Circadian variation of acute st segment elevation myocardial infarction by anatomic location in a Turkish cohort

Abstract

SummaryBackgroundTo evaluate the relationship between site of infarction (anterior vs. inferior) and circadian variation in patients with ST segment elevation myocardial infarction (STEMI) in a Turkish cohort.Material/MethodsThis restrospective study enrolled 465 patients (407 male, mean age 65±7 years) with STEMI. Patients were then categorised into 4 6-hour increments according to the time of day during which the symptoms began (12:00 AM–06:00 AM, 06:00 AM–12:00 PM; 12:00 PM–06:00 PM and 06:00 PM–12:00 AM hours). Characteristics of patients by site of infarction (anterior vs. inferior) were compared.ResultsThe frequency of onset of acute anterior MI as determined by onset of pain demonstrated significant circadian variation among the 4 time periods, demonstrating bimodal peaks (afternoon and morning) and a trough between 06:00 PM to 06:00 AM. The incidence of occurrence of MI between 06:00 AM to 06:00 PM was 4.50 times that of the average frequency of the remaining 12 hours of the day. The frequency of onset of acute inferior MI as determined by onset of pain exhibited significant circadian variation among the 4 time periods, demonstrating bimodal peaks (midnight to 06:00 AM and 06:00 AM to noon) and a trough between noon to midnight. The incidence of occurrence of MI between midnight to noon was 4.25 times that of the average frequency of the remaining 12 hours of the day.ConclusionsDifferent circadian periodicity in the time of onset of STEMI was found regarding infarction site in a Turkish cohort. This may be related to genetic and/or demographic characteristics of the Turkish population.

Circadian Variations and Associated Factors in Patients with Ischaemic Heart Disease

“…It is well known that anterior infarction is related to the severity of left coronary artery involvement, and it was in the morning when we observed more cases of anterior AMI. Furthermore, the onset of pain at night was associated with the subendocardial location of the infarction as opposed to an anterior location [ 38 ]. Our results are consistent with those of Moruzzi et al (2004), who showed that regarding the incidence of myocardial infarction, the time of onset from 6 am to noon (12 am) was associated with an increased risk of anterior infarction, suggesting the protective role of sleep [ 39 ].…”

Response to Relation Between Time of Symptom Onset of ST‐Segment Elevation Myocardial Infarction and Patient Baseline Characteristics: From the National Cardiovascular Data Registry

“…Additionally, circadian variation at the time of onset of chest pain in patients with STEMI may be different regarding infarction site in different population cohorts. 13,14 Circadian variation of STEMI might not be equally effective throughout the world. Ethnic disparities may be partly responsible for cardiovascular risk prevalence and outcomes of STEMI.…”

Free-Living Humans Cross Cardiovascular Disease Risk Categories Due to Daily Rhythms in Cholesterol and Triglycerides

“…Indeed, accounting for short-timescale variability has improved the ability to anticipate cardiovascular events. For example, accounting for diurnal variability in blood pressure has allowed clinicians to determine that the absence of a nightly dip indicates elevated cardiovascular risk [71113141516], and that individuals are more likely to experience chest pain [17] or heart attack [18] in the morning hours. Other risk factors, like blood glucose, vary significantly by time of day (e.g., Dawn phenomenon, ultradian glucose pulsatility), and current research aims to use knowledge of this variability to personalize clinical recommendations [19202122232425].…”