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Many epidemiologic studies have been reported the morning peak incidences of acute myocardial infarction (AMI). However, short and long-term clinical outcomes of circadian pattern have not been fully investigated in patients with AMI.
From Korea Acute Myocardial Infarction Registry (KAMIR) database, we analyzed 4754 eligible patients (2793 STEMI, 1961 NSTEMI; age=63.2±12.1 years) who had primary percutaneous coronary intervention (PCI) and early invasive PCI. The clinical impact of circadian variation was evaluated among four 6-hour intervals (12:00 midnight-6:00 AM, 6:00 AM-12:00 noon, 12:00 noon-6:00 PM, 6:00 PM-12:00 midnight). Various major adverse cardiac events (MACEs) at 12 months were evaluated.
There was a marked circadian variation with increased incidences of AMI during the second quarter of day (6:00 AM to 12:00 noon). In a concordance of previous studies, hypertension was more prevalent during the second quarter of day (STEMI: 45% vs. 51% vs. 46% vs. 46%, respectively; NSTEMI: 53% vs. 59% vs. 52% vs. 48%, respectively, p <0.05). Among four 6-hour-interval groups, symptom-to-door time, door-to-balloon time, procedural complexity, and successful rates of PCI were not significantly different. As shown in table, in-hospital mortality, MACEs were not significantly different for 12-month follow-up. Instead, old age, diabetes, and Killip class higher than II were independent factors for 12-month
Older age and additional comorbidities, but not the onset time of AMI, are likely to explain the deteriorating short-and long-term outcomes in patients with primary PCI and early invasive PCI.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Acute Coronary Syndromes: Clinical Outcomes
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1299-181
- 2013 American College of Cardiology Foundation