Heart attack patients treated with primary percutaneous intervention (PCI) at hospitals after hours and on weekends wait longer to receive clot busters and other treatments and have a higher risk of death than those treated during regular hospital hours, researchers at Yale School of Medicine report in the August 17 issue of Journal of the American Medical Association (JAMA).
The researchers found that while 67.9 percent of heart attack patients were treated during off-hours (weekdays 5 p.m. to 7 p.m. and on weekends), the time from hospital arrival to receiving clot dissolving medications varied from only one minute longer wait for clot busting medications to 21 minutes longer wait for (PCI) therapy.
"The findings suggest that the delayed treatment associated with PCI treatment is associated with a greater mortality risk," said Harlan M. Krumholz, M.D., professor of medicine and public health at Yale School of Medicine. Krumholz is also director of the Robert Wood Johnson Clinical Scholars Program at Yale.
He added, "Many patients at night and on weekends have very long delays. This study highlights the need to focus on improving our systems of care during these times for patients who are referred for procedures to treat heart attacks."
Heart attack patients generally receive reperfusion therapy, which consists of either clot busting drugs to restore blood flow to an organ or tissue, or PCI treatments such as angioplasty where a catheter-guided balloon is used to open a narrowed coronary artery. Reperfusion therapy reduces the risk of death for eligible ST-segment elevation myocardial infarction (STEMI), which is detected on an electrocardiogram after a heart attack. The shorter the time from symptom onset to treatment, the greater the survival benefit with either therapy. Krumholz said all things being equal, PCI produces a better outcome, but delays will undermine that advantage.