Changing strategies in the management of acute myocardial infarction in modern China
Chen Z., Jiang L.
Ischaemic heart disease (IHD) is a common condition in China, accounting for more than 700,000 deaths each year mainly due to acute myocardial infarction (MI). Currently there is no nationally representative registry in China to provide data about the epidemiology, clinical management and prognosis of patients with MI. The present review has used information from a few large nationwide randomised trials and some small regional registries to assess the patterns of management of MI in China. As in many other countries, the management of acute MI in China has undergone a significant transformation during recent decades, due chiefly to an evidence-based approach to cardiovascular medicine. Antiplatelet therapy is now routinely given to almost all patients admitted with acute MI, using not only aspirin but increasingly combining it with clopidogrel. The overall use of reperfusion therapy is also consistent with that reported in Western populations, even though primary PCI is much less frequently used and the type of fibrinolytic agents commonly used may be less optimal in terms of the achieved patency rate of the infarct related artery. Anticoagulant therapy and ACE inhibitors are also used routinely in hospital, with about three-quarters of patients receiving such treatments consistently across different types of hospitals or regions. The use of beta-blocker therapy for acute MI in China has conventionally involved oral agents with little use of initial intravenous regimens, and this approach seems adequate for most patients with acute MI given the findings of the large COMMIT/CCS-2 trial in China. As a result of improved treatments, the hospital mortality for acute MI has declined significantly since the early 1990s. Despite a significant improvement in the general care of MI, there is still substantial under-, over- and inappropriate treatment of many patients in China. Further improvements, especially with respect to long-term management after MI, will rely not only on better implementation of the many established cost-effective treatments but also on improvements in the medical care system and more active engagement of the medical profession to improve risk factor management, such as smoking cessation. © 2008 World Heart Federation.