Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction☆,☆☆,★,★★
Section snippets
Methods
The MITRA study is a German prospective multicenter observational study of the current management of acute myocardial infarction.17 Fifty-four hospitals in the southwest of Germany, including university hospitals, tertiary care centers, and smaller hospitals, participated in the study. All patients with acute myocardial infarction who came to medical attention within the first 96 hours after the onset of pain were registered prospectively as soon as the diagnosis of acute myocardial infarction
Results
Between June 1994 and January 1997, 5905 patients with acute myocardial infarction were registered (Figure 1).
Among these patients 491 (8.3%) were treated with primary angioplasty. Three hundred seventy-eight patients (77%) were treated during the day and 113 (23%) at night. Primary angioplasty was performed in 8 of 54 participating hospitals. Table I shows the baseline characteristics of the 2 groups.
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Discussion
The results of this study showed that similar results were achieved with primary angioplasty performed during the night and during the day in a routine clinical setting at different hospitals. Although only 23% of all patients were treated during the night, there was no difference in patient characteristics. Patients treated during the day have about a 60-minute longer prehospital delay time. This was mainly caused by a prolonged delay among patients whose symptoms began in the early morning
Acknowledgements
We thank Heinz Hochadel for his assistance with the statistical analysis and Stefan Wagner and Sinéad Trainor for their helpful comments on the manuscript.
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Supported in part by Zeneca, Ministerium für Gesundheit, Arbeit, Soziales des Landes Rheinland-Pfalz, Landesversicherungsanstalt Rheinland-Pfalz, Betriebskrankenkassen Rheinland-Pfalz.
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Reprint requests: Ralf Zahn, MD, Herzzentrum Ludwigshafen, Dept. of Cardiology, Bremserstraße 79, D-67063 Ludwigshafen, Germany.
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