The effects of off-normal hours, age, and gender for coronary angioplasty on hospital mortality in patients undergoing coronary angioplasty for acute myocardial infarction

Saleem, Mohammad; Kannam, Hari; Aronow, Wilbert S.; Weiss, Melvin B.; Kalapatapu, Kumar; Pucillo, Anthony L.; Monsen, Craig E.

doi:10.1016/j.amjcard.2003.11.057

Cited by 43 publications

(19 citation statements)

References 7 publications

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“…The studies with inclusion periods ranging from 1998 to 2002 found that pPCI performed during off hours were associated with an impaired outcome compared with pPCI performed during office hours. [15][16][17]19 On the contrary, Ortolani et al 18 and Jneid et al 20 have found that outcome was independent of off hours pPCI treatment. As in this current study with 1019 patients from 2004, the inclusion periods in these studies were relatively updated (2003-2005 and 2000 -2005, respectively).…”

Section: Time Of Patient Presentation (Office Hours Versus Off-hours)mentioning

confidence: 90%

Long-Term Prognosis in an ST-Segment Elevation Myocardial Infarction Population Treated With Routine Primary Percutaneous Coronary Intervention

Pedersen

Galatius

Møgelvang

et al. 2009

Circ: Cardiovascular Interventions

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Background-We sought to describe the long-term prognosis after routine primary percutaneous coronary intervention (pPCI) in a contemporary consecutive population of patients with presumed ST-segment elevation myocardial infarction, compare it with similar results from the landmark DANAMI-2 trial, and to identify a possible impact of time of presentation and referral pattern. Methods and Results-Long-term prognosis in 1019 presumed ST-segment elevation myocardial infarction patients, treated according to modern routine pPCI during the year 2004, was analyzed and compared with similar data from the DANAMI-2 trial. Furthermore, we analyzed the impact of patient presentation to the angioplasty center during "off hours" (4 PM to 8 AM plus weekends and holidays) and the impact of being referred from noninvasive hospitals. At 3 years, 20.4% in the routinely treated population versus 19.6% in the DANAMI-2 trial reached the combined end point of death, reinfarction, or stroke (Pϭ0.68), whereas the all-cause mortality was 13.0% and 13.7%, respectively (Pϭ0.65). Patients admitted during off hours had the same risk of reaching the combined end point of death, reinfarction, or stroke compared with patients admitted during office hours (hazards ratio, 1.04; 95% CI, 0.8 to 1.5; Pϭ0.81). Door-to-balloon times of less than 90 minutes were achieved in 60% among patients admitted directly to an invasive center but only in 40% among transferred patients (PϽ0.001). Despite this difference, no difference in unadjusted or adjusted long-term prognosis was found between the 2 groups. Conclusions-This study shows that ST-segment elevation myocardial infarction patients treated with contemporary routine pPCI achieve a similar long-term prognosis as patients in the landmark randomized pPCI trial (DANAMI-2). Furthermore, the long-term prognosis was the same regardless of whether the pPCI was performed during off hours or office hours. Thus, pPCI including transportation of patients from noninvasive centers can be applied successfully in a real-life population. (Circ Cardiovasc Intervent. 2009;2:392-400.)

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Section: Time Of Patient Presentation (Office Hours Versus Off-hours)mentioning

confidence: 90%

Long-Term Prognosis in an ST-Segment Elevation Myocardial Infarction Population Treated With Routine Primary Percutaneous Coronary Intervention

Pedersen

Galatius

Møgelvang

et al. 2009

Circ: Cardiovascular Interventions

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“…Whereas some studies showed that presentation and treatment during off-hours only had limited impact on in-hospital mortality, 7,9,12,13,15,16,18 other studies revealed higher in-hospital mortality in pPCI patients during off-hours than regular hours. 8,10,11,14 A straightforward comparison of these clinical studies is complicated by differences in patient characteristics and (medical) co-treatment, as well as by the applied definitions. For example, Henriques et al, who reported higher mortality after off-hour treatment, focused on the circadian patterns of symptom onset, including routine duty hours (0800-1800) versus off-hours irrespective of day of the week.…”

Section: Discussionmentioning

confidence: 99%

“…However, most of these studies were conducted in centres using both fibrinolysis and pPCI for treatment of patients with STEMI, and did not evaluate long-term outcomes. [7][8][9][10][11][12][13][14][15][16][17][18] In the year 2000, pPCI became the standard treatment for STEMI in our institution and a 24/7 programme was established. Baseline, procedural and follow-up data of all patients undergoing PCI in our institution were systematically collected.…”

