Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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The Impact of Circadian Variation on 12-Month Mortality in Patients With Acute Myocardial Infarction

  • Bae, Myung-Hwan (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Ryu, Hyeon-Min (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Lee, Jang-Hoon (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Lee, Ju-Hwan (Department of Internal Medicine, Gumi Cha Hospital) ;
  • Kwon, Yong-Seop (Department of Internal Medicine, Busan St. Mary's Medical Center) ;
  • Lee, Sang-Hyuk (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Yang, Dong-Heon (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Park, Hun-Sik (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Cho, Yong-Keun (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Chae, Shung-Chull (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Jun, Jae-Eun (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Park, Wee-Hyun (Department of Internal Medicine, Kyungpook National University Hospital)
  • Received : 2010.02.13
  • Accepted : 2010.05.12
  • Published : 2010.12.30
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Abstract

Background and Objectives: Although circadian variation in the onset of acute myocardial infarction (AMI) has been reported in a number of studies, not much is known about the impact of circadian variation on 12-month mortality. The aim of this study was to investigate the impact of circadian variation on 12-month mortality in patients with AMI. Subjects and Methods: Eight hundred ninety two patients (mean age 67${\pm}$12; 66.1% men) with AMI who visited Kyungpook National University Hospital from November 2005 to December 2007 were included in this study. Patients were divided into groups based on four 6-hours intervals: overnight (00:00-05:59); morning (06:00-11:59); afternoon (12:00-17:59) and evening (18:00-23:59). Results: Kaplan-Meier survival curves showed 12-month mortality rates of 9.6%, 9.1%, 12.1%, and 16.7% in the overnight, morning, afternoon, evening-onset groups, respectively (p=0.012). Compared with the morning-onset AMI group, the serum creatinine levels (p=0.002), frequency of Killip class ${\geq}$3 (p=0.004), and prescription rate of diuretics (p=0.011) were significantly higher in the evening-onset AMI group, while the left ventricular ejection fraction (p=0.012) was significantly lower. The proportion of patients who arrived in the emergency room during routine duty hours was significantly lower in evening-onset groups irrespective of the presence or absence of ST-segment elevation (p<0.001). According to univariate analysis, the 12-month mortality rate in the evening group was significantly higher compared to the morning group (hazard ratio 1.998, 95% confidence interval 1.196 to 3.338, p=0.008). Conclusion: Patients with evening-onset AMI had poorer baseline clinical characteristics, and this might affect the circadian impact on 12-month mortality. Further studies are needed to clarify the role of circadian variation on the long-term outcome of AMI.

Keywords

References

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