Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis.
Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis.
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DOI：
10.1136/bmj.f7393
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发表时间：
2014-01-21
期刊：
影响因子：
--
通讯作者：
Ting HH
中科院分区：
文献类型：
--
作者：
Sorita A;Ahmed A;Starr SR;Thompson KM;Reed DA;Prokop L;Shah ND;Murad MH;Ting HH
目的 评估急性心肌梗死患者的非工作时间（周末和晚上）就诊、入院至球囊时间与死亡率之间的关联。数据来源 Medline 处理中和其他非索引引文、Medline、Embase、Cochrane 系统评价数据库和 Scopus，截至 2013 年 4 月。 研究选择 任何评估急性心肌梗塞患者就诊时间与死亡率或球囊入院时间之间关系的研究均纳入其中。数据提取 提取研究的特征和结果数据。研究质量采用纽卡斯尔-渥太华量表进行评估。应用随机效应荟萃分析模型。使用 Q 统计量和 I2 评估异质性。结果荟萃分析纳入了 48 项质量较好的研究，共纳入了 1 896 859 名患者。 36 项研究报告了 1 892 424 名急性心肌梗死患者的死亡率结果，30 项研究报告了 70 534 名 ST 段抬高型心肌梗死 (STEMI) 患者的球囊入院时间。急性心肌梗死患者在非工作时间就诊与较高的短期死亡率相关（比值比 1.06，95% 置信区间 1.04 至 1.09）。非工作时间出现 STEMI 的患者在 90 分钟内接受经皮冠状动脉介入治疗的可能性较小（优势比为 0.40、0.35 至 0.45），并且球囊介入时间延长了 14.8 分钟（95% 置信区间为 10.7 至 19.0）分钟。 STEMI 的诊断和北美以外的国家与非工作时间死亡率的大幅增加有关。近年来，非工作时间和正常工作时间之间的死亡率差异有所增加。分析与统计异质性相关。结论 本系统评价表明，非工作时间就诊的急性心肌梗死患者死亡率较高，STEMI 患者接受球囊治疗的时间较长。临床表现测量可能需要考虑因到医疗机构就诊的时间而产生的差异。
Objective To assess the association between off-hour (weekends and nights) presentation, door to balloon times, and mortality in patients with acute myocardial infarction. Data sources Medline in-process and other non-indexed citations, Medline, Embase, Cochrane Database of Systematic Reviews, and Scopus through April 2013. Study selection Any study that evaluated the association between time of presentation to a healthcare facility and mortality or door to balloon times among patients with acute myocardial infarction was included. Data extraction Studies’ characteristics and outcomes data were extracted. Quality of studies was assessed with the Newcastle-Ottawa scale. A random effect meta-analysis model was applied. Heterogeneity was assessed using the Q statistic and I2. Results 48 studies with fair quality, enrolling 1 896 859 patients, were included in the meta-analysis. 36 studies reported mortality outcomes for 1 892 424 patients with acute myocardial infarction, and 30 studies reported door to balloon times for 70 534 patients with ST elevation myocardial infarction (STEMI). Off-hour presentation for patients with acute myocardial infarction was associated with higher short term mortality (odds ratio 1.06, 95% confidence interval 1.04 to 1.09). Patients with STEMI presenting during off-hours were less likely to receive percutaneous coronary intervention within 90 minutes (odds ratio 0.40, 0.35 to 0.45) and had longer door to balloon time by 14.8 (95% confidence interval 10.7 to 19.0) minutes. A diagnosis of STEMI and countries outside North America were associated with larger increase in mortality during off-hours. Differences in mortality between off-hours and regular hours have increased in recent years. Analyses were associated with statistical heterogeneity. Conclusion This systematic review suggests that patients with acute myocardial infarction presenting during off-hours have higher mortality, and patients with STEMI have longer door to balloon times. Clinical performance measures may need to account for differences arising from time of presentation to a healthcare facility.
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影响因子：
1.9
作者：
Duval, S;Tweedie, R
通讯作者：
Tweedie, R
影响因子：
6.2
作者：
Garceau, Patrick;Dery, Jean-Pierre;de Larochelliere, Robert
通讯作者：
de Larochelliere, Robert
影响因子：
2.8
作者：
Berger, Alexandre;Stauffer, Jean-Christophe;Erne, Paul
通讯作者：
Erne, Paul
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
3.4
作者：
Becker, David J.
通讯作者：
Becker, David J.