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[Analysis of current treatment practice and outcomes for in-patients with ST-segment elevation acute coronary syndrome in 31 provinces of China].

OBJECTIVE
To evaluate the current clinical practice that has been proven effective by evidence-based medicine on patients with ST segment elevation Acute Coronary Syndrome(ACS)in China.


METHODS
A total of 1 307 in-patients with ST segment elevation ACS from 64 hospitals across China were recruited and a standard questionnaire was used to get information about the patients including demographic, treatment and in-hospital outcomes. We analyzed the status of application of reperfusion and aspirin, angiotensin-converting enzyme inhibitors (ACEI), β-blocker, low molecular weight heparin (LWMH), clopidogrel and cholesterol lowering agents on ST segment elevation ACS patients.


RESULTS
(1)30.9%-69.4% of the patients 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%).(2) percentages of medications in aspirin were 88.0%-98. 6%; in ACEI 60.5%-84. 4%; in β-blocker 55.8%-84.4%; in LWMH 54.2%- 94.2%; in clopidogrel 14.3%-88.6%; in cholesterol lowering agents (Statins) 51.9%-90.9%. (3)major in-hospital events, death rates and the incidence of combined outcomes were significantly higher in secondary hospitals than in tertiary hospitals, and higher in patients without reperfusion therapy compared with the patients who underwent reperfusion. (4) multivariate logistic regression analysis showed that age>75 years, hypertension , diabetes, reperfusion,aspirin, β-blocker, and ACEI/ARB inhibitor use were associated independently with in-hospital mortality.


CONCLUSION
In most tertiary hospitals in China the application of medications 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.