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Robustness of Fractional Flow Reserve for Lesion Assessment in Non-Infarct-Related Arteries of Patients With Myocardial Infarction Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis Identification of High-Risk Plaques Destined to Cause Acute Coronary Syndrome Using Coronary Computed Tomographic Angiography and Computational Fluid Dynamics Coronary Microcirculation Downstream Non-Infarct-Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology-Guided Revascularization Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease: A Meta-Analysis Lesion-Specific and Vessel-Related Determinants of Fractional Flow Reserve Beyond Coronary Artery Stenosis Coronary Flow Reserve in the Instantaneous Wave-Free Ratio/Fractional Flow Reserve Era: Too Valuable to Be Neglected Coronary CT Angiographic and Flow Reserve-Guided Management of Patients With Stable Ischemic Heart Disease The Impact of Coronary Physiology on Contemporary Clinical Decision Making Coronary Physiology in the Cardiac Catheterization Laboratory
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Original Research2015 Sep;170(3):506-15.e1.

JOURNAL：Am Heart J. Article Link

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

Zhang H, Jiang L, China PEACE Collaborative Group. Keywords: AMI; early β-blocker therapy; China PEACE

ABSTRACT

BACKGROUND - Since 2007, clinical practice guidelines have recommended β-blocker therapy early in the course of acute myocardial infarction (AMI) for patients who are not at high risk for complications. Our objective was to perform a national quality assessment of early β-blocker use during hospitalization for AMI over the past decade in China.


METHODS - We conducted medical record review of a nationally representative sample of patients admitted to Chinese hospitals with AMI and studied those without absolute contraindications to β-blocker therapy in 2001, 2006, and 2011. We evaluated the use, type, and dose of β-blockers within the first 24 hours of admission over time and identified predictors of not using this treatment both in ideal candidates and in those with risk factors for cardiogenic shock.


RESULTS - Among 14,241 patients with AMI (representing 43,165 patients in 2001, 106,167 patients in 2006, and 221,874 patients in 2011 in China, respectively), 45.1% had no contraindications to early β-blocker therapy; 21.1% had risk factors for cardiogenic shock but no absolute contraindication. β-blocker use in ideal patients was 54.3% in 2001, 67.8% in 2006, and 61.8% in 2011 (P = .28 for trend). Predictors of nontreatment were older age, lower systolic blood pressure, lower heart rate, absence of chest discomfort, and admission to a nonteaching hospital. Use in patients with risk factors for cardiogenic shock was 42.6% in 2001, 59.5% in 2006, and 52.9% in 2011 (P = .31 for trend). Metoprolol was used most frequently (91.5%), but dosages were often below those recommended in guidelines.


CONCLUSIONS - The use of early β-blocker therapy for patients with AMI in China is suboptimal, with underuse in patients who could benefit and substantial use among those who might be harmed. Patterns of use have not changed over time, thus creating an important target of efforts to improve quality of care for AMI.


TRIAL REGISTRATION - ClinicalTrials.gov NCT01624883.


Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

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