Comparison of the Characteristics of Coronary Interventions Performed During Day and Night Shifts in Patients with Acute Myocardial Infarction

Abstract

Therapeutic percutaneous coronary intervention (PCI) is the treatment of choice in acute myocardial infarction (AMI). If optimally performed, PCI reduces myocardial injury and improves the likelihood of a positive clinical outcome. Therefore, the equal quality of PCI throughout both day and night shifts is of paramount importance. Our aim was to compare urgent diagnostic and therapeutic coronary interventions performed during day and night shifts. We retrospectively analyzed the medical records of 144 patients who underwent coronary angiography for AMI over six months in a tertiary referral center working in 24/7 mode. The patients’ characteristics, procedural data and the operator’s experience in interventional cardiology were compared according to the time of intervention during a day shift (8 a.m. until 8 p.m., group A, n = 106) and night shift (from 8 p.m. until 8 a.m. next day, group B, n = 36). The baseline characteristics of the subjects of groups A and B were similar, except for a higher proportion of AMI without persistent ST-segment elevation (NSTEMI) in patients who underwent coronary angiography during regular working hours compared to off-hours (58% vs. 34%, p < 0.05). The average time of diagnostic coronary angiography was longer by about 5 min during the day shift (28.5 ± 12.2 vs. 23.8 ± 8.9 min, p < 0.05), while other procedural data, including the arterial access route, the number of catheters needed and the contrast-medium volume, were similar. The use of additional diagnostic tools for coronary lesion assessment (intracoronary ultrasound or fractional flow reserve measurement) was almost twice as frequent during regular working hours (15% vs. 8%). Urgent therapeutic PCI on the culprit artery was performed in 79% and 89% of group A and B patients, respectively. The groups did not differ in procedural characteristics regarding the total interventional session, including both diagnostic angiography and therapeutic PCI, such as total procedure duration, fluoroscopy time, radiation dose, stenting technique and total stent length. Coronary thrombectomy or rotational atherectomy were more frequently used in group A (27% vs. 15%, p = 0.16). The percentage of doctors with the least experience in interventional cardiology was, albeit insignificantly, lower during day shifts (31% vs. 42%). In conclusion, the majority of clinical and periprocedural characteristics appeared to be independent of intervention time, except for a longer duration of diagnostic coronary angiography during daytime. This finding could probably result from a higher proportion of NSTEMI patients frequently requiring additional angiographic projections and special techniques to properly identify the infarct-related artery during the day shift. Whether a tendency of less frequent use of additional tools at off-hours may also be due to a lower percentage of NSTEMI interventions at night, or whether this can be linked to lower availability of experienced operators, remains to be validated in a large study. The latter possibility, if confirmed, might encourage public health authorities and healthcare organizers to improve off-hours cathlab staffing with experienced interventionalists. Finally, additional obligatory training in special diagnostic and therapeutic invasive techniques might be advisable for the least experienced operators scheduled to work night shifts.