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Objective: To evaluate the acute and long-term outcome of patients with ST segment elevation myocardial infarction (STEMI) concurrent with chronic total occlusion (CTO) undergoing primary percutaneous coronary intervention (PCI). Methods: 11 905 STEMI patients from the China Acute Myocardial Infarction Registry were enrolled in this study and divided into CTO group and non-CTO group according to the angiography results of primary PCI. 1∶3 propensity score matching was used to match the patients between the two groups. The primary endpoint was in-hospital mortality and mortality at 1-year post PCI. The secondary endpoint was major adverse cardiovascular events (MACE) including death, re-myocardial infarction, revascularization, heart failure associated readmission, stroke and major bleeding at 1-year post PCI. Results: There were 931 CTO patients (7.8%) in this cohort (male=755 (81.1%), mean age (62.2±11.4 years)). The rest 10 974 patients were STEMI without CTO (male=8 829 (80.5%),mean age (60.0±11.8) years). After propensity score matching, 896 patients were enrolled in CTO group and 2 688 in non-CTO group. In-hospital mortality was significantly higher in the CTO group than in non-CTO group (4.2% vs. 2.4%, P=0.006). The ratio of all cause death, cardiac death, and MACE at 1-year follow up was also significantly higher in the CTO group than in non-CTO group (8.5% vs. 4.4%, P<0.001, 5.3% vs. 2.6%, P=0.001, 35.1% vs. 23.3%, P<0.001, respectively). Multiple regression analysis showed that CTO (HR=1.54, 95%CI 1.06-2.22, P=0.022), advanced age (HR=1.06, 95%CI 1.04-1.08, P<0.001), and previous heart failure history (HR=4.10, 95%CI 1.90-8.83, P<0.001) were independent risk factors of 1-year mortality. Conclusions: The in-hospital and 1-year mortality increased significantly in STEMI patients concurrent with CTO. CTO, advanced age and history of heart failure are independent risk factors of 1-year death among STEMI patients.
Subject(s)
Aged , Humans , Male , Middle Aged , China , Chronic Disease , Coronary Occlusion/complications , Myocardial Infarction , Percutaneous Coronary Intervention , Risk Factors , ST Elevation Myocardial Infarction/surgery , Treatment OutcomeABSTRACT
BACKGROUND@#Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients.@*METHODS@#We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups.@*RESULTS@#Compared with patients with STEMI (N = 16,315), those with NSTEMI (N = 5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs. 71.4%), diaphoresis (48.6% vs. 70.0%), radiation pain (26.4% vs. 33.8%), and more likely to have chest distress (42.4% vs. 38.3%) than STEMI patients (all P < 0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval: 1.849-2.107).@*CONCLUSIONS@#Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction.@*TRIAL REGISTRATION@#www.clinicaltrials.gov (No. NCT01874691).
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Aged , Female , Humans , Male , Middle Aged , Arrhythmias, Cardiac , Pathology , China , Electrocardiography , Methods , Hospital Mortality , Myocardial Infarction , Pathology , Odds Ratio , Registries , Risk Factors , ST Elevation Myocardial Infarction , PathologyABSTRACT
BACKGROUND@#Patients with ST-segment elevation myocardial infarction (STEMI) who present without typical chest pain are associated with a poor outcome. However, whether angiographic characteristics are related to a higher risk of mortality in this population is unclear. This study aimed to investigate whether the higher mortality risk in patients with STEMI without chest pain could be explained by their "high-risk" angiographic characteristics.@*METHODS@#We used data of 12,145 patients with STEMI who was registered in China Acute Myocardial Infarction registry from January 2013 to September 2014. We compared the infarct-related artery (IRA), thrombolysis in myocardial infarction (TIMI) flow grade in the IRA, and other angiographic characteristics between patients without and those with chest pain. Multivariable logistic regression model was used to identify independent risk factor of in-hospital mortality.@*RESULTS@#The 2922 (24.1%) patients with STEMI presented without typical chest pain. These patients had a higher TIMI flow grade (mean TIMI flow grade: 1.00 vs. 0.94, P = 0.02) and a lower rate of IRA disease of the left anterior descending artery (44.6% vs. 51.2%, χ = 35.63, P < 0.01) than did those with typical chest pain. Patients without chest pain were older, more likely to have diabetes, longer time to hospital and higher Killip classification, and less likely to receive optimal medication treatment and primary percutaneous coronary intervention and higher In-hospital mortality (3.3% vs. 2.2%, χ = 10.57, P < 0.01). After adjusting for multi-variables, presentation without chest pain was still an independent predictor of in-hospital death among patients with STEMI (adjusted odds ratio: 1.36, 95% confidence interval: 1.02-1.83).@*CONCLUSIONS@#Presentation without chest pain is common and associated with a higher in-hospital mortality risk in patients with acute myocardial infarction. Our results indicate that their poor prognosis is associated with baseline patient characteristics and delayed treatment, but not angiographic lesion characteristics.@*CLINICAL TRIAL REGISTRATION@#NCT01874691, https://clinicaltrials.gov.
