Onset-to-device time of patients who arrive at off-hours: Importance of prehospital management and public awareness for patients with ST-segment elevation myocardial infarction.
OBJECTIVE
The influence of the time of arrival at the hospital on the door-to-device (DTD) time has been investigated; however, the influence on the onset-to-device (OTD) time is unclear in ST-segment elevation myocardial infarction (STEMI) patients. The aim of this study was to investigate the relationship between the time of arrival at the hospital and the OTD time in STEMI patients.


METHODS
We evaluated 377 STEMI patients who underwent primary percutaneous coronary intervention (pPCI) between January 2008 and December 2014.


RESULTS
During the study period, 222 patients arrived at our hospital between 9 AM and 9 PM (on-hours group) and 155 patients arrived between 9 PM and 9 AM (off-hours group). The DTD time was longer in the off-hours group than in the on-hours group (50.4 vs 39.3 minutes; P<.001), while the OTD time was longer in the on-hours group than in the off-hours group (285.7 vs 184.5 minutes, P<.001). The 30-day mortality and peak creatinine kinase levels were similar between the groups. Transfer from a non-pPCI-capable facility to our hospital was more common in the on-hours group than in the off-hours group (49.1% vs 15.5%, P<.001). The OTD time was shorter in patients who directly visited our hospital than in those who were transferred (172.9 vs 338.5 minutes, P<.001).


CONCLUSIONS
The OTD time might be markedly longer in STEMI patients who arrive at the hospital during on-hours than in those who arrive at the hospital during off-hours because of the underuse of emergency medical services at STEMI onset.
Cardiovascular Section, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
Yukio
Y
Mizuguchi
Cardiovascular Section, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
Hiroki
H
Shibutani
Cardiovascular Section, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
Sho
S
Hashimoto
Cardiovascular Section, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
Takeshi
T
Yamada
Cardiovascular Section, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
Norimasa
N
Taniguchi
Cardiovascular Section, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
Shunsuke
S
Nakajima
Cardiovascular Section, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
Tetsuya
T
Hata
Cardiovascular Section, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
Akihiko
A
Takahashi
D039602:After-Hours Care / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood; D019091:Critical Pathways; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D016896:Treatment Outcome; D057188:Workflow
D015415:Biomarkers; D003402:Creatine Kinase
Door-to-device time; Emergency medical services; Primary percutaneous coronary intervention; ST-segment elevation myocardial infarction