Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction
Identifieur interne : 001388 ( Istex/Corpus ); précédent : 001387; suivant : 001389Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction
Auteurs : Ralf Zahn ; Rudolf Schiele ; Karlheinz Seidl ; Stefan Schuster ; Karl E. Hauptmann ; Thomas Voigtl Nder ; Martin Gottwik ; Gunther Berg ; Thomas Kunz ; Hans Georg Glunz ; Peter Limbourg ; Jochen SengesSource :
- American Heart Journal [ 0002-8703 ] ; 1999.
Abstract
Background Concern exists regarding the results of primary angioplasty for acute myocardial infarction when the procedure is performed during night hours. Methods and Results Between June 1994 and January 1997, 491 patients with acute myocardial infarction who underwent primary angioplasty procedures were consecutive registered in the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study. Three hundred seventy-eight patients (77%) were treated during the day and 113 (23%) at night. Baseline characteristics showed no major differences between the 2 groups. Prehospital delay time was 60 minutes shorter during the night (median value 180 minutes for day, 120 minutes for night, P = .005), and in-hospital time to treatment was 9 minutes longer (median value 85 minutes day, 94 minutes night, P = .037). Patients treated during the night more often received angiotensin-converting enzyme blockers (61.4% day, 76.1% night, P = .004) and the so-called optimal adjunctive therapy (54% day, 64.6% night, P = .045). There were no differences concerning clinical events between the 2 groups. Hospital mortality was 8.7% during the day and 5.3% during the night (univariate analysis P = .238; logistic regression P = .653). Conclusions In a clinical setting, primary angioplasty for acute myocardial infarction can be performed safely during the night with a clinically insignificant prolongation of in-hospital time to reperfusion compared with practice during the day. (Am Heart J 1999;138:1111-7.)
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DOI: 10.1016/S0002-8703(99)70077-3
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction</title><author><name sortKey="Zahn, Ralf" sort="Zahn, Ralf" uniqKey="Zahn R" first="Ralf" last="Zahn">Ralf Zahn</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Schiele, Rudolf" sort="Schiele, Rudolf" uniqKey="Schiele R" first="Rudolf" last="Schiele">Rudolf Schiele</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Seidl, Karlheinz" sort="Seidl, Karlheinz" uniqKey="Seidl K" first="Karlheinz" last="Seidl">Karlheinz Seidl</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Schuster, Stefan" sort="Schuster, Stefan" uniqKey="Schuster S" first="Stefan" last="Schuster">Stefan Schuster</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Hauptmann, Karl E" sort="Hauptmann, Karl E" uniqKey="Hauptmann K" first="Karl E." last="Hauptmann">Karl E. Hauptmann</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Voigtl Nder, Thomas" sort="Voigtl Nder, Thomas" uniqKey="Voigtl Nder T" first="Thomas" last="Voigtl Nder">Thomas Voigtl Nder</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Gottwik, Martin" sort="Gottwik, Martin" uniqKey="Gottwik M" first="Martin" last="Gottwik">Martin Gottwik</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Berg, Gunther" sort="Berg, Gunther" uniqKey="Berg G" first="Gunther" last="Berg">Gunther Berg</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Kunz, Thomas" sort="Kunz, Thomas" uniqKey="Kunz T" first="Thomas" last="Kunz">Thomas Kunz</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Glunz, Hans Georg" sort="Glunz, Hans Georg" uniqKey="Glunz H" first="Hans Georg" last="Glunz">Hans Georg Glunz</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Limbourg, Peter" sort="Limbourg, Peter" uniqKey="Limbourg P" first="Peter" last="Limbourg">Peter Limbourg</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Senges, Jochen" sort="Senges, Jochen" uniqKey="Senges J" first="Jochen" last="Senges">Jochen Senges</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:07C97F4B7B5F76B4ED7D47E866160C95EAF8047B</idno><date when="1999" year="1999">1999</date><idno type="doi">10.1016/S0002-8703(99)70077-3</idno><idno type="url">https://api.istex.fr/document/07C97F4B7B5F76B4ED7D47E866160C95EAF8047B/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001388</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001388</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction</title><author><name sortKey="Zahn, Ralf" sort="Zahn, Ralf" uniqKey="Zahn R" first="Ralf" last="Zahn">Ralf Zahn</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Schiele, Rudolf" sort="Schiele, Rudolf" uniqKey="Schiele R" first="Rudolf" last="Schiele">Rudolf Schiele</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Seidl, Karlheinz" sort="Seidl, Karlheinz" uniqKey="Seidl K" first="Karlheinz" last="Seidl">Karlheinz Seidl</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Schuster, Stefan" sort="Schuster, Stefan" uniqKey="Schuster S" first="Stefan" last="Schuster">Stefan Schuster</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Hauptmann, Karl E" sort="Hauptmann, Karl E" uniqKey="Hauptmann K" first="Karl E." last="Hauptmann">Karl E. Hauptmann</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Voigtl Nder, Thomas" sort="Voigtl Nder, Thomas" uniqKey="Voigtl Nder T" first="Thomas" last="Voigtl Nder">Thomas Voigtl Nder</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Gottwik, Martin" sort="Gottwik, Martin" uniqKey="Gottwik M" first="Martin" last="Gottwik">Martin Gottwik</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Berg, Gunther" sort="Berg, Gunther" uniqKey="Berg G" first="Gunther" last="Berg">Gunther Berg</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Kunz, Thomas" sort="Kunz, Thomas" uniqKey="Kunz T" first="Thomas" last="Kunz">Thomas Kunz</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Glunz, Hans Georg" sort="Glunz, Hans Georg" uniqKey="Glunz H" first="Hans Georg" last="Glunz">Hans Georg Glunz</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Limbourg, Peter" sort="Limbourg, Peter" uniqKey="Limbourg P" first="Peter" last="Limbourg">Peter Limbourg</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author><author><name sortKey="Senges, Jochen" sort="Senges, Jochen" uniqKey="Senges J" first="Jochen" last="Senges">Jochen Senges</name><affiliation><mods:affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">American Heart Journal</title><title level="j" type="abbrev">YMHJ</title><idno type="ISSN">0002-8703</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999">1999</date><biblScope unit="volume">138</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="1111">1111</biblScope><biblScope unit="page" to="1117">1117</biblScope></imprint><idno type="ISSN">0002-8703</idno></series><idno type="istex">07C97F4B7B5F76B4ED7D47E866160C95EAF8047B</idno><idno type="DOI">10.1016/S0002-8703(99)70077-3</idno><idno type="PII">S0002-8703(99)70077-3</idno><idno type="ArticleID">96677</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-8703</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Concern exists regarding the results of primary angioplasty for acute myocardial infarction when the procedure is performed during night hours. Methods and Results Between June 1994 and January 1997, 491 patients with acute myocardial infarction who underwent primary angioplasty procedures were consecutive