Clinical Pathway for Acute Coronary Syndrome in China Phase 3 (CPACS-3)

CPACS-3 aims to develop and evaluate interventions for improving the management of patients with Acute Coronary Syndrome (ACS) in remote county hospitals with limited resources. 


The CPACS-3 study was a multi-centre cluster, randomised trial that was carried out in 101 county hospitals from 15 provinces of China. All centres received quality of care improvements (QCI). These included: establishment of a QCI team, implementation of clinical pathways, hospital performance audit and feedback, technical training for medical staff, online technical support and patient education. 

All adult patients admitted from the outpatient or emergency department with ACS were eligible for the study. Patient’s medical history/medical condition, physical examination, in-hospital treatment and discharge status were collected. The study analysed in-hospital major adverse cardiac effects (MACE), including all-cause mortality, myocardial infarction, or recurrent myocardial infarction and nonfatal stroke. Secondary outcomes of the study included the measurement of key performance indicators (KPIs).

The study was a Ministry of Health project while TGI, China and Chinese Society of Cardiology jointly provided technical support. TGI, China was the study coordinating centre.