Original Paper

Clinical Research in Cardiology

, Volume 99, Issue 9, pp 565-572

First online:

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

  • Birga MaierAffiliated withBerliner Herzinfarktregister, Technische Universitaet Berlin Email author 
  • , Steffen BehrensAffiliated withKlinik für Innere Medizin, Kardiologie und konservative Intensivmedizin, Vivantes Humboldt Klinikum and Vivantes Klinikum Spandau
  • , Claudia Graf-BotheAffiliated withKlinik für Innere Medizin, Schwerpunkt Kardiologie, DRK Kliniken
  • , Holger KuckuckAffiliated withKlinik für Innere Medizin, Allgemeine Innere Medizin, Vivantes Wenckebach Klinikum
  • , Jens-Uwe RoehnischAffiliated withKlinik für Innere Medizin, Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Vivantes Klinikum Hellersdorf
  • , Ralph G. SchoellerAffiliated withKlinik für Innere Medizin, Schwerpunkt Kardiologie, DRK Kliniken
  • , Helmut SchuehlenAffiliated withKlinik für Innere Medizin, Kardiologie, Diabetologie und konservative Intensivmedizin, Vivantes Auguste-Viktoria-Klinikum
  • , Heinz P. TheresAffiliated withMedizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Universitaetsmedizin Charité

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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 infarction Time of hospital admission Registries Hospital mortality