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Li YY, Zhong XJ, Luo JT, Zeng CM, Li H, Zhong LQ, Zou GX. Fondaparinux Sodium for Anticoagulant Therapy After Primary Percutaneous Coronary Intervention: A Single-Center Randomized Trial in China. J Cardiovasc Pharmacol 2024; 84:331-339. [PMID: 39240728 DOI: 10.1097/fjc.0000000000001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/13/2024] [Indexed: 09/08/2024]
Abstract
ABSTRACT In this study, we investigated the safety and efficacy of fondaparinux sodium in postpercutaneous coronary intervention (PCI) anticoagulation therapy for patients with ST-segment elevation myocardial infarction. There are a total of 200 patients with ST segment elevation myocardial infarction underwent PCI and anticoagulation therapy. They were randomly split into experimental (n = 108) and control groups (n = 92). The experimental group received postoperative fondaparinux sodium (2.5 mg q.d), while the control group received enoxaparin (4000 IU q12 h). We did not use a loading dose for enoxaparin. Bleeding incidence and major adverse cardiovascular/cerebrovascular events were monitored during hospitalization, and at 1, 3, and 6 months postsurgery. The primary end points, including bleeding, mortality, and myocardial infarction during hospitalization, were not significantly different between the 2 groups. For secondary end points, the incidence of combined end point events at 1 month, 3 months, and 6 months after surgery in the experimental group was lower than in the control group (P < 0.05). According to Cox regression analysis, the risk of bleeding in the experimental group was significantly lower than that in the control group [hazard ratios: 0.506, 95% confidence interval (CI): 0.284-0.900] (P = 0.020). The risk of mortality in the experimental group was significantly lower than in the control group (hazard ratio: 0.188, 95% CI: 0.040-0.889) (P = 0.035). In summary, perioperative use of fondaparinux sodium during PCI in patients with STEMI in this study was associated with a lower risk of bleeding and death compared with enoxaparin use in the absence of loading dose.
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Affiliation(s)
| | | | | | | | - He Li
- Emergency Department; and
| | - Li-Qiu Zhong
- Pharmaceutical Department, Yulin First People's Hospital (The Sixth Affiliated Hospital, Guangxi Medical University), Yulin, Guangxi, China
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2
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Fisher T, Hill N, Kalakoutas A, Lahlou A, Rathod K, Proudfoot A, Warren A. Sex differences in treatments and outcomes of patients with cardiogenic shock: a systematic review and epidemiological meta-analysis. Crit Care 2024; 28:192. [PMID: 38845019 PMCID: PMC11157877 DOI: 10.1186/s13054-024-04973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Women are at higher risk of mortality from many acute cardiovascular conditions, but studies have demonstrated differing findings regarding the mortality of cardiogenic shock in women and men. To examine differences in 30-day mortality and mechanical circulatory support use by sex in patients with cardiogenic shock. MAIN BODY Cochrane Central, PubMed, MEDLINE and EMBASE were searched in April 2024. Studies were included if they were randomised controlled trials or observational studies, included adult patients with cardiogenic shock, and reported at least one of the following outcomes by sex: raw mortality, adjusted mortality (odds ratio) or use of mechanical circulatory support. Out of 4448 studies identified, 81 met inclusion criteria, pooling a total of 656,754 women and 1,018,036 men. In the unadjusted analysis for female sex and combined in-hospital and 30-day mortality, women had higher odds of mortality (Odds Ratio (OR) 1.35, 95% confidence interval (CI) 1.26-1.44, p < 0.001). Pooled unadjusted mortality was 35.9% in men and 40.8% in women (p < 0.001). When only studies reporting adjusted ORs were included, combined in-hospital/30-day mortality remained higher in women (OR 1.10, 95% CI 1.06-1.15, p < 0.001). These effects remained consistent across subgroups of acute myocardial infarction- and heart failure- related cardiogenic shock. Overall, women were less likely to receive mechanical support than men (OR = 0.67, 95% CI 0.57-0.79, p < 0.001); specifically, they were less likely to be treated with intra-aortic balloon pump (OR = 0.79, 95% CI 0.71-0.89, p < 0.001) or extracorporeal membrane oxygenation (OR = 0.84, 95% 0.71-0.99, p = 0.045). No significant difference was seen with use of percutaneous ventricular assist devices (OR = 0.82, 95% CI 0.51-1.33, p = 0.42). CONCLUSION Even when adjusted for confounders, mortality for cardiogenic shock in women is approximately 10% higher than men. This effect is seen in both acute myocardial infarction and heart failure cardiogenic shock. Women with cardiogenic shock are less likely to be treated with mechanical circulatory support than men. Clinicians should make immediate efforts to ensure the prompt diagnosis and aggressive treatment of cardiogenic shock in women.
