Key result
Out-of-hours symptom onset in patients with acute myocardial infarction was associated with a significantly longer time to first medical contact (230 vs 203 minutes) and delayed door-to-balloon time (101 vs 84 minutes) compared to working hours onset.
Why the study?
Does out-of-hours symptom onset increase treatment delay and in-hospital mortality in patients with acute myocardial infarction?
Observational (n=4,573)
Yes
Does out-of-hours symptom onset increase treatment delay and in-hospital mortality in patients with acute myocardial infarction?
Absolute Event Rate: 230% vs 203%
p-value: p=0.003
Out-of-hours symptom onset in Korean AMI patients is associated with longer times to first medical contact and door-to-balloon times, and delayed presentation in STEMI patients correlates with increased in-hospital mortality.
Out-of-hours AMI delays may worsen outcomes; leaves open whether interventions improve survival in prospective studies.
BACKGROUND: The characteristics of the periodic variation in acute myocardial infarction (AMI) and the subsequent effect on management and prognosis have not been fully investigated in a large number of Asian populations. METHODS AND RESULTS: From a prospective, observational multicenter online registry, 4,573 patients diagnosed as AMI in Korea from January to December 2006 were included. The highest incidence of AMI was between 8 a.m. and noon. The number of cases was highest in the winter and lowest in the autumn (13.6 vs 11.4 patients per day, P<0.001). Patients with symptom onset during working hours had a shorter time to first medical contact (203+/-288 min) compared with out-of-hours onset (230+/-288 min, P=0.003). In patients who underwent primary angioplasty, out-of hours symptom onset was associated with a greater time delay in both the patient's and the medical facility's response (door-to-balloon time out-of hours vs working hours: 101+/-54 min vs 84+/-44 min, P<0.001). In patients with ST-segment elevation myocardial infarction, symptoms to first medical contact showed a significant relationship to in-hospital mortality (for every 10 min of symptoms to first medical contact, odds ratio 1.006, 95% confidence interval 1.001-1.012, P=0.018) CONCLUSIONS: Circadian and periodic variation in AMI exists in Korean patients, which resulted in different patient behavior, hospital management and outcomes.
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Park et al. (2010) conducted an observational in Acute Myocardial Infarction (n=4,573). Out-of-hours symptom onset vs. Working hours symptom onset was evaluated on Time to first medical contact (minutes) (p=0.003). Out-of-hours symptom onset in patients with acute myocardial infarction was associated with a significantly longer time to first medical contact (230 vs 203 minutes) and delayed door-to-balloon time (101 vs 84 minutes) compared to working hours onset.
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