Effectiveness of a New Regional Network on STEMI Care in an Under-developed Area of Southwest China

Background ST-elevation myocardial infarction (STEMI) is life-threatening and need time-critical care. A new prefecture-wide STEMI Network was implemented in Chuxiong, Yunnan, China, the first reported STEMI network in underdeveloped area. How the Network impacted STEMI care in the prefecture has not previously been evaluated. The study aims to estimate the efficacy of the STEMI Network. Methods A longitudinal study including 5-years STEMI patients covering the pre-network, creation and post-network phase was conducted to assess the changes of STEMI care. Outcomes including timely presentation, reperfusion therapy, timely reperfusion, heart failure, inpatient mortality, length of hospital stay, in-hospital charge, and various intervals of ischemic time (total ischemic time, patient delay, system delay, diagnosis time, reperfusion delay, Z to N time, Z to W time) were compared among the three Network phases. Results A total of 1436 STEMI patients (380 in pre-network, 375 in creation and 681 in post-network phases) were included. Significantly increasing proportions of timely presentation (71.3%, 73.3%, 81.4%) and reperfusion (58.2%, 59.2%, 65.3%) were found over the 3 phases. Compared with pre-network patients, post-network patients had shorter medians of patient delay (193 vs. 215 minutes), total ischemic time (348 vs. 380 minutes) and system delay (152 vs. 174 minutes). A significant decreasing trend of heart failure was observed (11.1%, 8.8%, 7.0%) across network phases. After conditioning, post-network patients were more likely than pre-network patients to have timely presentation (OR=1.70 [1.26, 2.30]), receive reperfusion therapy (OR=1.33 [1.02, 1.73]), and have shorter patient delay (HR=1.23 [1.08,1.40]) and total ischemic time (HR=1.22 [1.03,1.44]), but were less likely to receive timely reperfusion (OR=0.55 [0.36, 0.84]), timely PCI (OR=0.55 [0.34, 0.86), and shorter Z to W time (HR=0.78 [0.65, 0.94). Conclusion Improvements of STEMI reperfusion care by the regional Network were evident in this under-developed area; however, timely reperfusion care still needs to be enhanced. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial It is a retrospective observational study. ### Funding Statement None. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: After receiving the ethical approval from the Chest Pain Centre of Chuxiong prefecture, Yunnan, China, and also from the Human Research Ethic Committee in the Prince of Songkhla University, Thailand, the STEMI registry system database was searched to access STEMI index cases. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Will individual participant data be available (including data dictionaries)? Yes. What data in particular will be shared? Individual participant data that underlie the results reported in this article, after de-identification (text, tables, figures, and appendices). What other documents will be available? Study Protocol, Statistical Analysis Plan, Informed Consent Form, Clinical Study Report, Analytic Code. When will data be available (start and end dates)? Beginning 6 months and ending 36 months following article publication. With whom? Investigators whose proposed use of the data has been approved by an independent review committee identified for this purpose. For what types of analyses? To achieve aims in the approved proposal, such as to compare with STEMI care in other region. By what mechanism will data be made available? Proposals should be directed to the responsible author, zhanglimei12131{at}sina.com. To gain access, data requestors will need to sign a data access agreement.