Relationship Between Primary Percutaneous Coronary Intervention, Door-to-balloon Times, and Mortality for Heart Attack Patients Across England

London School of Economics and Political Science

Status: Completed

Conditions: Myocardial Infarction

Treatments: Other: Standard Hospital Care

Study type: Observational

Funder types: Other

Identifiers

NCT02374190

LSEHE40914022015

Details and patient eligibility

About

The degree to which elevated mortality associated with weekend or night-time hospital admissions reflects poorer quality of care ('off-hours effect') is a contentious issue. We examined if off-hours admissions for primary percutaneous coronary intervention (PPCI) were associated with higher adjusted mortality and estimated the extent to which potential differences in door-to-balloon (DTB) times-a key indicator of care quality for ST elevation myocardial infarction (STEMI) patients-could explain this association. Nationwide registry-based prospective observational study using Myocardial Ischemia National Audit Project data in England. We examined how off-hours admissions and DTB times were associated with our primary outcome measure, 30-day mortality, using hierarchical logistic regression models that adjusted for STEMI patient risk factors. In-hospital mortality was assessed as a secondary outcome. Our study found that higher adjusted mortality associated with off-hours admissions for PPCI could be partly explained by differences in DTB times.

Enrollment: 42,677 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• STEMI patients admitted from 1 January 2007 to 31 December 2012
• STEMI patients aged over 18 years
• STEMI patients admitted directly to '24/7' PPCI-capable hospitals for PPCI
• Discharge diagnosis of STEMI
• Provision of PPCI based on initial reperfusion strategy

Exclusion criteria

• Hospitals performing less than 20 procedures per year
• Hospitals performing PPCIs only during regular hours
• Interhospital transfers
• PPCIs conducted within 6 hours on hospital arrival

Trial design

42,677 participants in 1 patient group

Hospital Admitted STEMI Patients

Description:

The analytical cohort for this study consisted of STEMI patients aged over 18 years admitted directly to '24/7' PPCI-capable hospitals for PPCI. STEMI patients were identified based on their discharge diagnoses and were selected as having received PPCI according to their initial reperfusion strategy. Hospitals performing only sporadic PPCI procedures, which we defined as less than 20 procedures per year, and only performing PPCIs during regular hours were not included in the analysis. Interhospital transfers were not included in the analysis, and we limited our analysis to PPCIs conducted within 6 hours on hospital arrival on the assumption that patients with a DTB time beyond this did not receive PCI as a primary reperfusion strategy. The analysis was conducted for the time period for which data were available-1 January 2007 to 31 December 2012. We conducted a complete-case analysis.

Treatment:

Other: Standard Hospital Care