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Ghozy S, Hasanzadeh A, Kobeissi H, Abdelghaffar M, Shafie M, Beizavi Z, Hassankhani A, Azzam AY, Dmytriw AA, Kadirvel R, Kallmes DF. The impact of off-hour mechanical thrombectomy therapy on outcomes for acute ischemic stroke: A systematic review and meta-analysis. J Neurol Sci 2023; 453:120802. [PMID: 37741122 DOI: 10.1016/j.jns.2023.120802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The impact of off-hours and on-hours mechanical thrombectomy (MT) treatment for acute ischemic stroke (AIS) is not well understood. We conducted a systematic review and met-analysis comparing outcomes between patients undergoing off-hours MT versus on-hours MT. METHODS This study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. A systematic literature review of the English language literature was conducted using Web of Science, Embase, Scopus, and PubMed databases. We included all original studies comparing off-hour and on-hour outcomes or time metrics in AIS undergoing MT. R software version 4.3.1 and the 'meta' statistical package were used to analyze all the data presented in this study. RESULTS We included 26 studies with 82,850 patients. Patients undergoing MT during off-hours achieved lower rates of 90-day functional independence (OR 0.92, 95% CI 0.86-0.99; p = 0.04) and successful recanalization (OR 0.89, 95% CI 0.81-0.98; p = 0.014). Patients undergoing off-hours MT experienced similar rates of 90-day mortality (OR 1.07, 95% CI 0.96-1.19; p = 0.21) and sICH (OR 1.04, 95% CI 0.85-1.28; p = 0.674). Patients in the off-hour group experienced longer onset to door time (MD = 12.23 min; 95% CI 4.53-19.93; p = 0.002), imaging to puncture time (MD = 10.59 min; 95% CI 4.00-17.19; p = 0.002), and door to recanalization time (MD = 13.31 min; 95% CI 4.60-22.03; p = 0.003). CONCLUSIONS Patients undergoing MT for AIS during off-hours experienced lower rates of functional independence. This may be attributed to treatment delays during off-hours. Future studies should work to optimize hospital workflows and identify factors which may contribute to treatment delays.
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Affiliation(s)
- Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
| | | | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | | | - Mahan Shafie
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Zahra Beizavi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Amir Hassankhani
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Ahmed Y Azzam
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA; Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Ozbek M, Ildirimli K, Arik B, Aktan A, Coskun MS, Evsen A, Guzel T, Acet H, Demira M. Dependence of clinical outcomes on time of hospital admission in patients with ST-segment elevation myocardial infarction. Ann Saudi Med 2023; 43:25-34. [PMID: 36739499 PMCID: PMC9899343 DOI: 10.5144/0256-4947.2023.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference. OBJECTIVES Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission. DESIGN Retrospective SETTING: Tertiary percutaneous coronary intervention center. PATIENTS AND METHODS Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals. MAIN OUTCOME MEASURES Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women. RESULTS Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime (P=.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV (P=.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime (P=.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night (P=.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality. CONCLUSIONS While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. Although patients admitted at night with STEMI presented with worse clinical conditions, similar results were observed between the groups in clinical outcomes. LIMITATIONS More "real world" results might have been obtained if the study had replicated more typical referral conditions for PCI. CONFLICT OF INTEREST None.
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Affiliation(s)
- Mehmet Ozbek
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Kamran Ildirimli
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Baran Arik
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Adem Aktan
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Mehmet Sait Coskun
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Ali Evsen
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Tuncay Guzel
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Halit Acet
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Muhammed Demira
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
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Dharma S, Kamarullah W, Sabrina AP. Association of Admission Time and Mortality in STEMI Patients: A Systematic Review and Meta-analysis. Int J Angiol 2022; 31:273-283. [PMID: 36588865 PMCID: PMC9803553 DOI: 10.1055/s-0042-1742610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This systematic review and meta-analysis aimed to evaluate patients with acute ST-segment elevation myocardial infarction (STEMI) who were admitted during off-hours and treated with primary angioplasty associated with an increased risk of mortality compared with those admitted during regular working hours. We performed a systematic literature search using PubMed, SCOPUS, Europe PMC, and Cochrane CENTRAL databases that was finalized on March 15, 2021. The primary outcome was mortality comprising early (in-hospital), midterm (30 days to 1 year), and long-term mortality (>1 year). A total of 384,452 patients from 56 studies were included. The overall mortality of acute STEMI patients admitted during off-hours and regular hours were 6.1 and 6.7%, respectively. Patients admitted during off-hours had similar risk of early, midterm, and long-term mortality compared to those admitted during regular working hours ([relative risk or RR = 1.07, 95% confidence interval or CI, 1.00-1.14, p = 0.06; I 2 = 45%, p = 0.0009], [RR = 1.00, 95% CI, 0.95-1.05, p = 0.92; I 2 = 13%, p = 0.26], and [RR = 0.95, 95% CI, 0.86-1.04, p = 0.26; I 2 = 0%, p = 0.76], respectively). Subgroup analyses indicated that the results were consistent across all subgroups ([women vs. men], [age >65 years vs. ≤65 years], and [Killip classification II to IV vs. Killip I]). Funnel plot was asymmetrical. However, Egger's test suggests no significance of small-study effects ( p = 0.19). This meta-analysis showed that patients with acute STEMI who were admitted during off-hours and treated with primary angioplasty had similar risk of early, midterm, and long-term mortality compared with those admitted during regular working hours.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
- Faculty of Medicine, University of Prima Indonesia, Medan, Indonesia
| | - William Kamarullah
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Adelia Putri Sabrina
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Genç Ö, Yıldırım A, Kurt İH, Kılıçkap M, Erol MK, Kayıkçıoğlu M. Relationship Between Work Mode, Time of Admission, and Mortality in St-Segment Elevation Myocardial Infarction: Results From the TURKMI Registry. Angiology 2022; 74:553-562. [PMID: 35833843 DOI: 10.1177/00033197221113139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment of acute myocardial infarction has evolved steadily. However, limited studies exist regarding the effect of all innovations on mortality. We aimed to investigate the effect of time of admission and work mode on 1-year outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI). Based on the TURKMI registry, we analyzed 735 STEMI patients recruited consecutively and prospectively from 50 PCI-capable cardiology clinics within a prespecified two-week period. Centers were categorized as "on-call" and "on-duty" according to their work mode. At 1-year follow-up, all-cause mortality and cardiovascular mortality were the primary outcomes. The secondary outcome was a composite of coronary revascularization, re-infarction/stroke, and recurrent angina. One-fifth of the participants (19.5%) were treated in the on-call group. All-cause mortality (7.9 vs 10.5%, aHR: 1.16, P = .650) and cardiovascular mortality rates (6.1 vs 9.1%, aHR: 1.35, P = .413) were similar between centers' modes of work. Likewise, both groups were equally likely to undergo coronary revascularization (P = .278), re-MI/stroke (P = .280), recurrent angina (P = .175), and the composite outcome of these components (P = .482). No significant difference was observed in primary outcomes between weekend and weekday admissions. In conclusion, we observed similar outcomes between the on-call and on-duty groups among STEMI patients.
