Emergency service admission time and in-hospital mortality in acute coronary syndrome.
BACKGROUND
The relationship between admission time to an emergency service and in-hospital outcomes in acute coronary syndrome (ACS) is controversial. Admission during off-hours would be associated with worse prognosis.


OBJECTIVE
To assess the influence of admission time on prolonged hospitalization and mortality for ACS patients, regarding regular hours (7AM-7PM) and off-hours (7PM-7AM).


METHODS
The study assessed prospectively 1,104 consecutive ACS patients. In-hospital mortality and length of hospital stay ≥ 5 days were the outcomes analyzed.


RESULTS
Admission during regular hours was greater as compared with that during off-hours (63% vs. 37%; p < 0.001). Unstable angina was more prevalent during regular hours (43% vs. 32%; p < 0.001), while non-ST-segment elevation myocardial infarction (NSTEMI) was during off-hours (33% vs. 43%; p = 0.001). Differences in neither mortality nor length of hospital stay were observed in the time periods studied. Predictive factors for length of hospital stay ≥ 5 days were as follows: age [OR 1.042 (95%CI: 1.025 - 1.058), p < 0.001]; ejection fraction (EF) [OR 0.977 (95%CI: 0.966 - 0.988), p < 0.001]; NSTEMI [OR 1.699 (95%CI: 1.221 - 2.366), p = 0.001]; and smoking [OR 1.723 (95%CI: 1.113 - 2.668), p = 0.014]. Predictive factors for in-hospital mortality were as follows: age [OR 1.090 (95%CI: 1.047 - 1.134), p < 0.001]; EF [OR 0.936 (95%CI: 0.909 - 0.964), p < 0.001]; and surgical treatment [OR 3.781 (95%CI: 1.374 - 10.409), p = 0.01].


CONCLUSIONS
Prolonged length of hospital stay and in-hospital mortality in ACS patients do not depend on admission time.
Instituto do Coração, HC, FMUSP, São Paulo, SP, Brasil.
Julio Yoshio
JY
Takada
Larissa Cardoso
LC
Roza
Rogério Bicudo
RB
Ramos
Solange Desiree
SD
Avakian
José Antonio Franchini
JA
Ramires
Antonio de Pádua
Ade P
Mansur
D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy; D000789:Angina, Unstable / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D013997:Time Factors