Department of Cardiovascular Medicine, Miyazaki Prefecture Nobeoka Hospital, Miyazaki, Japan.
Department of Cardiovascular Medicine, Miyazaki Prefecture Nobeoka Hospital, Miyazaki, Japan.
J Cardiol. 2020 Aug;76(2):184-190. doi: 10.1016/j.jjcc.2020.02.016. Epub 2020 Mar 19.
Owing to reduced staffing, patients hospitalized for acute myocardial infarction (AMI) during off-hours (nights, weekends, and holidays) have poorer outcomes than those admitted during regular hours. Whether the presence of an on-duty cardiologist in a hospital during off-hours is related to better outcomes for patients with AMI remains unclear. The Miyazaki Prefectural Nobeoka Hospital had a unique medical care system in that cardiologists were on call for half of the week and on duty for the other half during off-hours, thus providing an opportunity to assess the relationship between the presence of an on-duty cardiologist and patient outcomes. We examined clinical outcomes of patients admitted for AMI during off-hours according to the presence of an on-duty cardiologist.
We recruited 225 consecutive patients with AMI hospitalized during off-hours, who underwent stent implantation at Miyazaki Prefecture Nobeoka Hospital from 2013 to 2017. The endpoints were in-hospital death or long-term major adverse cardiac events (MACE) including cardiovascular death, non-fatal MI, non-fatal stroke, stent thrombosis, ischemia-driven target-lesion revascularization, admission owing to unstable angina, or admission owing to heart failure.
Based on the presence of an on-call cardiologist at admission, we divided patients into the cardiologist on-call group (n = 112) or cardiologist on-duty group (n = 113). The presence of an on-duty cardiologist did not affect door-to-reperfusion time (p = 0.776), level of peak creatine kinase (p = 0.971), or in-hospital death (p = 0.776). The Kaplan-Meier curve analysis showed similar prognosis for the cardiologist on-duty and cardiologist on-call groups (p = 0.843), and multivariable Cox regression analysis showed that the presence of an on-duty cardiologist was not associated with MACE.
The presence of an on-duty cardiologist is not a prognostic factor for patients hospitalized for AMI during off-hours in our medical system. Further prospective multicenter studies should confirm our results.
由于人手减少，在非工作时间（夜间、周末和节假日）住院的急性心肌梗死（AMI）患者的预后比在正常工作时间住院的患者差。在非工作时间医院是否有值班心脏病专家与 AMI 患者的预后是否相关尚不清楚。宫崎县延冈医院有一个独特的医疗保健系统，即心脏病专家每周有一半时间值班，另一半时间在非工作时间值班，因此有机会评估值班心脏病专家的存在与患者预后之间的关系。我们根据是否有值班心脏病专家检查了非工作时间因 AMI 住院的患者的临床结局。
我们招募了 2013 年至 2017 年在宫崎县延冈医院接受支架植入术的 225 例连续因 AMI 在非工作时间住院的患者。终点是住院期间死亡或长期主要不良心脏事件（MACE），包括心血管死亡、非致死性心肌梗死、非致死性卒中和支架血栓形成、缺血驱动的靶病变血运重建、因不稳定型心绞痛入院或因心力衰竭入院。
根据入院时是否有值班心脏病专家，我们将患者分为值班心脏病专家组（n=112）或值班心脏病专家组（n=113）。值班心脏病专家的存在并未影响门到再灌注时间（p=0.776）、肌酸激酶峰值水平（p=0.971）或住院期间死亡（p=0.776）。Kaplan-Meier 曲线分析显示，值班心脏病专家组和值班心脏病专家组的预后相似（p=0.843），多变量 Cox 回归分析显示，值班心脏病专家的存在与 MACE 无关。
在我们的医疗体系中，值班心脏病专家的存在并不是非工作时间因 AMI 住院患者的预后因素。应进行进一步的前瞻性多中心研究来证实我们的结果。
