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Circadian variations in pathogenesis of ST-segment elevation myocardial infarction: an optical coherence tomography study

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Abstract

Previous studies have reported a circadian variation in the onset of ST-segment elevation myocardial infarction (STEMI). However, underlying mechanisms for the circadian variation have not been fully elucidated. We investigated the relationship between onset of STEMI and the underlying pathology using optical coherence tomography (OCT). Patients with a diagnosis of STEMI were selected from a multicenter OCT registry. Patients were divided into 4 groups based on the estimated time of onset (00:00–05:59, 06:00–11:59, 12:00–17:59, or 18:00–23:59). Underlying pathologies of MI (plaque rupture, plaque erosion, and calcified plaque) were compared among the 4 groups. Among 648 patients, plaque rupture was diagnosed in 386 patients (59.6%), plaque erosion in 197 patients (30.4%), and calcified plaque in 65 patients (10.0%). A marked circadian variation was detected in the incidence of plaque rupture with a peak at 09:00, whereas it was not evident in plaque erosion or calcified plaque. The probability of plaque rupture significantly increased in the periods of 06:00–11:59 [odds ratio (OR) 2.13, 95% confidence interval (CI) 1.30–3.49, p = 0.002] and 12:00–17:59 (OR 2.10, 95% CI 1.23–3.58, p = 0.005), compared to the period of 00:00–05:59. This circadian pattern was observed only during weekdays (p = 0.010) and it was not evident during the weekend (p = 0.742). Plaque rupture occurred most frequently in the morning and this circadian variation was evident only during weekdays. Acute MI caused by plaque rupture may be related to catecholamine surge.

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References

  1. Vedanthan R, Seligman B, Fuster V (2014) Global perspective on acute coronary syndrome: a burden on the young and poor. Circ Res 114(12):1959–1975

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Bhaskaran K, Hajat S, Haines A, Herrett E, Wilkinson P, Smeeth L (2010) Short term effects of temperature on risk of myocardial infarction in England and Wales: time series regression analysis of the Myocardial Ischaemia National Audit Project (MINAP) registry. BMJ 341:c3823

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mohammad MA, Karlsson S, Haddad J et al.(2018) Christmas, national holidays, sport events, and time factors as triggers of acute myocardial infarction: SWEDEHEART observational study 1998–2013. BMJ 363:k4811

    Article  PubMed  PubMed Central  Google Scholar 

  4. Muller JE, Stone PH, Turi ZG et al.(1985) Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 313:1315–1322

    Article  CAS  PubMed  Google Scholar 

  5. Hjalmarson A, Gilpin EA, Nicod P et al.(1989) Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction. Circulation 80(2):267–275

    Article  CAS  PubMed  Google Scholar 

  6. Holmes DR, Aguirre FV, Aplin R et al.(2010) Circadian rhythms in patients with ST-elevation myocardial infarction. Circulation 3(4):382–389

    PubMed  Google Scholar 

  7. Willich SN, Linderer T, Wegscheider K, Leizorovicz A, Alamercery I, Schroder R (1989) Increased morning incidence of myocardial infarction in the ISAM Study: absence with prior beta-adrenergic blockade. ISAM Study Group Circulation 80(4):853–858

    CAS  Google Scholar 

  8. Tofler GH, Muller JE, Stone PH et al.(1992) Modifiers of timing and possible triggers of acute myocardial infarction in the Thrombolysis in Myocardial Infarction Phase II (TIMI II) Study Group. J Am Coll Cardiol 20(5):1049–1055

    Article  CAS  PubMed  Google Scholar 

  9. Falk E, Nakano M, Bentzon JF, Finn AV, Virmani R (2013) Update on acute coronary syndromes: the pathologists' view. Eur Heart J 34(10):719–728

    Article  CAS  PubMed  Google Scholar 

  10. Jia H, Abtahian F, Aguirre AD et al.(2013) In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol 62(19):1748–1758

    Article  PubMed  Google Scholar 

  11. Ibanez B, James S, Agewall S et al.(2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39(2):119–177

    Article  PubMed  Google Scholar 

  12. Shiomi H, Nakagawa Y, Morimoto T et al.(2012) Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study. BMJ 344:e3257

    Article  PubMed  Google Scholar 

  13. Cannon CP, Gibson CM, Lambrew CT et al.(2000) Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 283(22):2941–2947

    Article  CAS  PubMed  Google Scholar 

  14. Eagle KA, Nallamothu BK, Mehta RH et al.(2008) Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go. Eur Heart J 29(5):609–617