registered in the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study. Three hundred seventy-eight patients (77%) were treated during the day and 113 (23%) at night. Baseline characteristics showed no major differences between the 2 groups. Prehospital delay time was 60 minutes shorter during the night (median value 180 minutes for day, 120 minutes for night, P = .005), and in-hospital time to treatment was 9 minutes longer (median value 85 minutes day, 94 minutes night, P = .037). Patients treated during the night more often received angiotensin-converting enzyme blockers (61.4% day, 76.1% night, P = .004) and the so-called optimal adjunctive therapy (54% day, 64.6% night, P = .045). There were no differences concerning clinical events between the 2 groups. Hospital mortality was 8.7% during the day and 5.3% during the night (univariate analysis P = .238; logistic regression P = .653). Conclusions In a clinical setting, primary angioplasty for acute myocardial infarction can be performed safely during the night with a clinically insignificant prolongation of in-hospital time to reperfusion compared with practice during the day. (Am Heart J 1999;138:1111-7.)</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Ralf Zahn MD</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Rudolf Schiele MD</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Karlheinz Seidl MD</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Stefan Schuster MD</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Karl E. Hauptmann MDa</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Thomas Voigtländer MDb</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Martin Gottwik MDc</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Gunther Berg MDd</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Thomas Kunz MDe</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Hans Georg Glunz MDf</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Peter Limbourg MDg</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item><json:item><name>Jochen Senges MD</name><affiliations><json:string>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</json:string></affiliations></json:item></author><articleId><json:string>96677</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Background Concern exists regarding the results of primary angioplasty for acute myocardial infarction when the procedure is performed during night hours. Methods and Results Between June 1994 and January 1997, 491 patients with acute myocardial infarction who underwent primary angioplasty procedures were consecutive registered in the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study. Three hundred seventy-eight patients (77%) were treated during the day and 113 (23%) at night. Baseline characteristics showed no major differences between the 2 groups. Prehospital delay time was 60 minutes shorter during the night (median value 180 minutes for day, 120 minutes for night, P = .005), and in-hospital time to treatment was 9 minutes longer (median value 85 minutes day, 94 minutes night, P = .037). Patients treated during the night more often received angiotensin-converting enzyme blockers (61.4% day, 76.1% night, P = .004) and the so-called optimal adjunctive therapy (54% day, 64.6% night, P = .045). There were no differences concerning clinical events between the 2 groups. Hospital mortality was 8.7% during the day and 5.3% during the night (univariate analysis P = .238; logistic regression P = .653). Conclusions In a clinical setting, primary angioplasty for acute myocardial infarction can be performed safely during the night with a clinically insignificant prolongation of in-hospital time to reperfusion compared with practice during the day. 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systems</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>cardiovascular system & hematology</json:string></scienceMetrix></categories><publicationDate>1999</publicationDate><copyrightDate>1999</copyrightDate><doi><json:string>10.1016/S0002-8703(99)70077-3</json:string></doi><id>07C97F4B7B5F76B4ED7D47E866160C95EAF8047B</id><score>0.4260099</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/07C97F4B7B5F76B4ED7D47E866160C95EAF8047B/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/07C97F4B7B5F76B4ED7D47E866160C95EAF8047B/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/07C97F4B7B5F76B4ED7D47E866160C95EAF8047B/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1999 Mosby, Inc.</p></availability><date>1999</date></publicationStmt><notesStmt><note>Supported in part by Zeneca, Ministerium für Gesundheit, Arbeit, Soziales des Landes Rheinland-Pfalz, Landesversicherungsanstalt Rheinland-Pfalz, Betriebskrankenkassen Rheinland-Pfalz.</note><note>The people and institutions who participated in the MITRA study are listed in reference17.</note><note>Reprint requests: Ralf Zahn, MD, Herzzentrum Ludwigshafen, Dept. of Cardiology, Bremserstraße 79, D-67063 Ludwigshafen, Germany.</note><note>0002-8703/99/$8.00 + 0 4/1/96677</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction</title><author><orgName>For the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group</orgName></author><author xml:id="author-2"><persName><forename type="first">Ralf</forename><surname>Zahn</surname></persName><roleName type="degree">MD</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-3"><persName><forename type="first">Rudolf</forename><surname>Schiele</surname></persName><roleName type="degree">MD</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-4"><persName><forename type="first">Karlheinz</forename><surname>Seidl</surname></persName><roleName type="degree">MD</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-5"><persName><forename type="first">Stefan</forename><surname>Schuster</surname></persName><roleName type="degree">MD</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-6"><persName><forename type="first">Karl E.</forename><surname>Hauptmann</surname></persName><roleName type="degree">MDa</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-7"><persName><forename type="first">Thomas</forename><surname>Voigtländer</surname></persName><roleName type="degree">MDb</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-8"><persName><forename type="first">Martin</forename><surname>Gottwik</surname></persName><roleName type="degree">MDc</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-9"><persName><forename type="first">Gunther</forename><surname>Berg</surname></persName><roleName type="degree">MDd</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-10"><persName><forename type="first">Thomas</forename><surname>Kunz</surname></persName><roleName type="degree">MDe</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-11"><persName><forename type="first">Hans Georg</forename><surname>Glunz</surname></persName><roleName type="degree">MDf</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-12"><persName><forename type="first">Peter</forename><surname>Limbourg</surname></persName><roleName type="degree">MDg</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author><author xml:id="author-13"><persName><forename type="first">Jochen</forename><surname>Senges</surname></persName><roleName type="degree">MD</roleName><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation></author></analytic><monogr><title level="j">American Heart Journal</title><title