Instituto de Cardiologia - Programa de Pós-Graduação em Ciências da Saúde, Porto Alegre, RS - Brasil.
McMaster University - Department of Medicine, Hamiton, Ontario - Canadá.
Arq Bras Cardiol. 2024 Nov 22;121(11):e20240396. doi: 10.36660/abc.20240396. eCollection 2024.
The impact of performing a primary percutaneous coronary intervention (pPCI) off-hours on clinical outcomes is not well established.
Compare characteristics and major adverse cardiovascular events (MACE) of pPCI off-hours versus on-hours in a high-volume cardiology center.
Prospective cohort of patients who underwent pPCI for ST elevation myocardial infarction (STEMI) from 2009 to 2019. We defined off-hours pPCI as workdays from 8pm to 7:59 am as well as weekends and holidays. We compared patients treated on- and off-hours as to baseline characteristics and 1-year events.
A total of 2,560 patients were treated off-hours and 1,876 patients treated on-hours. The groups were similar for most of the baseline characteristics. A higher thrombus burden was seen in patients treated off-hours (50% x 45%; p < 0.01), and in this group the radial access was more frequently used (62% x 58%; p = 0.01). Procedural success was not statistically different between the groups (95.7% x 96.4%; p = 0.21). MACE rates were higher in patients treated off-hours at 30 days (10.2% x 8.5%; p = 0.04) and at one year of follow-up (15.4% x 13.1%; p = 0.03), driven by higher death rates at 30 days (7.8% x 6.1%; p = 0.03) and at 1 year follow-up (11.1% x 9.0%; p = 0.02).
In a high-volume cardiology center, clinical characteristics, door-to-balloon times, procedural pPCI success and complication rates of STEMI patients treated on and off-hours were similar. However, patients treated off-hours presented higher MACE and mortality rates, in spite of similar MI and stroke rates.
非工作时间行直接经皮冠状动脉介入治疗（pPCI）对临床结果的影响尚未得到充分证实。
比较高容量心脏病中心非工作时间和工作时间行 pPCI 的特征和主要不良心血管事件（MACE）。
前瞻性队列研究了 2009 年至 2019 年间因 ST 段抬高型心肌梗死（STEMI）而行 pPCI 的患者。我们将非工作时间 pPCI 定义为工作日从晚上 8 点到早上 7 点 59 分以及周末和节假日。我们比较了在工作时间和非工作时间接受治疗的患者的基线特征和 1 年的事件。
共有 2560 名患者在非工作时间接受治疗，1876 名患者在工作时间接受治疗。两组患者的大多数基线特征相似。非工作时间治疗的患者血栓负荷较高（50%x45%；p<0.01），且在该组中更常使用桡动脉入路（62%x58%；p=0.01）。两组之间的手术成功率无统计学差异（95.7%x96.4%；p=0.21）。非工作时间治疗的患者在 30 天（10.2%x8.5%；p=0.04）和 1 年随访时（15.4%x13.1%；p=0.03）的 MACE 发生率更高，这主要是由于 30 天（7.8%x6.1%；p=0.03）和 1 年随访时（11.1%x9.0%；p=0.02）的死亡率更高。
在高容量心脏病中心，STEMI 患者在工作时间和非工作时间接受治疗的临床特征、门球时间、pPCI 成功率和并发症发生率相似。然而，尽管心肌梗死和中风发生率相似，但非工作时间治疗的患者 MACE 和死亡率更高。
