Background There is conflicting evidence to whether the outcomes of primary percutaneous coronary Intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) are as favourable out of hours as during routine working hours.
Aim To assess the impact of the time of PPCI on the mortality in STEMI. Main outcome measures: In-hospital and long-term all-cause mortality.
Method Retrospective analysis of prospectively collected data on 2571 consecutive STEMI patients treated with PPCI between March 2008 and June 2011 at a regional tertiary centre. Of these, 1036 patients (40.3%) underwent PPCI at weekdays between 08:00 and 18:00 (routine-hours group) and 1535 patients (59.7%) underwent PPCI at weekdays between 18:00 and 08:00 or at weekends (out-of-hours group).
Results Compared to the routine-hours group, the out-of-hours group had a lower mean age (62.5±13.1 vs 64.1±13.7 years, p=0.001), a lower proportion of patients with previous history of angina (18.9% vs 23.6%, p=0.005) and a longer call-to-hospital time. The two groups were otherwise similar in all other clinical and procedural characteristics. The overall cohort in-hospital mortality rate was 4.5%; 4.2% in the routine-hours group and 4.6% in the out-of-hours group (OR; 1.05, 95% CI 0.72 to 1.54, p=0.794). During a mean follow-up period of 560 days, a total of 295 patients died (11.5%). Of these, 126 were in the routine-hours group (12.2%) and 169 in the out-of-hours group (11.0%). In the multiple Cox's proportional hazards model, there was no difference in mortality between the two groups (adjusted HR; 1.09, 95% CI 0.82 to 1.46; p=0.565). Similarly, no difference in mortality was seen in patients, who underwent PPCI at late-night time (22:00–06:00).
Conclusions PPCI outside routine working hours is safe with no difference in outcome of in-hospital and long-term mortality in comparison to PPCI during routine-working hours.
- Out of hours
- primary percutaneous coronary intervention
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