Circadian pattern of symptoms onset in patients ≤ 35 years presenting with ST-segment elevation acute myocardial infarction

• Our study suggests that AMI in young adults has a circadian pattern with a morning peak.
• ~ 20% of young patients with AMI have atypical clinical presentation.
• Smoking is the most prevalent risk factor for AMI in young adults.

BackgroundThere are scarce data regarding the circadian pattern of symptoms onset in young patients presenting with acute myocardial infarction (AMI). We explored whether young patients with ST-segment elevation AMI exhibit a circadian variation in symptoms onset.MethodsWe recruited prospectively 256 consecutive patients who had survived their first ST-segment elevation AMI ≤ 35 years of age. Patients were categorized into 4 groups by 6-h intervals over 24 h.ResultsIn 49 patients (19.1%) the clinical presentation of AMI was atypical. The symptoms onset was as follows: 00:01 to 06:00, 19.1%, 06:01 to 12:00, 32.4%; 12:01 to 18:00, 28.1%; and 18:01 to 24:00, 20.3%. There was a significant association between the time of day and the likelihood of symptoms onset (Rayleigh test, p < 0.001). Between 00:01 and 06:00 the incidence of AMI onset was lower than expected and between 06:01 and 12:00 was higher (p = 0.034 and p = 0.011, respectively), whereas in the other 6-h period groups no difference was found between expected and observed AMI incidence (p = 0.280 and p = 0.131). No significant differences were found regarding clinical characteristics, i.e. traditional risk factors, reperfusion treatment of AMI, ejection fraction of left ventricle, time interval from pain onset to hospital arrival, dietary habits and physical activity, among the 6-h period groups.ConclusionsST-segment elevation AMI in individuals ≤ 35 years of age follows a circadian pattern with a morning peak. This information might be useful for the prompt diagnosis and treatment of AMI in very young patients which occurs rarely and frequently with atypical clinical presentation.