ST segment elevation myocardial infarction (STEMI) alert during night shift; a misfortune for the patient or just an overstatement?
Muhammad Arslan Cheema1, Ali R. Ghani1, Waqas Ullah1, Usman Sarwar1, Hafez Mohammad R. Abdollah2, Marc Cohen3. 1Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, United States, 2Internal Medicine, University of North Dak, Grand Forks, North Dakota, United States, 3Cardiology, Abington Jefferson Health, Abington, Pennsylvania, United States
Purpose of Study Conflicting data exisst regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) when the intervention is performed during the night in comparison to daytime.
Methods Used We did a retrospective study to determine the difference in the door to balloon time and their impact on patient outcomes. The study involved a total of 300 patients were randomized into two groups based on their ages, gender and baseline characteristics. Group A had 150 patients who had PCI done during the daytime (between 6 AM and 6 PM) while group B had 150 patients who had PCI performed at night time (between 6 PM and 6 AM).
Summary of Results The mean door to balloon time during the day was (78.75 ± 6.28) versus (97.22 ± 8.55) at night time. The homogeneity of variances, was assessed by Levene's test for equality of variances (p =.239). The mean door to balloon time during the day was -18.47 ± 10.51 SEM (95% CI, -39.17 to 2.21) as compared to the mean door to balloon time during the night. However, the p-value was 0.08 (p value>0.05) signifying no statistical significance between the 2 groups in the door to balloon time. The mean troponin rise during the day was (62.99 ± 8.00) which was higher than the mean troponin rise at night (60.89 ± 6.72). The mean troponin rise during the day was 2.10 ± 10.44 SEM (95% CI, -18.46 to 22.65) higher as compared to the mean troponin rise during the night. However, the p-value was 0.84 (p value>0.05) signifying no statistical significance between the 2 groups in the troponin rise. Very few patients had a decrease in LVEF, on average a mean fall in LVEF of just 0.93% in patients presenting during the day vs 0.90% during the night, with a p-value of 0.94 that was also not statistically significant. The mortality and readmission data was too insignificant to analyze.
Conclusions There was no significant difference in the mean door to balloon time, the rise in troponin, fall in LVEF, readmission rates, or mortality, and hence no negative effects on patient outcomes based on the patient's time of presentation between the two groups.
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