Percutaneous coronary intervention during on- and off-hours in patients with ST-segment elevation myocardial...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Services Research

Background:

• Conflicting data exist regarding clinical outcomes of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on procedure timing.
• Understanding the impact of on-hours versus off-hours PCI is crucial for optimizing patient care and resource allocation in emergency cardiology.

Purpose of the Study:

• To evaluate the clinical outcomes of STEMI patients undergoing PCI during on-hours versus off-hours.
• To compare periprocedural complications, radiation doses, and mortality rates between these two timeframes.

Main Methods:

• Analysis of a large cohort of 99,783 consecutive STEMI patients treated with PCI.
• Patients were categorized into on-hours (weekday, 7:00 AM–4:59 PM) and off-hours (evenings, nights, weekends, holidays) groups.
• Propensity score matching was employed to compare 37,469 matched pairs, minimizing preselection bias.

Main Results:

• Off-hours PCI procedures were associated with significantly higher radiation doses (1081.6 mGy vs. 1055.2 mGy, p=0.001).
• No significant difference in periprocedural complications was observed between on-hours and off-hours PCI.
• Mortality rates were higher during off-hours (1.49%) compared to on-hours (1.17%) (p=0.001).

Conclusions:

• Primary PCI for STEMI performed during off-hours may be linked to increased periprocedural mortality.
• Higher radiation exposure is a notable outcome of off-hours PCI procedures.
• These findings highlight the importance of timely and efficient STEMI care, irrespective of working hours.