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Dehghani M, Cheragi M, Delfan B, Dehghani M, Shakarami A, Bagheri Y, Namdari P, Namdari M. Difference of cardiac rehabilitation in the morning or evening on indexes of left ventricular and N-terminal pro-brain natriuretic peptide: a randomized controlled trial. Ann Med Surg (Lond) 2023; 85:3482-3490. [PMID: 37427217 PMCID: PMC10328671 DOI: 10.1097/ms9.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/22/2023] [Indexed: 07/11/2023] Open
Abstract
The present study aimed to evaluate the effects a cardiac rehabilitation program (CRP) performed in the morning or evening on left ventricular (LV) filling indices and the level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in patients undergoing percutaneous coronary angioplasty during the COVID-19 pandemic. Methods This was a randomized controlled single-blinded clinical trial. Ninety-six patients (mean age: 50.2 ± 8.1 years, 36 women and 44 men) with percutaneous coronary angioplasty were divided into two groups of intervention and control. In each group, the CRP was performed in either morning or evening. The CRP included walking and performing push-ups and sit-ups for 8 weeks. The participants of the control groups received routine care. The functional indices of LV, including LV ejection fraction, systolic function, and diastolic function (i.e. the transmitral flow), the E/e' to left atrium peak strain ratio (as an estimation for LA stiffness), and NT-proBNP level were measured in all participants before starting and at the end of the CRP. Results In the intervention group, the individuals performing the CRP in the evening had significantly higher E-wave (0.76±0.02 vs. 0.75±0.03; P=0.008), ejection fraction (52.5±5.64 vs. 55.5±3.59; P=0.011), and diastolic function velocity (E/A ratio, 1.03±0.06 vs. 1.05±0.03; P=0.014) and significantly lower A-wave (0.72±0.02 vs. 0.71±0.01; P=0.041), E/e' ratio (6.74±0.29 vs. 6.51±0.38; P=0.038), and NT-proBNP level (2007.9±214.24 vs. 1933.9±253.13; P=0.045) compared with those performing the program in the morning. Conclusions A supervised CRP performed in the evening compared with morning was more effective in improving LV functional indices. Therefore, such home-based interventions are recommended to be performed in the evening during the COVID-19 pandemic.
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Affiliation(s)
- Mostafa Dehghani
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
| | - Mostafa Cheragi
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
| | - Bahram Delfan
- Department of Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad
| | | | - Amir Shakarami
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
| | - Yagoob Bagheri
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
| | - Parsa Namdari
- Department of University of Debrecen, Debrecen, Faculty of Medicine, Hungary
| | - Mehrdad Namdari
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
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Daios S, Savopoulos C, Kanellos I, Goudis CA, Nakou I, Petalloti S, Hadjidimitriou N, Pilalas D, Ziakas A, Kaiafa G. Circadian Pattern of Acute Myocardial Infarction and Atrial Fibrillation in a Mediterranean Country: A study in Diabetic Patients. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57010041. [PMID: 33418926 PMCID: PMC7825022 DOI: 10.3390/medicina57010041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 05/13/2023]
Abstract
Background and objectives: The circadian pattern seems to play a crucial role in cardiovascular events and arrhythmias. Diabetes mellitus is a complex metabolic disorder associated with autonomic nervous system alterations and increased risk of microvascular and macrovascular disease. We sought to determine whether acute myocardial infarction (AMI) and atrial fibrillation (AF) follow a circadian pattern in diabetic patients in a Mediterranean country. Materials and Methods: This retrospective study included 178 diabetic patients (mean age: 67.7) with AMI or AF who were admitted to the coronary care unit. The circadian pattern of AMI and AF was identified in the 24-h period (divided in 3-h and 1-h intervals). Patients were also divided in 3 groups according to age; 40-65 years, 66-79 years and patients older than 80 years. A chi-square goodness-of-fit test was used for the statistical analysis. Results: AMI seems to occur more often in the midnight hours (21:00-23:59) (p < 0.001). Regarding age distribution, patients between 40 and 65 years were more likely to experience an AMI compared to other age groups (p < 0.001). Autonomic alterations, working habits, and social reasons might contribute to this phenomenon. AF in diabetic patients occurs more frequently at noon (12:00-14:59) (p = 0.019). Conclusions: Diabetic patients with AMI and AF seem to follow a specific circadian pattern in a Mediterranean country, with AMI occurring most often at midnight hours and AF mostly at noon. Autonomic dysfunction, glycemic fluctuations, intense anti-diabetic treatment before lunch, and patterns of insulin secretion and resistance may explain this pattern. More studies are needed to elucidate the circadian pattern of AMI and AF in diabetic patients to contribute to the development of new therapeutic approaches in this setting.
