Alkhadra Faisal, Bohaligah Sarah, Alhashim Zahraa, AlZahrani Farah, Alkhalifa Maryam, Alsaihati Fatimah, Khader Hussam, Maghraby Nisreen, Al-Hariri Mohammed
Emergency Medicine Department, Collage of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
Collage of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
Med Arch. 2025;79(3):172-180. doi: 10.5455/medarh.2025.79.172-180.
Timely reperfusion is crucial in patients with ST-segment elevation myocardial infarction (STEMI), with door-to-balloon time often considered a key metric for assessing quality of care. However, the impact of door-to-balloon time on clinical outcomes during off-hours remains uncertain.
To compare clinical outcome and door-to-balloon time of patients with STEMI in off-hours versus on-hours in King Fahad Uni-versity Hospital (KFHU).
A mixed-method, qualitative and quantitative retrospective cohort study was conducted at KFUH in Al Khobar, Saudi Arabia, including adults diagnosed with STEMI and managed with primary percutaneous coronary intervention (PCI) between May 2023 to February 2024. The sample was divided into two groups based on-duty hours. The first group comprised patients presenting during duty hours, including weekdays (Sunday to Thursday, 8 a.m. - 4 p.m.), while the second group included patients presenting during off-duty hours, which consisted of weekdays (Sunday to Thursday, 4:01 pm to 7:59 am), weekends (Friday to Saturday), national holidays, and Eid holidays.
The study included 79 patients (57 off-hours and 22 in-hours) diagnosed with STEMI who underwent primary PCI. The mean age of the participants was 55.0 years (±10.8), 89.9% were males, 36.7% were Saudi, and 41.8% were smokers. Off-hours presentation did not significantly impact mortality rates or complications compared to on-hours presentation (p > 0.05), Similarly, no significant association was found between door-to-balloon time and 48-hour or 30-day mortality rates (p > 0.05). The mean time was statistically significant across the on- and off-duty time groups (65.2±18.0 vs 107.4±44.5, p<0.0001). Hypotension was the only complication signifi-cantly associated with mortality at 30 days (p < 0.001).
Our results revealed that neither door-to-balloon time nor off-hours presentation significantly affected mortality rates or complications in pa-tients with STEMI undergoing Primary PCI, with the exception of hypotension being significantly associat-ed with 30-day mortality. Further research is warranted to explore other factors that may influence STEMI outcomes beyond door-to-balloon time and presentation hours. Additionally, investigating the specific rela-tionship between hypotension and 30-day mortality could lead to improved risk stratification and manage-ment strategies for STEMI patients.
对于ST段抬高型心肌梗死（STEMI）患者，及时再灌注至关重要，门球时间通常被视为评估医疗质量的关键指标。然而，非工作时间的门球时间对临床结局的影响仍不确定。
比较法赫德国王大学医院（KFHU）非工作时间与工作时间STEMI患者的临床结局和门球时间。
在沙特阿拉伯胡拜尔的KFHU进行了一项混合方法、定性和定量的回顾性队列研究，纳入2023年5月至2024年2月期间诊断为STEMI并接受直接经皮冠状动脉介入治疗（PCI）的成年人。样本根据值班时间分为两组。第一组包括在工作日（周日至周四，上午8点至下午4点）工作时间就诊的患者，而第二组包括在非工作时间就诊的患者，非工作时间包括工作日（周日至周四，下午4:01至上午7:59）、周末（周五至周六）、国家法定节假日和开斋节假期。
该研究纳入了79例诊断为STEMI并接受直接PCI的患者（57例非工作时间就诊，22例工作时间就诊）。参与者的平均年龄为55.0岁（±10.8），89.9%为男性，36.7%为沙特人，41.8%为吸烟者。与工作时间就诊相比，非工作时间就诊对死亡率或并发症没有显著影响（p>0.05）。同样，门球时间与48小时或30天死亡率之间也没有显著关联（p>0.05）。工作时间和非工作时间组的平均时间在统计学上有显著差异（65.2±18.0 vs 107.4±44.5，p<0.0001）。低血压是唯一与30天死亡率显著相关的并发症（p<0.001）。
我们的结果显示，对于接受直接PCI的STEMI患者，门球时间和非工作时间就诊均未显著影响死亡率或并发症，但低血压与30天死亡率显著相关。有必要进一步研究探索除门球时间和就诊时间之外可能影响STEMI结局的其他因素。此外，研究低血压与30天死亡率之间的具体关系可能会改善STEMI患者的风险分层和管理策略。
