Department of Cardiology, CHU Rangueil, Toulouse, France.
Arch Cardiovasc Dis. 2009 Dec;102(12):811-20. doi: 10.1016/j.acvd.2009.09.010. Epub 2009 Nov 20.
Previous studies have reported circadian variation in the rate of post-percutaneous coronary intervention (PCI) complications and mortality.
To assess whether in-hospital outcomes during the first 48h after admission are related to the time or the day when PCI is performed.
Emergency PCIs (2266 total; 1396 during regular hours and 870 during off hours) performed consecutively during a 3.5-year-period (2005-2008) were evaluated. The primary endpoint was death and the secondary endpoint was a composite score based on cardiovascular complications. The association between PCI start time and in-hospital outcome was assessed using multivariable logistic regression and propensity score analysis.
The patients' mean age was 64.8 years and 77.3% were men. The highest death rate was for night-time PCI (3.6%), with a 5.1% occurrence rate for PCI performed between 00:00 and 03:59, and a 3.0% occurrence rate for weekend daytime PCI compared with 1.5% for weekday daytime (regular-hours) PCI. The frequency of occurrence of other clinical events did not vary significantly throughout the day. Compared with weekday daytime PCI, the odds ratio for mortality was 2.95 for night-time PCI (95% confidence interval [CI] 1.58-6.01; p=0.0007) and 2.42 for weekend daytime PCI (95% CI 0.97-6.01; p=0.06).
Our study shows a significant time-dependent effect on in-hospital deaths in patients treated with emergency PCI. Healthcare organization and circadian variation of ischaemic processes could explain this variation in mortality.
先前的研究报告称，经皮冠状动脉介入治疗（PCI）后并发症和死亡率存在昼夜节律变化。
评估患者入院后 48 小时内的住院结局是否与 PCI 实施的时间或日期有关。
评估了在 3.5 年期间（2005-2008 年）连续进行的 2266 例紧急 PCI（1396 例在常规时段内进行，870 例在非常规时段内进行）。主要终点为死亡，次要终点为基于心血管并发症的综合评分。使用多变量逻辑回归和倾向评分分析评估 PCI 开始时间与住院结局之间的关系。
患者的平均年龄为 64.8 岁，77.3%为男性。夜间 PCI 的死亡率最高（3.6%），00:00 至 03:59 进行的 PCI 发生率为 5.1%，周末白天 PCI 的发生率为 3.0%，而工作日白天（常规时段）PCI 的发生率为 1.5%。全天发生其他临床事件的频率没有明显差异。与工作日白天 PCI 相比，夜间 PCI 的死亡比值比为 2.95（95%置信区间 [CI] 1.58-6.01；p=0.0007），周末白天 PCI 的比值比为 2.42（95% CI 0.97-6.01；p=0.06）。
我们的研究表明，在接受紧急 PCI 治疗的患者中，住院死亡存在显著的时间依赖性效应。医疗保健组织和缺血过程的昼夜节律变化可以解释这种死亡率的变化。
