Off-Hours Presentation, Door-to-Balloon Time, and Clinical Outcomes in Patients Referred for Primary Percutaneous
Mohammed K Rashid, George Wells, Derek Y So
1University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada. mlemay@ottawaheart.ca.
Insights
Patients presenting with ST-segment-elevation myocardial infarction (STEMI) during off-hours experienced longer door-to-balloon times. However, this delay did not significantly impact in-hospital mortality rates in this study.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Off-hours presentation of ST-segment-elevation myocardial infarction (STEMI) may affect treatment timeliness and patient outcomes.
- Primary percutaneous coronary intervention (PCI) is the gold standard for STEMI reperfusion.
Purpose of the Study:
- To investigate the association between off-hours presentation, door-to-balloon time, and in-hospital mortality in STEMI patients undergoing primary PCI.
- To determine if off-hours STEMI care impacts quality of care indicators and clinical outcomes.
Main Methods:
- Retrospective analysis of 5132 consecutive STEMI patients undergoing primary PCI from 2004 to 2017.
- Patients were categorized into off-hours (weekends, holidays, evenings) and on-hours (weekdays 08:00-17:59) groups.
- Door-to-balloon time and in-hospital mortality were primary endpoints.
Main Results:
- Off-hours presentation was associated with significantly longer median door-to-balloon times (102 vs. 77 minutes).
- Onset-to-door times were similar between groups.
- No significant difference in in-hospital mortality rates (3.5% vs. 3.0%) or adjusted mortality was observed between off-hours and on-hours groups.
Conclusions:
- Off-hours STEMI presentation independently predicts longer door-to-balloon times.
- While door-to-balloon time is an independent predictor of mortality, off-hours presentation in this cohort did not lead to increased in-hospital mortality.
Objectives:
Presentation with ST-segment-elevation myocardial infarction (STEMI) during off-hours may impact timely reperfusion and clinical outcomes. We investigated the association between off-hours presentation, door-to-balloon time, and in-hospital mortality in patients with STEMI referred for primary percutaneous coronary intervention (PCI).
Methods:
We included consecutive patients referred for primary PCI at the University of Ottawa Heart Institute between July 2004 and December 2017. The off-hours group included patients presenting on weekends, statutory holidays, or between 18:00 to 07:59 hours on weekdays. The on-hours group included patients presenting between 08:00 and 17:59 hours on weekdays. The primary clinical outcome was the adjusted in-hospital mortality. The primary quality-of-care indicator was door-to-balloon time.
Results:
A total of 5132 patients were included, with 3152 (61.4%) in the off-hours group and 1980 (38.6%) in the on-hours group. The median door-to-balloon time was longer in the off-hours group compared with the on-hours group (102 minutes vs 77 minutes; P<.001), while the median onset-to-door time was similar (P=.40). There was no difference in the rates of in-hospital mortality (3.5% vs 3.0%; P=.32) or in the adjusted mortality (odds ratio, 1.2; 95% confidence interval, 0.8-1.8; P=.44) between off-hours and on-hours groups. However, door-to-balloon time was an independent predictor of in-hospital mortality (P<.01) and off-hours presentation was an independent predictor of longer door-to-balloon time (P<.001), with an excess of 22.1 minutes.
Conclusion:
Patients treated with primary PCI during off-hours had longer door-to-balloon times. Treatment during off-hours was an independent predictor of longer door-to-balloon time and longer door-to-balloon times were associated with higher mortality.
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