Out-of-hours vs in-hours PPCI have comparable outcomes

Patients receiving out-of-hours primary percutaneous coronary intervention (PPCI) endure a slightly longer door-to-balloon time (DTBT) but otherwise have comparable outcomes to those receiving the procedure during regular working hours, a recent study has found.

The study included 4,590 patients with ST-elevation myocardial infarction (STEMI) who underwent PPCI. The procedure was categorized as out-of-hours if it took place during weekends, public holidays, or weekdays from 6 PM to 8 AM. Any procedure that occurred during weekdays between 8 AM to 6 PM was defined as an in-hours procedure.

Most of the participants received PPCI out of hours (n=2,725; mean age, 62.1±12.6 years; 80.0 percent male). These patients tended to be younger than those who received in-hours PPCI (p<0.001), but the two groups were otherwise comparable in terms of baseline demographics and cardiovascular risk factors.

Patients in the out-of-hours PPCI group had a slightly but significantly shorter median symptom-to-door time (95 vs 100 mins; p=0.04), while the DTBT was significantly prolonged (83 vs 60 mins; p<0.001). The percentage of patients with DTBT <90 minutes was likewise smaller in the out-of-hours group (58.3 percent vs 77.5 percent; p<0.001).

Despite such differences, outcomes remained largely similar between groups. Researchers found no significant differences in terms of in-hospital mortality (p=0.50) or major adverse cardiac events (p=0.87). The same was true for 30-day and 12-month mortality rates.

Moreover, the use of dual antiplatelet therapy likewise remained similar between the groups, as did the rates of complications such as major bleeding, peri-procedural myocardial infarction, and target vessel revascularization.