Multiple Fistula Emptying into the Left Ventricle through the Entire Left Ventricular Wall.

Coronary artery fistulae are usually identified during invasive coronary angiographies. However, in this case, we made the early detection of coronary artery fistulae during non-invasive transthoracic echocardiography, by demonstrating diastolic multiple abnormal color Doppler flows on the entire left ventricular walls including left ventricular free wall, interventricular septum and apex, which were mimicking firecracker on the whole left ventricle. Fistulous communication from the coronary artery to the left ventricle is rare. Moreover, a case of multiple coronary fistulae emptying into the left ventricle through the entire left ventricular walls including left ventricular free wall, interventricular septum and apex is uncommon. We report a case of a 31-year-old woman who was diagnosed with multiple fistula communicating with entire left ventricular wall.

Erroneous computer electrocardiogram interpretation of atrial fibrillation and its clinical consequences.

BACKGROUND: The aim of this study was to determine the frequency and nature of errors made by computer electrocardiogram (ECG) analysis of atrial fibrillation (AF), and the clinical consequences. HYPOTHESIS: Computer software for interpreting ECGs has advanced. METHODS: A total of 10279 ECGs were collected, automatically interpreted by the built-in ECG software, and then reread by 2 cardiologists. AF-related ECGs were classified into 3 groups: overinterpreted AF (rhythms other than AF interpreted as AF), misinterpreted AF (AF interpreted as rhythms other than AF), and true AF (AF interpreted as AF by both computer ECG interpretation and cardiologists). RESULTS: There were 1057 AF-related ECGs from 409 patients. Among these, 840 ECGs (79.5%) were true AF. Overinterpretation occurred in 98 (9.3%) cases. Sinus rhythm and sinus tachycardia with premature atrial contraction and/or baseline artifact and sinus arrhythmia were commonly overinterpreted as AF. Heart rate ≤60 bpm and baseline artifact significantly increased the likelihood of overinterpreted AF. Misdiagnosis occurred in 119 (11.3%) cases, in which AF was usually misdiagnosed as sinus or supraventricular tachycardia. The presence of tachycardia and low-amplitude atrial activity significantly increased the likelihood of misdiagnosis of AF. Among the erroneous computer ECG interpretations, 17 cases (7.8%) were not corrected by the ordering physicians and/or repeat computer-ECG interpretation; inappropriate follow-up studies or treatments of the patients were undertaken with no serious sequelae. CONCLUSIONS: Erroneous computer ECG interpretation of AF was not rare. Attention should be concentrated on educating physicians about ECG appearance and confounding factors of AF, along with ongoing quality control of built-in software for automatic ECG interpretation.

Impact of multivessel coronary disease with chronic total occlusion on one-year mortality in patients with acute myocardial infarction.

BACKGROUND AND OBJECTIVES: The impact of multivessel coronary disease (MVD) with chronic total occlusion (CTO) on one-year mortality in patients with acute myocardial infarction (AMI) is not clearly known. We investigated the impact of MVD with concurrent CTO lesion on one-year mortality in patients with AMI. SUBJECTS AND METHODS: We studied 1008 consecutive patients who underwent coronary angiography between November 2005 and December 2008 with a diagnosis of AMI. RESULTS: Among 1008 patients, 432 patients (43%) had MVD, and 88 patients (8.7%) had CTO lesion. The one-year overall mortality was higher in patients with MVD than in patients with single vessel disease (SVD) (10.2% vs. 5.9%, p=0.012). However, the one-year overall mortality was not significantly higher in patients with CTO lesion than in patients without that lesion (12.5% vs. 7.3%, p=0.080). In multivariate analysis, independent predictors of one-year overall mortality were age older than 65 years {hazard ratio (HR) 2.41, 95% confidence interval (CI): 1.43 to 4.08}, Killip class ≥III (HR 3.59, 95% CI: 2.24 to 5.77), ST-elevation myocardial infarction (HR 2.45, 95% CI: 1.49 to 4.05) and MVD (HR 1.76, 95% CI: 1.07 to 2.89). CONCLUSION: Patients with MVD showed higher one-year mortality than patients with SVD. However, the presence of CTO was not an independent predictor of one-year mortality in this study that included patients with successfully revascularized CTO lesion.

Catecholaminergic polymorphic ventricular tachycardia in a patient with recurrent exertional syncope.

