Jha Anil, Ojha Chandra P, Bhattad Pradnya Brijmohan, Sharma Ashish, Thota Ajit, Mishra Ajay Kumar, Krishnan Anand M, Roumia Mazen
Department of Cardiovascular Medicine, St. Vincent Hospital, UMass Chan Medical School, Worcester, Massachusetts.
Department of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas.
Coron Artery Dis. 2023 Mar 1;34(2):119-126. doi: 10.1097/MCA.0000000000001211. Epub 2022 Dec 23.
Patientswho present with acute ST elevation myocardial infarction (STEMI) need emergent revascularization. Our study aims to investigate the outcomes in patients with STEMI admitted during weekends versus weekdays.
We conducted a retrospective analysis of the nationwide inpatient sample database. Patients with an admitting diagnosis of STEMI identified by the International Classification of Disease code for the year 2016 were analyzed. A weighted descriptive analysis was performed to generate national estimates. Patients admitted over the weekend were compared to those admitted over the weekday. Patients were stratified by demographic and clinical factors including the Elixhauser comorbidity index. The primary outcome was in-hospital mortality and secondary outcomes were percutaneous coronary intervention (PCI) utilization rate, rate of transfer-out, length of stay (LOS), and total hospital charges. Statistical analysis including linear and logistic regression was performed using STATA.
A total of 163 715 adult patients were admitted with STEMI, of which 27.9% (45 635) were admitted over the weekend. There were 76.2% Caucasians, 9.3% African Americans, and 8.0% Hispanics. Mean age of the patients was 63.2 years (95% CI, 62.9-63.5) for the weekend group and 63.7 years (95% CI, 63.5-63.9) for weekday admissions. The majority of the patients in both groups had Medicare (43.7% and 45.8% on weekends and weekdays, respectively; P = 0.0047). After adjusting for age, sex, race, income, Elixhauser comorbidity index, PCI use, hospital location, teaching status, and bed size, mortality was not significantly different in weekend versus weekday admissions (odds ratios 1.04; P = 0.498; 95% CI, 0.93-1.16). There was no significant difference in mean total charge per admission during the weekend versus weekday admissions ($107 093 versus $106 869; P = 0.99.) Mean LOS was 4.1 days for both groups (P = 0.81).
There were no significant differences in mortality, LOS, or total hospital charge in STEMI patients being admitted during the weekend versus weekdays.
急性ST段抬高型心肌梗死（STEMI）患者需要紧急血运重建。我们的研究旨在调查周末与工作日入院的STEMI患者的治疗结果。
我们对全国住院患者样本数据库进行了回顾性分析。分析了通过2016年国际疾病分类代码确定为STEMI入院诊断的患者。进行加权描述性分析以得出全国估计值。将周末入院的患者与工作日入院的患者进行比较。根据人口统计学和临床因素（包括埃利克斯豪泽合并症指数）对患者进行分层。主要结局是住院死亡率，次要结局是经皮冠状动脉介入治疗（PCI）利用率、转出率、住院时间（LOS）和总住院费用。使用STATA进行包括线性和逻辑回归在内的统计分析。
共有163715名成年患者因STEMI入院，其中27.9%（45635名）在周末入院。患者中有76.2%为白人，9.3%为非裔美国人，8.0%为西班牙裔。周末组患者的平均年龄为63.2岁（95%置信区间，62.9 - 63.5），工作日入院患者的平均年龄为63.7岁（95%置信区间，63.5 - 63.9）。两组中的大多数患者都有医疗保险（周末和工作日分别为43.7%和45.8%；P = 0.0047）。在调整年龄、性别、种族、收入、埃利克斯豪泽合并症指数、PCI使用情况、医院位置、教学状况和床位规模后，周末与工作日入院患者的死亡率无显著差异（比值比1.04；P = 0.498；95%置信区间，0.93 - 1.16）。周末与工作日入院每次住院的平均总费用无显著差异（107093美元对106869美元；P = 0.99）。两组的平均住院时间均为4.1天（P = 0.81）。
周末与工作日入院的STEMI患者在死亡率、住院时间或总住院费用方面无显著差异。
