Circadian variation in ST-segment elevation myocardial infarction: a nationwide analysis of onset, treatment delays,
Artur Dziewierz1,2, Krzysztof Malinowski3,4, Natalia Dardzińska5
1Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
Insights
ST-segment elevation myocardial infarction (STEMI) onset follows a daily pattern, peaking in the morning. Nocturnal STEMI onset leads to significant treatment delays, with distinct circadian patterns observed for left anterior descending versus right coronary artery involvement.
Area of Science:
- Cardiology
- Circadian Biology
- Public Health
Background:
- ST-segment elevation myocardial infarction (STEMI) onset exhibits circadian variation.
- Limited data exist on how STEMI onset time impacts treatment delays and coronary pathology in large contemporary registries.
Purpose of the Study:
- To investigate the circadian patterns of STEMI onset.
- To assess the influence of onset time on treatment delays, culprit vessel involvement, and mortality.
Main Methods:
- Retrospective analysis of 153,543 STEMI patients from the Polish National PCI Registry (2014-2022).
- Examination of hourly symptom onset distribution and its association with patient characteristics, treatment delays, and infarct-related artery location.
Main Results:
- STEMI onset peaked at 8:00 AM, with earlier onset in males. Nocturnal onset (3:00 AM) was linked to doubled pain-to-first-medical-contact times compared to daytime onset (1:00 PM).
- Opposing circadian rhythms were found for infarct-related artery location: Left Anterior Descending (LAD) artery involvement peaked nocturnally, while Right Coronary Artery (RCA) involvement peaked during the day.
- Periprocedural mortality did not significantly differ based on STEMI onset time despite treatment delays.
Conclusions:
- STEMI onset demonstrates a strong circadian pattern influencing system delays.
- The time of day impacts STEMI triggering and its pathophysiological manifestation, as evidenced by opposing circadian rhythms in LAD versus RCA involvement.
Introduction:
ST‑segment elevation myocardial infarction (STEMI) onset follows a circadian rhythm, yet data from large contemporary national registries remain limited, particularly regarding how the onset time influences treatment delays and coronary pathology.
Objectives:
We aimed to examine circadian patterns of STEMI onset and their impact on treatment delays, culprit vessel involvement, and periprocedural mortality.
Patients And Methods:
We retrospectively analyzed 153 543 STEMI patients from the Polish National Percutaneous Intervention Registry hospitalized between 2014 and 2022. We examined the hourly distribution of symptom onset and its associations with patient characteristics, treatment delays, and infarct‑related artery location.
Results:
STEMI onset showed pronounced circadian variation, peaking at 8:00 AM. Although the overall pattern was similar between sexes (P for interaction = 0.15), median onset time occurred earlier in men than women (10:00 AM vs 11:00 AM; P = 0.007). Nocturnal onset (eg, 3:00 AM) was associated with substantially longer median pain‑to‑first‑medical‑contact times than daytime onset (180 vs 90 min at 1:00 PM; P <0.001). We identified a novel opposing circadian rhythm for the infarct‑related artery location-the left anterior descending (LAD) artery seemed to be the main culprit during nocturnal hours with a nadir at noon, while the right coronary artery (RCA) involvement demonstrated an inverse pattern (P <0.001). Despite delayed presentation, periprocedural mortality did not vary significantly by onset time.
Conclusions:
This large nationwide cohort demonstrates that STEMI onset follows a robust circadian pattern significantly affecting system delays. The discovery of opposing circadian rhythms for LAD and RCA involvement suggests that time of day influences not only STEMI triggering but also its pathophysiological manifestation.
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