Key result
Off-hour primary PCI linked to ~14-minute longer door-to-balloon times than on-hour PCI in STEMI.
Why the study?
Conflicting data exist regarding potential treatment delays for primary PCI performed during off hours in STEMI patients.
Does off-hour primary PCI compared to on-hour primary PCI affect treatment times and clinical outcomes in STEMI patients?
Cohort (n=2,246)
Yes
Does off-hour primary PCI compared to on-hour primary PCI affect treatment times and clinical outcomes in STEMI patients?
Absolute Event Rate: 74% vs 60%
p-value: p=<0.0001
Although off-hour primary PCI for STEMI is associated with longer door-to-balloon times, short-term clinical outcomes including in-hospital mortality remain similar to on-hour PCI.
Longer off-hour door-to-balloon times may not worsen short-term STEMI outcomes; leaves open optimization strategies and long-term impact.
OBJECTIVE: Evaluate treatment times and clinical outcome in a consecutive series of ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) in Los Angeles County. BACKGROUND: Primary PCI for STEMI is beneficial if performed in a timely manner. Conflicting data exist regarding potential treatment delays for primary PCI performed during off hours. METHODS: The Emergency Medical Services STEMI Receiving Center Database was queried from 2007 to 2009 to identify patients with a pre-hospital ECG showing STEMI who underwent PCI. On-hour PCI (On-hour Group, n = 1324) was defined as PCI occurring from 8 am to 5 pm and off-hour PCI (Off-hour Group, n = 922) was defined as occurring from 5 pm to 8 am. Treatment times, length of stay, vascular complications, achievement of TIMI 3 flow and in-hospital mortality were evaluated. RESULTS: Off-hours PCI occurred in 41% of patients. Medical contact to door time was similar in the Off-hour Group compared to the On-hour Group, 20.7 ± 14.6 versus 20.3 ± 12.3 min, respectively, P = 0.47. In patients with available data (n = 1366), the door-to-catheterization laboratory (CL) activation time was significantly shorter in the On-hour Group as compared to the Off-hour Group, -4.9 ± 11.9 versus -0.2 ± 27.5 min, respectively, P < 0.0001. Door-to-balloon time was significantly longer in the Off-hour Group compared to the On-hour Group, 74 ± 35 versus 60 ± 26 min respectively, P < 0.0001. Length of stay, vascular complications, final TIMI 3 flow and in-hospital mortality were similar between both groups. CONCLUSIONS: In STEMI patients receiving primary PCI in Los Angeles County, off-hour PCI was common. Short-term clinical outcomes were similar despite longer door-to-balloon time in patients receiving off-hour PCI. The longer door-to-balloon time in the off-hour PCI patients were partly explained by longer door-to-CL activation time.
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Shavelle et al. (2013) conducted a cohort in ST segment elevation myocardial infarction (STEMI) (n=2,246). Off-hour PCI (5 pm to 8 am) vs. On-hour PCI (8 am to 5 pm) was evaluated on Door-to-balloon time (p=<0.0001). Off-hour primary PCI for STEMI was associated with significantly longer door-to-balloon times compared to on-hour PCI (74 vs 60 minutes, P<0.0001), with similar short-term clinical outcomes.
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