Freeman Hospital, Newcastle University, Newcastle-upon-Tyne NE7 7DN, UK.
Eur Heart J. 2012 Dec;33(24):3046-53. doi: 10.1093/eurheartj/ehs261. Epub 2012 Sep 4.
To assess the impact of the time of primary percutaneous coronary intervention (PPCI) on in-hospital and long-term all-cause mortality in ST-segment elevation myocardial infarction (STEMI).
The study retrospectively analyses the prospectively collected data on 2571 consecutive PPCI-treated STEMI patients between March 2008 and June 2011. Of these, 1036 patients (40.3%) underwent PPCI during a weekday between 08:00 and 18:00 (routine-hours group) and 1535 patients (59.7%) underwent PPCI on a weekday between 18:00 and 08:00 or a weekend (out-of-hours group). Compared with the routine-hours group, the out-of-hours group had a lower mean age, fewer patients with previous angina, longer call-to-hospital time, and fewer multivessel PCI. The overall in-hospital mortality rate was 4.5% with no significant difference [0.2%, 95% confidence interval (CI): -1.4 to 1.9%] between the routine-hours group (4.3%) and the out-of-hours group (4.6%) (adjusted odds ratio: 1.33, 95% CI: 0.73-2.40, P = 0.35). During a mean follow-up period of 560 days, 295 patients (11.5%) died, 12.2% in the routine-hours group and 11.0% in the out-of-hours group (difference of -0.1%, 95% CI: -0.4 to 0.2%). In the multiple Cox proportional hazards model, there was no difference in mortality between the two groups (adjusted hazard ratio: 1.09, 95% CI: 0.82-1.46, P = 0.57). Similarly, no increase in mortality was seen in patients who underwent PPCI later at night (22:00-06:00).
This study of real-world, unselected STEMI patients demonstrates that in a large, well-staffed centre, PPCI outside routine-working hours is safe with no difference in outcome of in-hospital and long-term mortality compared with PPCI during routine-working hours.
评估直接经皮冠状动脉介入治疗（PPCI）的时间对 ST 段抬高型心肌梗死（STEMI）患者住院期间和长期全因死亡率的影响。
本研究回顾性分析了 2008 年 3 月至 2011 年 6 月期间连续 2571 例接受 PPCI 治疗的 STEMI 患者前瞻性收集的数据。其中，1036 例（40.3%）患者在 08:00 至 18:00（常规时段）之间的工作日进行 PPCI（常规时段组），1535 例（59.7%）患者在工作日 18:00 至 08:00 或周末（非工作时段组）进行 PPCI。与常规时段组相比，非工作时段组患者年龄更小，既往心绞痛患者更少，呼叫至医院时间更长，多血管 PCI 更少。住院期间总体死亡率为 4.5%，常规时段组（4.3%）和非工作时段组（4.6%）之间无显著差异[0.2%，95%置信区间（CI）：-1.4 至 1.9%]（校正优势比：1.33，95%CI：0.73-2.40，P=0.35）。在平均 560 天的随访期间，有 295 例（11.5%）患者死亡，常规时段组为 12.2%，非工作时段组为 11.0%（差异为-0.1%，95%CI：-0.4 至 0.2%）。在多 Cox 比例风险模型中，两组死亡率无差异（校正风险比：1.09，95%CI：0.82-1.46，P=0.57）。同样，在夜间较晚时间（22:00-06:00）进行 PPCI 的患者死亡率也没有增加。
这项针对真实世界、未经选择的 STEMI 患者的研究表明，在一个人员配备充足的大型中心，非工作时段进行 PPCI 是安全的，与工作时段进行 PPCI 相比，住院期间和长期死亡率的结果没有差异。
