Circadian rhythms in patients with ST-elevation myocardial infarction

David Holmes, Frank V. Aguirre, Richard Aplin, Ryan J. Lennon, David M. Nestler, Malcolm R. Bell, Charanjit Rihal, Henry H. Ting

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background-Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle. Methods and Results-The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was a significant association between time of onset and the circadian cycle, with the greatest percentage (39%) of patients experiencing onset between 8 AM and 3 PM (P<0.001). Time of onset was associated with prehospital delay and timeliness of reperfusion. Patients with onset from 12 AM to 5:59 AM had median prehospital delays of 121 minutes versus 70 minutes from 12 PM to 5:59 PM (P<0.001). Patients with onset time from 12 AM to 5:59 AM had median door-to-balloon times of 75 minutes versus 60 minutes from 6 AM to 11:59 AM (P<0.001). Using multivariable modeling to control for baseline patient characteristics, prehospital delay, and timeliness of reperfusion, there was no significant association between time of symptom onset with in-hospital death. Conclusions-Patients with ST-elevation myocardial infarction exhibit significant circadian patterns in symptom onset, prehospital delay, and timeliness of reperfusion. Patients who develop symptoms from 12 AM to 5:59 AM present with longer prehospital delays and have longer door-to-balloon times. After multivariable adjustment, there was no significant association between circadian patterns of time of onset and in-hospital death.

Original languageEnglish (US)
Pages (from-to)382-389
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume3
Issue number4
DOIs
StatePublished - Jul 2010

Fingerprint

Circadian Rhythm
Reperfusion
Tertiary Healthcare
ST Elevation Myocardial Infarction
Myocardial Infarction

Keywords

  • Circadian rhythm
  • Myocardial infarction
  • Reperfusion injury

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Holmes, D., Aguirre, F. V., Aplin, R., Lennon, R. J., Nestler, D. M., Bell, M. R., ... Ting, H. H. (2010). Circadian rhythms in patients with ST-elevation myocardial infarction. Circulation: Cardiovascular Quality and Outcomes, 3(4), 382-389. https://doi.org/10.1161/CIRCOUTCOMES.109.913343

Circadian rhythms in patients with ST-elevation myocardial infarction. / Holmes, David; Aguirre, Frank V.; Aplin, Richard; Lennon, Ryan J.; Nestler, David M.; Bell, Malcolm R.; Rihal, Charanjit; Ting, Henry H.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 3, No. 4, 07.2010, p. 382-389.

Research output: Contribution to journalArticle

Holmes, D, Aguirre, FV, Aplin, R, Lennon, RJ, Nestler, DM, Bell, MR, Rihal, C & Ting, HH 2010, 'Circadian rhythms in patients with ST-elevation myocardial infarction', Circulation: Cardiovascular Quality and Outcomes, vol. 3, no. 4, pp. 382-389. https://doi.org/10.1161/CIRCOUTCOMES.109.913343
Holmes, David ; Aguirre, Frank V. ; Aplin, Richard ; Lennon, Ryan J. ; Nestler, David M. ; Bell, Malcolm R. ; Rihal, Charanjit ; Ting, Henry H. / Circadian rhythms in patients with ST-elevation myocardial infarction. In: Circulation: Cardiovascular Quality and Outcomes. 2010 ; Vol. 3, No. 4. pp. 382-389.
@article{72ea83e1ae7449e681b020dbf0747616,
title = "Circadian rhythms in patients with ST-elevation myocardial infarction",
abstract = "Background-Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle. Methods and Results-The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was a significant association between time of onset and the circadian cycle, with the greatest percentage (39{\%}) of patients experiencing onset between 8 AM and 3 PM (P<0.001). Time of onset was associated with prehospital delay and timeliness of reperfusion. Patients with onset from 12 AM to 5:59 AM had median prehospital delays of 121 minutes versus 70 minutes from 12 PM to 5:59 PM (P<0.001). Patients with onset time from 12 AM to 5:59 AM had median door-to-balloon times of 75 minutes versus 60 minutes from 6 AM to 11:59 AM (P<0.001). Using multivariable modeling to control for baseline patient characteristics, prehospital delay, and timeliness of reperfusion, there was no significant association between time of symptom onset with in-hospital death. Conclusions-Patients with ST-elevation myocardial infarction exhibit significant circadian patterns in symptom onset, prehospital delay, and timeliness of reperfusion. Patients who develop symptoms from 12 AM to 5:59 AM present with longer prehospital delays and have longer door-to-balloon times. After multivariable adjustment, there was no significant association between circadian patterns of time of onset and in-hospital death.",
keywords = "Circadian rhythm, Myocardial infarction, Reperfusion injury",
author = "David Holmes and Aguirre, {Frank V.} and Richard Aplin and Lennon, {Ryan J.} and Nestler, {David M.} and Bell, {Malcolm R.} and Charanjit Rihal and Ting, {Henry H.}",
year = "2010",
month = "7",
doi = "10.1161/CIRCOUTCOMES.109.913343",
language = "English (US)",
volume = "3",
pages = "382--389",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Circadian rhythms in patients with ST-elevation myocardial infarction

