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Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation

Chinese Medical Journal 2024年第2期137卷 172-180页

作者： Jing Lin Deyong Long Chenxi Jiang Caihua Sang Ribo Tang Songnan Li Wei Wang Xueyuan Guo Man Ning Zhaoqing Sun Na Yang Yongchen Hao Jun Liu Jing Liu Xin Du Louise Morgan Gregg C.Fonarow Sidney C.Smith Jr Gregory Y.H.Lip Dong Zhao Jianzeng Dong Changsheng Ma on behalf of ccc-af investigators Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China National Clinical Research Center for Cardiovascular Diseases Beijing 100029 China Department of Epidemiology Beijing Anzhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China International Quality Improvement Department American Heart AssociationDallasTX 07076USA Division of Cardiology Geffen School of Medicine at University of CaliforniaLos Angeles CA 90024USA Division of Cardiology University of North CarolinaChapel HillNC 27599USA Department of Cardiology Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart&Chest HospitalLiverpool L143PEUK Department of Clinical Medicine Aalborg UniversityAalborg 9000Denmark 不详

Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(af).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with af in China.Methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(ccc-af)registry,guideline-recommended OAC use in eligible patients was assessed.Results:A total of 52,530 patients with non-valvular af were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed af and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed af population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;Pccc-af project,>70%of af patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the ccc-af project has made progress in stroke prevention in the Chinese af population.Registration:ClinicalTrials.gov,NCT02309398.

关键词： Atrial fibrillation Oral anti-coagulants OAC Stroke prevention Contraindication

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Association between stress hyperglycemia ratio and in-hospital outcomes:findings from the improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(ccc-ACS)Project

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Journal of Geriatric Cardiology 2024年第6期21卷 658-668页

作者： Wen-Jie WANG Ke-Xin WANG Jia-Long NIU Yi-Xuan LIU Hai-Long GE Hua SHEN On behalf of ccc-ACS investigators Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijingChina

BACKGROUND Stress hyperglycemia ratio(SHR)could provide accurate information on the acute status of hyperglycemia.The relationship between SHR and acute coronary syndrome(ACS)prognosis remains unclear.This study was conducted to identity the association between SHR and in-hospital outcomes in patients with ACS.METHODS A total of 12,010 patients were eventually enrolled in the study.The relationship between SHR and in-hospital major adverse cardiovascular events(MACEs)was then modeled by restricted cubic spline(RCS)curves,and all patients were divided into three groups according to the results.The multivariate logistic regression analysis was used to determine the associations between the SHR and in-hospital outcomes,described as odds ratios(ORs)and 95%confidence intervals(CIs).Subgroup analyses were also performed on different diseases.RESULTS The median age of this cohort was 63(54,71)years old,and 8942(74.5%)were male.Group 1 was defined as SHR1(n=5763).Compared with Group 2,Group 1(OR=1.891,95%CI:1.028-3.479,P<0.001)and Group 3(OR=1.868,95%CI:1.434-2.434,P<0.001)had higher risks of suffering from in-hospital MACEs.SHR was associated with higher risks of in-hospital MACEs in the subgroups of DM[OR=2.282,95%CI:1.477-3.524).CONCLUSIONS Both low and high SHR levels were independently associated with in-hospital MACEs.Young males with DM,hypertension,and decreased renal function had much higher risks of suffering from SHR-correlated MACEs.

关键词： acute cardiovascular finding

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Practice of reperfusion in patients with ST-segment elevation myocardial infarction in China:findings from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome project

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Chinese Medical Journal 2022年第23期135卷 2821-2828页

作者： Yiqian Yang Yongchen Hao Jun Liu Na Yang Danqing Hu Zhaoqing Sun Dong Zhao Jing Liu on behalf of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(ccc-ACS)investigators Department of Epidemiology Beijing An Zhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China 不详

