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Higher in-hospital mortality during weekend admission for acute coronary syndrome

a large-scale cross-sectional Italian study

Malanchini, Giovannia; Stefanini, Giulio Giuseppeb; Malanchini, Margheritac; Lombardi, Federicoa

Journal of Cardiovascular Medicine: February 2019 - Volume 20 - Issue 2 - p 74–80
doi: 10.2459/JCM.0000000000000743
Research articles: Coronary artery disease

Aims An increased mortality risk during weekend hospital admission has been consistently observed. In the present study, we evaluated whether the current improvement in management of acute coronary syndromes (ACS) has reduced this phenomenon.

Methods and results We extracted data from the Italian National Healthcare System Databank of 80 391 ACS admissions in the region of Lombardia between 2010 and 2014. ICD-9 codes were used to assess the diagnosis. We performed a multiple logistic regression analysis to compare the mortality rates between weekend and weekday admissions.

Mean age of the study population was 67.6 years; 30.1% of patients were women. ST segment elevation myocardial infarction (STEMI) accounts for 42.2% of admissions. The total in-hospital mortality was 3.05% and was positively predicted by weekend admission [odds ratio (OR) 1.13, P = 0.006], age and female sex. The weekend effect on mortality was only significant for STEMI (OR 1.11, P = 0.04) in comparison to non-STEMI (NSTEMI) or unstable angina.

The trend of the risk of death was found to be negatively correlated with age: the risk of death was significantly higher in all age clusters younger than 75 (OR 1.22, P < 0.01) and even greater in the very young subgroup under 45 years of age (OR 2.09, P = 0.03).

Conclusion Our data indicate that increased mortality risk is still present during weekend admissions. This phenomenon is particularly evident in younger patients and in individuals admitted for STEMI.

aCardiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan

bHumanitas University, Department of Biomedical Sciences, Rozzano, Italy

cDepartment of Psychology, University of Texas at Austin, Austin, Texas, USA

Correspondence to Federico Lombardi, MD, FESC, Cardiologia Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy Tel: +390250320483; e-mail:

Received 15 May, 2018

Accepted 18 November, 2018

© 2019 Italian Federation of Cardiology. All rights reserved.