HealthDay News — Off-hour presentation is linked with poorer outcomes in patients with acute myocardial infarction, according to research published online in BMJ.

Atsushi Sorita, MD, of the Mayo Clinic in Rochester, Minn., and colleagues conducted a systematic review and meta-analysis to assess the effect of off-hour presentation on door-to-balloon times and mortality in patients with acute MI.

The researchers found that patients presenting with acute MI during off-hours had significantly higher short-term mortality (odds ratio, 1.06; 95% CI: 1.04-1.09). Patients presenting with ST-segment elevation MI during off-hours were less likely to receive percutaneous coronary intervention within 90 minutes (odds ratio, 0.40; 95% CI: 0.35- 0.45) and had door-to-balloon times that were 14.8 minutes longer (95% CI: 10.7-19.0).

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“The pooled results confirmed the presence of a 5% relative increase in mortality (both in-hospital and 30-day) as well as a delay of nearly 15 minutes in door-to-balloon time for patients presenting during off-hours,” Chaim M Bell, MD, PhD, associate professor in the department of medicine at the University of Toronto wrote in an accompanying editorial.

“Future studies should try to identify specific deficits in the care pathway during off-hours, allowing differences in outcomes to be linked to differences in processes.”


  1. Sorita A et al. BMJ. 2014; 348:f7393.
  2. Bell CM et al. BMJ. 2014; 348:f7696.