Geng Jin, Ye Xiao, Liu Chen, Xie Jun, Chen Jianzhou, Xu Biao, Wang Bingjian
Department of Cardiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an Department of Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Department of Cardiology, Yangzhou No.1 People's hospital, Yangzhou, China.
Medicine (Baltimore). 2016 Jul;95(27):e4093. doi: 10.1097/MD.0000000000004093.
Studies evaluating the outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are scarce, particularly in China. The purpose of present study was therefore to compare the impact of off-hours and on-hours admission on clinical outcomes in STEMI patients from China.We retrospectively analyzed 1594 patients from 4 hospitals. Of these, 903 patients (56.65%) were admitted during off-hours (weekdays from 18:00 to 08:00, weekends and holidays) and 691 (43.35%) were during on-hours (weekdays from 08:00 to 18:00).Patients admitted during off-hours had higher thrombolysis in myocardial infarction risk score (4.67 ± 2.27 vs 4.39 ± 2.10, P = 0.012) and longer door-to-balloon time (72 [50-96] vs 64 [42-92] minutes, P < 0.001) than those admitted during on-hours. Off-hours admission had no association with in-hospital (unadjusted odds ratio 2.069, 95% confidence interval [CI] 0.956-4.480, P = 0.060) and long-term mortality (unadjusted hazards ratio [HR] 1.469, 95%CI 0.993-2.173, P = 0.054), even after adjustment for confounders. However, long-term outcomes, the composite of deaths and other adverse events, differed between groups with an unadjusted HR of 1.327 (95%CI, 1.102-1.599, P = 0.003), which remained significant in regression models. In a subgroup analysis, off-hours admission was associated with higher long-term mortality in the high-risk subgroup (unadjusted HR 1.965, 95%CI 1.103-3.512, P = 0.042), but not in low- and moderate-risk subgroups.This study showed no association between off-hours admission and in-hospital and long-term mortality. Stratified analysis indicated that off-hours admission was significantly associated with long-term mortality in the high-risk subgroup.
评估接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者预后的研究很少，在中国尤其如此。因此，本研究的目的是比较非工作时间入院和工作时间入院对中国STEMI患者临床预后的影响。我们回顾性分析了来自4家医院的1594例患者。其中，903例患者（56.65%）在非工作时间（工作日18:00至08:00、周末和节假日）入院，691例（43.35%）在工作时间（工作日08:00至18:00）入院。与工作时间入院的患者相比，非工作时间入院的患者心肌梗死溶栓风险评分更高（4.67±2.27 vs 4.39±2.10，P = 0.012），门球时间更长（72[50 - 96]分钟 vs 64[42 - 92]分钟，P < 0.001）。非工作时间入院与住院期间（未调整优势比2.069，95%置信区间[CI]0.956 - 4.480，P = 0.060）和长期死亡率（未调整风险比[HR]1.469，95%CI 0.993 - 2.173，P = 0.054）均无关联，即使在对混杂因素进行调整后也是如此。然而，长期预后，即死亡和其他不良事件的综合情况，在两组之间存在差异，未调整的HR为1.327（95%CI：1.102 - 1.599，P =
0.003），在回归模型中仍然显著。在亚组分析中，非工作时间入院与高危亚组的较高长期死亡率相关（未调整HR 1.965，95%CI 1.103 - 3.512，P = 0.042），但在低风险和中风险亚组中无此关联。本研究表明非工作时间入院与住院期间和长期死亡率之间无关联。分层分析表明，非工作时间入院与高危亚组的长期死亡率显著相关。
