Circulation, Vol 80, 267-275, Copyright © 1989 by American Heart Association
A Hjalmarson, EA Gilpin, P Nicod, H Dittrich, H Henning, R Engler, AR Blacky, SC Smith Jr, F Ricou and J Ross Jr
Circadian variation of the onset of acute myocardial infarction has been
noted in many studies and may carry important pathophysiologic
implications. However, only a few previous studies have attempted subgroup
analyses. In 4,796 patients with documented acute myocardial infarction,
the time of symptom onset was recorded. As in other studies, the peak of
onset occurred in the morning from 6:01 AM to 12:00 noon, and 28% of the
population (1.16 times the average percentage for the other time periods)
experienced symptom onset in that period (p less than 0.001). There was a
second, lower peak (25%) in the evening between 6:01 PM and 12:00 midnight,
which was also observed in some previous studies. We sought to determine
whether or not the presence of subgroups with specific clinical
characteristics would exhibit different patterns and thereby contribute to
these peaks in the overall population. In patients with a history of
congestive heart failure (n = 606) or with non-Q wave infarction (n = 832),
a pronounced peak (29%) occurred only in the evening. Two nearly equal
peaks were observed in patients older than 70 years of age (n = 1,422),
smokers (n = 2,057), diabetics (n = 767), women (n = 1,213), and patients
taking beta-blocking drugs (n = 847). Finally, in patients with a previous
myocardial infarction (n = 1,104), no peaks were observed.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction
Division of Cardiology, University of California, San Diego, La Jolla 92093.
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