Manabu Ogita1, Satoru Suwa2, Hideki Ebina2, Koichi Nakao3, Yukio Ozaki4, Kazuo Kimura5, Junya Ako6, Teruo Noguchi7, Satoshi Yasuda7, Kazuteru Fujimoto8, Yasuharu Nakama9, Takashi Morita10, Wataru Shimizu11, Yoshihiko Saito12, Atsushi Hirohata13, Yasuhiro Morita14, Teruo Inoue15, Atsunori Okamura16, Masaaki Uematsu17, Kazuhito Hirata18, Kengo Tanabe19, Yoshisato Shibata20, Mafumi Owa21, Seiji Hokimoto22, Hiroshi Funayama23, Nobuaki Kokubu24, Ken Kozuma25, Shiro Uemura26, Tetsuya Toubaru27, Keijiro Saku28, Shigeru Oshima29, Kunihiro Nishimura30, Yoshihiro Miyamoto30, Masaharu Ishihara31. 1. Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan. Electronic address: m-ogita@sa2.so-net.ne.jp. 2. Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan. 3. Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan. 4. Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan. 5. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 6. Department of Cardiovascular Medicine, Kitasato University, Sagamihara, Japan. 7. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. 8. Department of Cardiology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan. 9. Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan. 10. Division of Cardiology, Osaka General Medical Center, Osaka, Japan. 11. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. 12. First Department of Internal Medicine, Nara Medical University, Kashihara, Japan. 13. Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 14. Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan. 15. Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan. 16. Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan. 17. Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan. 18. Department of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan. 19. Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan. 20. Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan. 21. Department of Cardiovascular Medicine, Suwa Red Cross Hospital, Suwa, Japan. 22. Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan. 23. Department of Integrated Medicine, Saitama Medical Center Jichi Medical University, Saitama, Japan. 24. Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan. 25. Department of Cardiology, Teikyo University, Tokyo, Japan. 26. Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan. 27. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan. 28. Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan. 29. Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. 30. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan. 31. Division of Coronary Artery Disease, Hyogo College of Medicine, Nishinomiya, Japan.
Abstract
BACKGROUND: The association between patients with acute myocardial infarction (AMI) who present during off-hours and clinical outcomes has not been fully elucidated. METHODS: We investigated 3283 consecutive patients with AMI who were selected from a prospective, nationwide, multicenter registry (J-MINUET) database comprising 28 institutions in Japan between July 2012 and March 2014 to determine the current impact of off-hours presentation on in-hospital mortality among Japanese patients with AMI. RESULTS: Among the patients, 52% presented in off-hours. Baseline characteristics were comparable, although those who presented during off-hours were younger and had a higher incidence of ST-elevation myocardial infarction and advanced Killip Class. The time from symptom onset to presentation time was shorter in off-hour patients (120min, interquartile range 60 to 256 vs. 215min, interquartile range 90 to 610, p<0.0001). In contrast, 85% of patients underwent primary percutaneous coronary intervention (PCI) and door to balloon time was comparable between the groups (74min, interquartile range 52 to 113 vs. 75min, interquartile range 52 to 126, p=0.34). The rates of in-hospital mortality were comparable (6.2% vs 6.8%, p=0.39). Multivariate logistic regression analysis revealed that off-hours presentation was not significantly associated with in-hospital mortality [odds ratio (OR) 0.94; 95% CI, 0.68-1.30, p=0.70]. CONCLUSION: The clinical impact of presenting during off-hours or regular hours on AMI patients in Japan is comparable in contemporary practice. TRIAL REGISTRATION: UMIN Unique trial Number: UMIN000010037.
BACKGROUND: The association between patients with acute myocardial infarction (AMI) who present during off-hours and clinical outcomes has not been fully elucidated. METHODS: We investigated 3283 consecutive patients with AMI who were selected from a prospective, nationwide, multicenter registry (J-MINUET) database comprising 28 institutions in Japan between July 2012 and March 2014 to determine the current impact of off-hours presentation on in-hospital mortality among Japanese patients with AMI. RESULTS: Among the patients, 52% presented in off-hours. Baseline characteristics were comparable, although those who presented during off-hours were younger and had a higher incidence of ST-elevation myocardial infarction and advanced Killip Class. The time from symptom onset to presentation time was shorter in off-hour patients (120min, interquartile range 60 to 256 vs. 215min, interquartile range 90 to 610, p<0.0001). In contrast, 85% of patients underwent primary percutaneous coronary intervention (PCI) and door to balloon time was comparable between the groups (74min, interquartile range 52 to 113 vs. 75min, interquartile range 52 to 126, p=0.34). The rates of in-hospital mortality were comparable (6.2% vs 6.8%, p=0.39). Multivariate logistic regression analysis revealed that off-hours presentation was not significantly associated with in-hospital mortality [odds ratio (OR) 0.94; 95% CI, 0.68-1.30, p=0.70]. CONCLUSION: The clinical impact of presenting during off-hours or regular hours on AMI patients in Japan is comparable in contemporary practice. TRIAL REGISTRATION: UMIN Unique trial Number: UMIN000010037.