level="j" type="abbrev">YMHJ</title><idno type="pISSN">0002-8703</idno><idno type="PII">S0002-8703(05)X7073-9</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999"></date><biblScope unit="volume">138</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="1111">1111</biblScope><biblScope unit="page" to="1117">1117</biblScope></imprint></monogr><idno type="istex">07C97F4B7B5F76B4ED7D47E866160C95EAF8047B</idno><idno type="DOI">10.1016/S0002-8703(99)70077-3</idno><idno type="PII">S0002-8703(99)70077-3</idno><idno type="ArticleID">96677</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1999</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background Concern exists regarding the results of primary angioplasty for acute myocardial infarction when the procedure is performed during night hours. Methods and Results Between June 1994 and January 1997, 491 patients with acute myocardial infarction who underwent primary angioplasty procedures were consecutive registered in the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study. Three hundred seventy-eight patients (77%) were treated during the day and 113 (23%) at night. Baseline characteristics showed no major differences between the 2 groups. Prehospital delay time was 60 minutes shorter during the night (median value 180 minutes for day, 120 minutes for night, P = .005), and in-hospital time to treatment was 9 minutes longer (median value 85 minutes day, 94 minutes night, P = .037). Patients treated during the night more often received angiotensin-converting enzyme blockers (61.4% day, 76.1% night, P = .004) and the so-called optimal adjunctive therapy (54% day, 64.6% night, P = .045). There were no differences concerning clinical events between the 2 groups. Hospital mortality was 8.7% during the day and 5.3% during the night (univariate analysis P = .238; logistic regression P = .653). Conclusions In a clinical setting, primary angioplasty for acute myocardial infarction can be performed safely during the night with a clinically insignificant prolongation of in-hospital time to reperfusion compared with practice during the day. (Am Heart J 1999;138:1111-7.)</p></abstract></profileDesc><revisionDesc><change when="1999">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/07C97F4B7B5F76B4ED7D47E866160C95EAF8047B/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity></istex:docType><istex:document><article docsubtype="fla" xml:lang="en" version="5.0"><item-info><jid>YMHJ</jid><aid>96677</aid><ce:pii>S0002-8703(99)70077-3</ce:pii><ce:doi>10.1016/S0002-8703(99)70077-3</ce:doi><ce:document-thread><ce:refers-to-document><ce:pii>S0002-8703(99)00048-4</ce:pii></ce:refers-to-document></ce:document-thread><ce:copyright type="full-transfer" year="1999">Mosby, Inc.</ce:copyright></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>Supported in part by Zeneca, Ministerium für Gesundheit, Arbeit, Soziales des Landes Rheinland-Pfalz, Landesversicherungsanstalt Rheinland-Pfalz, Betriebskrankenkassen Rheinland-Pfalz.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>☆☆</ce:label><ce:note-para><ce:italic>The people and institutions who participated in the MITRA study are listed in reference</ce:italic><ce:cross-ref refid="bib17"><ce:sup loc="post">17</ce:sup></ce:cross-ref><ce:italic>.</ce:italic></ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★</ce:label><ce:note-para>Reprint requests: Ralf Zahn, MD, Herzzentrum Ludwigshafen, Dept. of Cardiology, Bremserstraße 79, D-67063 Ludwigshafen, Germany.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★★</ce:label><ce:note-para><ce:italic>0002-8703/99/$8.00 + 0</ce:italic> <ce:bold><ce:italic>4/1/96677</ce:italic></ce:bold></ce:note-para></ce:article-footnote><ce:title>Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction</ce:title><ce:author-group><ce:author><ce:given-name>Ralf</ce:given-name><ce:surname>Zahn</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Rudolf</ce:given-name><ce:surname>Schiele</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Karlheinz</ce:given-name><ce:surname>Seidl</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Stefan</ce:given-name><ce:surname>Schuster</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Karl E.</ce:given-name><ce:surname>Hauptmann</ce:surname><ce:degrees>MD<ce:sup loc="post">a</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Thomas</ce:given-name><ce:surname>Voigtländer</ce:surname><ce:degrees>MD<ce:sup loc="post">b</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Martin</ce:given-name><ce:surname>Gottwik</ce:surname><ce:degrees>MD<ce:sup loc="post">c</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Gunther</ce:given-name><ce:surname>Berg</ce:surname><ce:degrees>MD<ce:sup loc="post">d</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Thomas</ce:given-name><ce:surname>Kunz</ce:surname><ce:degrees>MD<ce:sup loc="post">e</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Hans Georg</ce:given-name><ce:surname>Glunz</ce:surname><ce:degrees>MD<ce:sup loc="post">f</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Peter</ce:given-name><ce:surname>Limbourg</ce:surname><ce:degrees>MD<ce:sup loc="post">g</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Jochen</ce:given-name><ce:surname>Senges</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:collaboration><ce:text>For the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group</ce:text></ce:collaboration><ce:affiliation><ce:textfn>Ludwigshafen, Germany</ce:textfn></ce:affiliation><ce:affiliation><ce:textfn>From Herzzentrum Ludwigshafen, <ce:sup loc="post">a</ce:sup>Krankenhaus der Barmherzigen Brüder Trier, <ce:sup loc="post">b</ce:sup>Johannes Gutenberg Universität Mainz, <ce:sup loc="post">c</ce:sup>Klinikum Nürnberg, <ce:sup loc="post">d</ce:sup>Universitätskliniken Homburg/Saar, <ce:sup loc="post">e</ce:sup>Winterbergkliniken Saarbrücken, <ce:sup loc="post">f</ce:sup>Städtisches Klinikum Kaiserslautern, and <ce:sup loc="post">g</ce:sup>Städtisches Klinikum Worms</ce:textfn></ce:affiliation></ce:author-group><ce:date-received day="30" month="1" year="1998"></ce:date-received><ce:date-accepted day="25" month="6" year="1998"></ce:date-accepted><ce:abstract class="author"><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para view="all" id="simple-para.0010"><ce:bold>Background</ce:bold> Concern exists regarding the results of primary angioplasty for acute myocardial infarction when the procedure is performed during night hours. <ce:bold>Methods and Results</ce:bold> Between June 1994 and January 1997, 491 patients with acute myocardial infarction who underwent primary angioplasty procedures were consecutive registered in the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study. Three hundred seventy-eight patients (77%) were treated during the day and 113 (23%) at night. Baseline characteristics showed no major differences between the 2 groups. Prehospital delay time was 60 minutes shorter during the night (median value 180 minutes for day, 120 minutes for night, <ce:italic>P</ce:italic> = .005), and in-hospital time to treatment was 9 minutes longer (median value 85 minutes day, 94 minutes night, <ce:italic>P</ce:italic> = .037). Patients treated during the night more often received angiotensin-converting enzyme blockers (61.4% day, 76.1% night, <ce:italic>P</ce:italic> = .004) and the so-called optimal adjunctive therapy (54% day, 64.6% night, <ce:italic>P</ce:italic> = .045). There were no differences concerning clinical events between the 2 groups. Hospital mortality was 8.7% during the day and 5.3% during the night (univariate analysis <ce:italic>P</ce:italic> = .238; logistic regression <ce:italic>P</ce:italic> = .653). <ce:bold>Conclusions</ce:bold> In a clinical setting, primary angioplasty for acute myocardial infarction can be performed safely during the night with a clinically insignificant prolongation of in-hospital time to reperfusion compared with practice during the day. (Am Heart J 1999;138:1111-7.)