Comparação da mortalidade e do tempo porta-balão de indivíduos submetidos a intervenção coronariana primária nos dias da semana e nos finais de semana: uma revisão sistemática

Abstract

Introduction: Cardiovascular diseases, especially Acute Myocardial Infarction (AMI) with ST segment elevation (STEMI), are among the main causes of mortality and disability in worldwide. It is observed a circadian pattern of AMI with a peak in the early morning waking hours. Hence, studies have been carried out to identify prognostic factors that may predict negative outcomes and mortality in patients with STEMI who underwent percutaneous primary coronary intervention (PCI). Some results have shown the association between night or weekend admission and outcomes, influencing the time of treatment, PCI and mortality. Objectives: It was aimed compare the mortality rate and Door to Ballon Time (DBT) among patients with STEMI who underwent PCI in on-hours period (day time) and off-hours period (night of weekdays, weekends and holidays). Methods: A systematic review was carried out. Only studies that compared mortality among patients with STEMI who underwent PCI in the on-hours period with off-hours period were included. Results: A total of twenty one eligible studies were used in this study. It was identified a predominance of patients with STEMI undergoing PCI in the off-hours group (58%). Just nineteen studies analized the DBT in PCI, of these: nine studies showed longer time in the off-hours group, and, of these, the majority had cardilogists working in a on call regimen on the period; three studies showed longer time in on-hours group, without association with working regimen; and seven studies showed no diferences between groups. Of nine studies that analized the time between the onset of symptoms and hospital admission just one showed longer time on off-hours group, suggesting no relationhip of longer time between the onset of symptoms and hospital admission on off hours group of patients. Finally, of all studies only two showed a statistically significant difference in mortality between groups, both showing higher in-hospital mortality in the off hours groupDiscussion: Possible explanations were proposed on the predominance of patients in the "off hours" period, discussing the impact of the presence of a team of interventional cardiologists 24 hours a day in hospitals and factors that may be associated with absence of mortality difference between the groups. Conclusions: the off-hours group, despite having a longer door-to-baloon time in PCI, did not present higher mortality or other adverse events in hospital events.