INTRODUCTION: Primary percutaneous coronary intervention (PPCI) by experienced centres is safe and effective in improving outcomes in patients presenting with acute ST elevation myocardial infarction (STEMI). Yet, performing PPCI in patients presenting during off-hours and weekends may introduce unnecessary delay in mechanical coronary reperfusion thus reducing its efficacy. Since early 1990s, Foothills Interventional Cardiology Service (FICS) offers PPCI to patients presenting with acute STEMI in the Calgary Health Region (CHR) 24 hours a day, 7 days a week and 365 days a year.

METHODS: Since Jan02, demographic, process of care and clinical outcomes information of all patients presented for PPCI were prospectively collected as part of a STEMI initiative and APPROACH project.

RESULTS: Between Jan02 and Dec03, a total of 529 patients presented for PPCI from 3 hospitals in the CHR. Patients presented during off-hours as defined by weekday from 1800 to 0759 and weekends (N=336) were compared to patients presented during normal operating hours (N=193). Although the median total ischemic time did not differ (199 vs. 198 min; p=0.315), the median door-to-balloon time is slightly prolonged during off-hours and weekends (100 vs. 94 min; p<0.05). Difference in 30-day mortality rates (4.5% vs. 3.6% p=0.822) was not demonstrated between the two groups in this study cohort.

CONCLUSION: Although performing PPCI during off-hours in an experienced centre is safe with comparable process of care and clinical outcomes, overall ischemic time in both groups is still not ideal. Public heath education and process of care improvements in emergency and cardiology services to reduce total ischemic time may further improve overall clinical outcomes.

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