title: Influence of presentation at the weekend on treatment and outcome in ST-elevation myocardial infarction in hospitals with catheterization laboratories.
abstract: BACKGROUND
  Studies about the influence of various factors on clinical therapy and course in acute coronary syndromes have shown that the outcome is related to admission time to the hospital, with an impaired prognosis in patients admitted out of regular working hours. However little is known about the impact of admission on weekend in hospitals with catheterisation laboratories.
  
  
  METHODS
  We analyzed data of the prospective MITRA-PLUS registry of 11,516 patients with ST-elevation myocardial infarction (STEMI) admitted to hospitals with catheterization facilities for differences of in-hospital mortality between patients admitted during regular working hours, at night and on weekends.
  
  
  RESULTS
  The prehospital delay and "door-to-balloon"-time were significantly longer on weekends and at nights than at regular working hours (median 196 Vs. 240 Vs. 155 min; P < 0.0001; 60 Vs. 84 min at weekends, resp. 75 min at nights; P < 0.0001). Reperfusion therapy was performed in 72.8% (8,248/11,332) patients, and there were less patients treated on weekend versus "on"-hours (69.7 Vs. 77 %, P < 0.0001). On weekends we found a significant higher in-hospital mortality (11.1 Vs. 9.4%, P = 0.01) and at night there was a trend to higher in-hospital mortality when compared with regular working hours (10.6 Vs. 9.4%, P = 0.07).
  
  
  CONCLUSIONS
  In patients with STEMI admitted to hospitals with catheterization facilities, admission during the "off"-hours is associated with higher in-hospital mortality. This may be due to lower rates of revascularization therapy and longer prehospital and in-hospital delays as compared to "on"-hours.
authors.affiliation: Herzzentrum, Med Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany. kruethp@klilu.de
authors.forename: Patricia
authors.initials: P
authors.lastname: Krüth
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Anselm
authors.initials: A
authors.lastname: Gitt
authors.forename: Claus
authors.initials: C
authors.lastname: Jünger
authors.forename: Harm
authors.initials: H
authors.lastname: Wienbergen
authors.forename: Franz
authors.initials: F
authors.lastname: Niedermeier
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Glunz
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors