October 29, 2019
Off-Hour Versus On-Hour Admission Time and Mortality Studied in STEMI Patients Treated With Primary PCI
October 30, 2019—Investigators from the ACTION Study Group at Hôpital Pitié-Salpêtrière in Paris, France, sought to assess the association between admission time and patient care, procedural characteristics, and clinical outcomes within a contemporary ST-segment elevation myocardial infarction (STEMI) network of patients referred for primary percutaneous coronary intervention (PCI). Benoit Lattuca, MD, et al published the findings online in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.
The study’s background is that the effect of admission time on STEMI patients’ outcomes remains controversial when primary PCI is the preferred reperfusion strategy.
As summarized in JACC: Cardiovascular Interventions, the investigators collected characteristics and clinical outcomes of 2,167 consecutive STEMI patients admitted in a tertiary PCI-capable center. They assessed in-hospital and 1-year all-cause mortality, as well as key time delays. “On-hours” were defined as admission from Monday through Friday between 8:00 AM and 6:00 PM. “Off-hours” were defined as admission during night shift, weekend, and nonworking holidays.
The investigators reported that a total of 1,048 patients (48.3%) were admitted during on-hours, and 1,119 patients (51.7%) were admitted during off-hours. Characteristics were well-balanced between the two groups, including rates of cardiac arrest (7.9% vs 8.8%, respectively; P = .55) and cardiogenic shock (12.3% vs 14.7%, respectively; P = .16).
There was no difference in on- versus off-hours admission for:
- Median symptom-to-first medical contact time (120 min vs 126 min; P = .25)
- Median first medical contact-to-sheath insertion time (90 min vs 93 min; P = .58)
- Rate of radial access for catheterization (85.6% vs 87.5%; P = .27)
No association was found between on- versus off-hours groups for:
- In-hospital mortality (8.1% vs 7%; P = .49)
- One-year mortality (11% vs 11.1%; P = .89)
In a contemporary organized STEMI network, patients admitted in a high-volume, tertiary, primary PCI center during on-hours or off-hours had similar management and 1-year outcomes, concluded the investigators in JACC: Cardiovascular Interventions.