Acute myocardial infarction in Fukushima area of Japan

Area of Science:

• Cardiology
• Circadian Rhythms
• Public Health

Background:

• Acute myocardial infarction (AMI) remains a leading cause of death, with onset and mortality factors not fully elucidated, particularly in Japan.
• Understanding temporal patterns and treatment efficacy is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the temporal patterns of AMI onset.
• To evaluate the in-hospital mortality rates associated with different reperfusion therapies for AMI.
• To identify factors influencing in-hospital mortality in AMI patients.

Main Methods:

• A prospective study involving 1,590 AMI patients from June 1999 to May 2005 in the Fukushima area, Japan.
• Analysis of AMI onset times, categorizing patients into four reperfusion therapy groups: no therapy, thrombolysis alone, PCI alone, and PCI with thrombolysis.
• Logistic regression analysis to determine predictors of in-hospital mortality.

Main Results:

• AMI onset exhibited two distinct peaks: 9:00 AM–10:00 AM and 9:00 PM–10:00 PM, suggesting a link to human biorhythms.
• Percutaneous coronary intervention (PCI) alone significantly reduced in-hospital mortality (8.4%) compared to no reperfusion therapy (33.0%) and thrombolysis alone (18.8%).
• No significant difference in mortality was observed between PCI alone and PCI with thrombolysis (9.9%). Age, peak creatine kinase, hypertension, and diabetes mellitus were significant predictors of mortality.

Conclusions:

• The diurnal variation in AMI onset suggests a potential influence of circadian rhythms.
• Percutaneous coronary intervention (PCI) is a highly effective reperfusion strategy for reducing in-hospital mortality in AMI patients.
• Further research into the role of biorhythms and optimization of reperfusion strategies is warranted.