A 16-year-old male with a prior history of recurrent syncope was referred to our hospital after being resuscitated from cardiac arrest developed while playing volleyball. His electrocardiogram (ECG) demonstrated ventricular fibrillation at a local emergency department. After referral, an ECG showed bidirectional ventricular tachycardia (VT) and nonsustained Torsade de Pointes. Two days later, his heart rate became regular, and no additional episodes of VT were observed. His ECG showed sinus rhythm with a corrected QT interval of 423 msec, and two-dimensional echocardiography was unremarkable. We made the diagnosis of a catecholaminergic polymorphic VT. However, only premature ventricular complex bigeminy was induced on exercise ECG and epinephrine infusion tests, and the patient showed no episodes of syncope. His father and mother had different missense mutations in the cardiac ryanodine receptor on genetic testing. The proband had both mutations in different alleles and was symptomatic. It was recommended that the patient avoid competitive physical activities, and a ß-blocker was prescribed.

Familial Transthyretin Amyloidosis with Variant Asp38Ala Presenting with Orthostatic Hypotension and Chronic Diarrhea.

A 53-year-old man complained of orthostatic, non-rotating dizziness, and chronic watery diarrhea of several years duration. His nerve-conduction velocity test revealed peripheral sensory-motor polyneuropathy and he showed an autonomic function abnormality. Echocardiographic examination showed ventricular and atrial wall thickening with a granular "sparkling" appearance. Left ventricular systolic function was preserved but pseudonormal diastolic dysfunction was present. Coronary angiography showed normal coronary arteries and an endomyocardial biopsy revealed lesions consistent with cardiac amyloidosis. Colonoscopic biopsy also revealed the deposition of amyloid fibrils. Gene analysis found the transthyretin variant Asp38Ala. His son had same mutation, but three daughters did not. In conclusion, we report a case of familial transthyretin amyloidosis with Asp38Ala.

A case of chronic periaortitis with retroperitoneal fibrosis.

A 73-year-old man with a history of hypertension and ascending aortic dissection was hospitalized for aggravated abdominal pain and general ache for 3 months. Follow-up CT showed aggravated abdominal aortic hematoma with aneurysm, atherosclerotic periaortitis and bilateral hydronephrosis. An initial laboratory finding showed elevated levels of inflammatory markers and renal dysfunction. Positron emission tomography-CT showed an increased standardized uptake values level in the aortic arch, descending thoracic aorta, major branch, abdominal aorta, and common iliac artery. For bilateral hydronephrosis, a double J catheter insertion was performed. Tissue specimens obtained from previous surgery on the aorta indicated the infiltration of lympho-plasma cells without granuloma formation in the aortic wall. After a combined therapy of high dose steroid therapy with azathioprine, the patient's initial complaints of abdominal pain, weakness and azotemia improved. This case was diagnosed as chronic periaortitis based on aortic inflammation at biopsy, which was complicated with retroperitoneal fibrosis and ureteric obstruction.

Clinical characteristics of defecation and micturition syncope compared with common vasovagal syncope.

BACKGROUND: Little is known about the clinical characteristics of patients with situational syncope such as defecation syncope (DS) or micturition syncope (MS) compared with those with common vasovagal syncope (VVS). METHODS: Among 680 consecutive patients, who underwent a head-up tilt test between January 2006 and November 2010, 282 patients (40.4±16.7 years; 48.6% men) diagnosed as DS (n = 38), MS (n = 38), or common VVS (n = 208) were included. RESULTS: Ages at diagnosis (38.7±17.3 vs 48.3±14.1 vs 42.0±13.8, P = 0.004) and the first syncope (33.7±18.4 vs 44.5±15.3 vs 37.5±14.6, P = 0.002) were significantly less in patients with common VVS than those with DS or MS, respectively. The patients with MS were more likely to be men (73.7%, P = 0.036), whereas patients with DS were more commonly women (73.7%). No sexual preference was observed in patients with common VVS. Body mass index was significantly lower (P = 0.047) and syncopal episodes were more recurrent (P = 0.049) in patients with common VVS than those with DS or MS. The frequency of drinking alcoholbefore syncope was significantly higher in patients with MS (39.5%, P < 0.001). CONCLUSIONS: DS tended to occur in older women, whereas MS tended to occur in middle-aged men and drinking alcohol was an important precipitating factor for MS. However, common VVS was observed more in a thin and young population, which was more recurrent compared with those situational syncopes.

Threshold level of low-density lipoprotein cholesterol for the short-term benefit of statin therapy in the acute phase of myocardial infarction.

