Ischemic Burden in ST Elevation Myocardial Infarction and Circadian Rhythms

Circulation Research. 2013;113:e42,

Fournier S , Taffé P, Muller O

To the Editor:

We read the recent publication by Ammirati et al1 with interest. It analyzed a cohort of 1099 patients in Italy, Scotland, and China to confirm results of Suárez-Barrientos et al,2 Reiter et al,3 and our own study.4 The authors of these 3 recent publications showed statistically significant relationships between the time of symptom onset and the size of ST-segment–elevation myocardial infarction in terms of peak creatine kinase.

Both Reiter et al and our team found a higher vulnerability to ischemia in patients with symptom onset occurring at night (between midnight and 6:00 am). In their study, Ammirati et al concluded that they were unable to reproduce our results or draw similar conclusions. However, we feel that their methodology failed to adequately investigate the time-of-day effect on myocardial infarct size, and we have several comments.


  • Fournier S, Taffé P, Muller O. Ischemic burden in ST elevation myocardial infarction and circadian rhythms. Circ Res. 2013 Aug 2;113(4):e42. PMID: 23908335.