Evaluation Of Medical Quality Evaluation Of Clopidogrel In Patients With Acute Myocardial Infarction Treated By Percutaneous Coronary Intervention

Objective To explore the application and affecting factors of clopidogrel loading therapy in Chinese patients with Acute Myocardial Infarction (AMI) undergoing Percutaneous Coronary Intervention (PCI) in China in 2006 and 2011.Method Based on China Patient-centered Evaluative Assessment of Cardiac Events-Retrospective Study of Acute Myocardial Infarction, we collected clinical information of AMI patients undergoing PCI from 2006 and 2011, and analyzed use of clopidogrel loading therapy, defined as once dose of 300mg and above, by year in patient and hospital level. The relevant factors affecting clopidogrel loading therapy status were identified by binary logistic regression analysis.Result We enrolled 2,819 eligible patients, of which 87.2%were 75 years old and yonger,22.5% were female,88.0% were diagnosised as STEMI and 76.5% were hospitalized in 2011. From 2006 to 2011, there was no significant change in the use of clopidogrel loading therapy in both patient level (50.4% vs.47.1%, P=0.137) and hospital level (44.4% vs.48.1%,P=0,987). In patient level, use rates of clopidogrel loading therapy among patients who were 75 years old and yonger, received primary PCI or got less CRUSADE score were significantly higher than that of their counterparts, respectively. Marked varation of clopidogrel loading use was noticed across hospitals, while no significant diference existed among median rates of clopidogrel loading use among hospitals that were urben or rural hopitals, tertiary or secondary hospitals, affiliated hoptials or not, owned capacity of CABG or not, located in estern, central or western areas, had different treatment scales of AMI patients per year. Binary logistic regression analysis showed that time from onset of isheamic symptom to admission, pattern of PCI and early use of other antiplatelet agents were independent factors influcing use of clopidogrel loading therapy.Conclusion Clopidogrel loading therapy was noticeably underused in Chinese AMI patients undergoing PCI, variation existed across hospitals and the status was similar between 2006 and 2011. Quality improvement initiatives are needed to increase application and consistency of clopidogrel loading use for patients with AMI undergoing PCI.