Emergency service admission time and in-hospital mortality in acute coronary syndrome.

BACKGROUND

The relationship between admission time to an emergency service and in-hospital outcomes in acute coronary syndrome (ACS) is controversial. Admission during off-hours would be associated with worse prognosis.

OBJECTIVE

To assess the influence of admission time on prolonged hospitalization and mortality for ACS patients, regarding regular hours (7AM-7PM) and off-hours (7PM-7AM).

METHODS

The study assessed prospectively 1,104 consecutive ACS patients. In-hospital mortality and length of hospital stay ≥ 5 days were the outcomes analyzed.

RESULTS

Admission during regular hours was greater as compared with that during off-hours (63% vs. 37%; p < 0.001). Unstable angina was more prevalent during regular hours (43% vs. 32%; p < 0.001), while non-ST-segment elevation myocardial infarction (NSTEMI) was during off-hours (33% vs. 43%; p = 0.001). Differences in neither mortality nor length of hospital stay were observed in the time periods studied. Predictive factors for length of hospital stay ≥ 5 days were as follows: age [OR 1.042 (95%CI: 1.025 - 1.058), p < 0.001]; ejection fraction (EF) [OR 0.977 (95%CI: 0.966 - 0.988), p < 0.001]; NSTEMI [OR 1.699 (95%CI: 1.221 - 2.366), p = 0.001]; and smoking [OR 1.723 (95%CI: 1.113 - 2.668), p = 0.014]. Predictive factors for in-hospital mortality were as follows: age [OR 1.090 (95%CI: 1.047 - 1.134), p < 0.001]; EF [OR 0.936 (95%CI: 0.909 - 0.964), p < 0.001]; and surgical treatment [OR 3.781 (95%CI: 1.374 - 10.409), p = 0.01].

CONCLUSION

Prolonged length of hospital stay and in-hospital mortality in ACS patients do not depend on admission time.