In-hospital Reperfusion And Secondary Preventive Drug Therapy For Acute Stsegment Elevation Myocardial Infarction Patients In Zhangjiakou Prefecture/Area

Objective:To analysis of reperfusion and secondary preventive drug therapy for in-hospital patients with acute ST-elevation myocardial infarction（STEMI）in Zhangjiakou from 2014 to 2019.Methods:Through retrospective analysis,a representative in-hospital STEMI patient group in Zhangjiakou from 2014 to 2019.In first step,a simple random-sampling procedure was conducted to identify the collaborating hospital.The second step was select patients admitted to each participating hospitals for acute myocardial infarction in the year from 2014to 2019.Through extraction and exclusion,clinical information was extracted from the included medical records.Demographic data,reperfusion as thrombolytic therapy（TT）and percutaneous coronary intervention（PCI）and secondary preventive drug therapy as aspirin,P2Y₁₂inhibitors,statins,β-blockers,angiotensin-conversion enzyme inhibitors（ACEI）/angiotensin receptor blockers（ARB）were analyzed and compared among 2014 to 2019.Results:（1）A total of 2 961 STEMI medical records were collected,in which 1 788 patients were identified eligible,with an average age of 65.25±12.25 years old,and the ratio of male to female was 2.64 to 1.There was no change in the ratio of male,P=0.716.The proportion of STEMI patients under the age of 60 increased,P=0.006.The proportion of complications by hyperlipidemia,diabetes mellitus and smoking were increased.There were 386（21.6%）patients who arrived at the hospital within 2 hours of symptom onset.There were 1 494（83.6%）patients who came hospital by private vehicle.（2）There were 1 016（56.8%）patients received reperfusion including 961（53.7%）PCI and 55（3.1%）TT.From 2014 to 2019,reperfusion increased from 47.8%to 65.0%,P<0.001;application of PCI increased from46.9%to 62.8%,P<0.001;dual antiplatelet therapy（DAPT）increased from46.9%to 64.7%,P<0.001.（3）The in-hospital application of aspirin was 1461（81.7%）patients,P2Y₁₂ inhibitors was 1 315（73.5%）,statins was in 1019（57.0%）,β-blockers was 732（40.9%）and ACEI/ARB was 748（41.8%）respectively.From 2014 to 2019,administration of aspirin elevated form68.1%to 91.3%,P<0.001;P2Y₁₂ inhibitors from 65.0%to 82.4%,P<0.001;statins from 40.3%to 74.0%,P<0.001;administration ofβ-blockers elevated from 39.8%to 45.8%,P=0.083 and ACEI/ARB from 33.6%to46.4%,P=0.001.Conclusion:From 2014 to 2019,reperfusion and effective secondary preventive drug therapy was improved for patients who arrived at the hospital within 2 hours of symptom onset in Zhangjiakou area,but there is still a gap with evidence-based medicine.Therefore,strengthen the clinician and the patients education and make them fully understand the important of reperfusion and secondary preventive drug therapy for STEMI in therapeutic and preventive effects.Meanwhile,establish policies to improve health care quality,make diagnosis and treatment of STEMI more scientific and reasonable.