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Background@#Patients with ST-segment elevation myocardial infarction (STEMI) who present without typical chest pain are associated with a poor outcome. However, whether angiographic characteristics are related to a higher risk of mortality in this population is unclear. This study aimed to investigate whether the higher mortality risk in patients with STEMI without chest pain could be explained by their "high-risk" angiographic characteristics.@*Methods@#We used data of 12,145 patients with STEMI who was registered in China Acute Myocardial Infarction registry from January 2013 to September 2014. We compared the infarct-related artery (IRA), thrombolysis in myocardial infarction (TIMI) flow grade in the IRA, and other angiographic characteristics between patients without and those with chest pain. Multivariable logistic regression model was used to identify independent risk factor of in-hospital mortality.@*Results@#The 2922 (24.1%) patients with STEMI presented without typical chest pain. These patients had a higher TIMI flow grade (mean TIMI flow grade: 1.00 vs. 0.94, P = 0.02) and a lower rate of IRA disease of the left anterior descending artery (44.6% vs. 51.2%, χ2 = 35.63, P < 0.01) than did those with typical chest pain. Patients without chest pain were older, more likely to have diabetes, longer time to hospital and higher Killip classification, and less likely to receive optimal medication treatment and primary percutaneous coronary intervention and higher In-hospital mortality (3.3% vs. 2.2%, χ2 = 10.57, P < 0.01). After adjusting for multi-variables, presentation without chest pain was still an independent predictor of in-hospital death among patients with STEMI (adjusted odds ratio: 1.36, 95% confidence interval: 1.02–1.83).@*Conclusions@#Presentation without chest pain is common and associated with a higher in-hospital mortality risk in patients with acute myocardial infarction. Our results indicate that their poor prognosis is associated with baseline patient characteristics and delayed treatment, but not angiographic lesion characteristics.@*Clinical trial registration@#NCT01874691, https://clinicaltrials.gov.
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Objectives: To analyze the rate of hospitalization for acute myocardial infarction (AMI) and the cost of hospitalization for urban residents participating in national basic medical insurance in China. Methods: Of the sample database of inpatients participating in the national basic medical insurance system from 2010 to 2014, 2%, 5% and 10% of the insured persons was selected from provincial cities, one prefecture-level city, and two county-level coordinating regions of each province, with a total of 2 523 265 person-times. Patients with AMI who were diagnosed with ICD-10 code I21-I22 from the hospital were selected for analysis. Results: A total of 1 347 patients were diagnosed with AMI in the sample database. It was estimated that the annual AMI hospitalization rate was 44.2 per 100 000 according to the hospitalized AMI patients from 2012 to 2014. The median hospitalization cost was 31 000 (42 000) RMB and the median length of stay was 9 (8) days. The per capita hospitalization cost of provincial insured personnel was the highest (40 000 RMB), followed by prefecture insured personnel (30 000 RMB), and the county insured personnel (15 000 RMB, P<0.001). The proportion of patients receiving percutaneous coronary intervention (PCI) in provincial and prefecture cities was significantly higher than that of county-level patients (50.1%, 43.2%, and 14.9%, respectively, P<0.001). The median hospitalization cost for PCI was 52 000 RMB, which was significantly higher than thrombolytic therapy (20 000 RMB) and conservative treatment (13 000 RMB, P<0.001). Conclusions: The cost of AMI hospitalization for patients with basic medical insurance in provincial cities, perfeture and county cities in China is significantly different, and it is related to the large difference in the proportion of patients receiving PCI or not.
