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Akihiro Ogushi, Shungo Hikoso, Tetsuhisa Kitamura, Daisaku Nakatani, H ...
Article type: ORIGINAL ARTICLE
Subject area: Acute Coronary Syndrome
2022 Volume 86 Issue 4 Pages
600-608
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: December 24, 2021
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Background:The Japan Circulation Society launched the STOP-MI campaign in 2014, focusing on immediate hospital arrival for acute myocardial infarction (AMI) treatment. This study aimed to determine the factors influencing longer prehospital time among patients with AMI in Japan.
Methods and Results:This study analyzed a total of 4,625 AMI patients enrolled in the Osaka Acute Coronary Insufficiency Study registry from 1998 to 2014. The prehospital time delay was defined as the time interval from the onset of initial symptoms to hospital arrival time ≥2 h. Among eligible patients, 2,927 (63.3%) had a prehospital time ≥2 h. In multivariable analyses, age 65–79 years (adjusted odds ratio [AOR] 1.19, 95% confidence interval [CI] 1.02–1.39), age ≥80 years (AOR 1.42, 95% CI 1.13–1.79), diabetes mellitus (AOR 1.33, 95% CI 1.16–1.52), and onset time of 0:00–5:59 h (AOR 1.63, 95% CI 1.37–1.95) were positively associated with prehospital time ≥2 h, whereas smoking (AOR 0.78, 95% CI 0.68–0.90) and ambulance use (AOR 0.37, 95% CI 0.32-0.43) were negatively associated with prehospital time ≥2 h.
Conclusions:Older age, diabetes mellitus, and nighttime onset were associated with prehospital time delay for AMI patients, whereas smoking and ambulance use were associated with no prehospital time delay. Healthcare providers and patients could help reduce the time to get to a medical facility by being aware of these findings.
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Kazuoki Dai, Nobuo Shiode, Yukiko Nakano
Article type: EDITORIAL
2022 Volume 86 Issue 4 Pages
609-610
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: February 17, 2022
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Noriaki Iwahashi, Mutsuo Horii, Jin Kirigaya, Takeru Abe, Masaomi Gohb ...
Article type: ORIGINAL ARTICLE
Subject area: Acute Coronary Syndrome
2022 Volume 86 Issue 4 Pages
611-619
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: December 11, 2021
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Background:Two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography (STE) after ST-elevation acute myocardial infarction (STEMI) can predict the prognosis. This study investigated the clinical significance of a serial 3D-STE can predict the prognosis after onset of STEMI.
Methods and Results:This study enrolled 272 patients (mean age, 65 years) with first-time STEMI treated with reperfusion therapy. At 24 h after admission, standard 2D echocardiography and 3D full-volume imaging were performed, and 2D-STE and 3D-STE were calculated. Within 1 year, 19 patients who experienced major adverse cardiac events (MACE; cardiac death, heart failure requiring hospitalization) were excluded. Among the 253 patients, 248 were examined with follow-up echocardiography. The patients were followed up for a median of 108 months (interquartile range: 96–129 months). The primary endpoint was the occurrence of a MACE; 45 patients experienced MACEs. Receiver operating characteristic curves and Cox hazard multivariate analysis showed that the 2D-global longitudinal strain (GLS) and 3D-GLS at 1-year indices were significant predictors of MACE. The Kaplan-Meier curve demonstrated that a 3D-GLS of >−13.1 was an independent predictor for MACE (log-rank χ2=165.5, P<0.0001). The deterioration of 3D-GLS at 1 year was a significant prognosticator (log-rank χ2=36.7, P<0.0001).
Conclusions:The deterioration of 3D-GLS measured by STE at 1 year after the onset of STEMI is the strongest predictor of long-term prognosis.
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Hidekazu Tanaka
Article type: EDITORIAL
2022 Volume 86 Issue 4 Pages
620-621
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: December 16, 2021
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Daichi Yamashita, Yuichi Saito, Takanori Sato, Tadahiro Matsumoto, Kan ...
Article type: ORIGINAL ARTICLE
Subject area: Acute Coronary Syndrome
2022 Volume 86 Issue 4 Pages
622-629
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: September 29, 2021
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Background:The PARIS and CREDO-Kyoto risk scores were developed to identify patients at risks of thrombotic and bleeding events individually after percutaneous coronary intervention (PCI). However, these scores have not been well validated in different cohorts.
