Cardiac Catheterization and PCI in China
What is the quality and outcome of cardiac catheterization and percutaneous coronary intervention (PCI) in China?
The authors reported the results of the China PEACE (Patient-Centered Evaluative Assessment of Cardiac Events)–Retrospective CathPCI Study. This observational study used a two-stage, random sampling strategy to create a nationally representative sample of 11,241 patients undergoing coronary catheterization and PCI at 55 urban Chinese hospitals in calendar years 2001, 2006, and 2011.
The study enrolled 11,241 patients. The weighted proportion of women increased from 29% in 2001 to 36% in 2006 and 36% in 2011. The average age of the cohort increased from 58 to 60 to 61 years. Between 2001 and 2011, the national rate of cardiac catheterization increased 17-fold, and of PCI, 21 times. The use of the radial approach increased from 3.5% to 79%, and of drug-eluting stents, from 18% to 97%. There was a significant decline in the rate of bleeding over time. Significant gaps in quality of data were noted for process metrics including door-to-balloon times for primary PCI and the prescription of evidence-based medications at discharge.
The use of invasive cardiac procedures has increased dramatically in the last few years in China. While the overall outcomes were excellent, specific gaps in care were identified.
The registry provides a snapshot of coronary artery disease treatment in China and identifies several quality issues. The impressive decline in complications over time suggests that the Chinese physicians have been quick to adapt new practices, and it is likely that the major gaps in quality that were identified in this study are being bridged with quality improvement efforts already. As the volume of invasive procedures increases worldwide, observational studies/registries like this will be key in guiding quality improvement efforts and enhancing procedural safety and appropriateness.
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