On-Hours Versus Off-Hours Primary PCI for STEMI: Outcomes in a Real-World Tertiary Hospital Cohort

Q: What are the key findings of this study?

Off-hours presentation for primary PCI in STEMI was associated with a shorter median door-to-balloon time compared to on-hours presentation (80 vs 89 minutes; p=0.018) with comparable 1-year MACE.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ST-Elevation Myocardial Infarction (STEMI) (n=287). Intervention: Off-hours primary PCI vs. On-hours primary PCI (weekdays 08:00-20:00). Primary outcome: Median Door-to-Balloon (D2B) time (minutes) (p=0.018).

Q: What does this research mean for the field?

Off-hours presentation for primary PCI in STEMI is associated with a shorter median door-to-balloon time and comparable 1-year MACE rates compared to on-hours presentation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Reforma Setiana; Doni Firman; Callista Rizvidella; Daniel Valentino Chrismara

doi:10.30701/ijc.2043

October 25, 2026Indonesian Journal of CardiologyOpen Access

On-Hours Versus Off-Hours Primary PCI for STEMI: Outcomes in a Real-World Tertiary Hospital Cohort

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Key result

Off-hours primary PCI in STEMI is linked to ~9-minute shorter door-to-balloon times with similar MACE.

P=0.018
n=287

Why the study?

Primary PCI is the preferred reperfusion strategy in STEMI, but concerns remain regarding potential delays and adverse outcomes during off-hours such as nights, weekends, and holidays.

Does off-hours presentation prolong Door-to-Balloon (D2B) time or increase 1-year Major Adverse Cardiovascular Events (MACE) compared to on-hours presentation in hemodynamically stable STEMI patients undergoing primary PCI?

Study Design

Type

Cohort (n=287)

Multicenter

No

Structured PICO

Does off-hours presentation prolong Door-to-Balloon (D2B) time or increase 1-year Major Adverse Cardiovascular Events (MACE) compared to on-hours presentation in hemodynamically stable STEMI patients undergoing primary PCI?

P

Population

287 hemodynamically stable adults (median age 56 years, 12.5% female) with STEMI undergoing primary PCI at a single tertiary center in Indonesia, free of cardiogenic shock or in-hospital death, followed for 1 year.

E

Exposure

Primary percutaneous coronary intervention (pPCI) performed during off-hours (all times outside of weekdays 08:00–20:00, including nights, weekends, and holidays; n=189)

C

Comparator

Primary percutaneous coronary intervention (pPCI) performed during on-hours (weekdays 08:00–20:00; n=98)

O

Outcome

Door-to-Balloon (D2B) time (in minutes)surrogate

Main Result

Absolute Event Rate: 80% vs 89%

p-value: p=0.018

In a tertiary Indonesian cardiac center, off-hours primary PCI for stable STEMI was associated with slightly faster door-to-balloon times and comparable 1-year MACE rates compared to on-hours procedures, demonstrating consistent 24/7 care quality.

Limitations

Single-center retrospective design limiting generalizability and potentially introducing selection or information bias
Exclusion of patients with cardiogenic shock or in-hospital mortality limits applicability to higher-risk populations
Substantial proportion of patients lost to telephone follow-up introducing potential attrition bias
Local definition of off-hours based on institutional cath lab operations may not reflect other centers
Potential underestimation of overall mortality due to exclusion of patients who died before or during transfer
Did not evaluate post-procedural guideline-directed medical therapies
Relatively small sample size limiting statistical power to detect differences in MACE
Single-center retrospective study, which may limit generalizability and introduce selection or information bias
Excluded patients with cardiogenic shock or in-hospital mortality, limiting applicability to hemodynamically unstable STEMI patients and potentially underestimating overall mortality
Substantial proportion of patients were lost to follow-up due to inability to reach via telephone, introducing potential attrition bias
Definition of off-hours was based on local catheterization laboratory operations and may not reflect practices at other centers
Did not evaluate post-procedural guideline-directed medical therapies and had a relatively small sample size, limiting statistical power for infrequent outcomes

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Off-hours STEMI presentations linked to shorter D2B times without excess MACE; leaves open generalizability and causal mechanisms beyond this single-center cohort.

Abstract

Background: Primary Percutaneous Coronary Intervention (pPCI) is the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI). However, concerns remain regarding potential delays and adverse outcomes during off-hours (nights, weekends, and holidays). This study compared clinical outcomes between on-hours and off-hours pPCI, focusing on Door-to-Balloon (D2B) time and Major Adverse Cardiovascular Events (MACE).Methods: We conducted a single-center retrospective cohort study of consecutive patients with ST-Elevation Myocardial Infarction (STEMI) who underwent pPCI at Harapan Kita National Cardiovascular Center, Jakarta, Indonesia, between January 2023 and April 2024. On-hours were weekdays 08:00–20:00; all other times were off-hours. Only hemodynamically stable STEMI patients were included. The primary outcome was D2B (D2B) time, and the secondary outcome was 1-year MACE, defined as a composite of urgent revascularization, recurrent myocardial infarction, cardiovascular death, or stroke/Transient Ischemic Attack (TIA). Continuous variables were compared using the Mann–Whitney U test, and categorical variables using the chi-square test. Logistic regression analysis was performed to assess the association between off-hours PCI and clinical outcomes.Results: Among 287 patients, 98 presented during on-hours and 189 during off-hours. Baseline age was similar (median 55–56 years). Median D2B time was shorter on off-hours: 80 [Interquartile Range (IQR) 70–104] vs 89 [74–121] minutes (p=0.018). The proportion achieving D2B <90 minutes did not differ (63.5% vs 58.2%; p=0.443). At 1 year, MACE rates were comparable (14.8% off-hours vs 17.3% on-hours, p=0.576), with no significant differences across individual components.Conclusions: In this real-world cohort from a tertiary cardiac hospital in Indonesia, off-hours presentation was associated with faster D2B times and no increase in 1-year MACE, suggesting consistent quality and efficiency of STEMI care across all hours.

Discussion

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Cite This Study

Setiana et al. (2026) conducted a cohort in ST-Elevation Myocardial Infarction (STEMI) (n=287). Off-hours primary PCI vs. On-hours primary PCI (weekdays 08:00-20:00) was evaluated on Median Door-to-Balloon (D2B) time (minutes) (p=0.018). Off-hours presentation for primary PCI in STEMI was associated with a shorter median door-to-balloon time compared to on-hours presentation (80 vs 89 minutes; p=0.018) with comparable 1-year MACE.

synapsesocial.com/papers/6ae28f09cbadf70daf6c4409 https://doi.org/10.30701/ijc.2043

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On-Hours Versus Off-Hours Primary PCI for STEMI: Outcomes in a Real-World Tertiary Hospital Cohort

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

On-Hours Versus Off-Hours Primary PCI for STEMI: Outcomes in a Real-World Tertiary Hospital Cohort

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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