“Off-Hours” Versus “On-Hours” Presentation in ST-Segment Elevation Myocardial Infarction: CHAMPION PHOENIX Findings

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Abstract

Background: Several analyses have demonstrated worse outcomes for patients presenting with STEMI during off hours compared with those presenting during the workday. We sought to determine if such differences existed in a large, contemporary, international trial. Methods: The subgroup of patients with STEMI (N=1992) from CHAMPION PHOENIX was dichotomized according to time of presentation. Off hour PCI was defined by intervention performed during weekends, holidays, and weekdays from 7PM-7AM. Endpoints were evaluated at 48 hours and 30 days. The primary efficacy outcome was a combined endpoint of all-cause death, myocardial infarction, stent thrombosis, or ischemia-driven revascularization at 48 hours. The primary safety outcome was GUSTO severe bleeding. Results: Mean age was 61+/-12 years, 26% were female, and 10% were enrolled from the United States. Participants presenting on hours were more likely to be enrolled from the United States, have diabetes mellitus, have a prior PCI, and receive a higher dose clopidogrel load, bivalirudin, and a drug-eluting stent (p<0.05 for all comparisons). Off hours participants underwent PCI more rapidly from symptom onset (median: 5 vs. 6 hours, P<0.001). There was no difference in the primary efficacy outcome (RR=1.11 [95% CI 0.68, 1.83], p=0.67) (see Table). No difference in bleeding was observed in the primary safety outcome. No interaction was observed by randomization arm. Conclusions: In contrast to findings from several prior series, time of PCI did not affect STEMI outcomes in this population of patients enrolled in a contemporary clinical trial. (Table Presented).

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Selvaraj, S., Bhatt, D. L., Stone, G. W., Gibson, C. M., Steg, P. G., Hamm, C. W., … Harrington, R. A. (2016, November 29). “Off-Hours” Versus “On-Hours” Presentation in ST-Segment Elevation Myocardial Infarction: CHAMPION PHOENIX Findings. Journal of the American College of Cardiology. Elsevier USA. https://doi.org/10.1016/j.jacc.2016.08.023

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