Time of day variation in door-to-balloon time for STEMI patients in Los Angeles County: does time of day make a
David M Shavelle1, Ling Zheng, Marcus Ottochian
1Division of Cardiovascular Medicine, University of Southern California, Los Angeles, 90033, USA. shavelle@usc.edu
Insights
Off-hour percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is common. While off-hour PCI had longer door-to-balloon times, clinical outcomes like mortality were similar to on-hour PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Primary percutaneous coronary intervention (PCI) is a critical treatment for ST-elevation myocardial infarction (STEMI).
- Timely treatment is crucial for optimal outcomes in STEMI patients.
- Existing research presents conflicting data on potential treatment delays associated with off-hours primary PCI.
Purpose of the Study:
- To evaluate treatment times and clinical outcomes for STEMI patients undergoing primary PCI.
- To compare outcomes between on-hour and off-hour PCI procedures in Los Angeles County.
Main Methods:
- A consecutive series of STEMI patients undergoing primary PCI from 2007-2009 were analyzed.
- Data were extracted from the Emergency Medical Services STEMI Receiving Center Database.
- Treatment times, length of stay, complications, and in-hospital mortality were compared between on-hour (8 am-5 pm) and off-hour (5 pm-8 am) PCI groups.
Main Results:
- Off-hour PCI accounted for 41% of cases.
- Door-to-balloon time was significantly longer for off-hour PCI (74 ± 35 min) compared to on-hour PCI (60 ± 26 min).
- Length of stay, vascular complications, TIMI 3 flow, and in-hospital mortality were similar between the on-hour and off-hour groups.
Conclusions:
- Off-hour primary PCI for STEMI is frequent in Los Angeles County.
- Despite longer door-to-balloon times, off-hour PCI demonstrated similar short-term clinical outcomes compared to on-hour PCI.
- Longer door-to-CL activation times contributed to the extended door-to-balloon times observed in off-hour PCI patients.
Objective:
Evaluate treatment times and clinical outcome in a consecutive series of ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) in Los Angeles County.
Background:
Primary PCI for STEMI is beneficial if performed in a timely manner. Conflicting data exist regarding potential treatment delays for primary PCI performed during off hours.
Methods:
The Emergency Medical Services STEMI Receiving Center Database was queried from 2007 to 2009 to identify patients with a pre-hospital ECG showing STEMI who underwent PCI. On-hour PCI (On-hour Group, n = 1324) was defined as PCI occurring from 8 am to 5 pm and off-hour PCI (Off-hour Group, n = 922) was defined as occurring from 5 pm to 8 am. Treatment times, length of stay, vascular complications, achievement of TIMI 3 flow and in-hospital mortality were evaluated.
Results:
Off-hours PCI occurred in 41% of patients. Medical contact to door time was similar in the Off-hour Group compared to the On-hour Group, 20.7 ± 14.6 versus 20.3 ± 12.3 min, respectively, P = 0.47. In patients with available data (n = 1366), the door-to-catheterization laboratory (CL) activation time was significantly shorter in the On-hour Group as compared to the Off-hour Group, -4.9 ± 11.9 versus -0.2 ± 27.5 min, respectively, P < 0.0001. Door-to-balloon time was significantly longer in the Off-hour Group compared to the On-hour Group, 74 ± 35 versus 60 ± 26 min respectively, P < 0.0001. Length of stay, vascular complications, final TIMI 3 flow and in-hospital mortality were similar between both groups.
Conclusions:
In STEMI patients receiving primary PCI in Los Angeles County, off-hour PCI was common. Short-term clinical outcomes were similar despite longer door-to-balloon time in patients receiving off-hour PCI. The longer door-to-balloon time in the off-hour PCI patients were partly explained by longer door-to-CL activation time.
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