title: STEMI Outcomes in Guangzhou and Hong Kong: Two-Centre Retrospective Interregional Study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Chen
authors.affiliation: Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.affiliation: Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Huilin
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yunmei
authors.initials: Y
authors.lastname: Li
authors.affiliation: Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Junrong
authors.initials: J
authors.lastname: Mo
authors.affiliation: Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Peiyi
authors.initials: P
authors.lastname: Lin
authors.affiliation: Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Colin A
authors.initials: CA
authors.lastname: Graham
authors.affiliation: Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Rainer
mesh_terms: D000368:Aged; D002681:China; D005260:Female; D006723:Hong Kong; D006761:Hospitals; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D018579:Patient Selection; D015424:Reperfusion; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography