Abstract
Abstract Background: Primary percutaneous coronary intervention is the preferred treatment in ST-elevation myocardial infarction. At night period, the delay until performing primary percutaneous coronary intervention may be determinant to prognosis worsening. Objective: To analyze the results of primary percutaneous coronary intervention performed at day and night periods. Methods: Cohort study that included patients admitted with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention from December 2013 until December 2016 in a ST-elevation myocardial infarction reference hospital of a metropolitan region in Brazil, followed from admission to hospital discharge or death, compared according to time of primary percutaneous coronary intervention (night or day). Statistical analysis comprehended the Chi-square test, the Fisher test, the Student's t-test and the analysis of variance, with significance level of 5%. Results: 446 patients were submitted to primary percutaneous coronary intervention, 159 (35.6%) at night time and 287 (64.4%) at day time. No differences were found between the two groups concerning clinical baseline characteristics. Door-to-balloon time (101 ± 81 minutes vs. 99 ± 78 minutes; p = 0,59) and onset-to-ballon time (294 ± 158 minutes vs. 278 ± 174 minutes; p = 0,32) did not differ between the groups. The incidence of combined major adverse cardiac events (15.1% vs. 14.3%; p = 0,58) and in-hospital mortality (9.4% vs. 8.0%; p = 0,61) were similar between the groups, as well as length of hospital stay (6.0 ± 4 days vs. 4.9 ± 4 days; p = 0,91). Conclusion: Primary percutaneous coronary intervention at night time showed similar results as the procedure performed at day time, without significant increase of in-hospital adverse events, length of stay or mortality.
Highlights
The exclusion criteria were segment elevation myocardial infarction (STEMI) with more than 12 hours of evolution, nonconfirmed or uncertain diagnosis of STEMI, patients not submitted to primary percutaneous coronary intervention (PPCI) immediately after the coronary angiography, patients younger than 18 years of age or refusal to sign the Free and Informed Consent Form (FICF) or to participate in the study through prospective data collection
We demonstrated that it is possible to attain satisfactory results in the Brazilian scenario, with times of delay and incidence of similar adverse events among the PPCIs performed in the nighttime and daytime periods
We demonstrated that the strategy of having an onduty Interventional Cardiology team at nighttime can shorten the delay in STEMI treatment at these times
Summary
In the treatment of ST-segment elevation myocardial infarction (STEMI), mechanical coronary reperfusion through primary percutaneous coronary intervention (PPCI) has an important position and its efficacy has been demonstrated and proven in large studies.[1,2,3] In addition to attaining target vessel patency in more than 90% of cases, it is able to increase survival and reduce the rates of reinfarction and cerebrovascular accident (CVA) related to chemical thrombolysis.[3,4,5,6] PPCI is a class I indication for treatment of the STEMI within the first 12 hours of evolution, when available in a timely manner and performed in qualified centers.[7,8,9]Access to PPCI is not always easy to achieve, and its unavailability can lead to severe delays and the ineffective treatment of STEMI, with significantly more severe clinical outcomes. The delay until performing primary percutaneous coronary intervention may be determinant to prognosis worsening. Objective: To analyze the results of primary percutaneous coronary intervention performed at day and night periods. Results: 446 patients were submitted to primary percutaneous coronary intervention, 159 (35.6%) at night time and 287 (64.4%) at day time. The incidence of combined major adverse cardiac events (15.1% vs 14.3%; p = 0,58) and in-hospital mortality (9.4% vs 8.0%; p = 0,61) were similar between the groups, as well as length of hospital stay (6.0 ± 4 days vs 4.9 ± 4 days; p = 0,91). Conclusion: Primary percutaneous coronary intervention at night time showed similar results as the procedure performed at day time, without significant increase of in-hospital adverse events, length of stay or mortality. (Int J Cardiovasc Sci. 2018;31(5)513-519) Keywords: Myocardial Infarction; Percutaneous Coronary Intervention; Cohort Studies; Night Care Conclusion: Primary percutaneous coronary intervention at night time showed similar results as the procedure performed at day time, without significant increase of in-hospital adverse events, length of stay or mortality. (Int J Cardiovasc Sci. 2018;31(5)513-519) Keywords: Myocardial Infarction; Percutaneous Coronary Intervention; Cohort Studies; Night Care
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