</ce:simple-para></ce:abstract-sec></ce:abstract></head><body view="all"><ce:sections><ce:para view="all" id="para.0010"><ce:bold>See related Editorial on page 1012. .</ce:bold></ce:para><ce:para view="all" id="para.0015">Primary angioplasty is an accepted alternative therapeutic option to intravenous thrombolysis in the treatment of patients with acute myocardial infarction.<ce:cross-refs refid="bib1 bib2 bib3 bib4 bib5 bib6 bib7 bib8 bib9 bib10"><ce:sup loc="post">1-10</ce:sup></ce:cross-refs> However, primary angioplasty is a complex procedure that requires a team of experienced interventional cardiologists and well-established hospital logistics to keep the time short between admission to the hospital and reperfusion of the infarction-related artery.<ce:cross-ref refid="bib11"><ce:sup loc="post">11</ce:sup></ce:cross-ref> There has been concern that primary angioplasty performed during the night may not achieve similar success rates to procedures performed during the day.<ce:cross-refs refid="bib12 bib13 bib14"><ce:sup loc="post">12-14</ce:sup></ce:cross-refs> A few small studies<ce:cross-refs refid="bib15 bib16"><ce:sup loc="post">15,16</ce:sup></ce:cross-refs> have shown comparable feasibility, safety, and results of primary angioplasty performed day or night. However, these small studies were performed at single centers and therefore the results do not reflect overall clinical practice. To investigate the practice and results of primary angioplasty during day and night hours, we analyzed the data of the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study.</ce:para><ce:section view="all" id="section.0010"><ce:section-title>Methods</ce:section-title><ce:para view="all" id="para.0020">The MITRA study is a German prospective multicenter observational study of the current management of acute myocardial infarction.<ce:cross-ref refid="bib17"><ce:sup loc="post">17</ce:sup></ce:cross-ref> 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 was established.</ce:para><ce:para view="all" id="para.0025">Acute myocardial infarction was diagnosed in the presence of at least 2 of the 3 following signs: persistent angina pectoris for 20 minutes or more, ST-segment elevation 1 mm or more in at least 2 standard leads or 2 mm or more in at least 2 contiguous precordial leads, elevation of enzyme levels (creatine kinase and its MB isoenzyme, aspartate aminotransferase, lactic dehydrogenase) twice the upper normal range. The final diagnosis of acute myocardial infarction and the decision regarding the type of treatment were left to the discretion of the treating physician and not to the study protocol.</ce:para><ce:para view="all" id="para.0030">The recommended use of drugs was as follows: acetylsalicylic acid (aspirin), initial dose as soon as acute myocardial infarction was suspected with 500 mg intravenously or 300 mg orally followed by 100 mg once a day; β-blockers, started as soon as possible, first intravenously with a target heart rate of 50 to 60 beats/min; and angiotensin-converting enzyme inhibitors, started the first day after the diagnosis of acute myocardial infarction with low initial doses to be increased during the following days up to the recommended dosages in previous large trials. Angioplasty was performed according to the standard protocol of each center.</ce:para><ce:para view="all" id="para.0035">Patients were categorized as being individually optimally treated (optimal treatment) if they received aspirin, β-blockers, and ACE inhibitors. Patients also were classified as being optimally treated if any of these medications were withheld in the presence of absolute contraindications to use of the drug. The contraindication to use of aspirin was active bleeding, to ACE inhibitors was systolic blood pressure at admission 100 mm Hg or less, cardiogenic shock, and to β-blockers was apparent cardiac failure, bradycardia 50 beats/min or fewer, second- or third-degree atrioventricular block, or the presence of chronic obstructive pulmonary disease.</ce:para><ce:section view="all" id="section.0015"><ce:section-title>Definitions</ce:section-title><ce:para view="all" id="para.0040">Time to reperfusion was defined as being the time from admission to the hospital to the start of primary angioplasty (angiographic needle entry). Postinfarction angina was diagnosed in the presence of new angina pectoris within 2 weeks after myocardial infarction. Reinfarction was defined as recurrent chest pain lasting more than 20 minutes with new ST-segment elevation and either emergency angiographic confirmation of an occluded vessel or recurrent elevation of cardiac enzyme levels. Minor stroke was defined as transient cerebral ischemia and major stroke as persistent cerebral ischemia. A combined clinical end point was defined by the occurrence of death, reinfarction, postinfarction angina or heart failure in New York Heart Association class III or higher.</ce:para><ce:para view="all" id="para.0045">We compared results for consecutively treated patients who underwent primary angioplasty during the day with those for consecutively treated patients who underwent the procedure during the night. According to time of admission to the hospital day was defined as admission between 8 <ce:small-caps>AM</ce:small-caps> and 8 pm and night as admission between 8 <ce:small-caps>PM</ce:small-caps> and 8 <ce:small-caps>AM.</ce:small-caps></ce:para></ce:section><ce:section view="all" id="section.0020"><ce:section-title>Statistical analysis</ce:section-title><ce:section view="all" id="section.0025"><ce:section-title>Data collection</ce:section-title><ce:para view="all" id="para.0050">Data from the prehospital period and the early intrahospital period (first 48 hours) were collected on a 1-page record form within the first 2 to 3 days in the intensive care unit. Clinical events afterward were registered on a separate 1-page record form at hospital discharge. Every participating center was committed by written consent to include each patient with acute myocardial infarction during the study period. The patients gave informed consent for processing of anonymous data. All data sheets were sent to a central data-processing center (department of cardiology, Herzzentrum Ludwigshafen) for uniform monitoring and registration.</ce:para></ce:section><ce:section view="all" id="section.0030"><ce:section-title>Data analysis</ce:section-title><ce:para view="all" id="para.0055">Absolute numbers and percentages were computed to describe the patient population. Medians and 25% and 75% percentiles were computed. Categorical values were compared by means of χ<ce:sup loc="post">2</ce:sup> analysis and continuous variables were compared by means of a 2-tailed Wilcoxon rank sum test. Multiple logistic regression was used to analyze factors influencing hospital mortality. Variables examined were age, sex, location of infarction, systolic blood pressure, heart rate, presence of bundle branch block, presence of concomitant disease, time to treatment, concomitant use of medication, and admission during the day or night. <ce:italic>P</ce:italic> values < .05 were considered significant. All <ce:italic>P</ce:italic> values are 2 tailed. The tests were performed with the SAS statistical package, version 6.12 (Cary, North Carolina).