Total ischemic time and outcomes for patients with ST-elevation myocardial infarction: does time of admission make a
Jun-Xian Song1, Li Zhu2, Chong-You Lee1
1Department of Cardiology, Peking University People's Hospital, Beijing, China; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing, China.
Insights
Admission time did not affect reperfusion therapy delays or in-hospital death for ST-elevation myocardial infarction (STEMI) patients. Off-hours admission was not linked to worse outcomes, suggesting other factors influence STEMI care quality.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Timely reperfusion therapy is critical for ST-elevation myocardial infarction (STEMI) outcomes.
- Concerns exist regarding potential delays and adverse events associated with off-hours hospital admissions.
Purpose of the Study:
- To determine if admission timing (off-hours vs. regular hours) impacts reperfusion therapy delay and in-hospital mortality in STEMI patients.
- To identify factors independently associated with in-hospital death in STEMI patients.
Main Methods:
- Retrospective analysis of STEMI patients undergoing primary percutaneous coronary intervention.
- Comparison of clinical characteristics, ischemic times, and in-hospital death between off-hours and regular hours admissions.
- Multivariate logistic regression to assess the association of off-hours admission with clinical outcomes.
Main Results:
- Patients admitted during off-hours had significantly shorter total ischemic and onset-to-door times.
- Door-to-balloon times and the proportion of patients achieving timely reperfusion (≤90 min) were similar between groups.
- Off-hours admission was not independently associated with increased in-hospital death; age and creatinine levels were significant predictors.
Conclusions:
- Off-hours admission does not appear to delay reperfusion therapy or increase mortality in STEMI patients.
- Focus should shift to other factors contributing to pre-hospital and in-hospital delays in reperfusion.
- Quality improvement initiatives for STEMI reperfusion programs are essential.
Objective:
To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction (STEMI).
Methods:
All patients with STEMI who were admitted to the emergency department and underwent primary percutaneous coronary intervention at Peking University People's Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome.
Results:
The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours (all P < 0.05). Door-to-balloon (DTB) time, the rate of DTB time ≤ 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death.
Conclusions:
Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.
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