title: Trends in cardiac biomarker testing in China for patients with acute myocardial infarction, 2001 to 2011: China PEACE-retrospective AMI study.
abstract: OBJECTIVE
  To describe trends in the availability of biomarker testing in Chinese hospitals and how practice complies with established standards for the diagnosis of acute myocardial infarction (AMI).
  
  
  BACKGROUND
  Cardiac biomarker testing is standard in high-income countries, but little is known about the availability and use of cardiac biomarker testing in low- and middle-income countries (LMICs) such as China.
  
  
  METHODS
  Based on a nationally representative sample of Chinese hospitals in 2001, 2006 and 2011, we describe the temporal trends and regional differences in the hospital capability and rates of use of cardiac biomarker testing, as well as the variation in use across hospitals with testing capability, for patients labeled with the diagnosis of AMI.
  
  
  RESULTS
  We sampled 175 hospitals (162 participated in the study) and 18,631 AMI admissions. 14,370 patients were included in analysis of biomarker use. The proportion of hospitals with biomarker testing capability was 57.4% in 2001 (25.0% troponin and 32.4% creatine kinase MB fraction (CK-MB) only) and 96.3% (81.4% troponin and 14.9% CK-MB only) in 2011. The proportion of hospitals with troponin testing capability in 2011 was significantly higher in urban compared with rural hospitals (96.8% vs. 71.4%, p< 0.001). In 2011, only 55.9% of hospitals with troponin testing capability (71 out of 127 hospitals) used the assay for more than 80% of their patients with AMI. Among hospitals with either biomarker testing capability, there was marked variation in use in both rural (from 7.1% to 100.0% of patients) and urban hospitals (from 57.9% to 100.0% of patients). In 2011, 36.1% of the patients with AMI did not have troponin tested and 4.9% did not have either biomarker measured.
  
  
  CONCLUSIONS
  The recommended biomarker tests for AMI diagnosis are not universally available and the testing is not consistently applied when it is available in China.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01624883.
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Zhan
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Xi
authors.initials: X
authors.lastname: Li
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Shuang
authors.initials: S
authors.lastname: Hu
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, United States of America; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America; Department of Emergency medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Arjun K
authors.initials: AK
authors.lastname: Venkatesh
authors.affiliation: Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, United States of America.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America.
authors.forename: Zhenqiu
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America.
authors.forename: Nihar R
authors.initials: NR
authors.lastname: Desai
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, United States of America; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Lixin
authors.initials: L
authors.lastname: Jiang
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000378:metabolism; D002681:China; D019963:Clinical Chemistry Tests / Q000706:statistics & numerical data / Q000639:trends*; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000378:metabolism*; D009206:Myocardium / Q000378:metabolism*; D012189:Retrospective Studies; D014336:Troponin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D014336:Troponin; D052279:Creatine Kinase, MB Form