Impact of Off-Hour Versus Work-Hour Presentation on Clinical Outcomes in Acute STEMI Patients Treated With Primary PCI: A Retrospective Analysis

Öz

For patients with ST-segment elevation myocardial infarction (STEMI), optimal reperfusion timing is crucial for positive outcomes. The existence of treatment delays or disparities in outcomes for off-hours presentations is still debated. This study examined how the timing of hospital presentation (working hours vs. off-hours) affects procedural efficiency and early clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). This retrospective, single-center study examined 186 consecutive adult STEMI patients who were treated with primary PCI between January and December 2023. Patients were divided into two groups based on their time of admission: working hours (8:00 a.m.–5:00 p.m. on weekdays; n = 54) and off-hours (5:00 p.m.–8:00 a.m. on weekends and holidays; n = 132). Door-to-balloon time (DTB), PCI duration, left ventricular ejection fraction (EF), length of stay (LOS) and in-hospital mortality were compared. DTB ≤ 60 minutes was achieved in 86.1% of all patients, with no difference between the two groups (working vs. off-hours: 87.0% vs. 85.6%; p=0.909). However, the duration of PCI was significantly longer during off-hours (43.00 ± 24.87 minutes vs. 32.13 ± 17.05 minutes; p = 0.001). There were no statistically significant differences in in-hospital mortality (6.82% vs. 7.41%; p = 1.000), ejection fraction (EF), or length of stay (LOS). Despite the longer PCI times during off-hours, the early clinical outcomes were equivalent to those during working hours. This underscores the importance of dedicated 24/7 STEMI protocols with robust PCI infrastructure in providing consistent, high-quality care regardless of admission time. Streamlining off-hours workflows could further optimize procedural efficiency within emergency cardiovascular systems.

Anahtar Kelimeler

• ST-segment elevation myocardial infarction
• primary PCI
• door-to-balloon time
• off-hours

Primer PCI ile Tedavi Edilen Akut STEMI Hastalarında Mesai Saatleri Dışında Başvurunun Klinik Sonuçlara Etkisi: Retrospektif Bir Analiz

Öz

ST segment yükselmesi olan miyokard enfarktüsü (STEMI) hastalarında, olumlu sonuçlar için optimal reperfüzyon zamanlaması çok önemlidir. Mesai saatleri dışında başvurularda tedavi gecikmeleri veya sonuçlarda farklılıklar olup olmadığı hala tartışılmaktadır. Bu çalışma, hastaneye başvuru zamanının (çalışma saatleri ve çalışma dışı saatlerde) ST segment yükselmeli miyokard enfarktüsü (STYMI) geçiren ve primer perkütan koroner girişim (PKG) uygulanan hastalarda prosedür verimliliğini ve erken klinik sonuçları nasıl etkilediğini incelemiştir. Bu retrospektif, tek merkezli çalışmada, Ocak ve Aralık 2023 tarihleri arasında birincil PKG ile tedavi edilen 186 ardışık yetişkin STYMI hastası incelenmiştir. Hastalar, kabul saatlerine göre iki gruba ayrıldı: çalışma saatleri (hafta içi 08:00-17:00; n = 54) ve çalışma dışı saatler (hafta sonu ve tatil günleri 17:00-08:00; n = 132). Kapı-balon süresi (KBS), PCI süresi, sol ventrikül ejeksiyon fraksiyonu (EF), yatış süresi (LOS) ve hastane içi mortalite karşılaştırıldı. Tüm hastaların %86,1'inde DTB ≤ 60 dakika elde edildi ve iki grup arasında fark yoktu (çalışma saatleri içinde ve dışında: %87,0 ve %85,6; p=0,909). Ancak, PKG süresi mesai saatleri dışında önemli ölçüde daha uzundu (43,00 ± 24,87 dakika karşı 32,13 ± 17,05 dakika; p = 0,001). Hastane içi mortalite (6,82% vs. 7,41%; p = 1,000), ejeksiyon fraksiyonu (EF) veya yatış süresi (LOS) açısından istatistiksel olarak anlamlı bir fark yoktu. Mesai dışı saatlerde PCI sürelerinin daha uzun olmasına rağmen, erken klinik sonuçlar mesai saatlerindeki sonuçlarla eşdeğerdi. Bu durum, yatış saatinden bağımsız olarak tutarlı ve yüksek kaliteli bakım sağlamak için sağlam PCI altyapısına sahip 7/24 STEMI protokollerinin önemini vurgulamaktadır. Mesai dışı saatlerdeki iş akışlarının düzene sokulması, acil kardiyovasküler sistemlerdeki prosedür verimliliğini daha da optimize edebilir.

Anahtar Kelimeler

• ST segment yükselmesi miyokard enfarktüsü
• primer PCI
• mesai dışı saatler
• kapı-balon zamanı

Kaynakça

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