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Cited by 374Acute Myocardial Infarction ResearchCardiac Ischemia and ReperfusionHeart rate and cardiovascular health

Increased morning incidence of myocardial infarction in the ISAM Study: absence with prior beta-adrenergic blockade. ISAM Study Group.

Willich, S N, Linderer, T, Wegscheider, K, Leizorovicz, A, Alamercery, I, Schröder, R·1989·Circulation
DOI 10.1161/01.cir.80.4.853
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Abstract

The time of acute myocardial infarction was determined in all 1,741 patients of the ISAM (Intravenous Streptokinase in Acute Myocardial Infarction) Study, based on onset of clinical symptoms and evaluation of plasma CK-MB enzyme time-activity curves. The incidence of myocardial infarction was markedly increased between 6:00 AM and 12:00 noon compared with other times of day (p less than 0.001). Myocardial infarction occurred 3.8 times more frequently between 8:00 and 9:00 AM (hour of maximum incidence) than between 12:00 midnight and 1:00 AM (hour of minimum incidence). Time of myocardial infarction based on clinical and enzymatic methods correlated well (r = 0.95). Patients with higher or lower left ventricular ejection fraction, higher or lower degree of wall motion abnormalities and residual stenosis of the coronary arteries, and one-, two-, or three-vessel disease exhibited a similar circadian pattern, suggesting that the morning is a risk period for patients with mild as well as severe coronary artery disease. Only the group of patients receiving beta-adrenergic blocking therapy before the event did not show an increased morning incidence of myocardial infarction. This observation may contribute to an understanding of the mechanisms by which beta-blockers reduce the incidence of myocardial infarction. Further investigation of physiologic changes occurring during the morning period of increased risk of myocardial infarction may lead to better understanding of the disorder. Design and timing of cardioprotective medication may play a crucial role in improving prevention of acute myocardial infarction.

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  • Murray et al. found no significant increase in cardiac events in morning as compared with afternoon cardiac-rehabilitation classes, but the study had insufficient power to exclude a relative risk of 6 or less.

    “Murray et al.33 found no significant increase in cardiac events in morning as compared with afternoon cardiac-rehabilitation classes, but the study had insufficient power to exclude a relative risk of 6 or less and many patients were taking beta-blockers, which might decrease a morning peak in onset.34-36”

    From Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion (1993) · cites this paper as [34]

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Research works printed but not linked: 28

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Cited by

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Authors
Willich, S. N., Linderer, T., Wegscheider, K., Leizorovicz, A., Alamercery, I., & Schröder, R.
Affiliations
Freie Universität Berlin (DE)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1989-10
Volume
80
Issue
4
Pages
853-858
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.80.4.853
OpenAlex
W2025481838
Cited by
374
References
3
Citations by year
2026: 5 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 5 · 2016: 4 · 2015: 4 · 2014: 8 · 2013: 8 · 2012: 12
FWCI
13.54
Type
journal article
Language
en
Open access
closed
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Cardiac Ischemia and Reperfusion
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
Keywords
acute myocardial infarction, circadian rhythm, beta-adrenergic blockade, beta-blockers, time of symptom onset, coronary artery disease, left ventricular ejection fraction, wall motion abnormalities, residual coronary stenosis, cardioprotection
MeSH terms
Adrenergic beta-Antagonists, Aged, Circadian Rhythm, Coronary Disease, Female, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Streptokinase

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