title: Impact of therapy options on in-hospital and three-year outcome of patients with ST-elevation myocardial infarction in Beijing.
abstract: OBJECTIVE
  To evaluate the clinical characteristics, in-hospital and three-year outcome in ST-elevation myocardial Infraction (STEMI) patients receiving conservative treatment (CT), thrombolytic treatment (TT) and primary percutaneous coronary intervention (PCI) in Beijing.
  
  
  METHODS
  This 12-month prospective, multicenter registry study was conducted in 19 hospitals with 808 patients with STEMI in Beijing between Jan. 2006 and Dec. 2006, 518 (64%) received PCI, 106 (16.1%) received TT and 184 (22.8%) received CT therapy. Patients were followed up for 3 years.
  
  
  RESULTS
  At baseline, the age of patients in CT group [(64.5 ± 13.5) years] was significantly higher than those in TT group p(57.9 ± 11.0) years] and in PCI group [ (60.4 ± 12.3) years, all P<0.01]; and the median time from symptom onset to hospital in CT group (207 min) was significantly longer than those in TT group (130 min) and PCI group (130 min, all P<0.01). Emergency Medical Service (EMS) use was significantly higher in PCI group (184/518, 35.5%) than in CT group (46/184, 27.3%) and TT group (29/107, 25.0%, all P<0.05). Health insurance holder was the highest in PCI group (P<0.01). PCI was performed less frequently than thrombolytic therapy [66.6% (345/518) vs. 80.2% (85/106)m P=0.02] during off-hours and more frequently performed in tertiary hospitals than in secondary hospitals[66.8%(437/651) vs. 52.6% (81/154, P<0.01)]. The in-hospital mortality and the cardiovascular mortality at 3 year after hospital discharge was significantly higher in CT group [9.2% (17/185) and 9.4% (15/159)] than in PCI group [3.5% (18/518), 4.5% (20/446)] and TT group [6.6% (7/106), 2.3% (2/86), all P<0.01]. Patients in PCI group had the highest adherence level of aspirin, β-blocker, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or statins at 3-years follow-up (all P<0.05). Multivariable Cox proportional hazards regression analysis showed that only PCI was associated with lower risk of cardiovascular death (HR-0.40, 95% CI:0.21-0.73, P<0.01).
  
  
  CONCLUSIONS
  Social and clinical setting may affect the physician's decision to provide reperfusion therapy in Beijing for STEMI patients. Better adherence of secondary preventive drugs and lower cardiovascular death are observed in STEMI patients receiving PCI during the 3-year follow-up
authors.forename: Jin-gang
authors.initials: JG
authors.lastname: Yang
authors.forename: Lin
authors.initials: L
authors.lastname: Pi
authors.forename: Li
authors.initials: L
authors.lastname: Song
authors.forename: Yi-hong
authors.initials: YH
authors.lastname: Sun
authors.forename: Da-yi
authors.initials: DY
authors.lastname: Hu
mesh_terms: D000368:Aged; D002681:China; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis