Circadian rhythms in patients with ST-elevation myocardial infarction
David R Holmes1, Frank V Aguirre, Richard Aplin
1Mayo Clinic, Rochester, MN 55905, USA. holmes.david@mayo.edu
Circulation. Cardiovascular Quality and Outcomes
|June 24, 2010
Summary
Patients with ST-elevation myocardial infarction show circadian patterns in symptom onset. Those with onset from 12 AM to 5:59 AM experience longer delays in care, but this did not impact in-hospital death rates.
Area of Science:
- Cardiology
- Circadian Biology
- Public Health
Background:
- Circadian rhythms influence acute myocardial infarction symptom onset.
- Previous studies debated the impact of these rhythms on patient outcomes.
- This study focuses on ST-elevation myocardial infarction (STEMI) and circadian patterns.
Purpose of the Study:
- To evaluate circadian rhythms in STEMI patients.
- To assess the relationship between symptom onset time and patient outcomes.
- To analyze delays in prehospital care and reperfusion therapy.
Main Methods:
- Assessed 2143 STEMI patients from 2004-2008.
- Analyzed symptom onset relative to the 24-hour circadian cycle.
- Used multivariable modeling to control for confounding factors.
Main Results:
- STEMI symptom onset shows significant circadian variation, peaking between 8 AM and 3 PM.
- Patients with onset between 12 AM and 5:59 AM had longer prehospital delays (121 vs. 70 minutes).
- Door-to-balloon times were longer for early morning symptom onset (75 vs. 60 minutes).
Conclusions:
- STEMI patients exhibit circadian patterns in symptom onset, prehospital delay, and reperfusion timeliness.
- Early morning symptom onset is associated with increased care delays.
- Circadian patterns of symptom onset were not significantly associated with in-hospital death after adjustment.
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