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Title: The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction.
Austin Authors: Biswas, Sinjini;Brennan, Angela;Duffy, Stephen J;Andrianopoulos, Nick;Chan, William;Walton, Antony;Noaman, Samer;Shaw, James A;Ajani, Andrew;Clark, David J ;Freeman, Melanie;Hiew, Chin;Oqueli, Ernesto;Lefkovits, Jeffrey;Reid, Christopher M;Stub, Dion
Affiliation: Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
School of Medicine, Deakin University, Ballarat, Victoria, Australia
Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
School of Public Health, Curtin University, Perth, WA, Australia
Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
Department of Cardiology, University Hospital Geelong, Geelong, Victoria, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Issue Date: Jun-2020 2019-06-22
Publication information: Heart, Lung & Circulation 2020; 29(6): 814-823
Abstract: Systems of care have been established to ensure patients with ST-elevation myocardial infarction (STEMI) get timely access to primary percutaneous coronary intervention (PPCI). In this study, we evaluated whether patients undergoing PPCI both in-hours and out-of-hours experience similar care and clinical outcomes. Of 9,865 patients who underwent PCI for STEMI from 2005 to 2016 and were enrolled in the multi-centre Melbourne Interventional Group registry, patients who had initially presented to a non-PCI capable hospital, received thrombolysis or presented >12hourspost-symptom onset were excluded. Our final study cohort of 4,590 patients were dichotomised by whether PPCI was performed in-hours or out-of-hours, and compared. The primary outcome was 30-day mortality. The in-hours group included 1,865 patients (40.6%) while 2,725 patients (59.4%) had out-of-hours PPCI. Patients presenting out-of-hours had longer median door-to-balloon time (DTBT; 83 [IQR 61-109] vs. 60 [IQR 41-88] mins, p<0.01) and were more likely to receive a drug-eluting stent (p=0.001). Procedural characteristics were otherwise similar although rates of radial access were low overall (18.4%). No differences in in-hospital, 30-day or 12-month mortality were observed between the groups (p=NS). On Cox proportional hazards modelling, out-of-hours presentation was not an independent predictor of 30-day mortality (HR 0.94, 95% CI 0.71-1.22). A landmark analysis of data from 2012 did not change the primary outcome. Despite a slightly longer DTBT, patients undergoing PPCI out-of-hours experienced similar care and clinical outcomes to the in-hours group. Given the majority of patients with STEMI present out-of-hours, these data have implications for STEMI systems of care.
DOI: 10.1016/j.hlc.2019.05.184
Journal: Heart, Lung & Circulation
PubMed URL: 31262617
Type: Journal Article
Subjects: Out-of-hours presentation
Primary percutaneous coronary intervention
ST-elevation myocardial infarction
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