Clinical outcomes of secondary prevention among patients with acute coronary syndromes in Tianjin city_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Xin , HE Xiaoning ,  WU Jing

School of Pharmacology Science and Technology, Tianjin University, Tianjin, 300072, P.R.China;

Corresponding?author：

WU Jing, Email: jingwu@tju.edu.cn

Keywords：

Acute coronary syndromes; Outcome; Major adverse cardiovascular events; Stroke; Myocardial infarction; Tianjin; Arban employee; Basic medical insurance database; Real world study

DOI：

10.7507/1672-2531.201807137

Video：

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Objectives To evaluate the clinical outcomes and identify its associated factors in patients with acute coronary syndromes (ACS) in Tianjin city. Methods Data were obtained from Tianjin urban employee basic medical insurance database. Adult patients who were discharged alive after the first ACS-related hospitalization (the index hospitalization) during January, 2012 to December, 2014 and without malignant tumor were included. Clinical outcomes were measured by subsequent major adverse cardiovascular events (MACE) including hospitalization for myocardial infarction (MI) or stroke, all-cause death, or their composite endpoint. Cox model was used to explore the factors associated with MACE. Results 22 041 patients were identified, in which 9.5% experienced MACE during follow-up with a mean number of 1.3 MACEs. 3.1% of patients had MI, 5.7% had stroke and 1.4% had all-cause death. Among patients who experienced MACEs, the average time from index discharge to the 1^st MACE was 143.2 days. Patients being older, male or had higher Charlson Comorbidity Index (CCI) were more likely to experience MACE. Patients who had prior stroke and prior all-cause hospitalization were also more likely to experience MACE, whereas patients who had prior angina, prior β-blockers utilization and received percutaneous coronary intervention (PCI) during index event were less likely to experience MACE. Conclusion Stroke is the most common type of MACE among ACS patients in Tianjin, China. Almost half of the 1^st MACE occur within the 3 months after ACS. Patients who are older, male, have higher CCI or have prior stroke are at higher risk of MACE.

Citation： LIU Xin, HE Xiaoning, WU Jing. Clinical outcomes of secondary prevention among patients with acute coronary syndromes in Tianjin city. Chinese Journal of Evidence-Based Medicine, 2018, 18(11): 1232-1238. doi: 10.7507/1672-2531.201807137 Copy

