Guo Yibo, Cui Lina, Li Lulu, Wang Zhuozhong, Fang Chao, Yu Bo
Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.
State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Harbin Medical University, Harbin, China.
Front Cardiovasc Med. 2024 Dec 10;11:1393390. doi: 10.3389/fcvm.2024.1393390. eCollection 2024.
The peak incidence of cardiovascular diseases (CVD) usually occurs in the morning. This study aimed to investigate the exact distribution pattern of peak incidence of ST-segment elevation myocardial infarction (STEMI) in the Chinese population, and to explore whether it is associated with the prognosis.
This study included 7,805 patients with STEMI from the multicenter, prospective AMI cohort in China, for whom had a definite time of symptom onset. In the overall population and the predefined subgroup populations, the circadian rhythms of STEMI onset were statistically analyzed. Then patients were divided into four groups based on the time of onset (6 h interval) to assess the association of symptom onset time and major adverse cardiovascular and cerebrovascular events (MACCE) after discharge.
The onset of STEMI had a bimodal distribution: a well-defined primary peak at 8:38 AM [95% confidence interval (CI): 7:49 to 9:28 AM], and a less well-defined secondary peak at 12:55 PM (95% CI: 7:39 AM to 18:10 PM) (bimodal: < 0.001). A similar bimodal circadian rhythm pattern was observed in subgroups of patients with STEMI defined with respect to day of the week, age, sex, and coronary risk factors. Notedly, the two peaks on Sunday were significantly later than other days, and the secondary peaks became clear and concentrated. In addition, no significant difference was found in MACCE among the four groups ( = 0.905).
In the Chinese population, the onset of STEMI exhibited a bimodal circadian rhythm pattern, with a clear primary peak and a less clear secondary peak. One-year clinical outcomes were unrelated to the timing of STEMI onset.
心血管疾病（CVD）的发病率高峰通常出现在早晨。本研究旨在调查中国人群中ST段抬高型心肌梗死（STEMI）发病率高峰的确切分布模式，并探讨其是否与预后相关。
本研究纳入了来自中国多中心前瞻性AMI队列的7805例STEMI患者，这些患者有明确的症状发作时间。在总体人群和预先定义的亚组人群中，对STEMI发作的昼夜节律进行了统计分析。然后根据发作时间（间隔6小时）将患者分为四组，以评估症状发作时间与出院后主要不良心血管和脑血管事件（MACCE）的关联。
STEMI的发作呈双峰分布：上午8:38有一个明确的主要高峰[95%置信区间（CI）：上午7:49至9:28]，下午12:55有一个不太明确的次要高峰（95%CI：上午7:39至下午18:10）（双峰：<0.001）。在根据一周中的日期、年龄、性别和冠状动脉危险因素定义的STEMI患者亚组中观察到类似的双峰昼夜节律模式。值得注意的是，周日的两个高峰明显晚于其他日子，次要高峰变得清晰且集中。此外，四组之间的MACCE无显著差异（=0.905）。
在中国人群中，STEMI的发作呈现双峰昼夜节律模式，有一个明确的主要高峰和一个不太明确的次要高峰。一年的临床结局与STEMI发作时间无关。
