Coronary Catheterization and Percutaneous Coronary Intervention in China

Zheng, Xin; Curtis, Jeptha P.; Hu, Shuang; Wang, Yongfei; Yang, Yuejin; Masoudi, Frederick A.; Spertus, John A.; Li, Xi; Li, Jing; Dharmarajan, Kumar; Downing, Nicholas S.; Krumholz, Harlan M.; Jiang, Lixin

doi:10.1001/jamainternmed.2016.0166

Cited by 78 publications

(56 citation statements)

References 30 publications

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“…Unfortunately, the use of cardiac catheterization information was unavailable in our current data set, which is a limitation of this study. Based on our review of relevant literature, a survey of a nationally representative sample in China reported that 82.4% (2551/3094) of AMI patients with a cardiac catheterization underwent PCI 63. Fifth, some severely ill patients may have stopped treatment and been discharged alive from hospitals because they wanted to die at home or could not afford to remain at the hospital.…”

Section: Discussionmentioning

confidence: 99%

Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis

Chen

Shi

Xue

et al. 2018

JAHA

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BackgroundPrevalence of acute myocardial infarction (AMI) is increasing in China, and AMI has become a major cause of mortality; however, information is very limited about the nationwide geographic and hospital variation in in‐hospital mortality (IHM) and the use of percutaneous coronary intervention (PCI) after AMI.Methods and ResultsFrom the Nationwide Hospital Discharge Database of China, we identified 242 866 adult admissions with AMI in 2015 from 1055 tertiary hospitals. We used multivariable logistic regressions to analyze the associations between geographic or hospital characteristics with IHM or PCI use. The national IHM rate was 4.71% (95% confidence interval, 4.62–4.79%). There was a greater risk of mortality in the Northeast (odds ratio [OR]: 1.86), West (OR: 1.73), South (OR: 1.32), and North (OR: 1.14) regions than in the East region of China. Non–teaching hospitals (OR: 1.18) and tertiary level B hospitals (OR: 1.06) were associated with higher IHM rates. The national PCI use rate was 45.3% (95% confidence interval, 45.1–45.5%). Compared with the East region of China, PCI use was lower in the Northeast (OR: 0.50), West (OR: 0.64), North (OR: 0.84), and South (OR: 0.88) regions. Non–teaching hospitals (OR: 0.83) and tertiary level B hospitals (OR: 0.55) were also associated with lower usage rates. There was a significant negative correlation between IHM and PCI use (r=−0.955), and IHM rates for patients with and without PCI both differed by geographic regions.ConclusionsThere were significant differences in IHM and PCI use among China's tertiary hospitals, linked to both geographic and hospital characteristics. More targeted intervention at national and regional levels is needed to improve access to effective health technologies and, eventually, outcomes following AMI.

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Section: Discussionmentioning

confidence: 99%

Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis

Chen

Shi

Xue

et al. 2018

JAHA

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“…The incidence of CIN is about 3.3% in general population5, whereas it can be 20% and up to 50% in patients with concomitant or previous history of severe cardiac4 and kidney6 diseases, respectively. In the past decade, the number of cardiac catheterizations, including coronary angiography (CAG) and percutaneous coronary intervention (PCI), has increased by 17 and 21 fold, respectively, in China, according to the China PEACE study7. As per the Chinese National data of coronary intervention, there were 567,583 cases of PCI in 2015, with an annual growth rate of 10–15%8.…”

mentioning

confidence: 99%

Post-Hoc Study: Intravenous Hydration Treatment in Chinese Patients with High Risk of Contrast-Induced Nephropathy Following Percutaneous Coronary Intervention

Bei

Lin

et al. 2017

Sci Rep

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Contrast-induced nephropathy (CIN) develops after the injection of iodinated contrast media. This is a post hoc analysis of the data obtained from the TRUST study, which was a prospective, multicentre, observational study conducted to evaluate the safety and tolerability of the contrast medium iopromide in patients undergoing cardiac catheterization from August 2010 to September 2011 in China, conducted to explore the current status, trends and risk predictors of hydration treatment. The status of hydration to prevent CIN in each patient was recorded. Of the total 17,139 patients from the TRUST study (mean age, 60.33 ± 10.38 years), the overall hydration usage was 46.1% in patients undergoing percutaneous coronary intervention (PCI) and 77.4%, 51.7%, and 48.5% in patients with pre-existing renal disease, diabetes mellitus, and hypertension, respectively. The proportion of hydration use increased from 36.5% to 55.5% from August 2010 to September 2011, which was independently associated with risk predictors like older age, pre-existing renal disease, hypertension, diabetes mellitus, prior myocardial infarction, ST segment elevation MI, high contrast dose, multi-vessel disease and reduced LVEF (<45%). Overall, the usage of intravenous hydration treatment for patients with a high risk of CIN following PCI was high in China.

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“…There are several possible explanations for this finding. Our study was conducted at a time when PCI was being adopted rapidly across China 17. Early outcomes associated with the use of this new technology could have been suboptimal as operators gained experience, thus providing a possible explanation for the higher RSMRs observed at PCI‐capable hospitals in 2006 before their outcomes improved by 2011.…”

Section: Discussionmentioning

confidence: 99%

Quality of Care in Chinese Hospitals: Processes and Outcomes After ST‐segment Elevation Myocardial Infarction

Downing

Wang

Dharmarajan

et al. 2017

JAHA

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BackgroundChina has gaps in the quality of care provided to patients with ST‐elevation myocardial infarction, but little is known about how quality varies between hospitals.Methods and ResultsUsing nationally representative data from the China PEACE‐Retrospective AMI Study, we characterized the quality of care for ST‐elevation myocardial infarction at the hospital level and examined variation between hospitals. Two summary measures were used to describe the overall quality of care at each hospital and to characterize variations in quality between hospitals in 2001, 2006, and 2011. The composite rate measured the proportion of opportunities a hospital had to deliver 6 guideline‐recommended treatments for ST‐elevation myocardial infarction that were successfully met, while the defect‐free rate measured the proportion of patients at each hospital receiving all guideline‐recommended treatments for which they were eligible. Risk‐standardized mortality rates were calculated. Our analysis included 12 108 patients treated for ST‐elevation myocardial infarction at 162 hospitals. The median composite rate increased from 56.8% (interquartile range [IQR], 45.9–72.0) in 2001 to 80.5% (IQR, 74.7–84.8) in 2011; however, substantial variation remained in 2011 with defect‐free rates ranging from 0.0% to 76.9%. The median risk‐standardized mortality rate increased from 9.9% (IQR, 9.1–11.7) in 2001 to 12.6% (IQR, 10.9–14.6) in 2006 before falling to 10.4% (IQR, 9.1–12.4) in 2011.ConclusionsHigher rates of guideline‐recommended care and a decline in variation between hospitals are indicative of an improvement in quality. Although some variation persisted in 2011, very top‐performing hospitals missed few opportunities to provide guideline‐recommended care. Quality improvement initiatives should focus on eliminating residual variation as well as measuring and improving outcomes.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

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Coronary Catheterization and Percutaneous Coronary Intervention in China

Cited by 78 publications

References 30 publications

Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis

Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis

Post-Hoc Study: Intravenous Hydration Treatment in Chinese Patients with High Risk of Contrast-Induced Nephropathy Following Percutaneous Coronary Intervention

Quality of Care in Chinese Hospitals: Processes and Outcomes After ST‐segment Elevation Myocardial Infarction

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