Backgroud
Methods
Study design and setting
Inclusion and exclusion criteria
Measurements and data collection
Follow up
Sample size calculation
Outcomes
Statistical analyses
Results
Recruitment of patients from the two centers
Baseline characteristics and final diagnoses of chest pain patients
AHGZMU (n = 407) | PWH (n = 589) |
P
| |
---|---|---|---|
Age, years, mean (SD) | 66.6 (14.4) | 63.7 (14.6) | 0.002* |
Males, n (%) | 220 (54.1) | 325 (55.2) | 0.726 |
Past histories | |||
Smoker, n (%) | 69 (17.0) | 78 (13.2) | 0.105 |
Hypertension, n (%) | 245 (60.2) | 362 (60.9) | 0.688 |
Diabetes, n (%) | 79 (19.4) | 153 (26.0) | 0.016* |
Hyperlipidemia, n (%) | 92 (22.6) | 266 (45.2) | < 0.0001* |
Chronic heart failure, n (%) | 26 (6.4) | 62 (10.5) | 0.024* |
Family heart disease, n (%) | 72 (17.7) | 125 (21.2) | 0.169 |
Stroke, n (%) | 26 (6.4) | 72 (12.2) | 0.002* |
Peripheral arterial disease, n (%) | 6 (1.5) | 20 (3.4) | 0.062 |
NHYA classification | |||
NHYA class I, n (%) | 234 (57.5) | 401 (68.1) | 0.001* |
NHYA class II, n (%) | 118 (29.0) | 75 (12.7) | < 0.0001 |
NHYA class III, n (%) | 51 (12.5) | 108 (18.3) | 0.014* |
NHYA class IV, n (%) | 4 (1.0) | 5 (0.8) | 0.826 |
First ED characteristics | |||
Heart rate, bpm, mean (SD) | 88.4 (27.8) | 82.0 (19.1) | < 0.0001* |
Systolic blood pressure, mmHg, mean (SD) | 141.3 (30.1) | 148.7 (25.9) | 0.001* |
Diastolic blood pressure, mmHg, mean (SD) | 78.2 (17.0) | 80.1 (15.4) | 0.018 |
First lab results in ED | |||
Creatinine, μmoL/L, median (IQR) | 88.0 (71.0, 109.0) | 81.0 (66.0, 97.0) | < 0.0001* |
Troponin | |||
≤ 1× | 224 (78.9) | 420 (72.4) | < 0.0001* |
1×-2× | 21 (7.4) | 85 (14.7) | < 0.0001* |
2×-3× | 8 (2.8) | 22 (3.8) | 0.108 |
≥ 3× | 31 (10.9) | 53 (9.1) | 0.441 |
Number of CK done, n (%) | 399 (98.0) | 339 (57.6) | < 0.0001* |
Number of CK-MB done, n (%) | 399 (98.0) | 0 (0) | < 0.0001* |
ST segment depression, n (%) | 80 (8.0) | 19 (1.9) | < 0.0001* |
Onset- ED time,hour, median (IQR) | 4.03 (1.5–13.21) | 6.52 (2.01–23.27) | < 0.0001* |
ED-ECG time, hour, median (IQR) | 0.17 (0.03–0.47) | 0.18 (0.12–0.28) | 0.234 |
HEART Score, median (IQR) | 4 (3,6) | 4 (2,5) | < 0.0001* |
Number of admission | 231 (56.8) | 334 (56.7) | 0.987 |
Final diagnoses | |||
Ischemia coronary chest pain | 120 (29.5) | 163 (27.7) | 0.534 |
NSTEMI, n (%) | 40 (9.8) | 32 (5.4) | |
Unstable angina, n (%) | 65(16.0) | 71(12.1) | |
Stable angina, n (%) | 15 (3.7) | 60 (10.2) | |
Non-ischaemia cardiac chest pain, n (%) | 136 (33.4) | 84 (14.3) | < 0.0001* |
Non-cardiac chest pain, n (%) | 151 (37.1) | 342 (58.1) | < 0.0001* |
Comparison of clinical outcomes of chest pain patients in the two centres
30-day mortality in GZ (n = 407) | 30-day mortality in HK (n = 589) |
P
| 6-month mortality in GZ (n = 407) | 6-month mortality in HK (n = 589) |
P
| |
---|---|---|---|---|---|---|
Final diagnoses | ||||||
Ischemia coronary chest pain | 6 (1.5) | 0 (0) | 0.005* | 7 (1.7) | 2 (0.3) | 0.036* |
NSTEMI, n (%) | 4 (1.0) | 0 (0) | 5 (1.2) | 1 (0.2) | ||
Unstable angina, n (%) | 2 (0.5) | 0 (0) | 2 (0.5) | 0 (0) | ||
Stable angina, n (%) | 0 (0) | 0 (0) | 0 (0) | 1 (0.2) | ||
Non-ischaemia cardiac causes, n (%) | 4 (1.0) | 0 (0) | 0.28 | 5 (1.2) | 3 (0.5) | 0.283 |
Non-cardiac causes, n (%) | 5 (1.2) | 2 (0.3) | 0.129 | 7 (1.7) | 6 (1.0) | 0.339 |
Total | 15 (3.7) | 2 (0.3) | < 0.0001* | 19 (4.7) | 11 (1.9) | 0.011 |
