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Circadian rhythms in patients with ST-elevation myocardial infarction.
MedLine Citation:
PMID:  20570918     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle.
METHODS AND RESULTS: The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was a significant association between time of onset and the circadian cycle, with the greatest percentage (39%) of patients experiencing onset between 8 AM and 3 PM (P<0.001). Time of onset was associated with prehospital delay and timeliness of reperfusion. Patients with onset from 12 AM to 5:59 AM had median prehospital delays of 121 minutes versus 70 minutes from 12 PM to 5:59 PM (P<0.001). Patients with onset time from 12 AM to 5:59 AM had median door-to-balloon times of 75 minutes versus 60 minutes from 6 AM to 11:59 AM (P<0.001). Using multivariable modeling to control for baseline patient characteristics, prehospital delay, and timeliness of reperfusion, there was no significant association between time of symptom onset with in-hospital death.
CONCLUSIONS: Patients with ST-elevation myocardial infarction exhibit significant circadian patterns in symptom onset, prehospital delay, and timeliness of reperfusion. Patients who develop symptoms from 12 AM to 5:59 AM present with longer prehospital delays and have longer door-to-balloon times. After multivariable adjustment, there was no significant association between circadian patterns of time of onset and in-hospital death.
Authors:
David R Holmes; Frank V Aguirre; Richard Aplin; Ryan J Lennon; David M Nestler; Malcolm R Bell; Charanjit S Rihal; Henry H Ting
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Publication Detail:
Type:  Journal Article     Date:  2010-06-22
Journal Detail:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  3     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  United States    
Other Details:
Languages:  eng     Pagination:  382-9     Citation Subset:  IM    
Affiliation:
Mayo Clinic, Rochester, MN 55905, USA. holmes.david@mayo.edu
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