Intended for healthcare professionals


Acute myocardial infarction

BMJ 2014; 348 doi: (Published 21 January 2014) Cite this as: BMJ 2014;348:f7696
  1. Lauren Lapointe-Shaw, fellow,
  2. Chaim M Bell, associate professor
  1. 1Mount Sinai Hospital and Department of Medicine, University of Toronto, Toronto, Canada
  1. cbell{at}

Never a good time, but some times are better than others

Acute myocardial infarction has high mortality, but early medical and surgical intervention can be lifesaving.1 2 3 4 5 6 Previous studies have shown that the time of day or day of the week when patients seek care can affect outcomes.5 7 8 In most of these studies, patients presenting to hospital with an acute myocardial infarction during off-hours (evenings and weekends) wait longer for interventional treatments than those presenting during regular office hours and have a higher mortality. In a linked paper (doi:10.1136/bmj.f7393), Sorita and colleagues report the first systematic review of the effect of off-hour presentation on outcomes after acute myocardial infarction.9

The authors evaluated the literature on acute myocardial infarction and off-hour care. Outcomes included in-hospital and 30 day mortality, as well as door to balloon time for the subset of patients with ST elevation myocardial infarction. Using a random effects model, they reported pooled odds ratios for each outcome measure. The pooled results confirmed the presence of a 5% relative increase in mortality (both in-hospital …

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