Key result
Admission during off-hours was not associated with a significant difference in the risk of overall mortality compared to admission during regular working hours in patients with acute STEMI (RR 1.03).
Why the study?
The study aimed to evaluate whether acute STEMI patients admitted during off-hours and treated with primary angioplasty have an increased risk of mortality compared with those admitted during regular working hours.
Does admission during off-hours increase mortality in STEMI patients treated with primary angioplasty compared to admission during regular working hours?
Meta-Analysis (n=384,452)
Does admission during off-hours increase mortality in STEMI patients treated with primary angioplasty compared to admission during regular working hours?
Relative Risk: 1.03 (95% CI 0.99–1.07)
Absolute Event Rate: 6.1% vs 6.7%
p-value: p=0.17
In STEMI patients treated with primary angioplasty, admission during off-hours is not associated with increased early, midterm, or long-term mortality compared to regular working hours.
Reassures clinicians of equivalent mortality for off-hours STEMI with primary angioplasty; confirms no time-of-day effect in contemporary systems.
This systematic review and meta-analysis aimed to evaluate patients with acute ST-segment elevation myocardial infarction (STEMI) who were admitted during off-hours and treated with primary angioplasty associated with an increased risk of mortality compared with those admitted during regular working hours. We performed a systematic literature search using PubMed, SCOPUS, Europe PMC, and Cochrane CENTRAL databases that was finalized on March 15, 2021. The primary outcome was mortality comprising early (in-hospital), midterm (30 days to 1 year), and long-term mortality (>1 year). A total of 384,452 patients from 56 studies were included. The overall mortality of acute STEMI patients admitted during off-hours and regular hours were 6.1 and 6.7%, respectively. Patients admitted during off-hours had similar risk of early, midterm, and long-term mortality compared to those admitted during regular working hours ([relative risk or RR = 1.07, 95% confidence interval or CI, 1.00–1.14, p = 0.06; I 2 = 45%, p = 0.0009], [RR = 1.00, 95% CI, 0.95–1.05, p = 0.92; I 2 = 13%, p = 0.26], and [RR = 0.95, 95% CI, 0.86–1.04, p = 0.26; I 2 = 0%, p = 0.76], respectively). Subgroup analyses indicated that the results were consistent across all subgroups ([women vs. men], [age >65 years vs. ≤65 years], and [Killip classification II to IV vs. Killip I]). Funnel plot was asymmetrical. However, Egger's test suggests no significance of small-study effects (p = 0.19). This meta-analysis showed that patients with acute STEMI who were admitted during off-hours and treated with primary angioplasty had similar risk of early, midterm, and long-term mortality compared with those admitted during regular working hours.
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Dharma et al. (2022) conducted a meta-analysis in Acute ST-segment elevation myocardial infarction (STEMI) (n=384,452). Admission during off-hours vs. Admission during regular working hours was evaluated on Overall mortality (RR 1.03, 95% CI 0.99-1.07, p=0.17). Admission during off-hours was not associated with a significant difference in the risk of overall mortality compared to admission during regular working hours in patients with acute STEMI (RR 1.03).
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