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. 2012 Apr;1(1):33-9.
doi: 10.1177/2048872612441581.

Primary PCI during off-hours is not related to increased mortality

Sanneke Pm de Boer  1 , Rohit M Oemrawsingh, Mattie J Lenzen, Nicolas M van Mieghem, Carl Schultz, K Martijn Akkerhuis, Maarten Ah van Leeuwen, Felix Zijlstra, Ron T van Domburg, Patrick Wjc Serruys, Eric Boersma
Affiliations

Primary PCI during off-hours is not related to increased mortality

Sanneke Pm de Boer et al. Eur Heart J Acute Cardiovasc Care. 2012 Apr.

Abstract

Aim: Previous studies have shown contradictory outcomes in ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (pPCI) during off-hours versus regular 'office' hours. We aimed to evaluate the relationship between pPCI timing (off-hours versus regular hours) and mortality in patients with STEMI undergoing pPCI.

Methods: The study population comprised 4352 consecutive STEMI patients treated with pPCI in a high-volume centre with a 24/7 programme during 2000-2009. Descriptive statistics and multivariable survival analyses were applied to evaluate the relationship between treatment during off-hours (Monday-Friday, 6.00 pm-8.00 am and weekends) versus regular hours and the incidence of all-cause mortality at 30-day and 4-year follow-up.

Results: A total of 2760 patients (63.4%) were treated during off-hours and 1592 patients (36.6%) during regular hours. With the exception of smoking, diabetes mellitus, use of glycoprotein IIb/IIIa antagonists and calcium antagonists, no major differences in baseline characteristics were observed between the groups. Mortality at 30-day follow-up was similar in patients treated during off-hours and those treated during regular hours (7.7% vs 7.7%; hazard ratio adjusted for potential confounders 1.03; 95% CI 0.82-1.28). Four-year mortality was similar (17.3% vs 17.3%; adjusted hazard ratio 0.95; 95% CI 0.81-1.11).

Conclusion: In STEMI patients who present during off-hours in a high-volume centre with 24/7 service, pPCI provides similar survival as patients who were treated during regular hours.

Keywords: STEMI; off hours; outcome; primary percutaneous coronary intervention.

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Conflict of interest statement

None declared by authors.

Figures

Figure 1.
Figure 1.
Clinical outomes according to regular vs off hours. (A) all-cause mortality, (B) reMI, (C) rePCI, (D) CABG, (E) composite endpoint of all-cause mortality, reMI, rePCI and CABG.
Figure 2.
Figure 2.
Treatment during off hours in different subgroups.
See this image and copyright information in PMC

References

    1. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003; 361:13–20 - PubMed
    1. Smith SC, Jr, Feldman TE, Hirshfeld JW, Jr, et al. , American College of Cardiology/American Heart Association Task Force on Practice G, Intervention AASWCtUtGfPC ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006; 47: e1–121 - PubMed
    1. Van de Werf F, Bax J, Betriu A, et al. , Guidelines ESCCfP. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008; 29: 2909–45 - PubMed
    1. Cannon CP, Gibson CM, Lambrew CT, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 2000; 283: 2941–47 - PubMed
    1. De Luca G, Suryapranata H, Ottervanger JP, et al. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004; 109: 1223–25 - PubMed