Cannon C P, McCabe C H, Stone P H, Schactman M, Thompson B, Theroux P, Gibson R S, Feldman T, Kleiman N S, Tofler G H, Muller J E, Chaitman B R, Braunwald E
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Am J Cardiol. 1997 Feb 1;79(3):253-8. doi: 10.1016/s0002-9149(97)00743-1.
Circadian variation has been demonstrated in several types of acute cardiovascular disease, including acute myocardial infarction (AMI), sudden cardiac death, silent ambulatory ischemia, and thrombotic stroke. In contrast, no diurnal variation was observed in 1 study of non-Q-wave AMI, and limited data are available for unstable angina. To assess whether circadian variation is present in unstable angina and non-Q-wave AMI, we examined the time of onset of ischemic pain in 7,731 patients who were prospectively identified in the Thrombolysis in Myocardial Ischemia (TIMI) III Registry, 3,318 of whom were enrolled in the prospective study, and in 1,473 patients enrolled in the TIMI IIIB trial. A circadian variation in the onset of pain was observed, with an increase in the number of patients experiencing the onset of pain in the morning hours between 6 A.M. and 12 noon (p <0.001). This circadian variation was observed both in patients with unstable angina and in those with evolving non-Q-wave AMI. A similar circadian pattern was observed in all subgroups tested. These findings were confirmed in the TIMI IIIB trial and complement previous studies suggesting that circadian variation exists in the onset of the full spectrum of myocardial ischemic syndromes.
昼夜节律变化已在多种急性心血管疾病中得到证实，包括急性心肌梗死（AMI）、心源性猝死、无症状性动态缺血和血栓性中风。相比之下，在一项关于非Q波AMI的研究中未观察到昼夜变化，且关于不稳定型心绞痛的数据有限。为了评估不稳定型心绞痛和非Q波AMI中是否存在昼夜节律变化，我们在心肌缺血溶栓治疗（TIMI）III注册研究中前瞻性确定的7731例患者中检查了缺血性疼痛的发作时间，其中3318例患者纳入了前瞻性研究，另外1473例患者纳入了TIMI IIIB试验。观察到疼痛发作存在昼夜节律变化，上午6点至中午12点之间经历疼痛发作的患者数量增加（p<0.001）。在不稳定型心绞痛患者和进展性非Q波AMI患者中均观察到这种昼夜节律变化。在所有测试的亚组中均观察到类似的昼夜节律模式。这些发现在TIMI IIIB试验中得到了证实，并补充了先前的研究，表明在整个心肌缺血综合征谱的发作中存在昼夜节律变化。
