CCC Project- Acute Coronary Syndrome

• ClinicalTrials.gov Identifier: NCT02306616
• Recruitment Status: Completed
• First Posted: December 3, 2014
• Last Update Posted: January 27, 2021
• Sponsor: Beijing Institute of Heart, Lung and Blood Vessel Diseases
• Collaborators: American Heart Association; Chinese Society of Cardiology
• Information provided by (Responsible Party): Dong ZHAO, Beijing Institute of Heart, Lung and Blood Vessel Diseases

Tracking Information

• First Submitted Date: November 29, 2014
• First Posted Date: December 3, 2014
• Last Update Posted Date: January 27, 2021
• Study Start Date: November 2014
• Actual Primary Completion Date: December 2020 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: December 5, 2014)

The overall composite of 11 performance measures for ACS care [ Time Frame: Duration of hospital stay, an expected average of 1 week ]

Performance measures for ACS care including:

1. Proportion of patients received aspirin at arrival
2. Proportion of patients received fibrinolytic therapy within 30 mins (STEMI)
3. Proportion of patients received primary percutaneous coronary intervention within 90 mins (STEMI)
4. Proportion of patients received reperfusion therapy (STEMI)
5. Proportion of patients with aspirin prescribed at discharge
6. Proportion of patients with clopidogrel or other P2Y12 inhibitors prescribed at discharge
7. Proportion of patients with beta-blocker prescribed at discharge
8. Proportion of patients with statin prescribed at discharge
9. Proportion of patients received evaluation of left ventricular systolic function
10. Proportion of left ventricular systolic dysfunction patients with ACEI or ARB prescribed at discharge
11. Proportion of patients received smoking cessation advice/ counseling

Original Primary Outcome Measures (submitted: November 29, 2014)

Performance measures for ACS care [ Time Frame: One month ]

Performance measures for ACS care including:

1. Proportion of patients received aspirin at arrival
2. Proportion of patients received fibrinolytic therapy within 30 mins (STEMI)
3. Proportion of patients received primary percutaneous coronary intervention within 90 mins (STEMI)
4. Proportion of patients received reperfusion therapy (STEMI)
5. Proportion of patients with aspirin prescribed at discharge
6. Proportion of patients with clopidogrel or other P2Y12 inhibitors prescribed at discharge
7. Proportion of patients with beta-blocker prescribed at discharge
8. Proportion of patients with statin prescribed at discharge
9. Proportion of patients received evaluation of left ventricular systolic function
10. Proportion of left ventricular systolic dysfunction patients with ACEI or ARB prescribed at discharge
11. Proportion of patients received smoking cessation advice/ counseling

• Current Secondary Outcome Measures: Not Provided
• Original Secondary Outcome Measures: Not Provided
• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: CCC Project- Acute Coronary Syndrome
• Official Title: Improving Care for Cardiovascular Disease in China: A Collaborative Project of AHA and CSC (CCC Project) - Acute Coronary Syndrome
• Brief Summary: To develop and implement quality improvement programs for the treatment of acute coronary syndrome (ACS) in China based on the successful experience of the AHA-Get with the Guidelines program. This program will use data collection, analysis, feedback, and process improvement to extend the use of evidence-based guidelines throughout the healthcare system and improve patient care of acute coronary syndrome.
• Detailed Description: Not Provided
• Study Type: Observational
• Study Design: Observational Model: Case-Only; Time Perspective: Retrospective
• Target Follow-Up Duration: Not Provided
• Biospecimen: Not Provided
• Sampling Method: Non-Probability Sample
• Study Population: Hospitalized patients with acute coronary syndrome
• Condition: Acute Coronary Syndrome
• Intervention: Not Provided
• Study Groups/Cohorts: Not Provided

