In-Hospital Outcomes of Primary Percutaneous Coronary Interventions Performed at Hospitals With and Without On-Site Coronary Artery Bypass Graft Surgery

Shiraishi, Jun; Kohno, Yoshio; Sawada, Takahisa; Nishizawa, Shinya; Arihara, Masayasu; Hadase, Mitsuyoshi; Hyogo, Masayuki; Yagi, Takakazu; Shima, Takatomo; Okada, Takashi; Matoba, Satoaki; Yamada, Hiroyuki; Tatsumi, Tomohide; Kikuchi, Makoto; Furukawa, Koichi; Matsubara, Hiroaki

doi:10.1253/circj.71.1208

Cited by 20 publications

(17 citation statements)

References 23 publications

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“…Additionally, the results of this study confirmed previous observations that age, left main artery disease, and unsuccessful myocardial tissue reperfusion are predictive of unfavorable clinical outcomes in AMI patients. [15][16][17] The present study, therefore, further strengthens the relevance of these 3 clinical relevant factors on untoward clinical outcomes following AMI.…”

Section: Discussionsupporting

confidence: 80%

Interleukin-18 Levels on Admission Are Associated With Mid-Term Adverse Clinical Events in Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

et al. 2010

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SummaryThe long-term prognostic value of interleukin (IL)-18 in patients with ST-segment elevation acute myocardial infarction (STEMI) has been conflicting. Thus, the purpose of this study was to test whether the level of interleukin-18 measured on admission can predict long-term adverse clinical events in patients with STEMI who were undergoing percutaneous coronary intervention (PCI).We recruited 288 consecutive STEMI patients (210 men, average age [71.42 ± 10.32] years) with onset < 6 hours who were undergoing primary PCI, and 148 age-and gender-matched control subjects. Plasma levels of IL-18 were measured by enzyme-linked immunosorbent assay (ELISA) in all subjects. The patients with STEMI were then followed prospectively over 434 days (range, 0 to 642 days) for the occurrence of composite major adverse clinical events (MACE) (cardiac mortality, recurrent myocardial infarction, or readmission due to advanced heart failure). Patients with STEMI exhibited higher levels of plasma IL-18 (P < 0.001) compared with the control subjects. Positive correlations between IL-18 and cardiac troponin-I (cTnI ) (r = 0.353, P = 0.0004) and IL-18 and high-sensitivity C-reactive protein (hs-CRP) (r = 0.420, P < 0.001) were observed by Spearman's correlations analysis. Logistic regression analysis demonstrated that IL-18 ≥ 450 pg/mL (OR 10.854, 95% CI 2.328 to 50.594, P < 0.0001) was a significant independent predictor of composite MACE at 60 days. Cox regression analysis demonstrated that high plasma IL-18 levels were not correlated with the occurrence of long-term composite MACE.The level of plasma IL-18 on admission may predict 60-day adverse clinical outcome, but not the long-term adverse clinical events in patients with STEMI undergoing PCI, and may be useful for mid-term risk stratification. (Int Heart J 2010; 51: 75-81) Key words: Coronary heart disease, ST-segment elevation acute myocardial infarction, Percutaneous coronary intervention, Cytokine, Interleukin-18 (IL-18), Prognosis A therosclerosis is widely accepted as a chronic inflammatory disease initiated by different vascular and extravascular sources. 1) On the site of the atherosclerotic plaque, the intima is infiltrated with activated macrophages and T lymphocytes, both of which produce and secrete cytokines to drive the inflammatory process. 2)Acute coronary syndrome (ACS) is characterized by ruptured atherosclerotic coronary plaque with superimposed thrombosis, which constitutes the most common, general, and pathological background of ACS. A previous study has also demonstrated that inflammatory mechanisms play an essential role in triggering ACS. 3)Interleukin-18 (IL-18) is a multifunctional proinflammatory cytokine which can induce T lymphocytes and natural killer cells to produce interferon-γ.4) It was originally named interferon-γ inducing factor, 5) and was then later renamed IL-18 because it was found to have many other biological effects. Recent evidence has indicated that IL-18 is closely related to the progress of atherosclerotic plaques and the inst...

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Section: Discussionsupporting

confidence: 80%

Interleukin-18 Levels on Admission Are Associated With Mid-Term Adverse Clinical Events in Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

et al. 2010

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“…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. Variables reaching P<0.05 on univariate analysis were entered into the multivariate analysis.…”

Section: Discussionmentioning

confidence: 83%

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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“…espite recent outstanding advances in coronary interventional technologies, [1][2][3][4][5] cardiogenic shock is still the leading cause of death for patients with acute myocardial infarction (AMI). 6 Cardiogenic shock principally develops during the hospitalization and the widespread of percutaneous coronary intervention has certainly helped the hemodynamic compromise in patients with AMI.…”

mentioning

confidence: 99%

Acute Impact of Right Ventricular Infarction on Early Hemodynamic Course After Inferior Myocardial Infarction

Shiraki

Yokozuka

Negishi

et al. 2010

Circ J

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Background: Right ventricular myocardial infarction (RVMI) is the major cause of hypotension and/or shock (HpS) after acute inferior myocardial infarction (inferior AMI). It is, however, unclear how RVMI affects the acute hemodynamic course. Methods and Results:In the present study, 153 patients with inferior AMI caused by right coronary artery occlusion were examined. Associations between in-hospital outcome and HpS before admission (preER-HpS) or HpS after admission (postER-HpS) were assessed using multivariate logistic regression analysis. Multivariate analysis was also conducted to determine a predictor for postER-HpS, including clinical findings in the emergency room as independent variables. HpS developed in 48.4% of patients with inferior AMI. Patients with RVMI more frequently had HpS than their counterparts in the first 6 h after infarction onset. RVMI was, however, not associated with preER-HpS, but was independently with postER-HpS (odds ratio (OR): 10.1; 4.0-27.7), whereas left ventricular failure was associated with preER-HpS, but not with postER-HpS. Furthermore, RVMI (OR: 9.4; 3.6-27.1) identified at presentation predicted postER-HpS.Conclusions: Independent of concomitant left ventricular involvement, RVMI was significantly associated with postER-HpS, but not with preER-HpS. These findings highlight the importance of identifying RVMI immediately after admission in the setting of inferior AMI. (Circ J 2010; 74: 148 - 155)

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In-Hospital Outcomes of Primary Percutaneous Coronary Interventions Performed at Hospitals With and Without On-Site Coronary Artery Bypass Graft Surgery

Cited by 20 publications

References 23 publications

Interleukin-18 Levels on Admission Are Associated With Mid-Term Adverse Clinical Events in Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Interleukin-18 Levels on Admission Are Associated With Mid-Term Adverse Clinical Events in Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

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

Acute Impact of Right Ventricular Infarction on Early Hemodynamic Course After Inferior Myocardial Infarction

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