China STEMI Care Project

Study Overview
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Brief Summary
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The China ST-elevation myocardial infarction (STEMI) Care Project (CSCAP) aims to improve the reperfusion treatment rate and shorten the total duration of myocardial ischemia by establishing a regional STEMI treatment network covering the whole-city region, whole-city population, and whole-disease process step by step. The CSCAP is a prospective, multicenter registry involving three phases. A total of 18 provinces, 4 municipalities, and 2 autonomous regions in China were included. Patients with STEMI who met with the third acute myocardial infarction definition and the Chinese STEMI diagnosis and treatment guidelines were enrolled and the estimated number is over 50,000. Phase 1 (CSCAP-1) focused on the in-hospital process optimization of primary percutaneous coronary intervention (PPCI) hospitals. Phase 2 (CSCAP-2) focused on the PPCI hospital-based regional STEMI transfer network, including emergency medical services and non-PPCI hospitals. Phase 3 (CSCAP-3) focused on the whole-city STEMI care network construction by promoting chest pain center accreditation. Systematic data collection, assessment of quality of care, and subsequent improvement were implemented throughout the project to continuously improve the quality of care for patients with STEMI. CSCAP is the first project that focused on establishing a regional STEMI emergency care network in China to help understand the condition of STEMI care in China extensively. Moreover, its objective was to optimize the quality of STEMI care through in-hospital process optimization (2012-2013), PPCI hospital-based regional STEMI transfer network construction (2015-2018), and construction of the whole-city STEMI care network step by step (2018-2021). However, hospitals were not randomly selected in CSCAP, which might be because of the lack of representatives to some degree. Alternatively, it focused on providing a tailored quality-of-care improvement plan based on the conditions of different regions.

Official Title
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China STEMI Care Project: a 10-year Project to Improve Quality of Care by Building up the a Regional STEMI Care Network

Conditions
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ST-Elevation Myocardial Infarction

Intervention / Treatment
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* Other: in-hospital process optimization
* Other: PPCI hospital-based regional STEMI transfer network construction
* Other: the whole-city STEMI care network construction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: STEMI patients Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CSCAP-1<br>STEMI with symptom onset within 12 h regardless of whether receiving reperfusion or symptom onset within 12-24 h of needing PPCI | Other: in-hospital process optimization<br> <br> |
| CSCAP-2<br>STEMI patients with symptom onset within 30 days | Other: PPCI hospital-based regional STEMI transfer network construction<br> <br> |
| CSCAP-3<br>STEMI patients with symptom onset within 30 days | Other: the whole-city STEMI care network construction<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the total duration of myocardial ischemia | Median time from symptom onset to target vessel open in STEMI patients | 12 hours | 
| the reperfusion treatment ratio | the ratio of primary PCI plus thrombolysis usage in STEMI patients | 12 hours |