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Prognosis is similar for patients who undergo primary PCI during regular-hours and off-hours: A report from SCAAR
Björn Redfors1,2, Christian Dworeck1,2, Oskar Angerås1,2
1Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.
Insights
Outcomes for ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) were similar regardless of whether treatment occurred during off-hours or regular hours. This finding suggests no difference in prognosis for STEMI patients based on timing of PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- ST-elevation myocardial infarction (STEMI) requires timely percutaneous coronary intervention (PCI) for optimal prognosis.
- Previous studies suggest worse outcomes for STEMI patients treated during off-hours (evenings, nights, weekends).
Purpose of the Study:
- To compare the outcomes of primary PCI for STEMI between off-hours and regular hours in a specific region.
- To investigate if presentation time impacts mortality, cardiogenic shock, stent thrombosis, or in-stent restenosis.
Main Methods:
- Retrospective analysis of the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) data from 2004-2013.
- Inclusion of all STEMI patients undergoing primary PCI in Region Västra Götaland.
- Propensity score-adjusted Cox proportional-hazards models used to compare outcomes, with death as the primary endpoint.
Main Results:
- A total of 7,136 patients were analyzed; 65% underwent off-hours PCI.
- No significant difference in the risk of death at any time (HR 1.00) or within 30 days (HR 1.03) between off-hours and regular hours groups.
- Similar risks observed for cardiogenic shock, stent thrombosis, and in-stent restenosis between the two groups.
Conclusions:
- In Region Västra Götaland, primary PCI for STEMI yields similar short- and long-term prognoses for patients presenting during off-hours compared to regular hours.
- The timing of primary PCI does not appear to affect patient outcomes in this specific geographical area.
Background:
Timely percutaneous coronary intervention (PCI) improves prognosis in ST-elevation myocardial infarction (STEMI). However, recent reports indicate that patients with STEMI who present during non-regular working hours (off-hours) have a worse prognosis. The aim of this study was to compare outcome between patients with STEMI who underwent primary PCI during off-hours and regular hours.
Methods:
We retrieved data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) for all patients who underwent primary PCI in Region Västra Götaland due to STEMI between January 2004 and May 2013. We modeled unadjusted and adjusted Cox proportional-hazards regression and logistic regression models for the outcomes death, cardiogenic shock, stent thrombosis and in-stent restenosis. A propensity score-adjusted Cox proportional-hazards model, which adjusted for traditional cardiovascular risk factors was predefined as the primary statistical model. Death at any time during the study period was pre-specified as primary end-point.
Results:
During the study period 4.611 (65%) patients underwent primary PCI due to STEMI during off-hours and 2,525 (35%) during regular hours. The risk of dying was similar among the groups for the primary endpoint death at any time during the study period (HR 1.00, 95% CI 0.89-1.12, P = 0.991) and for secondary end-point death within 30 days (HR 1.03; 95% CI 0.85-1.25, P = 0.735). The risks of developing cardiogenic shock, stent thrombosis, or in-stent restenosis were similar between the groups.
Conclusions:
In our region, short- and long-term prognosis for patients with STEMI who undergo primary PCI is similar for patients presenting during off-hours and regular hours.
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