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Myocardial infarct size and mortality depend on the time of day-a large multicenter study.

Fournier S, Taffé P, Radovanovic D, Von Elm E, Morawiec B, Stauffer JC, Erne P, Beggah A, Monney P, Pascale P, Iglesias JF, Eeckhout E, Muller O - PLoS ONE (2015)

Bottom Line: Different studies have shown circadian variation of ischemic burden among patients with ST-Elevation Myocardial Infarction (STEMI), but with controversial results.Only the 24-hour harmonic was significantly associated with peak CK (p = 0.0001).Remarkably, only the 24-hour harmonic was significantly associated with in-hospital mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland.

ABSTRACT

Background: Different studies have shown circadian variation of ischemic burden among patients with ST-Elevation Myocardial Infarction (STEMI), but with controversial results. The aim of this study was to analyze circadian variation of myocardial infarction size and in-hospital mortality in a large multicenter registry.

Methods: This retrospective, registry-based study was based on data from AMIS Plus, a large multicenter Swiss registry of patients who suffered myocardial infarction between 1999 and 2013. Peak creatine kinase (CK) was used as a proxy measure for myocardial infarction size. Associations between peak CK, in-hospital mortality, and the time of day at symptom onset were modelled using polynomial-harmonic regression methods.

Results: 6,223 STEMI patients were admitted to 82 acute-care hospitals in Switzerland and treated with primary angioplasty within six hours of symptom onset. Only the 24-hour harmonic was significantly associated with peak CK (p = 0.0001). The maximum average peak CK value (2,315 U/L) was for patients with symptom onset at 23:00, whereas the minimum average (2,017 U/L) was for onset at 11:00. The amplitude of variation was 298 U/L. In addition, no correlation was observed between ischemic time and circadian peak CK variation. Of the 6,223 patients, 223 (3.58%) died during index hospitalization. Remarkably, only the 24-hour harmonic was significantly associated with in-hospital mortality. The risk of death from STEMI was highest for patients with symptom onset at 00:00 and lowest for those with onset at 12:00.

Discussion: As a part of this first large study of STEMI patients treated with primary angioplasty in Swiss hospitals, investigations confirmed a circadian pattern to both peak CK and in-hospital mortality which were independent of total ischemic time. Accordingly, this study proposes that symptom onset time be incorporated as a prognosis factor in patients with myocardial infarction.

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Mentions: For the purpose of this analysis, we selected patients who: (i) had experienced an acute (<12 hours) STEMI between January 1997 and May 2013; (ii) had undergone primary PCI; (iii) had a known time of symptom onset and peak CK values; and (iv) a symptom-to-needle time of less than 6 hours (Fig. 1). Furthermore, patients with peak CK > 10,000 were excluded because exceedingly high values are likely due to causes other than STEMI, such as rhabdomyolysis.


Myocardial infarct size and mortality depend on the time of day-a large multicenter study.

Fournier S, Taffé P, Radovanovic D, Von Elm E, Morawiec B, Stauffer JC, Erne P, Beggah A, Monney P, Pascale P, Iglesias JF, Eeckhout E, Muller O - PLoS ONE (2015)

Study flow chart.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356554&req=5

pone.0119157.g001: Study flow chart.
Mentions: For the purpose of this analysis, we selected patients who: (i) had experienced an acute (<12 hours) STEMI between January 1997 and May 2013; (ii) had undergone primary PCI; (iii) had a known time of symptom onset and peak CK values; and (iv) a symptom-to-needle time of less than 6 hours (Fig. 1). Furthermore, patients with peak CK > 10,000 were excluded because exceedingly high values are likely due to causes other than STEMI, such as rhabdomyolysis.

Bottom Line: Different studies have shown circadian variation of ischemic burden among patients with ST-Elevation Myocardial Infarction (STEMI), but with controversial results.Only the 24-hour harmonic was significantly associated with peak CK (p = 0.0001).Remarkably, only the 24-hour harmonic was significantly associated with in-hospital mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland.

ABSTRACT

Background: Different studies have shown circadian variation of ischemic burden among patients with ST-Elevation Myocardial Infarction (STEMI), but with controversial results. The aim of this study was to analyze circadian variation of myocardial infarction size and in-hospital mortality in a large multicenter registry.

Methods: This retrospective, registry-based study was based on data from AMIS Plus, a large multicenter Swiss registry of patients who suffered myocardial infarction between 1999 and 2013. Peak creatine kinase (CK) was used as a proxy measure for myocardial infarction size. Associations between peak CK, in-hospital mortality, and the time of day at symptom onset were modelled using polynomial-harmonic regression methods.

Results: 6,223 STEMI patients were admitted to 82 acute-care hospitals in Switzerland and treated with primary angioplasty within six hours of symptom onset. Only the 24-hour harmonic was significantly associated with peak CK (p = 0.0001). The maximum average peak CK value (2,315 U/L) was for patients with symptom onset at 23:00, whereas the minimum average (2,017 U/L) was for onset at 11:00. The amplitude of variation was 298 U/L. In addition, no correlation was observed between ischemic time and circadian peak CK variation. Of the 6,223 patients, 223 (3.58%) died during index hospitalization. Remarkably, only the 24-hour harmonic was significantly associated with in-hospital mortality. The risk of death from STEMI was highest for patients with symptom onset at 00:00 and lowest for those with onset at 12:00.

Discussion: As a part of this first large study of STEMI patients treated with primary angioplasty in Swiss hospitals, investigations confirmed a circadian pattern to both peak CK and in-hospital mortality which were independent of total ischemic time. Accordingly, this study proposes that symptom onset time be incorporated as a prognosis factor in patients with myocardial infarction.

Show MeSH
Related in: MedlinePlus