Methods and Results:This 2-center registry enrolled 905 patients with acute myocardial infarction (MI) undergoing primary PCI. Patients were divided into 3 groups according to the PARIS and CREDO-Kyoto thrombotic and bleeding risk scores. The study endpoints included ischemic (cardiovascular death, recurrent MI, and ischemic stroke) and major bleeding events. Of 905 patients, 230 (25%) and 219 (24%) had high thrombotic and bleeding risks, respectively, with the PARIS scores, compared with 78 (9%) and 50 (6%) patients, respectively, with the CREDO-Kyoto scores. According to the 2 scores, >50% of patients with high bleeding risk had concomitant high thrombotic risk. During the mean follow-up period of 714 days, 163 (18.0%) and 95 (10.5%) patients experienced ischemic and bleeding events, respectively. Both PARIS and CREDO-Kyoto scores were significantly associated with ischemic and bleeding events after primary PCI. For ischemic events, the CREDO-Kyoto rather than PARIS thrombotic risk score had better diagnostic ability.
Conclusions:In the present Japanese cohort of acute MI patients undergoing contemporary primary PCI, the PARIS and CREDO-Kyoto thrombotic and bleeding risk scores were discriminative for predicting ischemic and bleeding events.
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Kensaku Nishihira, Yoshisato Shibata
Article type: EDITORIAL
2022 Volume 86 Issue 4 Pages
630-631
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: October 14, 2021
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Hiroaki Yokoyama, Hirofumi Tomita, Satoshi Honda, Kensaku Nishihira, S ...
Article type: ORIGINAL ARTICLE
Subject area: Acute Coronary Syndrome
2022 Volume 86 Issue 4 Pages
632-639
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: November 20, 2021
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Background:Acute myocardial infarction (AMI) patients with low body mass index (BMI) exhibit worse clinical outcomes than obese patients; however, to our knowledge, no prospective, nationwide study has assessed the effect of BMI on the clinical outcomes of AMI patients.
Methods and Results:In this multi-center, prospective, nationwide Japanese trial, 2,373 AMI patients who underwent emergent percutaneous coronary intervention within 12 h of onset from the Japanese AMI Registry (JAMIR) were identified. Patients were divided into the following 4 groups based on their BMI at admission: Q1 group (BMI <18.5 kg/m2, n=133), Q2 group (18.5≤BMI<25.0 kg/m2, n=1,424), Q3 group (25.0≤BMI<30.0 kg/m2, n=672), and Q4 group (30.0 kg/m2≤BMI, n=144). The primary endpoint was all-cause death, and the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. The median follow-up period was 358 days. Q1 patients were older and had lower prevalence of coronary risk factors. Q1 patients also had higher all-cause mortality and higher incidence of secondary endpoints than normal-weight or obese AMI patients. Multivariate analysis showed that low BMI (Q1 group) was an independent predictor for primary endpoint.
Conclusions:AMI patients with low BMI had fewer coronary risk factors but worse clinical outcomes than normal-weight or obese patients.
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Hiromasa Otake
Article type: EDITORIAL
2022 Volume 86 Issue 4 Pages
640-641
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: January 08, 2022
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Zhiyong Wang, Yuxia Yin, Jianfei Li, Wantao Qi, Bo Yu, Zhiru Xu, Wangl ...
Article type: ORIGINAL ARTICLE
Subject area: Acute Coronary Syndrome
2022 Volume 86 Issue 4 Pages
642-650
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: November 10, 2021
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Background:Application of drug-coated balloons (DCBs) is popular for the treatment of percutaneous coronary intervention (PCI). A new DCB has been designed as ultrasound-controlled paclitaxel releasing. This study was conducted to determine whether a DCB-only strategy has a similar safety profile and equal angiographic and clinical outcomes to DES implantation in primary ST-elevation myocardial infarction (STEMI) patients, as well as determine the efficiency and safety of this new DCB.
Methods and Results:Overall, 184 pretreated STEMI patients were randomized into DCB and DES groups with a 1:1 allocation. The main study end-point was late lumen loss (LLL) during the 9 months after PCI. Late lumen loss was reported to be 0.24±0.39 mm in the DCB group and 0.31±0.38 mm in the DES group (P=0.215). Diameter stenosis was 28.27±15.35% in the DCB group and 25.73±15.41% in the DES group (P=0.312). Major adverse cardiovascular events (MACEs) were reported in 3 patients (3.4%) in the DCB group and 4 patients (4.7%) in the DES group (P=0.718). TLR and TVR in the DCB group was 2.3%, 3.4% and 2.4%, 3.5% in the DES group (P=1.000), respectively. No cardiac death and stent thrombosis (ST) was found in the DCB group at 12 months clinical follow up.
