Aventura Hospital Medical Center, Miami, FL, USA.
Am J Cardiol. 2013 Apr 1;111(7):946-54. doi: 10.1016/j.amjcard.2012.11.062. Epub 2013 Jan 19.
Patients with ST-segment elevation myocardial infarction (STEMI) admitted during nonregular working hours (off-hours) have been reported to have greater mortality than those admitted during regular working hours (on-hours), perhaps because of the lower availability of catheterization laboratory services and longer door-to-balloon times. This might not be the case, however, for hospital centers in which primary percutaneous coronary intervention (PCI) is invariably performed. We conducted a substudy using the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction study data to determine whether the STEMI arrival time was associated with differing clinical outcomes. We identified all patients with STEMI admitted to a PCI-capable hospital who underwent primary PCI. Patients presenting during on-hours were compared to those presenting during off-hours. The primary outcome of death, major adverse cardiovascular events, and net adverse clinical events was examined. We identified 2,440 patients (1,205 [49%] on-hours and 1,235 [51%] off-hours). Similar baseline characteristics were observed. The off-hour patients had a significantly longer door-to-balloon time (92 vs 75 minutes; p <0.0001) and total ischemic time (209 vs 194 minutes; p <0.0001). Despite these differences, the risk-adjusted all-cause mortality, major adverse cardiovascular events, and net adverse clinical events rates were similar for both groups during the in-hospital, 1-year, and 3-year follow-up. In conclusion, patients with STEMI presenting to primary PCI hospitals during off-hours might have slightly longer delays to revascularization; however, they experienced similar short- and long-term survival and clinical outcomes as those arriving during on-hours.
ST 段抬高型心肌梗死(STEMI)患者在非工作时间(非工作时间)入院的死亡率高于在工作时间(工作时间)入院的死亡率,这可能是由于导管插入术实验室服务的可用性较低和 door-to-balloon 时间较长所致。然而,对于始终进行直接经皮冠状动脉介入治疗(PCI)的医院中心,情况可能并非如此。我们使用 Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction 研究数据进行了一项子研究,以确定 STEMI 到达时间是否与不同的临床结果相关。我们确定了所有在能够进行 PCI 的医院接受直接 PCI 的 STEMI 入院患者。将工作时间就诊的患者与非工作时间就诊的患者进行比较。检查了死亡、主要不良心血管事件和净不良临床事件的主要结局。我们确定了 2440 名患者(工作时间就诊 1205 名[49%],非工作时间就诊 1235 名[51%])。观察到相似的基线特征。非工作时间就诊患者的 door-to-balloon 时间(92 分钟比 75 分钟;p <0.0001)和总缺血时间(209 分钟比 194 分钟;p <0.0001)明显更长。尽管存在这些差异,但在住院期间、1 年和 3 年随访期间,两组的全因死亡率、主要不良心血管事件和净不良临床事件发生率风险调整后相似。总之,在直接 PCI 医院就诊的 STEMI 患者再灌注治疗的延迟时间可能稍长;然而,他们在短期和长期生存和临床结局方面与工作时间就诊的患者相似。