Abstract 236: Coronary Artery Procedures in the Cardiac Catheterization Laboratory After Overnight Call: Are Patients at Higher Risk?

Abstract

Background: Overnight call can lead to sleep deprivation and fatigue. It was hypothesized that complications will increase when coronary artery procedures are performed the day after overnight call (i.e. post-call). The present study was undertaken to test this hypothesis. Methods: From June 2009 to May 2013, >20,000 patients underwent a cardiac procedure in a large referral catheterization laboratory of which 10,190 patients (12.7%, n=1,298 post-call) underwent only coronary arteriography with (37%) or without (83%) percutaneous coronary intervention (PCI) with no other cardiac procedure(s). Procedural complications related to post-call status were determined. Results: Mean age was 61±12 years (male 65%). Overall complications were 2.6%: 1.0% bleeding, 1.0% myocardial infarction (MI), 0.3% new dialysis, 0.3% heart failure, 0.1% cardiogenic shock, 0.2% vascular, 0.1% stroke and 0.01% cardiac tamponade (certain patients had >1 complication). Overall there was statistically greater procedural complications when performed post-call (3.5%) compared to no post-call (2.5%; p=0.04); however, when adjusting for significant baseline variables, there was no difference seen between groups. From multivariate analysis of 23 factors, the following contributed independently to complications: ST-elevation MI (odds ratio 4.2, confidence interval [CI] 2.3-7.1), femoral vs. radial access (odds ratio 2.4, CI 1.7-3.3), non-ST-elevation MI (odds ratio 2.1, confidence interval [CI] 1.6-2.7), PCI (odds ratio 2.1, CI 1.6-2.7), history of heart failure (odds ratio 1.6, CI 1.2-2.1), female (odds ratio 1.4, CI 1.1-1.8), and age (odds ratio 1.2, CI 1.1-1.3 per 10 years). Glomerular filtration rate <60 ml/min was associated with more complications compared to >60 ml/min (p=0.007). Conclusion: There were greater procedural complications when performed post-call compared to no post-call; however, when adjusting for significant baseline variables, there was no significant difference seen between groups. Taking into consideration factors that contributed to procedural complications most likely will improve patient outcomes.