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Affiliation(s)
- Stylianos Daios
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
- Cardiology Department, Serres General Hospital, 62120 Serres, Greece; (C.A.G.); (I.N.)
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
- Correspondence: ; Tel.: +30-2310994783; Fax: +30-2310285128
| | - Ilias Kanellos
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
| | | | - Ifigeneia Nakou
- Cardiology Department, Serres General Hospital, 62120 Serres, Greece; (C.A.G.); (I.N.)
| | - Stergiani Petalloti
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
- Cardiology Department, Serres General Hospital, 62120 Serres, Greece; (C.A.G.); (I.N.)
| | - Nicolas Hadjidimitriou
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
| | - Antonios Ziakas
- First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece;
| | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi Street, 54636 Thessaloniki, Greece; (S.D.); (I.K.); (S.P.); (N.H.); (D.P.); (G.K.)
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Masiewicz S, Gutovitz S, Hart L, Leaman SM, Jehle D. Presentation Times of Myocardial Infarctions to the Emergency Department: Disappearance of the Morning Predominance. J Emerg Med 2020; 58:741-748. [PMID: 32229136 DOI: 10.1016/j.jemermed.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/27/2019] [Accepted: 01/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies show that myocardial infarctions (MIs) occur most frequently in the morning. OBJECTIVES We hypothesized that there no longer is a morning predominance of MI, and that the timing of ST-elevation myocardial infarction (STEMI) vs. non-ST-elevation myocardial infarction (NSTEMI) presentation differs. METHODS We reviewed MI, STEMI, and NSTEMI patients (2013-2017) from a multiple-hospital system, identified by diagnostic codes. Daily emergency department arrival times were categorized into variable time intervals for count and proportional analysis, then examined for differences. RESULTS There were 18,663 MI patients from 12 hospitals included in the analysis. Most MIs occurred between 12:00 pm and 5:59 pm (35.7%), and least between 12:00 am-5:59 am (16.3%). After subdividing all MIs into STEMIs and NSTEMIs, both groups continued to have the greatest presentation between 12:00 pm and 5:59 pm (33.1% and 36.0%, respectively). STEMIs (17.2%) and NSTEMIs (16.2%) were least frequent between 12:00 am and 5:59 am. We found the second most common presentation time for MIs was in the 6 pm-11:59 pm time period, which held true for both subtypes (MI 26.7%, STEMI 26.4%, NSTEMI 26.7%). CONCLUSIONS These data suggest a potential shift in the circadian pattern of MI, revealing an afternoon predominance for both STEMI and NSTEMI subtypes.
