| ST-elevation myocardial infarction mortality in a major academic center "on-" versus "off-" hours. | |
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MedLine Citation:
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PMID: 19805838 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: A higher mortality rate for weekend myocardial infarction (MI) admissions has been reported and attributed to the lower availability of primary percutaneous coronary intervention (PCI) during off-hours. However, the data are conflicting and, furthermore, inapplicable to hospitals where primary PCI is invariably performed. METHODS: This study was conducted in a tertiary hospital where primary PCI is routinely performed in all patients with ST-elevation myocardial infarction (STEMI). Patients admitted during on-hours (Monday through Friday 7 am-7 pm) where compared to off-hours patients (including weekends). The primary endpoint of in-hospital mortality, cardiogenic shock and recurrent MI was examined. A second analysis that excluded STEMI transfers, in-hospital mortality and reperfusion times was examined. RESULTS: Between 2003 and 2007, 747 STEMI patients (46% on-hours vs. 56% off-hours) underwent primary PCI. Demographic characteristics were similar between on- and off-hours groups. However, off-hours STEMI admissions had significantly greater in-hospital mortality rates (8% vs. 3.7%; p = 0.01) and higher rates of cardiogenic shock (37% vs. 24%; p = 0.0001). Admission arrival time was an independent predictor of in-hospital mortality (hazard ratio [HR] 3.98, 95% confidence interval [CI] 1.10-14.38; p = 0.035). Longer door-to-balloon times (DTB) were observed during off-hours (134 vs. 109 minutes; p < 0.0001), even after excluding the transfer population (63 vs. 89 minutes; p < 0.0001). CONCLUSION: Higher rates of in-hospital mortality and cardiogenic shock may be expected in STEMI patients admitted during off-hours, even when primary PCI is performed. Longer DTB times during off-hours may partially explain our findings. Strategies to optimize reperfusion time during off-hours, including perhaps a 24/7 in-house "STEMI team" may be necessary. |
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Authors:
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Roberto J Cubeddu; Ignacio Cruz-Gonzalez; Thomas J Kiernan; Quynh A Truong; Kenneth Rosenfield; Robert C Leinbach; Mary E Cadigan; Eugene V Pomerantsev; Igor F Palacios |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Journal of invasive cardiology Volume: 21 ISSN: 1557-2501 ISO Abbreviation: J Invasive Cardiol Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-06 Completed Date: 2010-02-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8917477 Medline TA: J Invasive Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 518-23 Citation Subset: IM |
Affiliation:
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Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts 02114, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Academic Medical Centers
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statistics & numerical data* After-Hours Care / statistics & numerical data* Aged Angioplasty, Transluminal, Percutaneous Coronary* Electrocardiography Female Health Services Accessibility / statistics & numerical data Hospital Mortality Humans Male Middle Aged Myocardial Infarction / mortality*, therapy* Recurrence Retrospective Studies Shock, Cardiogenic Time Factors |
| Comments/Corrections | |
Comment In:
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J Invasive Cardiol. 2009 Oct;21(10):523-4
[PMID:
19805839
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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