Comparison of results of percutaneous coronary interventions in patients with ST-segment elevation myocardial
Grzegorz Słonka1, Mariusz Gasior, Andrzej Lekston
13rd Chair and Department of Cardiology. Silessian Medical University, Siilesian Centre for Heart Diseases, Zabrze, Poland. gslonka@poczta.onet.pl
Insights
Percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI) yield similar outcomes regardless of whether treatment occurs during the day or off-shift hours. Proper staffing of cardiac catheterization labs ensures comparable results for all STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Limited data exist on percutaneous coronary interventions (PCI) efficacy for ST-segment elevation myocardial infarction (STEMI) during off-shift hours.
- Some studies suggest potentially worse outcomes for STEMI patients treated during off-shift periods.
Purpose of the Study:
- To compare PCI outcomes in STEMI patients admitted during daytime versus off-shift hours.
- To identify prognostic factors influencing STEMI patient outcomes after PCI.
Main Methods:
- A retrospective analysis of 1778 STEMI patients undergoing immediate PCI from January 1998 to October 2003.
- Patients were divided into daytime (n=482) and off-shift (n=1296) groups.
- Clinical characteristics, procedural data, and outcomes were compared between groups.
Main Results:
- No significant differences were observed in time to angiography, reocclusion, stroke, haemorrhagic complications, or in-hospital/long-term mortality between daytime and off-shift groups.
- The rate of stent implantation was slightly higher in the daytime group (71.2% vs. 66.2%, p=0.047).
Conclusions:
- Around-the-clock onsite staffing of cardiac catheterization laboratories enables comparable PCI results for STEMI patients treated during off-shift hours as during the daytime.
- Effective organization of cardiology and catheterization laboratory duties is crucial for achieving similar outcomes.
Background:
Data on the efficacy of coronary angioplasty in patients with ST-segment elevation myocardial infarction (STEMI) treated during off-shift hours are limited, but some publications suggest a worse outcome in this group of patients.
Aim:
To compare the results of percutaneous coronary interventions (PCI) in STEMI patients admitted to hospital during the daytime and off-shift hours and to identify factors which influence prognosis.
Methods:
From January 1998 to October 2003, 1992 patients with STEMI were hospitalised and 1778 of them were treated with immediate PCI, including 482 admitted in the daytime (weekdays 8 a.m. - 3 p.m.; group I) and 1296 during off-shift hours (weekdays 3 p.m. - 8 a.m., weekends and holidays; group II). The clinical characteristics of both groups were similar, except for less frequent hypercholesterolaemia in the daytime group (52.1 vs. 59.7%; p=0.0041).
Results:
There was no significant difference between the groups regarding time from admission to angiography (30 vs. 25 minutes), rates of reocclusion (5.2 vs. 4.9%), stroke (1.4 vs. 1.6%), haemorrhagic complications (8.1 vs. 6.9%), in-hospital mortality (6.8 vs. 6.2%) and long-term (24 months) mortality (13.7 vs. 13.6%) (p >0.05 for all parameters). The rate of stent implantation was significantly higher in the daytime group (71.2 vs. 66.2%; p=0.047).
Conclusions:
The proper organisation of duties of the division of cardiology and the cardiac catheterisation laboratory, with focus on providing onsite staffing of the cardiac catheterisation laboratory around the clock, enables similar results of PCI in patients with ST-segment elevation myocardial infarction treated during off-shift hours as compared with patients treated during the daytime.
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