Background:Reperfusion therapy is fundamental for ST-segment elevation myocardial infarction(STEMI).However,the details of contemporary practice and factors associated with reperfusion therapy in China are largely unknown.Therefore,this study aimed to explore reperfusion practice and its associated factors among hospitalized patients with STEMI in China.Methods:Patients with STEMI who were admitted to 159 tertiary hospitals from 30 provinces in China were included in the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome project from November 2014 to December 2019.The associations of the characteristics of patients and hospitals with reperfusion were examined using hierarchical logistic regression.The associations between therapies and in-hospital major adverse cardiovascular events were examined with a mixed effects Cox regression model.Results:Among the 59,447 patients,37,485(63.1%)underwent reperfusion,including 4556(7.7%)receiving fibrinolysis and 32,929(55.4%)receiving primary percutaneous coronary intervention(PCI).The reperfusion rate varied across geographical regions(48.0%–73.5%).The overall rate increased from 60.0%to 69.7%from 2014 to 2019,mainly due to an increase in primary PCI within 12 h of symptom onset.Timely PCI,but not fibrinolysis alone,was associated with a decreased risk of inhospital major adverse cardiovascular events compared with no reperfusion,with an adjusted hazard ratio(95%confidence interval)of 0.64(0.54,0.76)for primary PCI at<12 h,0.53(0.37,0.74)for primary PCI at 12 to 24 h,0.46(0.25,0.82)for the pharmaco-invasive strategy,and 0.79(0.54,1.15)for fibrinolysis alone.Conclusions:Nationwide quality improvement initiatives should be strengthened to increase the reperfusion rate and reduce inequality in China.Trial registration:www.ClinicalTrials.gov,NCT02306616。

关键词： Acute coronary syndrome Cardiovascular diseases China Fibrinolysis Percutaneous coronary intervention Quality improvement Reperfusion ST elevation myocardial infarction

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Thirty-day outcomes of in-hospital multi-vessel versus culpritonly revascularization strategy for ST-segment elevation myocardial infarction with multivessel coronary disease

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Journal of Geriatric Cardiology 2023年第7期20卷 485-494页

作者： Yu-Xi LI Bei-Ning WANG Fang-Fang FAN Yan ZHANG Jie JIANG Jian-Ping LI Ya-Ling HAN Yong Huo ccc investigators Department of Cardiology Peking University First HospitalBeijingChina Cardiovascular Research Institute and Department of Cardiology General Hospital of Northern Theater CommandShenyangLiaoningChina 不详

BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction(STEMI)and multivessel coronary artery disease.However,only a few single-center retrospective studies were performed on small Chinese cohorts.Our study aims to demonstrate the advantage of multivessel percutaneous intervention(PCI)strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population.METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(ccc-ACS)project,5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed.after 5:1 propensity score matching,3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included.The primary outcome was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of myocardial infarction,all-cause death,stent thrombosis,heart failure,and stroke.RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE(adjusted OR=0.75,95%CI:0.57-0.98,P=0.032)than culprit-only PCI and conferred no increased risk of allcause death,myocardial infarction,stent thrombosis,stroke,or bleeding.Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access(OR=0.34,95%CI:0.15-0.74)than with trans-radial access(OR=0.87,95%CI:0.66-1.16,P for interaction=0.017).CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.

关键词： infarction coronary myocardial

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中青年超高危ACS患者低密度脂蛋白胆固醇水平及降胆固醇药物使用现状

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中华心血管病杂志 2022年第12期50卷 1161-1168页

作者：刘军赵冬郝永臣杨娜孙兆庆刘静首都医科大学附属北京安贞医院北京市心肺血管疾病研究所临床与流行病研究中心北京100029

目的了解中国中青年超高危急性冠状动脉综合征(ACS)患者低密度脂蛋白胆固醇(LDL-C)水平及降胆固醇药物使用现状。方法本研究基于中华医学会心血管病学分会(CSC)和美国心脏协会(AHA)合作的中国心血管疾病医疗质量改善(ccc)项目。该项目... 详细信息

目的了解中国中青年超高危急性冠状动脉综合征(ACS)患者低密度脂蛋白胆固醇(LDL-C)水平及降胆固醇药物使用现状。方法本研究基于中华医学会心血管病学分会(CSC)和美国心脏协会(AHA)合作的中国心血管疾病医疗质量改善(ccc)项目。该项目在全国159家三级医院和82家二级医院连续入选ACS住院患者,系统收集患者临床相关信息。本研究纳入ccc项目2014年11月至2019年12月入选的中青年(年龄18~59岁)ACS住院患者,根据CSC《超高危动脉粥样硬化性心血管疾病患者血脂管理中国专家共识》超高危患者的界定标准,分析超高危ACS患者LDL-C平均水平及院前接受调脂治疗情况。结果研究共纳入42230例中青年ACS住院患者,年龄(50.4±6.9)岁,男性86.8%(36676/42230)。86.9%(36687/42230)的患者符合超高危标准。超高危ACS患者入院时LDL-C水平为(2.8±1.0)mmol/L,仅有5.3%(1948/36687)的患者达到1.4 mmol/L的目标值。超高危患者中,17.5%(6430/36687)的患者院前服用调脂药物,其中96.4%(6198/6430)的患者采用他汀单药治疗。接受他汀治疗的超高危患者中,9.9%(626/6323)的患者LDL-C<1.4 mmol/L。结论中青年ACS住院患者中绝大多数属于超高危,需要采用更低的LDL-C降脂治疗目标。超高危患者院前较少服用降胆固醇药物,大部分患者入院时LDL-C水平高于推荐的目标值且距目标值的差距较大。

