Significance of off-hours in centralized primary percutaneous coronary intervention network.
OBJECTIVE
To analyze the efficacy of a regionally organized primary percutaneous coronary intervention (PCI) network at the Heart Center, Semmelweis University Budapest, part of the "Budapest model," and the factors that influence it.


METHODS
In order to investigate the differences between regular and off-hours patient care in a 24-hour myocardial infarction primary care system, we included 1890 consecutive, unselected patients with ST-segment elevation myocardial infarction and followed them until at least one year. The follow-up was complete for all participants.


RESULTS
The difference between regular hours and off-hours mortality was not significant either after 30 days (8.6% vs 8.8%, respectively) or after 1 year (15.3% vs 14.7%, respectively). The rate of patients with re-infarction, frequency of re-intervention, and major adverse cardiac events, including death, re-infarction, re-intervention, and coronary artery bypass graft surgery, were similar in both patient groups. The time delay between the onset of chest pain and arrival to the clinic was 5.9+/-5.8 hours (mean+/- standard deviation) during regular hours and 5.2+/-4.6 hours during off-hours (P=0.235). Direct transport caused significant decrease in the 30-day and 1-year mortality independent of duty time (7.2% vs 9.9%, P=0.027; 12.6% vs 16.7%, P=0.028; respectively).


CONCLUSIONS
Centralized primary PCI network of the "Budapest model" achieved the same level of patient care during both off-hours and regular hours.
Heart Center Semmelweis University, Budapest, Hungary.
David
D
Becker
Pal
P
Soos
Balazs
B
Berta
Andrea
A
Nagy
Gabor
G
Fulop
Gyorgy
G
Szabo
Gyorgy
G
Barczi
Eva
E
Belicza
Istvan
I
Martai
Béla
B
Merkely
D039602:After-Hours Care / Q000458:organization & administration*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D019058:Community Networks; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009203:Myocardial Infarction / Q000628:therapy*; D011320:Primary Health Care / Q000458:organization & administration*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome