Off-hours Primary PCI Still Have the Highest Mortality Rate?

According to this contemporary study, in the current organized STEMI network, patients admitted to a tertiary high-volume center for primary PCI are managed similarly and have similar prognosis regardless admission time. 

¿Las angioplastias primarias a la madrugada siguen teniendo mayor mortalidad?

Several prior studies have shown primary PCI during off-hours (6 pm to 8 am) had worse outcomes vs. on-hour interventions (8 am to 6 pm). Something similar occurred when comparing weekend and holiday outcomes vs. working days. 

This study analyzed the outcomes of 2167 consecutive STEMI patients admitted to a tertiary primary PCI center 24 hours, 7 days a week, all year round.


Read also: Net Benefit of Left Atrial Appendage Closure vs. Anticoagulation in Atrial Fibrillation.


1048 patients (48.3%) were admitted on-hours and 1119 (51.7%) off-hours.

Baseline clinical characteristics were well balanced between the groups, including cardiac arrest rate (7.9% vs 8.8%) and cardiogenic shock (12.3% vs 14.7%).

Mean time between symptom onset and fist medical contact and mean time between first contact and sheath insertion resulted similar between both groups (120 min vs. 126 min; p=0.25 y 90 min vs. 93 min; p=0.58, respectively), same as radial access rate (85.6% vs. 87.5%; p=0.27).


Read also: International Consensus to Prevent Radial Artery Occlusion After Interventions.


There was no association between time and procedure and in-hospital mortality (8.1% vs. 7.0%; p=0.49) and mortality at one year (11.0% vs. 11.1%; p=0.89).

Conclusion

The contemporary organized STEMI network has successfully beaten the myth of worse off hours PCI prognosis. This was true for both in-hospital mortality and one year mortality, at least for one high volume tertiary center. 

Original title: On- Versus Off-Hours Presentation and Mortality of ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention.

Reference: Benoit Lattuca et al. J Am Coll Cardiol Intv 2019, article in press.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Pretreatment with DAPT in Acute Coronary Syndrome: An Ongoing Debate?

In acute coronary syndrome (ACS) dual antiplatelet therapy (DAPT) has become a fundamental pillar after percutaneous coronary intervention (PCI), preventing stent thrombosis and acute...

Another Blow for Intra-Aortic Balloon Pumo Counterpulsation? Randomized Study on Its Use in Chronic Heart Failure Progressing to Cardiogenic Shock

Cardiogenic shock (CS) remains a condition with extremely high mortality (around 50%). While most therapies for this pathology have been studied in CS secondary...

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...

iFR- vs. FFR-Guided Coronary Revascularization: 5-Year Clinical Outcomes

The assessment of coronary stenosis using coronary physiology has become a key tool in guiding revascularization. The two most widely used techniques are fractional...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Pretreatment with DAPT in Acute Coronary Syndrome: An Ongoing Debate?

In acute coronary syndrome (ACS) dual antiplatelet therapy (DAPT) has become a fundamental pillar after percutaneous coronary intervention (PCI), preventing stent thrombosis and acute...

Measuring Post-TAVI Gradients and Their Implications: Are Invasive and Echocardiographic Assessments Comparable?

Transcatheter aortic valve implantation (TAVI) is considered the treatment of choice for a significant proportion of patients with symptomatic aortic stenosis. Outcomes have improved...

Another Blow for Intra-Aortic Balloon Pumo Counterpulsation? Randomized Study on Its Use in Chronic Heart Failure Progressing to Cardiogenic Shock

Cardiogenic shock (CS) remains a condition with extremely high mortality (around 50%). While most therapies for this pathology have been studied in CS secondary...