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Title: The impact of out-of-hours presentation on clinical outcomes in st-elevation myocardial infarction.
Author: Biswas, S.
Brennan, A.
Duffy, S. J.
Andrianopoulos, N.
Chan, W.
Walton, A.
Noaman, S.
Shaw. J. A.
Ajani, A.
Clark, D. J.
Freeman, M.
Hiew, C.
Oqueli, Ernesto
Lefkovits, J.
Reid, C. M.
Stub, D.
Issue Date: 2020
Publication Title: Heart, Lung and Circulation
Volume: 29
Issue: 6
Start Page: 814
End Page: 823
Abstract: Background Systems of care have been established to ensure patients with ST-elevation myocardial infarction (STEMI) get timely access to primary percutaneous coronary intervention (PPCI). In this study, we evaluated whether patients undergoing PPCI both in-hours and out-of-hours experience similar care and clinical outcomes. Methods Of 9,865 patients who underwent PCI for STEMI from 2005 to 2016 and were enrolled in the multi-centre Melbourne Interventional Group registry, patients who had initially presented to a non-PCI capable hospital, received thrombolysis or presented >12 hours post-symptom onset were excluded. Our final study cohort of 4,590 patients were dichotomised by whether PPCI was performed in-hours or out-of-hours, and compared. The primary outcome was 30-day mortality. Results The in-hours group included 1,865 patients (40.6%) while 2,725 patients (59.4%) had out-of-hours PPCI. Patients presenting out-of-hours had longer median door-to-balloon time (DTBT; 83 [IQR 61–109] vs. 60 [IQR 41–88] mins, p < 0.01) and were more likely to receive a drug-eluting stent (p = 0.001). Procedural characteristics were otherwise similar although rates of radial access were low overall (18.4%). No differences in in-hospital, 30-day or 12-month mortality were observed between the groups (p = NS). On Cox proportional hazards modelling, out-of-hours presentation was not an independent predictor of 30-day mortality (HR 0.94, 95% CI 0.71–1.22). A landmark analysis of data from 2012 did not change the primary outcome. Conclusion Despite a slightly longer DTBT, patients undergoing PPCI out-of-hours experienced similar care and clinical outcomes to the in-hours group. Given the majority of patients with STEMI present out-of-hours, these data have implications for STEMI systems of care.
Internal ID Number: 01522
Type: Journal Article
Appears in Collections:Research Output

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