Off-hour admission and outcomes for patients with acute myocardial infarction undergoing percutaneous coronary interventions

Atsushi Sorita, Ryan J. Lennon, Qusay Haydour, Adil Ahmed, Malcolm R. Bell, Charanjit S. Rihal, Bernard J. Gersh, Jody L. Holmen, Nilay D Shah, Mohammad H Murad, Henry H. Ting

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Prior studies have suggested that patients with acute myocardial infarction (AMI) who are admitted during off-hours (weekends, nights and holidays) have higher mortality when compared with patients admitted during regular hours. Methods We analyzed consecutive patients with AMI (ST-elevation myocardial infarction [STEMI] and non-STEMI) who were treated with percutaneous coronary interventions from January 1998 to June 2010 at an academic medical center. Multivariable logistic regression models were used to estimate the association between off-hour admission and clinical outcomes adjusted for demographic and clinical variables. Results There were 3,422 and 2,664 patients with AMI admitted during off-hours and regular hours, respectively. Patients admitted during off-hours were more likely to have STEMI (56% vs 48%, P b .001), have cardiogenic shock at presentation (6% vs 4%, P = .002), and develop shock after presentation (6% vs 5%, P = .004). After multivariable analyses, off-hour admission was not significantly associated with in-hospital mortality (odds ratio [OR] 1.12, 95% CI 0.84-1.49), 30-day mortality (OR 1.12, 0.87-1.45), or 30-day readmissions (OR 1.01, 0.84-1.20) but was significantly associated with composite major complications and any of emergent coronary artery bypass graft surgery, ventricular arrhythmia, stroke/transient ischemic attack, and gastrointestinal/retroperitoneal/intracranial bleeding (OR 1.27, 1.05-1.55, P = .015). There was no significant time trend in the adjusted mortality difference between off-hours and regular hours. The results were not different between STEMI and non-STEMI. Conclusions Patients who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at an academic medical center. (Am Heart J 2015;169:62-8.).

Original languageEnglish (US)
Pages (from-to)62-68
Number of pages7
JournalAmerican Heart Journal
Volume169
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Patient Admission
Percutaneous Coronary Intervention
Myocardial Infarction
Odds Ratio
Mortality
Logistic Models
Holidays
Cardiogenic Shock
Transient Ischemic Attack
Hospital Mortality
Coronary Artery Bypass
Cardiac Arrhythmias
Shock
Stroke
Demography
Hemorrhage
Transplants
ST Elevation Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Off-hour admission and outcomes for patients with acute myocardial infarction undergoing percutaneous coronary interventions. / Sorita, Atsushi; Lennon, Ryan J.; Haydour, Qusay; Ahmed, Adil; Bell, Malcolm R.; Rihal, Charanjit S.; Gersh, Bernard J.; Holmen, Jody L.; Shah, Nilay D; Murad, Mohammad H; Ting, Henry H.

In: American Heart Journal, Vol. 169, No. 1, 2014, p. 62-68.

Research output: Contribution to journalArticle

Sorita, A, Lennon, RJ, Haydour, Q, Ahmed, A, Bell, MR, Rihal, CS, Gersh, BJ, Holmen, JL, Shah, ND, Murad, MH & Ting, HH 2014, 'Off-hour admission and outcomes for patients with acute myocardial infarction undergoing percutaneous coronary interventions', American Heart Journal, vol. 169, no. 1, pp. 62-68. https://doi.org/10.1016/j.ahj.2014.08.012
Sorita, Atsushi ; Lennon, Ryan J. ; Haydour, Qusay ; Ahmed, Adil ; Bell, Malcolm R. ; Rihal, Charanjit S. ; Gersh, Bernard J. ; Holmen, Jody L. ; Shah, Nilay D ; Murad, Mohammad H ; Ting, Henry H. / Off-hour admission and outcomes for patients with acute myocardial infarction undergoing percutaneous coronary interventions. In: American Heart Journal. 2014 ; Vol. 169, No. 1. pp. 62-68.
@article{03039309b73540a7bf34bfb30f785ed7,
title = "Off-hour admission and outcomes for patients with acute myocardial infarction undergoing percutaneous coronary interventions",
abstract = "Background Prior studies have suggested that patients with acute myocardial infarction (AMI) who are admitted during off-hours (weekends, nights and holidays) have higher mortality when compared with patients admitted during regular hours. Methods We analyzed consecutive patients with AMI (ST-elevation myocardial infarction [STEMI] and non-STEMI) who were treated with percutaneous coronary interventions from January 1998 to June 2010 at an academic medical center. Multivariable logistic regression models were used to estimate the association between off-hour admission and clinical outcomes adjusted for demographic and clinical variables. Results There were 3,422 and 2,664 patients with AMI admitted during off-hours and regular hours, respectively. Patients admitted during off-hours were more likely to have STEMI (56{\%} vs 48{\%}, P b .001), have cardiogenic shock at presentation (6{\%} vs 4{\%}, P = .002), and develop shock after presentation (6{\%} vs 5{\%}, P = .004). After multivariable analyses, off-hour admission was not significantly associated with in-hospital mortality (odds ratio [OR] 1.12, 95{\%} CI 0.84-1.49), 30-day mortality (OR 1.12, 0.87-1.45), or 30-day readmissions (OR 1.01, 0.84-1.20) but was significantly associated with composite major complications and any of emergent coronary artery bypass graft surgery, ventricular arrhythmia, stroke/transient ischemic attack, and gastrointestinal/retroperitoneal/intracranial bleeding (OR 1.27, 1.05-1.55, P = .015). There was no significant time trend in the adjusted mortality difference between off-hours and regular hours. The results were not different between STEMI and non-STEMI. Conclusions Patients who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at an academic medical center. (Am Heart J 2015;169:62-8.).",
author = "Atsushi Sorita and Lennon, {Ryan J.} and Qusay Haydour and Adil Ahmed and Bell, {Malcolm R.} and Rihal, {Charanjit S.} and Gersh, {Bernard J.} and Holmen, {Jody L.} and Shah, {Nilay D} and Murad, {Mohammad H} and Ting, {Henry H.}",
year = "2014",
doi = "10.1016/j.ahj.2014.08.012",
language = "English (US)",
volume = "169",
pages = "62--68",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Off-hour admission and outcomes for patients with acute myocardial infarction undergoing percutaneous coronary interventions

