Primary percutaneous coronary intervention during on- vs off-hours in patients with ST-elevation myocardial
Zbigniew Siudak1, Tomasz Rakowski, Artur Dziewierz
12nd Department of Cardiology, University Hospital, Krakow, Poland.
Insights
Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is safe and effective during off-hours in experienced European centers. Outcomes and safety profiles are comparable to on-hours PPCI, ensuring timely treatment regardless of the time of day.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Primary percutaneous coronary intervention (PPCI) is the gold standard for ST-elevation myocardial infarction (STEMI).
- Concerns exist regarding the efficacy and safety of off-hours PPCI compared to on-hours procedures.
- Experienced centers with 24/7 cathlab facilities are crucial for optimal PPCI delivery.
Purpose of the Study:
- To evaluate the immediate and long-term outcomes of off-hours PPCI.
- To compare the safety and effectiveness of PPCI performed during off-hours versus on-hours.
- To analyze data from a contemporary European registry study.
Main Methods:
- Data collected from STEMI patients undergoing PPCI in European networks (Nov 2005 - Jan 2007).
- Patients categorized into 'on-hours' and 'off-hours' (including weekends) PPCI groups.
- Comparison of baseline demographics, pre-hospital treatments, PPCI complications, and mortality rates.
Main Results:
- 1,650 patients included; 61% received off-hours PPCI.
- No significant differences in baseline demographics between groups.
- Off-hours PPCI showed a shorter time from chest pain onset to STEMI diagnosis (p=0.007).
- PPCI complications were rare and similar in both groups; in-hospital mortality was comparable (3.4% on-hours vs. 4.3% off-hours).
Conclusions:
- Off-hours PPCI in high-volume, experienced European centers yields comparable outcomes and safety to on-hours PPCI.
- The time of day does not negatively impact PPCI effectiveness in specialized centers.
- This supports the provision of timely PPCI irrespective of working hours.
Background:
Primary percutaneous coronary intervention (PPCI) is regarded as the treatment of choice for ST elevation myocardial infarction (STEMI) patients. It has been emphasised that only experienced centres with round-the-clock cathlab facilities should perform PPCI. Some investigators have doubted whether PPCI performed during 'off-hours' is as effective and safe as that performed during regular hours. Papers supporting both possibilities have been published.
Aim:
To investigate whether off-hours PPCI is associated with impaired immediate and long-term outcomes based on a contemporary European registry study.
Methods:
Consecutive data on STEMI patients referred for PPCI in hospital STEMI networks between November 2005 and January 2007 was gathered. Patients were divided into two groups: PPCI performed during 'on-hours' and PPCI performed during 'off-hours (including Saturdays and Sundays)'.
Results:
Data from a total of 1,650 patients were collected in the EUROTRANSFER Registry. There were 1,005 patients in the off-hours group (61%) and 645 (39%) patients in the on-hours group. Patients in both groups did not differ in baseline demographics. Thrombolysis before admission to cathlab was more frequently administered to patients off-hours (4.1% vs 2.3%, p = 0.041). The PPCI complications were rare and occurred in similar frequency in the studied groups. Time from chest pain onset to diagnosis of STEMI was shorter in the off-hours group (173 ± 210 vs 183 ± 187, p = 0.007). In-hospital mortality was 3.4% in the on-hours group and 4.3% in the off-hours group (NS).
Conclusions:
The PPCI performed in high-volume, experienced invasive cardiology centres in Europe during off-hours is associated with a comparable outcome and safety profile as PPCI performed during regular working hours.
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