Evidence-based oral antiplatelet therapy among hospitalized Chinese patients with acute myocardial infarction: results from the Chinese acute myocardial infarction registry

Abstract

Background Oral antiplatelet therapy is the cornerstone of treatment for acute myocardial infaction (AMI). However, detailed usage data on oral antiplatelet therapy are lacking. Methods Using data from a nationally representative sample of patients with AMI, the detailed usage of oral antiplatelet therapy was analyzed in 40,202 consecutive eligible patients. Results The proportions of patients with AMI taking loading doses of aspirin and P2Y12 inhibitors were relatively low (62.2% and 63.6%, respectively), whereas approximately 90% of patients received maintenance doses of aspirin, P2Y12 inhibitors, and dual antiplatelet therapy. The proportions of patients taking loading doses of aspirin and P2Y12 inhibitors gradually decreased with age. Male sex, an educational level of at least college, an interval from onset to treatment of < 24 h, and primary PCI use were associated with a higher proportion of patients taking a loading dose of antiplatelet therapy, whereas those receiving conservative treatment had a lower rate of antiplatelet use (all P < 0.05). The proportion of patients taking loading doses of aspirin was highest in the western region, and that of patients taking loading doses of P2Y12 inhibitors was highest in the eastern region (P < 0.05). In addition, 76.7% of patients with ST-elevation MI and 91% of patients with non-ST-elevation MI received 300-mg loading dose of clopidogrel. Conclusions The proportion of patients with AMI receiving loading doses of aspirin and P2Y12 inhibitors during hospitalization was relatively low, and this rate was affected by many factors, such as age, sex, educational level, region of residence, and the interval from onset to treatment. The underutilization of guideline-based P2Y12 inhibitors was also problematic. Hence, quality improvement initiatives are needed to enhance adherence to guidelines to improve consistent use of oral antiplatelet therapy. Trial registration The Chinese Acute Myocardial Infarction Registry; Trial registration number: ChiCTR-ONC-12002636; Registered 31 October 2012; http://www.chictr.org.cn/showproj.aspx?proj=6916

Changes in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015

“…We found processes of care improved, consistent with prior studies. 17 18 For example, we found a notable increase in use of antiplatelet therapies, which may be attributable to the introduction of ticagrelor as a guideline-based medical therapy (GDMT) for AMI during the study period. 19 However, obstacles remain, such as the persistent use of ineffective therapies such as magnesium sulfate, which had been shown to vary by hospital and physician characteristics in China.…”

Association between P2Y12 inhibitor reloading and in-hospital outcomes for patients with non-ST-segment elevation acute coronary syndrome already on chronic P2Y12 receptor inhibitors therapy in China: findings from the CCC–ACS (improving care for cardiovascular disease in China-acute coronary syndrome) project

“…reported that pre-admission P2Y12 receptor inhibitor use was 9.3% among STEMI patients and 18.9% among NSTEMI patients [ 13 ]. In a real-world clinical setting, the proportion of patients with AMI receiving loading doses of aspirin and P2Y12 inhibitors during hospitalization was relatively low [ 16 ]. For those patients on chronic treatment with P2Y12 inhibitors, the proportion of patients receiving loading doses of P2Y12 inhibitors was extremely low (28.6% in our present study).…”

Study on myocardial infarction based on nationwide inpatient sample database: a bibliometric analysis from 2000 to 2022

“…[2] Myocardial infarction (MI), the leading cause of morbidity and mortality from cardiovascular disease, has caused a significant increase in the rate of hospitalization in recent years and usually leads to a high in-hospital mortality. [3,4] The outcomes of patients hospitalized with MI may be affected by the process of healthcare, as in-hospital mortality varies substantially across hospitals. [5] Thus, it is critical to study and assess the characteristics and healthcare needs of patients with MI based on hospitalization data.…”