Conclusions:The DCB-only strategy showed good angiographic and clinical outcomes in the 9- and 12-month follow-up periods, respectively. The VasoguardTM DCB is safe and feasible to treat STEMI patients.
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Seiji Koga, Satoshi Honda, Koji Maemura, Kensaku Nishihira, Sunao Koji ...
Article type: ORIGINAL ARTICLE
Subject area: Acute Coronary Syndrome
2022 Volume 86 Issue 4 Pages
651-659
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: January 22, 2022
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Background:Previous studies have reported that acute myocardial infarction (AMI) related to left anterior descending (LAD) lesion is associated with worse outcomes than left circumflex artery (LCX) or right coronary artery (RCA) lesions. However, it is unknown whether those relationships are still present in the contemporary era of primary percutaneous coronary intervention (PCI), using newer generation drug-eluting stents and potent antiplatelet agents.
Methods and Results:This study is a sub-analysis of the Japan AMI Registry (JAMIR), a multicenter, prospective registry enrolling 3,411 AMI patients between December 2015 and May 2017. Among them, 2,780 patients undergoing primary PCI for only a culprit vessel were included and stratified based on infarction-related artery type (LAD, LCX, and RCA). The primary outcome was 1-year cardiovascular death. The overall incidence of cardiovascular death was 3.4%. Patients with LAD infarction had highest incidence of cardiovascular death compared to patients with LCX and RCA infarction (4.8%, 1.3%, and 2.4%, respectively); however, landmark analysis showed that culprit vessel had no significant effect on cardiovascular death if a patient survived 30 days after primary PCI. LAD lesion infarction was an independent risk factor for cardiovascular death in adjusted Cox regression analysis.
Conclusions:The present sub-analysis of the JAMIR demonstrated that LAD infarction is still associated with worse outcomes, especially during the first 30 days, even in the contemporary era of PCI.
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Seung Hun Lee, Ki Hong Choi, Jeong Hoon Yang, Young Bin Song, Joo Myun ...
Article type: ORIGINAL ARTICLE
Subject area: Acute Coronary Syndrome
2022 Volume 86 Issue 4 Pages
660-667
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: July 28, 2021
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Background:Because no data were available regarding the effect of preexisting left ventricular filling pressure (LVFP) on clinical outcomes in patients with acute myocardial infarction (AMI), we evaluated whether preexisting high LVFP can determine outcomes of subsequent AMI events.
Methods and Results:Among 399,613 subjects who underwent echocardiography for various reason from August 2004 to June 2019, 231 had experienced subsequent AMI and were stratified according to preexisting LVFP: low LVFP (E/e’ ≤14) and high LVFP (E/e’ >14). The primary outcome was cardiac death at 30 days and 1 year after AMI. Overall, 19.5% had high LVFP prior to AMI events. Preexisting high LVFP was associated with an increased risk of cardiac death at 30 days (3.8% vs. 11.6%; adjusted hazard ratio (HR) 4.56, 95% confidence interval (CI) 1.20–17.24, P=0.026) and 1 year after AMI (7.9% vs. 35.9%; adjusted HR 4.14, 95% CI 1.79–9.57, P<0.001). Preexisting E/e’ as a continuous value was significantly associated with 1-year risk of cardiac death (adjusted HR 1.08, 95% CI 1.02–1.15, P=0.007). Follow-up echocardiography showed that patients with high LVFP did not show improvement in systolic or diastolic function.
Conclusions:Preexisting high LVFP was associated with poor clinical course and 1-year cardiac death after subsequent AMI, as well as no improvement in systolic or diastolic function.
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Yohei Okada, Sho Komukai, Tetsuhisa Kitamura, Takeyuki Kiguchi, Taro I ...
Article type: ORIGINAL ARTICLE
Subject area: Cardiac Arrest
2022 Volume 86 Issue 4 Pages
668-676
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: November 02, 2021
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Background:The hypothesis of this study is that latent class analysis could identify the subphenotypes of out-of-hospital cardiac arrest (OHCA) patients associated with the outcomes and allow us to explore heterogeneity in the effects of extracorporeal cardiopulmonary resuscitation (ECPR).
