Background
Primary percutaneous coronary intervention (PPCI) for STEMI is beneficial if performed in a timely manner. Conflicting data exist regarding potential treatment delays for PPCI performed during off hours. We therefore sought to evaluate treatment times and clinical outcome in a consecutive series of STEMI patients undergoing PPCI in Los Angeles County.
Methods
The Emergency Medical Services STEMI Receiving Center Database was queried from 2007 to 2009 to identify patients with a prehospital ECG showing STEMI who underwent PPCI. Transfer-in, walk-in and those with incomplete data were excluded, yielding 2246 patients for analysis. On-hour PCI (on-hour group, n =1324) was defined as PCI occurring from 8 a.m. to 5 p.m., and off-hour PCI (off-hour group, n =922) was defined as occurring from 5 p.m. to 8 a.m.
Methods
The Emergency Medical Services STEMI Receiving Center Database was queried from 2007 to 2009 to identify patients with a prehospital ECG showing STEMI who underwent PPCI. Transfer-in, walk-in and those with incomplete data were excluded, yielding 2246 patients for analysis. On-hour PCI (on-hour group, n =1324) was defined as PCI occurring from 8 a.m. to 5 p.m., and off-hour PCI (off-hour group, n =922) was defined as occurring from 5 p.m. to 8 a.m.
Results
Off-hours PCI was common, occurring in 41% of patients. Medical contact to door time was similar in the off-hour group compared to the on-hour group, 20.7±14.6 vs. 20.3±12.3 min, respectively, P =.47 ( Table 1 ). In a subgroup of patients ( n =1366), there was a significantly shorter door to cath lab activation time in the on-hour group compared to the off-hour group, −4.9±11.9 vs. −0.2±27.5 min, respectively, P <.0001. Door to balloon (D2B) time was significantly longer in the off-hour group compared to the on-hour group, 74±35 vs. 60±26 min, respectively, P <.0001. Length of stay, vascular complications, achievement of TIMI 3 flow and in-hospital mortality were similar between both groups.
