Letter to the EditorOutcome of primary angioplasty for ST-segment elevation myocardial infarction during routine duty hours versus during off-hours. Results of a single-center in Spain
Introduction
Primary angioplasty is gradually becoming accepted as the treatment of choice for acute myocardial infarction. The improvement in the management of ST-segment elevation myocardial infarction (STEMI), characterized by early diagnosis and treatment of the acute event, has reduced complications, as well as general availability of pharmacological and mechanical reperfusion therapies, and has significantly reduced cardiac mortality in these patients [1]. A circadian variation in the time of symptom onset in patients with acute myocardial infarction has been described. In particular, a peak occurrence in morning hours is well documented for various cardiovascular events such as acute myocardial infarction, unstable angina, sudden cardiac death, transient myocardial ischemia, and ischemic stroke [2], [3]. We sought to investigate the impact of circadian patterns on the practice of primary angioplasty in individuals residing in Tenerife Island, Spain.
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Methods
A total of 90 consecutive patients with STEMI have been treated with primary angioplasty at our institution between May 2003 and May 2004. Our study was approved by the institutional review board. All patients were admitted within 6 h from symptom onset. All patients received aspirin (300 mg) and heparin ≥ 5000 IU intravenously before the procedure. Patients were divided into 2 groups according to the time of treatment: routine duty hours (0800–1800) and off-hours (1800–0800). All primary
Results
Demographic, clinical, and angiographic characteristics according to the time of treatment are reported in Table 1. Most of the patients (56,6%) were treated during daytime (between 0800 and 1800 h). There were no differences in baseline clinical characteristics or treatment delays between routine duty hours and off-hours patients. There is a significant higher rate of angioplasty failure and in-hospital mortality from 1800 to 0800 h compared to the time range from 0800 to 1800 h.
Discussion
The principal finding of our study is that a population of Spanish patients with STEMI treated during off-hours have worse outcome. Patients with symptom onset, hospital admission, and first balloon inflation during off-hours have a higher rate of angioplasty failure and, consequently, a higher in-hospital mortality. Previous reports have shown that patients undergoing primary angioplasty during routine duty hours had a significantly lower 30-day mortality in comparison to those treated during
Acknowledgements
The authors wish to express their gratitude to Ines Abreu-Afonso for the linguistic aids in preparing the manuscript.
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