Off-hour PCI procedures lead to higher death rates, longer door-to-balloon times.

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Patients undergoing primary PCI for acute STEMI during “off-hours” have higher mortality rates, according to a poster presentation at the Cardiovascular Revascularization Therapies (CRT) 2008 in Washington, D.C., last week.

Roberto J. Cubeddu, MD, of the department of vascular medicine and interventional cardiology at Massachusetts General Hospital in Boston, and colleagues retrospectively analyzed data from a single tertiary hospital where primary PCI is performed for all acute STEMI. They grouped the patients into “on hours” (Monday to Friday, between 7am and 6pm), and “off hours” (all other times), according to the time of presentation. The authors said that the primary endpoint was in-hospital mortality.

Cubeddu and colleagues examined 747 consecutive patients presenting with acute STEMI, who underwent primary PCI between 2003 and 2007. Of these, 44% were admitted during “on hours.” The authors found that group comparisons revealed no difference in baseline demographic or procedural characteristics.

The researchers found that patients admitted during “off hours” had significantly greater mortality. The total in-hospital morality rate was 3.5% in the “on hours,” compared to 8% in the “off hours,” according to the authors.

They found that the mean time to death was approximately nine days in both groups, and there was no difference in non-fatal, in-hospital cardiovascular events, procedural success and hospital length of stay.

Importantly, the researchers reported that the door-to-balloon (DTB) times were significantly longer among patients admitted during “off-hours” (109 minutes vs. 133 minutes).

Furthermore, the difference in DTB was only observed among emergency department (ED) admissions (63 minutes vs. 89 minutes), and not for transfers from another institution (147 minutes vs. 155 minutes), the authors wrote.

Cubeddu and colleagues consistently found that the difference in mortality observed between “on hours” and “off hours” was found only in ED admissions (1.5% vs. 4.3%). 

The researchers concluded that strategies to reduce DTB times during “off hours” need to be revised, particularly among STEMI presenting to the ED.