No Evidence of Worse STEMI Outcomes During Off-Hours Interview with:
Senthil Selvaraj, MD, MA and Deepak L. Bhatt, MD, MPH
Brigham and Women’s Hospital Heart & Vascular Center and
Harvard Medical School, Boston, MA What is the background for this study? What are the main findings?

Response: There has been significant controversy in the effect of off-hours presentation in ST-elevation myocardial infarction (STEMI). Off-hours presentation has been associated with longer treatment time, an independent predictor of worse outcomes in STEMI, though a number of other studies have shown no difference as well. Moreover, little data has been generated from clinical trials, which has the advantage of comprehensive and adjudicated outcomes.

In our analysis of nearly 2,000 STEMI patients from the CHAMPION PHOENIX study (a randomized, controlled trial of cangrelor in percutaneous coronary intervention), we found that off-hours presentation was not associated with worse efficacy or safety outcomes at 48 hours or 30 days. More specifically, outcomes not typically reported in registry data, such as ischemia-driven revascularization and stent thrombosis, were not significantly different between the groups. Interestingly, treatment times were actually faster in the “off-hours” group as well. What should readers take away from your report?

Response: In the context of a randomized trial, there is no evidence of worse STEMI outcomes during off-hours, which may be the result of improvements in STEMI management over time. Comprehensive outcomes analysis is crucial to understanding the totality of care provided. What recommendations do you have for future research as a result of this study?

Response: The lack of difference in efficacy and safety outcomes observed in our study may be due to the faster treatment times during off-hours presentation. Thus, we applaud the efforts of quality improvement programs to expedite treatment in STEMI care.

For example, the Mission: Lifeline STEMI Systems Accelerator project, which was designed to improve delivery and coordination of care in STEMI, increased the proportion of patients treated within guideline goals. Ongoing efforts like these to facilitate treatment in STEMI are necessary and important. Thank you for your contribution to the community.


Selvaraj S, Bhatt DL, Stone GW, et al. “Off-Hours” Versus “On-Hours” Presentation in ST-Segment Elevation Myocardial Infarction: Findings from CHAMPION PHOENIX. J Am Coll Cardiol. 2016;():. doi:10.1016/j.jacc.2016.08.023.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on September 4, 2016 by Marie Benz MD FAAD