State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China.
The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China.
J Am Coll Cardiol. 2022 May 31;79(21):2097-2115. doi: 10.1016/j.jacc.2022.03.370.
Shift work is associated with increased risk of acute myocardial infarction (AMI) and worsened prognosis. However, the mechanisms linking shift work and worsened prognosis in AMI remain unclear.
This study sought to investigate the impact of shift work on reperfusion injury, a major determinant of clinical outcomes in AMI.
Study patient data were obtained from the database of the EARLY-MYO-CMR (Early Assessment of Myocardial Tissue Characteristics by CMR in STEMI) registry, which was a prospective, multicenter registry of patients with ST-segment elevation myocardial infarction (STEMI) undergoing cardiac magnetic resonance (CMR) imaging after reperfusion therapy. The primary endpoint was CMR-defined post-reperfusion infarct size. A secondary clinical endpoint was the composite of major adverse cardiac events (MACE) during follow-up. Potential mechanisms were explored with the use of preclinical animal AMI models.
Of 706 patients enrolled in the EARLY-MYO-CMR registry, 412 patients with STEMI were ultimately included. Shift work was associated with increased CMR-defined infarct size (β = 5.94%; 95% CI: 2.94-8.94; P < 0.0001). During a median follow-up of 5.0 years, shift work was associated with increased risks of MACE (adjusted HR: 1.92; 95% CI: 1.12-3.29; P = 0.017). Consistent with clinical findings, shift work simulation in mice and sheep significantly augmented reperfusion injury in AMI. Mechanism studies identified a novel nuclear receptor subfamily 1 group D member 1/cardiotrophin-like cytokine factor 1 axis in the heart that played a crucial role in mediating the detrimental effects of shift work on myocardial injury.
The current study provided novel findings that shift work increases myocardial infarction reperfusion injury. It identified a novel nuclear receptor subfamily 1 group D member 1/cardiotrophin-like cytokine factor 1 axis in the heart that might play a crucial role in mediating this process. (Early Assessment of Myocardial Tissue Characteristics by CMR in STEMI [EARLY-MYO-CMR] registry; NCT03768453).
轮班工作与急性心肌梗死（AMI）风险增加和预后恶化有关。然而，轮班工作与 AMI 预后恶化之间的联系机制仍不清楚。
本研究旨在探讨轮班工作对再灌注损伤的影响，再灌注损伤是 AMI 临床结局的主要决定因素。
研究患者数据来自 EARLY-MYO-CMR（ST 段抬高型心肌梗死患者心脏磁共振早期评估组织特征）登记处的数据库，该登记处是接受再灌注治疗后进行心脏磁共振（CMR）成像的 ST 段抬高型心肌梗死（STEMI）患者的前瞻性、多中心登记处。主要终点是 CMR 定义的再灌注后梗死面积。次要临床终点是随访期间主要不良心脏事件（MACE）的综合指标。使用临床前 AMI 动物模型探索潜在机制。
在 EARLY-MYO-CMR 登记处纳入的 706 例患者中，最终纳入 412 例 STEMI 患者。轮班工作与 CMR 定义的梗死面积增加相关（β=5.94%；95%CI：2.94-8.94；P<0.0001）。在中位随访 5.0 年期间，轮班工作与 MACE 风险增加相关（调整后的 HR：1.92；95%CI：1.12-3.29；P=0.017）。与临床发现一致，在 AMI 中模拟轮班工作在小鼠和绵羊中显著加重了再灌注损伤。机制研究确定了心脏中一种新的核受体亚家族 1 组 D 成员 1/心营养素样细胞因子 1 轴，该轴在介导轮班工作对心肌损伤的有害影响方面起着关键作用。
本研究提供了新的发现，即轮班工作会增加心肌梗死再灌注损伤。它确定了心脏中一种新的核受体亚家族 1 组 D 成员 1/心营养素样细胞因子 1 轴，该轴可能在介导这一过程中起着关键作用。（STEMI 患者心脏磁共振早期评估组织特征登记研究[NCT03768453]）。