BACKGROUND: Little is known about the threshold level of low-density lipoprotein cholesterol (LDL-C) for statin therapy in acute myocardial infarction (AMI). HYPOTHESIS: The aim of this study was to investigate the short-term benefit of the statin in post-MI patients with low LDL-C levels. METHODS: Between November 2005 and January 2008, 6866 statin-naive patients were selected from the Korea AMI registry. Major adverse cardiac event (MACE) was defined as a composite of death, recurrent MI, and revascularizations. RESULTS: The 6-month MACE and mortality showed a U-shaped curve, with the lowest rate at 114-122 mg/dL. Propensity scores for statin use were calculated for patients with LDL-C ≤ 113 mg/dL, and they were used to match the patients who received statin (statin user, n = 1031) with those who did not receive it (statin nonuser, n = 1031). The 6-month MACE was not significantly different between statin users and statin nonusers (9.4% vs 11.0%; hazard ratio [HR]: 0.847, 95% confidence interval [CI]: 0.646-1.111, P = 0.230), whereas the 6-month mortality was significantly lower in statin users (7.2% vs 9.7%; HR: 0.728, 95% CI: 0.539-0.984, P = 0.039). However, when the analyses were repeated in the patients with LDL-C ≤ 105 mg/dL, not only the 6-month MACE (9.5% vs 9.9%; HR: 0.945, 95% CI: 0.700-1.277, P = 0.713) but also the 6-month mortality (7.0% vs 8.7%; HR: 0.793, 95% CI: 0.566-1.111, P = 0.177) was not significantly different between statin users and statin nonusers (n = 876 in each group). CONCLUSIONS: The beneficial effects of statin therapy seem to vanish when LDL-C is below a certain level in AMI patients.

Incidence of hypertension in Korea: 5-year follow-up study.

Limited data are available about the incidence of hypertension over the 5-yr in non-hypertensive subjects. The study subjects were 1,806 subjects enrolled in a rural area of Daegu, Korea for a cohort study from August to November 2003. Of them, 1,287 (71.3%) individuals had another examination 5 yr later. To estimate the incidence of hypertension, 730 non-hypertensive individuals (265 males; mean age = 56.6 ± 11.1 yr-old) at baseline examination were analyzed in this study. Hypertension was defined as either a new diagnosis of hypertension or self-reports of newly initiated antihypertensive treatment; prehypertension was if the systolic blood pressure was 120-139 mmHg and/or diastolic blood pressure was 80-89 mmHg. During the 5-yr follow-up, 195 (26.7%) non-hypertensive individuals developed incident hypertension. The age-adjusted 5-yr incidence rates of hypertension were 22.9% (95% confidence interval [CI] = 19.9-29.0) in overall subjects, 22.2% (95% CI = 17.2-27.2) in men, and 24.3% (95% CI = 20.4-28.2) in women. The incidence rates of hypertension significantly increased with age. In the multivariate analysis, prehypertension (Odds ratio [OR] 2.25; P < 0.001) and older age (OR 2.26; P = 0.010) were independent predictors for incident hypertension. In this rapidly aging society, population-based preventive approach to decrease blood pressure, particularly in subjects with prehypertension, is needed to reduce hypertension.

Serum uric acid as an independent and incremental prognostic marker in addition to N-terminal pro-B-type natriuretic peptide in patients with acute myocardial infarction.

BACKGROUND: There are limited data regarding the prognostic value of serum uric acid (UA) after acute myocardial infarction (AMI). We investigated whether UA predicts the prognosis independently and whether it has an incremental value to other factors, including N-terminal Pro-B-type natriuretic peptide (NT-ProBNP), in patients with AMI. METHODS AND RESULTS: This study included 850 patients with AMI who were enrolled in the Korea AMI Registry from a single center. A major adverse cardiovascular event (MACE) was defined as a composite of death, recurrent myocardial infarction, and revascularization. During 6-month follow-up, MACE developed in 109 (12.8%). UA was higher in patients with MACE than in those without MACE (6.5 ± 2.4 mg/dl vs. 5.4 ± 1.8 mg/dl, P < 0.001). In the Cox-proportional hazard model, UA (hazard ratio [HR] 1.297, 95% confidence interval [CI] 1.075-1.565, P=0.007) was an independent predictor for 6-month MACE in addition to log NT-ProBNP (HR 2.362, 95%CI 1.007-5.539, P = 0.048), heart rate (HR 1.028, 95%CI 1.009-1.047, P = 0.004) and 3-vessel disease (HR 3.278, 95%CI 1.378 to 7.797, P = 0.007). UA had incremental prognostic value to conventional risk factors (chi-squar e= 8, P = 0.005), and to the combination of conventional factors and NT-ProBNP (chi-square = 10, P = 0.002). CONCLUSIONS: UA is an independent predictor of short-term prognosis and has incremental value to NT-ProBNP in patients with AMI.

Prognostic value of standard electrocardiographic parameters for predicting major adverse cardiac events after acute myocardial infarction.

BACKGROUND: The prognostic value of electrocardiographic (ECG) variables in predicting major adverse cardiac events (MACEs) after acute myocardial infarction (AMI) in the era of modern therapy is unclear. This study was conducted to evaluate the prognostic significance of ECG parameters in predicting 1-year MACEs for AMI patients. METHODS: Between January 2006 and January 2008, 529 AMI patients were included. ECG variables were analyzed from the ECG taken on discharge day. The 1-year MACEs were defined as death, nonfatal MI, and revascularization including repeat percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Mean follow-up duration was 360 ± 119 days. RESULTS: Of these patients, 497 (94%) patients provided complete follow-up data (355 males; 67 ± 12 years old). The rate of 1-year MACEs was 16%. In univariate analysis, heart rate, corrected QT interval, left ventricular (LV) hypertrophy, voltage (SV(1) + RV(5) ), lateral ST-depression (V(5-6) or I, aVL), pathologic Q wave (V(1-4) , V(5-6) ), ST-elevation (V(1-4) , V(5-6) or I, aVL), and T-wave inversion (V(1-4) , V(5-6) , or I, aVL) had a significant association with 1-year MACEs. In the Cox regression hazard model, lateral ST-depression (hazard ratio [HR] 2.260, 95% confidence interval [CI] 1.204 to 4.241, P = 0.011) and corrected QT interval (HR 1.007, 95% CI 1.002 to 1.011, P = 0.004) were independent predictors of 1-year MACEs. After adjustment for all risk variables, lateral ST-depression (HR 3.781, 95% CI 1.047 to 13.656, P = 0.042) was the only ECG variable that independently predicted 1-year MACEs. CONCLUSION: Lateral ST-depression on discharge day ECG is an independent predictor of 1-year MACEs after AMI.

Intravascular ultrasound guided recanalization of stumpless chronic total occlusion.

BACKGROUND: The recanalization success rate of blunt and vague stump (stumpless) CTO lesions, especially those with a side branch arising from the occlusion, has been significantly lower than that of tapered stump CTO lesions. Intravascular ultrasound (IVUS) may be useful to identify the occlusion point and may facilitate the passage of guide-wires. We evaluated the clinical feasibility of the IVUS-guided wiring technique for stumpless CTO lesions. METHODS: Thirty-one consecutive patients (7 women; mean age: 61.0 ± 8.9 years) with 32 lesions were enrolled. The IVUS catheter was introduced into the side branch and it was withdrawn from the side branch to find the entry point of the occlusion, trying to engage another stiffer guide-wire on the occlusion point with the help of real-time IVUS imaging. RESULTS: The left anterior descending artery was the most common target-lesion location (22 lesions [69%]). CTO lesions were successfully reopened in 26 lesions (81%). IVUS guidance allowed confident navigation of the stiff guide-wires. The entry point could not be identified in one, and full guide-wire passage was impossible in 4 with the IVUS guidance; TIMI 3 flow could not be achieved even after stent deployment in 1. Although procedure-related complications developed in 8 lesions (25%), no events were serious. Emergent operation was not needed and death or fatal myocardial infarction did not develop during or after the procedures. CONCLUSIONS: The IVUS-guided wiring technique is useful and safe for the recanalization of stumpless CTO lesions and might be a valuable tool for the recanalization of complex CTO lesions.

Presence of conduction abnormalities as a predictor of clinical outcomes in patients with infective endocarditis.

