On- vs off-hours primary percutaneous coronary intervention: a single-center 5-year experience
Fernando Mané1, Rui Flores1, Rodrigo Silva1
1Cardiologia, Hospital de Braga, Braga, Portugal Cardiologia Hospital de Braga Braga Portugal.
Insights
Admission timing for ST-segment elevation myocardial infarction (STEMI) patients to a percutaneous coronary intervention (PCI) center did not impact reperfusion times or mortality. This finding suggests current emergency networks effectively manage STEMI care regardless of admission hour.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Treatment delays in ST-segment elevation myocardial infarction (STEMI) significantly impact patient outcomes.
- The influence of admission timing on STEMI patient outcomes, particularly with percutaneous coronary intervention (PCI), remains unclear.
Purpose of the Study:
- To investigate the association between STEMI patient admission time and outcomes in a PCI center.
- To determine if admission during on-hours versus off-hours affects reperfusion delays and mortality.
Main Methods:
- Retrospective cohort study of 1222 STEMI patients treated with PCI.
- Defined on-hours as Monday-Friday, 8:00 AM-6:00 PM, excluding national holidays.
- Compared baseline characteristics, reperfusion times, in-hospital mortality, and 1-year mortality between on-hours and off-hours admissions.
Main Results:
- 36% of patients were admitted on-hours, 64% off-hours, with balanced baseline characteristics.
- No significant difference in median reperfusion time between on-hours (120 min) and off-hours (123 min) admissions.
- No association found between admission time and in-hospital (5% vs 5%) or 1-year mortality (10% vs 10%).
Conclusions:
- Admission timing to a PCI center was not associated with reperfusion delays in STEMI patients.
- The timing of STEMI patient admission did not correlate with increased in-hospital or 1-year mortality.
- Contemporary emergency networks appear to provide consistent STEMI care irrespective of admission scheduling.
Introduction And Objectives:
In patients with ST-segment elevation myocardial infarction (STEMI) treatment delay significantly affects outcomes. The effect of admission time in STEMI patients is unknown when percutaneous coronary intervention (PCI) is the preferred reperfusion strategy. This study aimed to determine the association between STEMI outcomes and the timing of admission in a PCI center in south-western Europe.
Methods:
This retrospective cohort study analyzed the local electronic data from 1222 consecutive STEMI patients treated with PCI. On-hours were defined as admission from Monday to Friday between 8:00 AM and 6:00 PM on non-national holidays.
Results:
A total of 439 patients (36%) were admitted on-hours and 783 patients (64%) were admitted off-hours. Baseline characteristics were well-balanced between the 2 groups, including the percentage of patients admitted in cardiogenic shock (on-hours 5% vs off-hours 4%; P = .62). The median time from first medical contact to reperfusion did not differ between the 2 groups (on-hours 120 minutes vs off-hours 123 minutes, P = .54) and no association was observed between admission time and in-hospital mortality (on-hours 5% vs off-hours 5%, P = .90) or 1-year mortality (on-hours 10% vs off-hours 10%, P = .97). Survival analysis showed no differences in on-hours PCI vs off-hours PCI (HR, 1.1; 95%CI, 0.74-1.64; P = .64).
Conclusions:
In a contemporary emergency network, the timing of STEMI patients' admission to the PCI center was not associated with reperfusion delays or increased mortality.
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