Despite being a country that holds nearing a fifth of the world's population, China has had no nationally representative studies characterizing the clinical profiles, management and outcomes of acute myocardial infarction within the past decade.

Taking on the responsibility of collecting this necessary data, Jing Li, PhD, Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, China, and his team of co-authors conducted a retrospective analysis of hospital records to fill in this informational gap. The study, published June 23 in The Lancet, found that more than 85 percent of acute myocardial infarction (AMI) admissions between 2001 and 2011 were ST-segment elevation myocardial infarction (STEMI) admissions, and the STEMI rates more than quadrupled in the past decade.

The China PEACE-Retrospective AMI Study looked at 162 hospitals across China. Of the 18,631 acute myocardial infarction admissions, 12,264 patients were included in an analysis of treatments, procedures and tests, and 11,986 were included in an analysis of in-hospital outcomes. Li and his colleagues found that the estimated national rates of hospital admission for STEMI per 100,000 people increased from 3•7 in 2001, to 8•1 in 2006, to 15•8 in 2011, and that prevalence of risk factors such as smoking, hypertension, diabetes and dyslipidemia increased as well. While results showed an increase in the use of primary percutaneous coronary intervention, from 10•2 percent in 2001 to 27•6 percent in 2011, the proportion of patients who did not receive reperfusion did not significantly change (44•8 percent in 2001 to 45•0 percent in 2011). The data also showed that the median length of hospital stays decreased from 13 days in 2001 to 11 days in 2011, however, the adjusted in-hospital mortality did not significantly change between 2001 and 2011.

According to Lixin Jiang, MD, PhD, FACC, of the National Center for Cardiovascular Diseases in Beijing, and a co-author of the study, "The growing needs for inpatient STEMI care will create pressure for Chinese hospitals to increase capacity, adequately train health care professionals, develop infrastructure, and improve care. The striking increases in hospital admissions for STEMI noted in our study show that important improvements in capacity have been made; however, national STEMI mortality suggests that further growth will be necessary to ensure adequate access for patients with the disorder in China. Furthermore, our study underlines that access to care does not ensure the delivery of the highest-quality care; suggesting that in addition to improvements in capacity, hospitals in China must simultaneously strive to improve care."

"This paper sets the stage for a keen focus on achieving outstanding patient outcomes through quality improvement initiatives," adds Harlan Krumholz, MD, SM, FACC, Yale University School of Medicine, New Haven, CT, and a co-author of the study. "Improvement begins with a willingness to evaluate rigorously the results that are currently being achieved."

Also commenting on the results of the study, Ajay Kirtane, MD, FACC, and Gregg W. Stone, MD, FACC, Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center at Columbia University Medical Center, New York, note, "The look at contemporary STEMI care within China provided by the investigators is a laudable effort that has exposed areas for potential improvement in acute myocardial infarction processes in the country. And no doubt exists that the conditions described herein apply to other large countries and populations, each with their own unique considerations. To truly enhance global health, close collaboration between physician-scientists, industry, and governments on a multinational scale is necessary and should be prioritized, representing the ultimate expression of the heart team approach."