REVIEW  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2020 June;61(3):351-5

DOI: 10.23736/S0021-9509.17.10056-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Meta-analysis of day-of-week variation of acute aortic rupture or dissection

Hisato TAKAGI ¹ ✉, Tomo ANDO ², Shohei MITTA ¹, Takuya UMEMOTO ¹ on behalf of the All-Literature Investigation of Cardiovascular Evidence (ALICE) Group

¹ Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; ² Department of Cardiology, Detroit Medical Center, Detroit, MI, USA

INTRODUCTION: We performed a meta-analysis to assess the presence of a day-of-week rhythmic variability of acute aortic rupture or dissection (AARD) onset.
EVIDENCE ACQUISITION: Eligible studies were observational studies enrolling patients with AARD and reporting day-of-week variation of AARD. Study-specific estimates, i.e. day-of-week incidence of AARD, were combined using the random-effects model. Chronobiological analysis was performed by applying a partial Fourier series to pooled day-of-week incidence by using the inverse-variance weighted least-squares method.
EVIDENCE SYNTHESIS: We identified 9 eligible studies enrolling a total of 28,036 patients with AARD. Pooled incidence of AARD was 12.8% on Sunday, 15.9% on Monday, 14.8% on Tuesday, 15.1% on Wednesday, 14.7% on Thursday, 14.1% on Friday, and 12.1% on Saturday. Chronobiological analysis identified a significant (P=0.0098) day-of-week pattern in the occurrence of AARD with a peak on Monday and a nadir on Saturday. Pooled analysis demonstrated significantly more incidence on Monday than on Saturday (relative risk: 1.247; 95% CI: 1.131 to 1.374; P=0.012).
CONCLUSIONS: Incidence of AARD was 12.8%, 15.9%, 14.8%, 15.1%, 14.7%, 14.1%, and 12.1%, on Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday, respectively. A significant day-of-week pattern in the occurrence of AARD with a peak on Monday and a nadir on Saturday was identified with significantly more incidence on Monday than on Saturday.

KEY WORDS: Aortic rupture; Dissecting aneurysm; Meta-analysis