Time of day variation in door-to-balloon time for STEMI patients in Los Angeles County: Does time of day make a difference?

Abstract

In STEMI patients receiving primary PCI in Los Angeles County, off-hour PCI was common. Short-term clinical outcomes were similar despite longer door-to-balloon time in patients receiving off-hour PCI. The longer door-to-balloon time in the off-hour PCI patients were partly explained by longer door-to-CL activation time.

Relationship between time of initial diagnosis of acute myocardial infarction to primary angioplasty on patient’s outcome

“…Investigation the correlation of time from initial assessment to emergency department until the onset of primary angioplasty with the final outcome in patients with acute myocardial infarction was evaluated in all studies included in the review. In majority of cases, primary angioplasty was achieved initiation time of less than 90 minutes from the initial assessment, resulting in better outcomes of patients (5,6,9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). However, in case of performing culprit-vessel primary percutaneus coronary intervention before the unilateral or complete diagnostic angiography is associated with a statistically significant reduction in vascular access-to-balloon time, although the difference of 4-6 minutes is unlikely to be clinically relevant (22).…”

“…Approximately one in two AMI cases are fatal before admittance in hospital and occur more frequently within one hour of the onset of symptoms (26), whereas delayed onset of primary angioplasty by over two hours increases mortality (29). This review showed that in most cases primary angioplasty was achieved start within 90 minutes from the initial assessment, resulting in better outcomes of patients and agreement with the target time of guidelines (5,6,9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

“…However, the survival rates of patients on early angioplasty appear to be associated with younger age (less of 65 years) (5), as well as the stenosis at which patients with lesion in the left anterior descending artery appeared higher mortality rates (24). Furthermore, delays which are not due to the health system organizational structure appear to be responsible for a 4-fold higher mortality rate of one year (17), while delayed PCI application off time hemodynamic laboratory operating did not appear to adversely affect hospitalization time, vascular complications, thrombolysis in myocardial infarction (TIMI) 3 final flow and in-hospital mortality (16). However, benefits were only limited to the patients who presented to emergency department early after the onset of symptoms (11).…”

“…Another study showed that the establishment of a cardiological approach by a team of health professionals in the ED reduced the time of primary angioplasty in patients with STEMI (13). Also, the activation time of the laboratory to initiate post-evaluation PPCI appears to be lower at 8am-5pm (16), but a simultaneous electronic alert for the off-hours of the catheterization laboratory may reduce the time from entering PPCI and increasing the number of patients achieving target times (6) The performance of PPCI prior to contralateral or complete diagnostic angiography is associated with a statistically significant reduction in vascular access time (22), but not performing CT prior to primary PCI that changes clinical management in a very small percentage of patients (23).…”

Reassessing After-Hour Arrival Patterns and Outcomes in ST-Elevation Myocardial Infarction

“…In addition, conflicting research has shown that short-term clinical outcomes for PCI patients were similar, despite longer D2B times in patients receiving after-hour PCI. 18 Circadian variation has also been shown to impact both frequency of MI onset and infarct size. 19 Similarly, myocardial infarct size and left ventricular function after STEMI have been shown to have a circadian dependence on the time of day onset of ischemia.…”