STEMI outcomes similar whether patients present on or off hours, French study finds

No between-group difference was seen in median time from symptoms to first medical contact or from first medical contact to sheath insertion, rate of radial access for catheterization, or in-hospital and one-year mortality.

Patients presenting to one hospital with ST-segment elevation myocardial infarction (STEMI) received similar care and had similar outcomes at one year regardless of time of admission, according to a recent study.

Researchers in France looked at the characteristics and clinical outcomes of 2,167 consecutive patients with STEMI who were admitted to a tertiary care center for percutaneous coronary intervention (PCI), with the goal of determining the effect of admission time on outcomes. Admission was considered the arrival time at the catheterization laboratory. On-hours admission was defined as admission from Monday to Friday between 8 a.m. and 6 p.m., and off-hours admission was defined as admission during the night shift, on a weekend, or on a nonworking holiday. The primary outcomes were in-hospital and one-year all-cause mortality, and secondary outcomes were key time delays and therapeutic management. The study results were published Oct. 30 by JACC: Cardiovascular Interventions.

Overall, 1,048 patients (48.3%) had on-hours admissions and 1,119 (51.7%) had off-hours admissions. Rates of cardiac arrest, cardiogenic shock, and other characteristics were similar between groups. One-year follow-up data were available for 95.3% of patients. No between-group difference was seen in median time from symptoms to first medical contact (120 min for on-hours admission vs. 126 min for off-hours admission; P=0.25) or in median time from first medical contact to sheath insertion (90 min vs. 93 min, respectively; P=0.58). Rate of radial access for catheterization (85.6% vs. 87.5%, respectively; P=0.27) did not differ between groups, and no difference was seen for in-hospital (8.1% vs. 7.0%; P=0.49) and one-year mortality rates (11.0% vs. 11.1%; P=0.89).

The researchers noted that their study was done at a single, high-volume center in an urban STEMI network using radial primary PCI and that they used sheath insertion time rather than door-to-balloon time as an outcome measure. However, they concluded that time of admission was not associated with risk for death at one year in STEMI patients. “Our analysis demonstrates that a well-organized urban STEMI network allows [facilities] to bridge the gap between on-hours and off-hours management and provide the same quality of care whatever time of admission,” the authors wrote.

The author of an accompanying editorial called the results of the study “aspirational,” noting that France has a nationwide prehospital emergency response system with a mobile ICU that provides intensive care at first medical contact and offers rapid transfer to a PCI-capable facility. “We should all be inspired by this report to continue to pursue more efficient and effective pre-hospital and in-hospital STEMI care,” the editorialist wrote. “Access to [emergency medical services] and primary PCI services, and time-to-treatment, remain the most modifiable variables in the continuing effort to further decrease morbidity and mortality from STEMI.”