Comparison of the Efficacy of Reperfusion Therapies for Early Mortality From Acute Myocardial Infarction in Japan

Sakurai, Katsuhiko; Watanabe, Jun; Iwabuchi, Kaoru; Koseki, Yoshito; Konno, Yuji; Fukuchi, Mitsumasa; Komaru, Tatsuya; Shinozaki, Tsuyoshi; Miura, Makoto; Sakuma, Masashi; Kagaya, Yutaka; Kitaoka, Setsuko; Shirato, Kunio

doi:10.1253/circj.67.209

Cited by 42 publications

(25 citation statements)

References 33 publications

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“…We investigated whether a similar situation exists in Japanese hospitals. In contrast to Western countries, many hospitals in Japan can perform PCI and consequently, 75-94% of patients with STEMI undergo primary PCI for reperfusion therapy, [6][7][8] including those treated at low-volume centers. 11,12 Our find- ORs of prolonged DBT are shown.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Emergency Care for ST-Elevation Myocardial Infarction in an Urban Setting in Japan

Nakayama

Kimura

Endo

et al. 2009

Circ J

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he time from hospital admission to reperfusion is an important predictor of the outcome for patients with ST-elevation myocardial infarction (STEMI). 1-3 Guidelines for the management of STEMI issued by the American College of Cardiology/American Heart Association and the European Society of Cardiology recommend primary percutaneous coronary intervention (PCI) for reperfusion therapy when it can be performed in a timely manner (ie, door-to-balloon time (DTB) or first medical contact-to-balloon time within 90 min) by experienced operators at high-volume centers. 4,5 However, emergency primary PCI is not always feasible, and treatment is frequently delayed. In Japan, PCI can be performed at many hospitals, and the predominant strategy for reperfusion therapy is primary PCI, 6-9 but how rapidly reperfusion is achieved in Japanese hospitals that routinely perform PCI remains unclear. Drugs, devices, and techniques for primary PCI have been actively debated, whereas shortening the time to reperfusion has only recently received attention. This study evaluated DTB and analyzed its components in patients with STEMI who were admitted to emergency hospitals in an urban setting in Japan and examined differences in DTB according to the type of hospital. Methods Study PopulationWe retrospectively studied 369 patients (283 men, 86 women; mean age, 65 years) with STEMI who were admitted to 12 emergency hospitals in an urban setting in Japan and underwent emergency coronary angiography within 12 h after symptom onset. Patients with out-of-hospital cardiac arrest were excluded. All subjects had to have typical chest pain lasting for 20 min or more and ST-segment elevation in at least 2 adjacent leads (>0.1 mV in leads II, III, aVF, aVL, V4-6 and >0.2 mV in leads V1-3) on the admission electrocardiogram (ECG). The diagnosis of acute myocardial infarction (AMI) was confirmed by an increase in the creatine kinase level to more than twice the upper limit of normal. Another 20 patients with STEMI within 12 h after symptom onset were hospitalized during the study period, but did not undergo urgent cardiac catheterization because of advanced age or comorbidity. No patient Background: The door-to-balloon time (DTB) is an important predictor of the outcome for patients with STelevation myocardial infarction (STEMI). In Japan, percutaneous coronary intervention (PCI) can be performed at many hospitals, and the predominant strategy for reperfusion therapy is primary PCI. However, it remains unclear how rapidly reperfusion is achieved at these hospitals. Current Status of Emergency Care for ST-Elevation Myocardial Infarction in an Urban Setting in Japan

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Section: Discussionmentioning

confidence: 99%

Current Status of Emergency Care for ST-Elevation Myocardial Infarction in an Urban Setting in Japan

Nakayama

Kimura

Endo

et al. 2009

Circ J

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“…27,28 The SHOCK trial investigators 29 reported that early revascularization more effectively reduced mortality than medical therapy, so revascularization should be performed in all patients with CS after AMI as soon as possible. We previously reported that primary PCI reduced in-hospital mortality from 46.7% to 17.2%, 30 and in the present study the in-hospital mortality of the enrolled patients was 17.6%, which suggests that the early revascularization strategy significantly improved short-term survival; however, the moribund group, including the critical patients, were unable to undergo intensive invasive procedures, such as IABP insertion.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Major Adverse Cardiac Events in Acute Myocardial Infarction Patients Complicated by Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention

Lim

Jeong

Bae

et al. 2005

Circ J

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“…1,2) It is also widely accepted that direct percutaneous coronary intervention is an effective therapy in terms of maximizing the patient prognosis. 3,4) Despite this, in our study, we had some patients who showed a time-delay to peak-CK even after successful direct PCI.…”

Section: Discussionmentioning

confidence: 99%

“…1,2) One way to achieve this is direct percutaneous coronary intervention (PCI), now widely recognized as a useful and effective therapeutic strategy, and one associated with a good outcome for the patient. 3,4) The level of creatine kinase (CK) released from the damaged myocardium is a reflection of infarct size, 5.6) which means that there is a close relationship between high peak-CK value and poor prognosis.…”

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confidence: 99%

Prognostic Significance of Time-delay to Peak Creatine Kinase After Direct Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

et al. 2005

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SUMMARYThe aim of the present study was to investigate the prognostic significance of timedelay to peak creatine kinase (CK) after successful direct percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Our 240 consecutive first AMI attack subjects admitted within 5 hours from onset were successfully reperfused by direct PCI therapy. Subjects were divided into two groups according to the upper quartile value of peak-CK time from onset, the early peak-CK group (peak-CK time ≤ 16 hours from onset, n = 180) and the late peak-CK group (peak-CK time > 16 hours, n = 60).(I) The early ST-segment resolution rate was lower in the late peak-CK group compared with the early peak-CK group (P < 0.05), and there were significantly fewer patients with preinfarction angina pectoris in the late peak-CK group than in the early peak-CK group (P < 0.01). (II) LVEF in the chronic stage was significantly lower in the late peak-CK group than in the early peak-CK group (49 ± 13% versus 57 ± 13%, P < 0.001). (III) There were significantly more patients with major complications in the late peak-CK group than in the early peak-CK group (required CABG: 10% versus 3%, P < 0.05; cardiac death: 18% versus 3%, P = 0.0001). (IV) Multivariate analysis identified late peak-CK as an independent predictor of cardiac death (Odds ratio 7.91, 95% C.I. 1.40-44.11, P < 0.05).In patients with AMI, the time-delay to peak-CK after successful direct PCI may be closely related to left-ventricular systolic dysfunction and poor patient outcome, including mortality. (Int Heart J 2005; 46: 771-781)

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Comparison of the Efficacy of Reperfusion Therapies for Early Mortality From Acute Myocardial Infarction in Japan

Cited by 42 publications

References 33 publications

Current Status of Emergency Care for ST-Elevation Myocardial Infarction in an Urban Setting in Japan

Current Status of Emergency Care for ST-Elevation Myocardial Infarction in an Urban Setting in Japan

Predictive Factors of Major Adverse Cardiac Events in Acute Myocardial Infarction Patients Complicated by Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention

Prognostic Significance of Time-delay to Peak Creatine Kinase After Direct Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

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