Circadian pattern of symptoms onset in patients ≤ 35 years presenting with ST-segment elevation acute myocardial infarction

• Published in: European journal of internal medicine 2015-10, Vol.26 (8), p.607-610
• Main Authors: Rallidis, Loukianos S, Triantafyllis, Andreas S, Sakadakis, Eleftherios A, Gialeraki, Argyri, Varounis, Christos, Rallidi, Maria, Tsirebolos, Georgios, Liakos, Georgios, Dagres, Nikolaos, Lekakis, Jonh
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Chest Pain - etiology; Circadian Rhythm - physiology; Electrocardiography; Female; Humans; Internal Medicine; Male; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Prospective Studies; Time Factors
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2015.05.014

Abstract Background There are scarce data regarding the circadian pattern of symptoms onset in young patients presenting with acute myocardial infarction (AMI). We explored whether young patients with ST-segment elevation AMI exhibit a circadian variation in symptoms onset. Methods We recruited prospectively 256 consecutive patients who had survived their first ST-segment elevation AMI ≤ 35 years of age. Patients were categorized into 4 groups by 6-h intervals over 24 h. Results In 49 patients (19.1%) the clinical presentation of AMI was atypical. The symptoms onset was as follows: 00:01 to 06:00, 19.1%, 06:01 to 12:00, 32.4%; 12:01 to 18:00, 28.1%; and 18:01 to 24:00, 20.3%. There was a significant association between the time of day and the likelihood of symptoms onset (Rayleigh test, p < 0.001). Between 00:01 and 06:00 the incidence of AMI onset was lower than expected and between 06:01 and 12:00 was higher ( p = 0.034 and p = 0.011, respectively), whereas in the other 6-h period groups no difference was found between expected and observed AMI incidence ( p = 0.280 and p = 0.131). No significant differences were found regarding clinical characteristics, i.e. traditional risk factors, reperfusion treatment of AMI, ejection fraction of left ventricle, time interval from pain onset to hospital arrival, dietary habits and physical activity, among the 6-h period groups. Conclusions ST-segment elevation AMI in individuals ≤ 35 years of age follows a circadian pattern with a morning peak. This information might be useful for the prompt diagnosis and treatment of AMI in very young patients which occurs rarely and frequently with atypical clinical presentation.