Days, weekends and diurnal variations in the presentation of ST-elevation and non-ST elevation MI: An insight from Primary PCI/ACS Registry

摘要

Background: There appear to be variations in the time of presentation patients with ACS around the world. The working days and weekends differ in Qatar from the Western world. Methods: In 1846 patients admitted with ACS, 721 had Primary PCI for STEMI and 1125 had Non-ST Elevation ACS (NSTE-ACS). The days and time of onset of symptoms, Door to Balloon Time (DBT) and Out of Hospital Delay were compared in different time periods in relation to the weekend (Friday/Saturday), and 2-days before (B-WKE), or 2-days after (A-WKE). The intra-day variation was compared in day time (6AM-6PM), and night time (6PM-6AM). Results: Overall, almost half ACS patients (both STEMI and NSTE-ACS) presented in 2 days After WKE (Sun & Mon), with 60% of these presenting on Sunday alone, compared to only 16% over WKE (Fri & Sat). This was true for males with both STEMI and NSTEMI and for females with NSTE-ACS. However, the pattern was reversed in females with STEMI, 39% presented during week days vs only 19% After WKE (Sun & Mon). For both sexes and all ages, most (58%) presented early day time with modal symptoms starting time around 4?AM. In Primary PCI patients, the DBT was longer (77.5?min) during the night vs (61?min) during day, but in both >90% were within 90?min. 66% of STEMI total occlusion (TIMI-0) during the night. TIMI-3 flow was achieved in 94% during the day vs (87%) at night. Out of Hospital Delay was longer at night (270?min) vs (200?min) during the day. However, in-hospital mortality and LV function was similar. Conclusions: There are interesting variations diurnal and gender variation in time of presentation of ACS. However, this does not seem to make significant impact on in-hospital outcome in the Primary PCI, perhaps because majority achieved optimal Door to Balloon Time.