Nighttime PCI does not adversely affect outcomes
MedWire News: Middle-of-the-night percutaneous coronary intervention (PCI) procedures are no more likely than those performed during the day to be associated with adverse outcomes, researchers report.
"Although almost all interventional cardiologists work at least occasionally while sleep-deprived, the cardiology community has given remarkably little attention to whether sleep-deprived cardiologists can practice safely," remark Vitalie Crudu and colleagues (Geisinger Medical Center, Philadelphia, Pennsylvania, USA).
Their analysis included 3944 procedures performed between 23:00 h and 07:00 h over a 5-year period.
All procedures that were performed during the subsequent work day by the same interventionist were classified as "sleep-deprived" procedures (n=164) whereas all others were classified as "non-sleep-deprived" (n=3944).
The two groups were similar with respect to demographics, comorbidities, and procedural characteristics.
Intraprocedural death occurred more frequently in the sleep-deprived group than the non-sleep-deprived group, at 1.2% versus 0.2% (p=0.04). However, on multivariate analysis, the odds ratio for this association was nonsignificant.
Interestingly, excess bleeding at the arterial access site in the non-sleep-deprived group occurred more frequently than in the sleep-deprived group, at 2.7% versus 0% (p=0.02).
There were no significant differences in other individual safety endpoints (individual types of complications, operator-dependent complications, operator-independent complications, complications per physician, and any complication) or in the combined safety endpoints.
Also, there was no significant difference in PCI success rate (at least one attempted lesion treated with residual stenosis of 50%) between the two groups.
"Larger databases should be evaluated to identify any warning signals of correlations between sleep deprivation and procedural outcomes, write the authors.
"In the meantime, it would be prudent for sleep-deprived interventionists to minimize risk by deferring emergency cases to colleagues and avoiding ad hoc elective high risk PCIs, when possible," they conclude in Catheterization and Cardiovascular Interventions.
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By Piriya Mahendra