Outcomes of off- and on-hours admission in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Abstract

Studies evaluating the outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are scarce, particularly in China. The purpose of present study was therefore to compare the impact of off-hours and on-hours admission on clinical outcomes in STEMI patients from China.We retrospectively analyzed 1594 patients from 4 hospitals. Of these, 903 patients (56.65%) were admitted during off-hours (weekdays from 18:00 to 08:00, weekends and holidays) and 691 (43.35%) were during on-hours (weekdays from 08:00 to 18:00).Patients admitted during off-hours had higher thrombolysis in myocardial infarction risk score (4.67 ± 2.27 vs 4.39 ± 2.10, P = 0.012) and longer door-to-balloon time (72 [50–96] vs 64 [42–92] minutes, P < 0.001) than those admitted during on-hours. Off-hours admission had no association with in-hospital (unadjusted odds ratio 2.069, 95% confidence interval [CI] 0.956–4.480, P = 0.060) and long-term mortality (unadjusted hazards ratio [HR] 1.469, 95%CI 0.993–2.173, P = 0.054), even after adjustment for confounders. However, long-term outcomes, the composite of deaths and other adverse events, differed between groups with an unadjusted HR of 1.327 (95%CI, 1.102–1.599, P = 0.003), which remained significant in regression models. In a subgroup analysis, off-hours admission was associated with higher long-term mortality in the high-risk subgroup (unadjusted HR 1.965, 95%CI 1.103–3.512, P = 0.042), but not in low- and moderate-risk subgroups.This study showed no association between off-hours admission and in-hospital and long-term mortality. Stratified analysis indicated that off-hours admission was significantly associated with long-term mortality in the high-risk subgroup.

Off-hours presentation is associated with short-term mortality but not with long-term mortality in patients with ST-segment elevation myocardial infarction: A meta-analysis

“…Several factors may contribute to the association between off-hours presentation and high short-term mortality. Off-hours presentation is associated with adverse baseline characteristics, such as a higher prevalence of cardiac risk factors and lower ejection fraction; previous studies, including ours, have also found that patients who presented during off-hours had more severe symptoms than those who presented during on-hours[ 16 , 28 , 30 ], which may partially explain the increased short-term mortality. Another potential contributor is lower availability of PPCI, according to the result of our subgroup analysis.…”

“…All the studies were published in English, except two, which were in Portuguese[ 26 , 27 ]. All patients were from a prospective clinical registry cohort, except two, which were from a retrospective cohort[ 9 , 28 ]. All studies retrospectively analyzed the collected data.…”

Premature senescence of cardiac fibroblasts and atrial fibrosis in patients with atrial fibrillation

“…Data were presented as mean±standard deviation for continuous variables and percentages for categorical variables. Logarithmic transformation of the echocardiography data was applied to fulfill the requirement of normal distribution based on the results of Kolmogorov-Smirnov test [ 24 ]. Differences among the groups were analyzed using analysis of variance or chi-square analysis.…”

Catheter ablation versus rate control in patients with atrial fibrillation and heart failure

“…Patients were evaluated from the discharged day until death or December 2016, from at least 1 of the following 3 methods: medical records, telephone contact, and outpatient visitation as described previously. [ 25 ] A 12-lead electrocardiogram and/or 24-hour ambulatory electrocardiogram monitoring were made for the clinical assessment. Our primary endpoint was major adverse cardiac events (MACEs), a composite of all-cause mortality, stroke and unplanned hospitalization.…”