Abstract 19994: No Mortality Advantage of “On” versus “Off”-hours Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: Results from the Massachusetts Data Analysis Center Registry
Background: A higher mortality rate has been reported in STEMI admissions during off-hours due to lower availability of primary percutaneous coronary intervention (PCI) and longer door-to-balloon-times (DTB). The data however remains controversial, and is non-applicable to a wide range of hospitals that routinely perform primary PCI. The purpose of this study was to establish whether STEMI admissions undergoing primary PCI have worse in-hospital outcomes during off-hours.
Methods: Using the large, mandatory state-wide database of Massachusetts with consistently audited outcomes, we identified all STEMI patients who between 2006 and 2008 were admitted for primary PCI to an acute care hospital facility where primary PCI is routinely performed. Patients admitted during on-hours where compared to off-hours, which included weekends and holidays. Transfer patients or those previously treated with thrombolytics were excluded. The outcome of in-hospital mortality, cardiogenic shock and recurrent MI was examined.
Results: Our cohort included 3892 patients (42% on-hours vs. 58% off-hours) with a mean age of 61±13 years. Demographic characteristics were similar between on- and off-hours groups. Overall, among off- and on-hours respectively, there were no differences in the incidence of in-hospital death (p=0.66), recurrent MI (p=0.11), and cardiogenic shock (p=0.84) between both groups. However, off-hours STEMI admissions had significantly longer mean DTB (87.6 min vs. 68.4 min, p<0.001) and longer time period from onset of symptoms to admission was observed during the on-hour period (p=0.01)
Conclusions: Our findings, based on large registry data demonstrate that despite longer DTB times, similar rates of in-hospital death, recurrent MI, and periprocedural cardiogenic shock may be expected in STEMI patients admitted during off-hours when primary PCI is performed
- © 2010 by American Heart Association, Inc.