title: Impact of Morning Onset on the Incidence of Recurrent Acute Coronary Syndrome and Progression of Coronary Atherosclerosis in Acute Myocardial Infarction.
abstract: The relationship between time of onset of acute myocardial infarction (MI) and long-term clinical outcome has not been completely understood. We hypothesized that morning onset acute MI may be associated with adverse cardiac events.
  
  
  
  This study involved 663 patients who underwent primary percutaneous coronary intervention (PCI). The main outcome measures were cardiac death, recurrent acute coronary syndrome (ACS), and re-hospitalization for heart failure. Major adverse cardiac events (MACE) were defined as a composite of individual adverse outcomes. Morning onset acute MI occurred in 212 patients (32.0%); they had higher rates of recurrent ACS (13% vs. 8%, P=0.03) and MACE (21% vs. 14%, P=0.012) than the patients with other times of onset. The PCI rate for progressive lesions was also higher than for patients with other times of onset (23% vs. 14%, P=0.013). On multivariate Cox regression analysis, morning onset was an independent predictor of recurrent ACS, MACE, and PCI for progressive lesions, with adjusted hazard ratios of 1.34 (95% CI: 1.06-2.92, P=0.030), 1.51 (95% CI: 1.02-2.23, P=0.038), and 1.58 (95% CI: 1.03-2.42, P=0.037), respectively.
  
  
  
  Morning onset may be associated with increased risk of recurrent ACS and coronary atherosclerosis progression.
authors.affiliation: Department of Cardiovascular Medicine, Nagasaki Harbor Medical Center City Hospital.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakashima
authors.forename: Yuka
authors.initials: Y
authors.lastname: Mashimo
authors.forename: Masaya
authors.initials: M
authors.lastname: Kurobe
authors.forename: Shigenori
authors.initials: S
authors.lastname: Muto
authors.forename: Shinnosuke
authors.initials: S
authors.lastname: Furudono
authors.forename: Koji
authors.initials: K
authors.lastname: Maemura
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery