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Recent reports indicate that patients with STEMI who undergo primary PCI during off-hours may have worse prognosis compared to procedures performed during regular-hours. The aim of this study was to compare outcome between patients with STEMI who underwent primary PCI during off-hours and regular-hours.
We retrieved data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) for all patients who underwent primary PCI in Västra Götaland County due to STEMI between January 2004 and May 2013. We modelled unadjusted and propensity score adjusted Cox proportional-hazards regression and logistic regression models for the outcomes death, cardiogenic shock, stent thrombosis and in-stent restenosis. Death at any time during the study period was pre-specified as primary end-point.
During the study period 4.597 patients underwent primary PCI due to STEMI during off-hours and 2.547 during regular office hours. Risk of dying was similar among the groups, with HR 1.00 (0.89 - 1.12, p=0.991) for the pre-defined primary end-point death at any time during the study period, and 1.03 (0.85-1.25, p=0.735) for death within 30 days. The risks of developing cardiogenic shock, stent thrombosis or in-stent restenosis were similar between the groups. Time to reperfusion was associated with increased adjusted risk of death at any time during the study period (p=0.004) but not for death within 30 days (p=0.111). Median time to reperfusion decreased from 76 min. in 2005 to 68 min. in 2013 for primary PCI performed during office hours. Similarly, time to reperfusion decreased from 101 min. in 2005 to 77 min. in 2013 for primary PCI performed during office-hours.
In our region, short- and long-term prognosis for patients with STEMI who undergo primary PCI is similar for patients presenting during off-hours and regular-hours.