title: Middle-of-the-night percutaneous coronary intervention and its association with percutaneous coronary intervention outcomes performed the following day: an analysis from the National Cardiovascular Data Registry.
abstract: OBJECTIVE
  This study sought to compare in-hospital mortality and bleeding complications for procedures performed by sleep-deprived versus non-sleep-deprived operators.
  
  
  BACKGROUND
  To optimize the safety of percutaneous coronary intervention (PCI), it is essential to determine whether physicians performing emergent, middle-of-the-night procedures, and who may be sleep-deprived as a consequence, have equally safe outcomes when performing cases the following day.
  
  
  METHODS
  We used CathPCI registry data to compare in-hospital mortality and bleeding complications for procedures performed by sleep-deprived versus non-sleep-deprived operators using logistic regression with generalized estimating equations to account for within-operator clustering. Outcomes were risk-adjusted using previously validated models for in-hospital mortality and bleeding. Our cohort included 1,509,096 daytime PCI procedures performed by 5,014 operators between 7 am and midnight from July 1, 2009, through June 30, 2012. Operators were assumed to be acutely sleep-deprived if they began a middle-of-the-night PCI between midnight and 6:59 am and performed a next-day PCI between 7 am and midnight, and chronically sleep deprived if they had performed multiple middle-of-the-night PCI procedures during the previous 7 days.
  
  
  RESULTS
  Only 2.4% of all daytime PCI procedures were performed by operators who had performed at least 1 middle-of-the-night PCI procedure earlier that day. In adjusted analyses, when comparing procedures performed by acutely sleep-deprived with non-sleep-deprived operators, there were no significant differences in mortality (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.94 to 1.12; p = 0.61) or bleeding (OR: 1.03, 95% CI: 0.98 to 1.08; p = 0.19). However, a greater degree of chronic sleep deprivation was associated with a higher adjusted risk of bleeding (OR: 1.19, 95% CI: 1.05 to 1.34; p = 0.007).
  
  
  CONCLUSIONS
  Daytime PCI procedures are uncommonly performed by sleep-deprived operators. We found no signal of increased complications when acutely sleep-deprived operators performed PCI but an increased risk of bleeding associated with procedures performed by operators with greater degrees of chronic sleep deprivation.
authors.affiliation: Michigan Heart, Ann Arbor, Michigan. Electronic address: haronow@michiganheart.com.
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: James C
authors.initials: JC
authors.lastname: Blankenship
authors.affiliation: Division of Sleep Medicine, Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Czeisler
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: McCoy
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Neely
authors.affiliation: Section of Cardiology, Mid America Heart Institute, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
mesh_terms: D039602:After-Hours Care; D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence; D004630:Emergencies; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D010561:Personnel Staffing and Scheduling; D019984:Quality Indicators, Health Care; D012042:Registries; D012307:Risk Factors; D012890:Sleep; D012892:Sleep Deprivation / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: angioplasty; hemorrhage; mortality; sleep