1.	Lee H, Doig CJ, Ghali WA, et al. Detailed cost analysis of care for survivors of severe sepsis. Crit Care Med, 2004, 32(4): 981-985.
2.	沈正, 李屏. 急性冠脈綜合征患者預后不良危險因素的病例對照研究. 中國衛生統計, 2017, 34(4): 635-636, 640.
3.	孫志軍, 李虹偉. 降鈣素原在急性冠脈綜合征和心源性休克中的預測價值研究進展. 中國全科醫學, 2013, 16(6): 598-600.
4.	柯元南, 陳紀林. 不穩定性心絞痛和非 ST 段抬高心肌梗死診斷與治療指南. 中華心血管病雜志, 2007, 35(4): 295-304.
5.	Smith JN, Negrelli JM, Manek MB, et al. Diagnosis and management of acute coronary syndrome: an evidence-based update. J Am Board Fam Med, 2015, 28(2): 283-293.
6.	張麗華. 系統護理干預在冠心病介入治療中的應用. 護理研究, 2015, 29(18): 2245-2246.
7.	Menzin J, Wygant G, Hauch O, et al. One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database. Curr Med Res Opin, 2008, 24(2): 461-468.
8.	Chiang FT, Shyu KG, Wu CJ, et al. Predictors of 1-year outcomes in the Taiwan acute coronary syndrome full spectrum registry. J Formos Med Assoc, 2014, 113(11): 794-802.
9.	Berenson K, Ogbonnaya A, Casciano R, et al. Economic consequences of ACS-related rehospitalizations in the US. Curr Med Res Opin, 2010, 26(2): 329-336.
10.	王炳華, 孫桂芳. 急性冠脈綜合征患者 PCI 術預后的多因素分析. 社區醫學雜志, 2015, 13(17): 19-21.
11.	丁美幸, 王棟梅. 急性冠脈綜合征患者經皮冠脈介入治療術后心臟不良事件的發生情況與影響因素分析. 護理實踐與研究, 2018, 15(6): 1-4.
12.	國家衛生和計劃生育委員會. 2011 年中國衛生統計年鑒. Availble at: http://www.moh.gov.cn/htmlfiles/zwgkzt/ptjnj/year2011/index2011.html.
13.	Korsnes JS, Davis KL, Ariely R, et al. Health care resource utilization and costs associated with nonfatal major adverse cardiovascular events. J Manag Care Spec Pharm, 2015, 21(6): 443-450.
14.	Kassaian SE, Masoudkabir F, Sezavar H, et al. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian project for assessment of coronary events 2(IPACE2). BMJ Open, 2015, 5(12): e007786.
15.	Rich JD, Cannon CP, Murphy SA, et al. Prior aspirin use and outcomes in acute coronary syndromes. J Am Coll Cardiol, 2010, 56(17): 1376-1385.
16.	Park HW, Yoon CH, Kang SH, et al. Early- and late-term clinical outcome and their predictors in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. Int J Cardiol, 2013, 169(4): 254-261.
17.	張潤華, 劉改芬, 潘岳松, 等. 世界卒中流行趨勢概況. 中國卒中雜志, 2014, 9(9): 767-773.
18.	陳偉偉, 高潤霖, 劉力生, 等. 《中國心血管病報告 2017》概要. 中國循環雜志, 2018, (1): 1-8.
19.	Vagnarelli F, Taglieri N, Ortolani P, et al. Long-term outcomes and causes of death after acute coronary syndrome in patients in the Bologna, Italy, area. Am J Cardiol, 2015, 115(2): 171-177.
20.	Yan AT, Tan M, Fitchett D, et al. One-year outcome of patients after acute coronary syndromes (from the Canadian acute coronary syndromes registry). Am J Cardiol, 2004, 94(1): 25-29.
21.	Segev A, Strauss BH, Tan M, et al. Predictors and 1-year outcome of major bleeding in patients with non-ST-elevation acute coronary syndromes: insights from the Canadian acute coronary syndrome registries. Am Heart J, 2005, 150(4): 690-694.
22.	Henderson RA, Jarvis C, Clayton T, et al. 10-Year mortality outcome of a routine invasive strategy versus a selective invasive strategy in non-ST-segment elevation acute coronary syndrome: the british heart foundation rita-3 randomized trial. J Am Coll Cardiol, 2015, 66(5): 511-520.
23.	Lador A, Hasdai D, Mager A, et al. Incidence and prognosis of pericarditis after ST-elevation myocardial infarction (from the acute coronary syndrome Israeli survey 2000 to 2013 registry database). Am J Cardiol, 2018, 121(6): 690-694.
24.	楊勇, 盧清玉, 劉庚, 等. 高齡急性冠狀動脈綜合征患者介入治療預后影響因素分析. 解放軍預防醫學雜志, 2017, 35(2): 131-133, 136.
25.	Fath-Ordoubadi F, Barac Y, Abergel E, et al. Gender impact on prognosis of acute coronary syndrome patients treated with drug-eluting stents. Am J Cardiol, 2012, 110(5): 636-642.
26.	高原, 惠寧, 雌激素, 等. 雌激素對女性心血管系統保護作用的研究. 中國婦產科臨床雜志, 2014, (1): 90-92.
27.	Roberts R, Rogers WJ, Mueller HS, et al. Immediate versus deferred beta-blockade following thrombolytic therapy in patients with acute myocardial infarction. results of the thrombolysis in myocardial infarction (TIMI) II-B Study. Circulation, 1991, 83(2): 422-437.
28.	Galasso G, De Servi S, Savonitto S, et al. Effect of an invasive strategy on outcome in patients≥75 years of age with non-ST-elevation acute coronary syndrome. Am J Cardiol, 2015, 115(5): 576-580.
29.	Kleopatra K, Muth K, Zahn R, et al. Effect of an invasive strategy on in-hospital outcome and one-year mortality in women with non-ST-elevation myocardial infarction. Int J Cardiol, 2011, 153(3): 291-295.
30.	劉浙波, 夏豪, 方釗, 等. 替格瑞洛對急性冠脈綜合征冠脈多支病變行 PCI 術治療效果的中期隨訪. 中國心血管病研究, 2016, 14(7): 627-631.
31.	Singh M, Rihal CS, Lennon RJ, et al. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes, 2011, 4(5): 496-502.

