Key result
Off-hours primary PCI for STEMI is linked to higher periprocedural mortality vs. on-hours PCI.
Why the study?
Data on the clinical outcomes of PCI for STEMI based on the time of admission to the catheterization laboratory are conflicting.
Does performing primary PCI during off-hours compared to regular working on-hours affect periprocedural mortality and complications in patients with STEMI?
Cohort (n=99,783)
Does performing primary PCI during off-hours compared to regular working on-hours affect periprocedural mortality and complications in patients with STEMI?
In a large propensity-matched cohort of STEMI patients, primary PCI performed during off-hours was associated with higher periprocedural mortality and radiation exposure compared to regular working hours.
Answers are grounded in this paper and cite their sources.
Highlights potential system-level vulnerabilities during off-hours STEMI care, though observational design precludes causal inference; leaves open whether staffing or workflow modifications can eliminate this mortality gap.
OBJECTIVE: There are conflicting data on the clinical outcomes of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on the time of admission to the catheterization laboratory. Thus, we aimed to assess clinical outcomes in an unselected cohort of consecutive patients with STEMI treated with PCI during on-and-off hours of work. METHODS: A total of 99,783 patients were included in the analysis. Patients were divided using the most frequently used definition: On-hours (Monday-Friday 07:00 AM-04:59 PM); off-hours (Monday-Friday 05:00 PM-06:59 AM, Saturday, Sunday, and nonworking holidays) (37,469 matched pairs). To avoid potential preselection bias, a propensity score was calculated to compare on-and-off hour groups. RESULTS: Higher radiation doses were observed for PCIs performed during off-hours (1055.2(±1006.5) vs. 1081.6(±1003.25)[mGy] and p = 0.001). A similar prevalence of periprocedural complications was observed during on- and off-hours. However, there was a higher mortality rate during off-hours than during regular working hours (1.17% (439) vs. 1.49% (559) and p = 0.001). CONCLUSIONS: Primary PCIs in STEMI performed during off-hours might be associated with a higher rate of periprocedural mortality and higher radiation doses than procedures conducted during regular working hours.
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Tokarek et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=99,783). Primary PCI performed during off-hours (Monday-Friday 05:00 PM-06:59 AM, Saturday, Sunday, and nonworking holidays) vs. Primary PCI performed during on-hours (Monday-Friday 07:00 AM-04:59 PM) was evaluated on Periprocedural mortality (p=0.001). Off-hours primary PCI for STEMI was associated with higher periprocedural mortality compared to on-hours PCI (1.49% vs. 1.17%, p = 0.001).
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