Circadian variations in the onset of acute ST-segment Elevation Myocardial Infarction (STEMI): Impact on survival - 06/01/20
Résumé |
Background |
ST-segment Elevation Myocardial Infarction (STEMI) onset depends on chronobiology with a known daily peak incidence period: 06:00 am-12.00 pm. The circadian rhythm's influence on STEMI prognosis is, however, still a matter of open research.
Aim |
Study of the survival of patients who presented a STEMI onset during peak incidence (06:00 am–12.00 pm).
Methods |
A total of 3040 patients presenting with STEMI and with known time of symptoms’ onset were prospectively enrolled in the RIMA registry (Registre des Infarctus en Maine Anjou) from January 2003 to December 2015. Patients were divided in four groups according to their STEMI onset time. Following their onset, in-hospital, 30-day and 1-year cardiovascular or all-cause mortalities were evaluated.
Results |
Eight hundred and ninety-two patients (29.3%) had their onset of symptoms between 06:00 am–12:00 pm, the peak incidence period of the day (P<0.001). Most of them were men (73%), older than the rest of the population (65.3±14.7 vs. 63.8±14.5, P=0.006). On admission, the delay between onset to first medical call was shorter (P<0.001) and systolic blood pressure was lower: 136.8±28.5mmHg. In-hospital cardiovascular mortality was higher: 202 (6.6%) versus 72 (8.1%) (P=0.040). Similar results were found at thirty days: Hazard Ratio (HR): 1.348, 95% CI [1.019–1.783] (P=0.037), but not at the one year follow-up: HR: 1.243, 95% CI [0.970–1.593] (P=0.09). Taking into account confounding variables, onset time of symptoms did not however remain a significant predictive factor of in-hospital or 30-day cardiovascular mortality (Fig. 1).
Conclusions |
Patients presenting with STEMI at the peak incidence period of the day (06:00 am–12:00 pm) may have a different early prognosis. Nevertheless, mortality is driven by the same correlates than the rest of the population. Future work will focus on identifying the patho-physiological processes that determine the peak incidence period and lead to over mortality.
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Vol 12 - N° 1
P. 11-12 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.