Korean Circ J.  2010 Dec;40(12):616-624. 10.4070/kcj.2010.40.12.616.

The Impact of Circadian Variation on 12-Month Mortality in Patients With Acute Myocardial Infarction

• Bae MH
• Ryu HM
• Lee JH
• Lee JH
• Kwon YS
• Lee SH
• Yang DH
• Park HS
• Cho Y
• Chae SC
• Jun JE
• Park WH

• KMID: 2225159
• DOI: http://doi.org/10.4070/kcj.2010.40.12.616

Abstract

BACKGROUND AND OBJECTIVES
Although circadian variation in the onset of acute myocardial infarction (AMI) has been reported in a number of studies, not much is known about the impact of circadian variation on 12-month mortality. The aim of this study was to investigate the impact of circadian variation on 12-month mortality in patients with AMI.
SUBJECTS AND METHODS
Eight hundred ninety two patients (mean age 67+/-12; 66.1% men) with AMI who visited Kyungpook National University Hospital from November 2005 to December 2007 were included in this study. Patients were divided into groups based on four 6-hours intervals: overnight (00:00-05:59); morning (06:00-11:59); afternoon (12:00-17:59) and evening (18:00-23:59).
RESULTS
Kaplan-Meier survival curves showed 12-month mortality rates of 9.6%, 9.1%, 12.1%, and 16.7% in the overnight, morning, afternoon, evening-onset groups, respectively (p=0.012). Compared with the morning-onset AMI group, the serum creatinine levels (p=0.002), frequency of Killip class > or =3 (p=0.004), and prescription rate of diuretics (p=0.011) were significantly higher in the evening-onset AMI group, while the left ventricular ejection fraction (p=0.012) was significantly lower. The proportion of patients who arrived in the emergency room during routine duty hours was significantly lower in evening-onset groups irrespective of the presence or absence of ST-segment elevation (p<0.001). According to univariate analysis, the 12-month mortality rate in the evening group was significantly higher compared to the morning group (hazard ratio 1.998, 95% confidence interval 1.196 to 3.338, p=0.008).
CONCLUSION
Patients with evening-onset AMI had poorer baseline clinical characteristics, and this might affect the circadian impact on 12-month mortality. Further studies are needed to clarify the role of circadian variation on the long-term outcome of AMI.

Keyword

Myocardial infarction; Circadian rhythm

MeSH Terms

Circadian Rhythm
Creatinine
Diuretics
Emergencies
Humans
Kaplan-Meier Estimate
Myocardial Infarction
Prescriptions
Stroke Volume
Creatinine
Diuretics

Figure

• 

  Fig. 1 The circadian variation of the onset of AMI for the total study population obtained at 2-hour intervals. The distribution is not uniform (p<0.001) and a peak occurring between 8:00 and 9:59 hours was statistically significant (p<0.001). AMI: acute myocardial infarction.

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  Fig. 2 The circadian variation of the onset of AMI for the total study population obtained at 6-hour intervals. A morning peak was statistically significant (p<0.001). In contrast, the 12-month mortality rate was significantly higher in the evening-onset AMI group (p=0.012). AMI: acute myocardial infarction.

• 

  Fig. 3 Kaplan-Meier survival curves for 12-month mortality according to onset time in patients with all AMI (A), STEMI (B), and NSTEMI (C). In patients with AMI and NSTEMI, 12-month mortality rates in the evening-onset groups were significantly higher than those in the morning-onset groups. AMI: acute myocardial infarction, STEMI: ST-segment elevation myocardial infarction, NSTEMI: non-STEMI.

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