospital, ChinaGraduate school, China Medical University, Shenyang, ChinaObjectives 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.https://bmjopen.bmj.com/content/11/12/e053510.full |
| spellingShingle | 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 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 BMJ Open |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://bmjopen.bmj.com/content/11/12/e053510.full |
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