</ce:para></ce:section></ce:section></ce:section><ce:section view="all" id="section.0035"><ce:section-title>Results</ce:section-title><ce:para view="all" id="para.0060">Between June 1994 and January 1997, 5905 patients with acute myocardial infarction were registered (Figure 1). <ce:display><ce:figure id="figure.0010"><ce:label>Fig. 1</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0015">Selection of patients from the MITRA trial.</ce:simple-para></ce:caption><ce:link locator="gr1"></ce:link></ce:figure></ce:display>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. <ce:display><ce:table colsep="0" rowsep="0" frame="topbot" id="table.0010"><ce:label>Table I</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0020">Baseline characteristics of the patients</ce:simple-para></ce:caption><tgroup cols="4"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><thead><row><entry>Characteristic</entry><entry align="center">Day (n = 378/100%)</entry><entry align="center">Night (n = 113/100%)</entry><entry align="center"><ce:italic>P</ce:italic> value</entry></row></thead><tbody><row><entry>Age (y)</entry><entry align="center">62 (54-70)</entry><entry align="center">60 (52-71)</entry><entry align="center">.525</entry></row><row><entry>Male sex (%)</entry><entry align="center">276/73%</entry><entry align="center">87/77%</entry><entry align="center">.398</entry></row><row><entry>Anterior location of infarction</entry><entry align="center">177/47.2%</entry><entry align="center">56/50.5%</entry><entry align="center">.547</entry></row><row><entry>Prior infarction (%)</entry><entry align="center">65/17.3%</entry><entry align="center">26/23%</entry><entry align="center">.171</entry></row><row><entry>Systolic blood pressure (mm Hg)</entry><entry align="center">135 (120-150)</entry><entry align="center">140 (120-160)</entry><entry align="center">.006</entry></row><row><entry>Cardiogenic shock (before treatment)</entry><entry align="center">16/4.8%</entry><entry align="center">4/3.9%</entry><entry align="center">.695</entry></row><row><entry>History of heart failure</entry><entry align="center">9/2.5%</entry><entry align="center">3/2.8%</entry><entry align="center">.875</entry></row><row><entry>Resuscitation (%)</entry><entry align="center">22/6.6%</entry><entry align="center">5/4.8%</entry><entry align="center">.518</entry></row><row><entry>Heart rate (beats/min)</entry><entry align="center">79 (67-73)</entry><entry align="center">78 (68-94)</entry><entry align="center">.906</entry></row><row><entry>Left bundle branch block (%)</entry><entry align="center">7/1.9%</entry><entry align="center">5/4.6%</entry><entry align="center">.114</entry></row><row><entry>Right bundle branch block</entry><entry align="center">18/4.8%</entry><entry align="center">3/2.7%</entry><entry align="center">.343</entry></row><row><entry>Atrial fibrillation (%)</entry><entry align="center">18/5.3%</entry><entry align="center">5/5%</entry><entry align="center">.882</entry></row><row><entry>Prehospital delay (min)</entry><entry align="center">180 (100-480)</entry><entry align="center">120 (90-250)</entry><entry align="center">.005</entry></row><row><entry>In-hospital time to treatment (min)</entry><entry align="center">85 (50-145)</entry><entry align="center">94 (65-178)</entry><entry align="center">.037</entry></row><row><entry>Concomitant diseases and interventions</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>History of ulcer or active bleeding</entry><entry align="center">24/6.4%</entry><entry align="center">11/9.7%</entry><entry align="center">.220</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Recent (<3 months) cerebral infarction</entry><entry align="center">5/1.3%</entry><entry align="center">1/.9%</entry><entry align="center">.706</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Recent (<14 days) surgical intervention or trauma</entry><entry align="center">5/1.3%</entry><entry align="center">4/3.5%</entry><entry align="center">.125</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Renal insufficiency</entry><entry align="center">10/2.7%</entry><entry align="center">4/3.5%</entry><entry align="center">.623</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Chronic obstructive pulmonary disease</entry><entry align="center">8/2.1%</entry><entry align="center">2/1.8%</entry><entry align="center">.814</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Arterial hypertension</entry><entry align="center">123/36.6%</entry><entry align="center">43/41.4%</entry><entry align="center">.384</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Diabetes mellitus</entry><entry align="center">55/16.4%</entry><entry align="center">14/13.5%</entry><entry align="center">.476</entry></row><row><entry namest="col1" nameend="col4"></entry></row></tbody></tgroup><ce:legend><ce:simple-para view="all" id="simple-para.0025">Median values are given with interquartile range (25th and 75th percentiles).</ce:simple-para></ce:legend></ce:table></ce:display>Systolic blood pressure at admission was higher during the night (median value 135 mm Hg day, 140 mm Hg night; <ce:italic>P</ce:italic> = .006). Prehospital delay was 60 minutes shorter during the night (median value 180 minutes day, 120 minutes night; <ce:italic>P</ce:italic> = .005), and in-hospital time to treatment was 9 minutes longer (median value 85 minutes day, 94 minutes night; <ce:italic>P</ce:italic> = .037). There was no difference regarding other baseline characteristics between the 2 groups.</ce:para><ce:para view="all" id="para.0065">Patients treated during the night received ACE inhibitors more often than during the day (61.4% day, 76,1% night; <ce:italic>P</ce:italic> = .004) and they more often received the so-called optimal adjunctive therapy (54% day, 64.6% night; <ce:italic>P</ce:italic> = .045). No significant difference was found concerning treatment with nitroglycerin, heparin, aspirin, and β-blockers (Table II). <ce:display><ce:table colsep="0" rowsep="0" frame="topbot" id="table.0015"><ce:label>Table II</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0030">Concomitant medication of patients within the first 48 hours after admission to the hospital according to treatment group</ce:simple-para></ce:caption><tgroup cols="4"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><thead><row><entry>Medication</entry><entry align="center">Day (n = 378/100%)</entry><entry align="center">Night (n = 113/100%)</entry><entry align="center"><ce:italic>P</ce:italic> value</entry></row></thead><tbody><row><entry>IV nitroglycerin</entry><entry align="center">316/83.8%</entry><entry align="center">95/84.8%</entry><entry align="center">.799</entry></row><row><entry>Heparin</entry><entry align="center">370/98.1%</entry><entry align="center">110/98.2%</entry><entry align="center">.961</entry></row><row><entry>Aspirin</entry><entry align="center">367/97.1%</entry><entry align="center">108/95.6%</entry><entry align="center">.426</entry></row><row><entry>β-Blockers</entry><entry