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Affiliation(s)
- Ömer Genç
- Department of Cardiology, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Abdullah Yıldırım
- Department of Cardiology, Faculty of Medicine, 63990Ankara University, Ankara, Turkey
| | - İbrahim Halil Kurt
- Department of Cardiology, Faculty of Medicine, 63990Ankara University, Ankara, Turkey
| | - Mustafa Kılıçkap
- Department of Cardiology, Faculty of Medicine, 63990Ankara University, Ankara, Turkey
| | - Mustafa Kemal Erol
- Department of Cardiology, Şişli International Kolan Hospital, Istanbul, Turkey
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Faculty of Medicine, 60521Ege University, Izmir, Turkey
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Tokarek T, Dziewierz A, Plens K, Rakowski T, Jaroszyńska A, Bartuś S, Siudak Z. Percutaneous coronary intervention during on- and off-hours in patients with ST-segment elevation myocardial infarction. Hellenic J Cardiol 2021; 62:212-218. [PMID: 33540055 DOI: 10.1016/j.hjc.2021.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE There are conflicting data on the clinical outcomes of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on the time of admission to the catheterization laboratory. Thus, we aimed to assess clinical outcomes in an unselected cohort of consecutive patients with STEMI treated with PCI during on-and-off hours of work. METHODS A total of 99,783 patients were included in the analysis. Patients were divided using the most frequently used definition: On-hours (Monday-Friday 07:00 AM-04:59 PM); off-hours (Monday-Friday 05:00 PM-06:59 AM, Saturday, Sunday, and nonworking holidays) (37,469 matched pairs). To avoid potential preselection bias, a propensity score was calculated to compare on-and-off hour groups. RESULTS Higher radiation doses were observed for PCIs performed during off-hours (1055.2(±1006.5) vs. 1081.6(±1003.25)[mGy] and p = 0.001). A similar prevalence of periprocedural complications was observed during on- and off-hours. However, there was a higher mortality rate during off-hours than during regular working hours (1.17% (439) vs. 1.49% (559) and p = 0.001). CONCLUSIONS Primary PCIs in STEMI performed during off-hours might be associated with a higher rate of periprocedural mortality and higher radiation doses than procedures conducted during regular working hours.
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Affiliation(s)
- Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland.
| | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | | | - Tomasz Rakowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | - Anna Jaroszyńska
- Faculty of Medicine and Health Science, Jan Kochanowski University, 25-317, Kielce, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, 25-317, Kielce, Poland
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6
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Javanshir E, Ramandi ED, Ghaffari S, Nasiri B, Bodagh H, Davarmoin G, Aslanabadi N, Separham A. Association Between Off-hour Presentations and In-hospital Mortality for Patients with Acute ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention. J Saudi Heart Assoc 2020; 32:242-247. [PMID: 33154924 PMCID: PMC7640545 DOI: 10.37616/2212-5043.1059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives This study aimed to assess the effect of the admission time (on-hours versus off-hours) on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) in a region without STEMI network. Methods We analysed in-hospital the mortality among 300 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with PPCI between March 2012 and February 2017. Patients were divided according to admission time into on-hours admission (08:00 AM until 08:00 PM on weekdays) versus off-hours admission (08:00 PM until 08:00 AM on weekdays and 24 h on weekends and holidays). Demographic and clinical data as well as in-hospital mortality were compared between the two groups. Results One hundred and seventy eight (59.3%) patients were admitted during on-hours, and 122 (40.7%) patients were presented in off-hours. The mean door-to-balloon time was 42.3 min in the off-hours group and 34.2 min in the on-hours group with no statistically significant difference (p = 0.39). The mortality rate was 3.9% at on-hours presentation versus 4.09% in off-hours admission (p = 0.58). Multivariate logistic regression analysis showed that off-hours presentation was not associated with in-hospital mortality. [odds ratio (OR) 0.74; 95% CI, 0.21–2.61, p = 0.64]. Conclusion Despite no efficient STEMI network in present study, off-hour presentation had no significant impact on in-hospital prognosis in patients with STEMI treated with PPCI. Larger studies are warranted in order to determine the prognostic role of off-hour presentation in patients with STEMI undergoing PPCI.
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Affiliation(s)
- Elnaz Javanshir
- Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiology Department, Daneshgah Ave, Tabriz, Iran
| | - Elham Darzi Ramandi
- Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiology Department, Daneshgah Ave, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiology Department, Daneshgah Ave, Tabriz, Iran
| | - Babak Nasiri
- Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiac Surgery Department, Daneshgah Ave, Tabriz, Iran
| | - Haleh Bodagh
- Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiology Department, Daneshgah Ave, Tabriz, Iran
| | - Ghiti Davarmoin
- Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiology Department, Daneshgah Ave, Tabriz, Iran
| | - Naser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiology Department, Daneshgah Ave, Tabriz, Iran
| | - Ahmad Separham
- Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiology Department, Daneshgah Ave, Tabriz, Iran
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Suwa S, Ogita M, Ebina H, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Yasuda S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Mano T, Hirata K, Tanabe K, Shibata Y, Owa M, Tsujita K, Funayama H, Kokubu N, Kozuma K, Uemura S, Toubaru T, Saku K, Oshima S, Nishimura K, Miyamoto Y, Ogawa H, Ishihara M. Admission During Off-Hours Does Not Affect Long-Term Clinical Outcomes of Japanese Patients with Acute Myocardial Infarction. Int Heart J 2020; 61:215-222. [DOI: 10.1536/ihj.19-434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Hideki Ebina
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamoto Medical Center
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University
| | - Atsushi Hirohata
- Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama
| | | | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | | | | | - Kazuhito Hirata
- Department of Cardiology, Okinawa Prefectural Chubu Hospital
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Mafumi Owa
- Department of Cardiovascular Medicine, Suwa Red Cross Hospital
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Hiroshi Funayama
- Department of Integrated Medicine, Saitama Medical Center Jichi Medical University
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Ken Kozuma
- Department of Cardiology, Teikyo University
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | | | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
| | - Shigeru Oshima
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
| | - Hisao Ogawa
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
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Ullah W, Cheema MA, Abdullah HMA, Roomi S, Saeed R, Balaratna A. ST-Segment Elevation Myocardial Infaction Alert During the Night Shift, A Misfortune for the Patient or an Overstatement? Cardiol Res 2019; 10:150-156. [PMID: 31236177 PMCID: PMC6575109 DOI: 10.14740/cr862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 11/11/2022] Open
Abstract
Background Conflicting data exist regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on intervention timings. It is believed that short staffing at night hours may lead to a lapse in the delivery of effective, efficient and timely medical intervention. Methods A retrospective single-center study was performed, and a total of 436 patients were randomized into two groups. Group A had 279 patients who had the heart catheterization done during the daytime (between 6 am and 6 pm), while group B had 157 patients who had the same intervention performed at night (between 6 pm and 6 am). Results Door to balloon (DTB) time during the day was about 16 min shorter than the DTB time at night (81.29 ± 3.26 vs. 97.30 ± 8.54) with no statistical difference (P = 0.051). The mean troponin rise during the day was 1.94 ± 10.60 SEM (95% confidence interval (CI): -22.70 to 18.90) higher than night troponin levels (71.75 ± 7.18 vs. 69.80 ± 7.18), but P value was 0.85. The left ventricular ejection fraction (LVEF) fall for daytime was 0.93% vs. 0.90% for night time patients (P = 0.94). Conclusion There is no significant difference in the mean DTB time, the rise in troponin, fall in LVEF, readmission rates, or mortality, and hence no negative effects on patient outcomes based on the patient's time of presentation between the two groups.