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Affiliation(s)
- Thomas Fisher
- North Bristol NHS Trust, Southmead Rd, Bristol, BS10 5NB, UK
| | - Nicole Hill
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Avon, BA1 3NG, UK
| | | | - Assad Lahlou
- Barts Health Library Services, W Smithfield, London, EC1A 7BE, UK
| | - Krishnaraj Rathod
- Barts Health NHS Trust, W Smithfield, London, EC1A 7BE, UK
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, W Smithfield, London, EC1A 7BE, UK
| | - Alastair Proudfoot
- Barts Health NHS Trust, W Smithfield, London, EC1A 7BE, UK
- Critical Care and Perioperative Medicine Group, School of Medicine and Dentistry, Queen Mary University London, W Smithfield, London, EC1A 7BE, UK
| | - Alex Warren
- Barts Health NHS Trust, W Smithfield, London, EC1A 7BE, UK.
- Critical Care and Perioperative Medicine Group, School of Medicine and Dentistry, Queen Mary University London, W Smithfield, London, EC1A 7BE, UK.
- Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
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3
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Ahsan MJ, Ahmad S, Latif A, Lateef N, Ahsan MZ, Abusnina W, Nathan S, Altin SE, Kolte DS, Messenger JC, Tannenbaum M, Goldsweig AM. Transradial versus transfemoral approach for percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:640-650. [PMID: 35460230 PMCID: PMC9442849 DOI: 10.1093/ehjqcco/qcac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND In ST-elevation myocardial infarction (STEMI), transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with less bleeding and mortality than transfemoral access (TFA). However, patients in cardiogenic shock (CS) are more often treated via TFA. The aim of this meta-analysis is to compare the safety and efficacy of TRA vs. TFA in CS. METHODS Systematic review was performed querying PubMed, Google Scholar, Cochrane, and clinicaltrials.gov for studies comparing TRA to TFA in PCI for CS. Outcomes included in-hospital, 30-day and ≥1-year mortality, major and access site bleeding, TIMI3 (thrombolytics in myocardial infarction) flow, procedural success, fluoroscopy time, and contrast volume. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. RESULTS Six prospective and eight retrospective studies (TRA, n = 8032; TFA, n = 23 031) were identified. TRA was associated with lower in-hospital (RR 0.59, 95% CI 0.52-0.66, P < 0.0001), 30-day and ≥1-year mortality, as well as less in-hospital major (RR 0.41, 0.31-0.56, P < 0.001) and access site bleeding (RR 0.42, 0.23-0.77, P = 0.005). There were no statistically significant differences in post-PCI coronary flow grade, procedural success, fluoroscopy time, and contrast volume between TRA vs. TFA. CONCLUSIONS In PCI for STEMI with CS, TRA is associated with significantly lower mortality and bleeding complications than TFA while achieving similar TIMI3 flow and procedural success rates.
