Two-year survival of patients with ST-segment elevation myocardial infarction according to reperfusion strategies in China - Insights from the China Acute Myocardial Infarction (CAMI) Registry

Sep 29, 2026

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Contemporary guidance supports primary percutaneous coronary intervention (PPCI) as the preferred reperfusion option for ST-segment elevation myocardial infarction (STEMI) within 12 hours, yet real-world delivery is constrained in China by limited catheterization capacity and scarce coronary intervention resources, especially in rural settings. Fibrinolysis remains common in county-level hospitals, while many patients receive no evidence-based reperfusion. Using the China Acute Myocardial Infarction (CAMI) Registry, the study compares two-year outcomes and major adverse cardiovascular and cerebrovascular events among PPCI, fibrinolysis, and no reperfusion groups.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Correspondence

Clinical background and rationale for comparing reperfusion pathways

CAMI Registry study design and patient enrollment

Endpoints and follow-up approach

Ethics, authorship note, and correspondence information

Correspondence Two-year survival of patients with ST-segment elevation myocardial infarction according to reperfusion strategies in China: Insights from the China Acute Myocardial Infarction (CAMI) Registry Xiaojin Gao1, Mengyuan Liu2, Sidong Li3,4, Shuhong Su5, Haiyan Xu1, Ying Xian6, Yuan Wu1, Jun Zhang1, Lei Song1, Yongjian Wu1, Shubin Qiao1, Fenghuan Hu1, Xuan Zhang1, Yunqing Ye1, Rui Fu1, Qiuting Dong1, Hui Sun1, Xinxin Yan1, Wei Li1, Yang Wang1, Wei Zhao1, Chen Jin1, Jingang Yang7, Yuejin Yang1; for the China Acute Myocardial Infarction Registry Investigators 1Coronary Heart Disease Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; 2Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; 3Medical Research Biometric Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; 4Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230027, China; 5Xinxiang Central Hospital, Xinxiang, Henan 453000, China; 6Departments of Neurology and Population and Data Science, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA; 7Health Education Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. To the Editor: Contemporary guidelines recommend primary percutaneous coronary intervention (PPCI) asthe gold-standard reperfusion modality in patients with ST-segment elevation myocardial infarction (STEMI) within 12 h of symptom onset. [1] However, in realworld clinical practice, the implementation of PPCI faces substantial operational challenges, particularly in resource-limited settings, such as inadequate availability of specialized cardiac catheterization teams with requisite procedural expertise or the complete absence of coronary intervention capabilities in numerous rural healthcare facilities across China. [2] Consequently, fibrinolytic therapy remains the predominant reperfusion strategy for STEMI management in county-level hospitals, with particularly high utilization rates observed in geographically remote regions. [3,4] Furthermore, our previous study revealed that 42.5% of STEMI patients fail to receive any form of evidence-based reperfusion therapy, representing a critical gap in optimal care delivery. [3] To elucidate the prognostic implications of these treatment pathways within China’s unique healthcare system, this study aimed to compare the long-term outcomes among STEMI patients receiving PPCI, fibrinolysis, and no reperfusion therapy using data from the China Acute Myocardial Infarction Registry (CAMI Registry, [clinicaltrials.gov](clinicaltrials.gov), NCT01874691). | Access this article online | | | --- | --- | | Quick Response Code: | Website:
[www.cmj.org](www.cmj.org) | | | DOI:
10.1097/CM9.0000000000003836 | The CAMI Registry is a prospective, nationwide, multicenter observational registry study for patients with acute myocardial infarction (AMI) from 108 hospitals across 31 provinces and municipalities in China. Detail of the CAMI Registry was described previously. [3] From January 1, 2013, to September 30, 2014, 19,085 STEMI patients who were admitted within 7 days from symptom onset were consecutively enrolled [Supplementary Figure 1, [http://links.lww.com/CM9/C630](http://links.lww.com/CM9/C630)]. Standardized data collected during hospitalization and f

FAQs

Why does the study focus on reperfusion strategies for STEMI in China?

It addresses operational challenges in implementing PPCI within 12 hours, especially where catheterization teams and coronary intervention capabilities are limited. This leads to higher reliance on fibrinolysis and a substantial proportion of patients receiving no evidence-based reperfusion.

What data source does the study use to evaluate long-term outcomes?

The China Acute Myocardial Infarction (CAMI) Registry, a prospective, nationwide, multicenter observational registry enrolling STEMI patients from 108 hospitals across 31 provinces and municipalities in China.

How are survival and adverse events assessed over two years?

The primary endpoint is 2-year all-cause mortality, and secondary endpoints include major adverse cardiovascular and cerebrovascular events. Follow-up information is collected via clinic visits, telephone calls, and verification through national registered residence records when contact is not possible.

Sep 29, 2026

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