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Affiliation(s)
- Waqas Ullah
- Abington - Jefferson Health, Abington, PA, USA
| | | | | | | | - Rehan Saeed
- Abington - Jefferson Health, Abington, PA, USA
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9
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Eindhoven DC, Wu HW, Kremer SWF, van Erkelens JA, Cannegieter SC, Schalij MJ, Borleffs CJW. Mortality differences in acute myocardial infarction patients in the Netherlands: The weekend-effect. Am Heart J 2018; 205:70-76. [PMID: 30176441 DOI: 10.1016/j.ahj.2018.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 07/24/2018] [Indexed: 11/18/2022]
Abstract
Objective Several studies have shown that patients admitted with an acute myocardial infarction during the weekends have a higher mortality rate than those admitted during weekdays, possibly attributable to less trained personnel available and a lower use of medical procedures. The current study aimed to assess this ‘weekend-effect’ in a nationwide registry. Methods In the Netherlands, all inhabitants are, by law, obliged to have health insurance and all claim data are centrally registered. In 2012 and 2013, all national diagnose-codings of STEMI and NSTEMI patients were acquired. One-year mortality rates and treatment with percutaneous coronary intervention (PCI) were compared between weekdays and weekends (holidays included). Results In total, 59,534 patients (67 ± 13 years, 39,545(66%) male) were included of whom 33,904(57%) had a NSTEMI. Overall 6857(12%) patients died in the year following the acute myocardial infarction registration. In STEMI patients, no differences in one-year mortality rates were observed between admission on weekdays or weekends. In NSTEMI patients, one-year mortality was higher in those admitted during weekends (weekdays 11% versus weekends 13%, P < .001). Furthermore, STEMI patients admitted during weekends were more often treated with PCI (weekdays 77% versus weekends 81%, P < .001). Conversely, NSTEMI patients admitted during weekends were less often treated with PCI (weekdays 35% versus weekends 32%, P < .001). Conclusion Differences in treatment and mortality rates exist between acute myocardial infarction patients admitted during weekdays and weekends. NSTEMI patients admitted during weekends are less often treated with PCI and have a higher mortality rate than patients admitted during weekdays.
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Affiliation(s)
- Daniëlle C Eindhoven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hoi W Wu
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stijn W F Kremer
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Suzanne C Cannegieter
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Tscharre M, Jäger B, Farhan S, Christ G, Schreiber W, Weidinger F, Stefenelli T, Delle-Karth G, Kaff A, Maurer G, Huber K. Impact of time of admission on short- and long-term mortality in the Vienna STEMI registry. Int J Cardiol 2018; 244:1-6. [PMID: 28784440 DOI: 10.1016/j.ijcard.2017.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/07/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Several studies have shown contradictive findings regarding mortality and hospital admission time in patients presenting with ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the impact of "on-" or "off-hour" admission on short- and long-term all-cause mortality of patients in the advanced Vienna STEMI network between 2003 and 2009. METHODS AND RESULTS In total, 2829 patients were included into this analysis. Patients were stratified according to admission time into "on-hour" admission (07:30 until 15:00h on weekdays) and "off-hour" admission (15:00-7:30h on weekdays and 24h on weekends). As endpoint of interest, all-cause mortality was investigated after 30days and 3years of follow-up, the latter for all patients and as Landmark analysis for survivors of the index event. Mean age was 60.5±13.3years, 2048 (72.4%) patients were male and 1260 (44.5%) patients presented with anterior wall infarction. 683 (24.1%) patients were admitted "on-hours", 2146 (75.9%) patients were admitted "off-hours". All-cause death occurred in 176 (6.2%) patients after a follow-up of 30days and in 337 (11.9%) patients after 3years. For short- and long-term all-cause mortality no significant differences could be detected between "on-" and "off-hour" admission in univariate and multivariate Cox proportional hazard analyses as well as for propensity score adjusted outcome analysis. CONCLUSION In the Vienna STEMI network, "on-" or "off-hour" admission had no impact on short- and long-term mortality for all-comers presenting with acute STEMI. Our findings confirm the imperative need for well-structured STEMI networks of care, as previous data repeatedly demonstrated increased adverse cardiovascular outcome for "off-hour" admission.
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Affiliation(s)
- Maximilian Tscharre
- Wilhelminenhospital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Vienna, Austria.
