Association Between Off-hour Presentations and In-hospital Mortality for Patients with Acute ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Elnaz Javanshir; Elham Darzi Ramandi; Samad Ghaffari; Babak Nasiri; Haleh Bodagh; Ghiti Davarmoin; Naser Aslanabadi; Ahmad Separham

doi:10.37616/2212-5043.1059

Association Between Off-hour Presentations and In-hospital Mortality for Patients with Acute ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

J Saudi Heart Assoc. 2020 Jun 4;32(2):242-247. doi: 10.37616/2212-5043.1059. eCollection 2020.

Authors

Elnaz Javanshir¹, Elham Darzi Ramandi¹, Samad Ghaffari¹, Babak Nasiri², Haleh Bodagh¹, Ghiti Davarmoin¹, Naser Aslanabadi¹, Ahmad Separham¹

Affiliations

¹ Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiology Department, Daneshgah Ave, Tabriz, Iran.
² Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiac Surgery Department, Daneshgah Ave, Tabriz, Iran.

Abstract

Objectives: This study aimed to assess the effect of the admission time (on-hours versus off-hours) on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) in a region without STEMI network.

Methods: We analysed in-hospital the mortality among 300 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with PPCI between March 2012 and February 2017. Patients were divided according to admission time into on-hours admission (08:00 AM until 08:00 PM on weekdays) versus off-hours admission (08:00 PM until 08:00 AM on weekdays and 24 h on weekends and holidays). Demographic and clinical data as well as in-hospital mortality were compared between the two groups.

Results: One hundred and seventy eight (59.3%) patients were admitted during on-hours, and 122 (40.7%) patients were presented in off-hours. The mean door-to-balloon time was 42.3 min in the off-hours group and 34.2 min in the on-hours group with no statistically significant difference (p = 0.39). The mortality rate was 3.9% at on-hours presentation versus 4.09% in off-hours admission (p = 0.58). Multivariate logistic regression analysis showed that off-hours presentation was not associated with in-hospital mortality. [odds ratio (OR) 0.74; 95% CI, 0.21-2.61, p = 0.64].

Conclusion: Despite no efficient STEMI network in present study, off-hour presentation had no significant impact on in-hospital prognosis in patients with STEMI treated with PPCI. Larger studies are warranted in order to determine the prognostic role of off-hour presentation in patients with STEMI undergoing PPCI.

Keywords: Acute myocardial infarction; In-hospital mortality; Off-hours; Primary percutaneous coronary intervention; STEMI network.