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

Abstract

Background ST-segment elevation myocardial infarction (STEMI) displays circadian variability with the highest incidence in the morning hours. Data on whether the time-of-day at symptom onset affects infarct size or patients’ long-term prognosis are conflicting. We sought to investigate the association of time-of-day at symptom onset with infarct size or long-term mortality in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods This study included 1206 STEMI patients undergoing PPCI. All patients underwent single photon emission computed tomography (SPECT) imaging with 99mTc-sestamibi before and 7–14 days after PPCI. The co-primary endpoints were final infarct size on day 10 after STEMI and all-cause mortality at 5-year follow-up. Time-of-day at symptom onset of STEMI was categorized in 6-h intervals. Results In patients presenting from 0 to 6 h, 6 to 12 h, 12 to 18 h, and 18 to 24 h, the infarct sizes (median [25th–75th percentiles]) were 10.0 [3.0–24.7], 10.0 [3.0–24.0], 10.0 [3.0–22.0], and 9.0 [3.0–21.0] of the left ventricle, respectively (p = 0.87); the Kaplan–Meier estimates of 5-year all-cause mortality were 13.6%, 8.7%, 13.7% and 9.3%, respectively (log-rank test p = 0.30). After adjustment, time-of-day was not associated with infarct size (p ≥ 0.76 for comparisons with infarct size from reference [6–12 h] time interval) or 5-year all-cause mortality (p ≥ 0.25 for comparisons with mortality from reference [6–12 h] time interval). Time-of-day at symptom onset of STEMI was not associated with differences in the recovery of left ventricular ejection fraction 6 months after STEMI. Conclusions In patients with STEMI undergoing PPCI, time-of-day at symptom onset was neither associated with scintigraphic infarct size, left ventricular ejection fraction recovery at 6 months nor with 5-year mortality. Electronic supplementary material The online version of this article (10.1186/s12967-019-1934-z) contains supplementary material, which is available to authorized users.

Association between the time of day at stroke onset and functional outcome of acute ischemic stroke patients treated with endovascular therapy

“…15 Moreover, hemodynamic stress (i.e., alterations in blood pressure) and increased sympathetic activity in the morning may also contribute to the higher risk for stroke by inducing plaque rupture. 2,16,17 Among this study population, we also found that stroke onset during 00:00 to 06:00 and 06:00 to 12:00 was associated with higher proportion of favorable outcomes at 3 months. One of the factors that may contribute to this result is the circadian variation in the penumbra area.…”

“…15 Moreover, hemodynamic stress (i.e., alterations in blood pressure) and increased sympathetic activity in the morning may also contribute to the higher risk for stroke by inducing plaque rupture. 2,16,17…”

Size of Acute Myocardial Infarction Correlates with Earlier Time of Initiation of Reperfusion Therapy with Cardiac Perfusion Scintigraphy: A National Single-Center Study

“…Similar results were obtained by Tödt et al [ 15 ], who found a correlation between FMC and myocardial injury in STEMI patients treated with pPCI [ 15 ]. Furthermore, studies of infarct size, left ventricular function, and prognosis in women compared to men did not show significant differences [ 16 ], and the time of day of symptom onset was also not a significant variable [ 17 ]. On the contrary, we found that males were almost 13 times more likely to have a larger infarct site then females.…”

Contemporary Impact of circadian symptom-onset patterns of acute ST-Segment elevation myocardial infarction on long-term outcomes after primary percutaneous coronary intervention

“…Most previous studies have analysed short-term in-hospital, 30-day or 1-year mortality. Recently, Sager and colleagues [ 14 ] reported that time-of-day at symptom onset was neither associated with infarct size nor with 5-year mortality in patients with STEMI undergoing PPCI. However, in their study, STEMI patients enrolled between 2002 and 2007 were not be the most contemporary STEMI cohort with respect to stent technology and anti-platelet therapy; and only 37% patients finished 5-year follow-up.…”