Reassessing After-Hour Arrival Patterns and Outcomes in ST-Elevation Myocardial Infarction

Differences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours. Using a prospective observational study, we analyzed all 1,247 non-transfer STEMI patients treated in 15 pe...

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Bibliographic Details
Published in:The western journal of emergency medicine 2015-05, Vol.16 (3), p.388-394
Main Authors: Langabeer, James, Alqusairi, Diaa, DelliFraine, Jami L, Fowler, Ray, King, Richard, Segrest, Wendy, Henry, Timothy
Format: Article
Language:English
Subjects:
After-Hours Care - standards
Aged
Angioplasty, Balloon, Coronary - statistics & numerical data
Female
Health Outcomes
Health Services Accessibility
Healthcare Disparities - statistics & numerical data
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction - mortality
Myocardial Infarction - therapy
Practice Guidelines as Topic
Prospective Studies
Quality Improvement - standards
Texas - epidemiology
Thrombolytic Therapy
Time Factors
Time-to-Treatment
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Summary:Differences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours. Using a prospective observational study, we analyzed all 1,247 non-transfer STEMI patients treated in 15 percutaneous coronary intervention (PCI) facilities in Dallas, Texas, during a 24-month period (2010-2012). Controlling for confounding factors through a variety of statistical techniques, we explored differences in door-to-balloon (D2B) and in-hospital mortality for those presenting on weekends vs. weekdays and business vs. after hours. Patients who arrived at the hospital on weekends had larger D2B times compared to weekdays (75 vs. 65 minutes; KW=48.9; p16 minutes longer than those who arrived during business hours and a higher likelihood of mortality (OR 2.23, CI [1.15-4.32], p
ISSN:1936-900X
1936-9018
DOI:10.5811/westjem.2015.2.24166