Elsevier

American Heart Journal

Volume 138, Issue 6, December 1999, Pages 1111-1117
American Heart Journal

Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction,☆☆,,★★

https://doi.org/10.1016/S0002-8703(99)70077-3Get rights and content

Abstract

Background Concern exists regarding the results of primary angioplasty for acute myocardial infarction when the procedure is performed during night hours. Methods and Results Between June 1994 and January 1997, 491 patients with acute myocardial infarction who underwent primary angioplasty procedures were consecutive registered in the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study. Three hundred seventy-eight patients (77%) were treated during the day and 113 (23%) at night. Baseline characteristics showed no major differences between the 2 groups. Prehospital delay time was 60 minutes shorter during the night (median value 180 minutes for day, 120 minutes for night, P = .005), and in-hospital time to treatment was 9 minutes longer (median value 85 minutes day, 94 minutes night, P = .037). Patients treated during the night more often received angiotensin-converting enzyme blockers (61.4% day, 76.1% night, P = .004) and the so-called optimal adjunctive therapy (54% day, 64.6% night, P = .045). There were no differences concerning clinical events between the 2 groups. Hospital mortality was 8.7% during the day and 5.3% during the night (univariate analysis P = .238; logistic regression P = .653). Conclusions In a clinical setting, primary angioplasty for acute myocardial infarction can be performed safely during the night with a clinically insignificant prolongation of in-hospital time to reperfusion compared with practice during the day. (Am Heart J 1999;138:1111-7.)

Section snippets

Methods

The MITRA study is a German prospective multicenter observational study of the current management of acute myocardial infarction.17 Fifty-four hospitals in the southwest of Germany, including university hospitals, tertiary care centers, and smaller hospitals, participated in the study. All patients with acute myocardial infarction who came to medical attention within the first 96 hours after the onset of pain were registered prospectively as soon as the diagnosis of acute myocardial infarction

Results

Between June 1994 and January 1997, 5905 patients with acute myocardial infarction were registered (Figure 1).

. Selection of patients from the MITRA trial.

Among these patients 491 (8.3%) were treated with primary angioplasty. Three hundred seventy-eight patients (77%) were treated during the day and 113 (23%) at night. Primary angioplasty was performed in 8 of 54 participating hospitals. Table I shows the baseline characteristics of the 2 groups.

. Baseline characteristics of the patients

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Discussion

The results of this study showed that similar results were achieved with primary angioplasty performed during the night and during the day in a routine clinical setting at different hospitals. Although only 23% of all patients were treated during the night, there was no difference in patient characteristics. Patients treated during the day have about a 60-minute longer prehospital delay time. This was mainly caused by a prolonged delay among patients whose symptoms began in the early morning

Acknowledgements

We thank Heinz Hochadel for his assistance with the statistical analysis and Stefan Wagner and Sinéad Trainor for their helpful comments on the manuscript.

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    Supported in part by Zeneca, Ministerium für Gesundheit, Arbeit, Soziales des Landes Rheinland-Pfalz, Landesversicherungsanstalt Rheinland-Pfalz, Betriebskrankenkassen Rheinland-Pfalz.

    ☆☆

    The people and institutions who participated in the MITRA study are listed in reference17.

    Reprint requests: Ralf Zahn, MD, Herzzentrum Ludwigshafen, Dept. of Cardiology, Bremserstraße 79, D-67063 Ludwigshafen, Germany.

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