Acute Coronary Syndrome Presenting during On- and Off-Hours: Is There a Difference in a Tertiary Cardiovascular
Ivan Ilic1,2, Anja Radunovic1, Milica Matic1
1Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia.
Insights
Patients admitted for acute coronary syndrome (ACS) during on-hours present with more complex coronary artery disease (CAD) and undergo more demanding percutaneous coronary interventions (PCI), leading to higher rates of major adverse cardio-cerebral events (MACCEs). Outcomes differ based on timing of admission.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Acute coronary syndrome (ACS) requires timely intervention, but treatment and outcomes may vary based on hospital working hours.
- Understanding these variations is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To investigate the differences in clinical characteristics and outcomes of patients admitted for ACS during on-hours versus off-hours.
- To identify potential disparities in treatment and patient management based on admission timing.
Main Methods:
- Retrospective study of 1873 consecutive ACS patients undergoing coronary angiography and intervention.
- On-hours defined as Monday-Friday, 07:30-14:30; off-hours encompass all other times.
- Comparison of patient demographics, clinical presentation, procedural details, and clinical outcomes between on-hours and off-hours groups.
Main Results:
- Off-hours admissions had more males and STEMI, while on-hours admissions had more prior MI and NSTEMI.
- On-hours patients presented with more multivessel disease (MVD) and underwent more multivessel PCI.
- Major adverse cardio-cerebral events (MACCEs) were more frequent in the on-hours group, linked to higher rates of repeated PCI.
Conclusions:
- ACS patients admitted during on-hours exhibit more complex coronary artery disease (CAD).
- These patients require more complex interventions and experience higher rates of MACCEs, often related to myocardial infarctions and repeat procedures.
- Admission timing influences patient presentation, intervention complexity, and clinical outcomes in ACS management.
Abstract:
Background and Objectives: ACS presents an acute manifestation of coronary artery disease and its treatment is based on timely interventional diagnostics and PCI. It has been known that the treatment and the outcomes are not the same for all the patients with ACS during the working day, depending on the availability of the procedures and staff. The aim of the study was to explore the differences in clinical characteristics and outcomes in patients admitted for ACS during on- and off-hours. Materials and Methods: The retrospective study included 1873 consecutive ACS patients admitted to a tertiary, university hospital that underwent coronary angiography and intervention. On-hours were defined from Monday to Friday from 07:30 h to 14:30 h, while the rest was considered off-hours. Results: There were more males in the off-hours group (on-hours 475 (56%) vs. off-hours 635 (62%); p = 0.011), while previous MI was more frequent in the on-hours group (on 250 (30%) vs. off 148 (14%); p < 0.001). NSTEMI was more frequent during on-hours (on 164 (19%) vs. off 55 (5%); p < 0.001), while STEMI was more frequent during off-hours (on 585 (69%) vs. off 952 (93%); p < 0.001). Patients admitted during on-hours had more multivessel disease (MVD) (on 485 (57%) vs. off 489 (48%); p = 0.006), as well as multivessel PCI (on 187 (22%) vs. off 171 (16%); p = 0.002), while radial access was preferred in off-hours patients (on 692 (82%) vs. off 883 (86%); p = 0.004). Left main PCI was performed with similar frequency in both groups (on 37 (4%) vs. off 35 (3%); p = 0.203). Death occurred with similar frequency in both groups (on 17 (2.0%) vs. off 26 (2.54%); p = 0.404), while major adverse cardio-cerebral events (MACCEs) were more frequent in the on-hours group (on 105 (12.4%) vs. off 70 (6.8%); p = 0.039) probably due to the more frequent repeated PCI (on 49 (5.8%) vs. off 27 (2.6%); p = 0.035). Conclusions: Patients admitted for ACS during working hours in a tertiary hospital present with more complex CAD, have more demanding interventions, and experience more MACCEs during follow-up mostly due to myocardial infarctions and repeated procedures.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
09:21Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:30Coronary Artery Disease III: Clinical Manifestations