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中国急性心肌梗死注册研究

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Acute Myocardial Infarction Care Across Three Levels of Hospitals in China: A Report fr om the China Acute Myocardial Infarction Registry 您当前的位置:文章发表 >
Poster Contributions
Poster Hall B1
Sunday, March 15, 2015, 9:45 a.m.-10:30 a.m.
Session Title: ECG, Cardiac Markers and Triage, Oh My!
Abstract Category: 2. Acute Coronary Syndromes: Clinical
Presentation Number: 1175-068
Authors: Haiyan Xu, YueJin Yang, Xinran Tang, Marc Sabatine, Stephen Wiviott, Fuwai Hospital, Beijing, People’s Republic of China, TIMI
Study Group, Boston, MA, USA
Background: AMI has become a major cause of hospitalization and mortality in China over the last 2 decades. The unbalanced economy
and disparate medical care have the potential to lead to variation in treatment and outcomes across different-level hospitals.
Methods: The China AMI registry consists of 108 hospitals across three levels (province, prefecture and county) throughout Mainland
China. Treatment and adjusted in-hospital outcomes were compared across hospital levels.
Results: In total, 16,652 patients with AMI were primarily admitted to hospital. During the hospitalization, aspirin, P2Y12 receptor inhibitor
and statin uses were high (84-98%). However, the rates of reperfusion in STEMI and coronary revascularization in NSTEMI were
significantly lower in patients admitted to smaller hospitals (Fig A). The modality of reperfusion was primary PCI in 94% of patients in
provincial hospitals, compared to 76% in prefecture and 37% in county hospitals. After adjustment for clinical characteristics, the risk of inhospital
mortality was higher in smaller hospitals for STEMI patients [adj OR 1.31 (95%CI 0.94-1.84) and 2.15 (1.46-3.18) in prefecture and
county hospitals vs. provincial hospitals] but not for NSTEMI patients (Fig B).
Conclusion: Significant variations in treatment were observed for AMI patients across different levels of hospitals in China. Disparities in
observed rates of in-hospital mortality suggest that further research and quality improvement efforts in AMI are needed in China.
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