Impact of Chinese guidelines for management of patients with acute myocardial infarction on outcomes of hospitalized patients.
BACKGROUND
The first Chinese guidelines for the diagnosis and management of patients with acute myocardial infarction (AMI) were issued by the Cardiovascular Branch of the Chinese Medical Association, the Editorial Board of the Chinese Journal of Cardiology, and the Editorial Board of the Chinese Circulation Journal in December 2001. However, it is still unclear whether these guidelines have produced a major impact on clinical practice and patient outcomes. The purpose of this study was to evaluate the impact of these guidelines on the management and prognosis of Chinese patients with AMI.


METHODS
A retrospective study was carried out in patients with AMI who were admitted to Qilu Hospital of Shandong University from January 1994 to December 2004. Patients were divided into two groups: group A included patients admitted from January 1994 to December 2001, and group B comprised those admitted from January 2002 to December 2004. Therapeutic approaches and the occurrence rate of angina pectoris, reinfarction, heart failure and death during hospitalization were compared between two groups.


RESULTS
A total of 1783 patients including 1208 cases in group A and 575 cases in group B were enrolled in this study. No significant difference was found in baseline characteristics between group A and group B patients (all P > 0.05). There were more patients undergoing reperfusion therapy within the first 24 hours after symptom onset in group B than in group A (35.8% vs 21.7%, P < 0.001). Administration of beta-blockers, angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), statins, and heparins were more commonly seen in group B than in group A (P < 0.001). There were no significant differences in the use of nitrates or antiplatelet drugs between groups A and B (98.8% vs. 97.9%, P = 0.172, and 97.4% vs 98.6%, P = 0.113, respectively). In-hospital angina pectoris, heart failure and death were all lower in group B than in group A (32.2% vs 41.2%, P < 0.001; 17.2% vs 26.2%, P < 0.001; and 6.4% vs 9.4%, P = 0.038, respectively). There was no significant difference in the rate of reinfarction between group A and B patients (2.2% vs 1.7%, P = 0.492).


CONCLUSIONS
Chinese guidelines for the management of patients with AMI issued in December 2001 resulted in changes in therapy that led to a significant improvement of in-hospital outcomes but not in the rate of reinfarction in patients with AMI.
Jiang
Shi-liang
SL
Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan 250012, China.
Ji
Xiao-ping
XP
Zhang
Cheng
C
Wang
Xiao-rong
XR
Zhang
Mei
M
Zhang
Yun
Y
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors