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KMID : 0368120100400120616
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Korean Circulation Journal
2010 Volume.40 No. 12 p.616 ~ p.624
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The Impact of Circadian Variation on 12-Month Mortality in Patients With Acute Myocardial Infarction
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Bae Myung-Hwan
Ryu Hyeon-Min
Lee Jang-Hoon
Lee Ju-Hwan
Kwon Yong-Seop
Lee Sang-Hyuk
Yang Dong-Heon
Park Hun-Sik
Cho Yong-Keun
Chae Shung-Chull
Jun Jae-Eun
Park Wee-Hyun
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Abstract
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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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KEYWORD
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Myocardial infarction, Circadian rhythm
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