TY - JOUR
T1 - Temporal variation in inhospital mortality with percutaneous coronary intervention
T2 - A report from the National Heart, Lung and Blood Institute Dynamic Registry
AU - Laskey, Warren K.
AU - Selzer, Faith
AU - Holmes, David R.
AU - Wilensky, Robert L.
AU - Cohen, Howard A.
AU - Williams, David O.
AU - Kip, Kevin E.
AU - Detre, Katherine M.
PY - 2005/9
Y1 - 2005/9
N2 - Background: Cardiovascular morbidity and mortality display a distinct time dependence also known as circadian variation. Whether such time dependence extends to the risk of procedural-related mortality after percutaneous coronary intervention (PCI) is presently unknown. Methods: Inhospital mortality was analyzed in 6347 patients with PCI start times from 8:00 am to 6:59 pm ("usual" workday). The sample was divided into 3 evenly populated groups (morning start 8:00-10:59 am, midday start 11:00 am-1:59 pm, afternoon start 2:00-6:59 pm). The association between procedural start time and mortality was assessed using multivariable analysis including a propensity score accounting for factors associated with procedural start time. Results: There was a significant, nonlinear relationship between procedural-related mortality and start time (P = .03). Afternoon start patients were at higher adjusted risk of mortality compared with midday start patients (OR 2.03, 95% CI 1.07-3.83, P = .03 ). Morning start patients were also at higher risk compared with midday start patients although the association was not statistically significant (OR 1.73, 95% CI 0.89-3.39, P = .11). Conclusions: There is a significant time-dependent variation in the risk of inhospital PCI-related mortality during usual working hours. The highest risk period, taking into account numerous factors that confound this association, is the latter part of the workday. A second period of apparent greater risk occurs during the early part of the workday and is consistent with our present understanding of circadian variation in cardiovascular disease processes.
AB - Background: Cardiovascular morbidity and mortality display a distinct time dependence also known as circadian variation. Whether such time dependence extends to the risk of procedural-related mortality after percutaneous coronary intervention (PCI) is presently unknown. Methods: Inhospital mortality was analyzed in 6347 patients with PCI start times from 8:00 am to 6:59 pm ("usual" workday). The sample was divided into 3 evenly populated groups (morning start 8:00-10:59 am, midday start 11:00 am-1:59 pm, afternoon start 2:00-6:59 pm). The association between procedural start time and mortality was assessed using multivariable analysis including a propensity score accounting for factors associated with procedural start time. Results: There was a significant, nonlinear relationship between procedural-related mortality and start time (P = .03). Afternoon start patients were at higher adjusted risk of mortality compared with midday start patients (OR 2.03, 95% CI 1.07-3.83, P = .03 ). Morning start patients were also at higher risk compared with midday start patients although the association was not statistically significant (OR 1.73, 95% CI 0.89-3.39, P = .11). Conclusions: There is a significant time-dependent variation in the risk of inhospital PCI-related mortality during usual working hours. The highest risk period, taking into account numerous factors that confound this association, is the latter part of the workday. A second period of apparent greater risk occurs during the early part of the workday and is consistent with our present understanding of circadian variation in cardiovascular disease processes.
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U2 - 10.1016/j.ahj.2004.10.003
DO - 10.1016/j.ahj.2004.10.003
M3 - Article
C2 - 16169343
AN - SCOPUS:24944522424
SN - 0002-8703
VL - 150
SP - 569
EP - 576
JO - American heart journal
JF - American heart journal
IS - 3
ER -