    Article  PubMed  Google Scholar 

  15. Kubo T, Imanishi T, Takarada S et al.(2007) Assessment of culprit lesion morphology in acute myocardial infarction. J Am Coll Cardiol 50(10):933–939

    Article  PubMed  Google Scholar 

  16. Jang I-K, Tearney GJ, MacNeill B et al.(2005) In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation 111(12):1551–1555

    Article  PubMed  PubMed Central  Google Scholar 

  17. Higuma T, Soeda T, Abe N et al.(2015) A combined optical coherence tomography and intravascular ultrasound study on plaque rupture, plaque erosion, and calcified nodule in patients with ST-segment elevation myocardial infarction: incidence, morphologic characteristics, and outcomes after percutaneous coronary intervention. JACC Cardiovasc Interv 8(9):1166–1176

    Article  PubMed  Google Scholar 

  18. Dai J, Xing L, Jia H et al.(2018) In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study. Eur Heart J 39(22):2077–2085

    Article  PubMed  Google Scholar 

  19. Sugiyama T, Yamamoto E, Fracassi F et al.(2019) Calcified plaques in patients with acute coronary syndromes. JACC Cardiovasc Interv 12(6):531–540

    Article  PubMed  Google Scholar 

  20. Tearney GJ, Regar E, Akasaka T et al.(2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the international working group for intravascular optical coherence tomography standardization and validation. J Am Coll Cardiol 59(12):1058–1072

    Article  PubMed  Google Scholar 

  21. Weitzman ED, Fukushima D, Nogeire C, Roffwarg H, Gallagher TF, Hellman L (1971) Twenty-four hour pattern of the episodic secretion of cortisol in normal subjects. J Clin Endocrinol Metab 33(1):14–22

    Article  CAS  PubMed  Google Scholar 

  22. Tofler GH, Brezinski D, Schafer AI et al.(1987) Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 316(24):1514–1518

    Article  CAS  PubMed  Google Scholar 

  23. Panza JA, Epstein SE, Quyyumi AA (1991) Circadian variation in vascular tone and its relation to alpha-sympathetic vasoconstrictor activity. N Engl J Med 325(14):986–990

    Article  CAS  PubMed  Google Scholar 

  24. Millar-Craig MW, Bishop CN, Raftery EB (1978) Circadian variation of blood-pressure. Lancet 1(8068):795–797

    Article  CAS  PubMed  Google Scholar 

  25. Fukumoto Y, Hiro T, Fujii T et al.(2008) Localized elevation of shear stress is related to coronary plaque rupture: a 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution. J Am Coll Cardiol 51(6):645–650

    Article  PubMed  Google Scholar 

  26. Li ZY, Taviani V, Tang T et al.(2009) The mechanical triggers of plaque rupture: shear stress vs pressure gradient. Br J Radiol 82(1):S39–45

    Article  PubMed  Google Scholar 

  27. Mittleman MA, Mostofsky E (2011) Physical, psychological and chemical triggers of acute cardiovascular events: preventive strategies. Circulation 124(3):346–354

    Article  PubMed  PubMed Central  Google Scholar 

  28. Andreotti F, Davies GJ, Hackett DR et al.(1988) Major circadian fluctuations in fibrinolytic factors and possible relevance to time of onset of myocardial infarction, sudden cardiac death and stroke. Am J Cardiol 62(9):635–637

    Article  CAS  PubMed  Google Scholar 

  29. Ehrly AM, Jung G (1973) Circadian rhythm of human blood viscosity. Biorheology 10(4):577–583

    Article  CAS  PubMed  Google Scholar 

  30. Keatinge WR, Coleshaw SR, Cotter F, Mattock M, Murphy M, Chelliah R (1984) Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter. Br Med J (Clin Res Ed) 289(6456):1405–1408

    Article  CAS  Google Scholar 

  31. Partida RA, Libby P, Crea F, Jang IK (2018) Plaque erosion: a new in vivo diagnosis and a potential major shift in the management of patients with acute coronary syndromes. Eur Heart J 39(22):2070–2076

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pedicino D, Vinci R, Giglio AF et al.(2018) Alterations of hyaluronan metabolism in acute coronary syndrome: implications for plaque erosion. J Am Coll Cardiol 72(13):1490–1503

    Article  CAS  PubMed  Google Scholar 

  33. Murakami S, Otsuka K, Kubo Y et al.(2004) Repeated ambulatory monitoring reveals a Monday morning surge in blood pressure in a community-dwelling population. Am J Hypertens 17(12 Pt 1):1179–1183

