Impact of Morning Onset on the Incidence of Recurrent Acute Coronary Syndrome and Progression of Coronary Atherosclerosis in Acute Myocardial Infarction

Abstract

Background:The relationship between time of onset of acute myocardial infarction (MI) and long-term clinical outcome has not been completely understood. We hypothesized that morning onset acute MI may be associated with adverse cardiac events. Methods and Results:This study involved 663 patients who underwent primary percutaneous coronary intervention (PCI). The main outcome measures were cardiac death, recurrent acute coronary syndrome (ACS), and re-hospitalization for heart failure. Major adverse cardiac events (MACE) were defined as a composite of individual adverse outcomes. Morning onset acute MI occurred in 212 patients (32.0%); they had higher rates of recurrent ACS (13% vs. 8%, P=0.03) and MACE (21% vs. 14%, P=0.012) than the patients with other times of onset. The PCI rate for progressive lesions was also higher than for patients with other times of onset (23% vs. 14%, P=0.013). On multivariate Cox regression analysis, morning onset was an independent predictor of recurrent ACS, MACE, and PCI for progressive lesions, with adjusted hazard ratios of 1.34 (95% CI: 1.06-2.92, P=0.030), 1.51 (95% CI: 1.02-2.23, P=0.038), and 1.58 (95% CI: 1.03-2.42, P=0.037), respectively. Conclusions:Morning onset may be associated with increased risk of recurrent ACS and coronary atherosclerosis progression.

Time-of-day at symptom onset was not associated with infarct size and long-term prognosis in patients with ST-segment elevation myocardial infarction

“…In our study, most STEMI cases occurred between 6 and 12 h. This is in line with previous findings on MI occurrence [3, 32, 33] and may be explained by the fact that plaque rupture/erosion leading to coronary occlusion is more likely during morning hours due to increased hemodynamic stress (surge in heart rate and blood pressure), thrombotic activity, i.e., platelet aggregability, and recruitment of inflammatory leukocyte from blood to plaque during this time-of-day [34–36]. Regarding leukocyte recruitment, it was recently shown in mice that the sympathetic activity increases during the active phase which raises levels of endothelial cell adhesion molecules (ICAM-1, VCAM-1, P-, and E-selectin) facilitating leukocyte recruitment to peripheral tissues (bone marrow and cremaster muscle) [36, 37].…”

Abacavir use and risk of recurrent myocardial infarction

“…Firstly, recurrent MIs in those with an index MI are more likely to reflect the uptake and success of post-MI interventions to manage CVD and prevent subsequent cardiovascular events in this group than differences in established risk factors for a primary MI. Our finding that few of the established CVD risk factors are associated with recurrent MI, other than diabetes, supports the existence of a different set of risk factors for recurrent MI, a notion which is consistent with the limited literature from the general population [13][14][15]. Secondly, one of the reasons for the continued debate about the potential association between ABC and MI is that there is no confirmed biological mechanism for the association.…”

Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost‐effectiveness analysis

“…Since the risk score defines CVD as a composite of coronary intervention, MI, stroke (ischaemic or haemorrhagic) or other cardiovascular death, we apportioned the calculated risk into individual event types based on the proportions reported in Friis-Moller et al [24] Each individuals risk of non-CVD death was estimated by subtracting their calculated risk of CVD death from their age, sex and CD4 count specific risk of all-cause mortality [33]. Recurrent event probabilities (for example, the probability of a second MI or the probability of an MI after a prior ischaemic stroke) were mainly based on published estimates for the general population in high-income countries due to a lack of HIV-specific data or data from low-and middle-income countries; we did not use the D:A:D CVD risk score or a HIVspecific hazard ratio as current evidence suggests that risk factors for primary CVD differ substantially from those of recurrent CVD [34,[59][60][61]. Individuals accumulated costs and benefits up until their death or the time horizon, whichever came first.…”