Author + information
- Received April 8, 2019
- Revision received July 2, 2019
- Accepted July 11, 2019
- Published online October 30, 2019.
- Benoit Lattuca, MD,
- Mathieu Kerneis, MD,
- Anis Saib, MD,
- Lee S. Nguyen, MD,
- Laurent Payot, MD,
- Olivier Barthélemy, MD,
- Claude Le Feuvre, MD, PhD,
- Gérard Helft, MD, PhD,
- Remi Choussat, MD,
- Jean-Philippe Collet, MD, PhD∗ (, )@ActionCoeur@docjohanne,
- Gilles Montalescot, MD, PhD,
- Johanne Silvain, MD, PhD,
- for the ACTION Study Group
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
- ↵∗Address for correspondence:
Prof. Jean-Philippe Collet, ACTION Study Group, Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre, 47 Boulevard de l’Hôpital, 75013 Paris, France.
Objectives The authors sought to assess the association between admission time with patient’s care, procedure characteristics, and clinical outcomes within a contemporary ST-segment elevation myocardial infarction (STEMI) network of patients referred for primary percutaneous coronary intervention (PCI).
Background The effect of admission time on STEMI patient's outcomes remains controversial when primary PCI is the preferred reperfusion strategy.
Methods Characteristics and clinical outcomes of 2,167 consecutive STEMI patients admitted in a tertiary PCI-capable center were collected. On-hours were defined as admission from Monday through Friday between 8 am and 6 pm and off-hours as admission during night shift, weekend, and nonworking holidays. In-hospital and 1-year all-cause mortality were assessed as well as key time delays.
Results A total of 1,048 patients (48.3%) were admitted during on-hours, and 1,119 patients (51.7%) during off-hours. Characteristics were well-balanced between the 2 groups, including rates of cardiac arrest (7.9% vs. 8.8%; p = 0.55) and cardiogenic shock (12.3% vs. 14.7%; p = 0.16). Median symptom-to-first medical contact time and median first medical contact-to-sheath insertion time did not differ according to on- versus off-hours admission (120 min vs. 126 min; p = 0.25 and 90 min vs. 93 min; p = 0.58, respectively), as well as the rate of radial access for catheterization (85.6% vs. 87.5%; p = 0.27). There was no association between on- versus off-hours groups and in-hospital (8.1% vs. 7.0%; p = 0.49) or 1-year mortality (11.0% vs. 11.1%; p = 0.89), respectively.
Conclusions In a contemporary organized STEMI network, patients admitted in a high-volume tertiary primary PCI center during on-hours or off-hours had similar management and 1-year outcomes.
The present study was funded by Allies in Cardiovascular Trials Initiatives and Organized Networks ACTION Group. Dr. Lattuca has received research grants from Biotronik, Daiichi Sankyo, Fédération Française de Cardiologie, and the Institute of CardioMetabolism and Nutrition; consultant fees from Daiichi Sankyo and Eli Lilly; and lecture fees from AstraZeneca and Novartis. Dr. Kerneis has received research grants from Sanofi, Fédération Française de Cardiologie, Société Française de Cardiologie, European Society of Cardiology, AstraZeneca, Daiichi Sankyo, Eli Lilly, and Bayer; and lecture fees from Bayer, Sanofi, and Servier. Dr. Nguyen has received research grants from Fédération Française de Cardiologie and Société Française de Cardiologie; and consultant fees from CorWave. Dr. Helft has received research grants from Abbott, Boston Scientific, Medtronic, Sanofi, and Fédération Française de Cardiologie; and consultant fees from Bayer, BMS, Boehringer-Ingelheim, and Servier. Dr. Collet has received research grants from AstraZeneca, Bayer, BMS/Pfizer, Daiichi Sankyo, Eli Lilly, Fédération Française de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi, and WebMD; and honoraria from Bayer and AstraZeneca. Dr. Montalescot has received research grants from ACTELION, Amgen, AstraZeneca, Bayer, Beth Israel Deaconess Medical, Boehringer Ingelheim, Brigham Women’s Hospital, BMS, Cardiovascular Research Foundation, CCC, Celladon, CME Resources, Daiichi Sankyo, Eli -Lilly, Elsevier, Europa, Fédération Française de Cardiologie, ICAN, INSERM, Lead-Up, Medtronic, Menarini, MSD, Pfizer, Sanofi, Servier, the TIMI Study Group, and WebMD. Dr. Silvain has received research grants from Amed, Amgen, Algorythm, AstraZeneca, Bayer, Daiichi Sankyo, Eli Lilly, Fondation de France, Gilead Science, Iroko Cardio, Sanofi, and St. Jude Medical; consulting or lecture fees or travel support from AstraZeneca, Bayer HealthCare, Boehringer Ingelheim France, CSL Behring, Gilead Science, Sanofi France, Terumo France, and Abbott Medical France; and is a stockholder of Pharmaseeds. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. John Bittl, MD, served as Guest Editor of this paper.
- Received April 8, 2019.
- Revision received July 2, 2019.
- Accepted July 11, 2019.
- 2019 American College of Cardiology Foundation
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