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Affiliation(s)
| | - Soban Ahmad
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Azka Latif
- Division of Cardiovascular Medicine, Creighton University, Omaha, NE, USA
| | - Noman Lateef
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Waiel Abusnina
- Division of Cardiovascular Medicine, Creighton University, Omaha, NE, USA
| | - Sandeep Nathan
- Division of Cardiovascular Medicine, University of Chicago, Chicago, IL, USA
| | - S Elissa Altin
- Division of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Dhaval S Kolte
- Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John C Messenger
- Division of Cardiology Medicine, University of Colorado, Aurora, CO, USA
| | - Mark Tannenbaum
- Division of Cardiovascular Medicine, Iowa Heart Center, Des Moines, IA, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Comparative Analysis of Patient Characteristics in Cardiogenic Shock Studies: Differences Between Trials and Registries. JACC Cardiovasc Interv 2022; 15:297-304. [PMID: 35144785 DOI: 10.1016/j.jcin.2021.11.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study sought to evaluate the differences in cardiogenic shock patient characteristics in trial patients and real-life patients. BACKGROUND Cardiogenic shock (CS) is a leading cause of mortality in patients presenting with acute myocardial infarction (AMI). However, the enrollment of patients into clinical trials is challenging and may not be representative of real-world patients. METHODS We performed a systematic review of studies in patients presenting with AMI-related CS and compared patient characteristics of those enrolled into randomized controlled trials (RCTs) with those in registries. RESULTS We included 14 RCTs (n = 2,154) and 12 registries (n = 133,617). RCTs included more men (73% vs 67.7%, P < 0.001) compared with registries. Patients enrolled in RCTs had fewer comorbidities, including less hypertension (61.6% vs 65.9%, P < 0.001), dyslipidemia (36.4% vs 53.6%, P < 0.001), a history of stroke or transient ischemic attack (7.1% vs 10.7%, P < 0.001), and prior coronary artery bypass graft surgery (5.4% vs 7.5%, P < 0.001). Patients enrolled in RCTs also had lower lactate levels (4.7 ± 2.3 mmol/L vs 5.9 ± 1.9 mmol/L, P < 0.001) and higher mean arterial pressure (73.0 ± 8.8 mm Hg vs 62.5 ± 12.2 mm Hg, P < 0.001). Percutaneous coronary intervention (97.5% vs 58.4%, P < 0.001) and extracorporeal membrane oxygenation (11.6% vs 3.4%, P < 0.001) were used more often in RCTs. The in-hospital mortality (23.9% vs 38.4%, P < 0.001) and 30-day mortality (39.9% vs 45.9%, P < 0.001) were lower in RCT patients. CONCLUSIONS RCTs in AMI-related CS tend to enroll fewer women and lower-risk patients compared with registries. Patients enrolled in RCTs are more likely to receive aggressive treatment with percutaneous coronary intervention and extracorporeal membrane oxygenation and have lower in-hospital and 30-day mortality.
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Ishii M, Tsujita K, Okamoto H, Koto S, Nishi T, Nakai M, Sumita Y, Iwanaga Y, Azuma N, Matoba S, Hirata KI, Hikichi Y, Yokoi H, Ikari Y, Uemura S. Resources for cardiovascular healthcare associated with 30-day mortality in acute myocardial infarction with cardiogenic shock. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeab047. [PMID: 35919660 PMCID: PMC9242083 DOI: 10.1093/ehjopen/oeab047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 01/13/2023]
Abstract
Aims Although primary percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS), such as extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumping (IABP), have been widely used for acute myocardial infarction (AMI) patients with cardiogenic shock (AMICS), their in-hospital mortality remains high. This study aimed to investigate the association of cardiovascular healthcare resources with 30-day mortality in AMICS. Methods and results This was an observational study using a Japanese nationwide administrative data (JROAD-DPC) of 260 543 AMI patients between April 2012 and March 2018. Of these, 45 836 AMICS patients were divided into three categories based on MCS use: with MCS (ECMO with/without IABP), IABP only, or without MCS. Certified hospital density and number of board-certified cardiologists were used as a metric of cardiovascular healthcare resources. We estimated the association of MCS use, cardiovascular healthcare resources, and 30-day mortality. The 30-day mortality was 71.2% for the MCS, 23.9% for IABP only, and 37.8% for the group without MCS. The propensity score-matched and inverse probability-weighted Cox frailty models showed that primary PCI was associated with a low risk for mortality. Higher hospital density and larger number of cardiologists in the responsible hospitals were associated with a lower risk for mortality. Conclusion Although the 30-day mortality remained extremely high in AMICS, indication of primary PCI and improvement in providing cardiovascular healthcare resources associated with the short-term prognosis of AMICS.
