Does on- versus off-hours presentation impact in-hospital outcomes of ST-segment elevation myocardial infarction patients transferred to a tertiary care center?†
Manuel A. Gonzalez MD, MPH
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorItsik Ben-Dor MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorKohei Wakabayashi MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorGabriel Maluenda MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorMichael A. Gaglia Jr. MD, MSc
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorNicholas N. Hanna MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorCedric Delhaye MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorSara D. Collins MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorAsmir I. Syed MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorLavinia P. Mitulescu MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorRebecca Torguson MPH
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorWilliam O. Suddath MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorJoseph Lindsay MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorAugusto D. Pichard MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorLowell F. Satler MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorCorresponding Author
Ron Waksman MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010Search for more papers by this authorManuel A. Gonzalez MD, MPH
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorItsik Ben-Dor MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorKohei Wakabayashi MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorGabriel Maluenda MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorMichael A. Gaglia Jr. MD, MSc
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorNicholas N. Hanna MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorCedric Delhaye MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorSara D. Collins MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorAsmir I. Syed MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorLavinia P. Mitulescu MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorRebecca Torguson MPH
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorWilliam O. Suddath MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorJoseph Lindsay MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorAugusto D. Pichard MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorLowell F. Satler MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Search for more papers by this authorCorresponding Author
Ron Waksman MD
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia
Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010Search for more papers by this authorConflict of interest: Nothing to report.
Abstract
Objectives: To determine whether in-hospital outcome differs for transferred patients with ST-segment elevation myocardial infarction (STEMI) presenting during business (ON) hours vs. after (OFF) hours. Background: Door-to-device (DTD) time is a prognostic factor in patients with STEMI and is longer during OFF hours. However, the in-hospital mortality is controversial. Methods: This registry study included 786 consecutive patients with STEMI referred for primary percutaneous coronary intervention to a tertiary care center with an on-site cardiac catheterization team 24 hrs a day/7 days (24/7) a week. ON hours were defined as weekdays 8 a.m. to 5 p.m., while OFF hours were defined as all other times, including holidays. The primary outcomes were in-hospital death, reinfarction, and length of stay (LOS). Results: ON hours (29.5%, n = 232) and OFF hours (70.5%, n = 554) groups had similar demographic and baseline characteristics. A significantly higher proportion of patients presenting ON hours had a DTD time ≤120 min compared to OFF hours patients (32.6% vs. 22.1%, P = 0.007). The rates of in-hospital death (8.2% vs. 6%), reinfarction (0% vs. 1.1%), and mean LOS (5.7 ± 6 vs. 5.7 ± 5) were not significantly different in the ON vs. OFF hours groups, all P = nonsignificant. Conclusion: In a tertiary care center with an on-site cardiac catheterization team 24/7, there are no differences in in-hospital outcomes of transferred patients with STEMI during ON vs. OFF hours. © 2010 Wiley-Liss, Inc.
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