TY - JOUR
T1 - Reassessing after-hour arrival patterns and outcomes in st-elevation myocardial infarction
AU - Langabeer, James
AU - Alqusairi, Diaa
AU - Delli Fraine, Jami L.
AU - Fowler, Ray
AU - King, Richard
AU - Segrest, Wendy
AU - Henry, Timothy
N1 - Publisher Copyright:
© 2015 Heckmann et al.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Introduction: Differences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours. Methods: Using a prospective observational study, we analyzed all 1,247 non-transfer STEMI patients treated in 15 percutaneous coronary intervention (PCI) facilities in Dallas, Texas, during a 24-month period (2010-2012). Controlling for confounding factors through a variety of statistical techniques, we explored differences in door-to-balloon (D2B) and in-hospital mortality for those presenting on weekends vs. weekdays and business vs. after hours. Results: Patients who arrived at the hospital on weekends had larger D2B times compared to weekdays (75 vs. 65 minutes; KW=48.9; p<0.001). Patients who arrived after-hours had median D2B times >16 minutes longer than those who arrived during business hours and a higher likelihood of mortality (OR 2.23, CI [1.15-4.32], p<0.05). Conclusion: Weekends and after-hour PCI coverage is still associated with adverse D2B outcomes and in-hospital mortality, even in major urban settings. Disparities remain in after-hour STEMI treatment.
AB - Introduction: Differences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours. Methods: Using a prospective observational study, we analyzed all 1,247 non-transfer STEMI patients treated in 15 percutaneous coronary intervention (PCI) facilities in Dallas, Texas, during a 24-month period (2010-2012). Controlling for confounding factors through a variety of statistical techniques, we explored differences in door-to-balloon (D2B) and in-hospital mortality for those presenting on weekends vs. weekdays and business vs. after hours. Results: Patients who arrived at the hospital on weekends had larger D2B times compared to weekdays (75 vs. 65 minutes; KW=48.9; p<0.001). Patients who arrived after-hours had median D2B times >16 minutes longer than those who arrived during business hours and a higher likelihood of mortality (OR 2.23, CI [1.15-4.32], p<0.05). Conclusion: Weekends and after-hour PCI coverage is still associated with adverse D2B outcomes and in-hospital mortality, even in major urban settings. Disparities remain in after-hour STEMI treatment.
KW - Door to Balloon
KW - Outcomes
KW - STEMI
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U2 - 10.5811/westjem.2015.2.24166
DO - 10.5811/westjem.2015.2.24166
M3 - Article
C2 - 25987912
AN - SCOPUS:84929089636
SN - 1936-900X
VL - 16
SP - 388
EP - 394
JO - Western Journal of Emergency Medicine
JF - Western Journal of Emergency Medicine
IS - 3
ER -