Mehmet Ozbek, Kamran Ildirimli, Baran Arik, Adem Aktan, Mehmet Sait Coskun, Ali Evsen, Tuncay Guzel, Halit Acet, Muhammed Demira
{"title":"st段抬高型心肌梗死患者临床结局与住院时间的关系","authors":"Mehmet Ozbek, Kamran Ildirimli, Baran Arik, Adem Aktan, Mehmet Sait Coskun, Ali Evsen, Tuncay Guzel, Halit Acet, Muhammed Demira","doi":"10.5144/0256-4947.2023.25","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference.</p><p><strong>Objectives: </strong>Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission.</p><p><strong>Design: </strong>Retrospective SETTING: Tertiary percutaneous coronary intervention center.</p><p><strong>Patients and methods: </strong>Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals.</p><p><strong>Main outcome measures: </strong>Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women.</p><p><strong>Results: </strong>Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime (<i>P</i>=.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV (<i>P</i>=.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime (<i>P</i>=.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night (<i>P</i>=.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality.</p><p><strong>Conclusions: </strong>While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. Although patients admitted at night with STEMI presented with worse clinical conditions, similar results were observed between the groups in clinical outcomes.</p><p><strong>Limitations: </strong>More \"real world\" results might have been obtained if the study had replicated more typical referral conditions for PCI.</p><p><strong>Conflict of interest: </strong>None.</p>","PeriodicalId":8016,"journal":{"name":"Annals of Saudi Medicine","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e6/35/0256-4947.2023.25.PMC9899343.pdf","citationCount":"0","resultStr":"{\"title\":\"Dependence of clinical outcomes on time of hospital admission in patients with ST-segment elevation myocardial infarction.\",\"authors\":\"Mehmet Ozbek, Kamran Ildirimli, Baran Arik, Adem Aktan, Mehmet Sait Coskun, Ali Evsen, Tuncay Guzel, Halit Acet, Muhammed Demira\",\"doi\":\"10.5144/0256-4947.2023.25\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference.</p><p><strong>Objectives: </strong>Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission.</p><p><strong>Design: </strong>Retrospective SETTING: Tertiary percutaneous coronary intervention center.</p><p><strong>Patients and methods: </strong>Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals.</p><p><strong>Main outcome measures: </strong>Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women.</p><p><strong>Results: </strong>Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime (<i>P</i>=.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV (<i>P</i>=.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime (<i>P</i>=.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night (<i>P</i>=.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality.</p><p><strong>Conclusions: </strong>While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. 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Dependence of clinical outcomes on time of hospital admission in patients with ST-segment elevation myocardial infarction.
Background: There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference.
Objectives: Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission.
Patients and methods: Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals.
Main outcome measures: Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women.
Results: Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime (P=.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV (P=.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime (P=.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night (P=.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality.
Conclusions: While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. Although patients admitted at night with STEMI presented with worse clinical conditions, similar results were observed between the groups in clinical outcomes.
Limitations: More "real world" results might have been obtained if the study had replicated more typical referral conditions for PCI.
期刊介绍：
The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.
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