J Cardiovasc Interv.  2022 Jan;1(1):7-16. 10.54912/jci.2021.0005.

Differential Prognostic Impact of Off-Hours for Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

• Lee SY
• Yang JH
• Choi KH
• Lee JM
• Park TK
• Song YB
• Hahn JY
• Choi JH
• Choi SH
• Carriere K
• Ahn J
• Koo BK
• Jeong JO
• Kim J
• Jeong MH
• The KAMIR Investigators

• KMID: 2561241
• DOI: http://doi.org/10.54912/jci.2021.0005

Abstract

Background
Cardiogenic shock complicating acute myocardial infarction (AMI) which requires high-quality treatment may be influenced by the ‘off-hours effect.’ We investigated the association of off-hours admission with 30-day mortality in cardiogenic shock complicating AMI.
Methods
We analyzed 625 AMI subjects complicated by cardiogenic shock from the Korea Acute Myocardial Infarction-National Institute of Health registry between November 2011 and December 2015. They were divided into a regular-hours group and an off-hours group according to admission time. The primary outcome was 30-day mortality.
Results
Three hundred and ninety-nine patients (63.8%) were admitted during off-hours. Thirty-day mortality was higher in off-hours group than regular-hours group (33.3% vs. 26.1%, P = 0.017), although there were no differences in rates of major bleeding, ventricular tachyarrhythmia, and acute kidney injury. Based on a Cox proportional hazard regression analysis, off-hours admission was found differently associated with 30-day mortality depending upon presence of cardiac arrest; a 3.4-fold increased hazard (95% confidence interval [CI], 1.14–9.84; P = 0.028) in patients without cardiac arrest, while that of off-hours was 0.87 (95% CI, 0.63–1.22; P = 0.423) for patients with cardiac arrest.
Conclusions
In the setting of cardiogenic shock complicating AMI, off-hours admission was associated with 30-day mortality in patients without cardiac arrest, but not in patients with cardiac arrest.

Keyword

Cardiogenic shock; Mortality; Myocardial infarction