MA Chang-Sheng Department of Cardiology, Beijing Anzhen Hospital,

Capital Medical University

The Status of Clinical Cardiovascular Research in China

China is Changing the World • GDP now ranks 2nd in the world • Factory of the world: “ made in China” • However, innovation and research work

is essentialyl from “made in China” to “made with China”

Clinical Practice of Cardiology in China • Clinical practice of cardiology is keeping pace

with leading countries in China . • All current techniques and strategies in

cardiology are adopted in China as well as developed countries.

0

301000

40,000

86000

050000

100000150000200000250000300000350000400000450000

2004 2009

Domestic Imported

111053

9000

0100020003000400050006000700080009000

10000

1998 2004 2009

Coronary Stents inserted AF ablation procedures

Clinical Practice of Cardiology in China

49.0%

39.0%

0.1%

7.0% 4.9%

warfarinaspirinclopidogreldual anti-PLTnone

Registry of Elderly AF pts. In Beijing AF Antigoaculant Therapy

Incidence of major complications of AF ablation procedures

1.02

0.180.32

0.02

1.51

0.24

0.55

0.02

0.63

0.21 0.21

00

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Tamponade Stroke PV stenosis Fistula

International centers China Anzhen

Registry data of Huang CX et al JACC,2009,53:1798 Ma CS.Unpublished data

49.0%

39.0%

0.1%

7.0% 4.9%

warfarinaspirinclopidogreldual anti-PLTnone

1.02

0.180.32

0.02

1.51

0.24

0.55

0.02

0.63

0.21 0.21

00

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Tamponade Stroke PV stenosis Fistula

International centers China Anzhen

Registry of Elderly AF pts. In Beijing AF Antigoaculant Therapy

49.0%

39.0%

0.1%

7.0% 4.9%

warfarinaspirinclopidogreldual anti-PLTnone

1.02

0.180.32

0.02

1.51

0.24

0.55

0.02

0.63

0.21 0.21

00

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Tamponade Stroke PV stenosis Fistula

International centers China Anzhen

What About Clinical Research？

• High quality clinical practice is only essential, but not sufficient for advanced clinical medicine.

• Still a big gap exists between large clinical resource and academic contribution, just like the long journey on Great Wall.

Search Criterion

• Original article with corresponding author in mainland China

• Clinical research: conducted directly at the epidemiology diagnosis and treatment of CVD in pts

• Exclusion � Basic research in vitro � Animal experiments � Molecular and cell research although using pts specimen

• Search in pubmed

Clinical Researches by Chinese Physicians Published on Leading CV Journals

31

21

1516

7

4

1

02468

1012141618

NEJMLancet

JAMABMJ

Circulation

JACCEHJ

StrokeDiabetes

Trend Over The Past Decade

3 3

10

2 2 2

5

3

5

8

10

6

0

2

4

6

8

10

12

19891990-2000

20012002

20032004

20052006

20072008

20092010

2011

Distribution of speciaties

22

10

7

42 3

1 10

5

10

15

20

25

RFs CAD EP AA HF VHD CHD PAH

Ditribution of Objectives

2321

5

1 00

5

10

15

20

25

Epidemiology

Therapy stategy

Diagnosis

New drug

Device innovation

Institutes of Correspnding Authors

13

5 4 3 3 2 2 2 102468

101214

Fuwai Hosp.

Anzhen Hosp.

Fujian Union Hosp.

PLA general Hosp.

Xijing Hosp.

China-Japan Friendship ...

CDCSIBS

0ther 18

Beijing 27

Shanghai 5

Jiangsu 2

Fujian 4

Shaanxi 3

Regional Distribution

Summary

• A sharp increase of research work published on leading CV journals by Chinese physician in the past decade, especially in the last 5 years

• CV research in China remains in a data-accumulated phase, and more innovative work is relatively scarce � Epidemiological studies covered the largest proportion � Research into clinical therapeutic strategy starts to

increase � Lack of drug & device innovation

Number of Clinical Trials Registered: All over the world

Clinicaltrials.gov

Number of Clinical Trials Registered: East Asia

421689 515 431

2507 2366

2855

2054

0500

10001500200025003000

Mainlan

d

Taiwan

Korea

Japa

n

2008 2011

Clinicaltrials.gov

• Clinical trials are increasing rapidly in all regions

• China(mainland) ranks 2nd in 2011 compared with 4th in 2008

Number of Clinical CV Trials Registed in China(Mainland)

CV, 805,32%

Other,1702,68%

Clinicaltrials.gov

369

129 115

5733

17 14 120

50

100

150

200

250

300

350

400

CAD

HTN

PAD

EP HF CHD

CM VHD

Unsolved Clinical Problems in Chinese Pts

• Epidemiological data of major CVDs and related conditions in China

• Drug safety and effectiveness in Chinese population

• Evidence of CVD management based on Chinese population

• Drug and device innovation with independent intellectual property rights

• CVD management model innovation

Registry of Eldly AF Pts in Beijing • Age ≥65y,FU every 3 mon • 2 cohorts matched by propensity scores

� Ablation: Consecutively enrolled in Anzhen hospital

� Conservatively treated: Convenience sampling in 6 hospitals

• Endpoints � Primary endpoints: Composite endpoint of total

mortality, stroke and peripherial embolism � Secondary endpoints: Major bleeding and QoL

Construction of AF cohort in Beijing

• Registry of 10,000 NVAF pts from 22 hospitals • FU≥6 mon • Aims at unsolved problems in Chinese AF pts

� Risk assessment scheme for thrombo-embolism � Optimal anticoagulant intensity � Safety and effectiveness of AADs � Comparation of AADs and catheter ablation � Strategy for CAF management

Thank you!