Weekend compared with weekday presentation does not affect outcomes of patients presenting with non-ST elevation acute coronary syndrome

摘要

Aim: In non-ST elevation acute coronary syndromes (NSTEACS), early invasive management improves survival. However, since treatment strategies are urgent, not emergent, decisions to postpone invasive management due to weekend admission could affect outcome.Methods: Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), a population-based registry capturing all cardiac admissions in southern Alberta, we compared time to cardiac catheterization, modality of revascularization, and crude and risk-adjusted mortality for NSTEACS patients presenting on weekends vs. weekdays. From I April 2005 to 31 October 2010, 11 ,981 patients were admitted to care facilities in southern Alberta (32.1 % on weekends and 67.9% on weekdays).Results: Baseline characteristics were similar. Mean time to cardiac catheterization was 67.2 h in the weekend group, compared to 62.4 h in the weekday group (p=0.03), with 34.7% of weekend and 45.1% of weekday patients receiving catheterization within 24 h of admission (p<0.0001), and 49.1 and 59.9%, respectively, within 48 h (p=0.002). Mortality at 30 days was 2.2% in the weekend group compared to 2.0% in the weekday group (p=0.58). The crude hazard ratio (HR) for 30-day mortality in the weekend group was 1.08 (95% Cl 0.83-1.40). After adjusting for baseline risk factors, the HR for mortality remained non-significant (HR 1.06, 95% Cl 0.82-1.38). Mortality at I year was also similar. Conclusions: In a large unselected population of NSTEACS patients, weekend admission was associated with modest delays (4.8 h) in time to catheterization, but not with increased 30-day or I -year mortality.