Comparison of Outcomes of ST-Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention During
Tariq H Enezate1, Jad Omran2, Ashraf S Al-Dadah3
1University of Missouri, Columbia, Missouri.
Insights
Outcomes for ST-elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention were similar regardless of presentation time. Door-to-balloon times did not significantly differ between off-hours and on-hours presentations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Previous research indicated worse outcomes and longer door-to-balloon times (DBTs) for ST-elevation myocardial infarction (STEMI) patients presenting during off-hours (evenings, weekends, holidays) versus on-hours.
- Recent evidence suggests similar outcomes irrespective of presentation timing.
Purpose of the Study:
- To compare short-, intermediate-, and long-term outcomes for STEMI patients treated with percutaneous coronary intervention (PCI) based on presentation time (off-hours vs. on-hours).
- To evaluate the impact of presentation time on door-to-balloon times (DBTs) in STEMI patients undergoing PCI.
Main Methods:
- A systematic review and random-effects meta-analysis of studies published between January 1990 and December 2016.
- Searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for studies comparing STEMI outcomes during off-hours versus on-hours with PCI.
- Pooled data from 39 studies involving 86,776 patients to analyze short-term (<30 days), intermediate-term (1-2 years), and long-term (3-4 years) outcomes including mortality, myocardial infarction (MI), major adverse cardiovascular events (MACEs), and stent thrombosis.
Main Results:
- No significant difference was observed in mean or median door-to-balloon times (DBTs) between off-hours and on-hours STEMI presentations.
- Short-term, intermediate-term, and long-term outcomes, including mortality, MI, MACEs, and stent thrombosis, were not statistically different between patients presenting during off-hours versus on-hours.
- Meta-analysis included 86,776 patients from 39 studies, with no significant disparities in key clinical endpoints based on presentation timing.
Conclusions:
- STEMI patients undergoing PCI demonstrate comparable short-, intermediate-, and long-term clinical outcomes regardless of whether they present during off-hours or on-hours.
- Presentation time does not appear to significantly influence door-to-balloon times or patient outcomes in STEMI treated with PCI.
Abstract:
Previous studies have reported worse outcomes and longer door-to-balloon times (DBTs) in patients presenting with ST-elevation myocardial infarction (STEMI) after normal working hours, during weekends, and on holidays (off-hours) compared with normal business hours (on-hours). Recent studies, however, have reported similar outcomes regardless of presentation time. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1990 through December 2016. Only studies comparing STEMI outcomes during off-hours versus on-hours with percutaneous coronary intervention were included. A random-effects meta-analysis model was used to pool outcomes across the studies. Clinical end points included short- (<30 days of presentation), intermediate- (at 1 to 2 years), and long-term (at 3 to 4 years) stent thrombosis, mortality, recurrent myocardial infarction (MI), and major adverse cardiovascular events (MACEs). A total of 86,776 patients (62 years and 74.5% male) were identified from 39 studies. There was no significant difference between both groups with regard to mean DBT (odds ratio [OR] 0.74, 95% confidence interval [CI] -2.73 to 4.22, p = 0.67) or median DBT (p = 0.19). There was no significant difference between the 2 groups for short-term end points including mortality (OR 1.11, 95% CI 0.99 to 1.25, p = 0.08), MI (OR 1.25, 95% CI 0.90 to 1.74, p = 0.18), MACE (OR 1.06, 95% CI 0.93 to 1.20, p = 0.40), or stent thrombosis (OR 1.23, 95% CI 0.83 to 1.82, p = 0.31). Similarly, intermediate-term end points were not statistically different for mortality (OR 0.97, 95% CI 0.89 to 1.05, p = 0.46), MI (OR 0.86, 95% CI 0.73 to 1.02, p = 0.08), or MACE (OR 1.00, 95% CI 0.92 to 1.08, p = 0.98). Long-term end points did not differ statistically between groups for mortality (OR 0.95, 95% CI 0.83 to 1.09, p = 0.46), MI (OR 1.19, 95% CI 0.77 to 1.84, p = 0.44), or MACE (OR 0.98, 95% CI 0.89 to 1.08, p = 0.67). In conclusion, patients presenting with STEMI during off-hours and treated with percutaneous coronary intervention had similar short-, intermediate-, and long-term outcomes compared with patients presenting during on-hours. DBT was not affected by the time of presentation.
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