| | - Bernhard Jäger
- Wilhelminenhospital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - Serdar Farhan
- Wilhelminenhospital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - Günter Christ
- Sozialmedizinsiches Zentrum Süd - Kaiser-Franz-Josef-Spital, 5th Medial Department, Cardiology, Vienna, Austria
| | - Wolfgang Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Franz Weidinger
- Krankenhaus Rudolfstiftung, 2nd Medical Department, Cardiology, Vienna, Austria
| | - Thomas Stefenelli
- Sozialmedizinisches Zentrum Ost, 1st Medical Department, Cardiology, Vienna, Austria
| | - Georg Delle-Karth
- Krankenhaus Hietzing, 4th Medical Department, Cardiology, Vienna, Austria
| | | | - Gerald Maurer
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kurt Huber
- Wilhelminenhospital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria
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11
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Enezate TH, Omran J, Al-Dadah AS, Alpert M, Mahmud E, Patel M, Aronow HD, Bhatt DL. Comparison of Outcomes of ST-Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention During Off-Hours Versus On-Hours. Am J Cardiol 2017; 120:1742-1754. [PMID: 28893379 DOI: 10.1016/j.amjcard.2017.07.082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 11/29/2022]
Abstract
Previous studies have reported worse outcomes and longer door-to-balloon times (DBTs) in patients presenting with ST-elevation myocardial infarction (STEMI) after normal working hours, during weekends, and on holidays (off-hours) compared with normal business hours (on-hours). Recent studies, however, have reported similar outcomes regardless of presentation time. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1990 through December 2016. Only studies comparing STEMI outcomes during off-hours versus on-hours with percutaneous coronary intervention were included. A random-effects meta-analysis model was used to pool outcomes across the studies. Clinical end points included short- (<30 days of presentation), intermediate- (at 1 to 2 years), and long-term (at 3 to 4 years) stent thrombosis, mortality, recurrent myocardial infarction (MI), and major adverse cardiovascular events (MACEs). A total of 86,776 patients (62 years and 74.5% male) were identified from 39 studies. There was no significant difference between both groups with regard to mean DBT (odds ratio [OR] 0.74, 95% confidence interval [CI] -2.73 to 4.22, p = 0.67) or median DBT (p = 0.19). There was no significant difference between the 2 groups for short-term end points including mortality (OR 1.11, 95% CI 0.99 to 1.25, p = 0.08), MI (OR 1.25, 95% CI 0.90 to 1.74, p = 0.18), MACE (OR 1.06, 95% CI 0.93 to 1.20, p = 0.40), or stent thrombosis (OR 1.23, 95% CI 0.83 to 1.82, p = 0.31). Similarly, intermediate-term end points were not statistically different for mortality (OR 0.97, 95% CI 0.89 to 1.05, p = 0.46), MI (OR 0.86, 95% CI 0.73 to 1.02, p = 0.08), or MACE (OR 1.00, 95% CI 0.92 to 1.08, p = 0.98). Long-term end points did not differ statistically between groups for mortality (OR 0.95, 95% CI 0.83 to 1.09, p = 0.46), MI (OR 1.19, 95% CI 0.77 to 1.84, p = 0.44), or MACE (OR 0.98, 95% CI 0.89 to 1.08, p = 0.67). In conclusion, patients presenting with STEMI during off-hours and treated with percutaneous coronary intervention had similar short-, intermediate-, and long-term outcomes compared with patients presenting during on-hours. DBT was not affected by the time of presentation.
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Affiliation(s)
| | - Jad Omran
- UC San Diego Sulpizio Cardiovascular Center, San Diego, California
| | | | | | - Ehtisham Mahmud
- UC San Diego Sulpizio Cardiovascular Center, San Diego, California
| | - Mitul Patel
- UC San Diego Sulpizio Cardiovascular Center, San Diego, California
| | - Herbert D Aronow
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
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12
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Ogita M, Suwa S, Ebina H, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Yasuda S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Uematsu M, Hirata K, Tanabe K, Shibata Y, Owa M, Hokimoto S, Funayama H, Kokubu N, Kozuma K, Uemura S, Toubaru T, Saku K, Oshima S, Nishimura K, Miyamoto Y, Ishihara M. Off-hours presentation does not affect in-hospital mortality of Japanese patients with acute myocardial infarction: J-MINUET substudy. J Cardiol 2017; 70:553-558. [PMID: 28684209 DOI: 10.1016/j.jjcc.2017.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/11/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The association between patients with acute myocardial infarction (AMI) who present during off-hours and clinical outcomes has not been fully elucidated. METHODS We investigated 3283 consecutive patients with AMI who were selected from a prospective, nationwide, multicenter registry (J-MINUET) database comprising 28 institutions in Japan between July 2012 and March 2014 to determine the current impact of off-hours presentation on in-hospital mortality among Japanese patients with AMI. RESULTS Among the patients, 52% presented in off-hours. Baseline characteristics were comparable, although those who presented during off-hours were younger and had a higher incidence of ST-elevation myocardial infarction and advanced Killip Class. The time from symptom onset to presentation time was shorter in off-hour patients (120min, interquartile range 60 to 256 vs. 215min, interquartile range 90 to 610, p<0.0001). In contrast, 85% of patients underwent primary percutaneous coronary intervention (PCI) and door to balloon time was comparable between the groups (74min, interquartile range 52 to 113 vs. 75min, interquartile range 52 to 126, p=0.34). The rates of in-hospital mortality were comparable (6.2% vs 6.8%, p=0.39). Multivariate logistic regression analysis revealed that off-hours presentation was not significantly associated with in-hospital mortality [odds ratio (OR) 0.94; 95% CI, 0.68-1.30, p=0.70]. CONCLUSION The clinical impact of presenting during off-hours or regular hours on AMI patients in Japan is comparable in contemporary practice. TRIAL REGISTRATION UMIN Unique trial Number: UMIN000010037.
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Affiliation(s)
- Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Hideki Ebina
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University, Sagamihara, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yasuharu Nakama
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Atsushi Hirohata
- Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Atsunori Okamura
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masaaki Uematsu
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Kazuhito Hirata
- Department of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Mafumi Owa
- Department of Cardiovascular Medicine, Suwa Red Cross Hospital, Suwa, Japan
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Hiroshi Funayama
- Department of Integrated Medicine, Saitama Medical Center Jichi Medical University, Saitama, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University, Tokyo, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tetsuya Toubaru
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shigeru Oshima
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masaharu Ishihara
- Division of Coronary Artery Disease, Hyogo College of Medicine, Nishinomiya, Japan
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13
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Is there an association between time of admission and in-hospital mortality in patients with non-ST-elevation myocardial infarction? A meta-analysis. Sci Rep 2015; 5:14409. [PMID: 26391281 PMCID: PMC4585727 DOI: 10.1038/srep14409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 07/28/2015] [Indexed: 11/08/2022] Open
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14
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Sorita A, Lennon RJ, Haydour Q, Ahmed A, Bell MR, Rihal CS, Gersh BJ, Holmen JL, Shah ND, Murad MH, Ting HH. Off-hour admission and outcomes for patients with acute myocardial infarction undergoing percutaneous coronary interventions. Am Heart J 2015; 169:62-8. [PMID: 25497249 DOI: 10.1016/j.ahj.2014.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/16/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prior studies have suggested that patients with acute myocardial infarction (AMI) who are admitted during off-hours (weekends, nights and holidays) have higher mortality when compared with patients admitted during regular hours. METHODS We analyzed consecutive patients with AMI (ST-elevation myocardial infarction [STEMI] and non-STEMI) who were treated with percutaneous coronary interventions from January 1998 to June 2010 at an academic medical center. Multivariable logistic regression models were used to estimate the association between off-hour admission and clinical outcomes adjusted for demographic and clinical variables. RESULTS There were 3,422 and 2,664 patients with AMI admitted during off-hours and regular hours, respectively. Patients admitted during off-hours were more likely to have STEMI (56% vs 48%, P < .001), have cardiogenic shock at presentation (6% vs 4%, P = .002), and develop shock after presentation (6% vs 5%, P = .004). After multivariable analyses, off-hour admission was not significantly associated with in-hospital mortality (odds ratio [OR] 1.12, 95% CI 0.84-1.49), 30-day mortality (OR 1.12, 0.87-1.45), or 30-day readmissions (OR 1.01, 0.84-1.20) but was significantly associated with composite major complications and any of emergent coronary artery bypass graft surgery, ventricular arrhythmia, stroke/transient ischemic attack, and gastrointestinal/retroperitoneal/intracranial bleeding (OR 1.27, 1.05-1.55, P = .015). There was no significant time trend in the adjusted mortality difference between off-hours and regular hours. The results were not different between STEMI and non-STEMI. CONCLUSIONS Patients who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at an academic medical center.
