ASSOCIATION BETWEEN PRESENTATION TIME AND SHORT-TERM MORTALITY IN PATIENTS WITH CARDIOGENIC SHOCK COMPLICATING ACUTE CORONARY SYNDROME: FROM JCS SHOCK REGISTRY

Introduction: Several studies have shown that patients with acute coronary syndrome (ACS) presenting during off-hours have higher mortality, however, the impact of off-hour presentation on short-term mortality in patients with cardiogenic shock complicating ACS is uncertain. Hypothesis: Off-hour presentation may affect the short-term mortality in ACS patients with cardiogenic shock. Methods: We investigated consecutive 499 patients with cardiogenic shock complicating ACS from prospective and national-wide multicenter registry (JCS Shock Registry) database from March 2012 to April 2014. The primary outcomes of the present study were 30-day mortality among patients presenting either during regular-hours (defined as week-day from 8:00 AM to 8:00 PM) and off-hour (defined as weekdays from 8:01 PM to 7:59 AM, weekends and holidays). Results: Fifty-three percent of patients were presented in off-hour. Baseline characteristics were comparable including symptom onset to presentation time (off-hour; 65 min, interquartile range 39 to 180 vs. regular hour; 59 min, interquartile range 38 to 143, p = 0.22). Eighty percent of patients underwent urgent percutaneous coronary intervention and door to balloon time was also comparable between groups (off-hour; 86 min, interquartile range 60 to 110 vs. regular hour; 80 min, interquartile range 60 to 110, p = 0.74). The rate of 30-day mortality were comparable (off-hour; 35.1 % vs. regular hour 31.7 %, log-rank p = 0.48). In multivariate cox regression analysis, off-hours presentation did not affect the 30-day mortality (age- and gender-adjusted HR 1.12, 95% CI 0.82-1.52, p = 0.46). Conclusions: The clinical impact of either off-hours or regular-hours presentation is comparable in patients with cardiogenic shock complicating acute coronary syndrome (ACS) in Japan.