Relationship Between Primary Percutaneous Coronary Intervention, Door-to-balloon Times, and Mortality for Heart Attack Patients Across England

Completed

• Conditions: Myocardial Infarction

• Registration Number: NCT02374190
• Lead Sponsor: London School of Economics and Political Science

Brief Summary

The degree to which elevated mortality associated with weekend or night-time hospital admissions reflects poorer quality of care ('off-hours effect') is a contentious issue. We examined if off-hours admissions for primary percutaneous coronary intervention (PPCI) were associated with higher adjusted mortality and estimated the extent to which potential differences in door-to-balloon (DTB) times-a key indicator of care quality for ST elevation myocardial infarction (STEMI) patients-could explain this association. Nationwide registry-based prospective observational study using Myocardial Ischemia National Audit Project data in England. We examined how off-hours admissions and DTB times were associated with our primary outcome measure, 30-day mortality, using hierarchical logistic regression models that adjusted for STEMI patient risk factors. In-hospital mortality was assessed as a secondary outcome. Our study found that higher adjusted mortality associated with off-hours admissions for PPCI could be partly explained by differences in DTB times.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2015-02-13
• Study First Submitted QC: 2015-02-26
• Study First Posted: 2015-02-27
• Study Start: 2017-09-01
• Primary Completion: 2019-12-24
• Study Completion: 2019-12-24
• Status Verified: 2020-04
• Last Update Submitted: 2020-04-29
• Last Update Posted: 2020-05-01

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 42677

Inclusion Criteria

• STEMI patients admitted from 1 January 2007 to 31 December 2012
• STEMI patients aged over 18 years
• STEMI patients admitted directly to '24/7' PPCI-capable hospitals for PPCI
• Discharge diagnosis of STEMI
• Provision of PPCI based on initial reperfusion strategy

Exclusion Criteria

• Hospitals performing less than 20 procedures per year
• Hospitals performing PPCIs only during regular hours
• Interhospital transfers
• PPCIs conducted within 6 hours on hospital arrival

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
30-day mortality	30 days post-discharge

Secondary Outcome Measures

Name	Time	Method
In-hospital mortality	Patient length of stay in hospital until discharge, an average of 3 days

Trial Locations

Locations (1)

London School of Economics and Political Science; 🇬🇧 London, United Kingdom