title: The advantages of a consultant led primary percutaneous coronary intervention service on patient outcome.
abstract: BACKGROUND
  Mortality among emergency medical admissions has been reported to be higher when patients are admitted to hospital at nights and weekends.
  
  
  OBJECTIVE
  We studied the outcome of ST elevation myocardial infarction (STEMI) patients presenting at different times to our centre with 24/7 primary percutaneous coronary intervention (PPCI) service.
  
  
  METHODS
  We divided all patients who underwent PPCI between September 2009 and November 2011 into three groups according to the time of admission as group 1: in-hours (0800-1800 h weekdays), group 2: out-of-hours (1800- 0800 h weekdays) and group 3: weekends (Sat to Mon 0800-0800 h).
  
  
  RESULTS
  A total of 605 (41.1%), 397 (27%) and 469 (31.9%) were included in group 1, 2 and 3, respectively. Apart from cardiogenic shock (8.9%, 5.5% and 7.7%, P = 0.05) and door to balloon time (median 29, 33 and 36 min, P < 0.0001), there was no significant difference noted in the baseline and procedural characteristics between the groups. In-hospital mortality (4.6%, 4.3% and 5.3%, P = 0.5), 30-day mortality (6.4%, 6.3% and 7%, P = 0.7), 30-day stent thrombosis (0.8%, 0.8% and 0.2%, P = 0.1) and 1-year mortality (10.7%, 10.8% and 9.8%, P = 0.7) were no difference between the groups. On logistic regression analysis, out-of-hours and weekend admissions were not found to be a predictor of both 30-day and 1-year mortality.
  
  
  CONCLUSIONS
  In this consecutive series of patients admitted to a high volume PPCI centre, there was no difference in mortality when patients were admitted at different times. The involvement of senior medical staff early in the patients' admission may have contributed to these consistent outcomes.
authors.affiliation: Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, Essex SS16 5NL, UK. refais@gmail.com.
authors.forename: Refai
authors.initials: R
authors.lastname: Showkathali
authors.forename: John R
authors.initials: JR
authors.lastname: Davies
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Sayer
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kelly
authors.forename: Rajesh K
authors.initials: RK
authors.lastname: Aggarwal
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Clesham
mesh_terms: D039602:After-Hours Care / Q000592:standards* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D003253:Consultants; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000592:standards* / Q000706:statistics & numerical data*; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome