Clinical InvestigationInterventional CardiologyClinical comparison of “normal-hours” vs “off-hours” percutaneous coronary interventions for ST-elevation myocardial infarction
Section snippets
Study design, setting, and eligibility criteria
This retrospective cohort study was based on a prospectively assembled database dedicated to the contribution of S. Orsola-Malpighi hospital to the PRIMA RER project set up by the Regione Emilia-Romagna (http://www.regione.emilia-romagna.it/agenziasan/index.htm, accessed on October 22, 2006). This database contains demographic information and comprehensive clinical, electrocardiogram (ECG), and procedural data concerning patients with STEMI treated with PCI at the S. Orsola-Malpighi
Study population
During the study period, 985 patients with STEMI underwent PCI at our institution within 12 hours of self-reported out-of-hospital onset of symptoms in the absence of pretreatment with thrombolysis and were therefore included in the analysis. This study population comprises 79% of all 1249 patients with acute and subacute STEMI who were admitted at our institution over the same period and 92% of the 1068 patients treated within 12 hours. Of note, almost half the patients excluded due to
Discussion
In this registry, patients receiving PPCI in and outside normal working hours had equivalent angiographic and clinical outcomes. Volume of catheterization laboratory procedures, operator experience, and use of adjunctive therapies are all known to affect patient mortality.10
“Off-hours” PPCI generally accounts for most PPCI procedures because STEMI presents a bimodal onset distribution with a primary peak in the early morning hours11 (similarly to other reports,12 in our well-organized
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Cited by (40)
The impact of off-hour mechanical thrombectomy therapy on outcomes for acute ischemic stroke: A systematic review and meta-analysis
2023, Journal of the Neurological SciencesPercutaneous coronary intervention during on- and off-hours in patients with ST-segment elevation myocardial infarction
2021, Hellenic Journal of CardiologyCitation Excerpt :However, there are conflicting data on the clinical outcomes depending on the time of intervention. Some investigators demonstrated detrimental outcomes for PCIs performed during off-hours,2–7 while others reported no impact on mortality.8–18 Several possible factors explaining inconsistency in those results were postulated.
Mortality differences in acute myocardial infarction patients in the Netherlands: The weekend-effect
2018, American Heart JournalCitation Excerpt :Other studies showed that mainly younger and male patients are admitted during the weekends.5,8,9,11,16,26,28,29,32 However, this study did not found differences in age and gender between weekdays and weekends in STEMI and NSTEMI, which is observed in other studies.7,17,27,30,31 Surprisingly, the STEMI patients admitted during weekends are more often treated with PCI compared to STEMI-patients during weekdays.
Comparison of Outcomes of ST-Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention During Off-Hours Versus On-Hours
2017, American Journal of CardiologyImpact of time of admission on short- and long-term mortality in the Vienna STEMI registry
2017, International Journal of CardiologyCitation Excerpt :2) pPCI was offered to the majority of patients regardless of “on-” or “off-hour” admission (93.9% vs. 86.1%) and only a very small minority did not receive any reperfusion treatment at all (1.2% vs. 1.8%). These excellent results also translated into a similar and even lower short-term mortality rate compared to other registries, although direct comparability is difficult, as most of the other studies only included patients referred to pPCI [8,11,16–21,24]. 3) As indicated above FT was initiated in the ambulance in case of an expected system-related delay exceeding 90–120 min, with a subsequent transfer of out-of-hospital lysed patients to a tertiary hospital to allow fast rescue PCI in case of unsuccessful fibrinolysis or angiography in all patient after successful fibrinolysis.
This study was supported by the Fanti Melloni Foundation.