Circadian variations of onset of acute myocardial infarction and efficacy of thrombolytic therapy

Abstract

These findings suggest that adjustment of treatment based on the time of the onset of symptoms may be warranted for the patients with acute myocardial infarction.

Chronobiological Patterns of Acute Aortic Dissection

“…This finding is similar to many prior studies that have reported circadian variability of other cardiovascular conditions. [1][2][3][4][5][6][7][8][9][10][11][12] We also demonstrate that the peak incidence of this adverse cardiovascular event occurs during early morning, when people awaken and begin normal activities, identical to the timing of onset of other adverse cardiovascular events. 4,12 This similarity suggests that common underlying pathophysiological mechanisms may be responsible for the triggering of these cardiovascular events, including aortic dissection.…”

“…The cardiovascular conditions shown to be associated with such rhythmic variations include acute myocardial infarction, [1][2][3][4][5] sudden death, 6 supraventricular tachycardia, 7 stable angina, 8 silent ischemia, 9 cerebrovascular accidents, 10 subarachnoid hemorrhage, 11 and spontaneous rupture of abdominal aortic aneurysm. 12 An increased incidence of these events has been shown to occur early in the morning within the first 3 hours of waking up, 1,2,4 in winter, 3 and on Monday mornings. 4,5 However, the influence of the time of day, the day of the week, and the seasonal or monthly changes on the onset of acute aortic dissection (AAD) has not been well studied in a large cohort of patients.…”

The impact of time and day on the presentation of acute coronary syndromes

“…18 The mechanisms underlying the increase in STEMI, which is more often associated with an occlusive, fibrin-rich thrombus than NSTEMI and UA, may also underpin the resistance to thrombolytic therapy that has been observed in the early morning and late evening hours. 19 Morning and evening peaks of ischemia in patients with UA and with vasospasm and nonsignificant CAD have been described, 20 suggesting that differences in coronary vasospasm may play a role in the nighttime increase in STEMI. While the morning peak of AMI has been attributed to many of these factors, their interaction may also predispose to increased UA in the morning and increased AMI and STEMI at night.…”

Circadian Variation of the Onset of Acute Myocardial Infarction in the Osaka Area, 1998-1999

“…[7][8][9][10] Analysis of this circadian variations is important to clarify the triggering mechanisms of AMI.…”

“…[7][8][9][10] Analysis of this circadian variations is important to clarify the triggering mechanisms of AMI.Although the precise underlying mechanisms of the circadian variation of AMI are still unclear, the morning peak appears to be associated with surges of blood pressure, 11-13 neurohumoral factors 14,15 and platelet aggregability; [16][17][18] that is, it appears to be associated with an inherent biologic rhythm. However, the second peak in the evening is more associated with socioeconomic factors, such as the timing of the evening meal, 19 mental stress 20-22 and overtime work, 23 but it is unclear which population is more susceptible to the morning surge or to the nighttime socioeconomic factors.…”