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Int J Angiol 2022; 31(04): 273-283
DOI: 10.1055/s-0042-1742610
Original Article

Association of Admission Time and Mortality in STEMI Patients: A Systematic Review and Meta-analysis

Surya Dharma 
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
2   Faculty of Medicine, University of Prima Indonesia, Medan, Indonesia
,
William Kamarullah 
3   Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Adelia Putri Sabrina
3   Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
› Author Affiliations Funding None.
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Abstract

This systematic review and meta-analysis aimed to evaluate patients with acute ST-segment elevation myocardial infarction (STEMI) who were admitted during off-hours and treated with primary angioplasty associated with an increased risk of mortality compared with those admitted during regular working hours. We performed a systematic literature search using PubMed, SCOPUS, Europe PMC, and Cochrane CENTRAL databases that was finalized on March 15, 2021. The primary outcome was mortality comprising early (in-hospital), midterm (30 days to 1 year), and long-term mortality (>1 year). A total of 384,452 patients from 56 studies were included. The overall mortality of acute STEMI patients admitted during off-hours and regular hours were 6.1 and 6.7%, respectively. Patients admitted during off-hours had similar risk of early, midterm, and long-term mortality compared to those admitted during regular working hours ([relative risk or RR = 1.07, 95% confidence interval or CI, 1.00–1.14, p = 0.06; I 2 = 45%, p = 0.0009], [RR = 1.00, 95% CI, 0.95–1.05, p = 0.92; I 2 = 13%, p = 0.26], and [RR = 0.95, 95% CI, 0.86–1.04, p = 0.26; I 2 = 0%, p = 0.76], respectively). Subgroup analyses indicated that the results were consistent across all subgroups ([women vs. men], [age >65 years vs. ≤65 years], and [Killip classification II to IV vs. Killip I]). Funnel plot was asymmetrical. However, Egger's test suggests no significance of small-study effects (p = 0.19). This meta-analysis showed that patients with acute STEMI who were admitted during off-hours and treated with primary angioplasty had similar risk of early, midterm, and long-term mortality compared with those admitted during regular working hours.

Keywords

STEMI - admission time - primary angioplasty - mortality - off-hours - working hours

Authors' Contribution

S.D. contributed to the study design and concept, data interpretation, drafting, and editing the manuscript. W.K. and A.P.S. contributed to data acquisition, data analysis, interpretation, statistical expertise, and editing the manuscript.




Publication History

Article published online:
03 March 2022

© 2022. International College of Angiology. This article is published by Thieme.

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