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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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 <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. In conclusion, no differential treatment effect was found when comparing ICR versus SCR in patients presenting with acute coronary syndrome and multivessel disease during on- or off-hours.</description><identifier>ISSN: 0002-9149</identifier><identifier>ISSN: 1879-1913</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2024.05.020</identifier><identifier>PMID: 38777210</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>The American journal of cardiology, 2024-07, Vol.223, p.73-80</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>2024. The Authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c370t-d0513abcd7aaa07dad0b5d62a5cdaa9aa450ec73083fc85c5b068ca02c82d1583</citedby><cites>FETCH-LOGICAL-c370t-d0513abcd7aaa07dad0b5d62a5cdaa9aa450ec73083fc85c5b068ca02c82d1583</cites><orcidid>0000-0002-2344-6705 ; 0000-0002-1108-9608</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914924003825$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38777210$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Elscot, Jacob J.</creatorcontrib><creatorcontrib>Kakar, Hala</creatorcontrib><creatorcontrib>den Dekker, Wijnand K.</creatorcontrib><creatorcontrib>Bennett, Johan</creatorcontrib><creatorcontrib>Sabaté, Manel</creatorcontrib><creatorcontrib>Esposito, Giovanni</creatorcontrib><creatorcontrib>Boersma, Eric</creatorcontrib><creatorcontrib>Van Mieghem, Nicolas M.</creatorcontrib><creatorcontrib>Diletti, Roberto</creatorcontrib><creatorcontrib>BIOVASC Investigators</creatorcontrib><title>Timing of Complete Revascularization Stratified by Index Presentation During On- and Off-Hours</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><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 <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. In conclusion, no differential treatment effect was found when comparing ICR versus SCR in patients presenting with acute coronary syndrome and multivessel disease during on- or off-hours.</description><subject>acute coronary syndrome</subject><subject>Acute Coronary Syndrome - surgery</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Acute coronary syndromes</subject><subject>Aged</subject><subject>Biodegradation</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Coronary Artery Disease - surgery</subject><subject>Drug-Eluting Stents</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health services</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Implants</subject><subject>Ischemia</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>multivessel disease</subject><subject>Myocardial infarction</subject><subject>Myocardial Revascularization - methods</subject><subject>Myocardial Revascularization - statistics & numerical data</subject><subject>off-hours</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Physiology</subject><subject>Polymer coatings</subject><subject>Polymers</subject><subject>Rapamycin</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Sirolimus - therapeutic use</subject><subject>ST Elevation Myocardial Infarction - surgery</subject><subject>ST Elevation Myocardial Infarction - therapy</subject><subject>Statistical analysis</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Veins & arteries</subject><issn>0002-9149</issn><issn>1879-1913</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU2LFDEQhoMo7rj6E5SAFy_dVpJJp_skMn7swsKIrldDdVItafpjTLoX119vhhk9ePFUVfDUWy_1MvZcQClAVK_7EsfeYfSlBLktQZcg4QHbiNo0hWiEesg2ACCLRmybC_YkpT6PQujqMbtQtTFGCtiwb7dhDNN3Pnd8N4-HgRbin-kOk1sHjOEXLmGe-Jcl5qYL5Hl7z68nTz_5p0iJpuUEvFvjUWU_FRwnz_ddV1zNa0xP2aMOh0TPzvWSff3w_nZ3VdzsP17v3t4UThlYCg9aKGydN4gIxqOHVvtKonYesUHcaiBnFNSqc7V2uoWqdgjS1dILXatL9uqke4jzj5XSYseQHA0DTjSvySrQjdS1qWRGX_6D9tnplN1lyqgKQEmTKX2iXJxTitTZQwwjxnsrwB4DsL09B2CPAVjQNgeQ916c1dd2JP9368_HM_DmBFB-x12gaJMLNDnyIZJbrJ_Df078BspxmXY</recordid><startdate>20240715</startdate><enddate>20240715</enddate><creator>Elscot, Jacob J.</creator><creator>Kakar, Hala</creator><creator>den Dekker, Wijnand K.</creator><creator>Bennett, Johan</creator><creator>Sabaté, Manel</creator><creator>Esposito, Giovanni</creator><creator>Boersma, Eric</creator><creator>Van Mieghem, Nicolas M.</creator><creator>Diletti, Roberto</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2344-6705</orcidid><orcidid>https://orcid.org/0000-0002-1108-9608</orcidid></search><sort><creationdate>20240715</creationdate><title>Timing of Complete Revascularization Stratified by Index Presentation During On- and Off-Hours</title><author>Elscot, Jacob J. ; Kakar, Hala ; den Dekker, Wijnand K. ; Bennett, Johan ; Sabaté, Manel ; Esposito, Giovanni ; Boersma, Eric ; Van Mieghem, Nicolas M. ; Diletti, Roberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c370t-d0513abcd7aaa07dad0b5d62a5cdaa9aa450ec73083fc85c5b068ca02c82d1583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>acute coronary syndrome</topic><topic>Acute Coronary Syndrome - 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therapeutic use</topic><topic>ST Elevation Myocardial Infarction - surgery</topic><topic>ST Elevation Myocardial Infarction - therapy</topic><topic>Statistical analysis</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elscot, Jacob J.</creatorcontrib><creatorcontrib>Kakar, Hala</creatorcontrib><creatorcontrib>den Dekker, Wijnand K.</creatorcontrib><creatorcontrib>Bennett, Johan</creatorcontrib><creatorcontrib>Sabaté, Manel</creatorcontrib><creatorcontrib>Esposito, Giovanni</creatorcontrib><creatorcontrib>Boersma, Eric</creatorcontrib><creatorcontrib>Van Mieghem, Nicolas M.</creatorcontrib><creatorcontrib>Diletti, Roberto</creatorcontrib><creatorcontrib>BIOVASC Investigators</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elscot, Jacob J.</au><au>Kakar, Hala</au><au>den Dekker, Wijnand K.</au><au>Bennett, Johan</au><au>Sabaté, Manel</au><au>Esposito, Giovanni</au><au>Boersma, Eric</au><au>Van Mieghem, Nicolas M.</au><au>Diletti, Roberto</au><aucorp>BIOVASC Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Timing of Complete Revascularization Stratified by Index Presentation During On- and Off-Hours</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2024-07-15</date><risdate>2024</risdate><volume>223</volume><spage>73</spage><epage>80</epage><pages>73-80</pages><issn>0002-9149</issn><issn>1879-1913</issn><eissn>1879-1913</eissn><abstract>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 <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. In conclusion, no differential treatment effect was found when comparing ICR versus SCR in patients presenting with acute coronary syndrome and multivessel disease during on- or off-hours.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38777210</pmid><doi>10.1016/j.amjcard.2024.05.020</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2344-6705</orcidid><orcidid>https://orcid.org/0000-0002-1108-9608</orcidid><oa>free_for_read</oa></addata></record> |
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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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