Impact of admission hours on each stage of care and total reperfusion delays in patients with ST elevation myocardial infarction

摘要

Background: ST segment elevation myocardial infarction (STEMI) is preferably treated by prompt primary percutaneous coronary intervention (pPCI). Delays in initial stages of care of STEMI patients admitted off versus routine hours are controversial. The aim of this study was to evaluate time periods in each stage of care of STEMI patients submitted to pPCI in a private tertiary hospital during on- vs. off-hours, and the adherence to current guidelines recommended times. Methods: consecutive STEMI patients admitted 2013-2019 who underwent pPCI were enrolled in this cohort study. Time periods were prospectively registered and other variables retrieved from electronic medical records. Primary outcomes were the time periods of each stage of care, since patient arrival in the emergency room (ER) until reperfusion of the culprit artery, performed during on-hours (weekdays, from 08:00 AM to 07:59 PM) or off-hours (all other days and time periods, or holidays). Results: 218 patients were included, 131 (60%) presented off-hours, with longer time periods between calling the catheterization laboratory staff until reperfusion, [55 min × 72 min; P 0.001] and ER door-to-reperfusion [73 min × 98 min; P 0.001]. Exploratory analysis by year suggested a decreasing reperfusion delay during on-hours admissions. In most years, total time for reperfusion exceeded the sixty minutes frame recommended in current North American guidelines, for both on- and off-hours admissions. Considering the ninety minutes recommendation of the European guideline, only on-hour admissions were in accordance during most years. Conclusions: STEMI patients, particularly when admitted off-hours, have lags in some stages of care, culminating in delayed myocardial reperfusion greater than recommended in current guidelines.