The Effect Of Off-hour Emergency PCI On In-hospital Outcomes Of Acute Myocardial Infraction

Background: Scholars have found that in some serious diseases, the in-hospital mortality rate of patients admitted during weekend was higher than those admitted during working day[1,2,3,4,5,6,7]. Meanwhile, acute coronary syndrome(ACS) as a critical type of coronary heart disease is seriously harmful to human health[8]. Because of the high incidence and case fatality of ACS, small increases in the relative risk of mortality during off-hours can translate to important effects in the population[9]. So the impact of off-hour on prognosis of ACS patients should not be underestimated. The outcomes of acute myocardial infarction(AMI) are closely related to the emergency treatment[10]. So it is attracting more and more attention whether off-hour had impact on outcomes of AMI.Therefore, we want to collect information of patients with STEMI and to explore the relationship between off-hour and the outcomes of AMI patients.Objective: Analysing the baseline characteristics, the result of coronary angiography,treatment and patients in-hospital combined cardiovascular events of AMI patients who undergoing emergency Percutaneous coronary intervention(PCI) to investigate the effects of off-hour PCI on in-hospital outcomes of AMI.Method:(1) We studied 585 consecutive patients who admitted to the First Affiliated Hospital of Soochow University with acute myocardial infarction(AMI) who undergoing emergency PCI from January 2013 to may 2015.(2)The patients we selected were divided into two groups according to admitted time,the office-hour group A(155 cases) and the off-hour group B(43 cases).(3) The retrospective study was to collect the clinical data such as age, sex, history of diabetes, hypertension, postoperative heart rate, postoperative systolic pressure, postoperative diastolic pressure and so on. At the same time, results of heart Doppler examination, features of coronary angiography and treatment information were collected as well as in-hospital combined cardiac events such as cardiac death,malignant arrhythmia, cardiac shock, acute heart failure.(4) We assessed the relationship between the admitted time of AMI patients and there baseline characteristics, the result of coronary angiography, treatment and patients in-hospital combined cardiovascular events.(5) We used logistic regression analysis to assess the influencing factors of in-hospital combined cardiovascular events.Results: 1, There was significant difference in age, history of hypertension, smoking history, white blood cell count(WBC), high-sensitivity C-reactive protein(hs-CRP) and N-terminal brain natriuretic peptide(NT-pro-BNP) between the two groups(P > 0.05),while there was no significant differences in sex, history of diabetes mellitus, history of stroke, hyperlipemia, hemoglobin, fasting blood glucose, blood potassium concentration,creatine kinase MB(CK-MB) peak concentration, Cardiac troponin(cTn) concentrations,total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), blood calcium concentration, postoperative heart rate, postoperative systolic pressure, postoperative diastolic pressure and EF value between the two groups(P <0.05).2, In the results of coronary angiography, There was significant difference in the proportion of criminal vessel number and lesion vessel number between the two groups(P > 0.05), while there was no significant differences in stenosis location of crime vascular and type of crime vascular between the two groups(P <0.05). But when it came to the proportion of multi-criminal vessel and multi-lesion vessel of these STEMI patients, there were no significant difference between the two groups(P > 0.05).3, During treatment, there was significant difference in the using rate of Angiotensin converting enzyme inhibitor(ACEI) or Angiotensin receptor antagonist(ARB) drugs within 24 h between the two groups(P > 0.05), while there was no significant differences in the time from AMI onsetting to receiving PCI, beta blockers using rate within 24 h,antagonists of Ⅱb/Ⅲa receptor agent using rate and the days of low molecular weight heparin(LMWH) using between the two groups(P <0.05).4, The incidence of in-hospital combined cardiovascular events in patients with B was less than that of groupA(P < 0.05), and the incidence of acute heart failure and cardiac death in group B was significantly lower than that in group A(P < 0.05).5, Logistic regression analysis showed that the patient’s age, hs-CRP and postoperative heart rate were the independent risk factors of in-hospital combinedcardiovascular events(P < 0.05).Conclusion: 1, Time of receiving emergency PCI of AMI patients does have a certain relationship with the happening of in-hospital combined cardiovascular events. And there is a lower rate of in-hospital combined cardiovascular events for those who receiving operation during off-hour than other patients.2,Among AMI patients undergoing primary PCI, those who admitted in off-hour had lower hypertension history proportion, proportion of patients with smoking, next day WBC,hs-CRP and NT-pro-BNP than those of office-time group. And office-hour group had higher rate of ACEI or ARB drug using within 24 hours.3, Patient’s age, hs-CRP and postoperative heart rate were independent risk factors of in-hospital combined cardiovascular events in AMI patients undergoing emergency PCI.