Publications *

• Hao Y, Liu J, Liu J, Smith SC Jr, Huo Y, Fonarow GC, Ma C, Ge J, Taubert KA, Morgan L, Guo Y, Zhang Q, Wang W, Zhao D; CCC-ACS Investigators. Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome. Am Heart J. 2016 Sep;179:107-15. doi: 10.1016/j.ahj.2016.06.005. Epub 2016 Jun 18.
• Yang Q, Wang Y, Liu J, Liu J, Hao Y, Smith SC Jr, Huo Y, Fonarow GC, Ma C, Ge J, Taubert KA, Morgan L, Guo Y, Wang W, Zhou Y, Zhao D; CCC-ACS Investigators. Invasive Management Strategies and Antithrombotic Treatments in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome in China: Findings From the Improving CCC Project (Care for Cardiovascular Disease in China). Circ Cardiovasc Interv. 2017 Jun;10(6):e004750. doi: 10.1161/CIRCINTERVENTIONS.116.004750.
• Zhao G, Zhou M, Ma C, Huo Y, Smith SC Jr, Fonarow GC, Ge J, Han Y, Liu J, Hao Y, Liu J, Wang X, Taubert KA, Morgan L, Zhao D, Nie S; CCC-ACS Investigators. In-Hospital Outcomes of Dual Loading Antiplatelet Therapy in Patients 75 Years and Older With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Findings From the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) Project. J Am Heart Assoc. 2018 Mar 30;7(7):e008100. doi: 10.1161/JAHA.117.008100.
• Zhou M, Liu J, Hao Y, Liu J, Huo Y, Smith SC Jr, Ge J, Ma C, Han Y, Fonarow GC, Taubert KA, Morgan L, Yang N, Xing Y, Zhao D; CCC-ACS Investigators. Prevalence and in-hospital outcomes of diabetes among patients with acute coronary syndrome in China: findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project. Cardiovasc Diabetol. 2018 Nov 27;17(1):147. doi: 10.1186/s12933-018-0793-x.
• Xing Y, Liu J, Hao Y, Liu J, Huo Y, Smith SC Jr, Ge J, Ma C, Han Y, Fonarow GC, Taubert KA, Morgan L, Yang N, Zhou M, Zhao D; CCC-ACS Investigators. Prehospital statin use and low-density lipoprotein cholesterol levels at admission in acute coronary syndrome patients with history of myocardial infarction or revascularization: Findings from the Improving Care for Cardiovascular Disease in China (CCC) project. Am Heart J. 2019 Jun;212:120-128. doi: 10.1016/j.ahj.2019.02.019. Epub 2019 Mar 13.
• Yang N, Liu J, Liu J, Hao Y, Huo Y, Smith SC Jr, Ge J, Ma C, Han Y, Fonarow GC, Taubert KA, Morgan L, Zhou M, Xing Y, Zhao D; CCC-ACS Investigators. Performance on management strategies with Class I Recommendation and A Level of Evidence among hospitalized patients with non-ST-segment elevation acute coronary syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. Am Heart J. 2019 Jun;212:80-90. doi: 10.1016/j.ahj.2019.02.012. Epub 2019 Mar 4.
• Hao Y, Liu J, Liu J, Yang N, Smith SC Jr, Huo Y, Fonarow GC, Ge J, Taubert KA, Morgan L, Zhou M, Xing Y, Ma CS, Han Y, Zhao D. Sex Differences in In-Hospital Management and Outcomes of Patients With Acute Coronary Syndrome. Circulation. 2019 Apr 9;139(15):1776-1785. doi: 10.1161/CIRCULATIONAHA.118.037655.
• Gong W, Yan Y, Wang X, Zheng W, Smith SC Jr, Fonarow GC, Morgan L, Liu J, Zhao D, Ma C, Han Y, Montalescot G, Nie S; CCC-ACS Investigators. Risk Factors for In-Hospital Cardiac Arrest in Patients With ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol. 2022 Nov 8;80(19):1788-1798. doi: 10.1016/j.jacc.2022.08.797.
• Wang Y, Yang N, Suo M, Liu X, Wang Z, Zhang X, Liu J, Zhao D, Wu X; CCC-ACS Investigators. In-hospital outcomes of Ticagrelor versus Clopidogrel in high bleeding risk patients with acute coronary syndrome: Findings from the CCC-ACS project. Thromb Res. 2022 Aug;216:43-51. doi: 10.1016/j.thromres.2022.04.004. Epub 2022 May 10.
• Xu S, Li Z, Yang T, Li L, Song X, Hao Y, Smith SC, Fonarow GC, Morgan L, Liu J, Liu J, Zhao D, Yang Q, Zhou X, Li Y. Association between Early Oral beta-Blocker Therapy and Risk for In-Hospital Major Bleeding after Percutaneous Coronary Intervention for Acute Coronary Syndrome: Findings from CCC-ACS Project. Eur Heart J Qual Care Clin Outcomes. 2022 Jun 17:qcac036. doi: 10.1093/ehjqcco/qcac036. Online ahead of print.
• Lin YW, Huang JL, Wei XB, Jiang M, Ran P, Li J, Qiu J, Zhong Q, Zhou YL, Chen JY, Yu DQ. Estimated glomerular filtration rate derived from different formulas and prognosis in acute coronary syndrome: Findings from the improving care for cardiovascular disease in China-acute coronary syndrome project. Am J Med Sci. 2022 Nov;364(5):565-574. doi: 10.1016/j.amjms.2021.10.034. Epub 2022 Jun 2.
• Yang JQ, Ran P, Li J, Zhong Q, Smith SC Jr, Wang Y, Fonarow GC, Qiu J, Morgan L, Wei XB, Chen XB, Huang JL, Hao YC, Zhou YL, Siu CW, Zhao D, Chen JY, Yu DQ. A Risk Stratification Scheme for In-Hospital Cardiogenic Shock in Patients With Acute Myocardial Infarction. Front Cardiovasc Med. 2022 Mar 4;9:793497. doi: 10.3389/fcvm.2022.793497. eCollection 2022.
• Zhou M, Zhang J, Liu J, Smith SC Jr, Ma C, Ge J, Huo Y, Fonarow GC, Liu J, Hao Y, Gao F, Sun Y, Morgan L, Yang N, Hu G, Zeng Y, Han Y, Zhao D; CCC-ACS Investigators. Proton Pump Inhibitors and In-Hospital Gastrointestinal Bleeding in Patients With Acute Coronary Syndrome Receiving Dual Antiplatelet Therapy. Mayo Clin Proc. 2022 Apr;97(4):682-692. doi: 10.1016/j.mayocp.2021.11.037. Epub 2022 Feb 12.
• Wang X, Zhao G, Zhou M, Ma C, Ge J, Huo Y, Smith SC Jr, Fonarow GC, Hao Y, Liu J, Morgan L, Gong W, Yan Y, Liu J, Zhao D, Han Y, Nie S. Trends in Bleeding Events Among Patients With Acute Coronary Syndrome in China, 2015 to 2019: Insights From the CCC-ACS Project. Front Cardiovasc Med. 2021 Dec 13;8:769165. doi: 10.3389/fcvm.2021.769165. eCollection 2021.
• Yang Q, Sun D, Pei C, Zeng Y, Wang Z, Li Z, Hao Y, Song X, Li Y, Liu G, Tang Y, Smith SC, Han Y, Huo Y, Ge J, Ma C, Fonarow GC, Morgan L, Liu J, Liu J, Zhou M, Zhao D, Zhou Y, Zhou X; CCC-ACS Investigators. LDL cholesterol levels and in-hospital bleeding in patients on high-intensity antithrombotic therapy: findings from the CCC-ACS project. Eur Heart J. 2021 Aug 31;42(33):3175-3186. doi: 10.1093/eurheartj/ehab418.
• Yang L, Ye N, Wang G, Bian W, Xu F, Zhao D, Liu J, Hao Y, Liu J, Yang N, Cheng H; CCC-ACS. The association between atrial fibrillation and in-hospital outcomes in chronic kidney disease patients with acute coronary syndrome: findings from the improving care for cardiovascular disease in China-acute coronary syndrome (CCC-ACS) project. BMC Cardiovasc Disord. 2021 Jul 17;21(1):345. doi: 10.1186/s12872-021-02125-z.
• Ran P, Yang JQ, Li J, Li G, Wang Y, Qiu J, Zhong Q, Wang Y, Wei XB, Huang JL, Siu CW, Zhou YL, Zhao D, Yu DQ, Chen JY. A risk score to predict in-hospital mortality in patients with acute coronary syndrome at early medical contact: results from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project. Ann Transl Med. 2021 Jan;9(2):167. doi: 10.21037/atm-21-31.
• Zhao X, Kang Y, Wang X, Yang X, Ai G, Liu Y, Xu P, Zhang J, Gu C, Zhang Y, Hao Y, Zhao D, Han Y; CCC investigators. Clinical significance of glycated hemoglobin in acute coronary syndrome patients from the CCC-ACS project : Findings from a multicenter retrospective observational study. Herz. 2021 Sep;46(Suppl 2):287-294. doi: 10.1007/s00059-020-04999-9. Epub 2020 Nov 24.
• Hu G, Zhou M, Liu J, Smith SC Jr, Ma C, Ge J, Huo Y, Fonarow GC, Hao Y, Liu J, Taubert KA, Morgan L, Yang N, Zeng Y, Han Y, Zhao D; CCC-ACS Investigators. Smoking and Provision of Smoking Cessation Interventions among Inpatients with Acute Coronary Syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project. Glob Heart. 2020 Oct 23;15(1):72. doi: 10.5334/gh.784.
• Ye N, Yang L, Wang G, Bian W, Xu F, Ma C, Zhao D, Liu J, Hao Y, Liu J, Yang N, Cheng H; CCC-ACS. Admission fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project. BMC Cardiovasc Disord. 2020 Aug 20;20(1):380. doi: 10.1186/s12872-020-01662-3. Erratum In: BMC Cardiovasc Disord. 2021 Jul 22;21(1):349.

