TCT-160 Impact of admission during ON vs. OFF hours in unselected ST-Elevation Myocardial Infarction Patients treated with Primary Percutaneous Coronary Intervention.
Publié dans Journal of the American College of Cardiology, le 01 novembre 2016.
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The effect of admission during OFF-hours on patient’s outcome in ST Segment Elevation Myocardial Infarction remains controversial when primary Percutaneous Coronary Intervention (pPCI) is the chosen strategy for reperfusion. We aimed to evaluate the impact of time of admission on all cause mortality in unselected STEMI patients referred for pPCI.
We collected data from 2167 consecutive patients admitted in our institution for pPCI. Characteristics and clinical outcome of patients admitted during ON-hours (Monday through Friday, 8 am-6 pm) were compared to OFF-hours patients (night shifts, weekends and non-working Holydays). Clinical outcome was all-cause mortality, in-hospital and at 1-year follow-up.
A total of 1119 confirmed STEMI patients (51.7%) were admitted during OFF-hours and 1048 (48.3%) patients during ON-hours. Baseline characteristics were well balanced between the two groups including features of high risk STEMI such as cardiac arrest (8.9% vs. 7.9% p =0.55) and shock (14.7% vs. 12.3 % p= 0.30). Time from symptom onset to First Medical Contact (FMC) and from FMC to angiography were similar during OFF-hours and ON-hours (120 min p=0.67 and 94 min p=0.2). The use of radial access was high and not different (87.5 % and 88.4 %, p=0.27) in OFF- vs. ON-hours. In-Hospital mortality during OFF- vs. ON-hours was 1.6 % vs. 2.8% in patients without cardiac arrest or shock (p=0.14) and 45.1 % vs. 50.4% (p=0.39) in those with cardiac arrest or shock. At one-year follow-up, there was no impact of admission time on all-cause mortality (12% vs. 13.4%, p=0.40).
In our high volume, urban, primary PCI center connected with an effective pre-hospital system, we did not observe any difference in patient characteristics, management, and outcomes. The survival rate is similar during ON and OFF hours and is mainly driven by the presence of cardiac arrest or shock at admission.
CORONARY: Acute Coronary Syndromes