Kono T, Morita H, Nishina T, Fujita M, Hirota Y, Kawamura K, Fujiwara A
Osaka Mishima Critical Care Medical Center, Osaka Medical College, Takatsuki, Japan.
J Am Coll Cardiol. 1996 Mar 15;27(4):774-8. doi: 10.1016/0735-1097(95)00552-8.
The present study investigated whether the onset of acute myocardial infarction and resistance to thrombolysis have similar circadian variations.
Circadian variations of the onset of acute myocardial infarction and resistance to thrombolysis in the early morning have been reported. Some studies have also reported a secondary peak incidence in late evening; however, it is not known whether the resistance to thrombolysis has a similar circadian variation in these patients.
Six hundred eight Japanese patients with an acute myocardial infarction were the subjects of the study. Two hundred forty-four of the 608 patients were treated with thrombolysis within 12 h of the onset of symptoms. One hundred thirteen patients received urokinase, and 131 patients received tissue-type plasminogen activator (t-PA) over 60 min. Patency of the infarct-related artery, the primary end point of the study, was evaluated at 60 min after the initiation of thrombolytic therapy, and Thrombolysis in Myocardial Infarction (TIMI) grade 0, 1 or 2 was defined as resistant to thrombolysis.
The onset of acute myocardial infarction and resistance to thrombolysis showed circadian variations with early morning and late evening peaks (p<0.001 and p<0.05, respectively). These circadian patterns showed similar distributions as evaluated with Spearman's method (r=0.70, p<0.05), although resistance to thrombolysis showed a phase difference of about 2 h earlier than the infarction incidence. The circadian variation of the resistance to thrombolysis was independent of the types of thrombolytic agents (urokinase or t-PA).
These findings suggest that adjustment of treatment based on the time of the onset of symptoms may be warranted for the patients with acute myocardial infarction.
本研究调查急性心肌梗死的发病及溶栓抵抗是否具有相似的昼夜变化规律。
已有报道称急性心肌梗死的发病及清晨溶栓抵抗存在昼夜变化规律。一些研究还报道了傍晚有第二个发病高峰；然而，尚不清楚这些患者的溶栓抵抗是否有相似的昼夜变化规律。
608例日本急性心肌梗死患者作为研究对象。608例患者中有244例在症状发作后12小时内接受了溶栓治疗。113例患者接受尿激酶治疗，131例患者在60分钟内接受组织型纤溶酶原激活剂（t-PA）治疗。在溶栓治疗开始60分钟后评估梗死相关动脉的通畅情况，这是本研究的主要终点，心肌梗死溶栓（TIMI）0级、1级或2级被定义为溶栓抵抗。
急性心肌梗死的发病及溶栓抵抗均呈现昼夜变化规律，清晨和傍晚出现高峰（分别为p<0.001和p<0.05）。尽管溶栓抵抗比梗死发病率早约2小时出现相位差异，但用Spearman方法评估时，这些昼夜模式显示出相似的分布（r=0.70，p<0.05）。溶栓抵抗的昼夜变化与溶栓药物类型（尿激酶或t-PA）无关。
这些发现表明，对于急性心肌梗死患者，根据症状发作时间调整治疗可能是必要的。