align="center">239/63.2%</entry><entry align="center">80/70.8%</entry><entry align="center">.139</entry></row><row><entry>Angiotensin converting enzyme inhibitors</entry><entry align="center">232/61.4%</entry><entry align="center">86/76.1%</entry><entry align="center">.004</entry></row><row><entry>Optimal medication</entry><entry align="center">204/54%</entry><entry align="center">73/64.6%</entry><entry align="center">.045</entry></row></tbody></tgroup></ce:table></ce:display>There were no differences between patients treated during the day and those treated at night concerning clinical events (Table III). <ce:display><ce:table colsep="0" rowsep="0" frame="topbot" id="table.0020"><ce:label>Table III</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0035">Clinical events during hospitalization</ce:simple-para></ce:caption><tgroup cols="4"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><thead><row><entry>Event</entry><entry align="center">Day (n = 378/100%)</entry><entry align="center">Night (n = 113/100%)</entry><entry align="center"><ce:italic>P</ce:italic> value</entry></row></thead><tbody><row><entry>No complication</entry><entry align="center">198/62.3%</entry><entry align="center">71/72.5%</entry><entry align="center">.065</entry></row><row><entry>Bleeding (gastrointestinal or with need for transfusion)</entry><entry align="center">5/1.3%</entry><entry align="center">3/2.7%</entry><entry align="center">.326</entry></row><row><entry>Ventricular rupture</entry><entry align="center">—</entry><entry align="center">—</entry><entry align="center">1.000</entry></row><row><entry>Heart failure (≥NYHA III)</entry><entry align="center">19/5%</entry><entry align="center">7/6.2%</entry><entry align="center">.627</entry></row><row><entry>Minor stroke</entry><entry align="center">3/.8%</entry><entry align="center">2/1.8%</entry><entry align="center">.364</entry></row><row><entry>Major stroke</entry><entry align="center">7/1.9%</entry><entry align="center">1/.8%</entry><entry align="center">.476</entry></row><row><entry>Postinfarction angina</entry><entry align="center">28/7.4%</entry><entry align="center">8/7.1%</entry><entry align="center">.907</entry></row><row><entry>Reinfarction</entry><entry align="center">14/3.7%</entry><entry align="center">6/5.3%</entry><entry align="center">.449</entry></row><row><entry>Urgent CABG/PTCA</entry><entry align="center">67/21.3%</entry><entry align="center">14/14.3%</entry><entry align="center">.128</entry></row><row><entry>Death within 48 h</entry><entry align="center">16/4.2%</entry><entry align="center">2/1.8%</entry><entry align="center">.222</entry></row><row><entry>In-hospital death</entry><entry align="center">33/8.7%</entry><entry align="center">6/5.3%</entry><entry align="center">.238</entry></row><row><entry>Combined end point (death, reinfarction, postinfarction angina, heart failure)</entry><entry align="center">83/22%</entry><entry align="center">23/20.4%</entry><entry align="center">.716</entry></row></tbody></tgroup></ce:table></ce:display>Hospital mortality was 8.7% during the day compared with 5.3% during the night (<ce:italic>P</ce:italic> = .238).</ce:para><ce:para view="all" id="para.0070">Multiple logistic regression analysis demonstrated the following parameters to be independent predictors of mortality: age 65 years or older (odds ratio 3.52; 95% CI, 1.57-8.42; <ce:italic>P</ce:italic> = .0031), heart rate at admission 100 beats/min or more (odds ratio 3.34; 95% CI, 1.46-7.45; <ce:italic>P</ce:italic> = .0020), and optimal concomitant medication (odds ratio 0.69; 95% CI, 0.52-0.90; <ce:italic>P</ce:italic> = .0020). No independent effect could be shown for location of the infarction (odds ratio 1.02; 95% CI, 0.48-2.17; <ce:italic>P</ce:italic> = .96), systolic blood pressure at admission 100 mm Hg or less (odds ratio 2.46; 95% CI, 0.70-7.43; <ce:italic>P</ce:italic> = .11), the presence of bundle branch block (odds ratio 0.69; 95% CI, 0.10-2.74; <ce:italic>P</ce:italic> = .64), sex (odds ratio 1.24; 95% CI, 0.54-2.76; <ce:italic>P</ce:italic> = .60), concomitant diseases (odds ratio 1.40; 95% CI = 0.44-3.80; <ce:italic>P</ce:italic> = .53), or the time of treatment (night versus day; odds ratio 0.79; 95% CI, 0.25-2.05; <ce:italic>P</ce:italic> = .65). For the combined clinical end point of death, reinfarction, postinfarction angina or heart failure NYHA class III or greater, all parameters showed the same significance as for mortality, time at treatment being an insignificant predictor (odds ratio 1.07; 95% CI, 0.60-1.87; <ce:italic>P</ce:italic> = .81).</ce:para><ce:para view="all" id="para.0075">In the search for an explanation for the longer prehospital delay among patients treated during the day, we examined prehospital delay according to onset of symptoms (Figure 2). <ce:display><ce:figure id="figure.0015"><ce:label>Fig. 2</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0040">Prehospital delay (median value and 25th and 75th percentiles) according to time at onset of symptoms among patients treated with primary angioplasty.</ce:simple-para></ce:caption><ce:link locator="gr2"></ce:link></ce:figure></ce:display>Patients with onset of symptoms between 12 <ce:small-caps>PM</ce:small-caps> and 8 <ce:small-caps>AM</ce:small-caps> had much longer prehospital delay than did those whose symptoms began at any other time.</ce:para></ce:section><ce:section view="all" id="section.0040"><ce:section-title>Discussion</ce:section-title><ce:para view="all" id="para.0080">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 hours, perhaps because they were waiting for the day to begin. There was a clinically insignificant 9-minute difference in in-hospital time to treatment between day and night hours, the 9-minute delay occurring at night.</ce:para><ce:para view="all" id="para.0085">Primary angioplasty is a complex procedure that must be performed by experienced interventional cardiologists. Hospital logistics must be well-established to keep the time short between admission to the hospital and the beginning of intervention. Two small studies investigated the effect of the time at admission on performance of primary angioplasty. In a single-center study Garot et al<ce:cross-ref refid="bib15"><ce:sup loc="post">15</ce:sup></ce:cross-ref> analyzed data on 288 consecutively treated patients. They compared the treatment of patients admitted during the usual business hours (on hours, 8 <ce:small-caps>AM</ce:small-caps> to 8 <ce:small-caps>PM</ce:small-caps> ; n = 113) and off-shift hours (off hours, 8 <ce:small-caps>PM</ce:small-caps> to 8 <ce:small-caps>AM</ce:small-caps> and weekends; n = 175). They did not find a significant difference between the 2 groups, either in time from onset of symptoms to admission or in the outcome of the patients. They observed a 9-minute difference between admission to the coronary care unit and reperfusion (47 ± 24 minutes on hours, 56 ± 39 minutes off hours, <ce:italic>P</ce:italic> > .05), which is exactly the same as the difference observed in the current study (median value 85 minutes day, 94 minutes night, <ce:italic>P</ce:italic> = .037).</ce:para><ce:para view="all" id="para.0090">The in-hospital time to intervention in our study was about twice that in the data of Garot et al.