Resultados das Intervenções Coronárias Percutâneas Primárias Realizadas nos Horários Diurno e Noturno

Abstract

RESUMOIntrodução: Estudos demonstram que a intervenção coronária percutânea primária realizada fora do horário de rotina está relacionada a pior prognóstico. Nosso objetivo foi avaliar os desfechos da intervenção coronária percutânea primária realizada nos períodos diurno e noturno em um centro cardiológico de referência. Métodos: Estudo de coorte prospectivo, que incluiu 1.108 pacientes consecutivamente atendidos por infarto agudo do miocárdio com supradesnivelamento do segmento ST, divididos nos grupos intervenção coronária percutânea primária diurna (se realizada entre 8 e 20 horas) e intervenção coronária percutânea primária noturna (se realizada entre 20 e 8 horas). Resultados: Incluímos 680 pacientes no grupo diurno e 428 no grupo noturno. As características basais referentes ao perfil demográfico, fatores de risco e classificação Killip foram semelhantes em ambos os grupos, porém o tempo porta-balão foi significativamente maior no grupo noturno (84 ± 66 minutos vs. 102 ± 98 minutos; p < 0,01). Vasos culpados, e fluxos TIMI pré e pós-procedimento não foram diferentes entre os grupos. Não encontramos diferenças significantes em relação à mortalidade hospitalar (7,6% vs. 10,2%; p = 0,16), trombose de stent (2,8% vs. 2,4%; p = 0,69) ou presença de sangramento maior (1,9% vs. 2,1%; p = 0,50). Em 1 ano, a mortalidade também foi semelhante (9,5% vs. 12,6%; p = 0,12). O principal preditor de mortalidade em 1 ano foi a classe III/IV de Killip (OR = 10,02; IC 95% 5,8-17,1; p < 0,01). Conclusões: Pacientes com infarto agudo do miocárdio apresentam taxas de desfechos clínicos semelhantes, independentemente do horário de realização da intervenção coronária percutânea primária. No entanto, o tempo porta-balão é significativamente maior nos pacientes tratados entre 20 e 8 horas. DESCRITORES:Infarto do miocárdio. Intervenção coronária per cutânea. Reperfusão miocárdica. ABSTRACT Results of Primary Percutaneous Coronary Interventions Performed During On-and Off-HoursBackground: Previous studies have shown that off-hours primary percutaneous coronary interventions are related to a worse prognosis. The objective of this study was to evaluate the outcomes of patients undergoing on-and off-hours primary percutaneous coronary interventions performed at a reference cardiology center. Methods: Prospective cohort study, including 1,108 consecutive patients with ST elevation myocardial infarction divided into primary percutaneous coronary intervention performed during regular working hours group (on-hours: 8:00 am to 8:00 pm) and primary percutaneous coronary intervention during nonregular working hours group (off-hours: 8:00 pm to 8:00 am). Results: The sample included 680 patients in the on-hours group and 428 in the off-hours group. Baseline demographic data, risk factors and Killip classification were similar in both groups, however door-to-balloon time was significantly longer in the off-hours group (84 ± 66 minutes vs. 102 ± 98 minutes; p < 0.01). Culprit vessels, pre-and post-procedure TIMI flows were not different between ...

Association of door-to-balloon time and clinical factors with hospital shifts

“…These characteristics are in line with the European and national studies that had larger samples. [15][16][17][18] The median door-to-balloon time observed in this study was within the 90 minutes recommended by international guidelines, 5 with the exception of the procedures performed on weekends. Significant differences were observed in door-to-balloon time in primary PCI conducted during working days when compared to weekends, although there was no difference in door-to-balloon time when comparing day and night shifts or on-hours and off-hours.…”

Clinical-epidemiological aspects of patients submitted to Percutaneous Coronary Intervention in a university hospital

“…According to research done in Rio Grande do Sul State, the femoral route was more prevalent. However, a survey conducted in Bosnia and Herzegovina and another one conducted in the city of Marília -SP, the radial route predominated, respectively 70.8% and 94.3% (23)(24) . Analysis performed in the United States has shown that the radial approach is safer than the femoral approach, since they are less likely to cause complications, such as hemorrhage, hematoma formation, thrombophlebitis, ecchymosis and pseudoaneurysm (30) .…”

“…In relation to the treated coronary, the Mid Left Anterior Descending Artery (elective and urgency), followed by the Right Coronary Artery, predominated. Studies have confirmed that the most commonly treated coronary artery in patients performing PCI is the Mid Left Anterior Descending Artery and secondly the Right Coronary Artery (21)(22)(23)(24) .…”

“…Analysis of 5,664 patients from an Iranian Hospital showed that only 4% had undergone surgery (22) . In the city of Porto Alegre/RS, 4% of 1,108 patients from the survey had this history of CABS (23) .…”

“…In the United Kingdom, of 1,271, 65.4% are smokers (12) . Many other studies have shown that a large proportion of patients undergoing PCI are active smokers (13,16,(22)(23)(24) . In the same way that the current smoker is more predisposed to having Cardiovascular Diseases, the former smoker is also a risk factor to be considered (15) .…”