Author + information
- Received June 24, 2010
- Revision received November 2, 2010
- Accepted November 15, 2010
- Published online March 1, 2011.
- Gianni Casella, MD⁎,⁎ (, )
- Filippo Ottani, MD‡,
- Paolo Ortolani, MD§,
- Paolo Guastaroba, MSc†,
- Andrea Santarelli, MD∥,
- Marco Balducelli, MD¶,
- Alberto Menozzi, MD#,
- Paolo Magnavacchi, MD⁎⁎,
- Giuseppe Massimo Sangiorgi, MD††,
- Antonio Manari, MD‡‡,
- Rossana De Palma, MD† and
- Antonio Marzocchi, MD§
- ↵⁎Reprint requests and correspondence:
Dr. Gianni Casella, Divisione di Cardiologia, Ospedale Maggiore, Largo Nigrisoli 2, 40133 Bologna, Italy
Objectives This study aims to evaluate whether results of “off-hours” and “regular-hours” primary angioplasty (primary percutaneous coronary intervention [pPCI]) are comparable in an unselected population of patients with ST-segment elevation acute myocardial infarction treated within a regional network organization.
Background Conflicting results exist on the outcome of off-hours pPCI.
Methods We analyzed in-hospital and 1-year cardiac mortality among 3,072 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with pPCI between January 1, 2004, and June 30, 2006, during regular-hours (weekdays 8:00 am to 8:00 pm) and off-hours (weekdays 8:01 pm to 7:59 am, weekends, and holidays) within the STEMI Network of the Italian Region Emilia-Romagna (28 hospitals: 19 spoke and 9 hub interventional centers).
Results Fifty-three percent of patients were treated off-hours. Baseline findings were comparable, although regular-hours patients were older and had more incidences of multivessel disease. Median pain-to-balloon (195 min, interquartile range [IQR]: 140 to 285 vs. 186 min, IQR: 130 to 280 min; p = 0.03) and door-to-balloon time (88 min, IQR: 60 to 122 vs. 77 min, IQR: 48 to 116 min; p < 0.0001) were longer for off-hours pPCI. However, unadjusted in-hospital (5.8% off-hours vs. 7.2% regular-hours, p = 0.11) and 1-year cardiac mortality (8.4% off-hours vs. 10.3% regular-hours, p = 0.08) were comparable. At multivariate analysis, off-hours pPCI did not predict an adverse outcome either for the overall population (odds ratio [OR]: 0.70, 95% confidence interval [CI]: 0.49 to 1.01) or for patients directly admitted to the interventional center (OR: 0.79, 95% CI: 0.52 to 1.20).
Conclusions When pPCI is performed within an efficient STEMI network focused on reperfusion, the clinical effectiveness of either off-hours or regular-hours pPCI is comparable.
This study was supported by the Regional Health Care Agency of Emilia-Romagna, Bologna, Italy.
The authors have reported that they have no relationships to disclose.
- Received June 24, 2010.
- Revision received November 2, 2010.
- Accepted November 15, 2010.
- American College of Cardiology Foundation