There have been no studies that have assessed the possible correlation between conduction abnormality (CA) and systemic embolism, or the long-term outcomes of patients with infective endocarditis (IE). In this study, 82 consecutive patients with IE and interpretable electrocardiography (ECG) were admitted to Kyungpook National University Hospital from July 2002 to June 2008. ECGs obtained at the time of admission or during hospitalization were analyzed. Patients with CA, which was defined as atrioventricular or intraventricular block, of "new" or "of unknown duration" were considered as those with CA. Composite events were defined as the composite of death and embolic events. Twenty-three (28%) patients had CA classified as new (n = 11) or of unknown duration (n = 12). No significant differences were found between patients with and without CA in terms of age and gender. Mean follow-up duration was 21 ± 23 months. Patients with CA had more frequent embolic events (p = 0.001) and composite events (p = 0.002) during hospitalization, and had more frequent composite events (p < 0.001) during follow-up than those without CA. Kaplan-Meier survival curves showed that patients with CA had a higher composite event rate during follow-up (p = 0.003). However, there was no significant difference between the two groups regarding mortality rates during hospitalization and follow-up. In multivariate analysis, CA was an independent predictor of embolic event rates during hospitalization [odds ratio (OR) 5.198, 95% confidence interval (CI) 1.086-24.867, p = 0.039] and of composite event rates during follow-up (OR 27.168, 95% CI 4.590-160.802, p < 0.001). CA is associated with increased frequency of embolic events during hospitalization and follow-up. Moreover, CA might be a useful predictor of embolic event occurrences during both hospitalization and follow-up.

Electrocardiography patterns and the role of the electrocardiography score for risk stratification in acute pulmonary embolism.

BACKGROUND AND OBJECTIVES: Data on the usefulness of a combination of different electrocardiography (ECG) abnormalities in risk stratification of patients with acute pulmonary embolism (PE) are limited. We thus investigated 12-lead ECG patterns in acute PE to evaluate the role of the ECG score in risk stratification of patients with acute PE. SUBJECTS AND METHODS: One hundred twenty-five consecutive patients (63±14 years, 56 men) with acute PE who were admitted to Kyungpook National University Hospital between November 2001 and January 2008 were included. We analyzed ECG patterns and calculated the ECG score in all patients. We evaluated right ventricular systolic pressure (RVSP) (n=75) and RV hypokinesia (n=80) using echocardiography for risk stratification of acute PE patients. RESULTS: Among several ECG findings, sinus tachycardia and inverted T waves in V(1-4) (39%) were observed most frequently. The mean ECG score and RVSP were 7.36±6.32 and 49±21 mmHg, respectively. The ECG score correlated with RVSP (r=0.277, p=0.016). The patients were divided into two groups {high ECG-score group (n=38): ECG score >12 and low ECG-score group (n=87): ECG score ≤12} based on the ECG score, with the maximum area under the curve. RV hypokinesia was observed more frequently in the high ECG-score group than in the low ECG-score group (p=0.006). Multivariate analysis revealed that a high ECG score was an independent predictor of high RVSP and RV hypokinesia. CONCLUSION: Sinus tachycardia and inverted T waves in V(1-4) were commonly observed in acute PE. Moreover, the ECG score is a useful tool in risk stratification of patients with acute PE.

Suboptimal use of evidence-based medical therapy in patients with acute myocardial infarction from the Korea Acute Myocardial Infarction Registry: prescription rate, predictors, and prognostic value.

BACKGROUND: Only limited data are available for the recent trend of optimal evidence-based medical therapy at discharge after acute myocardial infarction (AMI) in Asia. We evaluated the predictors for the use of optimal evidence-based medical therapy at discharge and the association between discharge medications and 6-month mortality after AMI. METHODS: Between November 2005 and January 2008, we evaluated the discharge medications among 9,294 post-MI survivors who did not have any documented contraindications to antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors (ACE-Is)/angiotensin II receptor blockers (ARBs), or statins in the Korea Acute Myocardial Infarction Registry. Optimal evidence-based medical therapy was defined as the use of all 4 indicated medications. RESULTS: Of these patients, 4,684 (50.4%) received all 4 medications at discharge. The discharge prescription rates of antiplatelet drugs, beta-blockers, ACE-Is/ARBs, and statins were 99.0%, 72.7%, 81.5%, and 77.2%, respectively. In multivariate analysis, advanced age, lower systolic blood pressure, higher Killip class at admission, left ventricular systolic dysfunction, higher blood creatinine level, lower total cholesterol levels, and coronary artery bypass grafting during hospitalization were independently associated with less use of optimal evidence-based medical therapy. In contrast, patients who underwent percutaneous coronary intervention were more likely to use optimal medications. In Cox proportional hazards model, optimal evidence-based medical therapy was an independent predictor of 6-month mortality after adjusting clinical characteristics and angiographic and procedural data. CONCLUSIONS: The optimal evidence-based medical therapy is prescribed at suboptimal rates, particularly in patients with high-risk features. New educational strategies are needed to increase the use of these secondary preventive medical therapies.

The impact of circadian variation on 12-month mortality in patients with acute myocardial infarction.

