Circadian variation in ST-segment elevation myocardial infarction: a nationwide analysis of onset, treatmentdelays, and culprit artery patterns

Pol Arch Intern Med. 2026 Jan 7:17188. doi: 10.20452/pamw.17188

Abstract

Introduction: ST-segment elevation myocardialinfarction (STEMI) onset follows a circadian rhythm, yet data from large contemporary national registries remain limited, particularly regarding how onset time influences treatment delays and coronary pathology.

Objectives: To examine circadian patterns of ST-segmentelevation myocardial infarction onset and their impact on treatment delays, culprit vessel involvement, and periprocedural mortality.

Patients and methods: We retrospectively analyzed 1,53,543ST-segment elevation myocardial infarction patients from the Polish National PCI Registry (ORPKI) between 2014 and 2022. We examined the hourly distribution of symptom onset and its associations with patient characteristics, treatmentdelays, and infarct-related artery location.

Results: ST-segment elevation myocardial infarctiononset showed pronounced circadian variation, peaking at 8:00 AM. Although the overall pattern was similar between sexes (P for interaction = 0.15), median onset timeoccurred significantly earlier in males than females (10:00 AM vs. 11:00 AM, P = 0.007). Nocturnal onset (e.g., 3:00 AM) was associated with substantially longer median pain-to-first-medical-contact times compared with daytime onset (180 vs. 90 minutes at 1:00 PM; P <0.001). We identified a novel opposing circadian rhythm for the infarct-related artery location: left anterior descending (LAD) artery identified as the infarct-related artery peaked during nocturnal hours with a nadir at noon, while right coronary artery (RCA) involvement demonstrated the inverse pattern (P <0.001). Despite delayed presentation, periprocedural mortality did not vary significantly by onset time.

Conclusions: This large nationwide cohort demonstrates that ST-segment elevation myocardial infarction onset follows arobust circadian pattern significantly affecting system delays. The discovery of opposing circadian rhythms for left anterior descending versus right coronary artery involvement suggests that time of day influences not only ST-segmentelevation myocardial infarction triggering but also its pathophysiological manifestation.

Disclaimer:

Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Impact of Early Percutaneous Coronary Intervention on Long-Term Survival in Patients With Acute Myocardial InfarctionCureus 18(1): e101145. DOI 10.7759/cureus.101145

Abstract

Background: Early percutaneous coronary intervention(PCI) is the recommended standard of care for acute myocardial infarction (AMI), but long-term outcomes in mixed real-world cohorts remain underreported. This study evaluated the effects of early percutaneous coronary intervention (≤24 hours) compared with delayed or no percutaneous coronary intervention on short- and long-term clinical outcomes.

Materials and methods: A five-year mixed cohort studywas conducted and included 891 consecutive acute myocardial infarction patients (early PCI, n = 446;delayed/no PCI, n = 445). Demographics, clinical characteristics, procedural data, and in-hospital outcomes were collected. Long-term outcomes, such as all-cause mortality, cardiovascular mortality, recurrent myocardialinfarction (MI), heart failure (HF) hospitalization, and major adverse cardiovascular events (MACE), were assessed over a median follow-up of 48 months. Propensity score matching and Cox proportional hazards models were usedto adjust for confounding. Statistical analyses were done in the IBM SPSS Statistics software, version 27.0 (IBM Corp., Armonk, NY, USA).

Results: Early percutaneous coronary intervention wasassociated with lower in-hospital mortality (18/446, 4.0% vs 35/445, 7.9%; p = 0.01), shorter door-to-balloon time (median65 vs 210 minutes; p < 0.001), and better left ventricular function (mean left ventricular ejection fraction (LVEF) 48.7% vs 46.2%; p < 0.001). Over a median follow-upof 48 months, early percutaneous coronary intervention significantly reduced all-cause mortality (62/446,13.9% vs 112/445, 25.2%; adjusted hazard ratio (HR) 0.54, 95% CI 0.40-0.73, p < 0.001), cardiovascular mortality (44/446, 9.9% vs 82/445, 18.4%; adjusted HR 0.53, 95% CI 0.37-0.77, p = 0.001), heart failure hospitalization (56/446, 12.6% vs 84/445, 18.9%; adjusted HR 0.66, 95% CI 0.47-0.93, p = 0.02), and major adverse cardiovascular events (92/446,20.6% vs 138/445, 31.0%; adjusted HR 0.63, 95% CI 0.49-0.82, p < 0.001). Recurrent myocardial infarction was slightly lower with early percutaneous coronary intervention (38/446,8.5% vs 49/445, 11.0%; adjusted HR 0.78, 95% CI 0.52-1.16, p = 0.21) but did not reach statistical significance.

Conclusion:Early percutaneous coronary intervention confers substantial short- and long-term survival benefits in acute myocardial infarction patients, with significant reductions in all-cause and cardiovascular mortality, heart failure hospitalization, and major adverse cardiovascular events. These findingsunderscore the critical importance of timely reperfusion, supporting guideline-driven early percutaneous coronary intervention strategies in real-world practice.

Disclaimer:

Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Lower Ticagrelor Dosing in the Dual Antiplatelet Regimen for Neurointerventional Procedures

https://doi.org/10.1136/jnis-2024-022536

Abstract

Background Ticagrelor, a P2Y12 inhibitor, offersa rapid onset and consistent platelet inhibition, making it a viable alternative for dual antiplatelet therapy (DAPT). The optimal ticagrelor dose for neurointerventional procedures, however, remains unclear. We report our experience with ticagrelor 60 mg twice daily plus aspirin 81 mg daily compared with the standard aspirin and clopidogrel regimen forintracranial stenting.

Methods We conducted a retrospective analysis ofa prospectively maintained database, identifying consecutive patients who underwent intracranial stenting for aneurysm treatment or intracranial atherosclerosis. Patients received either ticagrelor 60 mg with aspirin or aspirin with clopidogrel 75 mg daily. Primary outcomes included peri-procedural ischemic and/or hemorrhagic events within 30 days.Secondary outcomes were the median P2Y12 reaction unit and in-stent stenosis rates at 6-month follow-up.

Results Among 119 patients, 59 received ticagrelor and 60 (50.4%) received clopidogrel. Baseline characteristics including age and gender were comparable between the two groups, although the ticagrelor group had a higher proportion of African-American patients. The majority of patients underwent aneurysm treatment (n=105; 88.23%), while the remainder received stenting for intracranial atherosclerosis (n=14; 11.77%). No ischemic events occurred in either group and intracranial hemorrhage rates were comparable (1.7% in both groups). The median P2Y12 reaction unit was significantly lower in the ticagrelor group (69 vs 126, P<0.001).In-stent stenosis rates were lower with ticagrelor (5% vs 21%).

Conclusion Ticagrelor 60 mg for dual antiplatelet therapy in intracranial stenting is safe and effective. Larger prospective studies may be required to validate these findings.

Disclaimer:

Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.