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Objectives: This study sought to compare both the safety and efficacy of transradial (TRI) versus transfemoral (TFI) approach in women undergoing percutaneous coronary intervention (PCI) in China. Methods: We retrospectively analyzed data from 5 067 women undergoing PCI in Fuwai Hospital, Beijing, China between 2006 and 2011. 4 105 patients underwent TRI and 962 patients underwent TFI. A One-to-one propensity score matching (PSM) was performed to control for potential biases. A total of 897 pairs were matched. Results: After controlling for confounders using PSM, baseline and procedural characteristics were well-balanced between TRI and TFI groups. Patients undergoing TRI had significantly fewer major post-PCI bleeding (1.0% vs 3.5%, P<0.001) and access site complications (8.5% vs 19.7%,P<0.001) after PSM. There was no statistical differences in the incidence rates of major adverse cardiac events (a composite of cardiac death, myocardial infarction, and target vessel revascularization) during hospitalization (P>0.05). Multiple logistic regression analysis showed that TRI was an independent predictor of reduced major bleeding (OR=0.64, 95%CI: 0.54-0.76, P<0.001) and access site complications (OR=0.67, 95%CI:0.61-0.74, P<0.001). Conclusions: Our result show that TRI is related to reduced major bleeding and access site complications as compared to TFI in Chinese female patients undergoing PCI.
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Objectives: To observe the prevalence of bleeding and to explore the independent predictors of bleeding in ST-segment elevation acute myocardial infarction patients with fibrinolysis therapy in China. Methods: From January 2013 to June 2014, 1 568 patients undergoing fibrinolysis in the Chinese Acute Myocardial Infarction Registry (CAMI) were prospectively included. Patients were divided into bleeding group (bleeding after fibrinolysis, n=55) and no bleeding group (without bleeding after fibrinolysis, n=1 513). Logistic regression analysis was performed to define the independent predictors of bleeding. Results: The prevalence of bleeding with fibrinolysis in these patients was 3.5% (55/1 568). The fibrinolysis success rate is 86%. Among them, the rate of intracranial bleeding was 0.6%, and the rate of gastrointestinal bleeding was 1.9%. The fibrinolysis success tended to be higher in patients with bleeding (94.1% vs 85.7%, P=0.0589) ,and the mortality rate was significantly higher in patients with bleeding (20.0% vs 7.1%, P=0.0019) . Logistic regression analysis showed that age≥75 years (OR=2.45, 95%CI:1.10-5.46, P=0.0290) and use of rtPA (HR=3.41, 95%CI:1.48~7.86, P=0.0040) were independent predictors of bleeding after fibrinolysis in this patient cohort. Conclusions: The prevalence of bleeding after fibrinolysis in Chinese STEMI patients is low. Older age and rtPA use are independent predictors of bleeding after fibrinolysis in this patient cohort.
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Objectives:The purpose of this study was to evaluate the prognostic value of the Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores for in-hospital mortality in Chinese ST-segment elevation myocardial infarction (STEMI) patients. Methods:Present data are obtained from the prospective, multicenter Chinese AMI (CAMI) registry, 107 hospitals from 31 provinces, municipalities or autonomous districts in China took part in this study. From January 2013 to September 2014, 17886 consecutive ST-segment elevation myocardial infarction patients admitted to these 107 hospitals were enrolled. For each patient, TIMI and GRACE risk scores were calculated using specific variables collected at admission. Their prognostic value on the primary endpoint (in-hospital mortality) was evaluated. Results:Mean age of this patient cohort was (61.9±12.4)years, 76.5% (n=13685) patients were males. The in-hospital mortality was 6.4%(n=1 153)and the median length of hospital stay was 10.0 days. The incidence of cardiac arrest at admission were 4.3% (n=764). Coronary reperfusion therapy including fibrinolytic therapy(n=1782), primary percutaneous coronary intervention (n=7763) and emergent coronary artery bypass grafting (n=10) were applied to 9555 (53.4%) patients and the median of time to reperfusion was 300.0 minutes. The predictive accuracy of TIMI and GRACE for in-hospital mortality was similar:TIMI risk score (AUC) [area under the curve:0.7956; 95% confidence interval (95%CI:0.7822~0.8090)] and GRACE risk score (AUC:0.8096; 95%CI:0.7963~0.8230). Conclusions:The TIMI and GRACE risk score demonstrate similar predictive accuracy for in-hospital mortality and there are some disadvantages in risk stratification by these two risk scores for Chinese STEMI patients.
