Study: Survival rates similar for off-hours, office-hours PCIs
Eric Boersma, PhD, of the cardiology department at Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues noted that since STEMI can occur at any time of the day or night, patients often are treated during off-hours. Results from previous studies on outcomes for patients who present with STEMI during off-hours have been contradictory, with no long-term outcome data and involving patients treated with both primary PCI and fibrinolysis.
In 2000, the Thoraxcenter Rotterdam made primary PCI its standard treatment for STEMI and established a program that remained open 24 hours a day, seven days a week. The program collected baseline, procedural and follow-up data on all STEMI patients, providing the database for a study to compare short- and long-term outcomes for patients treated during off-hours and regular hours, the authors explained. Off-hours were defined as 6 p.m. through 8 a.m., Monday through Friday, and weekends.
The study group included patients 18 years old or older who presented within 12 hours of STEMI symptom onset who then underwent primary PCI at the Thoraxcenter between January 2000, and December 2009. Of those patients, 4,352 underwent 4,541 primary PCIs. The primary endpoints were all-cause mortality within 30 days of the index event and all-cause mortality at one-year and four-year follow-up. The secondary endpoints included repeat PCI, CABG or recurrent MI, and the composite endpoint of recurrent MI, revascularization and all-cause mortality at 30-day, one-year and four-year follow-up.
The researchers found that 63.4 percent of the patients were treated during off-hours. There were no significant differences between the groups, with the exception of smoking, diabetes mellitus, use of glycoprotein IIb/IIIa antagonists and calcium antagonists rates being higher in the off-hours group. Mortality at 30-day and four-year follow-up was the same in patients treated during off-hours and those treated during regular hours, at 7.7 percent and 17.3 percent, respectively. There was no statistical difference in all-cause mortality at one-year follow-up as well.
The authors noted that the quality of care may differ for patients treated during off-hours compared with regular hours because generally off-hours shifts use a reduced staff. “The short-term outcome (after adjustment for any differences in case mix) may be regarded as a proxy measure of the quality of care during the procedure, whereas the long-term outcome to a greater extent depends on the development of the disease, the use of long-term medication and (probably) the use of coronary revascularisations,” they wrote.
Based on their analysis, “[t]he estimates of the effect for all the endpoints indicated that treatment during off-hours is as safe and effective as treatment during regular hours.”
They pointed out that the study involved only one center, which may not be reflective of other types of institutions. “Nevertheless, the Thoraxcenter Rotterdam can be considered representative for larger tertiary referring and teaching (academic) hospitals in Western populations,” Boersma and colleagues argued.
They concluded that their findings support continuation of their 24/7 program, and may be used to encourage other facilities to expand their services.