On- Versus Off-Hours Presentation and Mortality of ST-Segment Elevation Myocardial Infarction Patients Treated With
Benoit Lattuca1, Mathieu Kerneis1, Anis Saib1
1Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
Insights
Admission time did not impact ST-segment elevation myocardial infarction (STEMI) patient care or outcomes in a primary percutaneous coronary intervention (PCI) network. On-hours versus off-hours admissions showed similar management and 1-year mortality rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- The impact of admission timing on ST-segment elevation myocardial infarction (STEMI) patient outcomes is debated, particularly with primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy.
- Understanding potential disparities in care related to admission hours is crucial for optimizing STEMI networks.
Purpose of the Study:
- To evaluate the association between admission time (on-hours vs. off-hours) and patient care, procedural characteristics, and clinical outcomes in STEMI patients undergoing primary PCI.
- To assess if admission during standard working hours versus off-hours affects in-hospital and 1-year mortality.
Main Methods:
- A retrospective analysis of 2,167 consecutive STEMI patients admitted to a tertiary PCI-capable center.
- Patients were categorized into on-hours (Mon-Fri, 8 am-6 pm) and off-hours (nights, weekends, holidays) admission groups.
- Key time delays, procedural data (e.g., radial access), and in-hospital and 1-year all-cause mortality were compared between groups.
Main Results:
- Nearly half of STEMI patients (48.3%) were admitted during on-hours, with similar patient characteristics and rates of cardiac arrest or cardiogenic shock compared to off-hours admissions.
- No significant differences were observed in median symptom-to-first medical contact time, first medical contact-to-sheath insertion time, or radial access rates.
- In-hospital mortality (8.1% vs. 7.0%) and 1-year mortality (11.0% vs. 11.1%) showed no statistically significant association with on-hours versus off-hours admission.
Conclusions:
- In a contemporary, organized STEMI network, admission timing (on-hours vs. off-hours) did not adversely affect patient management or 1-year clinical outcomes.
- These findings suggest that high-volume, PCI-capable centers can provide consistent quality of care regardless of admission time.
Objectives:
The authors sought to assess the association between admission time with patient's care, procedure characteristics, and clinical outcomes within a contemporary ST-segment elevation myocardial infarction (STEMI) network of patients referred for primary percutaneous coronary intervention (PCI).
Background:
The effect of admission time on STEMI patient's outcomes remains controversial when primary PCI is the preferred reperfusion strategy.
Methods:
Characteristics and clinical outcomes of 2,167 consecutive STEMI patients admitted in a tertiary PCI-capable center were collected. On-hours were defined as admission from Monday through Friday between 8 am and 6 pm and off-hours as admission during night shift, weekend, and nonworking holidays. In-hospital and 1-year all-cause mortality were assessed as well as key time delays.
Results:
A total of 1,048 patients (48.3%) were admitted during on-hours, and 1,119 patients (51.7%) during off-hours. Characteristics were well-balanced between the 2 groups, including rates of cardiac arrest (7.9% vs. 8.8%; p = 0.55) and cardiogenic shock (12.3% vs. 14.7%; p = 0.16). Median symptom-to-first medical contact time and median first medical contact-to-sheath insertion time did not differ according to on- versus off-hours admission (120 min vs. 126 min; p = 0.25 and 90 min vs. 93 min; p = 0.58, respectively), as well as the rate of radial access for catheterization (85.6% vs. 87.5%; p = 0.27). There was no association between on- versus off-hours groups and in-hospital (8.1% vs. 7.0%; p = 0.49) or 1-year mortality (11.0% vs. 11.1%; p = 0.89), respectively.
Conclusions:
In a contemporary organized STEMI network, patients admitted in a high-volume tertiary primary PCI center during on-hours or off-hours had similar management and 1-year outcomes.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Acute Coronary Syndrome V: Nursing Management
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...