Does on‐ versus off‐hours presentation impact in‐hospital outcomes of ST‐segment elevation myocardial infarction patients transferred to a tertiary care center?

Objectives: To determine whether in‐hospital outcome differs for transferred patients with ST‐segment elevation myocardial infarction (STEMI) presenting during business (ON) hours vs. after (OFF) hours. Background: Door‐to‐device (DTD) time is a prognostic factor in patients with STEMI and is longer during OFF hours. However, the in‐hospital mortality is controversial. Methods: This registry study included 786 consecutive patients with STEMI referred for primary percutaneous coronary intervention to a tertiary care center with an on‐site cardiac catheterization team 24 hrs a day/7 days (24/7) a week. ON hours were defined as weekdays 8 a.m. to 5 p.m., while OFF hours were defined as all other times, including holidays. The primary outcomes were in‐hospital death, reinfarction, and length of stay (LOS). Results: ON hours (29.5%, n = 232) and OFF hours (70.5%, n = 554) groups had similar demographic and baseline characteristics. A significantly higher proportion of patients presenting ON hours had a DTD time ≤120 min compared to OFF hours patients (32.6% vs. 22.1%, P = 0.007). The rates of in‐hospital death (8.2% vs. 6%), reinfarction (0% vs. 1.1%), and mean LOS (5.7 ± 6 vs. 5.7 ± 5) were not significantly different in the ON vs. OFF hours groups, all P = nonsignificant. Conclusion: In a tertiary care center with an on‐site cardiac catheterization team 24/7, there are no differences in in‐hospital outcomes of transferred patients with STEMI during ON vs. OFF hours. © 2010 Wiley‐Liss, Inc.

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