    Article  PubMed  Google Scholar 

  34. Robertson D, Johnson GA, Robertson RM, Nies AS, Shand DG, Oates JA (1979) Comparative assessment of stimuli that release neuronal and adrenomedullary catecholamines in man. Circulation 59(4):637–643

    Article  CAS  PubMed  Google Scholar 

  35. Moncada S, Vane JR (1979) Arachidonic acid metabolites and the interactions between platelets and blood-vessel walls. N Engl J Med 300(20):1142–1147

    Article  CAS  PubMed  Google Scholar 

  36. Ogston D (1964) Fibrinolytic activity and anxiety and its relation to coronary artery disease. J Psychosom Res 8:219–222

    Article  CAS  PubMed  Google Scholar 

  37. Green LH, Seroppian E, Handin RI (1980) Platelet activation during exercise-induced myocardial ischemia. N Engl J Med 302(4):193–197

    Article  CAS  PubMed  Google Scholar 

  38. Estelles A, Tormo G, Aznar J, Espana F, Tormo V (1985) Reduced fibrinolytic activity in coronary heart disease in basal conditions and after exercise. Thromb Res 40(3):373–383

    Article  CAS  PubMed  Google Scholar 

  39. Levine SP, Towell BL, Suarez AM, Knieriem LK, Harris MM, George JN (1985) Platelet activation and secretion associated with emotional stress. Circulation 71(6):1129–1134

    Article  CAS  PubMed  Google Scholar 

  40. Naghavi M, Libby P, Falk E et al.(2003) From vulnerable plaque to vulnerable patient. Circulation 108(14):1664–1672

    Article  PubMed  Google Scholar 

  41. Sibley DR, Lefkowitz RJ (1985) Molecular mechanisms of receptor desensitization using the beta-adrenergic receptor-coupled adenylate cyclase system as a model. Nature 317(6033):124–129

    Article  CAS  PubMed  Google Scholar 

  42. Hofstetter A, Schutz Y, Jequier E, Wahren J (1986) Increased 24-hour energy expenditure in cigarette smokers. N Engl J Med 314(2):79–82

    Article  CAS  PubMed  Google Scholar 

  43. Hansen O, Johansson BW, Gullberg B (1992) Circadian distribution of onset of acute myocardial infarction in subgroups from analysis of 10,791 patients treated in a single center. Am J Cardiol 69(12):1003–1008

    Article  CAS  PubMed  Google Scholar 

  44. Ridker PM, Manson JE, Buring JE, Muller JE, Hennekens CH (1990) Circadian variation of acute myocardial infarction and the effect of low-dose aspirin in a randomized trial of physicians. Circulation 82(3):897–902

    Article  CAS  PubMed  Google Scholar 

  45. Jia H, Dai J, Hou J et al.(2017) Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study). Eur Heart J 38(11):792–800

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Ik-Kyung Jang’s research was supported by Mr. Michael and Mrs. Kathryn Park and by Mrs. Gill and Mr. Allan Gray. We are grateful to Iris McNulty, RN (Massachusetts General Hospital) for coordination and editorial work.

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Authors and Affiliations

  1. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA

    Makoto Araki, Osamu Kurihara, Akihiro Nakajima & Ik-Kyung Jang

  2. Department of Interventional Cardiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan

    Taishi Yonetsu

  3. Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Hang Lee

  4. Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan

    Tsunenari Soeda

  5. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Yoshiyasu Minami

  6. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Takumi Higuma

  7. Division of Cardiology, Kameda Medical Center, Chiba, Japan

    Shigeki Kimura

  8. Cardiovascular Center Nippon Medical School, Chiba Hokusoh Hospital, Inzai, Chiba, Japan

    Masamichi Takano

  9. Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

    Bryan P. Yan

  10. Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium

    Tom Adriaenssens

  11. Department of Cardiology, University of Giessen, Giessen, Germany

    Niklas F. Boeder & Holger M. Nef

  12. Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea

    Chong Jin Kim & Ik-Kyung Jang

  13. Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy

    Filippo Crea

  14. Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan

    Tsunekazu Kakuta

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  1. Makoto Araki
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Correspondence to Taishi Yonetsu or Ik-Kyung Jang.

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Ik-Kyung Jang has received educational grants from Abbott Vascular. They had no role in the design or conduct of this research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Araki, M., Yonetsu, T., Kurihara, O. et al. Circadian variations in pathogenesis of ST-segment elevation myocardial infarction: an optical coherence tomography study. J Thromb Thrombolysis 51, 379–387 (2021). https://doi.org/10.1007/s11239-020-02220-6

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