Abstract 3703: In-hospital Outcomes For Patients Undergoing Percutaneous Coronary Interventions In Emergency Procedure Setting
Objectives Time-dependent in-hospital complication of PCI is still questionable. The purpose of this study was to assess whether in-hospital outcomes, during the first 48 hours, for patients undergoing PCI are related to the time of the procedure.
Methods For two years (2005–2006), 5135 consecutive PCI were performed in our University Department of Cardiology. Only urgent procedures were studied (1414), 880 in routine duty hours and 534 during off-hours. The primary end-point was death and the second, a composite outcomes of death, stroke, emergency CABG surgery, recurrent myocardial infarction (MI) and new PCA. The association between procedure starting-time and in-hospital outcomes was assessed using multivariate logistic regression and propensity score analysis.
Results Patients’ age was in average 64.7 ±13.7 years and the number of diagnosis of acute MI was 783 (55.4%). The number of deaths and composite outcomes was 31 (2.2%) and 57 (4.0%) respectively. The greatest number of deaths occurred during the night (3.9%) and days of the week-end (3.3%) comparatively to the routine duty hours (1.3%), (p=0.008). Similarly, composite outcomes were more frequent in off-hours (6.2 %) than in routine duty hours (2.6 %), (p=0.001). During a 24h period, the greatest number of deaths (4.5%) occurred between 08.00PM and 4.00AM and the lowest between 12.00AM and 08.00PM (1.5 %) and between 04.00AM and 12.00AM (1.7%), p=0.007. The risk (OR [95% CI]) of death and composite outcomes during off-hours vs. routine duty hours was 3.34 ([1.50 –7.46], p=0.004) and 2.49 ([1.40 –3.84], p=0.002) respectively, after adjustment for age, gender, histories of MI and PCI, year of procedure, diagnosis of MI, number of vessel disease and number of vessels treated. Propensity score analysis (333 matched pairs) confirms the results: the risks of death and combined endpoint were 3.71 ([1.16 –11.9], p=0.03) and 2.72 ([1.17– 6.34], p=0.02) respectively, during off-hours PCI vs. duty hours.
Conclusion Our study shows a significant time-dependent effect on in-hospital complications in patients treated in emergency with PCI. Health care organisation from emergency call to cath-lab management and circadian variation of ischemic processes could explain the excess of complications.