Circadian variation in myocardial perfusion and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty - 21/08/11
, Jan Paul Ottervanger, MD, PhD, Arnoud W.J. van't Hof, MD, PhD, Jan C.A. Hoorntje, MD, PhD, A.T. Marcel Gosselink, MD, PhD, Jan-Henk E. Dambrink, MD, PhD, Felix Zijlstra, MD, PhD, Menko-Jan de Boer, MD, PhD, FACCRésumé |
Background |
Little is known about whether the physiological factors that determine the circadian variation in ST-segment elevation myocardial infarction (STEMI) onset and thrombolysis efficacy may affect myocardial perfusion and long-term outcome of patients with STEMI treated with primary angioplasty.
Methods |
Our study population consisted of 1548 consecutive patients with STEMI treated by primary angioplasty between April 1997 and October 2001. All clinical, angiographic, and follow-up data were collected.
Results |
Most of the patients (65.2%) were treated at daytime (between 8 am and 8 pm). Patients treated between 1 pm and midnight had a lower prevalence of anterior infarction and longer door-to-balloon time, whereas the shortest ischemic time and the largest use of stent were observed in patients treated between midnight and 4 am Patients treated between 4 and 8 am showed the worst outcome in terms of myocardial perfusion, enzymatic infarct size, and 1-year outcome, whereas patients treated between 8 am and 4 pm had the best myocardial perfusion and lowest 1-year mortality rate. After correction for baseline confounding factors, the time of treatment (between 4 and 8 am) was still significantly associated with 1-year mortality (relative risk 1.92, 95% CI 1.13-3.26, P = .016).
Conclusions |
This is the first study showing a significant relationship between the time of treatment, myocardial perfusion, and long-term mortality in patients with STEMI undergoing mechanical reperfusion.
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Vol 150 - N° 6
P. 1185-1189 - décembre 2005 Retour au numéro
Article précédent
- Benefit of clopidogrel according to timing of percutaneous coronary intervention in patients with acute coronary syndromes: Further results from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study
- Basil S. Lewis, Shamir R. Mehta, Keith A.A. Fox, David A. Halon, Feng Zhao, Ron J.G. Peters, Matyas Keltai, Andrzej Budaj, Salim Yusuf, for the CURE trial investigators
- The interaction of vascular inflammation and chronic kidney disease for the prediction of long-term death after percutaneous coronary intervention
- Robert B. Fathi, Hitinder S. Gurm, Derek P. Chew, Ritesh Gupta, Deepak L. Bhatt, Stephen G. Ellis
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