Original Research

DOI: 10.4244/EIJ-D-24-00331

Impact of off-hours admissions in STEMI-related cardiogenic shock managed with microaxial flow pump – insights from J-PVAD

Takahiro Suzuki1, MD, MPH; Taku Asano1, MD, PhD; Daisuke Yoneoka2, PhD; Masafumi Ono1, MD, PhD; Kotaro Miyata1, MD; Takayoshi Kanie1, MD; Yoshimitsu Takaoka1, MD, MPH; Akira Saito1, MD, MPH; Yosuke Nishihata1, MD, PhD; Yasufumi Kijima1, MD, PhD; Atsushi Mizuno1,3,4, MD, PhD; J-PVAD investigators

Abstract

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (STEMI-CS) is associated with high mortality rates. Patients admitted during off-hours, specifically on weekends and at night, show higher mortality rates, which is called the “off-hours effect”. The off-hours effect in patients with STEMI-CS treated with mechanical circulatory support, especially Impella, has not been fully evaluated.

AIMS: We aimed to investigate whether off-hours admissions were associated with higher mortality rates in this population.

METHODS: We used large-scale Japanese registry data for consecutive patients treated with Impella between February 2020 and December 2021 and compared on- and off-hours admissions. On- and off-hours were defined as the time between 8:00 and 19:59 on weekdays and the remaining time, respectively. The Cox proportional hazards model was used to calculate the adjusted hazard ratios (aHRs) for 30-day mortality.

RESULTS: Of the 1,207 STEMI patients, 566 (46.9%) patients (mean age: 69 years; 107 females) with STEMI-CS treated with Impella were included. Of these, 300 (53.0%) were admitted during on-hours. During the follow-up period (median 22 days [interquartile range 13-38 days]), 112 (42.1%) and 91 (30.3%) deaths were observed among patients admitted during off- and on-hours, respectively. Off-hours admissions were independently associated with a higher risk of 30-day mortality than on-hours admissions (aHR 1.60, 95% confidence interval: 1.07-2.39; p=0.02).

CONCLUSIONS: Our findings indicated the persistence of the “off-hours effect” in STEMI-CS patients treated with Impella. Healthcare professionals should continue to address the disparities in cardiovascular care by improving the timely provision of evidence-based treatments and enhancing off-hours medical services.

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Volume 20 Number 16
Aug 19, 2024
Volume 20 Number 16
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