Key result
Primary PCI for STEMI performed during off-time hours resulted in similar 30-day mortality compared to on-time hours (6.67% vs 8.3%; p=0.09).
Why the study?
Does primary PCI performed during off-time hours compared to on-time hours affect 30-day all-cause mortality in patients with STEMI?
Cohort (n=66)
No
Does primary PCI performed during off-time hours compared to on-time hours affect 30-day all-cause mortality in patients with STEMI?
Primary PCI for STEMI performed during off-hours with reduced staffing appears as safe as on-hours PCI, with no significant difference in 30-day mortality.
Answers are grounded in this paper and cite their sources.
Supports off-hours primary PCI safety in STEMI; leaves open confirmation via randomized trials.
There is contradictory evidence regarding outcomes of efficacy of primary PCI between On-time compared with Off-time. The aim of this study is to compare the results of primary PCI during Off-time Vs On-time in tertiary care hospital. This prospective study includes consecutive sixty six patients with STEMI who were treated with primary PCI during Off-time Vs On-time during the year Jan 2012–Dec 2013. During on time hours there will be availability of two senior professors along with two assistant professors, two lab technicians and two sisters (8 AM–8 PM during working days). During offtime hours there will be one assistant professor, one lab technician and one sister with on call senior cardiologist (8 PM–8 AM and any time during non working day). This study cohort includes 36 patients attended during on-time and 30 patients during off-time. 56 males and 10 females and age group ranges from 45 to 74 yrs. We used radial approach for 16 patients and IABP support for 7 patients. Thrombosuction was needed in 16 patients. The results were analyzed to evaluate the relation between On-time and Off-time and incidence of all cause mortality and 30 day follow-up. A total of 30 patients (45%) were treated during Off-time and 36 patients (55%) during On-time. There was no statistical difference in the incidence of diabetes, family history of CAD, dyslipidemia, IABP support, number of patients sent for surgery, patients presenting with mechanical complications. However we noted statistically significant difference in gender (84.8% were males; p-value <0.001), hypertension (p-value = 0.04) and smoking (p-value = 0.02). Out of 16 (24%) patients in whom radial access was used there was no switch over to femoral access. Mortality at 30-day follow-up was similar in patients treated during off-hours and those treated during regular hours (6.67% Vs 8.3%); (p = 0.09). The results of Off-time and On-time primary PCI are well comparable and Off-time PCI is as safe as On-time PCI despite of various limitations associated with Off-time PCI.
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Prasad et al. (2014) conducted a cohort in STEMI (n=66). Primary PCI during off-time hours vs. Primary PCI during on-time hours was evaluated on all cause mortality at 30 day follow-up (p=0.09). Primary PCI for STEMI performed during off-time hours resulted in similar 30-day mortality compared to on-time hours (6.67% vs 8.3%; p=0.09).
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