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Middle-of-the-night PCIs do not adversely affect success of next-day procedures
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Percutaneous coronary intervention procedures performed during the middle of the night did not adversely affect the safety and effectiveness of procedures performed the next day by the same interventional cardiologist, according to results of a single-center study.
Previous research has suggested higher complication and failure rates for PCIs performed after regular working hours. However, to date, no study has provided evidence of operator fatigue on the success and complication rates of PCI procedures.
Vitalie Crudu, MD, and colleagues at Geisinger Medical Center in Danville, Pa., identified PCIs performed at their center from Jan. 1, 2005, to Dec. 31, 2009. All procedures were performed between 11 a.m. and 7 a.m. PCIs performed during the following workday by the same interventional cardiologist were compared with PCIs performed by interventional cardiologists who were not on call the night before.
During the 5-year period, 3,944 PCIs were performed by four operators, including 167 procedures performed by operators after late-night work while on call. Overall, the incidence of complications was similar for PCIs performed by interventional cardiologists working the night before compared with PCIs performed by rested physicians. Types of complications identified as potentially more sensitive to operator error or judgment also occurred with similar frequency in both groups. More intraprocedural deaths were reported after procedures performed by post-call physicians compared with rested physicians (1.2% vs. 0.2%; P=.04). The rate of excessive bleeding at the access site was more frequent in the rested vs. post-call PCI procedures at 2.7% and 0%, respectively (P=.02). Researchers found no differences in combined safety/efficacy endpoints between the two groups.
“Our investigation found no evidence that middle-of-the-night PCIs adversely affect safety or efficacy of procedures performed the subsequent day by the same interventionist,” Crudu said in a press release. “Further study with a larger number of cases is necessary to identify any warning signals of correlations between sleep deprivation and PCI outcomes.”
In the interim, the researchers suggested sleep-deprived interventional cardiologists minimize risk by deferring emergency cases to rested colleagues and avoiding high-risk PCIs while fatigued.
Disclosure: Dr. Crudu and colleagues report no relevant financial disclosures.
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Crudu V. Catheter Cardiovasc Interv. 2012;doi:10.1002/ccd.23504.
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