Long-term outcomes in ST-elevation myocardial infarction patients treated according to hospital visit time

Abstract

Background/Aims: Rapid percutaneous coronary intervention (PCI) is the cornerstone of treatment for ST-elevation myocardial infarction (STEMI). However, there have been conflicting results regarding the differences in clinical outcomes between on-hours and off-hours presentation in STEMI patients. We aimed to examine the difference in long-term outcomes between off-hours and on-hours PCI in patients with STEMI.Methods: The characteristics and clinical outcomes of 5,364 STEMI patients between November 2011 and June 2015 from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) registry were analyzed. Patients were divided into two groups: the off-hours group (weekdays from 6:01 PM to 7:59 AM, weekends, and legal holidays) and the on-hours group (weekdays from 8:00 AM to 6:00 PM). Major adverse cardiac and cerebrovascular events (MACCEs) were defined as a composite of allcause mortality, non-fatal myocardial infarction, any revascularization, cerebrovascular accident, and stent thrombosis. The primary endpoint was the occurrence of MACCEs, and all other clinical outcomes were analyzed.Results: A total of 3,119 patients (58.1%) underwent primary PCI due to STEMI during off-hours and 2,245 patients (41.9%) during on-hours. At 36 months, the clinical outcomes of the off-hours group were similar to those of the on-hours group in both the unadjusted and propensity score weighting-adjusted analyses.Conclusions: Our analysis revealed that the long-term outcomes in STEMI patients admitted to hospitals during off-hours were similar to outcomes of those admitted during on-hours.

Off-hour presentation and outcomes for percutaneous coronary intervention in acute myocardial infarction with Killip III–IV

“…According to a meta-analysis, patients with STEMI presenting during off-hours had similar short-, intermediate-, and long-term (3–4 years) outcomes to those who presented during regular hours [ 23 ]. Off-hour presentation showed similar outcomes to on-hour presentation in the Korean STEMI population, as well [ 25 ].…”

Effect of delayed hospitalization on 3-year clinical outcomes according to renal function in patients with non-ST-segment elevation myocardial infarction

“…Patients with STD ≥ 24 h were included in the delayed hospitalization group based on the findings of a recent report [ 10 ]. The symptom onset time was defined as the time of onset of the last sustained chest pain [ 21 ]. Typical chest pain was defined as substernal chest discomfort of characteristic quality and duration, triggered by exertion or emotional stress and relieved by rest or nitroglycerin [ 2 , 4 ].…”

Effects of delayed hospitalization on the 3‐year clinical outcomes of patients with or without diabetes who had non‐ST‐segment‐elevation myocardial infarction and underwent new‐generation drug‐eluting stent implantation

“…Patients with SDT ≥ 24 h were included in the delayed hospitalization group based on the findings of a recent report 10 . Symptom onset time was defined as the time of onset of the last sustained chest pain 19 . Typical chest pain was defined as substernal chest discomfort of characteristic quality and duration, triggered by exertion or emotional stress and relieved by rest or nitroglycerin use 7,9 .…”

“…10 Symptom onset time was defined as the time of onset of the last sustained chest pain. 19 Typical chest pain was defined as substernal chest discomfort of characteristic quality and duration, triggered by exertion or emotional stress and relieved by rest or nitroglycerin use. 7,9 Atypical chest pain was defined as chest pain inconsistent with the characteristics of typical chest pain.…”