TY - JOUR
T1 - Presentation Times of Myocardial Infarctions to the Emergency Department: Disappearance of the Morning Predominance.
AU - Masiewicz, Spencer
AU - Gutovitz, Scott
AU - Hart, Leslie
AU - Leaman, Samuel Madden
AU - Jehle, Dietrich
N1 - Masiewicz S, Gutovitz S, Hart L, Leaman SM, Jehle D. Presentation Times of Myocardial Infarctions to the Emergency Department: Disappearance of the Morning Predominance [published online ahead of print, 2020 Mar 27]. J Emerg Med. 2020;S0736-4679(20)30004-4. doi:10.1016/j.jemermed.2020.01.002
PY - 2020/3/27
Y1 - 2020/3/27
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 - Emergency Department
KW - NSTEMI
KW - STEMI
KW - acute myocardial infarction
KW - circadian
KW - daily
KW - diurnal
KW - seasonal
UR - https://scholarlycommons.hcahealthcare.com/emergency/30
UR - https://doi.org/10.1016/j.jemermed.2020.01.002
M3 - Article
JO - Emergency Medicine
JF - Emergency Medicine
ER -