Research Article

Procedure utilization, latency and mortality: Weekend versus Weekday admission for Myocardial Infarction

Nader Makki, David M Kline, Arun Kanmanthareddy, Hansie Mathelier, Satya Shreenivas and Scott M Lilly*

Published: 19 May, 2017 | Volume 2 - Issue 1 | Pages: 020-025

Background: Due to variations in hospital protocols and personnel availability, individuals with myocardial infarction admitted on the weekend may be less likely to receive invasive procedures, or may receive them with a greater latency than those admitted during the week. Whether or not this occurs, and translates into a difference in outcomes is not established.

Method: Using the Nationwide Inpatient Sample (2008-2011) database, we identified all patients admitted with a principle diagnosis of acute myocardial infarction. They were stratified by weekend or weekday admission. Baseline clinical characteristics, procedure utilization and latency to procedure were compared, and logistic regression models were constructed to assess the relationship between these variables and in-hospital mortality.

Results: Patient demographics and provider-related characteristics (hospital type, geography) were similar between weekend and weekday admission for myocardial infarction. Adjusted for covariates, we found that the odds of mortality for a weekend admission are 5% greater than for a weekday admission (OR: 1.05; 95% CI: 1.01, 1.09, p=0.009). For the utilization of an invasive procedure, we found that the odds of receiving a procedure for a weekend admission were 12% less than the odds for a weekday admission, adjusted for the other covariates (OR: 0.88; 95% CI: 0.86, 0.91, p<0.001). In addition, we found that the time to procedure was an average of 0.18 days (4.32 hours) longer for weekend admissions compared to weekday admissions (95% CI: 0.16, 0.20, p<0.001). However, we did not observe a significant difference in the overall length of stay for weekend and weekday admissions (0.004 days; 95% CI: -0.04, 0.05, p=0.87).

Conclusion: In a large and diverse subset of patients admitted with myocardial infarction, weekend admission was associated with fewer procedures, increased latency to those procedures, and a non-significant trend towards greater in adjusted in-hospital mortality.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001008 Cite this Article Read Full Article PDF


Acute myocardial infarction; Mortality; Weekend admissions; Weekday admissions


  1. De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004; 109: 1223-1225. Ref.: https://goo.gl/4yXYAC
  2. Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 64: 139-228. Ref.: https://goo.gl/p7MvNR
  3. Fox KA, Clayton TC, Damman P, Pocock SJ, de Winter RJ, et al. Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol. 2010; 55: 2435-2445. Ref.: https://goo.gl/mj7GyY
  4. Alfredsson J, Clayton T, Damman P, Fox KA, Fredriksson M, et al. Impact of an invasive strategy on 5 years outcome in men and women with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2014; 168: 522-529. Ref.: https://goo.gl/GzWruD
  5. Lagerqvist B, Husted S, Kontny F, Stahle E, Swahn E, et al. 5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study. Lancet. 2006; 368: 998-1004. Ref.: https://goo.gl/w7iA9z
  6. Jneid H, Fonarow GC, Cannon CP, Palacios IF, Kilic T, et al. Impact of time of presentation on the care and outcomes of acute myocardial infarction. Circulation. 2008; 117: 2502-2509. Ref.: https://goo.gl/2GcEwB
  7. Hong JS, Kang HC, Lee SH. Comparison of case fatality rates for acute myocardial infarction in weekday vs weekend admissions in South Korea. Circ j. 2010; 74: 496-502. Ref.: https://goo.gl/GsAuhv
  8. Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2001; 345: 663-668. Ref.: https://goo.gl/10f16l
  9. Matsui K, Kojima S, Sakamoto T, Ishihara M, Kimura K, et al. Weekend onset of acute myocardial infarction does not have a negative impact on outcome in Japan. Cir J. 2007; 71: 1841-1844. Ref.: https://goo.gl/TDrEG0
  10. Turin TC, Kita Y, Rumana N, Sugihara H, Morita Y, et al. Incidence, admission and case-fatality of acute myocardial infarction: weekend versus weekday in a Japanese population: 16-year results from Takashima AMI Registry (1988-2003). Eur J Epidemiol. 2009; 24: 93-100. Ref.: https://goo.gl/kgzf8C
  11. Bekkers S, Bot AG, Makarawung D, Neuhaus V, Ring D. The National Hospital Discharge Survey and Nationwide Inpatient Sample: the databases used affect results in THA research. Clin Orthop Relat Res. 2014; 472: 3441-3449. Ref.: https://goo.gl/TCkG9h
  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40: 373-383. Ref.: https://goo.gl/VKbL4k
  13. D'Hoore W, Sicotte C, Tilquin C. Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med. 1993; 32: 382-387. Ref.: https://goo.gl/ZmCwwo
  14. Cram P, Hillis SL, Barnett M, Rosenthal GE. Effects of weekend admission and hospital teaching status on in-hospital mortality. Am J Med. 2004; 117: 151-157. Ref.: https://goo.gl/w2qIkR
  15. Khoshchehreh M, Groves EM, Tehrani D, Amin A, Patel PM, et al. Changes in mortality on weekend versus weekday admissions for Acute Coronary Syndrome in the United States over the past decade. Int J Cardiol. 2016; 210: 164-172. Ref.: https://goo.gl/B5NvCL
  16. Kostis WJ, Demissie K, Marcella SW, Shao YH, Wilson AC, et al. Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med. 2007; 356: 1099-1109. Ref.: https://goo.gl/SOgnON
  17. Bell CM, Redelmeier DA. Waiting for urgent procedures on the weekend among emergently hospitalized patients. Am J Med. 2004; 117: 175-181. Ref.: https://goo.gl/a1YzAi
  18. Snelder SM, Nauta ST, Akkerhuis KM, Deckers JW, van Domburg RT. Weekend versus weekday mortality in ST-segment elevation acute myocardial infarction patients between 1985 and 2008. Int J Cardiol. 2013; 168: 1576-1577. Ref.: https://goo.gl/PvobXa
  19. Magid DJ, Wang Y, Herrin J, McNamara RL, Bradley EH, et al. Relationship between time of day, day of week, timeliness of reperfusion, and in-hospital mortality for patients with acute ST-segment elevation myocardial infarction. JAMA. 2005; 294: 803-812. Ref.: https://goo.gl/llj7Hz
  20. Agrawal S, Garg L, Sharma A, Mohananey D, Bhatia N, et al. Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non-ST-Segment Elevation Acute Myocardial Infarction. Am J Cardiol. 2016; 118: 632-634. Ref.: https://goo.gl/lJwc6A

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