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Objectives:To explore the clinical and coronary disease characteristics and prognosis of Chinese patients with ST segment elevation myocardial infarction and without typical chest pain. Methods:By extracting data from China Acute Myocardial Infarction Registry, we included 12 145 STEMI patients who underwent coronary angiography between 01 January 2013 to 30 September 2014. Variables of interest were extracted and compared between AMI patients without vs with typical chest pain. Multivariable logistic regression analysis was used to identify independent predictors of in-hospital mortality. Results:There were approximately 24% (2922/12145) STEMI patients without typical chest pain. Compared with typical chest pain patients, patients without typical chest pain had higher prevalence of diabetes (20.0% vs 17.8%), longer time of disease onset to hospital, lower rate of IRA disease of left anterior descending artery (44.6% vs 51.2%). These patients were less likely to receive primary percutaneous coronary intervention (64.9% vs 73.9%) and had higher in-hospital mortality (3.3% vs 2.2%, P＜0.05). Multivarite Logistic regression analysis indicated atypical chest pain was an independent risk factor for in-hospital death (OR:1.364, 95% confidence interval:1.018-1.827). Conclusions:Approximately a quarter STEMI patients presented without typical chest pain in this patient cohort and they had longer disease onset to hospital time, were less likely to receive PCI, and associated with higher in-hospital mortality risk. Efforts should be made to identify these patients in order to apply the optimal treatments to them.
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Objective: To assess the relationship between bicycle ownership status and physical activity, time of sitting, overweight or obesity in China. Methods: Based on the information of China cohort from Prospective Urban Rural Epidemiology (PURE) study, we conducted a cross-sectional description. Multivariable linear and multivariable Logistic regression analysis were respectively used to distinguish the differences of physical activity, time of sitting, overweight or obesity status between bicycle owners and non-bicycle owners. Results: A total of 42 677 participants were analyzed, the average age was (51.23±9.72) years including 40.9% male. There were 27 744 (65.0%) bicycle owners, their MET-min/week for total physical activity, work, transportation,domestic and recreation time were 2513.00 (1114.00, 5271.00), 444.00 (0.00, 735.00), 420.00 (0.00, 990.00), 600.00 (180.00,1260.00) and 198.00 (0.00, 693.00) respectively; time of sitting was (1397.03±832.13) min/week and waist circumference was (81.03±10.53) cm. With adjusted potential confounders, bicycle owners had more transportation activity, while less total physical activity, work, domestic and recreation time than non-bicycle owners; bicycle owner had more time of sitting and less risk of obesity; BMI and waist-to-hip ratio were similar between bicycle owners and non-bicycle owners. Conclusion: Bicycle owners had more transportation related physical activity and less risk of obesity; while the total physical activity, domestic and recreation related physical activity might be reduced in them.
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Objective: To evaluate the predictive value of PARIS bleeding score on in-hospital bleeding of acute myocardial infarction (AMI) patients after drug-eluting stent (DES) implantation with dual-antiplatelet therapy (DAPT). Methods: There were 27 594 AMI patients enrolled in China acute myocardial infarction (CAMI) registry between 2013-01-01 to 2014-09-30 from 107 hospitals, and 14 625 of them had successful in-hospital DES implantation with DAPT were studied. Based on BARC (bleeding academic research consortium definition) criteria, the end point major bleeding (MB) events were defined by both BARC type 3, 5 and BARC type 2, 3, 5; the incidence of in-hospital bleeding, clinical features and predictive value of PARIS bleeding score according to different BARC type were evaluated. Results: Compared with non-MB patients, MB patients had the higher PARIS bleeding score, P<0.001. Based on PARIS score risk stratification, taking BARC type 3, 5 as endpoint, 77/14 625 (0.53%) patients had bleeding events, PARIS scores were different among high risk, mid risk and low risk patients, P<0.001; bleeding risk in mid risk patients was 2.38 times higher than low risk patients, P=0.006 and bleeding risk in high risk patients was 4.78 times higher than low risk patients, P<0.001.Taking BARC type 2,3,5 as endpoint,223(1.52%)patients had bleeding events,bleeding risk in mid risk patients was 1.64 times higher than low risk patients, P=0.002 and bleeding risk in high risk patients was 2.23 times higher than low risk patients, P=0.001. ROC analysis showed that PARIS score had predictive value on both BARC type 3, 5 and BARC type 2, 3, 5 bleeding, area under curve (AUC) of BARC type 3, 5 (AUC: 0.672) was higher than AUC of BARC type 2, 3, 5 (AUC:0.596) (z=2.079, P=0.038), which implied that PARIS score had better predictive value in severe bleeding events. Conclusion: PARIS bleeding score had predictive value on in-hospital bleeding in AMI patients after DES implantation with DAPT, it can also be used in bleeding risk stratification. PARIS bleeding score had better predictive value on severe bleeding.