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15
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Wieringa WG, Lexis CPH, Mahmoud KD, Ottervanger JP, Burgerhof JGM, Pundziute G, van ‘t Hof AWJ, van Gilst WH, Lipsic E. Time of symptom onset and value of myocardial blush and infarct size on prognosis in patients with ST-elevation myocardial infarction. Chronobiol Int 2014; 31:797-806. [DOI: 10.3109/07420528.2014.908897] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Sorita A, Ahmed A, Starr SR, Thompson KM, Reed DA, Prokop L, Shah ND, Murad MH, Ting HH. Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis. BMJ 2014; 348:f7393. [PMID: 24452368 PMCID: PMC3898160 DOI: 10.1136/bmj.f7393] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the association between off-hour (weekends and nights) presentation, door to balloon times, and mortality in patients with acute myocardial infarction. DATA SOURCES Medline in-process and other non-indexed citations, Medline, Embase, Cochrane Database of Systematic Reviews, and Scopus through April 2013. STUDY SELECTION Any study that evaluated the association between time of presentation to a healthcare facility and mortality or door to balloon times among patients with acute myocardial infarction was included. DATA EXTRACTION Studies' characteristics and outcomes data were extracted. Quality of studies was assessed with the Newcastle-Ottawa scale. A random effect meta-analysis model was applied. Heterogeneity was assessed using the Q statistic and I(2). RESULTS 48 studies with fair quality, enrolling 1,896,859 patients, were included in the meta-analysis. 36 studies reported mortality outcomes for 1,892,424 patients with acute myocardial infarction, and 30 studies reported door to balloon times for 70,534 patients with ST elevation myocardial infarction (STEMI). Off-hour presentation for patients with acute myocardial infarction was associated with higher short term mortality (odds ratio 1.06, 95% confidence interval 1.04 to 1.09). Patients with STEMI presenting during off-hours were less likely to receive percutaneous coronary intervention within 90 minutes (odds ratio 0.40, 0.35 to 0.45) and had longer door to balloon time by 14.8 (95% confidence interval 10.7 to 19.0) minutes. A diagnosis of STEMI and countries outside North America were associated with larger increase in mortality during off-hours. Differences in mortality between off-hours and regular hours have increased in recent years. Analyses were associated with statistical heterogeneity. CONCLUSION This systematic review suggests that patients with acute myocardial infarction presenting during off-hours have higher mortality, and patients with STEMI have longer door to balloon times. Clinical performance measures may need to account for differences arising from time of presentation to a healthcare facility.
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Affiliation(s)
- Atsushi Sorita
- Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA
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17
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Kim SS, Jeong MH, Rhew SH, Jeong WY, Ahn YK, Cho JG, Kim YJ, Cho MC, Kim CJ. Impact of patients' arrival time on the care and in-hospital mortality in patients with non-ST-elevation myocardial infarction. Am J Cardiol 2014; 113:262-9. [PMID: 24295548 DOI: 10.1016/j.amjcard.2013.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 11/30/2022]
Abstract
Only a few studies have focused on the clinical characteristics and outcomes of non-ST-segment myocardial infarction (NSTEMI) during off-hours. The purpose of this study was to compare the impact of patients' arrival time on the care of NSTEMI and whether this pattern might affect hospital mortality. This study analyzed 4,736 NSTEMI patients included in the Korea Acute Myocardial Infarction Registry from November 2005 to January 2008. Patients' arrival time was classified into regular hours (weekdays, 9:00 a.m. to 6:00 p.m.) and off-hours (weekdays 18:01 p.m. to 8:59 a.m., weekends, and holidays). A subtotal of 2,225 (46.9%) patients was admitted during off hours, compared with 2,511 (53.1%) patients with regular-hour admission. A higher proportion of patients admitted during off-hours had a higher Killip class, had more frequent cardiopulmonary resuscitation, were less likely to receive percutaneous coronary intervention (PCI) (67.7% vs 72.7%, p <0.001), and had longer door-to-balloon times (28 hours, interquartile range: 11 to 63 vs 23 hours, interquartile range 4 to 67, p <0.001). Although unadjusted hospital mortality was associated with admission during off-hours (4.5% vs 3.3%, p = 0.023), after adjusting for all patients covariates, the difference in mortality was attenuated and was no longer statistically significant (odds ratio 0.94, 95% confidence interval 0.59 to 1.48, p = 0.793). In conclusion, despite receiving fewer PCIs and having substantially longer waiting times to PCI, patients admitted during off-hours may not be at risk for increased in-hospital mortality. If patients are treated within an appropriate reperfusion strategy according to their clinical risk, arrival time may not influence on mortality.
