The time of day of primary percutaneous coronary intervention as an independent risk factor for long-term mortality and a prognosis modifier effect in patients with ST-segment elevation acute coronary syndrome: A case study at the Sakhalin Regional Clinical Hospital
Introduction. The impact of time of day of primary percutaneous coronary intervention (PCI) on long-term outcomes in patients with ST-segment elevation acute coronary syndrome (STE-ACS) remains controversial.N.V. Korneeva, A.N. Gryazev, N.N. Mislimova
Objective: To evaluate the impact of the day time of primary PCI on long-term survival in patients with STE-ACS.
Material and methods. A retrospective, single-center cohort study was performed involving 683 patients with STE-ACS who underwent PCI between 2016 and 2020. Participants were divided into two subgroups based on the timing of the procedure: “Day” (8:00–22:00) and “Night” (22:00–08:00). The median follow-up time was 2070 days. Multivariable logistic regression, Cox proportional hazards regression, and the Random Survival Forest (RSF) method with variable importance modeling (VIMP) and stratification by time of day were used for the analysis.
Results. The incidence of adverse outcome (death from all causes) was 26.4% (137/518) in the daytime and 32.7% (54/165) in the nighttime subgroups of the study. Independent predictors of adverse outcome were: age (odds ratio (OR) 1.08; 95% confidence interval (CI): 1.06–1.10), diabetes mellitus (OR 1.59; 95% CI: 1.03–2.45), no need for further revascularization (OR 1.79; 95% CI: 1.18–2.77), and nighttime intervention (OR 1.55; 95% CI: 1.01–2.36). In a Cox model, performing PCI at night was associated with a 49% increased risk (odds ratio 1.49; 95% CI 1.08–2.05). RSF analysis revealed that time of day acts as an effect modifier: in the “Night” subgroup, the prognostic significance of age was 58% higher (VIMP 0.377 vs. 0.238), and diabetes mellitus acquired statistical significance.
Conclusion. Performing primary PCI at night is an independent risk factor for long-term mortality in patients with STE-ACS and enhances the impact of age and diabetes mellitus on prognosis. Failure to require further revascularization is also associated with worse outcomes. These data highlight the need to optimize the organization of 24-hour care and develop differentiated monitoring strategies for patients undergoing surgery at nighttime.
Keywords
ST-segment elevation acute coronary syndrome
myocardial infarction
percutaneous coronary intervention
time of day
long-term mortality
circadian rhythms
diabetes mellitus
risk factors
Random Survival Forest
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About the Authors
Natalia V. Korneeva, MD, Dr. Sci. (Medicine), associate professor, head of the Department of faculty and outpatient therapy with a course in endocrinology, Far Eastern State Medical University, Khabarovsk, Russian Federation.E-mail: gladkova1982@mail.ru
ORCID: https://orcid.org/0000-0001-9878-180X. eLibrary SPIN: 7817-7670
Andrey N. Gryazev, MD, doctor of endovascular diagnostic and treatment methods at the Department of X-ray surgical diagnostic and treatment methods, Sakhalin Regional Clinical Hospital, Yuzhno-Sakhalinsk, Russian Federation.
E-mail: gryazev2005@yandex.ru
ORCID: https://orcid.org/0009-0008-1767-6783. eLibrary SPIN: 5050-6698
Natalia N. Mislimova, MD, cardiologist at the Department of cardiology No. 2, Sakhalin Regional Clinical Hospital, Yuzhno-Sakhalinsk, Russian Federation.
E-mail: natalisha1991@mail.ru
ORCID: https://orcid.org/0009-0001-6842. eLibrary SPIN: 8865-9434
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