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We investigated the usage of secondary prevention drugs and traditional Chinese medicine (TCM) products in individuals with cardiovascular diseases (CVDs) at the community level in China. Among 2,407 participants with self-reported coronary heart disease (CHD) and 872 with stroke, nearly 80% of individuals with CHD and 73% of individuals with stroke were not taking any proven secondary prevention drug. However, 32.9% of them took TCM products. Patients with CVDs in rural areas used less secondary prevention treatment, but more TCM products than their counterparts in the urban regions. After adjusting for confounding factors, lower rates of secondary prevention treatment were evident in Western China compared with Eastern China, which was more developed. Systematic change is needed to promote the development of evidence-based medicine at the community level in China.
Subject(s)
Female , Humans , Male , Middle Aged , Cardiovascular Agents , Therapeutic Uses , Cardiovascular Diseases , Drug Therapy , Epidemiology , China , Epidemiology , Drug Utilization , Logistic Models , Multivariate AnalysisABSTRACT
Objective To compare hospital costs and clinical outcomes between transradial intervention (TRI) and transfemoral intervention (TFI) in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention (PCI) in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting (IPW) model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 (95%CI: CNY4419-10 420). Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay (1.9 days, 95%CI: 1.1-2.7 days), shorter post-procedural stay (0.7 days, 95%CI: 0.3-1.1 days), and fewer major adverse cardiac events (adjusted odds ratio = 0.47, 95%CI: 0.31-0.73). There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI (P>0.05). Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.
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<p><b>BACKGROUND</b>The impact of body mass index (BMI) on the clinical outcomes after percutaneous coronary intervention (PCI) in patients ≥ 75 years old remained unclear.</p><p><b>METHODS</b>A total of 1098 elderly patients undergoing PCI with stent implantation were recruited. Patients were divided into four groups by the value of BMI: Underweight (≤ 20.0 kg/m 2 ), normal weight (20.0-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ) and obese (≥ 30.0 kg/m 2 ). Major clinical outcomes after PCI were compared between the groups. The primary endpoint was defined as in-hospital major adverse cardiovascular events (MACEs), which included death, myocardial infarction (MI) and target vessel revascularization. The secondary endpoint was defined as 1 year death. Logistic regression analysis was performed to adjust for the potential confounders.</p><p><b>RESULTS</b>Totally, 1077 elderly patients with available BMIs were included in the analysis. Patients of underweight, normal weight, overweight and obese accounted for 5.6%, 45.4%, 41.5% and 7.5% of the population, respectively. Underweight patients were more likely to attract ST-segment elevation MI, and get accompanied with anemia or renal dysfunction. Meanwhile, they were less likely to achieve thrombolysis in MI 3 grade flow after PCI, and receive beta-blocker, angiotensin converting enzyme inhibitor or angiotensin receptor blocker after discharge. In underweight, normal weight, overweight and obese patients, in-hospital MACE were 1.7%, 2.7%, 3.8%, and 3.7% respectively (P = 0.68), and 1 year mortality rates were 5.0%, 3.9%, 5.1% and 3.7% (P = 0.80), without significant difference between the groups. Multivariate regression analysis showed that the value of BMI was not associated with in-hospital MACE in patients at 75 years old.</p><p><b>CONCLUSIONS</b>The BMI "obese paradox" was not found in patients ≥ 75 years old. It was suggested that BMI may not be a sensitive predictor of adverse cardiovascular events in elderly patients.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Body Mass Index , Logistic Models , Percutaneous Coronary Intervention , Treatment OutcomeABSTRACT
