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On- vs. Off-Hours STEMI Presentation and Mortality
Study Questions:
Does presentation time (on-hours vs. off-hours) impact mortality among patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI)?
Methods:
This was a single-center, retrospective analysis of 2,167 STEMI patients undergoing primary PCI. In-hospital and 1-year mortality were compared among patients presenting during on-hours (Monday to Friday between 8 a.m. and 6 p.m.) versus off-hours (night shift, weekends, and nonworking holidays).
Results:
A total of 1,048 (48.3%) patients were admitted during on-hours and 1,119 (51.7%) patients during off-hours. Characteristics were well-balanced between the two 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 (FMC) time and median FMC-to-sheath insertion time did not differ according to on- versus off-hours admission (120 minutes vs. 126 minutes; p = 0.25 and 90 minutes vs. 93 minutes; 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.
Perspective:
Previous analyses evaluating outcomes for patients presenting with on-hours versus off-hours STEMI have varied depending on the setting, and some have shown worse outcomes for off-hours STEMI patients. This analysis from a well-organized urban STEMI network in Paris suggests that processes in place allow for similar outcomes (in-hospital and 1-year mortality) regardless of time of presentation. These data also highlight that in a more unselected population, STEMI mortality rates remain high despite the presence of advance systems of care.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure
Keywords: Anterior Wall Myocardial Infarction, Catheterization, Heart Arrest, Hospital Mortality, Myocardial Infarction, Outcome Assessment, Health Care, Patient Admission, Percutaneous Coronary Intervention, Shock, Cardiogenic
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