RT Journal Article
T1 Circadian variations of infarct size in acute myocardial infarction
A1 Suárez Barrientos, Aida
A1 López Romero, Pedro
A1 Vivas Balcones, Luis David
A1 Castro Ferreira, Francisco
A1 Núñez Gil, Ivan
A1 Franco, Eduardo
A1 Ruiz Mateos, Borja
A1 García Rubira, Juan Carlos
A1 Fernández Ortiz, Antonio Ignacio
A1 Macaya Miguel, Carlos
A1 Ibanez, Borja
AB Background: The circadian clock influences a number of cardiovascular (patho)physiological processes including the incidence of acute myocardial infarction. A circadian variation in infarct size has recently been shown in rodents, but there is no clinical evidence of this finding.Objective: To determine the impact of time-of-day onset of ST segment elevation myocardial infarction (STEMI) on infarct size.Methods: A retrospective single-centre analysis of 811 patients with STEMI admitted between 2003 and 2009 was performed. Infarct size was estimated by peak enzyme release. The relationship between peak enzyme concentrations and time-of-day were characterised using multivariate regression splines. Time of STEMI onset was divided into four 6-hour periods in phase with circadian rhythms.Results: Model comparisons based on likelihood ratio tests showed a circadian variation in infarct size across time-of-day as evaluated by peak creatine kinase (CK) and troponin-I (TnI) concentrations (p=0.015 and p=0.012, respectively). CK and TnI curves described similar patterns across time, with a global maximum in the 6:00-noon period and a local minimum in the noon-18:00 period. Infarct size was largest in patients with STEMI onset in the dark-to-light transition period (6:00-noon), with an increase in peak CK and TnI concentrations of 18.3% (p=0.031) and 24.6% (p=0.033), respectively, compared with onset of STEMI in the 18:00-midnight period. Patients with anterior wall STEMI also had significantly larger infarcts than those with STEMI in other locations.Conclusions: Significant circadian oscillations in infarct size were found in patients according to time-of-day of STEMI onset. The infarct size was found to be significantly larger with STEMI onset in the dark-to-light transition period (6:00-noon). If confirmed, these results may have a significant impact on the interpretation of clinical trials of cardioprotective strategies in STEMI
PB BMJ Publishing Group
SN 1355-6037
YR 2011
FD 2011-06-01
LK https://hdl.handle.net/20.500.14352/99940
UL https://hdl.handle.net/20.500.14352/99940
LA eng
NO Suárez-Barrientos A, López-Romero P, Vivas D, Castro-Ferreira F, Núñez-Gil I, Franco E, et al. Circadian variations of infarct size in acute myocardial infarction. Heart. 2011;97):970-6
NO Estudio retrospectivo unicéntrico que evaluó a 811 pacientes con un infarto agudo de miocardio. El estudio comparó el momento en el que presentaron el evento con el tamaño del infarto. Se pudo comprobar que los infartos fueron mas grandes en pacientes que lo padecieron durante la transición noche-día (entre las 6.00 y 12.00 am), resultados que ayudaron a interpretar el efecto cardioprotector de otras estrategias terapéuticas en pacientes con infarto de miocardio en ensayos clínicos posteriores.
DS Docta Complutense
RD 20 abr 2025