Clinical Research in Cardiology

, Volume 99, Issue 9, pp 565–572

Time of admission, quality of PCI care, and outcome of patients with ST-elevation myocardial infarction

Authors

    • Berliner HerzinfarktregisterTechnische Universitaet Berlin
  • Steffen Behrens
    • Klinik für Innere Medizin, Kardiologie und konservative IntensivmedizinVivantes Humboldt Klinikum and Vivantes Klinikum Spandau
  • Claudia Graf-Bothe
    • Klinik für Innere Medizin, Schwerpunkt KardiologieDRK Kliniken
  • Holger Kuckuck
    • Klinik für Innere Medizin, Allgemeine Innere MedizinVivantes Wenckebach Klinikum
  • Jens-Uwe Roehnisch
    • Klinik für Innere Medizin, Allgemeine Innere Medizin, Gastroenterologie und DiabetologieVivantes Klinikum Hellersdorf
  • Ralph G. Schoeller
    • Klinik für Innere Medizin, Schwerpunkt KardiologieDRK Kliniken
  • Helmut Schuehlen
    • Klinik für Innere Medizin, Kardiologie, Diabetologie und konservative IntensivmedizinVivantes Auguste-Viktoria-Klinikum
  • Heinz P. Theres
    • Medizinische Klinik mit Schwerpunkt Kardiologie und AngiologieUniversitaetsmedizin Charité
Original Paper

DOI: 10.1007/s00392-010-0158-2

Cite this article as:
Maier, B., Behrens, S., Graf-Bothe, C. et al. Clin Res Cardiol (2010) 99: 565. doi:10.1007/s00392-010-0158-2

Abstract

Objective

Our study aimed to analyse the hospital mortality of patients admitted in- and off-regular working hours with ST-elevation myocardial infarction (STEMI) within the special logistical setting of the urban area of the city of Berlin.

Background

There is a debate whether patients with acute myocardial infarction admitted to hospital outside regular working hours experience higher mortality rates than those admitted within regular working hours.

Methods

This study analyses data from the Berlin Myocardial Infarction Registry and comprises 2,131 patients with STEMI and treated with percutaneous coronary intervention (PCI) in 2004–2007. Data of patients admitted during in- and off-regular working hours were compared.

Results

There was significant difference in door-to-balloon time (median in-hours: 79 min; median off-hours: 90 min, p < 0.001) and in hospital mortality (in-hours: 4.3%; off-hours: 6.8%, p = 0.020) between STEMI patients admitted in- and off-hours for treatment with PCI. After adjustment, admission off-hours remained an independent predictor for in-hospital death for patients (OR = 2.50; 95% CI 1.38–4.56). In patients with primary care from physician-escorted Emergency Medical Services (EMS), door-to-balloon time was reduced by 10 min for in-hours as well as off-hours patients. The difference in hospital mortality between off-hour and in-hour admission was reduced to a non-significant OR = 1.61 (95% CI 0.79–3.27).

Conclusions

In conclusion, patients admitted off-hours experienced longer door-to-balloon times and higher hospital mortality than did those admitted in-hours. The differences observed between patients admitted in-hours and off-hours were reduced through physician-escorted EMS reflecting the influence of optimized STEMI care.

Keywords

ST-elevation myocardial infarctionTime of hospital admissionRegistriesHospital mortality

Copyright information

© Springer-Verlag 2010