Impact of time of admission on short- and long-term mortality in the Vienna STEMI registry

Background: Several studies have shown contradictive findings regarding mortality and hospital admission time in patients presenting with ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the impact of on- or off-hour admission on short- and long-term all-cause mortality of patients in the advanced Vienna STEMI network between 2003 and 2009. Methods and results: In total, 2829 patients were included into this analysis. Patients were stratified according to admission time into on-hour admission (07:30 until 15:00 h on weekdays) and off-hour admission (15:00-7:30 h on weekdays and 24 h on weekends). As endpoint of interest, all-cause mortality was investigated after 30 days and 3 years of follow-up, the latter for all patients and as Landmark analysis for survivors of the index event. Mean age was 60.5 +/- 13.3 years, 2048 (72.4%) patients were male and 1260 (44.5%) patients presented with anterior wall infarction. 683 (24.1%) patients were admitted on-hours, 2146 (75.9%) patients were admitted off-hours. All-cause death occurred in 176 (6.2%) patients after a follow-up of 30 days and in 337 (11.9%) patients after 3 years. For short- and long-term all-cause mortality no significant differences could be detected between on- and off-hour admission in univariate and multivariate Cox proportional hazard analyses as well as for propensity score adjusted outcome analysis. Conclusion: In the Vienna STEMI network, on- or off-hour admission had no impact on short- and long-term mortality for all-comers presenting with acute STEMI. Our findings confirm the imperative need for well-structured STEMI networks of care, as previous data repeatedly demonstrated increased adverse cardiovascular outcome for off-hour admission. (C) 2017 Elsevier B.V. All rights reserved.