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Eur Heart J Acute Cardiovasc Care. 2017 Apr;6(3):232-243. doi: 10.1177/2048872615626656. Epub 2016 Jan 19.

Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011: China PEACE-retrospective AMI study.

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1 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People's Republic of China.
2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.
3 Section of General Internal Medicine, Yale School of Medicine, USA.
4 The Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, USA.
5 Department of Health Policy and Management, Yale School of Public Health, USA.
6 Section of Cardiovascular Medicine, Yale School of Medicine, USA.
7 Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, USA.
8 Division of Cardiology, University of Colorado Anschutz Medical Campus, USA.
9 Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, USA.



Fibrinolytic therapy is the primary reperfusion strategy for ST-segment elevation myocardial infarction in China, and yet little is known about the quality of care regarding its use and whether it has changed over time. This issue is particularly important in hospitals without the capacity for cardiovascular intervention.


Using a sequential cross-sectional study with two-stage random sampling in 2001, 2006, and 2011, we characterised the use, timing, type and dose of fibrinolytic therapy in a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to hospitals without the ability to perform percutaneous coronary intervention.


We identified 5306 patients; 2812 (53.0%) were admitted within 12 hours of symptom onset, of whom 2463 (87.6%) were ideal candidates for fibrinolytic therapy. The weighted proportion of ideal candidates receiving fibrinolytic therapy was 45.8% in 2001, 50.0% in 2006, and 53.0% in 2011 ( Ptrend=0.0042). There were no regional differences in fibrinolytic therapy use. Almost all ideal patients (95.1%) were treated after admission to the hospital rather than in the emergency department. Median admission to needle time was 35 minutes (interquartile range 10-82) in 2011, which did not improve from 2006. Underdosing was common. Urokinase, with little evidence of efficacy, was used in 90.2% of patients.


Over the past decade in China, the potential benefits of fibrinolytic therapy were compromised by underuse, patient and hospital delays, underdosing and the predominant use of urokinase, an agent for which there is little clinical evidence. There are ample opportunities for improvement.


Fibrinolytic therapy; ST-segment elevation myocardial infarction; quality of care

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