The Impact of Circadian Variation on 12-Month Mortality in Patients With Acute Myocardial Infarction.
10.4070/kcj.2010.40.12.616
- Author:
Myung Hwan BAE
1
;
Hyeon Min RYU
;
Jang Hoon LEE
;
Ju Hwan LEE
;
Yong Seop KWON
;
Sang Hyuk LEE
;
Dong Heon YANG
;
Hun Sik PARK
;
Yongkeun CHO
;
Shung Chull CHAE
;
Jae Eun JUN
;
Wee Hyun PARK
Author Information
1. Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea. choyk@mail.knu.ac.kr
- Publication Type:Original Article
- Keywords:
Myocardial infarction;
Circadian rhythm
- MeSH:
Circadian Rhythm;
Creatinine;
Diuretics;
Emergencies;
Humans;
Kaplan-Meier Estimate;
Myocardial Infarction;
Prescriptions;
Stroke Volume
- From:Korean Circulation Journal
2010;40(12):616-624
- CountryRepublic of Korea
- Language:English
-
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.
