Pol Arch Intern Med. 2020 Sep 24. doi: 10.20452/pamw.15615. Online ahead of print.
INTRODUCTION: The weekend effect in Polish myocardial infarction (MI) patients treated in the current network of cathlabs is poorly understood.
OBJECTIVES: We sought to investigate long-term prognosis of MI admissions on weekends or public holidays (NWD) and on working days (WD).
PATIENTS AND METHODS: Enrolled were 865 MI patients hospitalized in the years 2012-2017. A long-term mortality within median time of 68.5 (36.7-78.4) months was determined in 223 (25.8%) patients admitted during NWD and in 642 (74.2%) on WD.
RESULTS: Patients admitted on NWD had more often ST elevation MI (STEMI) (41.3 vs 30.8%, P=0.005), left anterior descending artery as an infarct-related artery (38.1 vs 30.2%, P=0.031) and incomplete reperfusion expressed as Thrombolysis in Myocardial Infarction 0/1 flow following primary angioplasty (6.8 vs 1.6%, P<0.001) as compared with subjects hospitalized during WD. Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurred less often in NWD (4.0 vs 9.0%, P=0.019). The all-cause long-term mortality was higher in NWD patients as compared with those admitted on WD (36.3 vs 28.4%, P=0.037). By Cox proportional hazards model with time-dependent covariates MI at NWD (hazard ratio [HR] 1.027, 95% confidence interval [CI] 1.022-1.032, P<0.001) but not MINOCA (HR 0.971, 95% CI 0.595-1.583, P=0.91) was independently associated with long-term mortality.
CONCLUSIONS: Patients hospitalized during NWD as compared with those admitted on WD had a larger ischemic territory and more often transmural MI with incomplete epicardial reperfusion, what resulted in a higher long-term mortality. The latter outcome was not influenced by MINOCA.