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Affiliation(s)
- Spencer Masiewicz
- Department of Emergency Medicine, Grand Strand Medical Center, Myrtle Beach, South Carolina
| | - Scott Gutovitz
- Department of Emergency Medicine, Grand Strand Medical Center, Myrtle Beach, South Carolina; Department of Surgery, University of South Carolina School of Medicine - Columbia, Columbia, South Carolina
| | - Leslie Hart
- College of Charleston, Charleston, South Carolina
| | - Samuel Madden Leaman
- University of South Carolina School of Medicine - Columbia, Columbia, South Carolina
| | - Dietrich Jehle
- Department of Emergency Medicine, Grand Strand Medical Center, Myrtle Beach, South Carolina; Department of Surgery, University of South Carolina School of Medicine - Columbia, Columbia, South Carolina
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Protopapas A, Lambrinou E. Cultural factors and the circadian rhythm of ST elevation myocardial infarction in patients in a Mediterranean island. Eur J Cardiovasc Nurs 2019; 18:562-568. [PMID: 31072127 DOI: 10.1177/1474515119850680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The circadian rhythm of onset of myocardial infarction shows an increased risk during the morning hours. However, it is not clear whether habits, culture and sunshine hours differentiate circadian rhythm. The aim of this study was to investigate the influence of cultural factors on the circadian rhythm of acute myocardial infarction with ST segment elevation in a Mediterranean island. METHOD The study was a retrospective correlational survey. It included 123 patients with ST elevation myocardial infarction (mean age 60.7±12.6; 82% men). The 24 h of a day were divided into four six-hour periods of time for study purposes (00:01-06:00; 06:01-12:00; 12:01-18:00; and 18:01-24:00) and the chi-square test was used for the analysis. RESULTS A morning peak of symptoms onset of ST-elevation myocardial infarction was detected during the period 06:01-12:00 (p=0.044). In patients who were smokers, a bimodal pattern involving a morning (06:01-12:00) and an afternoon-to-night peak (18:01-24:00) (p=0.005) was detected. For patients with a history of hypertension, a morning peak of their symptoms was also detected (p=0.028). Different circadian variations were found between patients over the age of 60 years old and patients under the age of 60 years old (p=0.025). CONCLUSIONS Patients with ST elevation myocardial infarction seem to follow a circadian rhythm with a peak of onset of symptoms in the morning. In the smokers' subgroup, a different circadian pattern was found. The habit of smoking is likely to affect the circadian rhythm of the onset of ST elevation myocardial infarction in the Mediterranean area and culture.
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Albackr HB, AlHabib KF, AlShamiri MQ, Ullah A, Al Subaie FA, Alghamdi AG, Alfaleh H, Kashour T, Al Suwaidi J, Alsheikh-Ali AA, Almahmeed W, Salam AM. Circadian Rhythm and ST-Segment Elevation Myocardial Infarction: Insights From the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps). Angiology 2018; 70:352-360. [DOI: 10.1177/0003319718797470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Circadian rhythms have been identified in multiple physiological processes that may affect cardiovascular diseases, yet little is known about the impact of circadian rhythm on acute ST-segment elevation myocardial infarction (STEMI) onset and outcomes in the Middle East. The relationship between time of symptom onset during the 24-hour circadian cycle and prehospital delays and in-hospital death was assessed in 2909 patients with STEMI presenting in 6 Arabian Gulf countries. A sinusoidal smoothing function was used to show the average circadian trends. There was a significant association between time of symptom onset and the circadian cycle. The STEMIs were more frequent during the late morning and early afternoon hours ( P < .001). Patients with pain onset from 0.00 to 5:59 had median prehospital delays of 150 minutes versus 90 minutes from 6:00 to 11:59 and 12:00 to 17:59, respectively ( P < .001). Although there was no significant difference in mortality between the 4 groups ( P = .230), there was a significant association between time of symptom onset as sinusoidal function and in-hospital mortality ( P = .032). Patients with STEMI in the Middle East have significant circadian patterns in symptoms onset, prehospital delay, and timeliness of reperfusion. A circadian rhythm of in-hospital mortality was found over the 24-hour clock of symptom onset time.
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Affiliation(s)
- Hanan B. Albackr
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Khalid F. AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mostafa Q. AlShamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Fahad A. Al Subaie
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abduljabar G. Alghamdi
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hussam Alfaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Amar M. Salam
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
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Chongprasertpon N, Coughlan JJ, Cahill C, Kiernan TJ. Circadian and seasonal variations in patients with acute STEMI: A retrospective, single PPCI center study. Chronobiol Int 2018; 35:1663-1669. [PMID: 30067392 DOI: 10.1080/07420528.2018.1500478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This was a retrospective observational analysis of all (n = 876) ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) at University Hospital Limerick (UHL) from 2012 to 2016 to determine whether chronological patterns existed in incidence and mortality at our center. Data were obtained from the electronic Cardiology STEMI database in UHL. Statistical analysis was performed using the Independent Samples t Test, ANOVA and Pearson's Chi-Squared test. The rate of STEMI from 0800 and 2259 hours (46.9/hr) was greater than 2300 to 0759 hours (19.1/hr) (p < 0.001). No association was found between 30-day mortality and weekend/weekdays presentation (p = 0.81) or off/in hour presentation (p = 0.86). No seasonal variation was found in STEMI incidence at our center using international (p = 0.29) or Celtic (p = 0.82) seasonal calendars. 30-Day mortality is equivalent whether STEMI patients treated with PPCI present during "normal working hours" or during the "out of hours"/weekend period at our center. The majority of STEMIs occur during the hours 0800 to 2259, but no further chronological relationship was observed in incidence.
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Affiliation(s)
| | - John Joseph Coughlan
- a Department of Cardiology , University Hospital Limerick , Co. Limerick , Ireland
| | - Ciara Cahill
- a Department of Cardiology , University Hospital Limerick , Co. Limerick , Ireland
| | - Thomas John Kiernan
- a Department of Cardiology , University Hospital Limerick , Co. Limerick , Ireland
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Fabbian F, Bhatia S, De Giorgi A, Maietti E, Bhatia S, Shanbhag A, Deshmukh A. Circadian Periodicity of Ischemic Heart Disease: A Systematic Review of the Literature. Heart Fail Clin 2017; 13:673-680. [PMID: 28865776 DOI: 10.1016/j.hfc.2017.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The authors performed a MEDLINE search to identify reports, published during the last 20 years, focused on circadian variation of acute myocardial infarction (AMI), and prevalence and the ratios between the number of events per hour during the morning and the other hours of the day were calculated. Despite the optimization of interventional and medical therapy of AMI since the first reports of circadian patterns in AMI occurrence, it was found that such a pattern still exists and that AMI happens most frequently in the morning hours.
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Affiliation(s)
- Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, University Hospital St. Anna, Via Aldo Moro 8, I-44124, Cona, Ferrara, Italy.
| | - Subir Bhatia
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Afredo De Giorgi
- Department of Medical Sciences, University of Ferrara, University Hospital St. Anna, Via Aldo Moro 8, I-44124, Cona, Ferrara, Italy
| | - Elisa Maietti
- Department of Medical Sciences, University of Ferrara, Center for Clinical Epidemiology, 44121 Ferrara, Italy
| | - Sravya Bhatia
- School of Medicine, Duke University, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA
| | - Anusha Shanbhag
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Abhishek Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First Street Southwest, Rochester, Minnesota 55905, USA
