非工作时间就诊不影响日本急性心肌梗死患者的院内死亡率：J-MINUET 子研究
Off-hours presentation does not affect in-hospital mortality of Japanese patients with acute myocardial infarction: J-MINUET substudy.
作者信息
Ogita Manabu, Suwa Satoru, Ebina Hideki, Nakao Koichi, Ozaki Yukio, Kimura Kazuo, Ako Junya, Noguchi Teruo, Yasuda Satoshi, Fujimoto Kazuteru, Nakama Yasuharu, Morita Takashi, Shimizu Wataru, Saito Yoshihiko, Hirohata Atsushi, Morita Yasuhiro, Inoue Teruo, Okamura Atsunori, Uematsu Masaaki, Hirata Kazuhito, Tanabe Kengo, Shibata Yoshisato, Owa Mafumi, Hokimoto Seiji, Funayama Hiroshi, Kokubu Nobuaki, Kozuma Ken, Uemura Shiro, Toubaru Tetsuya, Saku Keijiro, Oshima Shigeru, Nishimura Kunihiro, Miyamoto Yoshihiro, Ishihara Masaharu
机构信息
Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
出版信息
J Cardiol. 2017 Dec;70(6):553-558. doi: 10.1016/j.jjcc.2017.05.006. Epub 2017 Jul 3.
BACKGROUND
The association between patients with acute myocardial infarction (AMI) who present during off-hours and clinical outcomes has not been fully elucidated.
METHODS
We investigated 3283 consecutive patients with AMI who were selected from a prospective, nationwide, multicenter registry (J-MINUET) database comprising 28 institutions in Japan between July 2012 and March 2014 to determine the current impact of off-hours presentation on in-hospital mortality among Japanese patients with AMI.
RESULTS
Among the patients, 52% presented in off-hours. Baseline characteristics were comparable, although those who presented during off-hours were younger and had a higher incidence of ST-elevation myocardial infarction and advanced Killip Class. The time from symptom onset to presentation time was shorter in off-hour patients (120min, interquartile range 60 to 256 vs. 215min, interquartile range 90 to 610, p<0.0001). In contrast, 85% of patients underwent primary percutaneous coronary intervention (PCI) and door to balloon time was comparable between the groups (74min, interquartile range 52 to 113 vs. 75min, interquartile range 52 to 126, p=0.34). The rates of in-hospital mortality were comparable (6.2% vs 6.8%, p=0.39). Multivariate logistic regression analysis revealed that off-hours presentation was not significantly associated with in-hospital mortality [odds ratio (OR) 0.94; 95% CI, 0.68-1.30, p=0.70].
CONCLUSION
The clinical impact of presenting during off-hours or regular hours on AMI patients in Japan is comparable in contemporary practice.
TRIAL REGISTRATION
UMIN Unique trial Number: UMIN000010037.
背景
非工作时间就诊的急性心肌梗死（AMI）患者与临床结局之间的关联尚未完全阐明。
方法
我们调查了2012年7月至2014年3月期间从日本28家机构的前瞻性全国多中心注册库（J-MINUET）数据库中选取的3283例连续AMI患者，以确定非工作时间就诊对日本AMI患者院内死亡率的当前影响。
结果
在这些患者中，52%在非工作时间就诊。尽管非工作时间就诊的患者更年轻，ST段抬高型心肌梗死和高级Killip分级的发生率更高，但基线特征具有可比性。非工作时间就诊患者从症状发作到就诊的时间更短（120分钟，四分位间距60至256分钟，而215分钟，四分位间距90至610分钟，p<0.0001）。相比之下，85%的患者接受了直接经皮冠状动脉介入治疗（PCI），两组之间的门球时间具有可比性（74分钟，四分位间距52至113分钟，而75分钟，四分位间距52至126分钟，p=0.34）。院内死亡率相当（6.2%对6.8%，p=0.39）。多因素逻辑回归分析显示，非工作时间就诊与院内死亡率无显著关联[比值比（OR）0.94；95%置信区间，0.68-1.30，p=0.70]。
结论
在当代实践中，非工作时间或正常时间就诊对日本AMI患者的临床影响相当。
试验注册
UMIN唯一试验编号：UMIN000010037。
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