Is there an association between time of admission and in-hospital mortality in patients with non-ST-elevation myocardial infarction? A meta-analysis

We performed a systematic review to assess whether being admitted during off-hours with non-ST-segment-elevation myocardial infarction (NSTEMI) is associated with increased in-hospital mortality. Previous studies have demonstrated an inconsistent association between patient arrival time for NSTEMI and the subsequent clinical outcomes. All studies published up to November 10, 2014 on the association between time of admission and mortality among patients with NSTEMI were identified by searching the MEDLINE, COCHRANE, EMBASE, and PUBMED databases. The characteristics and outcome data of the studies included in the systematic review were extracted. Summary odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Five cohort studies with a total of 129,548 patients met our inclusion criteria. The pooled analysis demonstrated that off-hours admission was not associated with increased in-hospital mortality (OR = 1.02 [95% CI (0.93–1.13)], P = 0.687). Furthermore, off-hours admission did not result in a longer door-to-balloon time (SMD = 0.37, [95%CI:−0.002 to 0.73], P = 0.051). The in-hospital mortality of patients admitted with NSTEMI during off-hours was similar to that of patients admitted during regular hours. Time of admission may not be a risk factor for increased in-hospital mortality.