Comparison of In‐Hospital Mortality and Length of Stay in Acute ST‐Segment‐Elevation Myocardial Infarction Among Urban Teaching Hospitals in China and the United States

Abstract

Background The aim of the study is to compare in‐hospital outcomes of acute ST‐segment‐elevation myocardial infarction (STEMI) between China and the United States. Methods and Results Urban teaching hospitals were queried for adult patients with a primary diagnosis of acute STEMI during 2007–2010. The primary outcome was in‐hospital mortality, and the secondary outcome was length of stay. Multivariable analyses adjusting for potential confounders were conducted for comparison between countries. Subgroup analysis was performed in acute STEMI patients receiving revascularization. In total, 32 228 patients in China and 76 117 patients in the United States were included. Overall in‐hospital mortality was 8.23% in China and 7.96% in the United States ( P <0.001). Multivariable analyses revealed that the 2 countries had similar overall in‐hospital mortality (odds ratio, 0.97; 95% CI , 0.87–1.09; P =0.59), whereas China had lower 3‐day mortality (odds ratio, 0.78; 95% CI , 0.70–0.89; P <0.001). In patients receiving primary percutaneous coronary interventions, Chinese hospitals had significant higher overall mortality (odds ratio, 2.39; 95% CI , 1.85–3.07; P <0.001) and 3‐day mortality (odds ratio, 2.39; 95% CI , 1.78–3.20; P <0.001). For total acute STEMI patients, acute STEMI patients receiving percutaneous coronary intervention and coronary artery bypass grafting, median length of stay in China and the United States were 10 versus 3, 9 versus 3, and 25 versus 9 days, respectively (all P <0.001). Conclusions Overall in‐hospital mortality in acute STEMI patients was comparable among urban teaching hospitals between China and the United States during 2007–2010. In addition, 3‐day mortality was lower in China. However, worse outcomes in patients undergoing early revascularization and longer length of stay in China need to be given more attention.