Association Between Off-Hour Presentations And In-Hospital Mortality For Patients With Acute ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Abstract

Objectives This study aimed to assess the effect of the admission time (on-hours versus off-hours) on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) in a region without STEMI network. Methods We analysed in-hospital the mortality among 300 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with PPCI between March 2012 and February 2017. Patients were divided according to admission time into on-hours admission (08:00 AM until 08:00 PM on weekdays) versus off-hours admission (08:00 PM until 08:00 AM on weekdays and 24 h on weekends and holidays). Demographic and clinical data as well as in-hospital mortality were compared between the two groups. Results One hundred and seventy eight (59.3%) patients were admitted during on-hours, and 122 (40.7%) patients were presented in off-hours. The mean door-to-balloon time was 42.3 min in the off-hours group and 34.2 min in the on-hours group with no statistically significant difference (p = 0.39). The mortality rate was 3.9% at on-hours presentation versus 4.09% in off-hours admission (p = 0.58). Multivariate logistic regression analysis showed that off-hours presentation was not associated with in-hospital mortality. [odds ratio (OR) 0.74; 95% CI, 0.21–2.61, p = 0.64]. Conclusion Despite no efficient STEMI network in present study, off-hour presentation had no significant impact on in-hospital prognosis in patients with STEMI treated with PPCI. Larger studies are warranted in order to determine the prognostic role of off-hour presentation in patients with STEMI undergoing PPCI.

Association of Admission Time and Mortality in STEMI Patients: A Systematic Review and Meta-analysis

“…The majority of studies included in this meta-analysis were performed in developed countries, of which the STEMI network of each developed country probably allows a timely primary PCI that contributes to similar mortality risk between the two admission times. In fact, several studies from developing countries 6 9 25 35 45 47 52 58 also found a similar early mortality risk between two admission times.…”

“…A total of 384,452 patients from 56 studies were included. 2 3 4 5 6 7 8 9 10 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Baseline characteristics are presented in Table 1 .…”

“…A total of 384,452 patients from 56 studies were included. [2][3][4][5][6][7][8][9][10] Baseline characteristics are presented in ►Table 1.…”

“…1 However, several recent studies found no differences in short and long-term mortality among patients with STEMI admitted during off-hours and regular hours. 2 3 4 5 6 7 8 9 10 We therefore conducted a systematic review and meta-analysis to evaluate whether patients with acute STEMI admitted during off-hours and treated with primary PCI were associated with an increased risk of early, midterm, and long-term mortality compared with those admitted during regular working hours.…”

Circulating microRNA-208 family as early diagnostic biomarkers for acute myocardial infarction

“…Early reperfusion, usually through percutaneous coronary intervention (PCI), was a primary factor in the prognosis and clinical outcome of AMI. [ 40 , 41 ] Severe neointimal proliferation and hyperplasia, vascular remodeling, increased vascular smooth muscle cell proliferation and migration, and chronic inflammation after the coronary stent implantation procedure are the main causes of restenosis. [ 10 ] MiR-208 had a higher AUC value in healthy controls and patients with acute chest pain and the mixed population.…”