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Celik M, Bugan B, Yalcinkaya E, Yuksel UC, Celik T. Response to Relation Between Time of Symptom Onset of ST-Segment Elevation Myocardial Infarction and Patient Baseline Characteristics: From the National Cardiovascular Data Registry. Clin Cardiol 2013; 36:E37-8. [DOI: 10.1002/clc.22192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 05/11/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Murat Celik
- Department of Cardiology, School of Medicine; Gulhane Military Medical Academy; Ankara; Turkey
| | - Baris Bugan
- Department of Cardiology, School of Medicine; Gulhane Military Medical Academy; Ankara; Turkey
| | - Emre Yalcinkaya
- Department of Cardiology, School of Medicine; Gulhane Military Medical Academy; Ankara; Turkey
| | - Uygar Cagdas Yuksel
- Department of Cardiology, School of Medicine; Gulhane Military Medical Academy; Ankara; Turkey
| | - Turgay Celik
- Department of Cardiology, School of Medicine; Gulhane Military Medical Academy; Ankara; Turkey
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Abstract
OBJECTIVE Nearly four decades ago, a circadian pattern of acute myocardial infarction (AMI) with a peak in the early morning waking hours was described. The goal of the present study was to determine whether major changes in lifestyle and significant advances in medical therapy have altered this pattern in the intervening years. DESIGN Retrospective chart review. SETTING Tertiary care hospital in central Wisconsin. METHODS We examined circadian patterns of ST elevation myocardial infarction (STEMI) in 519 patients diagnosed with STEMI over a 5-year period. Time of symptom onset was obtained from patient self-reports in the medical record and was recorded over 24 hours. RESULTS We observed a circadian pattern of STEMI occurrence with a morning peak at approximately 11:30 AM. This pattern was highly significant in patients who were not using beta-blockers (P <0.0001) and had no history of diabetes (P <0.0001), but was otherwise absent. The circadian pattern appeared to be attenuated in patients of a younger age, female gender, or who used statins or aspirin. Peak STEMI occurrence was earlier in smokers than non-smokers. CONCLUSIONS Despite significant lifestyle changes and medical advances in the nearly four decades since a circadian pattern of AMI occurrence was first described, patients with STEMI had a circadian pattern of symptom onset with a morning peak. Use of beta-blockers and a history of diabetes mellitus abolished this pattern. Other modifying factors, including medications, age, and gender attenuated, but did not abolish, the circadian pattern.
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Affiliation(s)
- Rajan Kanth
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI USA
| | - Sunitha Ittaman
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI USA
| | - Shereif Rezkalla
- Department of Cardiology, Marshfield Clinic, Marshfield, WI USA
- Corresponding Author: Shereif Rezkalla, MD, FACP; Department of Cardiology; Marshfield Clinic; 1000 North Oak Avenue; Marshfield, WI 54449; Tel: (715) 387-5845; Fax: (715) 389-5757;
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Isik T, Ayhan E, Uyarel H, Akkaya E, Ergelen M, Cicek G, Vuruskan E, Kurt M, Tanboga IH, Eren M. Circadian, Weekly, and Seasonal Variation in Early Stent Thrombosis Patients Who Previously Underwent Primary Percutaneous Intervention With ST Elevation Myocardial Infarction. Clin Appl Thromb Hemost 2012; 19:679-84. [DOI: 10.1177/1076029612445918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
One of the major concerns remaining in the treatment with stenting is the occurrence of stent thrombosis (ST). We reviewed 1960 consecutive patients (mean age 56 ± 11.6 years, 84.6% males) treated with primary coronary stenting for ST elevation myocardial infarction between 2003 and 2008. All clinical, angiographic, and follow-up data were retrospectively collected. The data when the patient had angina pectoris was obtained from medical record. Early ST was observed in 89 (4.5%) patients. We identified 86 patients with early ST and known date and time of symptom onset. In these patients (mean age 59.2 ± 13.9, 83.7% males), symptoms occurred mostly at night time (00.00-6.00 am) and during winter months but the day of the week effect was not presence. In conclusion, occurrences of early ST throughout the week were equally distributed, but early ST was more likely to occur in the winter months and night hours.
