TY - JOUR
T1 - Presentation Times of Myocardial Infarctions to the Emergency Department
T2 - Disappearance of the Morning Predominance
AU - Masiewicz, Spencer
AU - Gutovitz, Scott
AU - Hart, Leslie
AU - Leaman, Samuel Madden
AU - Jehle, Dietrich
N1 - Funding Information:
This research was supported (in whole or in part) by the Healthcare Corporation of America (HCA) or an HCA-affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA or any of its affiliated entities.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/5
Y1 - 2020/5
N2 - Background: Previous studies show that myocardial infarctions (MIs) occur most frequently in the morning. Objectives: We hypothesized that there no longer is a morning predominance of MI, and that the timing of ST-elevation myocardial infarction (STEMI) vs. non-ST-elevation myocardial infarction (NSTEMI) presentation differs. Methods: We reviewed MI, STEMI, and NSTEMI patients (2013–2017) from a multiple-hospital system, identified by diagnostic codes. Daily emergency department arrival times were categorized into variable time intervals for count and proportional analysis, then examined for differences. Results: There were 18,663 MI patients from 12 hospitals included in the analysis. Most MIs occurred between 12:00 PM and 5:59 PM (35.7%), and least between 12:00 AM–5:59 AM (16.3%). After subdividing all MIs into STEMIs and NSTEMIs, both groups continued to have the greatest presentation between 12:00 PM and 5:59 PM (33.1% and 36.0%, respectively). STEMIs (17.2%) and NSTEMIs (16.2%) were least frequent between 12:00 AM and 5:59 AM. We found the second most common presentation time for MIs was in the 6 PM–11:59 PM time period, which held true for both subtypes (MI 26.7%, STEMI 26.4%, NSTEMI 26.7%). Conclusions: These data suggest a potential shift in the circadian pattern of MI, revealing an afternoon predominance for both STEMI and NSTEMI subtypes.
AB - Background: Previous studies show that myocardial infarctions (MIs) occur most frequently in the morning. Objectives: We hypothesized that there no longer is a morning predominance of MI, and that the timing of ST-elevation myocardial infarction (STEMI) vs. non-ST-elevation myocardial infarction (NSTEMI) presentation differs. Methods: We reviewed MI, STEMI, and NSTEMI patients (2013–2017) from a multiple-hospital system, identified by diagnostic codes. Daily emergency department arrival times were categorized into variable time intervals for count and proportional analysis, then examined for differences. Results: There were 18,663 MI patients from 12 hospitals included in the analysis. Most MIs occurred between 12:00 PM and 5:59 PM (35.7%), and least between 12:00 AM–5:59 AM (16.3%). After subdividing all MIs into STEMIs and NSTEMIs, both groups continued to have the greatest presentation between 12:00 PM and 5:59 PM (33.1% and 36.0%, respectively). STEMIs (17.2%) and NSTEMIs (16.2%) were least frequent between 12:00 AM and 5:59 AM. We found the second most common presentation time for MIs was in the 6 PM–11:59 PM time period, which held true for both subtypes (MI 26.7%, STEMI 26.4%, NSTEMI 26.7%). Conclusions: These data suggest a potential shift in the circadian pattern of MI, revealing an afternoon predominance for both STEMI and NSTEMI subtypes.
KW - acute myocardial infarction
KW - circadian
KW - daily
KW - diurnal
KW - Emergency Department
KW - NSTEMI
KW - seasonal
KW - STEMI
UR - http://www.scopus.com/inward/record.url?scp=85082525702&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85082525702&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2020.01.002
DO - 10.1016/j.jemermed.2020.01.002
M3 - Article
C2 - 32229136
AN - SCOPUS:85082525702
SN - 0736-4679
VL - 58
SP - 741
EP - 748
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 5
ER -