AU - Sorita, Atsushi

AU - Lennon, Ryan J.

AU - Haydour, Qusay

AU - Ahmed, Adil

AU - Bell, Malcolm R.

AU - Rihal, Charanjit S.

AU - Gersh, Bernard J.

AU - Holmen, Jody L.

AU - Shah, Nilay D

AU - Murad, Mohammad H

AU - Ting, Henry H.

PY - 2014

Y1 - 2014

N2 - Background Prior studies have suggested that patients with acute myocardial infarction (AMI) who are admitted during off-hours (weekends, nights and holidays) have higher mortality when compared with patients admitted during regular hours. Methods We analyzed consecutive patients with AMI (ST-elevation myocardial infarction [STEMI] and non-STEMI) who were treated with percutaneous coronary interventions from January 1998 to June 2010 at an academic medical center. Multivariable logistic regression models were used to estimate the association between off-hour admission and clinical outcomes adjusted for demographic and clinical variables. Results There were 3,422 and 2,664 patients with AMI admitted during off-hours and regular hours, respectively. Patients admitted during off-hours were more likely to have STEMI (56% vs 48%, P b .001), have cardiogenic shock at presentation (6% vs 4%, P = .002), and develop shock after presentation (6% vs 5%, P = .004). After multivariable analyses, off-hour admission was not significantly associated with in-hospital mortality (odds ratio [OR] 1.12, 95% CI 0.84-1.49), 30-day mortality (OR 1.12, 0.87-1.45), or 30-day readmissions (OR 1.01, 0.84-1.20) but was significantly associated with composite major complications and any of emergent coronary artery bypass graft surgery, ventricular arrhythmia, stroke/transient ischemic attack, and gastrointestinal/retroperitoneal/intracranial bleeding (OR 1.27, 1.05-1.55, P = .015). There was no significant time trend in the adjusted mortality difference between off-hours and regular hours. The results were not different between STEMI and non-STEMI. Conclusions Patients who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at an academic medical center. (Am Heart J 2015;169:62-8.).

AB - Background Prior studies have suggested that patients with acute myocardial infarction (AMI) who are admitted during off-hours (weekends, nights and holidays) have higher mortality when compared with patients admitted during regular hours. Methods We analyzed consecutive patients with AMI (ST-elevation myocardial infarction [STEMI] and non-STEMI) who were treated with percutaneous coronary interventions from January 1998 to June 2010 at an academic medical center. Multivariable logistic regression models were used to estimate the association between off-hour admission and clinical outcomes adjusted for demographic and clinical variables. Results There were 3,422 and 2,664 patients with AMI admitted during off-hours and regular hours, respectively. Patients admitted during off-hours were more likely to have STEMI (56% vs 48%, P b .001), have cardiogenic shock at presentation (6% vs 4%, P = .002), and develop shock after presentation (6% vs 5%, P = .004). After multivariable analyses, off-hour admission was not significantly associated with in-hospital mortality (odds ratio [OR] 1.12, 95% CI 0.84-1.49), 30-day mortality (OR 1.12, 0.87-1.45), or 30-day readmissions (OR 1.01, 0.84-1.20) but was significantly associated with composite major complications and any of emergent coronary artery bypass graft surgery, ventricular arrhythmia, stroke/transient ischemic attack, and gastrointestinal/retroperitoneal/intracranial bleeding (OR 1.27, 1.05-1.55, P = .015). There was no significant time trend in the adjusted mortality difference between off-hours and regular hours. The results were not different between STEMI and non-STEMI. Conclusions Patients who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at an academic medical center. (Am Heart J 2015;169:62-8.).

UR - http://www.scopus.com/inward/record.url?scp=84925883388&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84925883388&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2014.08.012

DO - 10.1016/j.ahj.2014.08.012

M3 - Article

C2 - 25497249

AN - SCOPUS:84925883388

VL - 169

SP - 62

EP - 68

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 1

ER -