Timing of Complete Revascularization Stratified by Index Presentation During On- and Off-Hours

Recent trials suggested immediate complete revascularization (ICR) as a safe alternative to staged complete revascularization (SCR), but the impact of the respective percutaneous coronary intervention strategies between on- versus off-hours is unclear. On-hours was defined as an index revascularizat...

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Veröffentlicht in:The American journal of cardiology 2024-07, Vol.223, p.73-80
Hauptverfasser: Elscot, Jacob J., Kakar, Hala, den Dekker, Wijnand K., Bennett, Johan, Sabaté, Manel, Esposito, Giovanni, Boersma, Eric, Van Mieghem, Nicolas M., Diletti, Roberto
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container_start_page 73
container_title The American journal of cardiology
container_volume 223
creator Elscot, Jacob J.
Kakar, Hala
den Dekker, Wijnand K.
Bennett, Johan
Sabaté, Manel
Esposito, Giovanni
Boersma, Eric
Van Mieghem, Nicolas M.
Diletti, Roberto
description Recent trials suggested immediate complete revascularization (ICR) as a safe alternative to staged complete revascularization (SCR), but the impact of the respective percutaneous coronary intervention strategies between on- versus off-hours is unclear. On-hours was defined as an index revascularization performed between 8:00 a.m. and 6:00 p.m., Monday to Friday, or else the procedure was defined as performed during off-hours. The primary end point consisted of a composite of all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, and cerebrovascular events at 1-year follow-up. We used Cox regression models to relate randomized treatment with study end points. We evaluated multiplicative and additive interactions between on- versus off-hours and randomized treatment. The BIOVASC (Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndromes and Multivessel Disease) trial enrolled 1,097 and 428 patients during on- and off-hours, respectively. Patients randomized during off-hours were more likely to present with ST-segment elevation myocardial infarction (66.4% vs 29.5%, p
doi_str_mv 10.1016/j.amjcard.2024.05.020
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On-hours was defined as an index revascularization performed between 8:00 a.m. and 6:00 p.m., Monday to Friday, or else the procedure was defined as performed during off-hours. The primary end point consisted of a composite of all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, and cerebrovascular events at 1-year follow-up. We used Cox regression models to relate randomized treatment with study end points. We evaluated multiplicative and additive interactions between on- versus off-hours and randomized treatment. The BIOVASC (Percutaneous Complete Revascularization Strategies Using Sirolimus Eluting Biodegradable Polymer Coated Stents in Patients Presenting With Acute Coronary Syndromes and Multivessel Disease) trial enrolled 1,097 and 428 patients during on- and off-hours, respectively. Patients randomized during off-hours were more likely to present with ST-segment elevation myocardial infarction (66.4% vs 29.5%, p &lt;0.001). The composite primary outcome occurred in 8.4% and 10.1% of patients randomized to ICR and SCR, respectively, during on-hours (hazard ratio 0.80, 95% confidence interval 0.54 to 1.19). During off-hours, the primary composite outcome occurred in 5.4% and 7.7% in ICR and SCR (0.69, 95% confidence interval 0.32 to 1.46) with no evidence of a differential effect (interaction pmultiplicative = 0.70, padditive = 0.56). No differential effect was found between treatment allocation and on- versus off-hours in any of the secondary outcomes. 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The composite primary outcome occurred in 8.4% and 10.1% of patients randomized to ICR and SCR, respectively, during on-hours (hazard ratio 0.80, 95% confidence interval 0.54 to 1.19). During off-hours, the primary composite outcome occurred in 5.4% and 7.7% in ICR and SCR (0.69, 95% confidence interval 0.32 to 1.46) with no evidence of a differential effect (interaction pmultiplicative = 0.70, padditive = 0.56). No differential effect was found between treatment allocation and on- versus off-hours in any of the secondary outcomes. 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The composite primary outcome occurred in 8.4% and 10.1% of patients randomized to ICR and SCR, respectively, during on-hours (hazard ratio 0.80, 95% confidence interval 0.54 to 1.19). During off-hours, the primary composite outcome occurred in 5.4% and 7.7% in ICR and SCR (0.69, 95% confidence interval 0.32 to 1.46) with no evidence of a differential effect (interaction pmultiplicative = 0.70, padditive = 0.56). No differential effect was found between treatment allocation and on- versus off-hours in any of the secondary outcomes. 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subjects acute coronary syndrome
Acute Coronary Syndrome - surgery
Acute Coronary Syndrome - therapy
Acute coronary syndromes
Aged
Biodegradation
Clinical outcomes
Clinical trials
Coronary Artery Disease - surgery
Drug-Eluting Stents
Electrocardiography
Female
Follow-Up Studies
Health services
Heart attacks
Humans
Hypotheses
Implants
Ischemia
Male
Middle Aged
Mortality
multivessel disease
Myocardial infarction
Myocardial Revascularization - methods
Myocardial Revascularization - statistics & numerical data
off-hours
Percutaneous Coronary Intervention - methods
Physiology
Polymer coatings
Polymers
Rapamycin
Regression analysis
Regression models
Sirolimus - therapeutic use
ST Elevation Myocardial Infarction - surgery
ST Elevation Myocardial Infarction - therapy
Statistical analysis
Time Factors
Treatment Outcome
Veins & arteries
title Timing of Complete Revascularization Stratified by Index Presentation During On- and Off-Hours
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