J Korean Med Sci.  2015 Apr;30(4):414-425. 10.3346/jkms.2015.30.4.414.

The Effect of Admission at Weekends on Clinical Outcomes in Patients with Non-ST-segment Elevation Acute Coronary Syndrome and Its Contributing Factors

• Kim HJ
• Kim KI
• Cho YS
• Kang J
• Park JJ
• Oh IY
• Yoon CH
• Suh JW
• Youn TJ
• Chae IH
• Choi DJ

• KMID: 2164449
• DOI: http://doi.org/10.3346/jkms.2015.30.4.414

Abstract

We investigated the effects of weekend admission on adverse cardiac events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Patients with NSTEACS treated with percutaneous coronary intervention (PCI) were divided into a "weekend group" and a "weekday group" according to the emergency room arrival time. The primary outcome was 30-day major adverse cardiac events (MACE) including cardiac death, recurrent myocardial infarction, repeat revascularization, and urgent PCI. Of 577 patients, 168 patients were allocated to the weekend and 409 patients to the weekday group. The incidence of 30-day MACE was significantly higher in the weekend group (Crude: 15.5% vs. 7.3%, P = 0.005; propensity score matched: 12.8% vs. 4.8%, P = 0.041). After adjustment for all the possible confounding factors, in Cox proportional hazard regression analysis, weekend admission was associated with a 2.1-fold increased hazard for MACE (HR, 2.13; 95% CI, 1.26-3.60, P = 0.005). These findings indicate that weekend admission of patients with NSTE-ACS is associated with an increase in 30-day adverse cardiac event.

Keyword

Coronary Artery Disease; Acute Coronary Syndrome; Percutaneous Coronary Intervention

MeSH Terms

Acute Coronary Syndrome/*complications/mortality/therapy
Adult
Aged
*Death
Female
Humans
Male
Middle Aged
Myocardial Infarction/*epidemiology
Patient Admission
Percutaneous Coronary Intervention/*statistics & numerical data
Propensity Score
Proportional Hazards Models
Time Factors
Treatment Outcome

Figure

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  Fig. 1 Selection of patients. NSTEMI, non-ST-segment elevation myocardial infarction; NSTE-ACS, non-ST-segment elevation acute coronary syndrome; CABG, coronary artery bypass grafting.

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  Fig. 2 Thirty-day major adverse cardiac events (MACE) for patients with NSTE-ACS who were admitted on weekday or weekend. Of 577 patients, 26 patients in the weekend group (15.5%) and 30 patients in the weekday group (7.3%) had MACE within 30 days. The difference between the two groups was statistically significant (P = 0.005).

• 

  Fig. 3 Outcomes and baseline characteristics according to ER admission day. (A) Thirty-day major adverse cardiac events (MACE) according to ER admission day. The incidence of MACE shows a trend of increase from Monday to Sunday. (B) Baseline Troponin-I elevation according to ER admission day. Distribution of patients with elevated baseline troponin-I shows a trend of gradual increase from Monday to Sunday. (C) Baseline electrocardiographic ST-segment depression according to ER admission day. Distribution of patients with baseline ECG change does not show statistically significant trend. (D) Baseline high TIMI risk score according to ER admission day. Distribution of patients with high TIMI risk score did not get statistically significant trend. (E) Admission to-PCI time according to ER admission day. The admission-to-PCI time has a trend of gradual increase from Monday to Saturday, revealing significantly longer time on Saturday than Tuesday or Sunday. (F) Symptom to-admission time according to ER admission day. The distribution of symptom-to-admission time shows a trend of longest time on Monday and gradual decrease toward the weekend, without statistical significance.

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  Fig. 4 Thirty-day MACE-free survival. (A) MACE-free survival in all patients. The cumulative 30-day MACE-free survival rate is significantly lower in patients admitted during the weekend (dotted line) compared to patients admitted during the weekday (solid line). Survival curves begin to diverge at day 1 and continue to separate throughout the 30-day follow-up period. (B) MACE-free survival in propensity-matched population. The cumulative 30-day MACE-free survival rate is significantly lower in the weekend group in the propensity score-matched population, too. MACE, major adverse cardiac events.

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