Reassessing After-Hour Arrival Patterns and Outcomes in ST-Elevation Myocardial Infarction
James Langabeer1, Diaa Alqusairi2, Jami L DelliFraine3
1University of Texas Health Science Center, Houston, Texas.
The Western Journal of Emergency Medicine
|May 20, 2015
Summary
Patients arriving at ST-elevation myocardial infarction (STEMI) centers on weekends or after hours experience longer door-to-balloon times and increased in-hospital mortality, indicating persistent disparities in STEMI treatment.
Area of Science:
- Cardiology
- Health Services Research
Background:
- ST-elevation myocardial infarction (STEMI) center performance may vary outside of regular hours.
- After-hours capability can potentially impact patient outcomes for STEMI cases.
Purpose of the Study:
- To investigate the impact of weekend vs. weekday and business vs. after-hours presentation on door-to-balloon (D2B) times and in-hospital mortality for STEMI patients.
- To identify disparities in STEMI treatment during non-standard hours.
Main Methods:
- Prospective observational study of 1,247 non-transfer STEMI patients.
- Analysis of data from 15 percutaneous coronary intervention (PCI) facilities in Dallas, Texas (2010-2012).
- Statistical control for confounding factors to compare D2B times and mortality based on presentation timing (weekends/after-hours vs. weekdays/business hours).
Main Results:
- Patients presenting on weekends had significantly longer D2B times (75 vs. 65 minutes) compared to weekdays.
- After-hours arrivals experienced median D2B times over 16 minutes longer than business-hour arrivals.
- After-hours presentation was associated with a 2.23-fold increased likelihood of in-hospital mortality.
Conclusions:
- Weekend and after-hours percutaneous coronary intervention (PCI) coverage is linked to adverse D2B outcomes and higher in-hospital mortality.
- Significant disparities persist in the treatment of STEMI patients presenting outside of standard business hours, even in urban centers.
- The findings underscore the need for improved resource allocation and protocols to ensure equitable STEMI care across all hours.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
4.8K
08:19Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs
Published on: July 12, 2022
3.7K
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
465
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
465
01:28Acute Coronary Syndrome IV: Interprofessional Care
487
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
487
01:30Acute Coronary Syndrome I: Introduction
1.8K
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
1.8K
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
783
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
783
01:30Pulse rhythm
1.7K
Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
1.7K
01:20Angina V: Nursing Management
530
Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...
530