Influence of presentation at the weekend on treatment and outcome in ST-elevation myocardial infarction in hospitals with catheterization laboratories
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Studies about the influence of various factors on clinical therapy and course in acute coronary syndromes have shown that the outcome is related to admission time to the hospital, with an impaired prognosis in patients admitted out of regular working hours. However little is known about the impact of admission on weekend in hospitals with catheterisation laboratories.
We analyzed data of the prospective MITRA-PLUS registry of 11,516 patients with ST-elevation myocardial infarction (STEMI) admitted to hospitals with catheterization facilities for differences of in-hospital mortality between patients admitted during regular working hours, at night and on weekends.
The prehospital delay and “door-to-balloon”-time were significantly longer on weekends and at nights than at regular working hours (median 196 Vs. 240 Vs. 155 min; P < 0.0001; 60 Vs. 84 min at weekends, resp. 75 min at nights; P < 0.0001). Reperfusion therapy was performed in 72.8% (8,248/11,332) patients, and there were less patients treated on weekend versus “on”-hours (69.7 Vs. 77 %, P < 0.0001). On weekends we found a significant higher in-hospital mortality (11.1 Vs. 9.4%, P = 0.01) and at night there was a trend to higher in-hospital mortality when compared with regular working hours (10.6 Vs. 9.4%, P = 0.07).
In patients with STEMI admitted to hospitals with catheterization facilities, admission during the “off”-hours is associated with higher in-hospital mortality. This may be due to lower rates of revascularization therapy and longer prehospital and in-hospital delays as compared to “on”-hours.
Keywordsacute myocardial infarction weekend outcome reperfusion therapy
- 6.Bradley EH, Herrin J, Wang Y, Barton BA, Webster TR, Mattera JA, Roumanis SA, Curtis JP, Nallamothu BK, Magid DJ, McNamara RL, Parkosewich J, Loeb JM, Krumholz HM (2006) Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 355:2308–2320PubMedCrossRefGoogle Scholar
- 7.De Luca G, Suryapranata H, Ottervanger JP, van't Hof AW, Hoorntje JC, Gosselink AT, Dambrink JH, Zijlstra F, de Boer MJ (2005) Circadian variation in myocardial perfusion and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty. Am Heart J 150(6):1185–1189PubMedCrossRefGoogle Scholar
- 9.Garot P, Juliard JM, Benamer H, Steg PG (1997) Are the results of primary PTCA for acute myocardial infarction different during the „off”hours? J Am Coll Cardiol 79:1527–1529Google Scholar
- 13.Junker-Neff A, Eberle R, V Arnim T, Mehilli J, Hollweck R (2005) Is there an association between the sleep apnea syndrome and the circadian peak of myocardial infarction in the morning hours? Dtsch Med Wochenschr 130(49):2818–2822Google Scholar
- 17.Schuster S, Koch A, Burczyk U, Schiele R, Wagner S, Zahn R, Glunz HG, Heinrich F, Stuby K, Berg G, et al. (1997) [Early treatment of acute myocardial infarction: implementation of therapy guidelines in routine clinical practice, MITRA pilot phase] Frühbehandlung des akuten Myokardinfarktes: Umsetzung von Therapierichtlinien in den klinischen Alltag, MITRA-Pilotphase. Z Kardiol 86:273–283PubMedCrossRefGoogle Scholar
- 19.Wagner S, Schneider S, Schiele R, Fischer F, Dehn H, Grube R, Becker G, Baumgärtel B, Altmann E, Senges J (1999) Akuter Myokardinfarkt in Deutschland im Zeitraum zwischen 1996–1998: Therapie und hospitaler Verlauf. Ergebnisse des Myokardinfarktregisters (MIR) in Deutschland. [Acute myocardial infarction in Germany between 1996 and 1998: therapy and intrahospital course. Results of the myocardial infarction registry (MIR) in Germany]. Z Kardiol 88:857–867PubMedCrossRefGoogle Scholar
- 20.Zahn R, Vogt A, Zeymer U, Gitt AK, Seidl K, Gottwik M, Weber MA, Niederer W, Modl B, Engel HJ, Tebbe U, Senges J (2005) In-hospital time to treatment of patients with acute ST elevation myocardial infarction treated with primary angioplasty determinants and outcome. Results from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte. Heart 91(8):1041–1046PubMedCrossRefGoogle Scholar
- 22.Zahn R, Schiele R, Schneider S, Gitt AK, Wienbergen H, Seidl K, Bossaller C, Buttner HJ, Gottwik M, Altmann E, Rosahl W, Senges J (2000) Decreasing hospital mortality between 1994 and 1998 in patients with acute myocardial infarction treated with primary angioplasty but not in patients treated with intravenous thrombolysis. Results from the pooled data of the maximal individual therapy in acute myocardial infarction (MITRA) registry and the myocardial infarction registry (MIR). J Am Coll Cardiol 36(7):2067–2071CrossRefGoogle Scholar
- 23.Zahn R, Schweppe F, Zeymer U, Schiele R, Mark B, Frilling F, Gitt AK, Fraiture B, Gottwik M (2006) Einsatz der invasiven Diagnostik und Therapie bei konsekutiven unselektionierten NSTEMI- und STEMI-Patienten an einem Interventionszentrum. Herzmedizin 23:suppl 1 2Google Scholar
- 24.Zahn R, Schiele R, Seidl K, Bergmeier C, Schuster S, Hauptmann KE, Voigtlander T, Gottwik M, Glunz HG, Senges J, MITRA Study Group (1999) Primary angioplasty in acute myocardial infarction: differences between referred patients and those treated in hodpitals with on-site facilities? J Invasive Cardiol 11(4):213–219PubMedGoogle Scholar