<p><b>OBJECTIVES</b>To evaluate the clinical characteristics, in-hospital and three-year outcome in ST-elevation myocardial Infraction (STEMI) patients receiving conservative treatment (CT), thrombolytic treatment (TT) and primary percutaneous coronary intervention (PCI) in Beijing.</p><p><b>METHODS</b>This 12-month prospective, multicenter registry study was conducted in 19 hospitals with 808 patients with STEMI in Beijing between Jan. 2006 and Dec. 2006, 518 (64%) received PCI, 106 (16.1%) received TT and 184 (22.8%) received CT therapy. Patients were followed up for 3 years.</p><p><b>RESULTS</b>At baseline, the age of patients in CT group [(64.5 ± 13.5) years] was significantly higher than those in TT group p(57.9 ± 11.0) years] and in PCI group [ (60.4 ± 12.3) years, all P<0.01]; and the median time from symptom onset to hospital in CT group (207 min) was significantly longer than those in TT group (130 min) and PCI group (130 min, all P<0.01). Emergency Medical Service (EMS) use was significantly higher in PCI group (184/518, 35.5%) than in CT group (46/184, 27.3%) and TT group (29/107, 25.0%, all P<0.05). Health insurance holder was the highest in PCI group (P<0.01). PCI was performed less frequently than thrombolytic therapy [66.6% (345/518) vs. 80.2% (85/106)m P=0.02] during off-hours and more frequently performed in tertiary hospitals than in secondary hospitals[66.8%(437/651) vs. 52.6% (81/154, P<0.01)]. The in-hospital mortality and the cardiovascular mortality at 3 year after hospital discharge was significantly higher in CT group [9.2% (17/185) and 9.4% (15/159)] than in PCI group [3.5% (18/518), 4.5% (20/446)] and TT group [6.6% (7/106), 2.3% (2/86), all P<0.01]. Patients in PCI group had the highest adherence level of aspirin, β-blocker, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or statins at 3-years follow-up (all P<0.05). Multivariable Cox proportional hazards regression analysis showed that only PCI was associated with lower risk of cardiovascular death (HR-0.40, 95% CI:0.21-0.73, P<0.01).</p><p><b>CONCLUSIONS</b>Social and clinical setting may affect the physician's decision to provide reperfusion therapy in Beijing for STEMI patients. Better adherence of secondary preventive drugs and lower cardiovascular death are observed in STEMI patients receiving PCI during the 3-year follow-up</p>
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Aged , Female , Humans , Male , Middle Aged , China , Follow-Up Studies , Myocardial Infarction , Therapeutics , Percutaneous Coronary Intervention , PrognosisABSTRACT
<p><b>OBJECTIVE</b>To screen the cardiac troponin T (TNNT2) mutations in Chinese patients with hypertrophic cardiomyopathy (HCM) and to analyze the potential link between the genotype and the phenotype.</p><p><b>METHODS</b>Clinical features of 100 probands with HCM and some family members were evaluated, 200 unrelated normal subjects served as control. The exons and flanking introns of TNNT2 were amplified with PCR and direct sequencing was used to screen TNNT2 mutations/polymorphisms.</p><p><b>RESULTS</b>Two novel missense mutations were detected in 2 HCM patients: R92W and R286H. These 2 mutations were not found in 200 non-HCM controls. A five-basepair insertion/deletion polymorphism in intron 3 of TNNT2 was identified in this HCM cohort but was not related to the phenotype.</p><p><b>CONCLUSIONS</b>Two missense mutations, R92W and R286H, were found in 2/100 patients with HCM, TNNT 2 mutation is relatively low in Chinese patients with HCM.</p>
Subject(s)
Humans , Asian People , Cardiomyopathy, Hypertrophic , Genetics , Case-Control Studies , Exons , Genotype , Mutation , Mutation, Missense , Pedigree , Phenotype , Polymorphism, Genetic , Troponin T , GeneticsABSTRACT
Objective This study was to examine the relation of peripheral arterial disease (PAD) and renal insufficiency in cardiovascular patients with high risk. Methods PAD, defined as an ankle brachial index (ABI)≤0.9 in either leg and renal insufficiency, defined as an estimated creatinine clearance (CRCL) <60 ml ? min-1 ? 1.73 m-1 were evaluated in 5270 Chinese patients at high risk of CV. Results 2648(50.2%) patients had an estimated ABI≤0.9. ABI and CRCL were positively correlated (r=0.217,P<0.001). The prevalence of PAD in patients with renal dysfunction was significantly higher than those with normal renal function (19.9% vs. 8.3%,P<0.001). The association of ABI≤ 0.9 with CRCL was independent from potential confounders such as age, diabetes, hypertension, hypercholesterolemia, smoking, coronary artery disease and stroke history (OR=0.98, 95%CI: 0.98-0.99, P<0.001). Conclusion Results from the present study demonstrateda remarkably high prevalence of PAD (defined as an ABI≤0.9) among patients with renal dysfunction and at high risk. Even after adjustmentfor important confounders such as age, diabetes, and coronary artery and cerebro-vascular diseases etc., persons with lower CRCL were still more likely to have an ABI≤0.9.
