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Circadian Dependence of Infarct Size and Acute Heart Failure in ST Elevation Myocardial Infarction

Aruni Seneviratna1, Gek Hsiang Lim2, Anju Devi2

  • 1Cardiac Department, National University Heart Centre, National University Hospital, Singapore, Singapore.

Plos One
|June 4, 2015
PubMed

Insights

ST-elevation myocardial infarction (STEMI) infarct size and acute heart failure risk show a circadian pattern. Symptoms starting midnight to 6 AM are linked to larger infarcts and worse outcomes, while 6 AM to noon onset shows the opposite.

Area of Science:

  • Cardiology
  • Circadian Biology
  • Biomedical Science

Background:

  • Conflicting data exists on circadian influence on ST-elevation myocardial infarction (STEMI) infarct size.
  • The impact of circadian patterns on STEMI clinical outcomes remains largely unknown.

Purpose of the Study:

  • To investigate the circadian dependence of infarct size in STEMI.
  • To determine the impact of infarct size circadian patterns on clinical outcomes.

Main Methods:

  • A study of 6,710 STEMI patients hospitalized between 2006-2009.
  • Symptom onset categorized into four 6-hour intervals.
  • Peak creatine kinase used as a surrogate marker for infarct size.

Main Results:

  • Patients with symptom onset from midnight to 6 AM had the largest infarct size (peak creatine kinase) and highest risk of acute heart failure and mortality.
  • Patients with onset from 6 AM to noon showed the smallest infarct size and lowest risk.
  • Circadian variations in acute heart failure incidence remained significant after adjusting for key clinical factors.

Conclusions:

  • A circadian pattern in infarct size and acute heart failure incidence was observed in STEMI.
  • Onset from midnight to 6 AM is associated with peak infarct size and adverse outcomes.
  • Differences in diabetes, infarct location, and reperfusion therapy may partly explain these circadian variations.
Abstract

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