Are public holidays, sporting events and significant historical events triggers of ST-elevation myocardial infarction (STEMI) presentations in Victoria? A Melbourne Interventional Group (MIG) observational study.

Abstract

Introduction: Holidays, sporting and historical events can result in increased physical, emotional and chemical stress that may increase the risk of MI. We examined if STEMIs were more likely to be triggered on important days in Victoria, and whether having STEMI on these days portends a worse prognosis. Method: We compared the incidence of STEMIs on important days to regular days within the MIG registry from 2009 to 2018. Long-term mortality was assessed from NDI linkage (median follow-up 3.3 years). Results: 6,555 (90.8%) STEMIs occurred on regular days and 662 (9.1%) on important days with no difference in incidence. Baseline characteristics were similar. There was no increase in cardiac arrest, cardiogenic shock, pre-procedural intubation or mechanical support in those presenting on an important day, and there was a decrease in procedural intubation. STEMI-to-door time was not increased, indicating presentations were not delayed because of the important event. Door-to-balloon time was slightly delayed on important days (71.0 vs 75.0 mins, p=0.04). Uptake of cardiac medications, ejection fraction and in-hospital complications were similar for both groups. On multivariate analysis, there was no difference in mortality on an important day compared to a regular day, with age and co-morbidities the main predictors of mortality. Conclusions: When compared to STEMIs on a regular day, there was no difference in mortality when presenting with a STEMI on an important day. Patients were not delaying presentations and did not receive suboptimal care.