After-Hours Versus In-Hours Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

BACKGROUND Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains a time-critical emergency with persistently high mortality despite advances in reperfusion and mechanical circulatory support. Clinical outcomes may be influenced by the timing of percutaneous coronary intervention (PCI), with after-hours procedures potentially affected by logistical and staffing constraints. The impact of PCI timing on AMI-CS outcomes remains unclear. METHOD A retrospective cohort study was conducted using data from the Victorian Cardiac Outcomes Registry including all adults undergoing PCI for ST-elevation myocardial infarction (STEMI) or non-STEMI complicated by CS. PCI timing was classified as procedure start time in-hours (0800-1759 weekdays) or after-hours (all other times). Baseline, procedural, and outcome data were compared. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Long-term mortality was determined through linkage with the Australian National Death Index. RESULTS CS PCI cases were undertaken from 2013 to 2024; with 58.5% occurring after. CONCLUSIONS hours, with in-hospital mortality remaining high over the past decade irrespective of procedure timing. These findings underscore the need for the continued development of shock management paradigms and strategic deployment of emerging treatments in AMI-CS.