title: Reassessing After-Hour Arrival Patterns and Outcomes in ST-Elevation Myocardial Infarction.
abstract: BACKGROUND
  Differences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours.
  
  
  METHODS
  Using a prospective observational study, we analyzed all 1,247 non-transfer STEMI patients treated in 15 percutaneous coronary intervention (PCI) facilities in Dallas, Texas, during a 24-month period (2010-2012). Controlling for confounding factors through a variety of statistical techniques, we explored differences in door-to-balloon (D2B) and in-hospital mortality for those presenting on weekends vs. weekdays and business vs. after hours.
  
  
  RESULTS
  Patients who arrived at the hospital on weekends had larger D2B times compared to weekdays (75 vs. 65 minutes; KW=48.9; p<0.001). Patients who arrived after-hours had median D2B times >16 minutes longer than those who arrived during business hours and a higher likelihood of mortality (OR 2.23, CI [1.15-4.32], p<0.05).
  
  
  CONCLUSIONS
  Weekends and after-hour PCI coverage is still associated with adverse D2B outcomes and in-hospital mortality, even in major urban settings. Disparities remain in after-hour STEMI treatment.
authors.affiliation: University of Texas Health Science Center, Houston, Texas.
authors.forename: James
authors.initials: J
authors.lastname: Langabeer
authors.affiliation: University of Texas Health Science Center, Division of Management, Policy, and Community Health, Houston, Texas.
authors.forename: Diaa
authors.initials: D
authors.lastname: Alqusairi
authors.affiliation: Medical University of South Carolina, Department of Healthcare Leadership and Management, Charleston, South Carolina.
authors.forename: Jami L
authors.initials: JL
authors.lastname: DelliFraine
authors.affiliation: UT Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas.
authors.forename: Ray
authors.initials: R
authors.lastname: Fowler
authors.affiliation: UT Southwestern Medical Center, Department of Health Care Sciences, Dallas, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: King
authors.affiliation: American Heart Association, United States.
authors.forename: Wendy
authors.initials: W
authors.lastname: Segrest
authors.affiliation: Cedars-Sinai Heart Institute, United States.
authors.forename: Timothy
authors.initials: T
authors.lastname: Henry
mesh_terms: D039602:After-Hours Care / Q000592:standards*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards*; D013781:Texas / Q000453:epidemiology; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment