title: Impact of time of presentation on process performance and outcomes in ST-segment-elevation myocardial infarction: a report from the American Heart Association: Mission Lifeline program.
abstract: BACKGROUND
  Prior studies demonstrated that patients with ST-segment-elevation myocardial infarction presenting during off-hours (weeknights, weekends, and holidays) have slower reperfusion times. Recent nationwide initiatives have emphasized 24/7 quality care in ST-segment-elevation myocardial infarction. It remains unclear whether patients presenting off-hours versus on-hours receive similar quality care in contemporary practice.
  
  
  RESULTS
  Using Acute Coronary Treatment and Intervention Outcomes Network-Get With The Guidelines (ACTION-GWTG) database, we examined ST-segment-elevation myocardial infarction performance measures in patients presenting off-hours (n=27 270) versus on-hours (n=15 972; January 2007 to September 2010) at 447 US centers. Key quality measures assessed were aspirin use within first 24 hours, door-to-balloon time, door-to-ECG time, and door-to-needle time. In-hospital risk-adjusted all-cause mortality was calculated. Baseline demographic and clinical characteristics were similar. Aspirin use within 24 hours approached 99% in both groups. Among patients undergoing primary percutaneous coronary intervention (n=41 979; 97.1%), median door-to-balloon times were 56 versus 72 minutes (P<0.0001) for on-hours versus off-hours. The proportion of patients achieving door-to-balloon time ≤90 minutes was 87.8% versus 79.2% (P<0.0001), respectively. There were no differences attaining door-to-ECG time ≤10 minutes (73.4% versus 74.3%, P=0.09) and door-to-needle time ≤30 minutes (62.3% versus 58.7%; P=0.44) between on-hours versus off-hours. Although in-hospital all-cause mortality was similar (4.2%) in both groups, the risk-adjusted all-cause mortality was higher for patients presenting off-hours (odds ratio, 1.13; 95% confidence interval, 1.02-1.26).
  
  
  CONCLUSIONS
  In contemporary community practice, achievement of quality performance measures in patients presenting with ST-segment-elevation myocardial infarction was high, regardless of time of presentation. Door-to-balloon time was, however, slightly delayed (by an average of 16 minutes), and risk-adjusted in-hospital mortality was 13% higher in patients presenting off-hours.
authors: From the University of Oklahoma Health Sciences Center, Oklahoma City (T.W.D.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (M.T.R., A.Y.C., E.D.P.); Brigham and Women's Hospital, Boston, MA (R.P.G.); University of California, Los Angeles (G.C.F.); and NorthShore University Health System, Evanston, IL (J.F.S.).
authors: Tarun W
authors: TW
authors: Dasari
authors: From the University of Oklahoma Health Sciences Center, Oklahoma City (T.W.D.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (M.T.R., A.Y.C., E.D.P.); Brigham and Women's Hospital, Boston, MA (R.P.G.); University of California, Los Angeles (G.C.F.); and NorthShore University Health System, Evanston, IL (J.F.S.).
authors: Matthew T
authors: MT
authors: Roe
authors: From the University of Oklahoma Health Sciences Center, Oklahoma City (T.W.D.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (M.T.R., A.Y.C., E.D.P.); Brigham and Women's Hospital, Boston, MA (R.P.G.); University of California, Los Angeles (G.C.F.); and NorthShore University Health System, Evanston, IL (J.F.S.).
authors: Anita Y
authors: AY
authors: Chen
authors: From the University of Oklahoma Health Sciences Center, Oklahoma City (T.W.D.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (M.T.R., A.Y.C., E.D.P.); Brigham and Women's Hospital, Boston, MA (R.P.G.); University of California, Los Angeles (G.C.F.); and NorthShore University Health System, Evanston, IL (J.F.S.).
authors: Eric D
authors: ED
authors: Peterson
authors: From the University of Oklahoma Health Sciences Center, Oklahoma City (T.W.D.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (M.T.R., A.Y.C., E.D.P.); Brigham and Women's Hospital, Boston, MA (R.P.G.); University of California, Los Angeles (G.C.F.); and NorthShore University Health System, Evanston, IL (J.F.S.).
authors: Robert P
authors: RP
authors: Giugliano
authors: From the University of Oklahoma Health Sciences Center, Oklahoma City (T.W.D.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (M.T.R., A.Y.C., E.D.P.); Brigham and Women's Hospital, Boston, MA (R.P.G.); University of California, Los Angeles (G.C.F.); and NorthShore University Health System, Evanston, IL (J.F.S.).
authors: Gregg C
authors: GC
authors: Fonarow
authors: From the University of Oklahoma Health Sciences Center, Oklahoma City (T.W.D.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (M.T.R., A.Y.C., E.D.P.); Brigham and Women's Hospital, Boston, MA (R.P.G.); University of California, Los Angeles (G.C.F.); and NorthShore University Health System, Evanston, IL (J.F.S.). jsaucedo@northshore.org.
authors: Jorge F
authors: JF
authors: Saucedo
mesh_terms: D000368:Aged; D000572:American Heart Association; D001241:Aspirin / Q000627:therapeutic use; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D006297:Health Services Accessibility; D006693:Holidays; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention; D013997:Time Factors; D014481:United States
chemical_list: D001241:Aspirin
keywords: ST-segment elevation myocardial infarction; STEMI care; acute myocardial infarction; outcomes