<ce:cross-ref refid="bib15"><ce:sup loc="post">15</ce:sup></ce:cross-ref> The difference may be the result of different methods of measuring time. Garot et al measured time from admission to the coronary care unit to reperfusion. We measured time from admission to the hospital to the start of primary angioplasty. Our data were close to the time intervals of 79 minutes (median value) reported by Every et al<ce:cross-ref refid="bib8"><ce:sup loc="post">8</ce:sup></ce:cross-ref> and 114 minutes (median value) reported by the GUSTO II investigators,<ce:cross-ref refid="bib9"><ce:sup loc="post">9</ce:sup></ce:cross-ref> who also represented multicenter data and not a single-center experience.</ce:para><ce:para view="all" id="para.0095">McNamara et al<ce:cross-ref refid="bib16"><ce:sup loc="post">16</ce:sup></ce:cross-ref> reported data from a 2-center database of 291 consecutively treated patients. Their patients were divided into 3 groups according to time at admission, as follows: regular hours on work days (8 <ce:small-caps>AM</ce:small-caps> to 4:30 <ce:small-caps>PM</ce:small-caps> ; n = 102), nonwork waking hours (7 <ce:small-caps>AM</ce:small-caps> to 9 <ce:small-caps>PM</ce:small-caps> , 7 days a week, except regular working hours [off-shift days]; n = 109), and nights (9 <ce:small-caps>PM</ce:small-caps> to 7 <ce:small-caps>AM</ce:small-caps> ; n = 80). There was a slight trend toward more patients at high risk coming to medical attention on off-shift days. Median door-to-balloon time was significantly longer outside regular working hours (mean value 91 minutes workdays, 101 minutes off-shift days, <ce:italic>P</ce:italic> = .03; 115 minutes nights, <ce:italic>P</ce:italic> = .001). There were no differences between the groups, however, regarding technical success and mortality.</ce:para><ce:para view="all" id="para.0100">Despite different time intervals, the studies showed that primary angioplasty performed during the night is associated with results similar to those of the same procedure performed during the day. The delay in time from admission to intervention during the night compared with the delay during the day is small and does not seem to result in a worse clinical outcome. Nevertheless continuous efforts are mandatory to establish and maintain the shortest possible in-hospital time intervals. Caputo et al<ce:cross-ref refid="bib11"><ce:sup loc="post">11</ce:sup></ce:cross-ref> demonstrated that continuous quality control measurements lead to a shortening of in-hospital delay and better clinical results of primary angioplasty.</ce:para><ce:para view="all" id="para.0105">In contrast to the 2 studies cited earlier, in which nearly equal proportions of patients were treated during day and night hours, only 23% of all patients registered in our study were treated during the night. This was the result of a combination of different policies regarding the use of primary angioplasty at the 8 participating hospitals and the behavior of the patients.</ce:para><ce:para view="all" id="para.0110">As shown in a previous analysis of the MITRA data,<ce:cross-ref refid="bib18"><ce:sup loc="post">18</ce:sup></ce:cross-ref> there were major differences in the policies of the 8 hospitals regarding overall use of primary angioplasty to treat patients with acute myocardial infarction. The percentage of patients thus treated ranged from 1.8% to 57.5%. We also found great differences in the use of primary angioplasty during the night hours; 8% to 44% of all patients were treated with primary angioplasty at these hospitals. Hospitals with a low overall rate of performing primary angioplasty also rarely used primary angioplasty during the night because they did not have 24-hour service.</ce:para><ce:para view="all" id="para.0115">Behavior of the patients led to a shortened prehospital delay during the night. Prehospital delay was 60 minutes shorter among patients admitted during the night (median value 180 minutes day, 120 minutes night; <ce:italic>P</ce:italic> = .005). Patients with an onset of symptoms between 12 <ce:small-caps>PM</ce:small-caps> and 8 <ce:small-caps>AM</ce:small-caps> showed much longer prehospital delay compared with patients whose symptoms began at any other time. This indicates that patients with an onset of symptoms during this time period tend to wait for the morning hours to consult a physician, which led to prolonged prehospital delay during the day.</ce:para><ce:para view="all" id="para.0120">Patients treated during the night were almost always treated in hospitals with a primary preference for primary angioplasty and therefore greater experience with this method. Greater experience with primary angioplasty leads to better clinical results. The studies of Grassman et al<ce:cross-ref refid="bib19"><ce:sup loc="post">19</ce:sup></ce:cross-ref> and Zahn et al<ce:cross-ref refid="bib20"><ce:sup loc="post">20</ce:sup></ce:cross-ref> showed improved outcome of primary angioplasty when the case load of the hospitals is high. This had already been demonstrated for angioplasty for stable or unstable angina.<ce:cross-refs refid="bib21 bib22"><ce:sup loc="post">21,22</ce:sup></ce:cross-refs> The good results of primary angioplasty during the night in our study therefore are representative only of hospitals with experience in primary angioplasty and established 24-hour service.</ce:para><ce:para view="all" id="para.0125">The different patterns of use of primary angioplasty and the behavior of patients might have caused selection of patients treated during the night. However, because these factors are not related to special clinical characteristics of patients, we found no important difference in the baseline characteristics between the 2 groups.</ce:para><ce:para view="all" id="para.0130">Patients treated during the night more often received ACE inhibitors (61.4% day, 76,1% night; <ce:italic>P</ce:italic> = .004) and the so-called optimal adjunctive therapy (54% day, 64.6% night; <ce:italic>P</ce:italic> = .045) than during the day. There was also an insignificant trend toward increased use of β-blockers during the night (63.2% day, 70.8% night; <ce:italic>P</ce:italic> = .139). No significant difference was found concerning treatment with nitroglycerin, heparin, or aspirin. Because contraindications to each optimal medication therapy are considered in the definition, this difference cannot be attributed to a difference in the proportion of patients with contraindications to any of the medications during the day hours. An explanation might be that the hospitals with a preference for primary angioplasty as the first choice of therapy for acute myocardial infarction even at night also more often use adjunctive therapies with a proved beneficial effect in the care of patients with acute myocardial infarction.<ce:cross-refs refid="bib23 bib24 bib25"><ce:sup loc="post">23-25</ce:sup></ce:cross-refs></ce:para><ce:section view="all" id="section.0045"><ce:section-title>Limitations of the study</ce:section-title><ce:para view="all" id="para.0135">Because MITRA is an observational study it was not possible to control totally the selection of patients to be treated during 1 of the 2 time intervals. This was a strength of the current investigation, because it reflects clinical practice in different hospitals with different reperfusion strategies. Therefore ours was not simply a comparison of results from day and night but was a comparison of nighttime results mainly from centers with 24-hour service compared with daytime results from a larger cross section of hospitals performing primary angioplasty. We did not collect information on the number of vessels dilated and the rate of technical success (residual stenosis, TIMI grade 3 flow) of the angioplasty procedures, so we were unable to control the results for these important variables. For the given small sample size of 491 patients treated with primary angioplasty, the power to detect a significant 2.4% difference would be about 35% according to the nomogram of Altman.