Off-Hours Presentation Not Detrimental in STEMI

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Off-Hours Presentation Not Detrimental in STEMI
Off-Hours Presentation Not Detrimental in STEMI

WEDNESDAY, Aug. 31, 2016 (HealthDay News) -- For patients with ST-segment elevation myocardial infarction (STEMI), presentation off-hours seems not to be associated with risk, according to a research letter published online Aug. 30 in the Journal of the American College of Cardiology. The research was published to coincide with the annual European Society of Cardiology Congress, held from Aug. 27 to 31 in Rome.

Senthil Selvaraj, M.D., from Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School in Boston, and colleagues examined outcomes for 1,992 patients from the CHAMPION PHOENIX trial presenting with STEMI during off-hours versus during the workday. Patients were dichotomized according to time of presentation.

The researchers found that off-hours patients, who presented during weekdays from 7 p.m. to 7 a.m., weekends, and holidays, underwent percutaneous coronary intervention more rapidly from symptom onset (P < 0.0001). For the primary efficacy outcome (combined end point of all-cause mortality, MI, stent thrombosis, or ischemia-driven revascularization at 48 hours), the risk did not differ significantly for on-hours presentation on unadjusted analysis (relative risk, 1.11; 95 percent confidence interval, 0.68 to 1.83; P = 0.67) or after multivariable propensity score adjustment (relative risk, 1; 95 percent confidence interval, 0.57 to 1.74; P = 0.99). There was also no significant difference in the primary safety outcome (GUSTO [Global Use of Strategies to Open Occluded Coronary Arteries]-defined moderate or severe bleeding; P = 0.22).

"Previous hazards identified with off-hours presentation in STEMI were not seen in a large, international, contemporary trial with prospective data collection and adjudication of efficacy outcomes," the authors write

Several authors disclosed financial ties to pharmaceutical and medical device companies, including the Medicines Co., which sponsored the CHAMPION PHOENIX trial.

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