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PCI during colder months increases mortality odds in high-risk patients

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High-risk patients who underwent primary PCI for cardiogenic shock and/or cardiac arrest during the colder half of the year had increased risk for 30-day mortality compared with those who underwent the procedure during warmer months, according to data presented at the British Cardiovascular Society Conference.

“There is no physical reason why a heart attack, even the most severe, should be more deadly in winter than in summer, so we must do further research to find the cause of this difference and remedy it,” Arvindra Krishnamurthy, MD, of University of Leeds, said in a press release. “The next step is to find our if this trend is seen nationwide. Potential explanations could include longer time to treatment, prolonged hospitalization and delays to discharge, and increased prevalence of winter-associated infections, which in the sickest patients, could be potentially fatal.”

Researchers analyzed baseline and clinical outcome data from 4,056 patients who underwent primary PCI in 2009, 2010, 2011 and 2013. A minimum of 30-day follow-up was conducted in 91.3% of patients.

Patients were categorized by when they underwent PCI: colder months (n = 1,939; median age, 63 years; 46% men) and warmer months (n = 1,764; median age, 62 years; 50% men). Colder months in Leeds, England, were defined as between November and April.

Those in the non-high-risk group (n = 3,253) who underwent PCI during colder months (n = 1,697) did not have an increased risk for 30-day mortality after adjusting for sex, age at presentation, call-to-balloon time and out-of-hours primary PCI (adjusted HR = 0.8; 95% CI, 0.54-1.2). Patients in the high-risk cohort (n = 450) who underwent the procedure during colder months (n = 242) had an increased risk for 30-day mortality (aHR = 1.65; 95% CI, 1.1-2.48).

“Further studies interrogating the association between time of admission and outcomes, especially in the sickest and most vulnerable patients, are certainly warranted,” Krishnamurthy said in the press release. – by Darlene Dobkowski

Reference:

Krishnamurthy A, et al. Outcomes in patients undergoing primary percutaneous coronary intervention according to average monthly temperature. Presented at: British Cardiovascular Society Conference; June 4-6, 2018; Manchester, England.

Disclosure: Krishnamurthy reports no relevant financial disclosures.