Predictors of In-Hospital Prognosis After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Requiring Mechanical Support Devices

Shiraishi, Jun; Kohno, Yoshio; Sawada, Takahisa; Kimura, Masayoshi; Ariyoshi, Makoto; Matsui, Akihiro; Takeda, Mitsuo; Arihara, Masayasu; Hyogo, Masayuki; Shima, Takatomo; Okada, Takashi; Nakamura, Takeshi; Matoba, Satoaki; Yamada, Hiroyuki; Matsumuro, Akiyoshi; Kikuchi, Makoto; Furukawa, Koichi; Matsubara, Hiroaki; Group, The AMI-Kyoto Multi-Center Risk Study

doi:10.1253/circj.cj-09-0774

Cited by 16 publications

(13 citation statements)

References 19 publications

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“…22 Therefore, the TIMI grade might predict survival after percutaneous coronary intervention (PCI) in patients with ACS receiving PCPS, but final TIMI grade was not independently associated with the in-hospital mortality for these patients in a previous study. 22 In the present study, the final TIMI grade was also not significantly different between the survivor group and non-survivor group; furthermore, the door to reperfusion time and the rate of primary PCI were also not significantly different.…”

Section: Discussionmentioning

confidence: 94%

Predictive Score for Survival After Percutaneous Cardiopulmonary Support in Cardiovascular Disease Patients

Shirakabe

Nozaki

Hata

et al. 2013

Circ J

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2064SHIRAKABE A et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp the development of new devices and improvements in intensive care, a disappointingly high rate of short-term mortality is still observed. To date, there have been no guidelines established for the use of PCPS in patients with cardiovascular disease, although the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care state that it should be used for patients with disease of class IIb and with evidence level C. 5 Furthermore, the predictive factors for the survival of patients undergoing PCPS are also unclear. Because the extended use of this PCPS procedure, which requires highly specialized staff and equipment, might increase hospitals costs and affect resource utilization, ercutaneous cardiopulmonary support (PCPS) has recently become a common procedure because of its portability, rapid priming, and ease of handling. In 1992 the indications for PCPS were expanded to include medical emergency cases, based on the results of a multi-institutional study. 1 Therefore, PCPS has been used for severe cardiogenic shock or circulatory collapse complicating acute myocardial infarction, severe heart failure, fulminant myocarditis (FM), pulmonary thromboembolism, and refractory ventricular arrhythmia.

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Section: Discussionmentioning

confidence: 94%

Predictive Score for Survival After Percutaneous Cardiopulmonary Support in Cardiovascular Disease Patients

Shirakabe

Nozaki

Hata

et al. 2013

Circ J

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“…Several risk stratification models have been reported in the literature. The TIMI risk index is defined by age, SBP, and HR [4]. This risk index is used for assessment of severity for AMI and a triage during transportation.…”

Section: Discussionmentioning

confidence: 99%

“…The AMI-Kyoto multicenter risk study is a prospective, multicenter observational study of patients with AMI who were transferred to 15 participating institutions [4–7]. A total of 2,043 consecutive patients with AMI who were admitted at AMI Kyoto Multi-Center Risk Study Group Hospitals from January 2,009 to December 2,012 were enrolled in the present study.…”

Section: Methodsmentioning

confidence: 99%

A Simple Risk Stratification Model for ST-Elevation Myocardial Infarction (STEMI) from the Combination of Blood Examination Variables: Acute Myocardial Infarction-Kyoto Multi-Center Risk Study Group

et al. 2016

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BackgroundMany mortality risk scoring tools exist among patients with ST-elevation Myocardial Infarction (STEMI). A risk stratification model that evaluates STEMI prognosis more simply and rapidly is preferred in clinical practice.Methods and FindingsWe developed a simple stratification model for blood examination by using the STEMI data of AMI-Kyoto registry in the derivation set (n = 1,060) and assessed its utility for mortality prediction in the validation set (n = 521). We selected five variables that significantly worsen in-hospital mortality: white blood cell count, hemoglobin, C-reactive protein, creatinine, and blood sugar levels at >10,000/μL, <10 g/dL, >1.0 mg/dL, >1.0 mg/dL, and >200 mg/dL, respectively. In the derivation set, each of the five variables significantly worsened in-hospital mortality (p < 0.01). We developed the risk stratification model by combining laboratory variables that were scored based on each beta coefficient obtained using multivariate analysis and divided three laboratory groups. We also found a significant trend in the in-hospital mortality rate for three laboratory groups. Therefore, we assessed the utility of this model in the validation set. The prognostic discriminatory capacity of our laboratory stratification model was comparable to that of the full multivariable model (c-statistic: derivation set vs validation set, 0.81 vs 0.74). In addition, we divided all cases (n = 1,581) into three thrombolysis in myocardial infarction (TIMI) risk index groups based on an In TIME II substudy; the cases were further subdivided based on this laboratory model. The high laboratory group had significantly high in-hospital mortality rate in each TIMI risk index group (trend of in-hospital mortality; p < 0.01).ConclusionsThis laboratory stratification model can predict in-hospital mortality of STEMI simply and rapidly and might be useful for predicting in-hospital mortality of STEMI by further subdividing the TIMI risk index.