Section: Introductionmentioning

confidence: 99%

Primary PCI during off-hours is not related to increased mortality

Boer

Oemrawsingh

Lenzen

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Aim: Previous studies have shown contradictory outcomes in ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (pPCI) during off-hours versus regular 'office' hours. We aimed to evaluate the relationship between pPCI timing (off-hours versus regular hours) and mortality in patients with STEMI undergoing pPCI. Methods: The study population comprised 4352 consecutive STEMI patients treated with pPCI in a high-volume centre with a 24/7 programme during 2000-2009. Descriptive statistics and multivariable survival analyses were applied to evaluate the relationship between treatment during off-hours (Monday-Friday, 6.00 pm-8.00 am and weekends) versus regular hours and the incidence of all-cause mortality at 30-day and 4-year follow-up. Results: A total of 2760 patients (63.4%) were treated during off-hours and 1592 patients (36.6%) during regular hours. With the exception of smoking, diabetes mellitus, use of glycoprotein IIb/IIIa antagonists and calcium antagonists, no major differences in baseline characteristics were observed between the groups. Mortality at 30-day follow-up was similar in patients treated during off-hours and those treated during regular hours (7.7% vs 7.7%; hazard ratio adjusted for potential confounders 1.03; 95% CI 0.82-1.28). Four-year mortality was similar (17.3% vs 17.3%; adjusted hazard ratio 0.95; 95% CI 0.81-1.11). Conclusion: In STEMI patients who present during off-hours in a high-volume centre with 24/7 service, pPCI provides similar survival as patients who were treated during regular hours.

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“…7,10,11 Com a relação à aplicabilidade da ICPp, diversos estudos têm sugerido que o tempo porta-balão e que a mortalidade podem ser elevados no período noturno, comparativamente ao horário diurno. [12][13][14][15] No entanto, dados avaliando essa variável têm sido pouco relatados na literatura nacional. 16 Por conseguinte, foi objetivo deste trabalho avaliar os desfechos da ICPp realizada no horário de rotina (diurno) e no plantão (noturno) em um centro cardiológico de referência.…”

Section: Doi: 101590/0104-1843000000004unclassified

Resultados das Intervenções Coronárias Percutâneas Primárias Realizadas nos Horários Diurno e Noturno

Cardoso¹,

Lana²,

Bess³

et al. 2014

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: Estudos demonstram que a intervenção coronária percutânea primária realizada fora do horário de rotina está relacionada a pior prognóstico. Nosso objetivo foi avaliar os desfechos da intervenção coronária percutânea primária realizada nos períodos diurno e noturno em um centro cardiológico de referência. Métodos: Estudo de coorte prospectivo, que incluiu 1.108 pacientes consecutivamente atendidos por infarto agudo do miocárdio com supradesnivelamento do segmento ST, divididos nos grupos intervenção coronária percutânea primária diurna (se realizada entre 8 e 20 horas) e intervenção coronária percutânea primária noturna (se realizada entre 20 e 8 horas). Resultados: Incluímos 680 pacientes no grupo diurno e 428 no grupo noturno. As características basais referentes ao perfil demográfico, fatores de risco e classificação Killip foram semelhantes em ambos os grupos, porém o tempo porta-balão foi significativamente maior no grupo noturno (84 ± 66 minutos vs. 102 ± 98 minutos; p < 0,01). Vasos culpados, e fluxos TIMI pré e pós-procedimento não foram diferentes entre os grupos. Não encontramos diferenças significantes em relação à mortalidade hospitalar (7,6% vs. 10,2%; p = 0,16), trombose de stent (2,8% vs. 2,4%; p = 0,69) ou presença de sangramento maior (1,9% vs. 2,1%; p = 0,50). Em 1 ano, a mortalidade também foi semelhante (9,5% vs. 12,6%; p = 0,12). O principal preditor de mortalidade em 1 ano foi a classe III/IV de Killip (OR = 10,02; IC 95% 5,8-17,1; p < 0,01). Conclusões: Pacientes com infarto agudo do miocárdio apresentam taxas de desfechos clínicos semelhantes, independentemente do horário de realização da intervenção coronária percutânea primária. No entanto, o tempo porta-balão é significativamente maior nos pacientes tratados entre 20 e 8 horas. DESCRITORES:Infarto do miocárdio. Intervenção coronária per cutânea. Reperfusão miocárdica. ABSTRACT Results of Primary Percutaneous Coronary Interventions Performed During On-and Off-HoursBackground: Previous studies have shown that off-hours primary percutaneous coronary interventions are related to a worse prognosis. The objective of this study was to evaluate the outcomes of patients undergoing on-and off-hours primary percutaneous coronary interventions performed at a reference cardiology center. Methods: Prospective cohort study, including 1,108 consecutive patients with ST elevation myocardial infarction divided into primary percutaneous coronary intervention performed during regular working hours group (on-hours: 8:00 am to 8:00 pm) and primary percutaneous coronary intervention during nonregular working hours group (off-hours: 8:00 pm to 8:00 am). Results: The sample included 680 patients in the on-hours group and 428 in the off-hours group. Baseline demographic data, risk factors and Killip classification were similar in both groups, however door-to-balloon time was significantly longer in the off-hours group (84 ± 66 minutes vs. 102 ± 98 minutes; p < 0.01). Culprit vessels, pre-and post-procedure TIMI flows were not different between ...

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The effects of off-normal hours, age, and gender for coronary angioplasty on hospital mortality in patients undergoing coronary angioplasty for acute myocardial infarction

Cited by 43 publications

References 7 publications

Long-Term Prognosis in an ST-Segment Elevation Myocardial Infarction Population Treated With Routine Primary Percutaneous Coronary Intervention

Long-Term Prognosis in an ST-Segment Elevation Myocardial Infarction Population Treated With Routine Primary Percutaneous Coronary Intervention

Primary PCI during off-hours is not related to increased mortality

Resultados das Intervenções Coronárias Percutâneas Primárias Realizadas nos Horários Diurno e Noturno

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