Clinical comparison of "normal-hours" vs "off-hours" percutaneous coronary interventions for ST-elevation myocardial
Paolo Ortolani1, Antonio Marzocchi, Cinzia Marrozzini
1Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. paortol@tin.it
Insights
Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) during off-hours is as effective as normal-hours PPCI. This finding applies to high-volume centers, showing equivalent mortality rates regardless of treatment timing.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Off-hours primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) has been associated with higher mortality.
- A recent evaluation is needed in contemporary STEMI populations treated at high-volume centers.
Purpose of the Study:
- To assess the clinical outcomes of off-hours versus normal-hours PPCI in STEMI patients.
- To determine if treatment timing impacts mortality in a dedicated STEMI network.
Main Methods:
- Analysis of 985 STEMI patients undergoing PPCI between 2003-2005.
- Comparison of in-hospital and 1-year mortality between normal-hours and off-hours PPCI groups.
- Evaluation of clinical and angiographic characteristics, including ischemic time and electrocardiogram-to-balloon time.
Main Results:
- Most patients (61.2%) received off-hours PPCI.
- Off-hours group had slightly longer median total ischemic time (199 vs 179 minutes; P=.052).
- No significant differences in mortality rates (in-hospital or 1-year) between normal-hours and off-hours PPCI groups were observed.
Conclusions:
- Off-hours PPCI is clinically equivalent to normal-hours PPCI in STEMI patients.
- This equivalence is demonstrated in a high-volume, dedicated STEMI treatment center.
- Frequent use of glycoprotein IIb/IIIa agents may contribute to equivalent outcomes.
Background:
High mortality rates were reported in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary interventions (PPCI) "off-hours." The objective of this study was to evaluate this issue in a more recent population of patients with STEMI treated with PPCI in a high-volume tertiary center specifically dedicated to STEMI treatment.
Methods And Results:
We analyzed in-hospital/1-year mortality among 985 consecutive patients with STEMI treated with PPCI between January 2003 and December 2005 in a high-volume (>1400 PCI/year) hub center in a STEMI provincial network organization during "normal-hours" (weekdays 08:00 am to 07:29 pm) and "off-hours" (weekdays 07:30 pm to 07:59 am and weekends). Most (61.2%) patients were treated during "off-hours". Clinical and angiographic characteristics of the "normal-hours" and "off-hours" groups were comparable (in both groups, glycoprotein IIb/IIIa were administered to approximately 80% patients). The off-hours group tended toward higher median (25th-75th percentiles) total ischemic time (199 [135-312] minutes vs 179 [126-285] minutes; P = .052). Median electrocardiogram-to-balloon time was less than 90 minutes in both groups. Despite 20 minutes longer median total ischemic time, patients who underwent PPCI during "off-hours" showed similar post-PPCI Thrombolysis In Myocardial Infarction 3 flow grade and mean left ventricular ejection fraction. No difference could be observed between the 2 groups in terms of in-hospital and 1-year mortality rates.
Conclusion:
This study provides evidence that the clinical effectiveness of "normal" and "off-hours" PPCI can be equivalent, at least when performed at a center specifically dedicated to STEMI treatment with frequent use of glycoprotein IIb/IIIa agents.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Acute Coronary Syndrome IV: Interprofessional Care