title: Off-hour primary percutaneous coronary angioplasty does not affect outcome of patients with ST-Segment elevation acute myocardial infarction treated within a regional network for reperfusion: The REAL (Registro Regionale Angioplastiche dell'Emilia-Romagna) registry.
abstract: OBJECTIVE
  This study aims to evaluate whether results of "off-hours" and "regular-hours" primary angioplasty (primary percutaneous coronary intervention [pPCI]) are comparable in an unselected population of patients with ST-segment elevation acute myocardial infarction treated within a regional network organization.
  
  
  BACKGROUND
  Conflicting results exist on the outcome of off-hours pPCI.
  
  
  METHODS
  We analyzed in-hospital and 1-year cardiac mortality among 3,072 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with pPCI between January 1, 2004, and June 30, 2006, during regular-hours (weekdays 8:00 AM to 8:00 PM) and off-hours (weekdays 8:01 PM to 7:59 AM, weekends, and holidays) within the STEMI Network of the Italian Region Emilia-Romagna (28 hospitals: 19 spoke and 9 hub interventional centers).
  
  
  RESULTS
  Fifty-three percent of patients were treated off-hours. Baseline findings were comparable, although regular-hours patients were older and had more incidences of multivessel disease. Median pain-to-balloon (195 min, interquartile range [IQR]: 140 to 285 vs. 186 min, IQR: 130 to 280 min; p = 0.03) and door-to-balloon time (88 min, IQR: 60 to 122 vs. 77 min, IQR: 48 to 116 min; p < 0.0001) were longer for off-hours pPCI. However, unadjusted in-hospital (5.8% off-hours vs. 7.2% regular-hours, p = 0.11) and 1-year cardiac mortality (8.4% off-hours vs. 10.3% regular-hours, p = 0.08) were comparable. At multivariate analysis, off-hours pPCI did not predict an adverse outcome either for the overall population (odds ratio [OR]: 0.70, 95% confidence interval [CI]: 0.49 to 1.01) or for patients directly admitted to the interventional center (OR: 0.79, 95% CI: 0.52 to 1.20).
  
  
  CONCLUSIONS
  When pPCI is performed within an efficient STEMI network focused on reperfusion, the clinical effectiveness of either off-hours or regular-hours pPCI is comparable.
authors: Divisione di Cardiologia, Ospedale Maggiore, Bologna, Italy. gianni.casella@alice.it
authors: Gianni
authors: G
authors: Casella
authors: Filippo
authors: F
authors: Ottani
authors: Paolo
authors: P
authors: Ortolani
authors: Paolo
authors: P
authors: Guastaroba
authors: Andrea
authors: A
authors: Santarelli
authors: Marco
authors: M
authors: Balducelli
authors: Alberto
authors: A
authors: Menozzi
authors: Paolo
authors: P
authors: Magnavacchi
authors: Giuseppe Massimo
authors: GM
authors: Sangiorgi
authors: Antonio
authors: A
authors: Manari
authors: Rossana
authors: R
authors: De Palma
authors: Antonio
authors: A
authors: Marzocchi
mesh_terms: D039602:After-Hours Care; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002983:Clinical Competence; D017023:Coronary Angiography; D019033:Delivery of Health Care, Integrated; D005260:Female; D019983:Guideline Adherence; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012040:Regional Health Planning; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors