Author + information
- Kah Hua Peck1,
- Violet Hoon1,
- Wee Kiat Ang1,
- Jason Kwok Kong Loh1,
- Fahim Haider Jafary1,
- David Foo1,
- Timothy James Watson1,
- Paul JL Ong1 and
- Hee Hwa Ho1
Several studies have evaluated the circadian pattern of ST elevation myocardial infarction (STEMI) with differences observed in different regions.
We evaluated the circadian rhythm of STEMI, differences in clinical characteristics and its impact on clinical outcome in our southeast Asian cohort.
We studied 1,441 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) at our institution in Singapore from January 2009 to December 2014.
Patients were categorized by time of symptom onset into four 6-hour intervals: 00:00–06:00, 06:00-12:00, 12:00–18:00, and 18:00–24:00. Patients’ clinical characteristics, reperfusion time and in-hospital mortality in each subgroup were analyzed.
A significant circadian variation in the timing of symptom onset of STEMI was observed: early morning peak (31%) between 06:00-12:00 and trough (21%) between 18:00-2400.
There were no age, gender, multi-ethnic and socio-economic differences between the 4 subgroups. There was also no difference in the prevalence of cardiovascular risk factors between the 4 subgroups except for hypertension. Patients in the time interval of 18:00-24:00 have the highest proportion (55.3%) of antecedent hypertension followed by those (52.2%) in the time interval of 00:00-06:00.
Patients in the time interval of 06:00-12:00 have the shortest median door-to-balloon (D2B) time (46.5 mins) while those in the time interval of 00:00-06:00 has the longest median D2B time (57 mins).
An incidence of anterior STEMI was highest (57%) in the time interval of 00:00-06:00 followed by patient subgroup (49.3%) in the time interval of 18:00-24:00. There was no difference in the rates of cardiogenic shock across the 4 subgroups.
For in-hospital mortality, a patient subgroup in the time interval of 00:00-06:00 has the highest mortality (7.5%) followed by those (6%) in the time interval of 18:00-24:00.
We observed a circadian peak presentation of STEMI in our southeast Asian cohort with differences observed for baseline clinical characteristics, reperfusion time and in-hospital mortality.
The highest rates of anterior STEMIs and in-hospital mortality were observed in the two-time intervals (00:00-06:00 and 18:00-24:00) and this could represent a potential target for preventive strategies.