Circadian rhythm pattern of symptom onset in patients with ST-segment elevation myocardial infarction in the Chinese
Yibo Guo1,2,3, Lina Cui1,2,3, Lulu Li1,2,3
1Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.
Insights
ST-segment elevation myocardial infarction (STEMI) in China shows a bimodal onset pattern, with a primary morning peak and a secondary afternoon peak. The timing of STEMI onset did not affect patient outcomes.
Area of Science:
- Cardiology
- Circadian Biology
- Epidemiology
Background:
- Cardiovascular diseases (CVD) incidence often peaks in the morning.
- Understanding the precise timing of ST-segment elevation myocardial infarction (STEMI) onset is crucial for patient management.
- Previous research indicates a general morning peak for cardiovascular events.
Purpose of the Study:
- To determine the specific circadian distribution pattern of STEMI onset in the Chinese population.
- To investigate the association between STEMI symptom onset time and major adverse cardiovascular and cerebrovascular events (MACCE) after discharge.
Main Methods:
- Analysis of symptom onset times from 7,805 STEMI patients in a prospective Chinese cohort.
- Statistical analysis of circadian rhythms in STEMI onset, including subgroup analysis by demographics and risk factors.
- Stratification of patients into four groups based on STEMI onset time to assess prognosis.
Main Results:
- STEMI onset exhibited a significant bimodal circadian rhythm, with a primary peak at 8:38 AM and a secondary peak at 12:55 PM.
- This bimodal pattern was consistent across various subgroups, including day of the week, age, sex, and coronary risk factors.
- STEMI onset peaks occurred later on Sundays, with a clearer secondary peak observed.
Conclusions:
- The Chinese population displays a distinct bimodal circadian rhythm for STEMI onset, characterized by a pronounced morning peak and a less distinct afternoon peak.
- Clinical outcomes at one year were not significantly associated with the timing of STEMI symptom onset.
Background:
The peak incidence of cardiovascular diseases (CVD) usually occurs in the morning. This study aimed to investigate the exact distribution pattern of peak incidence of ST-segment elevation myocardial infarction (STEMI) in the Chinese population, and to explore whether it is associated with the prognosis.
Methods:
This study included 7,805 patients with STEMI from the multicenter, prospective AMI cohort in China, for whom had a definite time of symptom onset. In the overall population and the predefined subgroup populations, the circadian rhythms of STEMI onset were statistically analyzed. Then patients were divided into four groups based on the time of onset (6 h interval) to assess the association of symptom onset time and major adverse cardiovascular and cerebrovascular events (MACCE) after discharge.
Results:
The onset of STEMI had a bimodal distribution: a well-defined primary peak at 8:38 AM [95% confidence interval (CI): 7:49 to 9:28 AM], and a less well-defined secondary peak at 12:55 PM (95% CI: 7:39 AM to 18:10 PM) (bimodal: P < 0.001). A similar bimodal circadian rhythm pattern was observed in subgroups of patients with STEMI defined with respect to day of the week, age, sex, and coronary risk factors. Notedly, the two peaks on Sunday were significantly later than other days, and the secondary peaks became clear and concentrated. In addition, no significant difference was found in MACCE among the four groups (P = 0.905).
Conclusions:
In the Chinese population, the onset of STEMI exhibited a bimodal circadian rhythm pattern, with a clear primary peak and a less clear secondary peak. One-year clinical outcomes were unrelated to the timing of STEMI onset.
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