<ce:cross-ref refid="bib26"><ce:sup loc="post">26</ce:sup></ce:cross-ref> This low power was a problem of the current study.</ce:para></ce:section></ce:section></ce:sections><ce:acknowledgment><ce:section-title>Acknowledgements</ce:section-title><ce:para view="all" id="para.0140"><ce:italic>We thank Heinz Hochadel for his assistance with the statistical analysis and Stefan Wagner and Sinéad Trainor for their helpful comments on the manuscript.</ce:italic></ce:para></ce:acknowledgment></body><tail view="all"><ce:bibliography view="all" id="bibliography.0010"><ce:section-title>References</ce:section-title><ce:bibliography-sec id="bibliography-sec.0010"><ce:bib-reference id="bib1"><ce:label>1</ce:label><sb:reference><sb:contribution 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sample?</sb:maintitle></sb:title></sb:contribution><sb:host><sb:edited-book><sb:book-series><sb:editors><sb:editor><ce:given-name>SM</ce:given-name><ce:surname>Gore</ce:surname></sb:editor><sb:editor><ce:given-name>DG</ce:given-name><ce:surname>Altman</ce:surname></sb:editor></sb:editors><sb:series><sb:title><sb:maintitle>Statistics in practise</sb:maintitle></sb:title></sb:series></sb:book-series><sb:date>1982</sb:date><sb:publisher><sb:name>British Medical Association</sb:name><sb:location>London</sb:location></sb:publisher></sb:edited-book><sb:pages><sb:first-page>21</sb:first-page><sb:last-page>24</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference></ce:bibliography-sec></ce:bibliography></tail></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction</title></titleInfo><name type="corporate"><namePart>For the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group</namePart></name><name type="personal"><namePart type="given">Ralf</namePart><namePart type="family">Zahn</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rudolf</namePart><namePart type="family">Schiele</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Karlheinz</namePart><namePart type="family">Seidl</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Stefan</namePart><namePart type="family">Schuster</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Karl E.</namePart><namePart type="family">Hauptmann</namePart><namePart type="termsOfAddress">MDa</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thomas</namePart><namePart type="family">Voigtländer</namePart><namePart type="termsOfAddress">MDb</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Martin</namePart><namePart type="family">Gottwik</namePart><namePart type="termsOfAddress">MDc</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gunther</namePart><namePart type="family">Berg</namePart><namePart type="termsOfAddress">MDd</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thomas</namePart><namePart type="family">Kunz</namePart><namePart type="termsOfAddress">MDe</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hans Georg</namePart><namePart type="family">Glunz</namePart><namePart type="termsOfAddress">MDf</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Peter</namePart><namePart type="family">Limbourg</namePart><namePart type="termsOfAddress">MDg</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jochen</namePart><namePart type="family">Senges</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Ludwigshafen, GermanyFrom Herzzentrum Ludwigshafen, aKrankenhaus der Barmherzigen Brüder Trier, bJohannes Gutenberg Universität Mainz, cKlinikum Nürnberg, dUniversitätskliniken Homburg/Saar, eWinterbergkliniken Saarbrücken, fStädtisches Klinikum Kaiserslautern, and gStädtisches Klinikum Worms</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1999</dateIssued><copyrightDate encoding="w3cdtf">1999</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Background Concern exists regarding the results of primary angioplasty for acute myocardial infarction when the procedure is performed during night hours. Methods and Results Between June 1994 and January 1997, 491 patients with acute myocardial infarction who underwent primary angioplasty procedures were consecutive registered in the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study. Three hundred seventy-eight patients (77%) were treated during the day and 113 (23%) at night. Baseline characteristics showed no major differences between the 2 groups. Prehospital delay time was 60 minutes shorter during the night (median value 180 minutes for day, 120 minutes for night, P = .005), and in-hospital time to treatment was 9 minutes longer (median value 85 minutes day, 94 minutes night, P = .037). Patients treated during the night more often received angiotensin-converting enzyme blockers (61.4% day, 76.1% night, P = .004) and the so-called optimal adjunctive therapy (54% day, 64.6% night, P = .045). There were no differences concerning clinical events between the 2 groups. Hospital mortality was 8.7% during the day and 5.3% during the night (univariate analysis P = .238; logistic regression P = .653). Conclusions In a clinical setting, primary angioplasty for acute myocardial infarction can be performed safely during the night with a clinically insignificant prolongation of in-hospital time to reperfusion compared with practice during the day. (Am Heart J 1999;138:1111-7.)</abstract><note>Supported in part by Zeneca, Ministerium für Gesundheit, Arbeit, Soziales des Landes Rheinland-Pfalz, Landesversicherungsanstalt Rheinland-Pfalz, Betriebskrankenkassen Rheinland-Pfalz.</note><note>The people and institutions who participated in the MITRA study are listed in reference17.</note><note>Reprint requests: Ralf Zahn, MD, Herzzentrum Ludwigshafen, Dept. of Cardiology, Bremserstraße 79, D-67063 Ludwigshafen, Germany.</note><note>0002-8703/99/$8.00 + 0 4/1/96677</note><relatedItem type="host"><titleInfo><title>American Heart Journal</title></titleInfo><titleInfo type="abbreviated"><title>YMHJ</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">199912</dateIssued></originInfo><identifier type="ISSN">0002-8703</identifier><identifier type="PII">S0002-8703(05)X7073-9</identifier><part><date>199912</date><detail type="volume"><number>138</number><caption>vol.</caption></detail><detail type="issue"><number>6</number><caption>no.</caption></detail><extent unit="issue pages"><start>4A</start><end>1200</end></extent><extent unit="pages"><start>1111</start><end>1117</end></extent></part></relatedItem><identifier type="istex">07C97F4B7B5F76B4ED7D47E866160C95EAF8047B</identifier><identifier type="DOI">10.1016/S0002-8703(99)70077-3</identifier><identifier type="PII">S0002-8703(99)70077-3</identifier><identifier type="ArticleID">96677</identifier><accessCondition type="use and reproduction" contentType="copyright">©1999 Mosby, Inc.</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Mosby, Inc., ©1999</recordOrigin></recordInfo></mods></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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