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Open Access 01-12-2019 | ST-Segment Elevation Myocardial Infarction | Research

Time-of-day at symptom onset was not associated with infarct size and long-term prognosis in patients with ST-segment elevation myocardial infarction

Authors: Hendrik B. Sager, Oliver Husser, Sabine Steffens, Karl-Ludwig Laugwitz, Heribert Schunkert, Adnan Kastrati, Gjin Ndrepepa, Thorsten Kessler

Published in: Journal of Translational Medicine | Issue 1/2019

Abstract

Background

ST-segment elevation myocardial infarction (STEMI) displays circadian variability with the highest incidence in the morning hours. Data on whether the time-of-day at symptom onset affects infarct size or patients’ long-term prognosis are conflicting. We sought to investigate the association of time-of-day at symptom onset with infarct size or long-term mortality in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).

Methods

This study included 1206 STEMI patients undergoing PPCI. All patients underwent single photon emission computed tomography (SPECT) imaging with 99mTc-sestamibi before and 7–14 days after PPCI. The co-primary endpoints were final infarct size on day 10 after STEMI and all-cause mortality at 5-year follow-up. Time-of-day at symptom onset of STEMI was categorized in 6-h intervals.

Results

In patients presenting from 0 to 6 h, 6 to 12 h, 12 to 18 h, and 18 to 24 h, the infarct sizes (median [25th–75th percentiles]) were 10.0 [3.0–24.7], 10.0 [3.0–24.0], 10.0 [3.0–22.0], and 9.0 [3.0–21.0] of the left ventricle, respectively (p = 0.87); the Kaplan–Meier estimates of 5-year all-cause mortality were 13.6%, 8.7%, 13.7% and 9.3%, respectively (log-rank test p = 0.30). After adjustment, time-of-day was not associated with infarct size (p ≥ 0.76 for comparisons with infarct size from reference [6–12 h] time interval) or 5-year all-cause mortality (p ≥ 0.25 for comparisons with mortality from reference [6–12 h] time interval). Time-of-day at symptom onset of STEMI was not associated with differences in the recovery of left ventricular ejection fraction 6 months after STEMI.

Conclusions

In patients with STEMI undergoing PPCI, time-of-day at symptom onset was neither associated with scintigraphic infarct size, left ventricular ejection fraction recovery at 6 months nor with 5-year mortality.

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Title: Time-of-day at symptom onset was not associated with infarct size and long-term prognosis in patients with ST-segment elevation myocardial infarction
Authors: Hendrik B. Sager
Oliver Husser
Sabine Steffens
Karl-Ludwig Laugwitz
Heribert Schunkert
Adnan Kastrati
Gjin Ndrepepa
Thorsten Kessler
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: ST-Segment Elevation Myocardial Infarction
Myocardial Infarction
Published in: Journal of Translational Medicine / Issue 1/2019
Electronic ISSN: 1479-5876
DOI: https://doi.org/10.1186/s12967-019-1934-z

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Time-of-day at symptom onset was not associated with infarct size and long-term prognosis in patients with ST-segment elevation myocardial infarction

Abstract

Background

Methods

Results

Conclusions

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Abstract

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