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Background: Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention (PPCI) for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China., Methods: Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records., Results: The median in-hospital delay was 98 (interquartile range 105 to 180) minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals (147 minutes vs. 120 minutes, P < 0.001; 55 minutes vs. 45 minutes, P = 0.035). After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays., Conclusions: There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.

Background: Cumulative evidence demonstrates that primary percutaneous coronary intervention (PCI) is a reperfusion strategy for ST-elevation myocardial infarction (STEMI). This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system, which offers patients a choice between seeking care in a small community hospital (SH group) or a large hospital (LH group)., Methods: Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms., Results: Among the 566 patients interviewed, 28.3% first arrived at a small community hospital and were transferred to large hospitals with the ability to perform primary PCI. The median total pre-hospital delay in the SH group (n = 160) was significantly longer than in the LH group (n = 406) (225 vs. 120 minutes, P < 0.001). Multivariate analysis showed that interpreting symptoms to non-cardiac origin (OR, 1.996; 95%CI: 1.264 - 3.155), absence of history of myocardial infarction (OR, 1.595; 95%CI: 1.086 - 3.347), non-health insurance coverage (OR, 1.931; 95%CI: 1.079 - 3.012) and absence of sense of impending doom (OR, 4.367; 95%CI: 1.279 - 14.925) were independent predictors for choosing small hospitals. After adjusting for demographics and medical history, patients in the SH group were 1.698 times (95%CI: 1.182 - 3.661) less likely to receive primary PCI compared with those in the LH group., Conclusions: Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer. Factors including symptoms interpretation, symptoms, history of myocardial infarction, and insurance coverage were associated with the patients' pre-hospital care-seeking pathway. The patients who were transferred had longer pre-hospital delays and were less likely to receive primary PCI.

Purpose: To assess clinical practices and in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) in Beijing, China., Methods: This study was a prospective multicentre registry study in Metropolitan Beijing, China. Demographics, delay time, management strategy and in-hospital outcome data were collected from patients with STEMI enrolled in 19 hospitals., Results: A total of 803 patients (mean age 61+/-13 yr ,22% women and 42.1% >or= 65 yr) with STEMI were enrolled. More than half had a history of hypertension (50.4%) and current smoking (55.2%). Six hundred and fifty patients (80.9%) received reperfusion therapy: 124 (15.4% ) treated with thrombolysis and 526 (65.5% ) with primary percutaneous coronary intervention (PCI). The median door-to-needle time for thrombolysis was 83 min and door-to-balloon time for primary PCI was 132 min. Only 7% of patients treated with thrombolysis met the guidelines goal of the door-to-needle time