Time of admission, quality of PCI care, and outcome of patients with ST-elevation myocardial infarction
- 194 Downloads
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.
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.
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.
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).
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.
KeywordsST-elevation myocardial infarction Time of hospital admission Registries Hospital mortality
The Berlin Myocardial Infarction Registry was supported by unrestricted grants from the participating hospitals, the Technische Universität Berlin; the Senate of the City of Berlin; the Berlin Chamber of Physicians; Freunde und Förderer der Charité e.V. in Berlin, and the companies Boehringer Ingelheim Pharma GmbH & Co. KG (Ingelheim am Rhein), Cordis Medizinische Apparate GmbH (Langenfeld), Lilly Deutschland GmbH (Bad Homburg), MSD Chibropharm GmbH (Haar), Boston Scientific Medizin-Technik GmbH (Ratingen), GlaxoSmithKline GmbH & Co. KG (München). The BMIR is grateful to all the hospitals in which the study was carried out: Charité Universitätsmedizin Berlin, Campus Mitte; Charité Universitätsmedizin Berlin, Campus Virchow; DRK Kliniken Koepenick, Berlin; DRK Kliniken Westend, Berlin; Gemeinschaftskrankenhaus Havelhöhe; Juedisches Krankenhaus; Krankenhaus Lichtenberg; St. Gertrauden-Krankenhaus; Unfallkrankenhaus Berlin; Vivantes Auguste-Viktoria-Klinikum; Vivantes-Humboldt-Klinikum; Vivantes Klinikum Spandau. Their effort and support is very much appreciated.
Conflict of interest statement
No other financial conflicts of interest have been declared by the authors.
- 3.Magid DJ, Wang Y, Herrin J, McNamara RL, Bradley EH, Curtis JP, Pollack CV Jr, French WJ, Blaney ME, Krumholz HM (2005) Relationship between time of day, day of week, timeliness of reperfusion, and in-hospital mortality for patients with acute ST-segment elevation myocardial infarction. JAMA 294(7):803–812CrossRefPubMedGoogle Scholar
- 10.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(22):2308–2320CrossRefPubMedGoogle Scholar
- 14.Khot UN, Johnson ML, Ramsey C, Khot MB, Todd R, Shaikh SR, Berg WJ (2007) Emergency department physician activation of the catheterization laboratory and immediate transfer to an immediately available catheterization laboratory reduce door-to-balloon time in ST-elevation myocardial infarction. Circulation 116(1):67–76CrossRefPubMedGoogle Scholar
- 15.Le May MR, So DY, Dionne R, Glover CA, Froeschl MP, Wells GA, Davies RF, Sherrard HL, Maloney J, Marquis JF, O’Brien ER, Trickett J, Poirier P, Ryan SC, Ha A, Joseph PG, Labinaz M (2008) A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 358(3):231–240CrossRefPubMedGoogle Scholar
- 18.Bauer T, Hoffmann R, Juenger C, Koeth O, Zahn R, Gitt A, Heer T, Bestehorn K, Senges J, Zeymer U (2009) Efficacy of a 24-h primary percutaneous coronary intervention service on outcome in patients with ST elevation myocardial infarction in clinical practice. Clin Res Cardiol 98(3):171–178CrossRefPubMedGoogle Scholar
- 20.The Joint European Society of Cardiology/American College of Cardiology Committee (2000) Myocardial infarction redefined-a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J 21(18):1502–1513CrossRefGoogle Scholar
- 21.Holmes DR Jr, Bell MR, Gersh BJ, Rihal CS, Haro LH, Bjerke CM, Lennon RJ, Lim CC, Ting HH (2008) Systems of care to improve timeliness of reperfusion therapy for ST-segment elevation myocardial infarction during off hours: The Mayo clinic STEMI protocol. J Am Coll Cardiol Interv 1(1):88–96Google Scholar
- 22.Krueth P, Zeymer U, Gitt A, Juenger C, Wienbergen H, Niedermeier F, Glunz H-G, Senges J, Zahn R (2008) Influence of presentation at the weekend on treatment and outcome on ST-elevation myocardial infarction in hospitals with catheterization laboratories. Clin Res Cardiol 97(10):742–747CrossRefGoogle Scholar
- 23.Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, Julian D, Lengyel M, Neumann FJ, Ruzyllo W, Thygesen C, Underwood SR, Vahanian A, Verheugt FW, Wijns W (2003) Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task force on the management of acute myocardial infarction of the European society of cardiology. Eur Heart J 24(1):28–66CrossRefPubMedGoogle Scholar
- 24.Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, Gitt A, Hasdai D, Hasin Y, Marrugat J, Van de Werf F, Wallentin L, Behar S (2006) The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J 27:2285–2293CrossRefPubMedGoogle Scholar