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Affiliation(s)
- Sung Soo Kim
- Department of Internal Medicine, Chonnam National University Hospital Gwangju, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital Gwangju, Gwangju, Republic of Korea.
| | - Shi Hyun Rhew
- Department of Internal Medicine, Chonnam National University Hospital Gwangju, Gwangju, Republic of Korea
| | - Wook Young Jeong
- Department of Internal Medicine, Chonnam National University Hospital Gwangju, Gwangju, Republic of Korea
| | - Young Keun Ahn
- Department of Internal Medicine, Chonnam National University Hospital Gwangju, Gwangju, Republic of Korea
| | - Jeong Gwan Cho
- Department of Internal Medicine, Chonnam National University Hospital Gwangju, Gwangju, Republic of Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyunghee University Hospital, Seoul, Republic of Korea
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18
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de Boer SP, Oemrawsingh RM, Lenzen MJ, van Mieghem NM, Schultz C, Akkerhuis KM, van Leeuwen MA, Zijlstra F, van Domburg RT, Serruys PW, Boersma E. Primary PCI during off-hours is not related to increased mortality. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:33-9. [PMID: 24062885 DOI: 10.1177/2048872612441581] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 01/30/2012] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Sanneke Pm de Boer
- Thoraxcenter, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
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Rathod KS, Jones DA, Gallagher SM, Bromage DI, Whitbread M, Archbold AR, Jain AK, Mathur A, Wragg A, Knight CJ. Out-of-hours primary percutaneous coronary intervention for ST-elevation myocardial infarction is not associated with excess mortality: a study of 3347 patients treated in an integrated cardiac network. BMJ Open 2013; 3:e003063. [PMID: 23811175 PMCID: PMC3696864 DOI: 10.1136/bmjopen-2013-003063] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 05/21/2013] [Accepted: 05/29/2013] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Timely delivery of primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment elevation myocardial infarction (STEMI). Optimum delivery of PPCI requires an integrated network of hospitals, following a multidisciplinary, consultant-led, protocol-driven approach. We investigated whether such a strategy was effective in providing equally effective in-hospital and long-term outcomes for STEMI patients treated by PPCI within normal working hours compared with those treated out-of-hours (OOHs). DESIGN Observational study. SETTING Large PPCI centre in London. PARTICIPANTS 3347 STEMI patients were treated with PPCI between 2004 and 2012. The follow-up median was 3.3 years (IQR: 1.2-4.6 years). PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was long-term major adverse cardiac events (MACE) with all-cause mortality a secondary endpoint. RESULTS Of the 3347 STEMI patients, 1299 patients (38.8%) underwent PPCI during a weekday between 08:00 and 18:00 (routine-hours group) and 2048 (61.2%) underwent PPCI on a weekday between 18:00 and 08:00 or a weekend (OOHs group). There were no differences in baseline characteristics between the two groups with comparable door-to-balloon times (in-hours (IHs) 67.8 min vs OOHs 69.6 min, p=0.709), call-to-balloon times (IHs 116.63 vs OOHs 127.15 min, p=0.60) and procedural success. In hospital mortality rates were comparable between the two groups (IHs 3.6% vs OOHs 3.2%) with timing of presentation not predictive of outcome (HR 1.25 (95% CI 0.74 to 2.11). Over the follow-up period there were no significant differences in rates of mortality (IHs 7.4% vs OFHs 7.2%, p=0.442) or MACE (IHs 15.4% vs OFHs 14.1%, p=0.192) between the two groups. After adjustment for confounding variables using multivariate analysis, timing of presentation was not an independent predictor of mortality (HR 1.04 95% CI 0.78 to 1.39). CONCLUSIONS This large registry study demonstrates that the delivery of PPCI with a multidisciplinary, consultant-led, protocol-driven approach provides safe and effective treatment for patients regardless of the time of presentation.
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20
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Outcome of patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention during on- versus off-hours (a Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] trial substudy). Am J Cardiol 2013; 111:946-54. [PMID: 23340031 DOI: 10.1016/j.amjcard.2012.11.062] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 11/22/2022]
Abstract
Patients with ST-segment elevation myocardial infarction (STEMI) admitted during nonregular working hours (off-hours) have been reported to have greater mortality than those admitted during regular working hours (on-hours), perhaps because of the lower availability of catheterization laboratory services and longer door-to-balloon times. This might not be the case, however, for hospital centers in which primary percutaneous coronary intervention (PCI) is invariably performed. We conducted a substudy using the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction study data to determine whether the STEMI arrival time was associated with differing clinical outcomes. We identified all patients with STEMI admitted to a PCI-capable hospital who underwent primary PCI. Patients presenting during on-hours were compared to those presenting during off-hours. The primary outcome of death, major adverse cardiovascular events, and net adverse clinical events was examined. We identified 2,440 patients (1,205 [49%] on-hours and 1,235 [51%] off-hours). Similar baseline characteristics were observed. The off-hour patients had a significantly longer door-to-balloon time (92 vs 75 minutes; p <0.0001) and total ischemic time (209 vs 194 minutes; p <0.0001). Despite these differences, the risk-adjusted all-cause mortality, major adverse cardiovascular events, and net adverse clinical events rates were similar for both groups during the in-hospital, 1-year, and 3-year follow-up. In conclusion, patients with STEMI presenting to primary PCI hospitals during off-hours might have slightly longer delays to revascularization; however, they experienced similar short- and long-term survival and clinical outcomes as those arriving during on-hours.
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Graham MM, Ghali WA, Southern DA, Traboulsi M, Knudtson ML. Outcomes of after-hours versus regular working hours primary percutaneous coronary intervention for acute myocardial infarction. BMJ Qual Saf 2012; 20:60-7. [PMID: 21228077 PMCID: PMC3022364 DOI: 10.1136/bmjqs.2010.041137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Primary percutaneous coronary intervention (PCI) is a proven therapy for acute ST-segment elevation myocardial infarction. However, outcomes associated with primary PCI may differ depending on time of day. Methods and results Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, a clinical data-collection initiative capturing all cardiac catheterisation patients in Alberta, Canada, the authors described and compared crude and risk-adjusted survival for ST-segment elevation myocardial infarction patients undergoing primary PCI after-hours versus regular working hours. From 1 January 1999 to 31 March 2006, 1664 primary PCI procedures were performed (54.4% after-hours). Mortalities at 30 days were 3.6% for regular hours procedures and 5.0% for after-hours procedures (p=0.16). 1-year mortalities were 6.2% and 7.3% in the regular hours and after-hours groups, respectively (p=0.35). After adjusting for baseline risk factor differences, HRs for after-hours mortality were 1.26 (95% CI 0.78 to 2.02) for survival to 30 days and 1.08 (0.73 to 1.59) for survival to 1 year. A meta-analysis of our after-hours HR point estimate with other published risk estimates for after hours primary PCI outcomes yielded an RR of 1.23 (1.00 to 1.51) for shorter-term outcomes. Conclusions After-hours primary PCI was not associated with a statistically significant increase in mortality. However, a meta-analysis of this study with other published after-hours outcome studies yields an RR that leaves some questions about unexplored factors that may influence after-hours primary PCI care.
