International journal of cardiology · 2025
Report on the adherence to key management strategies and mortality rates in patients with acute myocardial infarction-related cardiogenic shock: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Liu Yuwei, Li Chenglong, Wang Liangshan, Hao Xing, Du Zhongtao, Wang Hong, Hou Xiaotong, CCC-ACS Investigators
Аннотация
BACKGROUND: Acute myocardial infarction-related cardiogenic shock (AMI-CS) is a severe complication with high in-hospital mortality. However, real-world data on AMI-CS care are limited. This study aimed to evaluate the adherence to management strategies for AMI-CS.
METHODS: Using data from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project, we assessed adherence to twelve key management strategies based on AMI-CS statements and AMI guidelines as well as overall treatment adherence, with a focus on both ST-segment elevation myocardial infarction (STEMI)-CS and non-ST-segment elevation myocardial infarction (NSTEMI)-CS. We also examined hospital-level variations in each management strategy.
RESULTS: A total of 2726 AMI-CS patients were included. High adherence was observed in cardiac troponin measurement (94.6 %), dual antiplatelet therapy (DAPT) administration at hospital arrival (92.4 %), DAPT (90.8 %) and statin (95.7 %) prescriptions at discharge, and smoking cessation counseling (89.9 %). However, adherence to risk stratification for NSTEMI-CS patients (59.5 %), primary percutaneous coronary intervention (PCI) within 90 min (39.5 %), fibrinolysis therapy within 30 min for STEMI-CS patients (20.2 %), and β-blocker (62.2 %) or angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) (45.3 %) prescriptions at discharge was significantly lower. Furthermore, regarding treatments not recommended during the acute phase, 69.8 % of patients did not receive β-blockers, and 77.4 % did not receive ACEI/ARBs upon admission. Overall, 9.2 % of AMI-CS patients received comprehensive care, with 10.2 % of STEMI-CS patients and 3.6 % of NSTEMI-CS patients receiving it.
CONCLUSION: A significant gap exists between guideline recommendations and clinical practice, with only 10 % of AMI-CS patients receiving high-quality care. The quality of care varied substantially across hospitals.
METHODS: Using data from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project, we assessed adherence to twelve key management strategies based on AMI-CS statements and AMI guidelines as well as overall treatment adherence, with a focus on both ST-segment elevation myocardial infarction (STEMI)-CS and non-ST-segment elevation myocardial infarction (NSTEMI)-CS. We also examined hospital-level variations in each management strategy.
RESULTS: A total of 2726 AMI-CS patients were included. High adherence was observed in cardiac troponin measurement (94.6 %), dual antiplatelet therapy (DAPT) administration at hospital arrival (92.4 %), DAPT (90.8 %) and statin (95.7 %) prescriptions at discharge, and smoking cessation counseling (89.9 %). However, adherence to risk stratification for NSTEMI-CS patients (59.5 %), primary percutaneous coronary intervention (PCI) within 90 min (39.5 %), fibrinolysis therapy within 30 min for STEMI-CS patients (20.2 %), and β-blocker (62.2 %) or angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) (45.3 %) prescriptions at discharge was significantly lower. Furthermore, regarding treatments not recommended during the acute phase, 69.8 % of patients did not receive β-blockers, and 77.4 % did not receive ACEI/ARBs upon admission. Overall, 9.2 % of AMI-CS patients received comprehensive care, with 10.2 % of STEMI-CS patients and 3.6 % of NSTEMI-CS patients receiving it.
CONCLUSION: A significant gap exists between guideline recommendations and clinical practice, with only 10 % of AMI-CS patients receiving high-quality care. The quality of care varied substantially across hospitals.