Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
JACC Cardiovasc Interv. 2019 Nov 25;12(22):2260-2268. doi: 10.1016/j.jcin.2019.07.017. Epub 2019 Oct 30.
The authors sought to assess the association between admission time with patient's care, procedure characteristics, and clinical outcomes within a contemporary ST-segment elevation myocardial infarction (STEMI) network of patients referred for primary percutaneous coronary intervention (PCI).
The effect of admission time on STEMI patient's outcomes remains controversial when primary PCI is the preferred reperfusion strategy.
Characteristics and clinical outcomes of 2,167 consecutive STEMI patients admitted in a tertiary PCI-capable center were collected. On-hours were defined as admission from Monday through Friday between 8 am and 6 pm and off-hours as admission during night shift, weekend, and nonworking holidays. In-hospital and 1-year all-cause mortality were assessed as well as key time delays.
A total of 1,048 patients (48.3%) were admitted during on-hours, and 1,119 patients (51.7%) during off-hours. Characteristics were well-balanced between the 2 groups, including rates of cardiac arrest (7.9% vs. 8.8%; p = 0.55) and cardiogenic shock (12.3% vs. 14.7%; p = 0.16). Median symptom-to-first medical contact time and median first medical contact-to-sheath insertion time did not differ according to on- versus off-hours admission (120 min vs. 126 min; p = 0.25 and 90 min vs. 93 min; p = 0.58, respectively), as well as the rate of radial access for catheterization (85.6% vs. 87.5%; p = 0.27). There was no association between on- versus off-hours groups and in-hospital (8.1% vs. 7.0%; p = 0.49) or 1-year mortality (11.0% vs. 11.1%; p = 0.89), respectively.
In a contemporary organized STEMI network, patients admitted in a high-volume tertiary primary PCI center during on-hours or off-hours had similar management and 1-year outcomes.
本研究旨在评估在一个当代 ST 段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）的网络中，患者的入院时间与治疗、操作特征和临床结局之间的关系。
当直接 PCI 是首选再灌注策略时，入院时间对 STEMI 患者结局的影响仍存在争议。
收集了 2167 例连续 STEMI 患者在一家三级 PCI 中心入院时的特征和临床结局。工作时间定义为周一至周五 8 点至下午 6 点之间的入院时间，非工作时间为夜班、周末和非工作日的入院时间。评估院内和 1 年全因死亡率以及关键的时间延迟。
共有 1048 例（48.3%）患者在工作时间入院，1119 例（51.7%）患者在非工作时间入院。两组患者的特征基本平衡，包括心搏骤停率（7.9%比 8.8%；p=0.55）和心源性休克率（12.3%比 14.7%；p=0.16）。根据入院时间，症状至首次医疗接触时间和首次医疗接触至鞘管插入时间的中位数没有差异（120 分钟比 126 分钟；p=0.25 和 90 分钟比 93 分钟；p=0.58），以及经皮冠状动脉介入治疗时的桡动脉入路率（85.6%比 87.5%；p=0.27）。与工作时间组相比，非工作时间组的院内（8.1%比 7.0%；p=0.49）和 1 年死亡率（11.0%比 11.1%；p=0.89）均无差异。
在一个当代有组织的 STEMI 网络中，在工作时间或非工作时间在大容量三级 PCI 中心就诊的患者具有相似的治疗和 1 年结局。
