Assessment of Early Clopidogrel Therapy Use among Acute Myocardial Infarction Patients in Central-rural China in 2006 and 2011.

Objective To explore the application and influencing factors of early clopidogrel use in patients with acute myocardial infarction (AMI) in the central-rural region of China in 2006 and 2011. Methods A representative sample of patients in central-rural region of China admitted to hospital for AMI was created from a two-stage random sampling. In the first phase,a simple random-sampling procedure was used to identify participating hospitals. In the second stage,we selected patients admitted to each participating hospitals for AMI with a systematic sampling approach. Then we obtained clinical information via central medical record abstraction for each patient. For analysis of early clopidogrel therapy (within 24 hours of admission) status,we used multilevel Logistical regression models with the use of generalized estimating equations. Results We identified 1464 patients eligible for early clopidogrel therapy. From 2006 to 2011,the early application rate of clopidogrel increased significantly,from 3.98% to 48.72% (P<0.0001). Logistic regression analysis showed that patients with hypertension were more likely to receive early clopidogrel(OR=1.65,95% CI=1.21-2.26,P=0.001),smokers were associated with greater likelihood to receive early clopidogrel(OR=1.87,95% CI=1.19-2.95,P=0.007),and patients with chest discomfort during hospitalization indicated association with higher likelihood of early clopidogrel use within 24 hours of admission (OR=2.17,95% CI=1.35-3.49,P=0.001). Conclusions Early clopidogrel use in AMI patients has been improved from 2006 to 2011. However,tremendous gap still exists between guidelines and clinical practice. Quality improvement initiatives are in urgent need to support further improvements in early clopidogrel use for AMI patients.