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Background: China is experiencing increasing burden of acute myocardial infarction (AMI) in the face of limited medical resources. Hospital length of stay (LOS) is an important indicator of resource utilization. Methods: We used data from the Retrospective AMI Study within the China Patient-centered Evaluative Assessment of Cardiac Events, a nationally representative sample of patients hospitalized for AMI during 2001, 2006, and 2011. Hospital-level variation in risk-standardized LOS (RS-LOS) for AMI, accounting for differences in case mix and year, was examined with two-level generalized linear mixed models. A generalized estimating equation model was used to evaluate hospital characteristics associated with LOS. Absolute differences in RS-LOS and 95% confidence intervals were reported. Results: The weighted median and mean LOS were 13 and 14.6 days, respectively, in 2001 (n = 1,901), 11 and 12.6 days in 2006 (n = 3,553), and 11 and 11.9 days in 2011 (n = 7,252). There was substantial hospital level variation in RS-LOS across the 160 hospitals, ranging from 9.2 to 18.1 days. Hospitals in the Central regions had on average 1.6 days (p = 0.02) shorter RS-LOS than those in the Eastern regions. All other hospital characteristics relating to capacity for AMI treatment were not associated with LOS. Conclusions: Despite a marked decline over the past decade, the mean LOS for AMI in China in 2011 remained long compared with international standards. Inter-hospital variation is substantial even after adjusting for case mix. Further improvement of AMI care in Chinese hospitals is critical to further shorten LOS and reduce unnecessary hospital variation. [ABSTRACT FROM AUTHOR]

Aims: ST-segment elevation myocardial infarctions (STEMI) in China and other low- and middle-income countries outnumber non-ST-segment elevation myocardial infarctions (NSTEMI). We hypothesized that the STEMI predominance was associated with lower biomarker use and would vary with hospital characteristics., Methods and Results: We hypothesized that the STEMI predominance was associated with lower biomarker use and would vary with hospital characteristics. Using data from the nationally representative China PEACE-Retrospective AMI Study during 2001, 2006, and 2011, we compared hospital NSTEMI proportion across categories of use of any cardiac biomarker (CK, CK-MB, or troponin) and troponin, as well as across region, location, level, and teaching status. Among 15 416 acute myocardial infarction (AMI) patients, 14% had NSTEMI. NSTEMI patients were older, more likely female, and to have comorbidities. Median hospital NSTEMI proportion in each study year was similar across categories of any cardiac biomarker use, troponin, region, location, level, and teaching status. For instance, in 2011 the NSTEMI proportion at hospitals without troponin testing was 11.2% [inter quartile range (IQR) 4.4-16.7%], similar to those with ≥ 75% troponin use (13.0% [IQR 8.7-23.7%]) (P-value for difference 0.77). Analysed as continuous variables there was no relationship between hospital NSTEMI proportion and proportion biomarker use. With troponin use there was no relationship in 2001 and 2006, but a modest correlation in 2011 (R = 0.16, P = 0.043). Admissions for NSTEMI increased from 0.3/100 000 people in 2001 to 3.3/100 000 people in 2011 (P-value for trend < 0.001)., Conclusion: STEMI is the dominant presentation of AMI in China, but the proportion of NSTEMI is increasing. Biomarker use and hospital characteristics did not account for the low NSTEMI rate., Clinical Trial Registration: www.clinicaltrials.gov (NCT01624883)., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions please email: journals.permissions@oup.com.)

Background: Fibrinolytic therapy is the primary reperfusion strategy for ST-segment elevation myocardial infarction in China, and yet little is known about the quality of care regarding its use and whether it has changed over time. This issue is particularly important in hospitals without the capacity for cardiovascular intervention., Methods: Using a sequential cross-sectional study with two-stage random sampling in 2001, 2006, and 2011, we characterised the use, timing, type and dose of fibrinolytic therapy in a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to hospitals without the ability to perform percutaneous coronary intervention., Results: We identified 5306 patients; 2812 (53.0%) were admitted within 12 hours of symptom onset, of whom 2463 (87.6%) were ideal candidates for fibrinolytic therapy. The weighted proportion of ideal candidates receiving fibrinolytic therapy was 45.8% in 2001, 50.0% in 2006, and 53.0% in 2011 ( P trend =0.0042). There were no regional differences in fibrinolytic therapy use. Almost all ideal patients (95.1%) were treated after admission to the hospital rather than in the emergency department. Median admission to needle time was 35 minutes (interquartile range 10-82) in 2011, which did not improve from 2006. Underdosing was common. Urokinase, with little evidence of efficacy, was used in 90.2% of patients., Conclusions: Over the past decade in China, the potential benefits of fibrinolytic therapy were compromised by underuse, patient and hospital delays, underdosing and the predominant use of urokinase, an agent for which there is little clinical evidence. There are ample opportunities for improvement.