Silent night? Incidence & mortality of ST-segment-Elevation-Myocardial-Infarction on Christmas & New-years-eve

Background

During Christmas/New-years-eve the incidence of myocardial infarction is said to be higher than usual. However, this could not be verified in all studies – the effect seems to vary with the country in which the data were collected with higher incidences on these holidays in the UK and US, but no differences for example in Australia. In some studies, a higher morbidity and mortality rate was observed if the heart attack occurred on a public holiday. Aim of this study was to examine patient characteristics as well as short- and long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI) hospitalized on Christmas/New-years-eve versus other days for the area of Bremen, Germany.

Methods

We analyzed all patients included in the monocentric Bremen STEMI-registry (BSR) between 2011 and 2021 hospitalized for STEMI (n=8284), receiving invasive coronary angiography. Patients were divided in 2 groups (hospitalization on holidays [24.-26.12.and 31.12.-1.1.] versus other days). The 2 groups then were compared to find out differences in patients characteristics, in-hospital-therapy and short- and long-term mortality. 

Results

During the observation period of 10 years, n=98 patients were hospitalized for STEMI during the holidays. This corresponds to an incidence of 2 patients per mentioned public holiday. On the other days, a total of n=8186 patients were hospitalized, corresponding to an incidence of 2.2 patients per day. The baseline characteristics did not differ significantly from each other, in particular there was no statistical difference in the occurrence of subacute infarctions (onset of symptoms > 12 hours) or coronary 3-vessel disease. Numerically, the number of cardiogenic shocks was higher in the holiday-cohort, but without statistical significance (n=25 [25.5%] vs. n=1410 [17.2%]; p n.s.). The door-to-balloon time was significantly lower in the holiday cohort (24 ± 25 vs. 31 ± 32 min, p = 0.01). The success of revascularization and the ejection fraction measured postinterventionally were not significantly different in the two cohorts. Intrahospital and 1-year mortality also did not differ (n=11 [11.2%] vs. n=801 [9.8%]; n=14 [14.3%] vs. n=986 [12%]; see Table). 

Discussion

Real world data from the BSR confirm that there is no difference in the patient characteristics and intrahospital as well as 1-year-mortality in patients presenting with a STEMI on Christmas/New-years-eve versus other days. Perhaps the differing results to other countries could be explained by differences in emergency care for acute coronary syndromes. 

Table