Worse long-term prognosis in myocardial infarction occurring at weekends or public holidays with insight into myocardial infarction with nonobstructive coronary arteries

Link to article at PubMed

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.

PMID:32969634 | DOI:10.20452/pamw.15615

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