| Objective:The objective of this study is to investigate the circadian rhythm of acute ST-segment elevation myocardial infarction(STEMI),and to analyze the influencing factors of circadian rhythm and its effects on major adverse cardiovascular events(MACE)during hospitalization,so as to provide a new strategy for the prevention and treatment of STEMI.Method:A total of 547 STEMI patients admitted to the Department of Cardiology of the First Affiliated Hospital of Jinan University from May 1,2014 to December 31,2018 were retrospectively enrolled.The clinical baseline data and the incidence of MACE during hospitalization of the enrolled patients were collected through the electronic medical record system.The histogram of STEMI occurrence at different time points was drawn,and the distribution difference was evaluated by chi-square goodness of fit test.Clinical data of the four groups were compared according to the onset time of symptoms: 00:00-05:59,06:00-11:59,12:00-17:59,and 18:00-23:59.According to the circadian rhythm of STEMI,the patients were divided into the peak onset group and the non-peak onset group,and the MACE group and the non-MACE group according to the occurrence of MACE.Univariate analysis and unconditional logistic regression analysis were conducted on the clinical indicators of the patients in the two groups,respectively,to explore the influencing factors of the circadian rhythm of STEMI and the occurrence of MACE during hospitalization.Result:1.The circadian rhythm of STEMI occurred as a morning peak,and the onset peak occurred in 06:00-11:59 by 6h,08:00-11:59 by 4h,and 10:00-11:59 by 2h.The chi-square goodness of fit test showed that the distribution was statistically different(all P < 0.001).2.Compared with non-06:00-11:59 group,STEMI patients in 06:00-11:59 group had higher triglyceride(TG)[1.63(1.24,2.25)vs.1.47(0.98,2.13),P=0.006] and lower creatine kinase isoenzymes MB(CK-MB)[89.50(33.00,211.00)vs.111.00(52.00,261.00),P=0.021].Unconditional logistic regression analysis showed that hypertension was an independent risk factor for the onset of STEMI between 06:00 and11:59 [OR=1.483,95%CI(1.028,2.139),P=0.035].3.Compared with the other three groups,STEMI patients in the 00:00-05:59 group had higher incidences of in-hospital MACE(30.8% vs.17.3% vs.14.5% vs.20.0%,P=0.018)and Heart failure(HF)(25.3% vs.13.3% vs.12.3% vs.17.2%,P=0.040).Compared with the non-MACE group,STEMI patients in the MACE group had more cases with onset from 00:00 to 05:59(26.2% vs.14.3%,P=0.003),higher Cys-C [1.32(1.00,1.80)vs.1.11(0.92,1.34),P=0.000],and lower LVEF(46.45±10.96 vs.56.79±7.53,P=0.000).Compared with the non-HF group,STEMI patients in the HF group had more cases with onset from 00:00 to 05:59(26.1% vs.14.8%,P=0.009),higher Cys-C [1.34(0.99,1.81)vs.1.11(0.93,1.35),P=0.000],and lower LVEF(45.54±11.43 vs.56.57±7.58,P=0.000).Unconditional logistic regression analysis showed that onset from 00:00 to05:59 was not the influencing factor of MACE [OR=1.656,95%CI(0.826,3.320),P=0.137] and HF [OR=1.827,95%CI(0.876,3.808),P=0.175] in STEMI patients during hospitalization.Cys-C was an independent risk factor for MACE [OR=2.217,95%CI(1.309,3.757),P=0.003] and HF [OR=1.950,95%CI(1.125,3.380),P=0.017]in STEMI patients during hospitalization.High LVEF was a protective factor for MACE[OR=0.893,95%CI(0.865,0.922),P=0.000] and HF [OR=0.890,95%CI(0.861,0.921),P=0.000] in STEMI patients during hospitalization.Conclusion:1.The circadian rhythm of STEMI occurred as the morning onset peak.2.Hypertension was an independent risk factor for the morning onset peak of STEMI.3.There’s no significant relationship between the onset time and the occurrence of MACE and HF in STEMI patients during hospitalization.Cys-C was an independent risk factor for MACE and HF in STEMI patients during hospitalization,and high LVEF was a protective factor for MACE and HF in STEMI patients during hospitalization. |
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