AU - Holmes, David

AU - Aguirre, Frank V.

AU - Aplin, Richard

AU - Lennon, Ryan J.

AU - Nestler, David M.

AU - Bell, Malcolm R.

AU - Rihal, Charanjit

AU - Ting, Henry H.

PY - 2010/7

Y1 - 2010/7

N2 - Background-Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle. Methods and Results-The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was a significant association between time of onset and the circadian cycle, with the greatest percentage (39%) of patients experiencing onset between 8 AM and 3 PM (P<0.001). Time of onset was associated with prehospital delay and timeliness of reperfusion. Patients with onset from 12 AM to 5:59 AM had median prehospital delays of 121 minutes versus 70 minutes from 12 PM to 5:59 PM (P<0.001). Patients with onset time from 12 AM to 5:59 AM had median door-to-balloon times of 75 minutes versus 60 minutes from 6 AM to 11:59 AM (P<0.001). Using multivariable modeling to control for baseline patient characteristics, prehospital delay, and timeliness of reperfusion, there was no significant association between time of symptom onset with in-hospital death. Conclusions-Patients with ST-elevation myocardial infarction exhibit significant circadian patterns in symptom onset, prehospital delay, and timeliness of reperfusion. Patients who develop symptoms from 12 AM to 5:59 AM present with longer prehospital delays and have longer door-to-balloon times. After multivariable adjustment, there was no significant association between circadian patterns of time of onset and in-hospital death.

AB - Background-Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle. Methods and Results-The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was a significant association between time of onset and the circadian cycle, with the greatest percentage (39%) of patients experiencing onset between 8 AM and 3 PM (P<0.001). Time of onset was associated with prehospital delay and timeliness of reperfusion. Patients with onset from 12 AM to 5:59 AM had median prehospital delays of 121 minutes versus 70 minutes from 12 PM to 5:59 PM (P<0.001). Patients with onset time from 12 AM to 5:59 AM had median door-to-balloon times of 75 minutes versus 60 minutes from 6 AM to 11:59 AM (P<0.001). Using multivariable modeling to control for baseline patient characteristics, prehospital delay, and timeliness of reperfusion, there was no significant association between time of symptom onset with in-hospital death. Conclusions-Patients with ST-elevation myocardial infarction exhibit significant circadian patterns in symptom onset, prehospital delay, and timeliness of reperfusion. Patients who develop symptoms from 12 AM to 5:59 AM present with longer prehospital delays and have longer door-to-balloon times. After multivariable adjustment, there was no significant association between circadian patterns of time of onset and in-hospital death.

KW - Circadian rhythm

KW - Myocardial infarction

KW - Reperfusion injury

UR - http://www.scopus.com/inward/record.url?scp=77957876025&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957876025&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.109.913343

DO - 10.1161/CIRCOUTCOMES.109.913343

M3 - Article

C2 - 20570918

AN - SCOPUS:77957876025

VL - 3

SP - 382

EP - 389

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 4

ER -