Myocardial infarct size and mortality depend on the time of day-a large multicenter study

PLoS One. 2015 Mar 11;10(3):e0119157.
Fournier S, Taffé P, Radovanovic D, Von Elm E, Morawiec B, Stauffer JC, Erne P, Beggah A, Monney P, Pascale P, Iglesias JF, Eeckhout E, Muller O
 
BACKGROUND:
Different studies have shown circadian variation of ischemic burden among patients with ST-Elevation Myocardial Infarction (STEMI), but with controversial results. The aim of this study was to analyze circadian variation of myocardial infarction size and in-hospital mortality in a large multicenter registry.

METHODS:
This retrospective, registry-based study was based on data from AMIS Plus, a large multicenter Swiss registry of patients who suffered myocardial infarction between 1999 and 2013. Peak creatine kinase (CK) was used as a proxy measure for myocardial infarction size. Associations between peak CK, in-hospital mortality, and the time of day at symptom onset were modelled using polynomial-harmonic regression methods.

RESULTS:
6,223 STEMI patients were admitted to 82 acute-care hospitals in Switzerland and treated with primary angioplasty within six hours of symptom onset. Only the 24-hour harmonic was significantly associated with peak CK (p = 0.0001). The maximum average peak CK value (2,315 U/L) was for patients with symptom onset at 23:00, whereas the minimum average (2,017 U/L) was for onset at 11:00. The amplitude of variation was 298 U/L. In addition, no correlation was observed between ischemic time and circadian peak CK variation. Of the 6,223 patients, 223 (3.58%) died during index hospitalization. Remarkably, only the 24-hour harmonic was significantly associated with in-hospital mortality. The risk of death from STEMI was highest for patients with symptom onset at 00:00 and lowest for those with onset at 12:00.

DISCUSSION:
As a part of this first large study of STEMI patients treated with primary angioplasty in Swiss hospitals, investigations confirmed a circadian pattern to both peak CK and in-hospital mortality which were independent of total ischemic time. Accordingly, this study proposes that symptom onset time be incorporated as a prognosis factor in patients with myocardial infarction.

 

 

References

  • Fournier S1, Taffé P2, Radovanovic D3, Von Elm E2, Morawiec B1, Stauffer JC4, Erne P3, Beggah A1, Monney P1, Pascale P1, Iglesias JF1, Eeckhout E1, Muller O1. Myocardial infarct size and mortality depend on the time of day-a large multicenter study. PLoS One. 2015 Mar 11;10(3):e0119157. PMID: 25760988.