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. 急性冠脉综合征患者预后不良危险因素的病例对照研究. 中国卫生统计, 2017, 34(4): 635-636, 640.
3.	孙志军, 李虹伟. 降钙素原在急性冠脉综合征和心源性休克中的预测价值研究进展. 中国全科医学, 2013, 16(6): 598-600.
4.	柯元南, 陈纪林. 不稳定性心绞痛和非 ST 段抬高心肌梗死诊断与治疗指南. 中华心血管病杂志, 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.	张丽华. 系统护理干预在冠心病介入治疗中的应用. 护理研究, 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.	王炳华, 孙桂芳. 急性冠脉综合征患者 PCI 术预后的多因素分析. 社区医学杂志, 2015, 13(17): 19-21.
11.	丁美幸, 王栋梅. 急性冠脉综合征患者经皮冠脉介入治疗术后心脏不良事件的发生情况与影响因素分析. 护理实践与研究, 2018, 15(6): 1-4.
12.	国家卫生和计划生育委员会. 2011 年中国卫生统计年鉴. 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.	张润华, 刘改芬, 潘岳松, 等. 世界卒中流行趋势概况. 中国卒中杂志, 2014, 9(9): 767-773.
18.	陈伟伟, 高润霖, 刘力生, 等. 《中国心血管病报告 2017》概要. 中国循环杂志, 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.	杨勇, 卢清玉, 刘庚, 等. 高龄急性冠状动脉综合征患者介入治疗预后影响因素分析. 解放军预防医学杂志, 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, 惠宁, 雌激素, 等. 雌激素对女性心血管系统保护作用的研究. 中国妇产科临床杂志, 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.	刘浙波, 夏豪, 方钊, 等. 替格瑞洛对急性冠脉综合征冠脉多支病变行 PCI 术治疗效果的中期随访. 中国心血管病研究, 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. 急性冠脉综合征患者预后不良危险因素的病例对照研究. 中国卫生统计, 2017, 34(4): 635-636, 640.
3. 孙志军, 李虹伟. 降钙素原在急性冠脉综合征和心源性休克中的预测价值研究进展. 中国全科医学, 2013, 16(6): 598-600.
4. 柯元南, 陈纪林. 不稳定性心绞痛和非 ST 段抬高心肌梗死诊断与治疗指南. 中华心血管病杂志, 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. 张丽华. 系统护理干预在冠心病介入治疗中的应用. 护理研究, 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. 王炳华, 孙桂芳. 急性冠脉综合征患者 PCI 术预后的多因素分析. 社区医学杂志, 2015, 13(17): 19-21.
11. 丁美幸, 王栋梅. 急性冠脉综合征患者经皮冠脉介入治疗术后心脏不良事件的发生情况与影响因素分析. 护理实践与研究, 2018, 15(6): 1-4.
12. 国家卫生和计划生育委员会. 2011 年中国卫生统计年鉴. 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. 张润华, 刘改芬, 潘岳松, 等. 世界卒中流行趋势概况. 中国卒中杂志, 2014, 9(9): 767-773.
18. 陈伟伟, 高润霖, 刘力生, 等. 《中国心血管病报告 2017》概要. 中国循环杂志, 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. 杨勇, 卢清玉, 刘庚, 等. 高龄急性冠状动脉综合征患者介入治疗预后影响因素分析. 解放军预防医学杂志, 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, 惠宁, 雌激素, 等. 雌激素对女性心血管系统保护作用的研究. 中国妇产科临床杂志, 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. 刘浙波, 夏豪, 方钊, 等. 替格瑞洛对急性冠脉综合征冠脉多支病变行 PCI 术治疗效果的中期随访. 中国心血管病研究, 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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