CBS 2019
CBSMD教育中心
English

急性冠脉综合征

科研文章

荐读文献

National assessment of early β-blocker therapy in patients with acute myocardial infarction in China, 2001-2011: The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective AMI Study Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial Frequency of nonsystem delays in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention and implications for door-to-balloon time reporting (from the American Heart Association Mission: Lifeline program) Balloon-to-door time: emerging evidence for shortening hospital stay after primary PCI for STEMI 1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor Revision: prognostic impact of baseline glucose levels in acute myocardial infarction complicated by cardiogenic shock-a substudy of the IABP-SHOCK II-trial Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis Changes in One-Year Mortality in Elderly Patients Admitted with Acute Myocardial Infarction in Relation with Early Management Response by Kaier et al to Letter Regarding Article, “Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction” Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial

Original Researche13197, 2019 Dec 27 [Online ahead of print]

JOURNAL:Eur J Clin Invest. Article Link

Improvement of Clinical Outcome in Patients With ST-Elevation Myocardial Infarction Between 1999 And 2016 in China : The Prospective, Multicenter Registry MOODY Study

MX Chen, J Kan, JJ Zhang et al. Keywords: STEMI; clinical events; in-hospital death; PCI; trained operator

ABSTRACT


BACKGROUND - Reports showed no change of 7day mortality after primary percutaneous coronary intervention (PCI) for STelevation myocardial infarction (STEMI) between 2001 and 2011 in China. National rolling oneyear interventional standardized training program began in September 2009. However, the improvement in clinical outcome following STEMI PCI after 2011 remains unclear.


METHODS AND RESULTS - This multicenter MOODY registry study aimed to analyze the clinical improvement after STEMI PCI. Of a total of 9265 acute MI patients registered from 24 centers, 3142 STEMIs having a first medical contact time 12 hours and undergoing primary PCI were assigned to the Pre Group (n=1014, between March 1999 and October 2010) or the Post Group (n=2128, between 2010 November and 2016 Ocotber). The primary endpoint was inhospital cardiac death. Study endpoints were also compared between trained and untrained operators and between experienced (50 primary PCIs/year) and inexperienced personnel.

 

Inhospital death after PCI was 3.0% in the Pre Group, significantly higher than 1.6% in the Post Group (p=0.035). The improvements in clinical outcome after PCI between the 2016 and Pre Groups were stably sustained through oneyear followup. The significant reduction for inhospital death was noted when primary PCI was performed by trained (1.4% vs 5.4%, p<0.001) or experienced (2.7% vs 4.8%, p=0.001) operators, compared to untrained or inexperienced operators, respectively. Inclusion of the untrained operator into the conventional risk model strongly enhanced the prediction for endpoints. Age, Killip Class 3, diabetes, transradial approach, and system delay were five predictors of inhospital death after primary PCI.

 

CONCLUSION - PCI for STEMI by a trained and experienced operator was associated with significant reduction of inhospital death. Our results strongly warrant the need for promoting the current system response and patient education.