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STEMI Outcomes in Guangzhou and Hong Kong: Two-Centre Retrospective Interregional Study
Xiaohui Chen1, Min Li1, Huilin Jiang1,2
1Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Insights
Comparing healthcare systems in Hong Kong and Guangzhou, this study found no significant difference in one-year mortality for ST-elevation myocardial infarction (STEMI) patients despite varied treatments. Key predictors for mortality included older age and hyperglycemia.
Area of Science:
- Cardiology
- Healthcare Management
- Public Health
Background:
- Healthcare systems in Hong Kong (HK) and Guangzhou (GZ) exhibit significant organizational differences.
- Emergency department (ED) management and patient outcomes for ST-elevation myocardial infarction (STEMI) vary between these regions.
Purpose of the Study:
- To compare the management of STEMI patients in the emergency departments of two teaching hospitals in Guangzhou and Hong Kong.
- To analyze and compare one-year all-cause mortality rates for STEMI patients between these two distinct healthcare settings.
Main Methods:
- A retrospective observational study was conducted from January to December 2010.
- Data on STEMI patient treatments and one-year mortality were collected from Prince of Wales Hospital (PWH) in HK and the Second Affiliated Hospital of Guangzhou Medical University (AHGZMU) in GZ.
- One-year all-cause mortality served as the primary outcome measure.
Main Results:
- While clinical characteristics were similar, AHGZMU had lower proportions of males, hyperlipidemia, and Killip class I patients compared to PWH.
- Onset-to-door times were longer in AHGZMU (median 205 min) than in PWH (median 120 min).
- AHGZMU primarily used primary percutaneous coronary intervention (PPCI) (77%), while PWH used thrombolytic therapy (67%) alongside PPCI (24%). Standardized one-year mortality rates were comparable (AHGZMU: 18.7% vs. PWH: 18.2%).
- Independent predictors for one-year mortality included older age (>67 years) and hyperglycemia (>10 mmol/L).
Conclusions:
- No statistically significant difference was found in standardized one-year all-cause mortality between STEMI patients in the two hospitals, despite differing primary reperfusion strategies and door-to-treatment times.
- Older age (>67 years) and hyperglycemia (>10 mmol/L) were identified as independent predictors of one-year mortality.
- Factors predicting in-hospital Major Adverse Cardiovascular Events (MACE) included older age, anterior wall infarction, lower body weight, lower systolic blood pressure at ED, and hyperglycemia.
Background And Objectives:
Healthcare systems are organized very differently in Hong Kong (HK) and Guangzhou (GZ). This study compared managements of the emergency departments (ED) and one-year mortalities of ST-segment elevation myocardial infarction (STEMI) patients in two teaching hospitals in Guangzhou and Hong Kong.
Methods:
Retrospective observational study of STEMI mortalities and treatments in the Prince of Wales Hospital (PWH) and the Second Affiliated Hospital of Guangzhou Medical University (AHGZMU), was conducted between January and December 2010. The primary outcome was one-year all cause mortality.
Results:
Univariate analysis of 76 cases from PWH and 111 cases from AHGZMU showed similar clinical characteristics, except for lower proportions of males (74% vs 92%, P = 0.002), hyperlipidemia (5% vs 25%, P<0.001), and Killip class I (56% vs 91%; P<0.001) in AHGZMU. The onset-to-door time of STEMI patients in AHGZMU was longer than in PWH (median 205 min [(IQR: 95-432) vs 120 min (IQR: 55-225), P = 0.001]. In AHGZMU, 85 (77%) patients received primary percutaneous coronary intervention (PPCI) as the main reperfusion treatment, whereas 18 (24%) received PPCI and 51 (67%) patients received thrombolytic therapy in PWH. Overall the one-year mortality in AHGZMU was 20%, whilst in PWH it was 14% (P = 0.436). The standardized one-year all-cause mortality ratios for AHGZMU and PWH were comparable (18.7 vs. 18.2%, P = 0894). Independent predictors of one-year mortality included older age (>67 years) and hyperglycemia (>10 mmol/L). Aged over 65 years, presence of anterior wall infarct, body weight ≤65 kg, SBP <100 mmHg at ED and glucose level >10 mmol/L were the independent predictors of in-hospital MACE.
Conclusion:
There was no statistically significant difference between the standardized one-year all-cause mortalities of STEMI patients in the setting mainly using thrombolysis with shorter door-to-treatment time and the setting mainly using PCI with longer door-to-treatment time. Aged over 67 years and glucose level over 10 mmol/L were the independent predictors of one-year mortality. Older age, presence of anterior wall infarct, lower body weight, lower SBP at ED and hyperglycemia were the independent predictors of in-hospital MACE.