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Birkemeyer R, Rillig A, Miljak T, Meyerfeldt U, Kaiser E, Jung W, Wöhrle J. The off-hours paradigm in primary PCI can be overcome by a uniform regional treatment protocol. Int J Cardiol 2012; 157:438-9. [PMID: 22513186 DOI: 10.1016/j.ijcard.2012.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 04/01/2012] [Indexed: 11/28/2022]
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23
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Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Taglieri N, Alessi L, Nardini P, Bacchi Reggiani ML, Guastaroba P, De Palma R, Grilli R, Picoco C, Gordini G, Branzi A. Pre-hospital ECG in patients undergoing primary percutaneous interventions within an integrated system of care: reperfusion times and long-term survival benefits. EUROINTERVENTION 2011; 7:449-57. [PMID: 21764663 DOI: 10.4244/eijv7i4a74] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Treatment delay is a powerful predictor of survival in STEMI patients undergoing primary PCI. We investigated the effectiveness of pre-hospital triage with direct referral to PCI, alongside more conventional referral strategies. METHODS AND RESULTS From January 2003 to December 2007, 1,619 STEMI patients were referred for primary PCI at our cathlab through two main triage groups: i.e., 1) following pre-hospital triage (n=524), 2) via more conventional triages (n=1,095) represented by the S. Orsola-Malpighi hospital emergency department triage (hub hospital) and local hospital triage. Pre-hospital diagnosis was associated with a 76 minute reduction in pain-to-balloon time (143 [107-216] vs. 219 [149-343], p=0.001) allowing mechanical revascularisation within 90 minutes from the first medical contact in the vast majority of the patients (>80%). Clinically, pre-hospital triage showed no significant reductions in terms of adjusted long-term mortality (HR 0.81, 95% CI 0.61-1.08; p=0.16) in the overall population. However, significant adjusted survival benefits were observed in high-risk groups (i.e., cardiogenic shock, TIMI risk score >30, diabetes mellitus). CONCLUSIONS This study shows that pre-hospital diagnosis allows for significant reductions in primary PCI treatment delays and suggests the hypothesis that this referral strategy might provide long-term survival benefits especially in high-risk patients.
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Affiliation(s)
- Paolo Ortolani
- Department of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
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Taglieri N, Saia F, Lanzillotti V, Faccioli R, Iarussi B, Ortolani P, Palmerini T, Cortesi P, Gordini G, Gallo P, Branzi A, Marzocchi A. Impact of a territorial ST-segment elevation myocardial infarction network on prognosis of patients with out-of-hospital cardiac arrest. ACUTE CARDIAC CARE 2011; 13:143-147. [PMID: 21877874 DOI: 10.3109/17482941.2011.606473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION We sought to assess the effect of a territorial system of care for ST-elevation myocardial infarction (STEMI) on the outcome of out-of-hospital cardiac arrest (OOHCA). MATERIALS AND METHODS We enrolled 720 patients who experienced a witnessed OOHCA of presumed cardiac origin during a four-year period in an area with a STEMI network and for whom resuscitation was attempted. RESULTS Overall, 242 (33.6%) patients had return of spontaneous circulation (ROSC), 645 (90%) died before discharge. We observed a trend toward decreased overall mortality for OOHCA between the years 2004 and 2007, both in the entire population and in patients with ROSC (2004=94%; 2005=89%; 2006=85%; 2007=89%; P=0.064; 2004=81%; 2005=69%; 2006=65%; 2007=60%; P=0.076, respectively). On multivariable analysis, age, crew-witnessed arrest and presence of shockable rhythm were independent predictors of mortality. Patients who experienced OOHCA in the year 2006 (OR=0.47; 95% CI: 0.21-1.05; P=0.07) and 2007 (OR=0.51; 95% CI: 0.23-1.12; P=0.09) showed a strong trend toward decreased risk of mortality compared to year 2004. In patients with ROSC, the year 2007 was associated with a significant lower risk of mortality compared to year 2004 (OR=0.38; 95% CI: 0.15-0.96; P=0.04). CONCLUSIONS Implementation of a territorial network of care for STEMI appears to be associated with reduced mortality OOHCA patients.
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Affiliation(s)
- Nevio Taglieri
- Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Italy.
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Casella G, Ottani F, Ortolani P, Guastaroba P, Santarelli A, Balducelli M, Menozzi A, Magnavacchi P, Sangiorgi GM, Manari A, De Palma R, Marzocchi A. Off-hour primary percutaneous coronary angioplasty does not affect outcome of patients with ST-Segment elevation acute myocardial infarction treated within a regional network for reperfusion: The REAL (Registro Regionale Angioplastiche dell'Emilia-Romagna) registry. JACC Cardiovasc Interv 2011; 4:270-8. [PMID: 21435603 DOI: 10.1016/j.jcin.2010.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 11/02/2010] [Accepted: 11/15/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aims to evaluate whether results of "off-hours" and "regular-hours" primary angioplasty (primary percutaneous coronary intervention [pPCI]) are comparable in an unselected population of patients with ST-segment elevation acute myocardial infarction treated within a regional network organization. BACKGROUND Conflicting results exist on the outcome of off-hours pPCI. METHODS We analyzed in-hospital and 1-year cardiac mortality among 3,072 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with pPCI between January 1, 2004, and June 30, 2006, during regular-hours (weekdays 8:00 AM to 8:00 PM) and off-hours (weekdays 8:01 PM to 7:59 AM, weekends, and holidays) within the STEMI Network of the Italian Region Emilia-Romagna (28 hospitals: 19 spoke and 9 hub interventional centers). RESULTS Fifty-three percent of patients were treated off-hours. Baseline findings were comparable, although regular-hours patients were older and had more incidences of multivessel disease. Median pain-to-balloon (195 min, interquartile range [IQR]: 140 to 285 vs. 186 min, IQR: 130 to 280 min; p = 0.03) and door-to-balloon time (88 min, IQR: 60 to 122 vs. 77 min, IQR: 48 to 116 min; p < 0.0001) were longer for off-hours pPCI. However, unadjusted in-hospital (5.8% off-hours vs. 7.2% regular-hours, p = 0.11) and 1-year cardiac mortality (8.4% off-hours vs. 10.3% regular-hours, p = 0.08) were comparable. At multivariate analysis, off-hours pPCI did not predict an adverse outcome either for the overall population (odds ratio [OR]: 0.70, 95% confidence interval [CI]: 0.49 to 1.01) or for patients directly admitted to the interventional center (OR: 0.79, 95% CI: 0.52 to 1.20). CONCLUSIONS When pPCI is performed within an efficient STEMI network focused on reperfusion, the clinical effectiveness of either off-hours or regular-hours pPCI is comparable.
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Affiliation(s)
- Gianni Casella
- Divisione di Cardiologia, Ospedale Maggiore, Bologna, Italy.
