The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction
Background: Systems of care have been established to ensure patients with ST-elevation myocardial infarction (STEMI) get timely access to primary percutaneous coronary intervention (PPCI). In this study, we evaluated whether patients undergoing PPCI both in-hours and out-of-hours experience similar...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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ELSEVIER SCIENCE INC
2020
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93770 |
| _version_ | 1848765785255706624 |
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| author | Biswas, S. Brennan, A. Duffy, S.J. Andrianopoulos, N. Chan, W. Walton, A. Noaman, S. Shaw, J.A. Ajani, A. Clark, D.J. Freeman, M. Hiew, C. Oqueli, E. Lefkovits, J. Reid, Christopher Stub, D. |
| author_facet | Biswas, S. Brennan, A. Duffy, S.J. Andrianopoulos, N. Chan, W. Walton, A. Noaman, S. Shaw, J.A. Ajani, A. Clark, D.J. Freeman, M. Hiew, C. Oqueli, E. Lefkovits, J. Reid, Christopher Stub, D. |
| author_sort | Biswas, S. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: Systems of care have been established to ensure patients with ST-elevation myocardial infarction (STEMI) get timely access to primary percutaneous coronary intervention (PPCI). In this study, we evaluated whether patients undergoing PPCI both in-hours and out-of-hours experience similar care and clinical outcomes. Methods: Of 9,865 patients who underwent PCI for STEMI from 2005 to 2016 and were enrolled in the multi-centre Melbourne Interventional Group registry, patients who had initially presented to a non-PCI capable hospital, received thrombolysis or presented >12 hours post-symptom onset were excluded. Our final study cohort of 4,590 patients were dichotomised by whether PPCI was performed in-hours or out-of-hours, and compared. The primary outcome was 30-day mortality. Results: The in-hours group included 1,865 patients (40.6%) while 2,725 patients (59.4%) had out-of-hours PPCI. Patients presenting out-of-hours had longer median door-to-balloon time (DTBT; 83 [IQR 61–109] vs. 60 [IQR 41–88] mins, p < 0.01) and were more likely to receive a drug-eluting stent (p = 0.001). Procedural characteristics were otherwise similar although rates of radial access were low overall (18.4%). No differences in in-hospital, 30-day or 12-month mortality were observed between the groups (p = NS). On Cox proportional hazards modelling, out-of-hours presentation was not an independent predictor of 30-day mortality (HR 0.94, 95% CI 0.71–1.22). A landmark analysis of data from 2012 did not change the primary outcome. Conclusion: Despite a slightly longer DTBT, patients undergoing PPCI out-of-hours experienced similar care and clinical outcomes to the in-hours group. Given the majority of patients with STEMI present out-of-hours, these data have implications for STEMI systems of care. |
| first_indexed | 2025-11-14T11:40:46Z |
| format | Journal Article |
| id | curtin-20.500.11937-93770 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:40:46Z |
| publishDate | 2020 |
| publisher | ELSEVIER SCIENCE INC |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-937702023-12-21T05:33:35Z The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction Biswas, S. Brennan, A. Duffy, S.J. Andrianopoulos, N. Chan, W. Walton, A. Noaman, S. Shaw, J.A. Ajani, A. Clark, D.J. Freeman, M. Hiew, C. Oqueli, E. Lefkovits, J. Reid, Christopher Stub, D. Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology ST-elevation myocardial infarction Primary percutaneous coronary intervention Outcomes Out-of-hours presentation PERCUTANEOUS CORONARY INTERVENTION TO-BALLOON TIME HOSPITAL PRESENTATION PRIMARY ANGIOPLASTY SYMPTOM ONSET MORTALITY REPERFUSION WEEKEND ASSOCIATION TIMELINESS Out-of-hours presentation Outcomes Primary percutaneous coronary intervention ST-elevation myocardial infarction After-Hours Care Coronary Angiography Drug-Eluting Stents Female Follow-Up Studies Hospital Mortality Humans Male Middle Aged Percutaneous Coronary Intervention Registries Retrospective Studies Risk Factors ST Elevation Myocardial Infarction Survival Rate Thrombolytic Therapy Time-to-Treatment Treatment Outcome Victoria Humans Coronary Angiography Treatment Outcome Thrombolytic Therapy Registries Hospital Mortality Survival Rate Risk Factors Retrospective Studies Follow-Up Studies Middle Aged After-Hours Care Victoria Female Male Drug-Eluting Stents Time-to-Treatment Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Background: Systems of care have been established to ensure patients with ST-elevation myocardial infarction (STEMI) get timely access to primary percutaneous coronary intervention (PPCI). In this study, we evaluated whether patients undergoing PPCI both in-hours and out-of-hours experience similar care and clinical