title: Outcomes of off- and on-hours admission in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A retrospective observational cohort study.
abstract: Studies evaluating the outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are scarce, particularly in China. The purpose of present study was therefore to compare the impact of off-hours and on-hours admission on clinical outcomes in STEMI patients from China.We retrospectively analyzed 1594 patients from 4 hospitals. Of these, 903 patients (56.65%) were admitted during off-hours (weekdays from 18:00 to 08:00, weekends and holidays) and 691 (43.35%) were during on-hours (weekdays from 08:00 to 18:00).Patients admitted during off-hours had higher thrombolysis in myocardial infarction risk score (4.67 ± 2.27 vs 4.39 ± 2.10, P = 0.012) and longer door-to-balloon time (72 [50-96] vs 64 [42-92] minutes, P < 0.001) than those admitted during on-hours. Off-hours admission had no association with in-hospital (unadjusted odds ratio 2.069, 95% confidence interval [CI] 0.956-4.480, P = 0.060) and long-term mortality (unadjusted hazards ratio [HR] 1.469, 95%CI 0.993-2.173, P = 0.054), even after adjustment for confounders. However, long-term outcomes, the composite of deaths and other adverse events, differed between groups with an unadjusted HR of 1.327 (95%CI, 1.102-1.599, P = 0.003), which remained significant in regression models. In a subgroup analysis, off-hours admission was associated with higher long-term mortality in the high-risk subgroup (unadjusted HR 1.965, 95%CI 1.103-3.512, P = 0.042), but not in low- and moderate-risk subgroups.This study showed no association between off-hours admission and in-hospital and long-term mortality. Stratified analysis indicated that off-hours admission was significantly associated with long-term mortality in the high-risk subgroup.
authors.affiliation: Department of Cardiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an Department of Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Department of Cardiology, Yangzhou No.1 People's hospital, Yangzhou, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Geng
authors.forename: Xiao
authors.initials: X
authors.lastname: Ye
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.forename: Jun
authors.initials: J
authors.lastname: Xie
authors.forename: Jianzhou
authors.initials: J
authors.lastname: Chen
authors.forename: Biao
authors.initials: B
authors.lastname: Xu
authors.forename: Bingjian
authors.initials: B
authors.lastname: Wang
mesh_terms: D000368:Aged; D002681:China; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D061665:Time-to-Treatment; D016896:Treatment Outcome