Admission During Off-Hours Does Not Affect Long-Term Clinical Outcomes of Japanese Patients with Acute Myocardial Infarction

Abstract

on behalf of J-MINUET investigators SummaryDiscordant results have been reported on outcomes of acute myocardial infarction (AMI) patients who present during off-hours.We investigated 3283 consecutive patients with AMI who were selected from the prospective, nationwide, multicenter registry (J-MINUET) database comprising 28 institutions in Japan between July 2012 and March 2014 to determine the current impact of off-hours presentation (defined as weekends, holidays, and weekdays from 8:01 PM to 7:59 AM) at hospitals on long-term clinical outcomes. The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure, and urgent revascularization for unstable angina for up to 3 years from the index event.During off-hours, 52% of patients presented. Primary percutaneous coronary intervention was performed in 85% of patients, and the door-to-balloon time was comparable between off-hours and regular hours (74, interquartile range [IQR] 52 to 113 versus 75, IQR 52 to 126 minutes, P = 0.34). Rate of overall primary endpoint overall did not overall significantly differ (25.3% versus 23.5%, log-rank P = 0.26), in patients with STelevation myocardial infarction (STEMI) (log-rank P = 0.93) and in patients with non-ST-elevation myocardial infarction (NSTEMI) (log-rank P = 0.14). Multivariate Cox regression analysis showed that off-hours presentation was not significantly associated with long-term clinical events in all cohorts. From the Int Heart J March 2020 216 SUWA, ET ALThe impact of presentation during off-hours or regular hours on the long-term clinical outcomes of Japanese patients with AMI is comparable in contemporary practice. (Int Heart J 2020; 61: 215-222)

Long-term outcomes in ST-elevation myocardial infarction patients treated according to hospital visit time

“…In a national cohort study in England, STEMI patients admitted during off-hours were younger and had higher proportion of male patients than those admitted during on-hours [22]. In a substudy from the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) registry, patients in the AMI group admitted during off-hours tended to be younger, included more male patients, used more frequent EMS and showed lower O2DT but similar D2DT compared with those in the AMI group treated during on-hours [6], which was consistent with the respective findings in our study.…”

“…A clinical study published in 2001 highlighted that patients presenting on weekends had worse clinical outcomes than those presenting on weekdays with respect to some serious medical disorders [ 23 ], drawing attention to the clinical impact of the timing of visit in case of acute medical conditions such as AMI. Since then, some studies on the clinical impact of off-hours presentation in AMI have been conducted [ 4 – 6 ]. Several studies have underlined that the off-hours presentation of AMI patients was associated with high rates of in-hospital [ 2 , 24 ] and 1-month mortality [ 2 , 22 ].…”

“…Nonetheless, recent studies found similar long-term outcomes in the off- and on-hours groups. Likewise, 1- or 2-year mortality rates have been reported to be similar in STEMI patients presenting during on-hours and off-hours [ 6 – 8 ]. Suwa et al [ 6 ] reported that patients with STEMI presenting during off-hours had similar 3-year clinical outcomes compared with those presenting during regular hours.…”

“…Likewise, 1- or 2-year mortality rates have been reported to be similar in STEMI patients presenting during on-hours and off-hours [ 6 – 8 ]. Suwa et al [ 6 ] reported that patients with STEMI presenting during off-hours had similar 3-year clinical outcomes compared with those presenting during regular hours. Furthermore, according to one meta-analysis, STEMI patients presenting during off-hours had similar short-, intermediate-, and long-term (at 3 to 4 years) outcomes as those who presented during regular hours [ 7 ].…”

“…2021 Nov 16. [Epub ahead of print] off than on-hours [2,3]. In contrast, other reports showed no significant differences in the clinical outcomes between on-hours and off-hours [4][5][6]. In addition to clinical studies on the overall AMI population, controversial results have been reported in comparative studies among STEMI patients [7][8][9][10].…”