Relationship between time of day and periprocedural myocardial infarction after elective angioplasty
Stephane Fournier1, Serban Puricel, Beata Morawiec
1Department of Cardiology, University Hospital Center (CHUV) , Lausanne , Switzerland .
Insights
Elective percutaneous coronary intervention (PCI) in the afternoon is associated with a higher risk of periprocedural myocardial infarction (PMI). Performing PCI in the morning may reduce the occurrence of PMI in patients undergoing the procedure.
Area of Science:
- Cardiology
- Circadian Biology
- Interventional Cardiology
Background:
- Circadian rhythms may influence myocardial infarction outcomes.
- Periprocedural myocardial infarction (PMI) is a concern in elective PCI.
- The impact of procedure timing on PMI is not well understood.
Purpose of the Study:
- To investigate if the time of day affects the incidence of type 4A myocardial infarction.
- To determine if periprocedural myocardial infarction (PMI) rates differ between morning and afternoon elective PCI procedures.
Main Methods:
- Retrospective analysis of 1021 patients undergoing elective PCI (2007-2011).
- Patients were grouped into morning (07:00-11:59) and afternoon (12:00-18:59) PCI groups.
- Propensity score matching was used to control for selection bias in 308 pairs.
Main Results:
- The overall rate of PMI was significantly lower in the morning group (20%) compared to the afternoon group (30%).
- This difference persisted after propensity score matching (21% vs. 29%).
- Afternoon PCI independently increased the risk for PMI (OR 2.0, p=0.02).
Conclusions:
- The timing of elective percutaneous coronary intervention (PCI) impacts the rate of periprocedural myocardial infarction (PMI).
- Morning PCI appears to be associated with a lower risk of PMI.
- Further research may explore mechanisms and optimize procedural scheduling.
Objectives:
To test if the time of day significantly influences the occurrence of type 4A myocardial infarction in elective patients undergoing percutaneous coronary intervention (PCI).
Background:
Recent studies have suggested an influence of circadian rhythms on myocardial infarction size and mortality among patients with ST-elevation myocardial infarction. The aim of the study is to investigate whether periprocedural myocardial infarction (PMI) is influenced by the time of day in elective patients undergoing PCI.
Methods:
All consecutive patients undergoing elective PCI between 2007 and 2011 at our institutions with known post-interventional troponin were retrospectively included. Patients (n = 1021) were divided into two groups according to the starting time of the PCI: the morning group (n = 651) between 07:00 and 11:59, and the afternoon group (n = 370) between 12:00 and 18:59. Baseline and procedural characteristics as well as clinical outcome defined as the occurrence of PMI were compared between groups. In order to limit selection bias, all analyses were equally performed in 308 pairs using propensity score (PS) matching.
Results:
In the overall population, the rate of PMI was statistically lower in the morning group compared to the afternoon group (20% vs. 30%, p < 0.001). This difference remained statistically significant after PS-matching (21% vs. 29%, p = 0.03). Multivariate analysis shows that being treated in the afternoon independently increases the risk for PMI with an odds ratio of 2.0 (95%CI: 1.1-3.4; p = 0.02).
Conclusions:
This observational PS-matched study suggests that the timing of an elective PCI influences the rate of PMI.
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