title: Impact of day versus night as intervention time on the outcomes of primary angioplasty for acute myocardial infarction.
abstract: BACKGROUND
  Conflicting datas exist regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) when the intervention is performed during night hours.
  
  
  RESULTS
  2,644 consecutive patients with STEMI (mean age 56.7 +/- 11.9, years, 2,188 male) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into this study (single high-volume center: >3,000 PCIs/year). Day time was defined according to intervention between 08:00 am and 06:00 pm and night as intervention time between 06:00 pm and 08:00 am. 1,141 patients (43.2%) were treated during the day and 1,503 (56.8%) at night. The baseline characteristics of both groups were similar except for more frequent hypertension (42.6 vs. 36.5%; P = 0.002), women (19.7 vs. 15.4%; P = 0.003), and old (> or =75 y) patients (9.6 vs. 7.4; P = 0.046) in the day time group. Compared with those treated during night time, day time patients had longer angina-reperfusion times (mean, 205 vs. 188 minutes, P = 0.016). Door-to-balloon times were similar (P = 0.87), and less than 90 minutes in both groups. There were no differences concerning clinical events and PCI success between the two groups. Hospital mortality was 6.1% during the day and 5.2% during the night (OR 0.98, 95% CI 0.7-1.36; P = 0.89). The median follow-up time was 21 months. The Kaplan-Meier survival plot for long-term cardiovascular death was not different for both groups (P = 0.78). In-hospital and long-term cardiovascular mortality was also similar in shock and nonshock subgroups.
  
  
  CONCLUSIONS
  Primary PCI can be performed safely during the night at a high-volume PCI center with suitable and effective organization of cardiology department and catheterisation laboratory with 24 hours per day, 7 days per week onsite staffing.
authors: Department of Cardiology, School of Medicine, Balikesir University, Balikesir, Turkey. uyarel@yahoo.com
authors: Huseyin
authors: H
authors: Uyarel
authors: Mehmet
authors: M
authors: Ergelen
authors: Emre
authors: E
authors: Akkaya
authors: Erkan
authors: E
authors: Ayhan
authors: Deniz
authors: D
authors: Demirci
authors: Mehmet
authors: M
authors: Gul
authors: Turgay
authors: T
authors: Isik
authors: Gokhan
authors: G
authors: Cicek
authors: Zeki Yuksel
authors: ZY
authors: Gunaydin
authors: Murat
authors: M
authors: Ugur
authors: Duygu Ersan
authors: DE
authors: Demirci
authors: Ceyhan
authors: C
authors: Turkkan
authors: Hatice Betul
authors: HB
authors: Erer
authors: Recep
authors: R
authors: Ozturk
authors: Ibrahim
authors: I
authors: Yekeler
mesh_terms: D039602:After-Hours Care; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D017023:Coronary Angiography; D005260:Female; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome