Circulation, Vol 80, 853-858, Copyright © 1989 by American Heart Association
SN Willich, T Linderer, K Wegscheider, A Leizorovicz, I Alamercery and R Schroder
The time of acute myocardial infarction was determined in all 1,741
patients of the ISAM (Intravenous Streptokinase in Acute Myocardial
Infarction) Study, based on onset of clinical symptoms and evaluation of
plasma CK-MB enzyme time-activity curves. The incidence of myocardial
infarction was markedly increased between 6:00 AM and 12:00 noon compared
with other times of day (p less than 0.001). Myocardial infarction occurred
3.8 times more frequently between 8:00 and 9:00 AM (hour of maximum
incidence) than between 12:00 midnight and 1:00 AM (hour of minimum
incidence). Time of myocardial infarction based on clinical and enzymatic
methods correlated well (r = 0.95). Patients with higher or lower left
ventricular ejection fraction, higher or lower degree of wall motion
abnormalities and residual stenosis of the coronary arteries, and one-,
two-, or three-vessel disease exhibited a similar circadian pattern,
suggesting that the morning is a risk period for patients with mild as well
as severe coronary artery disease. Only the group of patients receiving
beta-adrenergic blocking therapy before the event did not show an increased
morning incidence of myocardial infarction. This observation may contribute
to an understanding of the mechanisms by which beta-blockers reduce the
incidence of myocardial infarction. Further investigation of physiologic
changes occurring during the morning period of increased risk of myocardial
infarction may lead to better understanding of the disorder. Design and
timing of cardioprotective medication may play a crucial role in improving
prevention of acute myocardial infarction.
ARTICLES
Increased morning incidence of myocardial infarction in the ISAM Study: absence with prior beta-adrenergic blockade. ISAM Study Group
Department of Medicine, Klinikum Steglitz, Free University of Berlin, Federal Republic of Germany.
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