Circadian distribution of acute myocardial infarction by anatomic location and coronary artery involvement

Purpose Acute myocardial infarction follows a circadian pattern, with a morning peak ascribed to sympathetic activation. However, about 20% of myocardial infarctions occur between midnight and 6 ; these events may have different characteristics. Methods We studied 1571 patients with acute myocardial infarction (866 anterior and 705 inferior myocardial infarctions) who were admitted to our coronary care units from January 1997 to February 2001. We noted the time of the infarction, its anatomic location, and the involved coronary arteries. Results Inferior myocardial infarctions were more frequent during the night (midnight to 6 ) than during other periods of the day (n = 238, 34% of all inferior infarctions, P<0.01). When coronary angiography was performed (795 patients), 92% (127/138) of inferior infarctions were due to right coronary artery occlusion, whereas only 54% (130/242) of the remaining inferior infarctions involved that artery. Conclusion Inferior myocardial infarctions occur disproportionately at night, usually due to right coronary artery occlusion. This suggests that a protective role for sleep may be limited to left coronary artery–related events.