Key result
STEMI symptom onset shows bimodal circadian peaks but is not linked to 1-year MACCE.
Why the study?
Peak incidence of cardiovascular diseases usually occurs in the morning, but the exact distribution pattern of STEMI peak incidence and its prognostic relevance in the Chinese population required investigation.
Does the circadian timing of symptom onset affect one-year major adverse cardiovascular and cerebrovascular events (MACCE) in patients with STEMI?
Observational (n=7,805)
Yes
Does the circadian timing of symptom onset affect one-year major adverse cardiovascular and cerebrovascular events (MACCE) in patients with STEMI?
p-value: p=0.905
In a large Chinese cohort, STEMI symptom onset follows a bimodal circadian rhythm peaking in the morning and early afternoon, but the timing of onset does not impact one-year clinical outcomes.
STEMI onset timing should not guide 1-year risk stratification; leaves open whether circadian patterns affect MACCE in other populations.
Background The peak incidence of cardiovascular diseases (CVD) usually occurs in the morning. This study aimed to investigate the exact distribution pattern of peak incidence of ST-segment elevation myocardial infarction (STEMI) in the Chinese population, and to explore whether it is associated with the prognosis. Methods This study included 7,805 patients with STEMI from the multicenter, prospective AMI cohort in China, for whom had a definite time of symptom onset. In the overall population and the predefined subgroup populations, the circadian rhythms of STEMI onset were statistically analyzed. Then patients were divided into four groups based on the time of onset (6 h interval) to assess the association of symptom onset time and major adverse cardiovascular and cerebrovascular events (MACCE) after discharge. Results The onset of STEMI had a bimodal distribution: a well-defined primary peak at 8:38 AM [95% confidence interval (CI): 7:49 to 9:28 AM], and a less well-defined secondary peak at 12:55 PM (95% CI: 7:39 AM to 18:10 PM) (bimodal: P < 0.001). A similar bimodal circadian rhythm pattern was observed in subgroups of patients with STEMI defined with respect to day of the week, age, sex, and coronary risk factors. Notedly, the two peaks on Sunday were significantly later than other days, and the secondary peaks became clear and concentrated. In addition, no significant difference was found in MACCE among the four groups ( P = 0.905). Conclusions In the Chinese population, the onset of STEMI exhibited a bimodal circadian rhythm pattern, with a clear primary peak and a less clear secondary peak. One-year clinical outcomes were unrelated to the timing of STEMI onset.
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Guo et al. (2024) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=7,805). Time of STEMI onset vs. Different 6-hour time intervals was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) within 1 year (p=0.905). In Chinese patients, STEMI symptom onset exhibited a bimodal circadian rhythm with peaks at 8:38 AM and 12:55 PM, but the timing of onset was not associated with 1-year MACCE.
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