Key result
Off-hours admission did not significantly impact the risk of 2-year major adverse cardiovascular events (HR 1.071) compared to on-hours admission in STEMI patients treated with primary PCI within 90 minutes.
Why the study?
It remained unclear whether outcomes for STEMI patients treated with PPCI during off-hours are as favorable as on-hours, particularly among those with FMC-to-device time within 90 min.
Does off-hours admission impact 2-year MACEs in STEMI patients undergoing primary percutaneous coronary intervention with a first medical contact-to-device time within 90 min?
Cohort (n=670)
Yes
Does off-hours admission impact 2-year MACEs in STEMI patients undergoing primary percutaneous coronary intervention with a first medical contact-to-device time within 90 min?
Hazard Ratio: 1.071 (95% CI 0.649–1.767)
Absolute Event Rate: 9.6% vs 9.1%
p-value: p=0.788
For STEMI patients undergoing primary percutaneous coronary intervention within 90 minutes, off-hours admission is safe and does not negatively impact 2-year MACEs compared to on-hours admission.
Supports similar 2-year MACE risk with off-hours STEMI admission under timely primary PCI; leaves open generalizability and need for prospective confirmation.
BACKGROUND: It remains unclear whether the outcomes of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) during off-hours are as favorable as those treated during on-hours, especially those with a first medical contact-to-device (FMC-to-device) time within 90 min. We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time ≤90 min. METHODS: This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time ≤90 min from 19 chest pain centers in Beijing from January 2018 to December 2018. Patients were divided into on-hours group and off-hours group based on their arrival time. Baseline characteristics, clinical data, and key time intervals during treatment were collected from the Quality Control & Improvement Center of Cardiovascular Intervention of Beijing by the "Heart and Brain Green Channel" app. RESULTS: Overall, the median age of the patients was 58.8 years and 19.9% (133/670) were female. Of these, 296 (44.2%) patients underwent PPCI during on-hours and 374 (55.8%) patients underwent PPCI during off-hours. Compared with the on-hours group, the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time ≤60 min (P < 0.05). During the mean follow-up period of 24 months, a total of 64 (9.6%) participants experienced a major adverse cardiovascular event (MACE), with 28 (9.1%) in the on-hours group and 36 (9.6%) in the off-hours group (P > 0.05). According to the Cox regression analyses, off-hours admission was not a predictor of 2-year MACEs (P = 0.788). Similarly, the Kaplan-Meier curves showed that the risks of a MACE, all-cause death, reinfarction, and target vessel revascularization were not significantly different between the two groups (P > 0.05). CONCLUSIONS: This real-world, multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min, off-hours admission was safe, with no difference in the risk of 2-year MACEs compared with those with on-hours admission.
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Ma et al. (2021) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=670). Off-hours admission vs. On-hours admission was evaluated on 2-year major adverse cardiovascular events (MACEs) (HR 1.071, 95% CI 0.649-1.767, p=0.788). Off-hours admission did not significantly impact the risk of 2-year major adverse cardiovascular events (HR 1.071) compared to on-hours admission in STEMI patients treated with primary PCI within 90 minutes.
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