Document Detail


Circadian variation in myocardial perfusion and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty.
MedLine Citation:
PMID:  16338256     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Little is known about whether the physiological factors that determine the circadian variation in ST-segment elevation myocardial infarction (STEMI) onset and thrombolysis efficacy may affect myocardial perfusion and long-term outcome of patients with STEMI treated with primary angioplasty. METHODS: Our study population consisted of 1548 consecutive patients with STEMI treated by primary angioplasty between April 1997 and October 2001. All clinical, angiographic, and follow-up data were collected. RESULTS: Most of the patients (65.2%) were treated at daytime (between 8 AM and 8 PM). Patients treated between 1 PM and midnight had a lower prevalence of anterior infarction and longer door-to-balloon time, whereas the shortest ischemic time and the largest use of stent were observed in patients treated between midnight and 4 AM Patients treated between 4 and 8 AM showed the worst outcome in terms of myocardial perfusion, enzymatic infarct size, and 1-year outcome, whereas patients treated between 8 AM and 4 PM had the best myocardial perfusion and lowest 1-year mortality rate. After correction for baseline confounding factors, the time of treatment (between 4 and 8 AM) was still significantly associated with 1-year mortality (relative risk 1.92, 95% CI 1.13-3.26, P = .016). CONCLUSIONS: This is the first study showing a significant relationship between the time of treatment, myocardial perfusion, and long-term mortality in patients with STEMI undergoing mechanical reperfusion.
Authors:
Giuseppe De Luca; Harry Suryapranata; Jan Paul Ottervanger; Arnoud W J van 't Hof; Jan C A Hoorntje; A T Marcel Gosselink; Jan-Henk E Dambrink; Felix Zijlstra; Menko-Jan de Boer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  150     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-12     Completed Date:  2006-02-14     Revised Date:  2007-08-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1185-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Zwolle, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty / mortality*
Circadian Rhythm / physiology*
Coronary Angiography
Electrocardiography
Female
Humans
Male
Middle Aged
Myocardial Infarction / mortality,  physiopathology*,  radiography,  surgery*
Retrospective Studies
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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