BACKGROUND AND OBJECTIVES: Although circadian variation in the onset of acute myocardial infarction (AMI) has been reported in a number of studies, not much is known about the impact of circadian variation on 12-month mortality. The aim of this study was to investigate the impact of circadian variation on 12-month mortality in patients with AMI. SUBJECTS AND METHODS: Eight hundred ninety two patients (mean age 67±12; 66.1% men) with AMI who visited Kyungpook National University Hospital from November 2005 to December 2007 were included in this study. Patients were divided into groups based on four 6-hours intervals: overnight (00:00-05:59); morning (06:00-11:59); afternoon (12:00-17:59) and evening (18:00-23:59). RESULTS: Kaplan-Meier survival curves showed 12-month mortality rates of 9.6%, 9.1%, 12.1%, and 16.7% in the overnight, morning, afternoon, evening-onset groups, respectively (p=0.012). Compared with the morning-onset AMI group, the serum creatinine levels (p=0.002), frequency of Killip class ≥3 (p=0.004), and prescription rate of diuretics (p=0.011) were significantly higher in the evening-onset AMI group, while the left ventricular ejection fraction (p=0.012) was significantly lower. The proportion of patients who arrived in the emergency room during routine duty hours was significantly lower in evening-onset groups irrespective of the presence or absence of ST-segment elevation (p<0.001). According to univariate analysis, the 12-month mortality rate in the evening group was significantly higher compared to the morning group (hazard ratio 1.998, 95% confidence interval 1.196 to 3.338, p=0.008). CONCLUSION: Patients with evening-onset AMI had poorer baseline clinical characteristics, and this might affect the circadian impact on 12-month mortality. Further studies are needed to clarify the role of circadian variation on the long-term outcome of AMI.

Examining the relationship between triggering activities and the circadian distribution of acute aortic dissection.

BACKGROUND AND OBJECTIVES: There are limited data examining triggering activities and circadian distribution at the onset of acute aortic dissection (AAD) in the context of diagnostic and anatomical classification. The aim of this study was to further investigate this relationship between triggering activities and circadian distribution at the onset of AAD according to diagnostic and anatomic classification. SUBJECTS AND METHODS: A total of 166 patients with AAD admitted to Kyungpook National University Hospital between July 2001 and June 2009 were included. To assess the influence of diagnostic and anatomical classification, we categorized the patients into intramural hematoma (IMH) group (n=67)/non-IMH group (n=99) and Stanford type A (AAD-A, n=94)/type B (AAD-B, n=72). To evaluate circadian distribution, the day was divided into four 6-hour periods: night (00-06 hours), morning (06-12 hours), afternoon (12-18 hours), and evening (18-00 hours). RESULTS: Most (72%) AAD episodes were related to physical (53%) and mental activities (19%), with about one-third occurring during the afternoon, and only 12% occurring at night. No differences in triggering activities or circadian distribution were observed among the groups. Waking hours including morning, afternoon, and evening correlated with triggering activities (p=0.003). These relationships were observed for the non-IMH (p=0.008) and AAD-B (p=0.003) cases. The remaining categories had similar relationships, but did not reach statistical significance. CONCLUSION: Our findings suggest differences in the relationship between triggering activities and the circadian distribution of the onset of AAD according to diagnostic and anatomical classification.

Influence of weather on daily hospital admissions for acute myocardial infarction (from the Korea Acute Myocardial Infarction Registry).

BACKGROUND: We investigated the association between meteorological parameters and hospital admissions for acute myocardial infarction (AMI) in a temperate and continental climate, Korea. METHODS: From the Korean AMI Registry, 2136 Koreans admitted for AMI in four university hospitals in Daegu city from November 2005 to October 2007 were included in this study. We calculated the incidences of AMI per season, per month, and per day-of-week. The meteorological parameters, including air temperature, relative humidity, wind speed, sunshine duration, and a thermo-hydrological index, were provided by the database of the Korea Meteorological Administration. Generalized additive Poisson models were used. RESULTS: Seasonal variations were noted for AMI, characterized by winter peak and summer trough (p<0.001). Monthly occurrence rate of AMI was highest in January and lowest in October (p<0.001). There were significant associations between hospital admissions and meteorological parameters including air temperature, relative humidity, and sunshine duration after controlling for effects of day-of-week, season, and holidays (p<0.05). These associations were stronger in females and the younger age (<65 years) (p<0.01). CONCLUSIONS: The incidence of AMI shows seasonal and monthly variations. Meteorological parameters have a significant influence on the occurrence of AMI, particularly in females and the younger age.