Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Vektis B.V., Zeist, The Netherlands.
Am Heart J. 2018 Nov;205:70-76. doi: 10.1016/j.ahj.2018.07.015. Epub 2018 Aug 16.
Several studies have shown that patients admitted with an acute myocardial infarction during the weekends have a higher mortality rate than those admitted during weekdays, possibly attributable to less trained personnel available and a lower use of medical procedures. The current study aimed to assess this ‘weekend-effect’ in a nationwide registry.
In the Netherlands, all inhabitants are, by law, obliged to have health insurance and all claim data are centrally registered. In 2012 and 2013, all national diagnose-codings of STEMI and NSTEMI patients were acquired. One-year mortality rates and treatment with percutaneous coronary intervention (PCI) were compared between weekdays and weekends (holidays included).
In total, 59,534 patients (67 ± 13 years, 39,545(66%) male) were included of whom 33,904(57%) had a NSTEMI. Overall 6857(12%) patients died in the year following the acute myocardial infarction registration. In STEMI patients, no differences in one-year mortality rates were observed between admission on weekdays or weekends. In NSTEMI patients, one-year mortality was higher in those admitted during weekends (weekdays 11% versus weekends 13%, P < .001). Furthermore, STEMI patients admitted during weekends were more often treated with PCI (weekdays 77% versus weekends 81%, P < .001). Conversely, NSTEMI patients admitted during weekends were less often treated with PCI (weekdays 35% versus weekends 32%, P < .001).
Differences in treatment and mortality rates exist between acute myocardial infarction patients admitted during weekdays and weekends. NSTEMI patients admitted during weekends are less often treated with PCI and have a higher mortality rate than patients admitted during weekdays.
多项研究表明，与工作日相比，周末因急性心肌梗死入院的患者死亡率更高，这可能与周末可获得的培训人员较少和医疗程序使用率较低有关。本研究旨在全国范围内的登记处评估这种“周末效应”。
在荷兰，所有居民依法都必须参加健康保险，所有理赔数据都由中央登记处统一登记。在 2012 年和 2013 年，获取了所有 STEMI 和 NSTEMI 患者的全国诊断编码。比较了工作日和周末（包括节假日）之间的一年死亡率和经皮冠状动脉介入治疗（PCI）的治疗情况。
共纳入 59534 名患者（67±13 岁，39545 名（66%）为男性），其中 33904 名（57%）患有 NSTEMI。总体而言，在急性心肌梗死登记后一年，有 6857 名（12%）患者死亡。在 STEMI 患者中，在工作日或周末入院的一年死亡率没有差异。在 NSTEMI 患者中，周末入院的一年死亡率更高（工作日为 11%，周末为 13%，P<.001）。此外，周末入院的 STEMI 患者更常接受 PCI 治疗（工作日为 77%，周末为 81%，P<.001）。相反，周末入院的 NSTEMI 患者更常接受 PCI 治疗（工作日为 35%，周末为 32%，P<.001）。
在工作日和周末入院的急性心肌梗死患者之间存在治疗和死亡率差异。周末入院的 NSTEMI 患者接受 PCI 治疗的可能性较小，死亡率高于工作日入院的患者。
