Yu Yue-Yan, Zhao Bo-Wen, Ma Lan, Dai Xiao-Ce
Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, China.
Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Front Cardiovasc Med. 2021 Dec 14;8:752675. doi: 10.3389/fcvm.2021.752675. eCollection 2021.
Out-of-hour admission (on weekends, holidays, and weekday nights) has been associated with higher mortality in patients with acute myocardial infarction (AMI). We conducted a meta-analysis to verify the association between out-of-hour admission and mortality (both short- and long-term) in AMI patients. This Systematic review and meta-analysis of cohort studies. PubMed and EMBASE were searched from inception to 27 May 2021. Studies of any design examined the potential association between out-of-hour admission and mortality in AMI. In total, 2 investigators extracted the data and evaluated the risk of bias. Analysis was conducted using a random-effects model. The results are shown as odds ratios [ORs] with 95% confidence intervals (CIs). value was used to estimate heterogeneity. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the certainty of the evidence. The final analysis included 45 articles and 15,346,544 patients. Short-term mortality (defined as either in-hospital or 30-day mortality) was reported in 42 articles (15,340,220 patients). Out-of-hour admission was associated with higher short-term mortality (OR 1.04; 95%CI 1.02-1.05; = 69.2%) but there was a significant statistical indication for publication bias (modified Macaskill's test < 0.001). One-year mortality was reported in 10 articles (1,386,837 patients). Out-of-hour admission was also associated with significantly increased long-term mortality (OR 1.03; 95%CI 1.01-1.04; = 66.6%), with no statistical indication of publication bias ( = 0.207). In the exploratory subgroup analysis, the intervention effect for short-term mortality was pronounced among patients in different regions ( = 0.04 for interaction) and socio-economic levels ( = 0.007 for interaction) and long-term mortality was pronounced among patients with different type of AMI ( = 0.0008 for interaction) or on different types of out-to-hour admission ( = 0.006 for interaction). Out-of-hour admission may be associated with an increased risk of both short- and long-term mortality in AMI patients. PROSPERO (CRD42020182364).
非工作时间入院（周末、节假日和平日夜间）与急性心肌梗死（AMI）患者较高的死亡率相关。我们进行了一项荟萃分析，以验证AMI患者非工作时间入院与死亡率（短期和长期）之间的关联。这是一项对队列研究的系统评价和荟萃分析。从数据库建立至2021年5月27日检索了PubMed和EMBASE。任何设计的研究均考察了AMI患者非工作时间入院与死亡率之间的潜在关联。共有2名研究人员提取数据并评估偏倚风险。采用随机效应模型进行分析。结果以比值比（OR）及95%置信区间（CI）表示。I²值用于估计异质性。采用推荐分级评估、制定与评价方法评估证据的确定性。最终分析纳入45篇文章及15346544例患者。42篇文章（15340220例患者）报告了短期死亡率（定义为住院期间或30天死亡率）。非工作时间入院与较高的短期死亡率相关（OR 1.04；95%CI 1.02 - 1.05；I² = 69.2%），但存在显著的发表偏倚统计学指征（改良Macaskill检验P < 0.001）。10篇文章（1386837例患者）报告了1年死亡率。非工作时间入院也与长期死亡率显著增加相关（OR 1.03；95%CI 1.01 - 1.04；I² = 66.6%），无发表偏倚的统计学指征（P = 0.207）。在探索性亚组分析中，不同地区患者（交互作用P = 0.04）和社会经济水平患者（交互作用P = 0.007）的短期死亡率干预效应显著，不同类型AMI患者（交互作用P = 0.0008）或不同类型非工作时间入院患者（交互作用P = 0.006）的长期死亡率干预效应显著。非工作时间入院可能与AMI患者短期和长期死亡风险增加相关。国际前瞻性系统评价注册库（CRD42020182364）。
