Performance of Management Strategies With Class I Recommendations Among Patients Hospitalized With ST-Segment Elevation Myocardial Infarction in China
Authors: Yongchen Hao, Dong Zhao, Jing Liu, Jun Liu, Na Yang, Yong Huo, Gregg C. Fonarow, Junbo Ge, Louise Morgan, Changsheng Ma, Yaling Han, Sidney C. Smith, Mingcheng Bai, Cui Bin, Dongsheng Chai, Rong Chang, Jiyan Chen, Moshui Chen, Guoxiong Chen, Kaihong Chen, Kaiming Chen, Manhua Chen, Xiaoping Chen, Ximing Chen, Ping Chen, Xia Chen, Guoduo Chen, Jie Chen, Xiufeng Chen, Shengyong Chen, Xiaoshu Cheng, Huimin Chu, Honghua Deng, Junping Deng, Jinglan Diao, Jiawang Ding, Pingshuan Dong, Hui Dong, Tianmin Du, Juexin Fan, Weiqing Fan, Junping Fang, Xiaoyun Feng, Guosheng Fu, Xianghua Fu, Fudong Gan, Chuanyu Gao, Junbo Ge, Jun Guan, Ying Guo, Yansong Guo, Haiping Guo, Guangshu Han, Minghua Han, Yaling Han, Yinglu Hao, Shenghu He, Zhaofa He, Zeyuan He, Yuqing Hou, Ping Hou, Jing Hu, Lan Huang, Weijian Huang, Yi Huang, Fangfang Huang, Yuehua Huang, Zhenguo Ji, Lang Ji, Zheng Ji, Shaobin Jia, Nan Jia, Jie Jiang, Li Jiang, Weihong Jiang, Hong Jiang, Yuanzhe Jin, Chunlin Lai, Meisheng Lai, Bao Li, Bin Li, Guoqing Li, Hongwei Li, Jianhao Li, Junxia Li, Lang Li, Ling Li, Tianchang Li, Yongdong Li, Aihua Li, Jifu Li, Shuangbin Li, Xue Li, Zhanquan Li, Yong Li, Xiaolei Li, Dongyan Li, Songbai Li, Guo Li, Yue Li, Xudong Li, Fengwei Li, Xiaolan Li, Naiyi Liang, Chuanliang Liang, Wenhua Lin, Yingzhong Lin, Hailong Lin, Rong Lin, Haiyun Lin, Bin Liu, Junming Liu, Xiaohui Liu, Weijun Liu, Yin Liu, Hualing Liu, Hui Liu, Jianwen Liu, Xuebo Liu, Changyong Liu, Wei Liu, Hong Liu, Hong Luan, Suxin Luo, Caidong Luo, Kalan Luo, Yingchao Luo, Genshan Ma, Shixin Ma, Shuren Ma, Yitong Ma, Likun Ma, Xiaochuan Ma, Xiaowen Ma, Wei Mao, Lijun Meng, Fanju Meng, Shaoping Nie, Yanbo Niu, Zhihong Ou, Zewei Ouyang, Daoquan Peng, Xuemei Peng, Xiaowei Peng, Xiaoyong Qi, Peng Qu, Shuqiu Qu, Gengsheng Sang, Yuhuan Shi, Zhiyuan Song, Jinzi Su, Xi Su, Zhenqi Su, Qinfeng Su, Yingbi Su, Yuemin Sun, Xiaofei Sun, Yingxian Sun, Fakuan Tang, Jiong Tang, Lilong Tang, Xingsheng Tang, Xin Tang, Guizhou Tao, Ling Tao, Jianhong Tao, Miao Tian, Wei Tuo, Tian Tuo, Changqian Wang, Honhju Wang, Huifeng Wang, Jingfeng Wang, Zhirong Wang, Ningfu Wang, Wei Wang, Yan Wang, Yanggan Wang, Bin Wang, Siding Wang, Xiaojun Wang, Lin Wang, Chuntong Wang, Yanli Wang, Qichun Wang, Zhongshan Wang, Jinru Wei, Lin Wei, Li Wei, Di Wu, Lirong Wu, Chunyang Wu, Keng Wu, Qiang Wu, Tongguo Wu, Jiabin Xi, Shudong Xia, Jun Xiao, Ping Xie, Qiang Xie, Shuanli Xin, Guoqin Xin, Biao Xu, Dawen Xu, Gang Xu, Weiting Xu, Zesheng Xu, Jing Xu, Jinchuan Yan, Zhenyu Yang, Zhijian Yang, Zhiming Yang, Bosong Yang, Tianlun Yang, Xiangjun Yang, Yanzong Yang, JiaoMei Yang, Jian Yang, Yuheng Yang, Jie Yang, Xiaoli Yang, Liqiong Yang, Jianfeng Ye, Shaowu Ye, Jinxing Yi, Jiyan Yin, Bo Yu, Yang Yu, Zuyi Yuan, Zheng Zhang, Chunyan Zhang, Guixia Zhang, Hong Zhang, Man Zhang, Peiying Zhang, Ping Zhang, Yonglin Zhang, Xianan Zhang, Huifang Zhang, Xiaoqin Zhang, Pengfei Zhang, Congliang Zhang, Shuhua Zhang, Tao Zhang, Xianxian Zhao, Xingsheng Zhao, Yulan Zhao, Fang Zhao, Jingshan Zhao, Ruiping Zhao, Yang Zheng, Zeqi Zheng, Yanlie Zheng, Qiaoqing Zhong, Yuhua Zhu, Dongmei Zhu
