Key result
Off-hours STEMI presentation for primary PCI is not linked to higher in-hospital mortality versus on-hours.
Why the study?
The effect of admission time (on-hours versus off-hours) on in-hospital mortality in STEMI patients treated with PPCI in a region without a STEMI network was unclear.
Does off-hours admission increase in-hospital mortality in STEMI patients treated with primary PCI?
Cohort (n=300)
Does off-hours admission increase in-hospital mortality in STEMI patients treated with primary PCI?
Odds Ratio: 0.74 (95% CI 0.21–2.61)
Absolute Event Rate: 4.09% vs 3.9%
p-value: p=0.64
Off-hours presentation for STEMI treated with primary PCI does not significantly impact in-hospital mortality, even in regions without a dedicated STEMI network.
Off-hours STEMI presentation may not raise in-hospital mortality; leaves open the role of regional care networks in observational cohorts.
OBJECTIVES: This study aimed to assess the effect of the admission time (on-hours versus off-hours) on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) in a region without STEMI network. METHODS: We analysed in-hospital the mortality among 300 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with PPCI between March 2012 and February 2017. Patients were divided according to admission time into on-hours admission (08:00 AM until 08:00 PM on weekdays) versus off-hours admission (08:00 PM until 08:00 AM on weekdays and 24 h on weekends and holidays). Demographic and clinical data as well as in-hospital mortality were compared between the two groups. RESULTS: One hundred and seventy eight (59.3%) patients were admitted during on-hours, and 122 (40.7%) patients were presented in off-hours. The mean door-to-balloon time was 42.3 min in the off-hours group and 34.2 min in the on-hours group with no statistically significant difference (p = 0.39). The mortality rate was 3.9% at on-hours presentation versus 4.09% in off-hours admission (p = 0.58). Multivariate logistic regression analysis showed that off-hours presentation was not associated with in-hospital mortality. [odds ratio (OR) 0.74; 95% CI, 0.21-2.61, p = 0.64]. CONCLUSION: Despite no efficient STEMI network in present study, off-hour presentation had no significant impact on in-hospital prognosis in patients with STEMI treated with PPCI. Larger studies are warranted in order to determine the prognostic role of off-hour presentation in patients with STEMI undergoing PPCI.
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Javanshir et al. (2020) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=300). Off-hours admission vs. On-hours admission was evaluated on In-hospital mortality (OR 0.74, 95% CI 0.21-2.61, p=0.64). Off-hours presentation for STEMI treated with primary PCI was not associated with increased in-hospital mortality compared to on-hours presentation (OR 0.74; 95% CI 0.21-2.61; p=0.64).
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