Key result
Nighttime arrival in STEMI linked to ~187% higher odds of delayed door-to-balloon time.
Why the study?
The effects of temporal differences in emergency department arrival time on door-to-balloon time and its different segments remain inconclusive.
Does emergency department arrival time affect door-to-balloon time in STEMI patients receiving primary PCI?
Cohort (n=732)
No
Does emergency department arrival time affect door-to-balloon time in STEMI patients receiving primary PCI?
Odds Ratio: 2.87 (95% CI 1.5–5.51)
Absolute Event Rate: 16.06% vs 6.73%
p-value: p=0.002
STEMI patients arriving at the emergency department during nighttime have a significantly higher risk of delayed door-to-balloon time, primarily driven by delays between cath lab activation and patient arrival at the cath lab.
Door-to-balloon (DTB) time significantly affects the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). The effects of temporal differences in emergency department (ED) arrival time on DTB time and on different segments of DTB time remain inconclusive. Therefore, we performed a retrospective study in a tertiary hospital between January 2013 and December 2021 and investigated the relationship between a patient’s arrival time and both their DTB time and different segments of their DTB time. Of 732 STEMI patients, 327 arrived during the daytime (08:01–16:00), 268 during the evening (16:01–24:00), and 137 at night (00:01–08:00). Significantly higher odds of delay in DTB time were observed during the nighttime (adjusted odds ratio (aOR): 2.87; 95% confidence interval (CI): 1.50–5.51, p = 0.002) than during the daytime. This delay was mainly attributed to a delay in cardiac catheterization laboratory (cath lab) activation-to-arrival time (aOR: 6.25; 95% CI: 3.75–10.40, p < 0.001), particularly during the 00:00–04:00 time range. Age, sex, triage level, and whether patients arrived during the COVID-19 pandemic also had independent effects on different segments of DTB time. Further studies are required to investigate the root causes of delay in DTB time and to develop specific strategies for improvement.
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Hsiao et al. (2023) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=732). Nighttime emergency department arrival (00:01-08:00) vs. Daytime emergency department arrival (08:01-16:00) was evaluated on Door-to-balloon (DTB) time > 90 minutes (aOR 2.87, 95% CI 1.50-5.51, p=0.002). Nighttime emergency department arrival for STEMI patients was associated with significantly higher odds of a delayed door-to-balloon time >90 minutes compared to daytime arrival (aOR 2.87).
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