Enezate Tariq H, Omran Jad, Al-Dadah Ashraf S, Alpert Martin, Mahmud Ehtisham, Patel Mitul, Aronow Herbert D, Bhatt Deepak L
University of Missouri, Columbia, Missouri.
UC San Diego Sulpizio Cardiovascular Center, San Diego, California.
Am J Cardiol. 2017 Nov 15;120(10):1742-1754. doi: 10.1016/j.amjcard.2017.07.082. Epub 2017 Aug 4.
Previous studies have reported worse outcomes and longer door-to-balloon times (DBTs) in patients presenting with ST-elevation myocardial infarction (STEMI) after normal working hours, during weekends, and on holidays (off-hours) compared with normal business hours (on-hours). Recent studies, however, have reported similar outcomes regardless of presentation time. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1990 through December 2016. Only studies comparing STEMI outcomes during off-hours versus on-hours with percutaneous coronary intervention were included. A random-effects meta-analysis model was used to pool outcomes across the studies. Clinical end points included short- (<30 days of presentation), intermediate- (at 1 to 2 years), and long-term (at 3 to 4 years) stent thrombosis, mortality, recurrent myocardial infarction (MI), and major adverse cardiovascular events (MACEs). A total of 86,776 patients (62 years and 74.5% male) were identified from 39 studies. There was no significant difference between both groups with regard to mean DBT (odds ratio [OR] 0.74, 95% confidence interval [CI] -2.73 to 4.22, p = 0.67) or median DBT (p = 0.19). There was no significant difference between the 2 groups for short-term end points including mortality (OR 1.11, 95% CI 0.99 to 1.25, p = 0.08), MI (OR 1.25, 95% CI 0.90 to 1.74, p = 0.18), MACE (OR 1.06, 95% CI 0.93 to 1.20, p = 0.40), or stent thrombosis (OR 1.23, 95% CI 0.83 to 1.82, p = 0.31). Similarly, intermediate-term end points were not statistically different for mortality (OR 0.97, 95% CI 0.89 to 1.05, p = 0.46), MI (OR 0.86, 95% CI 0.73 to 1.02, p = 0.08), or MACE (OR 1.00, 95% CI 0.92 to 1.08, p = 0.98). Long-term end points did not differ statistically between groups for mortality (OR 0.95, 95% CI 0.83 to 1.09, p = 0.46), MI (OR 1.19, 95% CI 0.77 to 1.84, p = 0.44), or MACE (OR 0.98, 95% CI 0.89 to 1.08, p = 0.67). In conclusion, patients presenting with STEMI during off-hours and treated with percutaneous coronary intervention had similar short-, intermediate-, and long-term outcomes compared with patients presenting during on-hours. DBT was not affected by the time of presentation.
以往研究报告称，与正常工作时间（上班时间）相比，非工作时间（周末及节假日）出现ST段抬高型心肌梗死（STEMI）的患者预后较差，门球时间（DBT）较长。然而，近期研究报告称，无论就诊时间如何，预后相似。检索了1990年1月至2016年12月期间的MEDLINE、EMBASE和Cochrane对照试验中央注册库。仅纳入比较非工作时间与上班时间行经皮冠状动脉介入治疗的STEMI患者预后的研究。采用随机效应荟萃分析模型汇总各项研究的结果。临床终点包括短期（就诊后<30天）、中期（1至2年）和长期（3至4年）支架血栓形成、死亡率、再发心肌梗死（MI）和主要不良心血管事件（MACE）。从39项研究中识别出86776例患者（62岁，男性占74.5%）。两组间平均DBT（比值比[OR]0.74，95%置信区间[CI] -2.73至4.22，p = 0.67）或中位DBT（p = 0.19）无显著差异。两组间短期终点包括死亡率（OR 1.11，95%CI 0.99至1.25，p = 0.08）、MI（OR 1.25，95%CI 0.90至1.74，p = 0.18）、MACE（OR 1.06，95%CI 0.93至1.20，p = 0.40）或支架血栓形成（OR 1.23，95%CI 0.83至1.82，p = 0.31）无显著差异。同样，中期终点在死亡率（OR 0.97，95%CI 0.89至1.05，p = 0.46）、MI（OR 0.86，95%CI 0.73至1.02，p = 0.08）或MACE（OR 1.00，95%CI 0.92至1.08，p = 0.98）方面无统计学差异。两组间长期终点在死亡率（OR 0.95，95%CI 0.83至1.09，p = 0.46）、MI（OR 1.19，95%CI 0.77至1.84，p = 0.44）或MACE（OR 0.98，95%CI 0.89至1.08，p = 0.67）方面无统计学差异。总之，与上班时间就诊的患者相比，非工作时间出现STEMI并行经皮冠状动脉介入治疗的患者在短期、中期和长期预后相似。DBT不受就诊时间影响。