outcomes. Methods: Of 9,865 patients who underwent PCI for STEMI from 2005 to 2016 and were enrolled in the multi-centre Melbourne Interventional Group registry, patients who had initially presented to a non-PCI capable hospital, received thrombolysis or presented >12 hours post-symptom onset were excluded. Our final study cohort of 4,590 patients were dichotomised by whether PPCI was performed in-hours or out-of-hours, and compared. The primary outcome was 30-day mortality. Results: The in-hours group included 1,865 patients (40.6%) while 2,725 patients (59.4%) had out-of-hours PPCI. Patients presenting out-of-hours had longer median door-to-balloon time (DTBT; 83 [IQR 61–109] vs. 60 [IQR 41–88] mins, p < 0.01) and were more likely to receive a drug-eluting stent (p = 0.001). Procedural characteristics were otherwise similar although rates of radial access were low overall (18.4%). No differences in in-hospital, 30-day or 12-month mortality were observed between the groups (p = NS). On Cox proportional hazards modelling, out-of-hours presentation was not an independent predictor of 30-day mortality (HR 0.94, 95% CI 0.71–1.22). A landmark analysis of data from 2012 did not change the primary outcome. Conclusion: Despite a slightly longer DTBT, patients undergoing PPCI out-of-hours experienced similar care and clinical outcomes to the in-hours group. Given the majority of patients with STEMI present out-of-hours, these data have implications for STEMI systems of care. 2020 Journal Article http://hdl.handle.net/20.500.11937/93770 10.1016/j.hlc.2019.05.184 English http://purl.org/au-research/grants/nhmrc/1111170 http://purl.org/au-research/grants/nhmrc/1052960 http://purl.org/au-research/grants/nhmrc/1045862 ELSEVIER SCIENCE INC restricted |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology ST-elevation myocardial infarction Primary percutaneous coronary intervention Outcomes Out-of-hours presentation PERCUTANEOUS CORONARY INTERVENTION TO-BALLOON TIME HOSPITAL PRESENTATION PRIMARY ANGIOPLASTY SYMPTOM ONSET MORTALITY REPERFUSION WEEKEND ASSOCIATION TIMELINESS Out-of-hours presentation Outcomes Primary percutaneous coronary intervention ST-elevation myocardial infarction After-Hours Care Coronary Angiography Drug-Eluting Stents Female Follow-Up Studies Hospital Mortality Humans Male Middle Aged Percutaneous Coronary Intervention Registries Retrospective Studies Risk Factors ST Elevation Myocardial Infarction Survival Rate Thrombolytic Therapy Time-to-Treatment Treatment Outcome Victoria Humans Coronary Angiography Treatment Outcome Thrombolytic Therapy Registries Hospital Mortality Survival Rate Risk Factors Retrospective Studies Follow-Up Studies Middle Aged After-Hours Care Victoria Female Male Drug-Eluting Stents Time-to-Treatment Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Biswas, S. Brennan, A. Duffy, S.J. Andrianopoulos, N. Chan, W. Walton, A. Noaman, S. Shaw, J.A. Ajani, A. Clark, D.J. Freeman, M. Hiew, C. Oqueli, E. Lefkovits, J. Reid, Christopher Stub, D. The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction |
| title | The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction |
| title_full | The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction |
| title_fullStr | The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction |
| title_full_unstemmed | The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction |
| title_short | The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction |
| title_sort | impact of out-of-hours presentation on clinical outcomes in st-elevation myocardial infarction |
| topic | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology ST-elevation myocardial infarction Primary percutaneous coronary intervention Outcomes Out-of-hours presentation PERCUTANEOUS CORONARY INTERVENTION TO-BALLOON TIME HOSPITAL PRESENTATION PRIMARY ANGIOPLASTY SYMPTOM ONSET MORTALITY REPERFUSION WEEKEND ASSOCIATION TIMELINESS Out-of-hours presentation Outcomes Primary percutaneous coronary intervention ST-elevation myocardial infarction After-Hours Care Coronary Angiography Drug-Eluting Stents Female Follow-Up Studies Hospital Mortality Humans Male Middle Aged Percutaneous Coronary Intervention Registries Retrospective Studies Risk Factors ST Elevation Myocardial Infarction Survival Rate Thrombolytic Therapy Time-to-Treatment Treatment Outcome Victoria Humans Coronary Angiography Treatment Outcome Thrombolytic Therapy Registries Hospital Mortality Survival Rate Risk Factors Retrospective Studies Follow-Up Studies Middle Aged After-Hours Care Victoria Female Male Drug-Eluting Stents Time-to-Treatment Percutaneous Coronary Intervention ST Elevation Myocardial Infarction |
| url | http://purl.org/au-research/grants/nhmrc/1111170 http://purl.org/au-research/grants/nhmrc/1111170 http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93770 |