Elsevier

American Heart Journal

Volume 154, Issue 2, August 2007, Pages 366-372
American Heart Journal

Clinical Investigation
Interventional Cardiology
Clinical comparison of “normal-hours” vs “off-hours” percutaneous coronary interventions for ST-elevation myocardial infarction

https://doi.org/10.1016/j.ahj.2007.04.025Get rights and content

Background

High mortality rates were reported in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary interventions (PPCI) “off-hours.” The objective of this study was to evaluate this issue in a more recent population of patients with STEMI treated with PPCI in a high-volume tertiary center specifically dedicated to STEMI treatment.

Methods and Results

We analyzed in-hospital/1-year mortality among 985 consecutive patients with STEMI treated with PPCI between January 2003 and December 2005 in a high-volume (>1400 PCI/year) hub center in a STEMI provincial network organization during “normal-hours” (weekdays 08:00 am to 07:29 pm) and “off-hours” (weekdays 07:30 pm to 07:59 am and weekends). Most (61.2%) patients were treated during “off-hours”. Clinical and angiographic characteristics of the ”normal-hours” and “off-hours” groups were comparable (in both groups, glycoprotein IIb/IIIa were administered to ∼80% patients). The off-hours group tended toward higher median (25th-75th percentiles) total ischemic time (199 [135-312] minutes vs 179 [126-285] minutes; P = .052). Median electrocardiogram-to-balloon time was less than 90 minutes in both groups. Despite 20 minutes longer median total ischemic time, patients who underwent PPCI during “off-hours” showed similar post-PPCI Thrombolysis In Myocardial Infarction 3 flow grade and mean left ventricular ejection fraction. No difference could be observed between the 2 groups in terms of in-hospital and 1-year mortality rates.

Conclusion

This study provides evidence that the clinical effectiveness of “normal” and “off-hours” PPCI can be equivalent, at least when performed at a center specifically dedicated to STEMI treatment with frequent use of glycoprotein IIb/IIIa agents.

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

References (21)

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This study was supported by the Fanti Melloni Foundation.

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