1. Lee H, Doig CJ, Ghali WA, et al. Detailed cost analysis of care for survivors of severe sepsis. Crit Care Med, 2004, 32(4): 981-985.
2. 沈正, 李屏. 急性冠脈綜合征患者預后不良危險因素的病例對照研究. 中國衛生統計, 2017, 34(4): 635-636, 640.
3. 孫志軍, 李虹偉. 降鈣素原在急性冠脈綜合征和心源性休克中的預測價值研究進展. 中國全科醫學, 2013, 16(6): 598-600.
4. 柯元南, 陳紀林. 不穩定性心絞痛和非 ST 段抬高心肌梗死診斷與治療指南. 中華心血管病雜志, 2007, 35(4): 295-304.
5. Smith JN, Negrelli JM, Manek MB, et al. Diagnosis and management of acute coronary syndrome: an evidence-based update. J Am Board Fam Med, 2015, 28(2): 283-293.
6. 張麗華. 系統護理干預在冠心病介入治療中的應用. 護理研究, 2015, 29(18): 2245-2246.
7. Menzin J, Wygant G, Hauch O, et al. One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database. Curr Med Res Opin, 2008, 24(2): 461-468.
8. Chiang FT, Shyu KG, Wu CJ, et al. Predictors of 1-year outcomes in the Taiwan acute coronary syndrome full spectrum registry. J Formos Med Assoc, 2014, 113(11): 794-802.
9. Berenson K, Ogbonnaya A, Casciano R, et al. Economic consequences of ACS-related rehospitalizations in the US. Curr Med Res Opin, 2010, 26(2): 329-336.
10. 王炳華, 孫桂芳. 急性冠脈綜合征患者 PCI 術預后的多因素分析. 社區醫學雜志, 2015, 13(17): 19-21.
11. 丁美幸, 王棟梅. 急性冠脈綜合征患者經皮冠脈介入治療術后心臟不良事件的發生情況與影響因素分析. 護理實踐與研究, 2018, 15(6): 1-4.
12. 國家衛生和計劃生育委員會. 2011 年中國衛生統計年鑒. Availble at: http://www.moh.gov.cn/htmlfiles/zwgkzt/ptjnj/year2011/index2011.html.
13. Korsnes JS, Davis KL, Ariely R, et al. Health care resource utilization and costs associated with nonfatal major adverse cardiovascular events. J Manag Care Spec Pharm, 2015, 21(6): 443-450.
14. Kassaian SE, Masoudkabir F, Sezavar H, et al. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian project for assessment of coronary events 2(IPACE2). BMJ Open, 2015, 5(12): e007786.
15. Rich JD, Cannon CP, Murphy SA, et al. Prior aspirin use and outcomes in acute coronary syndromes. J Am Coll Cardiol, 2010, 56(17): 1376-1385.
16. Park HW, Yoon CH, Kang SH, et al. Early- and late-term clinical outcome and their predictors in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. Int J Cardiol, 2013, 169(4): 254-261.
17. 張潤華, 劉改芬, 潘岳松, 等. 世界卒中流行趨勢概況. 中國卒中雜志, 2014, 9(9): 767-773.
18. 陳偉偉, 高潤霖, 劉力生, 等. 《中國心血管病報告 2017》概要. 中國循環雜志, 2018, (1): 1-8.
19. Vagnarelli F, Taglieri N, Ortolani P, et al. Long-term outcomes and causes of death after acute coronary syndrome in patients in the Bologna, Italy, area. Am J Cardiol, 2015, 115(2): 171-177.
20. Yan AT, Tan M, Fitchett D, et al. One-year outcome of patients after acute coronary syndromes (from the Canadian acute coronary syndromes registry). Am J Cardiol, 2004, 94(1): 25-29.
21. Segev A, Strauss BH, Tan M, et al. Predictors and 1-year outcome of major bleeding in patients with non-ST-elevation acute coronary syndromes: insights from the Canadian acute coronary syndrome registries. Am Heart J, 2005, 150(4): 690-694.
22. Henderson RA, Jarvis C, Clayton T, et al. 10-Year mortality outcome of a routine invasive strategy versus a selective invasive strategy in non-ST-segment elevation acute coronary syndrome: the british heart foundation rita-3 randomized trial. J Am Coll Cardiol, 2015, 66(5): 511-520.
23. Lador A, Hasdai D, Mager A, et al. Incidence and prognosis of pericarditis after ST-elevation myocardial infarction (from the acute coronary syndrome Israeli survey 2000 to 2013 registry database). Am J Cardiol, 2018, 121(6): 690-694.
24. 楊勇, 盧清玉, 劉庚, 等. 高齡急性冠狀動脈綜合征患者介入治療預后影響因素分析. 解放軍預防醫學雜志, 2017, 35(2): 131-133, 136.
25. Fath-Ordoubadi F, Barac Y, Abergel E, et al. Gender impact on prognosis of acute coronary syndrome patients treated with drug-eluting stents. Am J Cardiol, 2012, 110(5): 636-642.
26. 高原, 惠寧, 雌激素, 等. 雌激素對女性心血管系統保護作用的研究. 中國婦產科臨床雜志, 2014, (1): 90-92.
27. Roberts R, Rogers WJ, Mueller HS, et al. Immediate versus deferred beta-blockade following thrombolytic therapy in patients with acute myocardial infarction. results of the thrombolysis in myocardial infarction (TIMI) II-B Study. Circulation, 1991, 83(2): 422-437.
28. Galasso G, De Servi S, Savonitto S, et al. Effect of an invasive strategy on outcome in patients≥75 years of age with non-ST-elevation acute coronary syndrome. Am J Cardiol, 2015, 115(5): 576-580.
29. Kleopatra K, Muth K, Zahn R, et al. Effect of an invasive strategy on in-hospital outcome and one-year mortality in women with non-ST-elevation myocardial infarction. Int J Cardiol, 2011, 153(3): 291-295.
30. 劉浙波, 夏豪, 方釗, 等. 替格瑞洛對急性冠脈綜合征冠脈多支病變行 PCI 術治療效果的中期隨訪. 中國心血管病研究, 2016, 14(7): 627-631.
31. Singh M, Rihal CS, Lennon RJ, et al. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes, 2011, 4(5): 496-502.

Chinese Journal of Evidence-Based Medicine

Clinical outcomes of secondary prevention among patients with acute coronary syndromes in Tianjin city

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