Berger Alexandre, Stauffer Jean-Christophe, Radovanovic Dragana, Urban Philip, Bertel Osmund, Erne Paul
Service of Cardiology, Clinic Cecil, Lausanne, Switzerland.
Am J Cardiol. 2008 Feb 15;101(4):422-7. doi: 10.1016/j.amjcard.2007.09.092. Epub 2007 Dec 20.
To improve long-term survival, prompt revascularization of the infarct-related artery should be done in patients with acute myocardial infarction (AMI); therefore, a large proportion of these patients would be hospitalized during out of hours. The clinical effects of out-of-hours AMI management were already questioned, with conflicting results. The purpose of this investigation was to compare the in-hospital outcome of patients admitted for AMI during out of hours and working hours. All patients with AMI included in the AMIS Plus Registry from January 1, 1997, to March 30, 2006, were analyzed. The working-hours group included patients admitted from 7 a.m. to 7 p.m. on weekdays, and the out-of-hours group included patients admitted from 7 p.m. to 7 a.m. on weekdays or weekends. Major cardiac events were defined as cardiovascular death, reinfarction, and stroke. The study primary end points were in-hospital death and major adverse cardiac event (MACE) rates. A total of 12,480 patients met the inclusion criteria, with 52% admitted during normal working hours, and 48%, during out of hours. Patients admitted during weekdays included more women (28.1% vs 26%; p = 0.009), older patients (65.5 +/- 13 vs 64.1 +/- 13 years; p = 0.0011), less current smokers (40.1% vs 43.5%; p <0.001), and less patients with a history of ischemic heart disease (31.5% vs 34.5%; p = 0.001). A significantly higher proportion of patients admitted during out of hours had Killip's class III and IV. No differences in terms of in-hospital survival rates between the 2 groups (91.5% vs 91.2%; p = 0.633) or MACE-free survival rates (both 88.5%; p = 1.000) were noted. In conclusion, the outcome of patients with AMI admitted out of hours was the same compared with those with a weekday admission. Of predictors for in-hospital outcome, timing of admission had no significant influence on mortality and/or MACE incidence.
为提高长期生存率，急性心肌梗死（AMI）患者应尽早对梗死相关动脉进行血运重建；因此，这些患者中有很大一部分会在非工作时间住院。非工作时间急性心肌梗死管理的临床效果已受到质疑，结果相互矛盾。本研究的目的是比较非工作时间和工作时间因急性心肌梗死入院患者的院内结局。对1997年1月1日至2006年3月30日纳入AMI S Plus注册研究的所有急性心肌梗死患者进行分析。工作时间组包括工作日上午7点至晚上7点入院的患者，非工作时间组包括工作日晚上7点至次日上午7点或周末入院的患者。主要心脏事件定义为心血管死亡、再梗死和中风。研究的主要终点是院内死亡和主要不良心脏事件（MACE）发生率。共有12480例患者符合纳入标准，其中52%在正常工作时间入院，48%在非工作时间入院。工作日入院的患者女性更多（28.1%对26%；p = 0.009），年龄更大（65.5±13岁对64.1±13岁；p = 0.0011），当前吸烟者更少（40.1%对43.5%；p <0.001），有缺血性心脏病史的患者更少（31.5%对34.5%；p = 0.001）。非工作时间入院的患者中，Killip分级为III级和IV级的比例显著更高。两组的院内生存率（91.5%对91.2%；p = 0.633）或无MACE生存率（均为88.5%；p = 1.000）无差异。总之与工作日入院的急性心肌梗死患者相比，非工作时间入院患者的结局相同。在院内结局的预测因素中，入院时间对死亡率和/或MACE发生率无显著影响。
