Presenting Off-Hours, Door-to-Balloon Time, and Clinical Results in Patients Primary Percutaneous Coronary Intervention

Abstract

Background: The timely management of ST-segment elevation myocardial infarction (STEMI) through primary percutaneous coronary intervention (PCI) significantly impacts patient outcomes. However, the influence of off-hours presentation (nights, weekends, and holidays) on door-to-balloon (D2B) time and clinical outcomes remains a pivotal concern, as it potentially affects the efficiency of care and patient prognosis. Objective: This study aims to evaluate the association between off-hours presentation, D2B time, and clinical outcomes in patients undergoing primary PCI for STEMI, to identify potential disparities in treatment efficacy and to inform strategies for improving cardiovascular emergency care. Methods: Conducting a retrospective cross-sectional analysis, this study included 90 patients admitted with STEMI who underwent primary PCI at a tertiary care center between March 2022 and March 2023. Patients were stratified into two groups based on the timing of hospital presentation: off-hours and regular hours. Primary outcomes assessed were D2B time, mortality rates, and incidences of cardiogenic shock and heart failure. Data were analyzed using descriptive statistics, t-tests, chi-square tests, and multivariable logistic regression to adjust for potential confounders. Results: The mean D2B time for patients presenting during off-hours was significantly longer (96.4 ± 12.3 minutes) compared to those presenting during regular hours (84.6 ± 9.8 minutes, p<0.001). No statistically significant differences were observed in mortality rates (off-hours 4.4% vs. regular hours 6.7%, p=0.155), cardiogenic shock (off-hours 6.7% vs. regular hours 4.4%, p=0.351), or heart failure (off-hours 8.9% vs. regular hours 6.7%, p=0.214). Multivariable analysis confirmed off-hours presentation as an independent predictor of prolonged D2B time (coefficient 11.8, 95% CI 8.2-15.5). Conclusion: Off-hours presentation is associated with significantly longer D2B times in STEMI patients undergoing primary PCI, underscoring the need for healthcare systems to address the disparities in care delivery during off-hours. However, no significant differences in short-term clinical outcomes were observed, suggesting that factors beyond D2B time contribute to patient prognosis. Further studies are warranted to explore comprehensive strategies to optimize care irrespective of presentation time.