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Affiliation(s)
- Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hiroshi Okamoto
- Cardiovascular Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Satoshi Koto
- Cardiovascular Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Takeshi Nishi
- Cardiovascular Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Michikazu Nakai
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Yoko Sumita
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Yoshitaka Iwanaga
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka higashi, Asahikawa, Hokkaido 078-8510, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-chou, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Yutaka Hikichi
- Department of Cardiology, Saga-Ken Medical Centre Koseikan, 400 Kasemachinakabaru, Saga-shi, Saka Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, 3-6-45, Momochihama, Sawara-ku, Fukuoka 814-0001, Japan
| | - Yuji Ikari
- Department of Cardiovascular Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa 259-1193, Japan
| | - Shiro Uemura
- Cardiovascular Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama 701-0192, Japan
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6
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Schrage B, Zeymer U, Montalescot G, Windecker S, Serpytis P, Vrints C, Stepinska J, Savonitto S, Oldroyd KG, Desch S, Fuernau G, Huber K, Noc M, Schneider S, Ouarrak T, Blankenberg S, Thiele H, Clemmensen P. Impact of Center Volume on Outcomes in Myocardial Infarction Complicated by Cardiogenic Shock: A CULPRIT-SHOCK Substudy. J Am Heart Assoc 2021; 10:e021150. [PMID: 34622680 PMCID: PMC8751884 DOI: 10.1161/jaha.120.021150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Little is known about the impact of center volume on outcomes in acute myocardial infarction complicated by cardiogenic shock. The aim of this study was to investigate the association between center volume, treatment strategies, and subsequent outcome in patients with acute myocardial infarction complicated by cardiogenic shock. Methods and Results In this subanalysis of the randomized CULPRIT‐SHOCK (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock) trial, study sites were categorized based on the annual volume of acute myocardial infarction complicated by cardiogenic shock into low‐/intermediate‐/high‐volume centers (<50; 50–100; and >100 cases/y). Subjects from the study/compulsory registry with available volume data were included. Baseline/procedural characteristics, overall treatment, and 1‐year all‐cause mortality were compared across categories. n=1032 patients were included in this study (537 treated at low‐volume, 240 at intermediate‐volume, and 255 at high‐volume centers). Baseline risk profile of patients across the volume categories was similar, although high‐volume centers included a larger number of older patients. Low‐/intermediate‐volume centers had more resuscitated patients (57.5%/58.8% versus 42.2%; P<0.01), and more patients on mechanical ventilation in comparison to high‐volume centers. There were no differences in reperfusion success despite considerable differences in adjunctive pharmacological/device therapies. There was no difference in 1‐year all‐cause mortality across volume categories (51.1% versus 56.5% versus 54.4%; P=0.34). Conclusions In this study of patients with acute myocardial infarction complicated by cardiogenic shock, considerable differences in adjunctive medical and mechanical support therapies were observed. However, we could not detect an impact of center volume on reperfusion success or mortality.
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Affiliation(s)
- Benedikt Schrage
- Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Uwe Zeymer
- Department of Cardiology Klinikum der Stadt Ludwigshafen Ludwigshafen am Rhein Germany
| | - Gilles Montalescot
- Sorbonne UniversityACTION Study GroupINSERM UMRS 1166Institut de CardiologieHôpital Pitié-Salpêtrière (AP-HP) Paris France
| | - Stephan Windecker
- Department of Cardiology Bern University HospitalInselspitalUniversity of Bern Bern Switzerland
| | - Pranas Serpytis
- Clinic of Emergency Medicine Faculty of Medicine VIilnius University Lithuania
| | | | - Janina Stepinska
- Department of the Intensive Cardiac Therapy National Institute of Cardiology Warsaw Poland
| | | | - Keith G Oldroyd
- West of Scotland Regional Heart and Lung Centre Golden Jubilee National Hospital Glasgow United Kingdom
| | - Steffen Desch
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Luebeck Germany
| | - Georg Fuernau
- Medical Clinic II (Cardiology, Angiology Intensive Care Medicine) University Heart Center Luebeck Luebeck Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Luebeck Germany
| | - Kurt Huber
- 3rd Department of Medicine Cardiology and Intensive Care Medicine Wilhelminenhospital and Sigmund Freud UniversityMedical Faculty Vienna Austria
| | - Marko Noc
- Center for Intensive Internal MedicineUniversity Medical Center Ljubljana Slovenia
