title: Outcomes by day and night for patients bypassing the emergency department presenting with ST-segment elevation myocardial infarction identified with a pre-hospital electrocardiogram.
abstract: BACKGROUND
  Pre-hospital ECG and emergency department (ED) bypass direct to the catheter laboratory may optimize reperfusion times for patients with ST-segment elevation myocardial infarction. Questions remain over feasibility and safety during off hours.
  
  
  OBJECTIVE
  To determine if presenting time of day is associated with differences in in-hospital and 30-day mortality and key reperfusion times.
  
  
  RESULTS
  Seven hundred and twenty consecutive patients with STEMI triaged directly from the field to the catheter laboratory between June 2004-May 2013. Vital status was reported as of August 2013. The mean age was 65 ± 14 years, and 75.1% were male. Overall mortality (in-hospital/30 days) did not significantly differ for patients (3.4% in hours and 3.1% off hours; P = N/S). Symptom onset-to-arrival to the heart attack was non-significantly lower (100 minutes off hours (IQR 78-174) versus 110 minutes in hours (IQR 75-199), P = N/S). Call-to-balloon time was not significantly affected by the time of presentation: 150 min in hours (IQR 111-239) versus 154 minutes during off hours (IQR 115-225) P = N/S. Overall door-to-balloon time was 36 minutes (IQR 25-51), 34 minutes in hours (IQR 24-49) versus 40 minutes off hours (IQR 29-55) P = N/S. The overall false positive activation rate was only 13.1%, (in hours 12.2% vs. off hours 14.6%, respectively, P = N/S).
  
  
  CONCLUSIONS
  In a unit with an established field triage system facilitating ED bypass, reperfusion times and mortality are not significantly influenced by whether the patient presents during standard working hours or outside of these hours.
authors.affiliation: Royal North Shore Hospital, St Leonard's, Sydney, NSW, Australia, 2065.
authors.forename: James
authors.initials: J
authors.lastname: Cockburn
authors.forename: Keyvan
authors.initials: K
authors.lastname: Karimi
authors.forename: Soo
authors.initials: S
authors.lastname: Hoo
authors.forename: Helge
authors.initials: H
authors.lastname: Rasmussen
authors.forename: Peter
authors.initials: P
authors.lastname: Hansen
authors.forename: Gregory
authors.initials: G
authors.lastname: Nelson
authors.forename: Michael
authors.initials: M
authors.lastname: Ward
authors.forename: Ravinay
authors.initials: R
authors.lastname: Bhindi
authors.forename: Gemma
authors.initials: G
authors.lastname: Figtree
mesh_terms: D039602:After-Hours Care; D000368:Aged; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009517:New South Wales; D062645:Percutaneous Coronary Intervention; D061665:Time-to-Treatment; D014218:Triage