BACKGROUND: A higher mortality rate for weekend myocardial infarction (MI) admissions has been reported and attributed to the lower availability of primary percutaneous coronary intervention (PCI) during off-hours. However, the data are conflicting and, furthermore, inapplicable to hospitals where primary PCI is invariably performed. METHODS: This study was conducted in a tertiary hospital where primary PCI is routinely performed in all patients with ST-elevation myocardial infarction (STEMI). Patients admitted during on-hours (Monday through Friday 7 am-7 pm) where compared to off-hours patients (including weekends). The primary endpoint of in-hospital mortality, cardiogenic shock and recurrent MI was examined. A second analysis that excluded STEMI transfers, in-hospital mortality and reperfusion times was examined. RESULTS: Between 2003 and 2007, 747 STEMI patients (46% on-hours vs. 56% off-hours) underwent primary PCI. Demographic characteristics were similar between on- and off-hours groups. However, off-hours STEMI admissions had significantly greater in-hospital mortality rates (8% vs. 3.7%; p = 0.01) and higher rates of cardiogenic shock (37% vs. 24%; p = 0.0001). Admission arrival time was an independent predictor of in-hospital mortality (hazard ratio [HR] 3.98, 95% confidence interval [CI] 1.10-14.38; p = 0.035). Longer door-to-balloon times (DTB) were observed during off-hours (134 vs. 109 minutes; p < 0.0001), even after excluding the transfer population (63 vs. 89 minutes; p < 0.0001). CONCLUSION: Higher rates of in-hospital mortality and cardiogenic shock may be expected in STEMI patients admitted during off-hours, even when primary PCI is performed. Longer DTB times during off-hours may partially explain our findings. Strategies to optimize reperfusion time during off-hours, including perhaps a 24/7 in-house "STEMI team" may be necessary.
BACKGROUND: A higher mortality rate for weekend myocardial infarction (MI) admissions has been reported and attributed to the lower availability of primary percutaneous coronary intervention (PCI) during off-hours. However, the data are conflicting and, furthermore, inapplicable to hospitals where primary PCI is invariably performed. METHODS: This study was conducted in a tertiary hospital where primary PCI is routinely performed in all patients with ST-elevation myocardial infarction (STEMI). Patients admitted during on-hours (Monday through Friday 7 am-7 pm) where compared to off-hours patients (including weekends). The primary endpoint of in-hospital mortality, cardiogenic shock and recurrent MI was examined. A second analysis that excluded STEMI transfers, in-hospital mortality and reperfusion times was examined. RESULTS: Between 2003 and 2007, 747 STEMI patients (46% on-hours vs. 56% off-hours) underwent primary PCI. Demographic characteristics were similar between on- and off-hours groups. However, off-hours STEMI admissions had significantly greater in-hospital mortality rates (8% vs. 3.7%; p = 0.01) and higher rates of cardiogenic shock (37% vs. 24%; p = 0.0001). Admission arrival time was an independent predictor of in-hospital mortality (hazard ratio [HR] 3.98, 95% confidence interval [CI] 1.10-14.38; p = 0.035). Longer door-to-balloon times (DTB) were observed during off-hours (134 vs. 109 minutes; p < 0.0001), even after excluding the transfer population (63 vs. 89 minutes; p < 0.0001). CONCLUSION: Higher rates of in-hospital mortality and cardiogenic shock may be expected in STEMI patients admitted during off-hours, even when primary PCI is performed. Longer DTB times during off-hours may partially explain our findings. Strategies to optimize reperfusion time during off-hours, including perhaps a 24/7 in-house "STEMI team" may be necessary.
Authors: Atsushi Sorita; Adil Ahmed; Stephanie R Starr; Kristine M Thompson; Darcy A Reed; Larry Prokop; Nilay D Shah; M Hassan Murad; Henry H Ting Journal: BMJ Date: 2014-01-21
Authors: Jawad A Al-Lawati; Ibrahim Al-Zakwani; Kadhim Sulaiman; Khalid Al-Habib; Jassim Al Suwaidi; Prashanth Panduranga; Alawi A Alsheikh-Ali; Wael Almahmeed; Husam Al Faleh; Shukri Al Saif; Ahmad Hersi; Nidal Asaad; Ahmed Al-Motarreb; Dimitri P Mikhailidis; Haitham Amin Journal: Open Cardiovasc Med J Date: 2012-09-07
Authors: Krishnaraj S Rathod; Daniel A Jones; Sean M Gallagher; Daniel I Bromage; Mark Whitbread; Andrew R Archbold; Ajay K Jain; Anthony Mathur; Andrew Wragg; Charles J Knight Journal: BMJ Open Date: 2013-06-28 Impact factor: 2.692