Invasive Management Strategies and Antithrombotic Treatments in Patients With Non–ST-Segment–Elevation Acute Coronary Syndrome in China: Findings From the Improving CCC Project (Care for Cardiovascular Disease in China)
From the Department of Epidemiology (Q.Y., Y.W., Jing Liu, Jun Liu, Y.H., Y.G., W.W., D.Z.) and Department of Cardiology (Q.Y., C.M., Y.Z.), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China; Department of Cardiology, University of North Carolina, Chapel Hill (S.C.S.); Department of Cardiology, Peking University First Hospital, China (Y.H.); Department of Cardiology, University of California, Los Angeles (G.C.F.); Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, China (J.G.); Department of International Science, American Heart Association, Basel, Switzerland (K.A.T.); and International Quality Improvement Department, American Heart Association, Dallas, TX (L.M.).
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Background—Early invasive strategies and antithrombotic treatments are key treatments of non–ST-segment–elevation acute coronary syndrome (NSTE-ACS). Few studies have examined the use of these strategies in patients with NSTE-ACS in China. This study aimed to assess the applications of invasive strategies and antithrombotic treatments in patients with NSTE-ACS and compare their outcomes.Methods and Results—A nationwide registry study, Improving CCC (Care for Cardiovascular Disease in China) ACS project, was launched in 2014 as a collaborative study of the American Heart Association and Chinese Society of Cardiology (CSC), with 142 participating hospitals reporting details of clinical management and outcomes of patients with NSTE-ACS. The use of invasive strategies and antithrombotic treatments was examined based on updated guidelines. Major adverse cardiovascular events were analyzed. A total of 9953 patients with NSTE-ACS were enrolled. Angiography was performed in 63.1% of these patients, and 58.2% underwent percutaneous coronary intervention (PCI). However, 40.6% of patients did not undergo early risk assessment, and very-high-risk patients had the lowest proportion of PCI (41.7%). PCI was performed within recommended times in 11.1% of very-high-risk patients and 26.3% of high risk patients. Those who underwent PCI within 2 hours had higher mortality in high-risk and very-high-risk patients who received PCI. Early dual antiplatelet treatment was given in 88.3% of patients.Conclusions—There are notable differences between guideline recommendations and the clinical management of patients with NSTE-ACS in China. The reasons for very-high-risk NSTE-ACS patients not undergoing PCI, and the optimal timing of PCI, require further clarification.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616.