Journal: JAMA Cardiology (2022)

<h3>Importance</h3> Despite advances in the treatment of ST-segment elevation myocardial infarction (STEMI), little is known about how this evolving knowledge is applied in current clinical practice in China. <h3>Objective</h3> To evaluate hospital performance and temporal trends in the management of STEMI. <h3>Design, Setting, and Participants</h3> This study used data from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome Project, a nationwide quality improvement registry, in collaboration with the American Heart Association and the Chinese Society of Cardiology. Participants included patients with STEMI admitted to 143 tertiary hospitals across China from November 2014 to July 2019, and data were analyzed from November 2020 to December 2021. <h3>Main Outcomes and Measures</h3> Levels, hospital-level variations, and trends for utilization rates of the 9 management strategies with Class I recommendations in Chinese and US guidelines. <h3>Results</h3> A total of 57 560 hospitalizations with STEMI were included. Overall, 20.0% of patients received all the care according to the 9 guideline-recommended strategies. The performance rate of quality measures was low for reperfusion therapy (61.0%, 35 115/57 560 patients), β-blocker at discharge (68.3%, 37 750/55 285 patients), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge (55.1%, 2524/4578 patients), and smoking cessation counseling (36.5%, 9586/26 265 patients) among those who were eligible. Of 25 563 patients who underwent primary percutaneous coronary intervention (PCI), 66.8% underwent this procedure within 90 minutes of hospital arrival. Of 1128 patients who underwent fibrinolysis therapy, 253 (22.4%) underwent this treatment within 30 minutes of hospital arrival. Measures with high performance rates included receipt of dual antiplatelet therapy within 24 hours (95.5%, 54 263/56 848 patients) and at discharge (91.8%, 51 452/56 019 patients) and receipt of statin at discharge (93.0%, 52 214/56 141 patients) for those eligible. There was significant variation between hospitals in all-or-none score (ranging from 0 to 61.9%) and performance of individual measures. The quality of care improved during the study period, especially for reperfusion therapy, primary PCI within the first 90 minutes of hospital arrival, and smoking cessation counseling. <h3>Conclusions and Relevance</h3> The quality of care for patients hospitalized with STEMI does not meet guideline-recommended strategies in China, with only 1 in 5 patients receiving all the care according to the 9 guideline-recommended strategies. Large disparities in the quality of care exist across hospitals.