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Affiliation(s)
- Turgay Isik
- Department of Cardiology, Balikesir University, School of Medicine, Balikesir, Turkey
| | - Erkan Ayhan
- Department of Cardiology, Balikesir University, School of Medicine, Balikesir, Turkey
| | - Huseyin Uyarel
- Department of Cardiology, Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Emre Akkaya
- Department of Cardiology, Gaziantep State Hospital, Gaziantep, Turkey
| | - Mehmet Ergelen
- Department of Cardiology, Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Gokhan Cicek
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Ertan Vuruskan
- Department of Cardiology, Gaziantep State Hospital, Gaziantep, Turkey
| | - Mustafa Kurt
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | | | - Mehmet Eren
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
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Selvi Y, Smolensky MH, Boysan M, Aydin A, Besiroglu L, Atli A, Gumrukcuoglu HA. Role of patient chronotype on circadian pattern of myocardial infarction: a pilot study. Chronobiol Int 2011; 28:371-7. [PMID: 21539429 DOI: 10.3109/07420528.2011.559605] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Population-based studies indicate the risk of acute myocardial infarction (AMI) is greatest in the morning, during the initial hours of diurnal activity. The aim of this pilot study was to determine whether chronotype, i.e., morningness and eveningness, impacts AMI onset time. The sample comprised 63 morning- and 40 evening-type patients who were classified by the Horne-Östberg Morningness-Eveningness Questionnaire (MEQ) in the hospital after experiencing the AMI. The average wake-up and bed times of morning types were ~2 h earlier than evening types. Although the lag in time between waking up from nighttime sleep and AMI onset during the day did not differ between the two chronotypes, the actual clock-hour time of the peak in the 24-h AMI pattern did. The peak in AMI of morning types occurred between 06:01 and 12:00 h and that of the evening types between 12:01 and 18:00 h. Although the results of this small sample pilot study suggest one's chronotype influences the clock time of AMI onset, larger scale studies, which also include assessment of 24-h patterning of events in neither types, must be conducted before concluding the potential influence of chronotype on the timing of AMI onset.
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Affiliation(s)
- Yavuz Selvi
- Department of Psychiatry, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey.
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Celik M, Celik T, Iyısoy A, Yuksel UC, Bugan B, Demırkol S, Kabul K, Gokoglan Y, Kılıc S. Circadian variation of acute st segment elevation myocardial infarction by anatomic location in a Turkish cohort. Med Sci Monit 2011; 17:CR210-5. [PMID: 21455107 PMCID: PMC3539529 DOI: 10.12659/msm.881717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background To evaluate the relationship between site of infarction (anterior vs. inferior) and circadian variation in patients with ST segment elevation myocardial infarction (STEMI) in a Turkish cohort. Material/Methods This restrospective study enrolled 465 patients (407 male, mean age 65±7 years) with STEMI. Patients were then categorised into 4 6-hour increments according to the time of day during which the symptoms began (12:00 AM–06:00 AM, 06:00 AM–12:00 PM; 12:00 PM–06:00 PM and 06:00 PM–12:00 AM hours). Characteristics of patients by site of infarction (anterior vs. inferior) were compared. Results The frequency of onset of acute anterior MI as determined by onset of pain demonstrated significant circadian variation among the 4 time periods, demonstrating bimodal peaks (afternoon and morning) and a trough between 06:00 PM to 06:00 AM. The incidence of occurrence of MI between 06:00 AM to 06:00 PM was 4.50 times that of the average frequency of the remaining 12 hours of the day. The frequency of onset of acute inferior MI as determined by onset of pain exhibited significant circadian variation among the 4 time periods, demonstrating bimodal peaks (midnight to 06:00 AM and 06:00 AM to noon) and a trough between noon to midnight. The incidence of occurrence of MI between midnight to noon was 4.25 times that of the average frequency of the remaining 12 hours of the day. Conclusions Different circadian periodicity in the time of onset of STEMI was found regarding infarction site in a Turkish cohort. This may be related to genetic and/or demographic characteristics of the Turkish population.
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Affiliation(s)
- Murat Celik
- Department of Cardiology, Gulhane Military Medical Academy, School of Medicine, Etlik-Ankara, Turkey.
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Bae MH, Ryu HM, Lee JH, Lee JH, Kwon YS, Lee SH, Yang DH, Park HS, Cho Y, Chae SC, Jun JE, Park WH. The impact of circadian variation on 12-month mortality in patients with acute myocardial infarction. Korean Circ J 2010; 40:616-24. [PMID: 21267383 PMCID: PMC3025334 DOI: 10.4070/kcj.2010.40.12.616] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 04/26/2010] [Accepted: 05/12/2010] [Indexed: 11/11/2022] Open
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 ≥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.
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Affiliation(s)
- Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
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