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<p><b>BACKGROUND</b>Cumulative evidence demonstrates that primary percutaneous coronary intervention (PCI) is a reperfusion strategy for ST-elevation myocardial infarction (STEMI). This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system, which offers patients a choice between seeking care in a small community hospital (SH group) or a large hospital (LH group).</p><p><b>METHODS</b>Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.</p><p><b>RESULTS</b>Among the 566 patients interviewed, 28.3% first arrived at a small community hospital and were transferred to large hospitals with the ability to perform primary PCI. The median total pre-hospital delay in the SH group (n = 160) was significantly longer than in the LH group (n = 406) (225 vs. 120 minutes, P < 0.001). Multivariate analysis showed that interpreting symptoms to non-cardiac origin (OR, 1.996; 95%CI: 1.264 - 3.155), absence of history of myocardial infarction (OR, 1.595; 95%CI: 1.086 - 3.347), non-health insurance coverage (OR, 1.931; 95%CI: 1.079 - 3.012) and absence of sense of impending doom (OR, 4.367; 95%CI: 1.279 - 14.925) were independent predictors for choosing small hospitals. After adjusting for demographics and medical history, patients in the SH group were 1.698 times (95%CI: 1.182 - 3.661) less likely to receive primary PCI compared with those in the LH group.</p><p><b>CONCLUSIONS</b>Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer. Factors including symptoms interpretation, symptoms, history of myocardial infarction, and insurance coverage were associated with the patients' pre-hospital care-seeking pathway. The patients who were transferred had longer pre-hospital delays and were less likely to receive primary PCI.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Acute Disease , Angioplasty, Balloon, Coronary , China , Cross-Sectional Studies , Electrocardiography , Multivariate Analysis , Myocardial Infarction , Therapeutics , Patient Acceptance of Health Care , Quality of Health Care , Thrombolytic TherapyABSTRACT
<p><b>BACKGROUND</b>Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention (PPCI) for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China.</p><p><b>METHODS</b>Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.</p><p><b>RESULTS</b>The median in-hospital delay was 98 (interquartile range 105 to 180) minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals (147 minutes vs. 120 minutes, P < 0.001; 55 minutes vs. 45 minutes, P = 0.035). After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.</p><p><b>CONCLUSIONS</b>There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , China , Decision Making , Electrocardiography , Hospitals , Myocardial Infarction , Therapeutics , Quality of Health Care , Time Factors , Treatment OutcomeABSTRACT
<p><b>BACKGROUND</b>Delay in seeking medical care in patients with acute myocardial infarction (AMI) is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI.</p><p><b>METHODS</b>Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review.</p><p><b>RESULTS</b>The median (25%, 75%) prehospital delay was 140 (75, 300) minutes. Only 264 (33.0%) arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain (71.4%), radiating arm or shoulder pain (68.7%), shortness of breath or dyspnea (65.5%), and loss of consciousness (52.1%). The most common symptoms experienced were central or left chest pain (82.1%), sweats (71.8%), shortness of breath or dyspnea (43.7%), nausea or vomiting (32.3%), and radiating pain (29.4%). A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport (86.5% vs. 52.9%, P < 0.001) and had longer prehospital delays (medians, 180 vs. 120 minutes, P < 0.001) compared to those who interpreted their symptoms as cardiac in origin.</p><p><b>CONCLUSIONS</b>Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emergency medical service (EMS).</p>