Wilhelminenhospital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Vienna, Austria.
Wilhelminenhospital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Vienna, Austria.
Int J Cardiol. 2017 Oct 1;244:1-6. doi: 10.1016/j.ijcard.2017.03.029.
Several studies have shown contradictive findings regarding mortality and hospital admission time in patients presenting with ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the impact of "on-" or "off-hour" admission on short- and long-term all-cause mortality of patients in the advanced Vienna STEMI network between 2003 and 2009.
In total, 2829 patients were included into this analysis. Patients were stratified according to admission time into "on-hour" admission (07:30 until 15:00h on weekdays) and "off-hour" admission (15:00-7:30h on weekdays and 24h on weekends). As endpoint of interest, all-cause mortality was investigated after 30days and 3years of follow-up, the latter for all patients and as Landmark analysis for survivors of the index event. Mean age was 60.5±13.3years, 2048 (72.4%) patients were male and 1260 (44.5%) patients presented with anterior wall infarction. 683 (24.1%) patients were admitted "on-hours", 2146 (75.9%) patients were admitted "off-hours". All-cause death occurred in 176 (6.2%) patients after a follow-up of 30days and in 337 (11.9%) patients after 3years. For short- and long-term all-cause mortality no significant differences could be detected between "on-" and "off-hour" admission in univariate and multivariate Cox proportional hazard analyses as well as for propensity score adjusted outcome analysis.
In the Vienna STEMI network, "on-" or "off-hour" admission had no impact on short- and long-term mortality for all-comers presenting with acute STEMI. Our findings confirm the imperative need for well-structured STEMI networks of care, as previous data repeatedly demonstrated increased adverse cardiovascular outcome for "off-hour" admission.
几项研究表明，ST 段抬高型心肌梗死（STEMI）患者的死亡率和住院时间存在矛盾的结果。本研究旨在评估 2003 年至 2009 年期间维也纳高级 STEMI 网络中“就诊时段”对患者短期和长期全因死亡率的影响。
共纳入 2829 例患者进行此项分析。根据就诊时间将患者分为“就诊时段内”（周一至周五 07:30 至 15:00）和“就诊时段外”（周一至周五 15:00 至 07:30 及周末 24 小时）。将全因死亡率作为研究终点，在 30 天和 3 年随访时进行评估，后者适用于所有患者，而对于事件幸存者，则采用 Landmark 分析。患者平均年龄为 60.5±13.3 岁，2048（72.4%）例为男性，1260（44.5%）例为前壁梗死。683（24.1%）例患者“就诊时段内”就诊，2146（75.9%）例患者“就诊时段外”就诊。30 天随访时，176（6.2%）例患者发生全因死亡，3 年随访时，337（11.9%）例患者发生全因死亡。单因素和多因素 Cox 比例风险分析以及倾向评分调整结局分析均显示，“就诊时段内”与“就诊时段外”就诊在短期和长期全因死亡率方面无显著差异。
在维也纳 STEMI 网络中，对于所有急性 STEMI 患者，“就诊时段内”或“就诊时段外”就诊对短期和长期死亡率均无影响。我们的研究结果证实了建立结构化 STEMI 治疗网络的必要性，因为先前的数据反复表明“就诊时段外”就诊与不良心血管结局增加有关。
