Rigatelli Gianluca, Zuin Marco
Cardioavascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
Section of Internal and Cardiopulmonary Medicine, Faculty of Medicine, University of Ferrara, Ferrara, Italy.
J Saudi Heart Assoc. 2020 Apr 17;32(1):12-16. doi: 10.37616/2212-5043.1003. eCollection 2020.
The existence of a "weekend effect" for onset of acute myocardial infarction (AMI) has been suggested in the past, but the relation with the culprit vessel has not been investigated. MI due to left main coronary artery lesion represents a particularly serious life-threatening condition. Our study was aimed to assess the chronobiology of admission to the emergency department for AMI considered to be induced by a left main culprit lesion.
We retrospectively reviewed patients who experienced an AMI due to a left main culprit lesion between January 1, 2008 and January 1, 2018 stratifying them according to the day of admission, on the basis of the symptom onset time; the 30-day cardiovascular mortality was also analyzed on the basis of the time of symptom onset.
Out of 1789 patients with AMI, 130 (7.2%, 104 males and 26 females, mean age 74.5 ± 8.1 years) had left main disease as the culprit lesion. Tuesday was significantly over-represented as the admission day ( < 0.001 for Tuesday vs. other days; = 0.009 for Tuesday vs. Sunday, respectively). The 30-day cardiovascular survival was not different between patients admitted on Tuesday and those admitted on remaining days (Log-rank, Mantel Cox, = 0.43; Chi-square = 0.611). A significant difference was noted in patients with AMI on Sunday versus remaining days (Log-rank, Mantel-Cox, = 0.005; Chi-square = 7.96). The diameter of the left main artery was larger in patients admitted on Tuesdays than on Sundays ( < 0.01).
The relation between AMI onset and the day of the week is confirmed by our study, which also suggests that in case of a left main lesion, some delay of the weekend effect might be expected.
过去曾有人提出急性心肌梗死（AMI）发病存在“周末效应”，但与罪犯血管的关系尚未得到研究。左主冠状动脉病变导致的心肌梗死是一种特别严重的危及生命的情况。我们的研究旨在评估因左主罪犯病变导致的AMI患者急诊入院的时间生物学特征。
我们回顾性分析了2008年1月1日至2018年1月1日期间因左主罪犯病变发生AMI的患者，根据症状发作时间按入院日期进行分层；还根据症状发作时间分析了30天心血管死亡率。
在1789例AMI患者中，130例（7.2%，男性104例，女性26例，平均年龄74.5±8.1岁）以左主病变为罪犯病变。周二作为入院日的比例显著过高（周二与其他日期相比，P<0.001；周二与周日相比，P=0.009）。周二入院的患者与其余日期入院的患者30天心血管生存率无差异（对数秩检验，Mantel Cox检验，P=0.43；卡方检验=0.611）。周日发生AMI的患者与其余日期的患者有显著差异（对数秩检验，Mantel-Cox检验，P=0.005；卡方检验=7.96）。周二入院患者的左主冠状动脉直径大于周日入院患者（P<0.01）。
我们的研究证实了AMI发病与一周中的日期之间的关系，这也表明在左主病变的情况下，可能会出现周末效应的某种延迟。
