Document Detail

Circadian variations of onset of acute myocardial infarction and efficacy of thrombolytic therapy.
MedLine Citation:
PMID:  8613602     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The present study investigated whether the onset of acute myocardial infarction and resistance to thrombolysis have similar circadian variations. BACKGROUND: Circadian variations of the onset of acute myocardial infarction and resistance to thrombolysis in the early morning have been reported. Some studies have also reported a secondary peak incidence in late evening; however, it is not known whether the resistance to thrombolysis has a similar circadian variation in these patients. METHODS: Six hundred eight Japanese patients with an acute myocardial infarction were the subjects of the study. Two hundred forty-four of the 608 patients were treated with thrombolysis within 12 h of the onset of symptoms. One hundred thirteen patients received urokinase, and 131 patients received tissue-type plasminogen activator (t-PA) over 60 min. Patency of the infarct-related artery, the primary end point of the study, was evaluated at 60 min after the initiation of thrombolytic therapy, and Thrombolysis in Myocardial Infarction (TIMI) grade 0, 1 or 2 was defined as resistant to thrombolysis. RESULTS: The onset of acute myocardial infarction and resistance to thrombolysis showed circadian variations with early morning and late evening peaks (p<0.001 and p<0.05, respectively). These circadian patterns showed similar distributions as evaluated with Spearman's method (r=0.70, p<0.05), although resistance to thrombolysis showed a phase difference of about 2 h earlier than the infarction incidence. The circadian variation of the resistance to thrombolysis was independent of the types of thrombolytic agents (urokinase or t-PA). CONCLUSIONS: These findings suggest that adjustment of treatment based on the time of the onset of symptoms may be warranted for the patients with acute myocardial infarction.
T Kono; H Morita; T Nishina; M Fujita; Y Hirota; K Kawamura; A Fujiwara
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  27     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1996 Mar 
Date Detail:
Created Date:  1996-06-03     Completed Date:  1996-06-03     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  774-8     Citation Subset:  AIM; IM    
Osaka Mishima Critical Care Medical Center, Osaka Medical College, Takatsuki, Japan.
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MeSH Terms
Circadian Rhythm*
Cohort Studies
Drug Resistance
Middle Aged
Myocardial Infarction / drug therapy,  physiopathology*
Plasminogen Activators / therapeutic use
Retrospective Studies
Thrombolytic Therapy*
Time Factors
Tissue Plasminogen Activator / therapeutic use
Urokinase-Type Plasminogen Activator / therapeutic use
Reg. No./Substance:
EC 3.4.21.-/Plasminogen Activators; EC Plasminogen Activator; EC Plasminogen Activator

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