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      Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011: China PEACE-retrospective AMI study

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          Abstract

          Fibrinolytic therapy is the primary reperfusion strategy for ST-segment elevation myocardial infarction in China, and yet little is known about the quality of care regarding its use and whether it has changed over time. This issue is particularly important in hospitals without the capacity for cardiovascular intervention.

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          2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

          Patrick O'Gara, Frederick Kushner, Deborah D Ascheim … (2013)
          Article 0 comments Cited 861 times – based on 0 reviews     Review now
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            ST-segment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data.

            Jing. Li, Xi Li, Qing Wang … (2015)
            Despite the importance of ST-segment elevation myocardial infarction (STEMI) in China, no nationally representative studies have characterised the clinical profiles, management, and outcomes of this cardiac event during the past decade. We aimed to assess trends in characteristics, treatment, and outcomes for patients with STEMI in China between 2001 and 2011.
            Article 0 comments Cited 196 times – based on 0 reviews     Review now
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              Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction.

              Paul W Armstrong, Anthony Gershlick, Patrick Goldstein … (2013)
              It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention (PCI) early after acute ST-segment elevation myocardial infarction (STEMI). Among 1892 patients with STEMI who presented within 3 hours after symptom onset and who were unable to undergo primary PCI within 1 hour, patients were randomly assigned to undergo either primary PCI or fibrinolytic therapy with bolus tenecteplase (amended to half dose in patients ≥75 years of age), clopidogrel, and enoxaparin before transport to a PCI-capable hospital. Emergency coronary angiography was performed if fibrinolysis failed; otherwise, angiography was performed 6 to 24 hours after randomization. The primary end point was a composite of death, shock, congestive heart failure, or reinfarction up to 30 days. The primary end point occurred in 116 of 939 patients (12.4%) in the fibrinolysis group and in 135 of 943 patients (14.3%) in the primary PCI group (relative risk in the fibrinolysis group, 0.86; 95% confidence interval, 0.68 to 1.09; P=0.21). Emergency angiography was required in 36.3% of patients in the fibrinolysis group, whereas the remainder of patients underwent angiography at a median of 17 hours after randomization. More intracranial hemorrhages occurred in the fibrinolysis group than in the primary PCI group (1.0% vs. 0.2%, P=0.04; after protocol amendment, 0.5% vs. 0.3%, P=0.45). The rates of nonintracranial bleeding were similar in the two groups. Prehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients with early STEMI who could not undergo primary PCI within 1 hour after the first medical contact. However, fibrinolysis was associated with a slightly increased risk of intracranial bleeding. (Funded by Boehringer Ingelheim; ClinicalTrials.gov number, NCT00623623.).
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                Author and article information

                Journal
                Title: European Heart Journal: Acute Cardiovascular Care
                Abbreviated Title: European Heart Journal: Acute Cardiovascular Care
                Publisher: SAGE Publications
                ISSN (Print): 2048-8726
                ISSN (Electronic): 2048-8734
                Publication date Created: February 2017
                Publication date Created: April 2017
                Publication date (Electronic): January 19 2016
                Publication date (Print): April 2017
                Volume: 6
                Issue: 3
                Pages: 232-243
                Affiliations
                [1 ]National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People’s Republic of China
                [2 ]Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA
                [3 ]Section of General Internal Medicine, Yale School of Medicine, USA
                [4 ]The Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, USA
                [5 ]Department of Health Policy and Management, Yale School of Public Health, USA
                [6 ]Section of Cardiovascular Medicine, Yale School of Medicine, USA
                [7 ]Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, USA
                [8 ]Division of Cardiology, University of Colorado Anschutz Medical Campus, USA
                [9 ]Saint Luke’s Mid America Heart Institute/University of Missouri-Kansas City, USA
                Article
                DOI: 10.1177/2048872615626656
                PubMed ID: 26787648
                SO-VID: b4d6f1db-bee9-4e44-8439-f7a5ccaf555f
                Copyright © © 2017
                License:

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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