Objective To evaluate the current practice of medications that have been proven effective by evidence-based medicine on inpatients with ST segment elevation ACS in China.
Methods 1307 in-patients with ST segment elevation ACS from 64 hospitals across China were received different therapies in hospitals and a standard questionnaire was used to get information of the patients including demographic, treatments and in-hospital outcomes. We analysed the status of application of reperfusion and aspirin, ACEI, β-blocker, LWMH, Clopidogrel and cholesterol lowering agents on ST segment elevation ACS patients.
Results 1. The were no significant differences in baseline characteristics between the patients from tertiary hospitals and that from the secondary hospitals. 2. 30.9%–69.4% received reperfusion therapies. 1.3%–62.7% received primary PCI, 1.9%–45.8% received Thrombolysis, and nearly 46.2% did not receive any form of reperfusion. Reperfusion therapy was more often used in tertiary hospitals (48.2%) than in secondary hospitals (6.46%). Thrombolysis was more often in secondary hospitals than that in tertiary hospitals (36.8% vs 14.6%) 3. Percentage of medications in ST ACS patients in different areas: aspirin (88.0%–98). 6%), ACEI (60.5%–84). 4%), β-blocker (55.8%–84.4%), LWMH54.2%–94.2%), Clopidogrel (14.3–88.6), cholesterol lowering agents Statins (51.9%–90.9%); 4. Major in-hospital events and death rates were significantly higher in secondary hospitals than in tertiary hospitals; 5. Mortality and congestive heart failure rate were significantly higher in patients with no reperfusion therapy compared to patients underwent reperfusion. The incidence of combined outcomes (death or MI, and death, MI or Stroke) was also higher in patients without reperfusion therapy 6. Multivariate logistic regression analysis showed that age>75 years, hypertension, diabetes, reperfusion, aspirin, β-blocker, ACEI/ARB inhibitor use were associated independently with in-hospital mortality.
Conclusion In the most tertiary hospitals in China the application of medications being proved effective by evidence-based medicine in clinical practice is better than that of the secondary hospitals, but there is a big gap between guidelines and current management of ST segment elevation ACS in China, and the application status in China could be further improved.
- Coronary disease