关键词：急性冠状动脉综合征中青年超高危 LDL-C达标

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螺内酯与可乐定作为难治性高血压第4种治疗药物的比较:难治性高血压的最佳治疗随机研究

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中华高血压杂志 2018年第3期26卷 299-299页

作者： Krieger EM Drager LF Giorgi DMA Pereira AC Barreto-Filho JAS Nogueira AR Mill JG Lotufo PA Amodeo C Batista MC Bodanese LC Carvalho ACC Castro I Chaves H Costa EAS Feitosa GS Franco RJS Fuchs FD Guimarāes AC Jardim PC Machado CA Magalhāes ME Mion D Jr Nascimento RM Nobre F Nóbrega AC Ribeiro ALP Rodrigues-Sobrinho CR Sanjuliani af Teixeira MDCB Krieger JE ReHOT investigators 赵狄练桂丽

该研究旨在通过一个多中心随机试验对作为难治性高血压患者的第4种治疗药物的螺内酯与可乐定进行比较。采用药丸计数评估药物治疗依从性。难治性高血压患者（定义为包括1种利尿剂在内的3种药物治疗12周,诊室及动态血压监测血压仍未控制... 详细信息

该研究旨在通过一个多中心随机试验对作为难治性高血压患者的第4种治疗药物的螺内酯与可乐定进行比较。采用药丸计数评估药物治疗依从性。难治性高血压患者（定义为包括1种利尿剂在内的3种药物治疗12周,诊室及动态血压监测血压仍未控制）随机给予螺内酯（12.5～50 mg/d）或可乐定（0.1～0．3mg，2次／d）继续治疗12周。

关键词：难治性高血压随机研究治疗药物可乐定螺内酯最佳治疗药物治疗依从性多中心随机试验

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缺血性卒中/TIA患者抗栓药物的使用及影响因素分析:中国七城市门诊连续病例的横断面调查

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中国卒中杂志 2007年第4期2卷 301-307页

作者： PRESS-China协作组王拥军王伊龙吴敌赵性泉王春雪廖晓凌濮月华周永首都医科大学附属北京天坛医院首都医科大学

目的评估中国缺血性卒中(IS)或短暂性脑缺血发作(TIA)患者应用抗血栓药物(包括抗血小板药物和抗凝药物)的现况,并分析其影响因素。方法采用横断面研究方法,调查2006年7月1日至8月15日期间,中国主要城市二、三级医院神经内科门诊连续IS或... 详细信息

目的评估中国缺血性卒中(IS)或短暂性脑缺血发作(TIA)患者应用抗血栓药物(包括抗血小板药物和抗凝药物)的现况,并分析其影响因素。方法采用横断面研究方法,调查2006年7月1日至8月15日期间,中国主要城市二、三级医院神经内科门诊连续IS或TIA患者近期的抗血栓药物使用情况。22家医院参加调查,总计2384例卒中患者连续入选;有3家不符合中心入选标准被除外,最后19家医院的资料被采用,总计有2283例卒中患者的数据纳入分析中。结果2283例卒中患者中,使用阿司匹林者占71.9%,使用阿司匹林+氯吡格雷占4.2%,使用氯吡格雷者占7.3%,各种抗血小板药物合计例数占75.6%。伴心房颤动的81例卒中患者中,使用华发林者占17.3%。医疗保险[比值比(OR)1.473,95%可信区间(CI)1.088～1.994]、公费医疗(OR 1.632,95%CI 1.029～2.589)、月均收入≥500元以上(OR 2.136,95% CI 1.508～3.026)、高血压(OR 1.463,95% CI 1.159～1.847)和脂代谢紊乱(OR1.499,95% CI1.187～1.893)是卒中患者接受抗血小板药物的促进因素。患者年龄≥75岁(OR 0.701,95% CI 0.498～0.988)及改良的Rankin评分4～5分(OR 0.684,95% CI 0.486～0.965)是用药的阻碍因素。结论中国大城市二、三级医院IS和TIA患者的抗血栓治疗现状不容乐观,各类抗血栓药物应用的比例较低,为改善以上状况,亟待探索有效的改进模式,缩短临床实践与指南间的差距。

关键词：卒中抗栓治疗二级预防医疗服务

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