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Gonzalez MA, Ben-Dor I, Wakabayashi K, Maluenda G, Gaglia MA, Hanna NN, Delhaye C, Collins SD, Syed AI, Mitulescu LP, Torguson R, Suddath WO, Lindsay J, Pichard AD, Satler LF, Waksman R. Does on- versus off-hours presentation impact in-hospital outcomes of ST-segment elevation myocardial infarction patients transferred to a tertiary care center? Catheter Cardiovasc Interv 2011; 76:484-90. [PMID: 20882649 DOI: 10.1002/ccd.22515] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine whether in-hospital outcome differs for transferred patients with ST-segment elevation myocardial infarction (STEMI) presenting during business (ON) hours vs. after (OFF) hours. BACKGROUND Door-to-device (DTD) time is a prognostic factor in patients with STEMI and is longer during OFF hours. However, the in-hospital mortality is controversial. METHODS This registry study included 786 consecutive patients with STEMI referred for primary percutaneous coronary intervention to a tertiary care center with an on-site cardiac catheterization team 24 hrs a day/7 days (24/7) a week. ON hours were defined as weekdays 8 a.m. to 5 p.m., while OFF hours were defined as all other times, including holidays. The primary outcomes were in-hospital death, reinfarction, and length of stay (LOS). RESULTS ON hours (29.5%, n = 232) and OFF hours (70.5%, n = 554) groups had similar demographic and baseline characteristics. A significantly higher proportion of patients presenting ON hours had a DTD time ≤120 min compared to OFF hours patients (32.6% vs. 22.1%, P = 0.007). The rates of in-hospital death (8.2% vs. 6%), reinfarction (0% vs. 1.1%), and mean LOS (5.7 ± 6 vs. 5.7 ± 5) were not significantly different in the ON vs. OFF hours groups, all P = nonsignificant. CONCLUSION In a tertiary care center with an on-site cardiac catheterization team 24/7, there are no differences in in-hospital outcomes of transferred patients with STEMI during ON vs. OFF hours.
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Affiliation(s)
- Manuel A Gonzalez
- Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
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Blankenship JC. Complacency, begone. Catheter Cardiovasc Interv 2011; 76:491-2. [PMID: 20882650 DOI: 10.1002/ccd.22776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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28
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Blankenship JC. Quality metrics for each component of the STEMI care system. Catheter Cardiovasc Interv 2009; 74:835-6. [PMID: 19902504 DOI: 10.1002/ccd.22317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ortolani P, Reimers B, Tubaro M, Sesana G. How to reduce the time windows for primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2009; 10 Suppl 1:S7-11. [PMID: 19851219 DOI: 10.2459/01.jcm.0000362038.41014.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Percutaneous coronary intervention (PCI) is an effective procedure for re-establishing coronary artery perfusion in ST-segment elevation myocardial infarction. PCI is the preferred therapeutic option when it can be performed by an experienced team within 90-120 min of the first medical contact. Time from the onset of symptoms to balloon inflation seems to correlate directly with mortality rates. We discuss both hospital strategies and territorial system networks aimed at reducing the time windows for primary PCI, thereby improving clinical outcome and survival rates.
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Affiliation(s)
- Paolo Ortolani
- Istituto di Cardiologia, Policlinico S. Orsola-Malpighi, Università degli Studi di Bologna, Bologna, Italy.
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Pedersen S, Galatius S, Mogelvang R, Davidsen U, Galloe A, Abildstrom SZ, Abildgaard U, Hansen PR, Bech J, Iversen A, Jorgensen E, Kelbaek H, Saunamaki K, Madsen JK, Jensen JS. Long-Term Prognosis in an ST-Segment Elevation Myocardial Infarction Population Treated With Routine Primary Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2009; 2:392-400. [DOI: 10.1161/circinterventions.108.845636] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
We sought to describe the long-term prognosis after routine primary percutaneous coronary intervention (pPCI) in a contemporary consecutive population of patients with presumed ST-segment elevation myocardial infarction, compare it with similar results from the landmark DANAMI-2 trial, and to identify a possible impact of time of presentation and referral pattern.
Methods and Results—
Long-term prognosis in 1019 presumed ST-segment elevation myocardial infarction patients, treated according to modern routine pPCI during the year 2004, was analyzed and compared with similar data from the DANAMI-2 trial. Furthermore, we analyzed the impact of patient presentation to the angioplasty center during “off hours” (4
pm
to 8
am
plus weekends and holidays) and the impact of being referred from noninvasive hospitals. At 3 years, 20.4% in the routinely treated population versus 19.6% in the DANAMI-2 trial reached the combined end point of death, reinfarction, or stroke (
P
=0.68), whereas the all-cause mortality was 13.0% and 13.7%, respectively (
P
=0.65). Patients admitted during off hours had the same risk of reaching the combined end point of death, reinfarction, or stroke compared with patients admitted during office hours (hazards ratio, 1.04; 95% CI, 0.8 to 1.5;
P
=0.81). Door-to-balloon times of less than 90 minutes were achieved in 60% among patients admitted directly to an invasive center but only in 40% among transferred patients (
P
<0.001). Despite this difference, no difference in unadjusted or adjusted long-term prognosis was found between the 2 groups.
Conclusions—
This study shows that ST-segment elevation myocardial infarction patients treated with contemporary routine pPCI achieve a similar long-term prognosis as patients in the landmark randomized pPCI trial (DANAMI-2). Furthermore, the long-term prognosis was the same regardless of whether the pPCI was performed during off hours or office hours. Thus, pPCI including transportation of patients from noninvasive centers can be applied successfully in a real-life population.
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Affiliation(s)
- Sune Pedersen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Soren Galatius
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Rasmus Mogelvang
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ulla Davidsen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Anders Galloe
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Steen Z. Abildstrom
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ulrik Abildgaard
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Peter Riis Hansen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Jan Bech
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Allan Iversen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Erik Jorgensen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Henning Kelbaek
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Kari Saunamaki
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Jan Kyst Madsen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Jan Skov Jensen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
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Impact of day versus night as intervention time on the outcomes of primary angioplasty for acute myocardial infarction. Catheter Cardiovasc Interv 2009; 74:826-34. [DOI: 10.1002/ccd.22154] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Taglieri N, Baldazzi F, Dall'Ara G, Nardini P, Gianstefani S, Guastaroba P, Grilli R, Branzi A. Long-term effectiveness of early administration of glycoprotein IIb/IIIa agents to real-world patients undergoing primary percutaneous interventions: results of a registry study in an ST-elevation myocardial infarction network. Eur Heart J 2008; 30:33-43. [DOI: 10.1093/eurheartj/ehn480] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Percutaneous and surgical revascularization procedures in women. CURRENT CARDIOVASCULAR RISK REPORTS 2008. [DOI: 10.1007/s12170-008-0042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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