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

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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.

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Berliner Herzinfarktregister, Technische Universitaet Berlin, Mueller Breslau Str. VWS4 HI, 10623, Berlin, Germany

    Birga Maier

  2. Klinik für Innere Medizin, Kardiologie und konservative Intensivmedizin, Vivantes Humboldt Klinikum and Vivantes Klinikum Spandau, Berlin, Germany

    Steffen Behrens

  3. Klinik für Innere Medizin, Schwerpunkt Kardiologie, DRK Kliniken, Westend, Berlin, Germany

    Claudia Graf-Bothe & Ralph G. Schoeller

  4. Klinik für Innere Medizin, Allgemeine Innere Medizin, Vivantes Wenckebach Klinikum, Berlin, Germany

    Holger Kuckuck

  5. Klinik für Innere Medizin, Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Vivantes Klinikum Hellersdorf, Berlin, Germany

    Jens-Uwe Roehnisch

  6. Klinik für Innere Medizin, Kardiologie, Diabetologie und konservative Intensivmedizin, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany

    Helmut Schuehlen

  7. Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Universitaetsmedizin Charité, Campus Mitte, Berlin, Germany

    Heinz P. Theres

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  1. Birga Maier
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  2. Steffen Behrens
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  3. Claudia Graf-Bothe
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Corresponding author

Correspondence to Birga Maier.

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For the Berlin Myocardial Infarction Registry (BMIR).

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Maier, B., Behrens, S., Graf-Bothe, C. et al. Time of admission, quality of PCI care, and outcome of patients with ST-elevation myocardial infarction. Clin Res Cardiol 99, 565–572 (2010). https://doi.org/10.1007/s00392-010-0158-2

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  • DOI: https://doi.org/10.1007/s00392-010-0158-2

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