The impact of arrival time of STEMI patients at PCI-capable hospitals in Dallas County on the door-to-balloon treatment time and mortality rate

Heart disease is a prevalent and costly health condition and is the leading cause of death in the United States. Heart attack patients are treated in PCI-capable hospitals and these hospitals receive patients throughout the different times of the day and week. This study looks at the impact of arrival time of heart attack patients at all of Dallas PCI-capable hospitals on the door-to-balloon (D2B) times and on mortality rates. We used the Kruskal-Wallis one-way analysis of variance by ranks and a generalized linear regression model to compare the differences in D2B times. We also used a generalized linear model to calculate the odd ratio of dying for patients based on their arrival time. We controlled for EMS transportation, CCL activation by EMS, age, gender, and presence of heart failure, cardiac arrest, or shock at first medical contact. Over the study period, 1,255 patient cases were treated for STEMI in Dallas County. We found differences in the D2B times based on patients\u27 arrival time at the hospital. Patients who arrived on weekends or holidays had a median D2B time that is 10 minutes longer than those who arrived on non-holiday weekdays (75.0 and 65.0 minutes respectively). Patients who arrived between 08:00 and 17:00 had a median D2B time that is 22 minutes shorter than for those who arrived between 17:00 and 08:00. Also, more patients achieved a D2B of \u3c90 minutes during business hours than during afterhours or weekends. We found mixed results regarding the impact of STEMI patients\u27 arrival on in-hospital mortality. There were no statistically significant differences in mortality rate between patients who arrived on weekends and patients who arrived on weekdays. On the other hand, there was statistically significant difference in the odds of dying for patients who arrived during business hours compared to those of patients who arrived afterhours. However, the differences in mortality were attenuated when we adjusted for D2B time in the model, suggesting that higher mortality rates among patients who arrived afterhours could be partially due to longer D2B times during this period.