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“…A short CCU stay (defined as a CCU stay ≤ 3 days) served as the dependent variable. Since age, sex, Killip class, the use of intra-aortic balloon pump support, anterior MI, chronic renal failure, contrast amount, fluoroscopy time, pre-PCI TIMI flow grade, PCI success and STEMI were considered confounding factors, [20][21][22][23][24][25][26][27][28][29][30][31] these variables were entered into the regression model as the independent variables. All variables were simultaneously adjusted in one step.…”

Section: Methodsmentioning

confidence: 99%

Transradial Percutaneous Coronary Intervention for Acute Myocardial Infarction Reduces CCU Stay in Patients 80 or Older

et al. 2012

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SummaryTransradial percutaneous coronary intervention (PCI), which is less invasive than transfemoral PCI, may facilitate early rehabilitation of patients with acute myocardial infarction (AMI). The aim of our study was to investigate whether transradial PCI is associated with a shorter coronary care unit (CCU) stay in very elderly AMI patients (≥ 80 years old). We enrolled 116 AMI patients aged ≥ 80 years. There were 39 patients in the transradial group and 77 patients in the non-transradial group. The length of CCU stay, the length of hospital stay, in-hospital mortality, the day of the monitored sitting and standing test, and the occurrence of delirium were compared between the two groups. The duration of CCU stay in the transradial and non-transradial groups was 3.6 ± 1.5 days and 5.0 ± 3.2 days, respectively (P = 0.001). The duration of hospital stay in the transradial and non-transradial groups was 13.3 ± 7.4 days and 19.2 ± 11.1 days, respectively (P = 0.001). In-hospital mortality was not different between the two groups (7.7% versus 2.6%, P = 0.20). The day of the monitored standing test in the transradial and non-transradial groups was 3.2 ± 0.7 and 4.6 ± 2.3, respectively (P < 0.0001). Multivariate logistic regression analysis identified a transradial approach as an independent predictor of short (≤ 3 days) CCU stay (OR: 3.01, 95%CI: 1.16-7.83, P = 0.02). In conclusion, transradial PCI was associated with a shorter CCU stay in AMI patients ≥ 80 years old. Furthermore, transradial PCI facilitated early rehabilitation in this high risk population. (Int Heart J 2012; 53: 79-84) Key words: Acute myocardial infarction, Percutaneous coronary intervention, Transradial approach, Elderly T he transradial approach has become an option in current percutaneous coronary interventions (PCI). 1-3) Compared with transfemoral PCI, transradial PCI is a less invasive procedure with fewer bleeding complications.2-9) Recently, the transradial approach has been used for patients who require emergent PCI. [10][11][12][13] Since the transradial approach does not require complete bed rest, transradial PCI may facilitate early rehabilitation of patients with acute myocardial infarction (AMI). 5,8,9,[14][15][16] Elderly patients, especially those ≥ 80 years old, have an elevated risk of complications in the ICU or CCU setting. [17][18][19] Avoiding a prolonged CCU stay and early rehabilitation should be beneficial for this high risk population. Therefore, elderly AMI patients ≥ 80 years old may be suitable candidates for transradial PCI. We hypothesized that transradial PCI would shorten the CCU stay in very elderly AMI patients compared with a transfemoral or transbrachial approach. The aim of our study was to investigate whether transradial PCI is associated with a shorter CCU stay in AMI patients ≥ 80 years old. MethodsPatients: A retrospective review of medical records identified patients who met the following criteria: (1) persistent chest pain, elevation of creatine kinase (at least 2-fold above the normal upper limit)...

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Predictors of In-Hospital Prognosis After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Requiring Mechanical Support Devices

Cited by 16 publications

References 19 publications

Predictive Score for Survival After Percutaneous Cardiopulmonary Support in Cardiovascular Disease Patients

Predictive Score for Survival After Percutaneous Cardiopulmonary Support in Cardiovascular Disease Patients

A Simple Risk Stratification Model for ST-Elevation Myocardial Infarction (STEMI) from the Combination of Blood Examination Variables: Acute Myocardial Infarction-Kyoto Multi-Center Risk Study Group

Transradial Percutaneous Coronary Intervention for Acute Myocardial Infarction Reduces CCU Stay in Patients 80 or Older

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