Recruitment Information

• Recruitment Status: Completed
• Actual Enrollment (submitted: January 26, 2021): 124363
• Original Estimated Enrollment (submitted: November 29, 2014): 76500
• Actual Study Completion Date: December 2020
• Actual Primary Completion Date: December 2020 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

Hospitalized patients with discharge diagnosis as acute coronary syndrome (including STEMI, NSTEMI and UAP) in 150 tertiary and 100 secondary hospitals.

Exclusion Criteria:

None

Sex/Gender

• Sexes Eligible for Study: All

• Ages: Child, Adult, Older Adult
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: China

Administrative Information

• NCT Number: NCT02306616
• Other Study ID Numbers: CCC-ACS-2014
• Has Data Monitoring Committee: Not Provided
• U.S. FDA-regulated Product: Not Provided
• IPD Sharing Statement: Not Provided
• Current Responsible Party: Dong ZHAO, Beijing Institute of Heart, Lung and Blood Vessel Diseases
• Original Responsible Party: Same as current
• Current Study Sponsor: Beijing Institute of Heart, Lung and Blood Vessel Diseases
• Original Study Sponsor: Same as current

Collaborators

• American Heart Association
• Chinese Society of Cardiology

Investigators

• Principal Investigator: Dong Zhao, Ph. D; Beijing Institute of Heart, Lung and Blood Vessel Diseases

• PRS Account: Beijing Institute of Heart, Lung and Blood Vessel Diseases
• Verification Date: January 2021