Trappolini M, Matteoli S, Borgia M C, Rinaldi R, Chillotti F M, Trappolini F, Del Vecchio R L, Puletti M
Policlinico Umberto I, Dipartimento di Scienze Cliniche, Università degli Studi La Sapienza, Rome, Italy.
Minerva Cardioangiol. 2001 Oct;49(5):289-96.
Several studies have observed a circadian pattern in the onset of acute myocardial infarction (AMI), with a peak incidence in the morning hours. It has been suggested that different circadian rhythms may exist in various subgroups of patients.
This study sought to determine whether the circadian incidence of AMI varied by sex, age, cardiovascular risk factors, previous history of ischemic accidents, the site of AMI, and the short-term outcome. These possibilities were examined in a population of 597 consecutive patients with AMI, admitted to the coronary care unit. 548 patients have been included in the study, 442 men (80.6%) and 106 women (19.4 %); mean age 64.5 years.
A peak incidence of AMI was found between 06.01 a.m. and 12.00 a.m. (32.4%; p<0.0002). This peak was present in patients 65 years old (33.2%; p<0.005), in men (32.5%; p<0.0002) but not in women, in smokers (32.1%; p<0.0005) and in those that did not smoke (33.0%; p<0.04), in patients with hypercholesterolemia (34.9%; p<0.006 ) and without hypercholesterolemia (31.1%; p<0.03). A circadian rhythm was absent in diabetics, hypertensives and in patients with a history of previous cardiovascular events. Regarding the site of AMI, inferior AMI showed an increased incidence between 06.01 a.m. and 12.00 a.m. (36.2%; p<0.002), while the circadian distribution of anterior AMI, as well as non-Q wave AMI, did not show this incidence. Finally, higher mortality was reported in patients with an AMI onset at night (22.3%).
These results give further clues in understanding the external and inner factors acting in the morning hours as triggers for AMI.
多项研究观察到急性心肌梗死（AMI）发病存在昼夜节律模式，早晨时段发病率最高。有人提出不同亚组患者可能存在不同的昼夜节律。
本研究旨在确定AMI的昼夜发病率是否因性别、年龄、心血管危险因素、既往缺血性事件史、AMI部位及短期预后而有所不同。在收治于冠心病监护病房的597例连续AMI患者群体中对这些可能性进行了研究。548例患者纳入研究，其中男性442例（80.6%），女性106例（19.4%）；平均年龄64.5岁。
发现AMI发病率高峰出现在上午6:01至中午12:00之间（32.4%；p<0.0002）。该高峰出现在65岁患者中（33.2%；p<0.005）、男性中（32.5%；p<0.0002）而非女性中、吸烟者中（32.1%；p<0.0005）及不吸烟者中（33.0%；p<0.04）、高胆固醇血症患者中（34.9%；p<0.006）及无高胆固醇血症患者中（31.1%；p<0.03）。糖尿病患者、高血压患者及有既往心血管事件史的患者不存在昼夜节律。关于AMI部位，下壁AMI在上午6:01至中午12:00之间发病率增加（36.2%；p<0.002），而前壁AMI以及非Q波AMI的昼夜分布未显示出这种发病率。最后，夜间发生AMI的患者报告有更高的死亡率（22.3%）。
这些结果为理解在早晨时段作为AMI触发因素的外部和内在因素提供了进一步线索。
