Circadian onset and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)

Abstract

Background Many acute cardiovascular events such as myocardial infarction (MI) follow circadian rhythms. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a newly noticed entity with limited data on onset pattern and its impact on prognosis. Material and methods In this observational study of Swedish MINOCA patients registered in the SWEDEHEART registry between 2003–2013 and followed until December 2013 we identified 9,092 unique patients with MINOCA out of 199,163 MI admissions in total. Incidence rate ratios (IRR) were calculated for whole hours, parts of the day, weekdays, months, seasons and major holidays. Results The mean age was 65.5 years, 62.0% were women and 16.6% presented with STEMI. The risk for MINOCA proved to be most common in the morning (IRR = 1.70, 95% CI [1.63–1.84]) with a peak at 08.00 AM (IRR = 2.25, 95% CI [1.96–2.59]) and on Mondays (IRR = 1.28, 95% CI [1.18–1.38]). No altered risk was detected during the different seasons, the Christmas and New Year holidays or the Swedish Midsummer festivities. There was no association between time of onset of MINOCA and short- or long-term prognosis. Conclusion The onset of MINOCA shows a circadian and circaseptan variation with increased risk at early mornings and Mondays, similar to previous studies on all MI, suggesting stress related triggering. However, during holidays were traditional MI increase, we did not see any increase for MINOCA. No association was detected between time of onset and prognosis, indicating that the underlying pathological mechanisms of MINOCA and the quality of care are similar at different times of onset but triggering mechanism may be more active early mornings and Mondays.

Worse long-term prognosis in myocardial infarction occurring at weekends or public holidays with insight into myocardial infarction with nonobstructive coronary arteries

“…Although MINOCA was less often diagnosed in NWD, it was not associated with higher long-term mortality. As has been shown in the SWEDEHEART registry, MINOCA occurred most frequently in the morning (incidence rate ratio [IRR] 1.70, 95% CI 1.63-1.84) and on Mondays (IRR 1.28, 95% CI 1.18-1.38) and also less often at the weekends [38]. Comparably to our study, the time of MINOCA occurrence did not affect the long-term prognosis [38].…”

“…As has been shown in the SWEDEHEART registry, MINOCA occurred most frequently in the morning (incidence rate ratio [IRR] 1.70, 95% CI 1.63-1.84) and on Mondays (IRR 1.28, 95% CI 1.18-1.38) and also less often at the weekends [38]. Comparably to our study, the time of MINOCA occurrence did not affect the long-term prognosis [38]. That circadian onset is probably associated with the pathophysiology of MINOCA [39].…”

Extreme weather conditions as a gender-specific risk factor for acute myocardial infarction

“…Some have considered binge alcohol consumption on weekends as a reason for increased cardiovascular deaths [26]. Others have found lower incidences of myocardial infarction with non-obstructive coronary arteries (MINOCA) on Saturdays and Sundays [27]. Kostis et al found no differences in the demographic characteristics of the population suffering from acute myocardial infarction between weekdays and weekends [28].…”

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

“…The seasonal variation of MINOCA and MI-CAD is different, and the incidence of MINOCA increases slightly in summer and autumn. MINOCA and MI-CAD are most common in the morning [18], and some studies have found that the onset time of MINOCA is not correlated with the prognosis of the disease [19].…”