Influence of presentation at the weekend on treatment and outcome in ST-elevation myocardial infarction in hospitals with catheterization laboratories

Abstract

In patients with STEMI admitted to hospitals with catheterization facilities, admission during the "off"-hours is associated with higher in-hospital mortality. This may be due to lower rates of revascularization therapy and longer prehospital and in-hospital delays as compared to "on"-hours.

Primary percutaneous intervention of ST-elevation myocardial infarction in Austria: Results from the Austrian acute PCI registry 2005–2007

“…Kalla et al reported a mean transport delay of 52 ± 44 min and a mean delay from symptom onset to hospital admission of 180 min for the urban region of Vienna [5]. In the MITRA plus registry the mean prehospital delay from symptom onset to hospital admission was 155 min during on-hours, and the German PREMIR registry reported a median delay of 91 min from fi rst medical contact until PPCI [11,13]. Th e prehospital delay, however, is only partially infl uenced by the emergency medical system and is in large part due to inadequate patient awareness.…”

Effect of weekend admission for acute myocardial infarction on in-hospital mortality: A retrospective cohort study

“…Although previous studies have examined the effect of off-hour admission for AMI on mortality, the results were inconsistent [1,[3][4][5][9][10][11][12][13][14]. In 2014, a meta-analysis which included 1,896,859 patients in 48 studies, reported that off-hour admission of patients with AMI was associated with higher short term mortality (OR 1.06, 95% CI 1.04 to 1.09), and patients with STEMI admitted during off-hours had longer door-to-balloon time (mean difference 14.8 min, 95% CI 10.7 to 19.0 min) [16].…”

“…The effect of off-hour admission for AMI on mortality has been controversial because previous studies have shown inconsistent results [1,[3][4][5][9][10][11][12][13][14][15]. Recently, a study using data from an administrative database in New Jersey reported that 30-day mortality for AMI was higher in patients admitted on weekends than on weekdays [10].…”

Does on‐ versus off‐hours presentation impact in‐hospital outcomes of ST‐segment elevation myocardial infarction patients transferred to a tertiary care center?

“…Their study population is different and included 315 (42%) patients presenting directly to their emergency department, they did not have a 24/7 on-site cardiac catheterization team at the time, and the 95% CI of their in-hospital mortality estimate is so wide that it raises concerns about the stability of the data. The other study reporting higher in-hospital mortality in the OFF hours group is the MITRA-PLUS registry from Germany in 11,516 patients with STEMI [12]. The investigators reported longer DTD times, lower rates of PPCI, and higher in-hospital mortality in the OFF (11.1%) vs. ON (9.4%) hours group mainly during the weekends, P ¼ 0.01.…”

“…However, they excluded 17,992 patients with STEMI referred from other hospitals in the NCDR database and the results do not apply to our referral population. Other studies have found increased in-hospital mortality in patients with STEMI presenting OFF hours [9,12]. For example, in a very similar study to ours with 747 consecutive patients with STEMI admitted to Massachusetts General Hospital, Cebeddu et al [9] reported higher in-hospital mortality in patients presenting OFF (8%) vs. ON (3.7%) hours (HR ¼ 3.98; 95% CI: 1.10-14.4, P ¼ 0.035).…”