Coronary artery diseaseOutcome of Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention During On- Versus Off-hours (A Harmonizing Outcomes With RevasculariZatiON and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Trial Substudy)
Section snippets
Methods
The HORIZONS-AMI trial was a prospective, open-label, dual-arm, factorial, randomized, multicenter trial in which bivalirudin alone was compared to heparin plus a glycoprotein IIb/IIIa inhibitor, and paclitaxel-eluting stents were compared to bare metal stents in patients with STEMI undergoing primary PCI.14 The study enrolled 3,602 patients from March 2005 to May 2007 among 123 hospitals in 11 countries. Consecutive patients aged ≥18 years who presented within 12 hours after the onset of
Results
Of the 2,440 patients included in the present substudy, 1,205 (49%) arrived to a PCI hospital during on-hours and 1,235 (51%) during off-hours. The median age was 60.2 years (interquartile range 52.4 to 69.7), with 76.6% men and 16.8% diabetics. The baseline demographic characteristics are listed in Table 1. The on-hours patients had, on average, a greater prevalence of previous angina (p = 0.008), and those presenting during off-hours were more likely to report a history of hyperlipidemia (p =
Discussion
Our results have indicated that the clinical outcomes of rather “low-risk” patients with STEMI admitted to hospitals with primary PCI capacity during off-hours are similar to those admitted during on-hours, although longer revascularization time can be expected. These findings are unique and the first to arise from nonregistry data. The HORIZONS-AMI was a large, prospective, randomized, multicenter trial of patients with STEMI. Consequently, in the present substudy, all the data were
Disclosures
Dr. Kovacic is supported by National Institutes of Health grant 1K08HL111330-01 (Bethesda, Maryland); Dr. Dangas has received research grants (institutional) from The Medicines Company (Parsippany, New Jersey), Bristol-Myers Squibb/Sanofi (New York, New York and Paris, France), and Eli Lilly and Company/Daiichi Sankyo Co. (Indianapolis, Indiana and Tokyo, Japan), and is a consultant to Abbott Vascular (Santa Clara, California), AstraZeneca (Wilmington, Delaware), Janssen Pharmaceuticals
References (26)
- et al.
Circadian variation in myocardial perfusion and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty
Am Heart J
(2005) - et al.
Factors associated with poorer prognosis for patients undergoing primary percutaneous coronary intervention during off-hours: biology or systems failure?
JACC Cardiovasc Interv
(2008) - et al.
Outcome of primary angioplasty for acute myocardial infarction during routine duty hours versus during off-hours
J Am Coll Cardiol
(2003) - et al.
The effects of off-normal hours, age, and gender for coronary angioplasty on hospital mortality in patients undergoing coronary angioplasty for acute myocardial infarction
Am J Cardiol
(2004) - et al.
Predictors of door-to-balloon delay in primary angioplasty
Am J Cardiol
(2002) - et al.
Magnitude and impact of treatment delays on weeknights and weekends in patients undergoing primary angioplasty for acute myocardial infarction (the CADILLAC trial)
Am J Cardiol
(2004) - et al.
Off-hour primary percutaneous coronary angioplasty does not affect outcome of patients with ST-segment elevation acute myocardial infarction treated within a regional network for reperfusion: the REAL (Registro Regionale Angioplastiche dell'Emilia-Romagna) registry
JACC Cardiovasc Interv
(2011) - et al.
The Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial: study design and rationale
Am Heart J
(2008) - et al.
Confronting the issues of patient safety and investigator conflict of interest in an international clinical trial of myocardial reperfusion. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) Steering Committee
J Am Coll Cardiol
(1992) - et al.
Predictors of reperfusion delay in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention from the HORIZONS-AMI trial
Am J Cardiol
(2010)
Clinical comparison of “normal-hours” vs “off-hours” percutaneous coronary interventions for ST-elevation myocardial infarction
Am Heart J
Relation of mortality of primary angioplasty during acute myocardial infarction to door-to-Thrombolysis In Myocardial Infarction (TIMI) time
Am J Cardiol
Door-to-balloon times under 90 min can be routinely achieved for patients transferred for ST-segment elevation myocardial infarction percutaneous coronary intervention in a rural setting
J Am Coll Cardiol
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2017, American Journal of CardiologyCitation Excerpt :The number of events in each trial was extracted when available. Table 1 depicts studies and patients' baseline characteristics.1,3,5–7,9–42 Methodological quality was defined as the control of bias assessed through the reported methods in each individual study using the Cochrane risk of bias tool43 and the Newcastle-Ottawa Scale44 to assess the quality of observational cohort studies.
“Off-Hours” Versus “On-Hours” Presentation in ST-Segment Elevation Myocardial Infarction: CHAMPION PHOENIX Findings
2016, Journal of the American College of Cardiology
The HORIZONS-AMI trial was sponsored by the Cardiovascular Research Foundation with research grant support from Boston Scientific (Natick, Massachusetts) and The Medicines Company (Parsippany, New Jersey).
See page 953 for disclosure information.