Abstract
IntroductionDifferences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours.MethodsUsing a prospective observational study, we analyzed all 1,247 non-transfer STEMI patients treated in 15 percutaneous coronary intervention (PCI) facilities in Dallas, Texas, during a 24-month period (2010–2012). Controlling for confounding factors through a variety of statistical techniques, we explored differences in door-to-balloon (D2B) and in-hospital mortality for those presenting on weekends vs. weekdays and business vs. after hours.ResultsPatients who arrived at the hospital on weekends had larger D2B times compared to weekdays (75 vs. 65 minutes; KW=48.9; p<0.001). Patients who arrived after-hours had median D2B times >16 minutes longer than those who arrived during business hours and a higher likelihood of mortality (OR 2.23, CI [1.15–4.32], p<0.05).ConclusionWeekends and after-hour PCI coverage is still associated with adverse D2B outcomes and in-hospital mortality, even in major urban settings. Disparities remain in after-hour STEMI treatment.
Highlights
Differences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours
Patients who arrived at the hospital on weekends had larger D2B times compared to weekdays (75 vs. 65 minutes; KW=48.9; p
Patients who arrived after-hours had median D2B times >16 minutes longer than those who arrived during business hours and a higher likelihood of mortality
Summary
Differences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours. Coronary heart disease is the leading cause of death and healthcare cost in the U.S.1. The median lifetime mortality rate is 159.2 for every 100,000 citizens nationally. Among those with heart disease, acute myocardial infarction (MI) is a leading contributor to mortality. Time to treatment for patients with ST-elevation myocardial infarction (STEMI) is critical, as it impacts both myocardial salvage and survival.[4,5] Door-to-balloon time (D2B) is a key component of time to treatment and a core quality measure for the Joint Commission.[6] The American College of Cardiology Foundation/American
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