Author + information
- Matthew N. Peters,
- Morgan J. Katz,
- John C. Moscona,
- Mohi E. Alkadri,
- Rashad K. Syed,
- Thomas A. Turnage,
- Vikram S. Nijjar,
- Mohannad B. Bisharat,
- Patrice Delafontaine and
- Anand M. Irimpen
The onset of acute myocardial infarction (AMI) has been shown to occur in a non-random pattern, with morning and weekday peaks (especially Monday). AMI has been shown to increase locally following natural disasters, but the effect of these events upon AMI chronobiology has not been previously investigated.
We identified AMI patients at Tulane University Health Sciences Center (TUHSC) using ICD 9 codes 410.1 to 410.9. All included patients had typical ischemic symptoms at rest and elevated troponin I. Specifically excluded were non-New Orleans residents, hospital transfers, patients with symptom onset while hospitalized and patients with inadequate documentation of day/time of symptom onset. There were 2 cohorts: pre-Katrina: 8/29/99 to 8/28/05 (storm landfall) (n=299) and post-Katrina: 2/16/06 (when TUHSC became first downtown hospital to reopen) to 2/15/09 (n=408). Medical records were retrospectively assessed to identify symptom onset, and demographic, clinical and laboratory data.
Post-Katrina AMI incidence decreased on Mondays (23.4% vs. 10.3%, p<0.0001), weekdays (60.2% vs. 39.2%, p<0.0001) and mornings (45.15% vs. 31.0%, p<0.01) and increased on nights (29.8% vs 50.0%, p<0.0001) and weekends (16.1% vs. 30.9%, p<0.0001) There were no significant differences in AMI pattern between years 1, 2 and 3 post-Katrina. The post-Katrina group had a higher prevalence of smoking (51.0% vs. 34.4%, p<0.001), unemployment (17.9% vs. 7.0%, p<0.0001) and lack of health insurance (19.4% vs. 8.4%, p<0.001). No significant differences were noted between groups in terms of age, sex, ethnicity, medical comorbidities, medications or substance abuse.
The normal pattern of AMI onset was altered following Hurricane Katrina and expected morning, weekday and Monday peaks were eliminated. Although the mechanism of these changes is unknown, our findings suggest a likely relationship to stress associated with the almost universal devastation in the New Orleans area. Traditional patterns of AMI onset associated with stressful times of the day and week may be altered during natural disasters and these patterns may persist for prolonged periods of time.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Stress, Coronary Spasm and AMI: Lessons from Japan, New Orleans, Greece
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1130-208
- 2013 American College of Cardiology Foundation