Univariate and multivariate logistic regression for 30-day and 6-month mortality
Unadjusted Odds Ratio (95% CI) |
P
| Adjusted Odds Ratio (95% CI) |
P
| |
---|---|---|---|---|
Age, years | 1.069 (1.023–1.117) | 0.003* | 1.031 (0.977-1.089) | 0.262 |
Males (vs Females) | 2.008 (0.702–5.744) | 0.193 | ||
Past histories | ||||
Smoker (vs non smoker) | 2.256 (0.644–7.905) | 0.204 | ||
Hypertension (vs non hypertension) | 1.094 (0.413–2.899) | 0.857 | ||
Diabetes (vs non diabetes) | 0.702 (0.2–2.464) | 0.58 | ||
Hyperlipidemia (vs non hyperlipidemia) | ||||
CHF (vs non CHF) | 2.254 (0.635–7.998) | 0.209 | ||
FHD (vs non FHD) | 1.153 (0.328–4.053) | 0.824 | ||
Stroke (vs non stroke) | 0.568 (0.075–4.332) | 0.586 | ||
PAD (vs non PAD) | ||||
First ED characteristics | ||||
Heart rate | 1.003 (0.982–1.024) | 0.804 | ||
SBP | 0.980 (0.962–0.990) | 0.044* | 0.990 (0.963-1.089) | 0.486 |
DBP | 0.973 (0.942–1.005) | 0.1 | 1.02 (0.97–1.072) | 0.435 |
NHYA class III, IV (vs NHYA class I,II) | 3.557 (1.334–9.481) | 0.011* | 1.554 (0.405-5.972) | 0.521 |
Troponin Elevation ≥2× (vs < 2×) | 10.385 (1.228–87.874) | 0.032* | 2.471 (0.613-9.955) | 0.203 |
Creatinine elevation (vs normal) | 11.643 (3.947–34.347) | < 0.0001* | 9.189 (2.319-36.407) | 0.002* |
ST segment depression (vs normal) | 0.175 (0.061–0.5) | 0.001* | 1.026 (0.973-1.083) | 0.34 |
HEART Score | 1.622 (1.228–2.143) | 0.001* | 0.706 (0.404-1.231) | 0.22 |
Onset- ED time | 0.966 (0.919–1.015) | 0.172 | ||
ED-ECG time | 1 (1–1) | 0.949 |
Unadjusted Odds Ratio (95% CI) |
P
| Adjusted Odds Ratio (95% CI) |
P
| |
---|---|---|---|---|
Age, years | 1.074 (1.038–1.112) | < 0.0001* | 1.033 (0.98-1.088) | 0.233 |
Males (vs Females) | 0.508 (0.230–1.121) | 0.093 | 0.592 (0.17–2.053) | 0.592 |
Past histories | ||||
Smoker (vs non smoker) | 0.755 (0.332–1.715) | 0.502 | ||
Hypertension (vs non hypertension) | 1.291 (0.598–2.789) | 0.515 | ||
Diabetes (vs non diabetes) | 1.002 (0.425–2.367) | 0.996 | ||
Hyperlipidemia (vs non hyperlipidemia) | 0.191 (0.058–0.635) | 0.007* | 0.00 (0.00-0.00) | 0.996 |
CHF (vs non CHF) | 4.812 (2.132–10.861) | < 0.0001* | 3.454 (0.705-16.93) | 0.126 |
FHD, (vs non FHD) | 0.442 (0.133–1.473) | 0.184 | ||
Stroke (vs non stroke) | 1.019 (0.303–1.473) | 0.976 | ||
PAD (vs non PAD) | 1.298 (.170–9.909) | 0.801 | ||
First ED characteristics | ||||
Heart rate | 1.007 (0.993–1.022) | 0.318 | ||
SBP | 0.979 (0.965–0.993) | 0.004* | 0.974 (0.95-0.999) | 0.045* |
DBP | 0.977 (0.954-1.001) | 0.061 | 1.045 (0.998–1.094) | 0.114 |
NHYA class III, IV (vs NHYA class I,II) | 5.314 (2.545–11.095) | < 0.0001* | 2.519 (0.685-9.266) | 0.165 |
Troponin Elevation ≥ 2× (vs < 2×) | 8.04 (1.693–38.185) | 0.009* | 2.983 (0.494-18.01) | 0.233 |
Creatinine elevation (vs normal) | 11.137 (4.23–29.326) | < 0.0001* | 7.48 (2.042-27.369) | 0.002* |
ST segment depression (vs normal) | 4.190 (1.968–8.917) | < 0.0001* | 1.006 (0.954-1.061) | 0.815 |
HEART Score | 1.603 (1.310–2.027) | < 0.0001* | 0.81(0.487-1.349) | 0.418 |
Onset- ED time | 0.986 (0.964–1.008) | 0.216 | ||
ED-ECG time | 1.00 (1.000–1.000) | 0.922 |
Survival analysis in two hospitals
HR(95% CI) |
P
| Adjusted HR (95% CI) |
P
| |
---|---|---|---|---|
30-day all-cause mortality | ||||
GZ | 11.05 (2.53–48.32) | 0.001* | 8.98 (1.78-45.2) | 0.008* |
HK | Reference | Reference | ||
6-month all-cause mortality | ||||
GZ | 2.55 (1.22–5.37) | 0.013* | 1.77 (0.73-4.26) | 0.205 |
HK | Reference | Reference |