title: Does on- versus off-hours presentation impact in-hospital outcomes of ST-segment elevation myocardial infarction patients transferred to a tertiary care center?
abstract: OBJECTIVE
  To determine whether in-hospital outcome differs for transferred patients with ST-segment elevation myocardial infarction (STEMI) presenting during business (ON) hours vs. after (OFF) hours.
  
  
  BACKGROUND
  Door-to-device (DTD) time is a prognostic factor in patients with STEMI and is longer during OFF hours. However, the in-hospital mortality is controversial.
  
  
  METHODS
  This registry study included 786 consecutive patients with STEMI referred for primary percutaneous coronary intervention to a tertiary care center with an on-site cardiac catheterization team 24 hrs a day/7 days (24/7) a week. ON hours were defined as weekdays 8 a.m. to 5 p.m., while OFF hours were defined as all other times, including holidays. The primary outcomes were in-hospital death, reinfarction, and length of stay (LOS).
  
  
  RESULTS
  ON hours (29.5%, n = 232) and OFF hours (70.5%, n = 554) groups had similar demographic and baseline characteristics. A significantly higher proportion of patients presenting ON hours had a DTD time ≤120 min compared to OFF hours patients (32.6% vs. 22.1%, P = 0.007). The rates of in-hospital death (8.2% vs. 6%), reinfarction (0% vs. 1.1%), and mean LOS (5.7 ± 6 vs. 5.7 ± 5) were not significantly different in the ON vs. OFF hours groups, all P = nonsignificant.
  
  
  CONCLUSIONS
  In a tertiary care center with an on-site cardiac catheterization team 24/7, there are no differences in in-hospital outcomes of transferred patients with STEMI during ON vs. OFF hours.
authors.affiliation: Division of Cardiology, Washington Hospital Center, Washington, District of Columbia.
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Gonzalez
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Hanna
authors.forename: Cedric
authors.initials: C
authors.lastname: Delhaye
authors.forename: Sara D
authors.initials: SD
authors.lastname: Collins
authors.forename: Asmir I
authors.initials: AI
authors.lastname: Syed
authors.forename: Lavinia P
authors.initials: LP
authors.lastname: Mitulescu
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D039602:After-Hours Care; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016507:Cardiology Service, Hospital; D016009:Chi-Square Distribution; D003422:Critical Care; D004219:District of Columbia; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012008:Recurrence; D012017:Referral and Consultation; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload