‘Off-hours’ pPCI has equivalent outcomes as ‘regular-hours’ pPCI
MedWire News: Outcomes of primary percutaneous coronary intervention (pPCI) procedures conducted during "off-hours" are equivalent to those performed during "regular hours," an Italian study suggests.
However the researchers add a caveat, namely, that outcomes are comparable so long as the procedures are being performed "within an efficient STEMI network focused on reperfusion."
The team analyzed data from the Registro Regionale Angioplastiche dell'Emilia-Romagna (REAL), which collects information on STEMI patients admitted to a network of 28 hospitals. Of these, nine have interventional intensive cardiac care facilities and 19 do not.
According to network protocol, STEMI patients admitted to an interventional center are treated with pPCI, whereas those admitted to a noninterventional center are rapidly transferred for pPCI according to their risk profile and an expected pPCI delay of less than 120 minutes.
Of 3072 consecutive patients with STEMI, 53% underwent pPCI during off-hours (defined as weekday evenings/night-times, weekends, and holidays).
Writing in the Journal of the American College of Cardiology Cardiovascular Interventions, the authors report that patients treated in "off-hours" had significantly longer median pain-to-balloon times (195 vs 186 minutes) and door-to-balloon times (88 vs 77 minutes) than those treated in regular hours.
However, rates of in-hospital and 1-year cardiac mortality did not differ between the two groups, and in multivariate analysis, off-hours pPCI was not associated with adverse outcomes.
This was true both for the overall population (odds ratio [OR]=0.70 for off-hours vs regular hours) and for patients admitted directly to an interventional center (OR=0.79).
Lead author Gianni Casella (Ospedale Maggiore, Bologna, Italy) and colleagues say that, when pPCI is performed within a highly specialized STEMI network, "the clinical effectiveness of either off-hours or regular-hours pPCI is equivalent."
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By Joanna Lyford