Published Online
on April 21, 2008

A more recent version of this article appeared on May 13, 2008

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Submitted on November 13, 2007
Accepted on March 13, 2008

Impact of Time of Presentation on the Care and Outcomes of Acute Myocardial Infarction

Hani Jneid MD^*, Gregg C. Fonarow MD, Christopher P. Cannon MD, Igor F. Palacios MD, Teoman Kilic MD, George V. Moukarbel MD, Andrew O. Maree MD, Kenneth A. LaBresh MD, Li Liang PhD, L. Kristin Newby MD, Gerald Fletcher MD, Laura Wexler MD, Eric Peterson MD, MPH, for the Get With the Guidelines Steering Committee and Investigators

From the Massachusetts General Hospital and Harvard Medical School, Boston (H.J., I.F.P., T.K., G.V.M., A.O.M.); UCLA Medical Center, Los Angeles, Calif (G.C.F.); TIMI Group and BWH, Boston, Mass (C.P.C.); Masspro, Inc, Waltham, Mass (K.A.L.); Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (L.L., L.K.N., E.P.); Mayo Clinic, Jacksonville, Fla (G.F.); and University of Cincinnati College of Medicine, Cincinnati, Ohio (L.W.).

^* To whom correspondence should be addressed. E-mail: jneid.hani{at}mgh.harvard.edu.

Background—Prior studies have demonstrated an inconsistent association between patients' arrival time for acute myocardial infarction (AMI) and their subsequent medical care and outcomes.

Methods and Results—Using a contemporary national clinical registry, we examined differences in medical care and in-hospital mortality among AMI patients admitted during regular hours (weekdays 7 AM to 7 PM) versus off-hours (weekends, holidays, and 7 PM to 7 AM weeknights). The study cohort included 62 814 AMI patients from the Get With the Guidelines–Coronary Artery Disease database admitted to 379 hospitals throughout the United States from July 2000 through September 2005. Overall, 33 982 (54.1%) patients arrived during off-hours. Compared with those arriving during regular hours, eligible off-hour patients were slightly less likely to receive primary percutaneous coronary intervention (adjusted odds ratio [OR], 0.93; 95% confidence interval [CI], 0.89 to 0.98), had longer door-to-balloon times (median, 110 versus 85 minutes; P<0.0001), and were less likely to achieve door-to-balloon 90 minutes (adjusted OR, 0.34; 95% CI, 0.29 to 0.39). Arrival during off-hours was associated with slightly lower overall revascularization rates (adjusted OR, 0.94; 95% CI, 0.90 to 0.97). No measurable differences, however, were found in in-hospital mortality between regular hours and off-hours in the overall AMI, ST-elevated MI, and non–ST-elevated MI cohorts (adjusted OR, 0.99; 95% CI, 0.93 to 1.06; adjusted OR, 1.05; 95% CI, 0.94 to 1.18; and adjusted OR, 0.97; 95% CI, 0.90 to 1.04, respectively). Similar observations were made across most age and sex subgroups and with an alternative definition for arrival time (weekends/holidays versus weekdays).

Conclusions—Despite slightly fewer primary percutaneous coronary interventions and overall revascularizations and significantly longer door-to-balloon times, patients presenting with AMI during off-hours had in-hospital mortality similar to those presenting during regular hours.

Key words: angioplasty • myocardial infarction • reperfusion • revascularization

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Circulation 2008 117: 2425-2427. [Extract] [Full Text]

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