PMID- 28388683 OWN - NLM STAT- MEDLINE DCOM- 20170907 LR - 20181113 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 12 IP - 4 DP - 2017 TI - Factors attributed to the higher in-hospital mortality of ST elevation myocardial infarction patients admitted during off-hour in comparison with those during regular hour. PG - e0175485 LID - 10.1371/journal.pone.0175485 [doi] LID - e0175485 AB - BACKGROUND: In-hospital mortality of patients with ST elevation myocardial infarction (STEMI) admitted during off-hour was reported higher than those admitted during regular hour, but which factors cause the difference remains largely unknown though the difference in medical resources was often accused. METHODS AND RESULTS: This registry-based study recruited 7456 STEMI patients prospectively from 99 level two hospitals across China. Generalized linear mixed models were applied to quantify the risk of in-hospital death attributed to admission time and the explainers of its change, accounting for the clustering of patients within hospitals. There were 45.2% patients admitted during regular hour and 54.8% during off-hour. In-hospital mortality was 7.0% for patients admitted during regular hour and 8.3% for those during off-hour (p<0.05). Generalized linear mixed models adjusting for age, gender and education showed that patients' disease severity at admission and medical treatments received after admission could explain the risk difference attributed to admission time by 55% and 20%, respectively. After all factors accounted, the residual relative risk difference left only 6% (adjusted OR = 0.94) and became no longer significant. CONCLUSIONS: The regular-and-off-hour mortality difference exists among STEMI patients in Chinese level two hospitals, which could be attributed primarily to disease severity at admission and secondly to the poorer medical treatments. These results call for public attention to the more severity of STEMI patients admitted during off-hour in addition to improving medical resources for STEMI at off-hour. FAU - Li, Min AU - Li M AD - Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. FAU - Li, Shenshen AU - Li S AD - The George Institute for Global Health at Peking University Health Science Center, Beijing, China. FAU - Du, Xin AU - Du X AD - Beijing Anzhen Hospital, Capital Medical University, Beijing, China. FAU - Wu, Tao AU - Wu T AD - The George Institute for Global Health at Peking University Health Science Center, Beijing, China. FAU - Li, Xian AU - Li X AD - The George Institute for Global Health at Peking University Health Science Center, Beijing, China. FAU - Ma, Changsheng AU - Ma C AD - Beijing Anzhen Hospital, Capital Medical University, Beijing, China. FAU - Huo, Yong AU - Huo Y AD - Peking University First Hospital, Beijing, China. FAU - Hu, Dayi AU - Hu D AD - Peking University People's Hospital, Beijing, China. FAU - Gao, Runlin AU - Gao R AD - The Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China. FAU - Wu, Yangfeng AU - Wu Y AD - Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. AD - The George Institute for Global Health at Peking University Health Science Center, Beijing, China. LA - eng PT - Comparative Study PT - Journal Article DEP - 20170407 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Aged MH - Female MH - *Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - *Patient Admission MH - ST Elevation Myocardial Infarction/*mortality PMC - PMC5384766 COIS- Competing Interests: Source of funding for CPACS-3 study was from Sanofi, China, through an unrestricted research grant. The sponsor of the study had no role in study design, data collection, data management, data analysis, data interpretation, or writing of the report. The principal investigators had full access to all data in the study. The Steering Committee did not include any representative of the sponsor, and had final responsibility for the decision to submit for publication. Drs Gao is principal investigator of CPACS-2 study. Drs Gao and Wu are principal investigators of CPACS-3 study. Both studies are funded by Sanofi, China. No author is an employee or consultant of Sanofi, or have any interests related to products of Sanofi. No author has relationships with companies that might have an interest in the submitted work in the previous 3 years. Their spouses, partners, or children have no financial relationships that may be relevant to the submitted work. We would 100% assure you that NO "any individual or organization not listed as an author contributed in any substantive way to the writing or editing of the paper or performance of any analyses described therein." In addition, we would like to make a statement that "This does not alter our adherence to PLOS ONE policies on sharing data and materials". EDAT- 2017/04/08 06:00 MHDA- 2017/09/08 06:00 PMCR- 2017/04/07 CRDT- 2017/04/08 06:00 PHST- 2016/09/04 00:00 [received] PHST- 2017/03/27 00:00 [accepted] PHST- 2017/04/08 06:00 [entrez] PHST- 2017/04/08 06:00 [pubmed] PHST- 2017/09/08 06:00 [medline] PHST- 2017/04/07 00:00 [pmc-release] AID - PONE-D-16-35502 [pii] AID - 10.1371/journal.pone.0175485 [doi] PST - epublish SO - PLoS One. 2017 Apr 7;12(4):e0175485. doi: 10.1371/journal.pone.0175485. eCollection 2017.