Circadian variation in the effectiveness of reperfusion therapy in ST-segment elevation myocardial infarction treated with primary angioplasty and circadian associations with prognosis
Barneto Valero MC, Garmendia Leiza JR, Bautista Encarnación D, Benéit Montesinos JV, Fernández Ortiz A, Suárez Barrientos A, García Klepzig JL, Fernández Pérez C, Aguilar García MD, Ibáñez B
Affiliation of the authors
SAMUR-PC, Madrid, Spain. Complejo Asistencial Universitario de Palencia, Palencia, España. GIR Laboratorio de Procesado de Imagen, Universidad de Valladolid, Valladolid, Spain. Hospital Clínico San Carlos, Madrid, Spain. Universidad Complutense de Madrid, Madrid, Spain. Hospital Clínico San Carlos, Madrid, Spain. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain. EAP Aguilar del Campo, Palencia, Spain. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), IIS Fundación Jiménez Díaz, Madrid, Spain.
Barneto Valero MC, Garmendia Leiza JR, Bautista Encarnación D, Benéit Montesinos JV, Fernández Ortiz A, Suárez Barrientos A, et al. Circadian variation in the effectiveness of reperfusion therapy in ST-segment elevation myocardial infarction treated with primary angioplasty and circadian associations with prognosis. Emergencias. 2016;28:327-32
Summary
Objectives.
To explore circadian variation in the effectiveness of percutaneous transluminal coronary angioplasty (PTCA) to treat ST-elevation myocardial infarction (STEMI) To explore the effects of circardian variation on infarct extension and
in-hospital complications.
Methods.
Observational retrospective cohort study including patients with PTCA-treated STEMI in a tertiary care university hospital between March 2003 and August 2009. The independent variable of interest was the time of onset of STEMI symptoms, grouped in 6-hour time frames. The main outcome variable was PTCA effectiveness. Secondary outcome variables were infarct extension and the presence of in-hospital complications.
Results.
A total of 522 patients records were studied. The mean (SD) age was 62.3 (13.6) years and 404 (77.4%) were men. The largest proportion of PTCA-treated STEMI cases first experienced symptoms between 6 AM and 12 PM (201 cases, 38.5%) (P<.001). PTCA was ineffective in 122 (23.4%). The 6 AM to 12 PM time frame was an independent predictor of PTCA ineffectiveness (odds ratio, 1.79; 95% CI, 1.09–2.94; P=.012). Onset in this interval was also associated with infarct extension but not with in-hospital complications.
Conclusions.
A time of onset of STEMI between 6 AM and 12 PM predicts the ineffectiveness of PTCA and greater infarct extension but not in-hospital complications.
