Key result
Night symptom-onset STEMI linked to ~57% higher risk of long-term MACE.
Why the study?
It was uncertain whether a similar circadian pattern of STEMI symptom onset occurs in contemporary patients treated with PPCI and its impact on long-term clinical outcomes.
Cohort (n=1,099)
No
Night-onset STEMI was associated with higher long-term MACE after PPCI; leaves open whether circadian timing informs risk stratification or warrants prospective trials.
Background Daytime variation with regard to onset time of ST-elevation myocardial infarction (STEMI) symptoms has been observed. Nevertheless, with the advanced medical therapy, it is not uncertainty if a similar circadian pattern of STEMI symptom onset occurs, as well as its possible impact on clinical outcomes. Few long-term data are available. We assess the impact of circadian symptom-onset patterns of STEMI on major adverse cardiovascular events (MACE) in more contemporary patients treated with primary percutaneous coronary intervention (PPCI).Methods and results A total of 1099 consecutive STEMI patients undergoing PPCI ≤12h from symptom onset during 2013 to 2019 were classified into 4 groups by 6-h intervals according to time-of-day at symptom onset: night (0:00–5:59), morning (6:00–11:59), afternoon (12:00–17:59), and evening (18:00–23:59). Incidence of MACE including cardiovascular death and nonfatal MI during a median follow-up of 48 months was compared among the 4 groups. A morning peak of symptom onset of STEMI was detected during the period 06:00–11:59 (p < .001). Compared with other three 6-h intervals, the incidence of long-term MACE during night onset-time (18.8%, 10.1%, 10.7% and 12.4%, p = .020) was significant higher that was driven by more mortality (13.1%, 6.5%, 7.1%and 7.7%, p = .044). Night symptom-onset STEMI was independently associated with subsequent MACE (hazard ratio = 1.57, 95%CI: 1.09–2.27, p = .017) even after multivariable adjustment.Conclusions Circadian variation of STEMI symptom-onset with morning predominance still exists in contemporary practice. Night symptom-onset STEMI was independently associated with increased risk of MACE in Chinese patients treated with PPCI.
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Peng et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,099). Night symptom-onset (0:00–5:59) vs. Other times of day (06:00–23:59) was evaluated on Major adverse cardiovascular events (MACE), a composite of cardiovascular mortality and nonfatal recurrence of MI (HR 1.57, 95% CI 1.09-2.27, p=0.017). Night symptom-onset of STEMI was independently associated with an increased risk of long-term major adverse cardiovascular events compared to other times of day (HR 1.57).
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