Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Int J Cardiol. 2013 Sep 30;168(2):1167-73. doi: 10.1016/j.ijcard.2012.11.071. Epub 2012 Nov 28.
Less invasive treatment and poorer outcomes have been shown among patients admitted with acute myocardial infarction (AMI) on weekends compared to weekdays.
To investigate the 'weekend-effect' on mortality in patients with AMI.
Using nationwide registers we identified 92,164 patients aged 30-90 years who were admitted to a Danish hospital with a first AMI from 1997 to 2009. Patients were stratified according to weekday- or weekend admissions and four time-periods to investigate for temporal changes. All-cause mortality at 2, 7, 30, and 365 days was investigated using proportional hazards Cox regression.
Mortality rates were higher on weekends within seven days of admission in 1997-99 (absolute difference ranging from 0.8 to 1.1%). Weekend-weekday hazard-ratios were 1.13 (1.03-1.23) at day 2 and 1.10 (1.01-1.18) at day 7. There were no significant differences in 2000-09 and estimates suggested an attenuation of the initial 'weekend-effect'. Overall, the use of coronary angiography (34.9% vs. 72.3%) and percutaneous coronary intervention (6.6% vs. 51.0%) within 30 days increased, as did the use of statins (49.9% vs. 80.1%.) and clopidogrel (26.7% vs. 72.7%). The cumulative mortality decreased during the study period from 5.4% to 2.5% at day of admission, from 19.5% to 11.0% at day 30 and from 28.0% to 19.0% at day 365 (all tests for trend p<0.0001).
No persistent 'weekend-effect' on mortality was present in patients with AMI in 1997-2009. Overall, mortality rates have decreased concomitantly with an increased use of current guideline-recommended invasive and medical therapy.
与工作日相比，在周末因急性心肌梗死（AMI）入院的患者接受的治疗侵入性更小，预后更差。
探讨 AMI 患者的“周末效应”对死亡率的影响。
利用全国性登记系统，我们确定了 1997 年至 2009 年期间年龄在 30-90 岁之间首次因 AMI 住院的 92164 名患者。根据工作日或周末入院情况和四个时间段进行分层，以研究时间变化。使用比例风险 Cox 回归分析 2、7、30 和 365 天的全因死亡率。
1997-99 年，入院后 7 天内周末的死亡率更高（绝对差值在 0.8%至 1.1%之间）。第 2 天和第 7 天的周末-工作日危险比分别为 1.13（1.03-1.23）和 1.10（1.01-1.18）。2000-09 年并无显著差异，且估计表明初始“周末效应”减弱。总体而言，30 天内接受冠状动脉造影（34.9% vs. 72.3%）和经皮冠状动脉介入治疗（6.6% vs. 51.0%）的比例增加，他汀类药物（49.9% vs. 80.1%）和氯吡格雷（26.7% vs. 72.7%）的使用率增加。研究期间，入院当天的累积死亡率从 5.4%降至 2.5%，第 30 天从 19.5%降至 11.0%，第 365 天从 28.0%降至 19.0%（所有趋势检验 p<0.0001）。
在 1997-2009 年期间，AMI 患者不存在持续的“周末效应”。总体而言，死亡率随着当前指南推荐的侵入性和药物治疗的使用增加而降低。
