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Does Percutaneous Coronary Intervention on Weekends or Holidays Effect on Mid-to-Long-Term Prognosis in Patients with Coronary Artery Disease in China?: Analysis of a Large Single-Center Data
Ru Liu1, Lijian Gao1, Zhan Gao1, Ce Zhang1, Xiao-Fang Tang1, Ying Song1, Sida Jia1, Jue Chen2, Shubin Qiao1, Yuejin Yang1, Runlin Gao1, Bo Xu1, Jinqing Yuan2
Fuwai Hospital, China1, Fuwai hospital, China2
Management of patients who underwent PCI requires considerable diagnostic and therapeutic procedures, which may not be uniformly available throughout the off days.
A total of 10,724 consecutive cases were enrolled from January to December 2013. 2-year clinical outcomes were evaluated between the patients who underwent PCI on workdays and on non-workdays. Major adverse coronary event (MACCE) included all-cause death, myocardial infarction (MI), revascularization and stroke.
The patients who underwent PCI on workdays and on non-workdays accounted for 98.8% and 1.2%, respectively. PCI on non-workdays group presented with predominant acute myocardial infarction (AMI) and primary PCI, higher body mass index, more prior revascularization, lower left ventricular ejection fraction, higher SNYTAX scores, less no. of target lesions and no. of stent per patient, longer time of procedure, less dual anti-platelet therapy as well as less statin, calcium antagonist and -blocker application, compared with PCI on workdays group. The rates of 2-year all-cause death, cardiac death and stent thrombosis were significantly higher in PCI on non-workday group (4.5% and 1.2%, P=0.001; 3.0% and 0.7%, P=0.001; 3.0% and 0.8%, P=0.007). The rates of 2-year MACCE, MI, revascularization, stroke, and bleeding were not significantly different between two groups. Multivariable Cox regression indicated that, after adjusting for possible confounding factors, compared with PCI on workdays group, PCI on off days group were not independently associated with all endpoints (all P>0.05).
Mid-to-long-term mortality of patients who underwent PCI on holidays or weekends were worse compared with those received PCI on workdays. But, PCI on off days was not independently associated with increased mortality. More coexisting conditions, more complicated lesions, predominant AMI, less secondary prevention medication and different invasive management were all contributing to the worse outcome of patients who received PCI on off days.
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