Methods and Results:This study was a retrospective analysis of a multicenter prospective observational study (CRITICAL study) of OHCA patients. It included adult OHCA patients with initial shockable rhythm. Patients from 2012 to 2016 (development dataset) were included in the latent class analysis, and those from 2017 (validation dataset) were included for evaluation. The association between subphenotypes and outcomes was investigated. Further, the heterogeneity of the association between ECPR implementation and outcomes was explored. In the study results, a total of 920 patients were included for latent class analysis. Three subphenotypes (Groups 1, 2, and 3) were identified, mainly characterized by the distribution of partial pressure of O2(PO2), partial pressure of CO2(PCO2) value of blood gas assessment, cardiac rhythm on hospital arrival, and estimated glomerular filtration rate. The 30-day survival outcomes were varied across the groups: 15.7% in Group 1; 30.7% in Group 2; and 85.9% in Group 3. Further, the association between ECPR and 30-day survival outcomes by subphenotype groups in the development dataset was as varied. These results were validated using the validation dataset.
Conclusions:The latent class analysis identified 3 subphenotypes with different survival outcomes and potential heterogeneity in the effects of ECPR.
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Takahiro Nakashima
Article type: EDITORIAL
2022 Volume 86 Issue 4 Pages
677-678
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: December 04, 2021
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Haruka Shida, Chika Nishiyama, Satoe Okabayashi, Yosuke Yamamoto, Tomo ...
Article type: ORIGINAL ARTICLE
Subject area: Cardiac Arrest
2022 Volume 86 Issue 4 Pages
679-686
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: November 10, 2021
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Background:Although bystanders’ performance is important to improve outcomes of patients after cardiac arrests, few studies have investigated the barriers of bystanders, including those who could not perform cardiopulmonary resuscitation or any other rescue actions in emergency situations. This study aimed to assess the relationship between the psychological barriers of laypersons who encountered emergency situations and their rescue actions.
Methods and Results:A questionnaire survey was conducted and this included laypersons who had encountered emergency situations during the last 5 years. Six questions were about the psychological barriers and 8 questions were about the laypersons’ rescue actions. The primary outcome was any rescue actions performed by laypersons in an actual emergency situation. Overall, 7,827 (92.8%) of 8,430 laypersons responded; of them, 1,361 (16.1%) had encountered emergency situations during the last 5 years, and 1,220 (14.5%) were eligible for inclusion in the analyses. Of the 6 psychological barriers, “fear of approaching a collapsed person” (adjusted odds ratio [AOR] 0.50; 95% confidence interval [95% CI] 0.32–0.79) and “difficulties in judging whether to perform any rescue action” (AOR 0.63; 95% CI 0.40–0.99) were significantly associated with performing any rescue actions.
Conclusions:The fear of approaching a collapsed person and difficulties in judging whether to take any actions were identified as the psychological barriers in performing any rescue actions by laypersons who encountered emergency situations.
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Kohei Kaneta, Kensuke Yokoi, Kota Jojima, Norihiko Kotooka, Koichi Nod ...
Article type: IMAGES IN CARDIOVASCULAR MEDICINE
2022 Volume 86 Issue 4 Pages
721-
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: November 06, 2021
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Toshinori Chiba, Sho Okada, Yusuke Kondo, Masayuki Ota, Jun-ichiro Ike ...
Article type: IMAGES IN CARDIOVASCULAR MEDICINE
2022 Volume 86 Issue 4 Pages
722-
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: November 16, 2021
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Tomoya Hasegawa, Yoshikazu Yazaki
Article type: IMAGES IN CARDIOVASCULAR MEDICINE
2022 Volume 86 Issue 4 Pages
723-
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: November 27, 2021
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Manabu Maeda, Tsuyoshi Isawa, Norio Tada
Article type: IMAGES IN CARDIOVASCULAR MEDICINE
2022 Volume 86 Issue 4 Pages
724-
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: December 04, 2021
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Keitaro Akita, Yutaro Kaneko, Ryota Sato, Keisuke Iguchi, Kenichiro Su ...
Article type: IMAGES IN CARDIOVASCULAR MEDICINE
2022 Volume 86 Issue 4 Pages
725-
Published: March 25, 2022
Released on J-STAGE: March 25, 2022
Advance online publication: December 02, 2021
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