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Croatian Medical Journal, Vol. 50 No. 5, 2009.

Original scientific paper

Significance of Off-hours in Centralized Primary Percutaneous Coronary Intervention Network

David Becker ; Heart Center Semmelweis University, Budapest, Hungary
Pal Soos ; Heart Center Semmelweis University, Budapest, Hungary
Balazs Berta ; Heart Center Semmelweis University, Budapest, Hungary
Andrea Nagy ; Heart Center Semmelweis University, Budapest, Hungary
Gabor Fulop ; Heart Center Semmelweis University, Budapest, Hungary
Gyorgy Szabo ; Heart Center Semmelweis University, Budapest, Hungary
Gyorgy Barczi ; Heart Center Semmelweis University, Budapest, Hungary
Eva Belicza ; Health Services Management, Training Centre Semmelweis University, Budapst, Hungary
Istvan Martai ; National Ambulance Service Middle-Hungarian Regional Office, Budapest, Hungary

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Abstract

Aim To analyze the efficacy of a regionally organized primary
percutaneous coronary intervention (PCI) network at
the Heart Center, Semmelweis University Budapest, part of
the “Budapest model,” and the factors that influence it.
Methods In order to investigate the differences between
regular and off-hours patient care in a 24-hour myocardial
infarction primary care system, we included 1890 consecutive,
unselected patients with ST-segment elevation myocardial
infarction and followed them until at least one year.
The follow-up was complete for all participants.
Results The difference between regular hours and offhours
mortality was not significant either after 30 days
(8.6% vs 8.8%, respectively) or after 1 year (15.3% vs 14.7%,
respectively). The rate of patients with re-infarction, frequency
of re-intervention, and major adverse cardiac
events, including death, re-infarction, re-intervention, and
coronary artery bypass graft surgery, were similar in both
patient groups. The time delay between the onset of chest
pain and arrival to the clinic was 5.9 ± 5.8 hours (mean ±
standard deviation) during regular hours and 5.2 ± 4.6
hours during off-hours (P = 0.235). Direct transport caused
significant decrease in the 30-day and 1-year mortality independent
of duty time (7.2% vs 9.9%, P = 0.027; 12.6% vs
16.7%, P = 0.028; respectively).
Conclusion Centralized primary PCI network of the “Budapest
model” achieved the same level of patient care during
both off-hours and regular hours.

Keywords

coronary disease; ST elevation myocardial infarction; shock; cardiogenic; duty; percutaneous coronary intervention; network; stent-trombosis

Hrčak ID:

47877

URI

https://hrcak.srce.hr/47877

Publication date:

15.10.2009.

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