Influence of circadian rhythm on mortality after myocardial infarction: Data from a prospective cohort of emergency calls

• Published in: The American journal of emergency medicine Vol. 22; no. 7; pp. 555 - 559
• Main Authors: Manfredini, Roberto, Boari, Benedetta, Bressan, Sabrina, Gallerani, Massimo, Salmi, Raffaella, Portaluppi, Francesco, Mehta, Rajendra H.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.11.2004; Elsevier; Elsevier Limited
• Subjects: Age Factors; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cause of Death; Circadian rhythm; Circadian Rhythm - physiology; Circadian rhythms; Cohort Studies; Colleges & universities; Coronary heart disease; Creatine Kinase - blood; Creatine Kinase, MB Form; Emergency and intensive care: techniques, logistics; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Female; Heart; Heart attacks; Hospital Mortality; Hospitalization; Humans; Hypotheses; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Internal medicine; Isoenzymes - blood; Italy - epidemiology; Kinases; Male; Medical sciences; Medicine; Mortality; Myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Patient Admission - statistics & numerical data; Prognosis; Prospective Studies; Statistical methods; Thrombolytic Therapy; Time Factors; Italy; Myocardial infarction; mortality; prognosis; circadian rhythm; Intensive care; Heart disease; Mortality; Cardiovascular disease; Biological rhythm; Circadian rhythm; Emergency; Myocardial disease; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2004.08.014

Myocardial infarction (MI) occurs more frequently in the morning as a result of the concomitant unfavorable timing of several physiological parameters and/or biochemical conditions. However, little is known about the possible influence of this circadian pattern on prognosis. To evaluate whether the time of symptom onset could potentially influence mortality from acute MI, this prospective study considered all consecutive MIs admitted to the ED of Ferrara, Italy, after a call to the Emergency Coordinating Unit from January 1, 1998, to December 31, 2001. The total sample consisted of 442 MIs (mean age, 68.7 years; males, 72%). Eighty patients (males, 82.5%) died in the ED; the remaining 362 were admitted to the hospital. Of these, 50 (males, 60%) died during their hospital stay. Based on the timing of their symptom onset, cases were categorized both into 24 1-hour intervals and four 6-hour intervals (midnight to 5:59 am, 6:00 am to 11:59 am, noon to 5:59 pm, and 6:00 pm to 11:59 pm), and the circadian distributions of fatal versus nonfatal MIs were compared. The circadian variation of MI peaked between 6:00 am and noon ( P < .001), and in this period, there was a trend toward a higher frequency of fatal cases (41.5% vs. 35.2%; χ 2 = 1.911, P = .167). To verify whether this higher frequency of fatal events in the morning hours could be related to possible higher severity of cases observed in that hours, a further separate analysis considering age, infarct site, and peak levels of MB was made. Again, no significant temporal differences among the four 6-hour intervals were found between fatal and nonfatal Mis, although a trend toward older age was observed in morning MIs. Not only the frequency, but also the mortality, of acute MI could be increased in the morning hours. This could be of practical interest for emergency doctors and could have significant implications for acute treatment, because several studies have reported a lowered efficacy of thrombolytic drugs in the morning hours.