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Comparative Study
. 2009 Oct;50(5):476-82.
doi: 10.3325/cmj.2009.50.476.

Significance of off-hours in centralized primary percutaneous coronary intervention network

David Becker  1 , Pal Soos, Balazs Berta, Andrea Nagy, Gabor Fulop, Gyorgy Szabo, Gyorgy Barczi, Eva Belicza, Istvan Martai, Béla Merkely
Affiliations
Comparative Study

Significance of off-hours in centralized primary percutaneous coronary intervention network

David Becker et al. Croat Med J. 2009 Oct.

Abstract

Aim: To analyze the efficacy of a regionally organized primary percutaneous coronary intervention (PCI) network at the Heart Center, Semmelweis University Budapest, part of the "Budapest model," and the factors that influence it.

Methods: In order to investigate the differences between regular and off-hours patient care in a 24-hour myocardial infarction primary care system, we included 1890 consecutive, unselected patients with ST-segment elevation myocardial infarction and followed them until at least one year. The follow-up was complete for all participants.

Results: The difference between regular hours and off-hours mortality was not significant either after 30 days (8.6% vs 8.8%, respectively) or after 1 year (15.3% vs 14.7%, respectively). The rate of patients with re-infarction, frequency of re-intervention, and major adverse cardiac events, including death, re-infarction, re-intervention, and coronary artery bypass graft surgery, were similar in both patient groups. The time delay between the onset of chest pain and arrival to the clinic was 5.9+/-5.8 hours (mean+/- standard deviation) during regular hours and 5.2+/-4.6 hours during off-hours (P=0.235). Direct transport caused significant decrease in the 30-day and 1-year mortality independent of duty time (7.2% vs 9.9%, P=0.027; 12.6% vs 16.7%, P=0.028; respectively).

Conclusion: Centralized primary PCI network of the "Budapest model" achieved the same level of patient care during both off-hours and regular hours.

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