[Clinical characteristics and prognosis comparison of Chinese non ST-segment elevation acute coronary syndrome patients in two different time periods].

OBJECTIVE: To compare the clinical characteristics, treatment methods and outcomes in Chinese non ST-segment elevation acute coronary syndrome (NSTE-ACS) patients from two large clinical trials in different time periods.

METHODS: All Chinese NSTE-ACS patients from two large International clinical trials (OASIS Registry and TIMACS) underwent coronary artery angiography after first admission were recruited in our analysis. The follow-up time was 180 days. A total of 1 473 NSTE-ACS patients were recruited in this analysis, in which 749 from Organization to Assess Strategies for Ischemic Syndromes (OASIS REISTRY) that completed in 38 centers in China from April 1999 to December 2000, and the rest 724 patients from The Timing of Intervention in Acute Coronary Syndromes (TIMACS) trial in 24 centers in China performed from April 2007 to June 2008.

RESULTS: Compared to OASIS patients, TIMACS group were older ((64.2 ± 10.1) years old vs. (58.7 ± 10.2) years old) , and fewer male patients (66.3% (480/724) vs. 74.4% (557/749)) , lower blood pressure at admission, and more histories of previous PCI (9.4% (68/724 vs. 6.4% (48/749)), stroke (8.8% (64/724) vs. 5.1% (38/749)) , hypertension (62.8% (455/724) vs. 56.6% (424/749)) and diabetes (23.3% (169/724) vs. 16.2% (121/749)), lower histories of coronary artery disease (37.4% (271/724) vs. 59.1% (443/749)) and myocardial infarction (12.0% (87/724) vs. 27.6% (207/749)) (all P < 0.05). After admission, comparing to OASIS group, TIMACS patients had significant higher PCI proportion (74.9% (524/724) vs. 49.3% (369/749), P < 0.001). In addition, for secondary prevention, TIMACS patients had significant higher standard medication treatment proportion during hospitalization, at discharge and at 180 days follow up than OASIS group (P < 0.05 for β-blocker, ACEI/ARB and lipid lowering drugs) and higher compliance rate. The combined primary outcome event rate at 180 days was much lower in TIMACS than in OASIS patients (13.3% (96/724) vs. 25.2% (189/749), P < 0.001) mostly due to the reduction on the refractory angina (5.2% (38/724) vs. 22.6% (169/749), P < 0.001) .

RESULTS: of COX regression model adjusted for baseline levels and treatment during hospitalization showed that the incidence rate of combination endpoint (HR = 0.39, 95% CI: 0.29-0.53, P < 0.001) and refractory ischemia/angina rehospitalization (HR = 0.17, 95% CI: 0.11-0.25, P < 0.001) were both lower in TIMACS patients than in OASIS patients.

CONCLUSION: PCI procedure and secondary prevention medication administration are more often applied in TIMACS patients than in OASIS group, which is related to less integrated incidence of primary outcomes reflecting progress in Chinese medical care for non ST elevated acute coronary syndrome patients according to the updated guidelines.