Concerns have persisted that after-hours percutaneous coronary intervention (PCI) may be associated with worse outcomes because of staffing and logistical limitations. In a retrospective registry analysis presented at the EuroPCR 2026, investigators evaluated the relationship between PCI timing and outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS).

The study used data from the Victorian Cardiac Outcomes Registry and included adults undergoing PCI for ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) complicated by cardiogenic shock between 2013 and 2024.

Findings

• A total of 2,656 PCI procedures for AMI-CS were included in the analysis.
• Among these procedures, 58.5% were performed after-hours.
• STEMI presentation was more frequent among after-hours cases compared with in-hours procedures (91.2% vs 84.4%; p<0.001).
• Door-to-device times were longer for after-hours PCI procedures [82 (57-116) vs 64 (43-93) minutes; p<0.001].
• Overall use of mechanical circulatory support was similar between groups.
• Intra-aortic balloon pump use was more common during after-hours PCI, whereas veno-arterial extracorporeal membrane oxygenation use was more frequent during in-hours procedures.
• Overall in-hospital mortality for the cohort was 39.8%.
• After multivariable adjustment, in-hospital mortality did not differ significantly between after-hours and in-hours PCI (adjusted OR 1.04; 95% CI 0.88-1.24; p=0.62).
• Adjusted 1-year mortality was also similar regardless of PCI timing.

The findings suggest that after-hours PCI for AMI complicated by cardiogenic shock was not associated with higher short- or long-term mortality despite longer treatment delays. Mortality remained high across both groups, highlighting the persistent clinical severity of AMI-CS.