title: On- versus off-hour care for patients with non-ST-segment elevation myocardial infarction in Germany : Exemplary results within the chest pain unit concept.
abstract: OBJECTIVE
  The aim of this study was to analyze differences in the timing of invasive management of patients with high-risk acute coronary syndrome without persistent ST-segment elevation (hr-NSTE-ACS) or myocardial infarction without persistent ST-segment elevation (NSTEMI) between on- and off-hours in a German chest pain unit (CPU).
  
  
  METHODS
  We retrospectively enrolled 160 NSTEMI patients in the study, who were admitted to two German CPUs in 2013. Patients presenting on weekdays between 8 a.m. and 6 p.m. were compared with patients presenting during off-hours. Data analysis included time intervals from admission to invasive management (goals: for hr-NSTE-ACS, <2 h; for NSTEMI, <24 h) and the resulting guideline adherence.
  
  
  RESULTS
  Guideline-adherent timing of an invasive strategy did not differ significantly between the on-hour (6.5 h [3.0-22.0 h], 79.9 %) and off-hour groups (10.5 h [2.0-20.0 h], 75.3 %; p = 0.94), without additional significant differences between admissions during off-hours Monday to Thursday and weekends (10.0 h [2.0-19.0 h], 75.6 % vs. 7.5 h [2.0-20.0 h], 76.2 %; p = 0.96).
  
  
  CONCLUSIONS
  Our exemplary experience in two different German CPUs demonstrates adequate timing of coronary catheterization in over 75 % of cases, irrespective of admission during on- or off-hours. Nationwide validation of our findings by the German CPU registry is mandatory.
authors.affiliation: Klinik für Kardiologie, Klinikum Arnsberg, Stolte Ley 5, 59759, Arnsberg, Germany. f.breuckmann@klinikum-arnsberg.de.
authors.forename: F
authors.initials: F
authors.lastname: Breuckmann
authors.affiliation: Klinik für Kardiologie, Klinikum Arnsberg, Stolte Ley 5, 59759, Arnsberg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Remberg
authors.affiliation: Klinik für Kardiologie, Klinikum Arnsberg, Stolte Ley 5, 59759, Arnsberg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Böse
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Waltenberger
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Fischer
authors.affiliation: West German Heart and Vascular Center Essen, Department of Cardiology, University Duisburg-Essen, Essen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Rassaf
mesh_terms: D039602:After-Hours Care / Q000592:standards* / Q000706:statistics & numerical data*; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D015897:Comorbidity; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006757:Hospital Units / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000592:standards* / Q000706:statistics & numerical data*; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Chest pain unit; Coronary angiography; Hospitalization; Myocardial infarction, non-ST segment elevation; Patient admission