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung Ludwigshafen am Rhein Germany
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung Ludwigshafen am Rhein Germany
| | - Stefan Blankenberg
- Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany
| | - Peter Clemmensen
- Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany.,Department of Regional Research and Department of Medicine Faculty of Health Sciences Nykoebing F HospitalUniversity of Southern Denmark Odense Denmark
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Matoba T, Sakamoto K, Nakai M, Ichimura K, Mohri M, Tsujita Y, Yamasaki M, Ueki Y, Tanaka N, Hokama Y, Fukutomi M, Hashiba K, Fukuhara R, Suwa S, Matsuura H, Hosoda H, Nakashima T, Tahara Y, Sumita Y, Nishimura K, Miyamoto Y, Yonemoto N, Yagi T, Tachibana E, Nagao K, Ikeda T, Sato N, Tsutsui H. Institutional Characteristics and Prognosis of Acute Myocardial Infarction With Cardiogenic Shock in Japan - Analysis From the JROAD/JROAD-DPC Database. Circ J 2021; 85:1797-1805. [PMID: 33658442 DOI: 10.1253/circj.cj-20-0655] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The high mortality of acute myocardial infarction (AMI) with cardiogenic shock (i.e., Killip class IV AMI) remains a challenge in emergency cardiovascular care. This study aimed to examine institutional factors, including the number of JCS board-certified members, that are independently associated with the prognosis of Killip class IV AMI patients. METHODS AND RESULTS In the Japanese registry of all cardiac and vascular diseases-diagnosis procedure combination (JROAD-DPC) database (years 2012-2016), the 30-day mortality of Killip class IV AMI patients (n=21,823) was 42.3%. Multivariate analysis identified age, female sex, admission by ambulance, deep coma, and cardiac arrest as patient factors that were independently associated with higher 30-day mortality, and the numbers of JCS board-certified members and of intra-aortic balloon pumping (IABP) cases per year as institutional factors that were independently associated with lower mortality in Killip class IV patients, although IABP was associated with higher mortality in Killip classes I-III patients. Among hospitals with the highest quartile (≥9 JCS board-certified members), the 30-day mortality of Killip class IV patients was 37.4%. CONCLUSIONS A higher numbers of JCS board-certified members was associated with better survival of Killip class IV AMI patients. This finding may provide a clue to optimizing local emergency medical services for better management of AMI patients in Japan.
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Affiliation(s)
- Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University
- JCS Shock Registry Scientific Committee
| | - Kazuo Sakamoto
- Department of Cardiovascular Medicine, Kyushu University
- JCS Shock Registry Scientific Committee
| | | | - Kenzo Ichimura
- Department of Cardiovascular Medicine, Kyushu University
- JCS Shock Registry Scientific Committee
| | - Masahiro Mohri
- Department of Cardiology, Japan Community Healthcare Organization Kyushu Hospital
- JCS Shock Registry Scientific Committee
| | - Yasuyuki Tsujita
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science
- JCS Shock Registry Scientific Committee
| | - Masao Yamasaki
- Department of Cardiovascular Medicine, NTT Medical Center
- JCS Shock Registry Scientific Committee
| | - Yasushi Ueki
- Emergency and Critical Care Center, Shinshu University School of Medicine
- JCS Shock Registry Scientific Committee
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
- JCS Shock Registry Scientific Committee
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
- JCS Shock Registry Scientific Committee
| | - Motoki Fukutomi
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine
- JCS Shock Registry Scientific Committee
| | - Katsutaka Hashiba
- Division of Cardiology, Yokohama City University Medical Center
- JCS Shock Registry Scientific Committee
| | - Rei Fukuhara
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
- JCS Shock Registry Scientific Committee
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital
- JCS Shock Registry Scientific Committee
| | - Hirohide Matsuura
- Department of Cardiology, Japanese Red Cross Fukuoka Hospital
- JCS Shock Registry Scientific Committee
| | | | | | | | | | | | | | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University
- JCS Shock Registry Scientific Committee
| | - Tsukasa Yagi
- Department of Cardiology, Kawaguchi Municipal Medical Center
- JCS Shock Registry Scientific Committee
| | - Eizo Tachibana
- Department of Cardiology, Kawaguchi Municipal Medical Center
- JCS Shock Registry Scientific Committee
| | - Ken Nagao
- Cardiovascular Center, Nihon University Hospital
- JCS Shock Registry Scientific Committee
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University
- JCS Shock Registry Scientific Committee
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
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Henry TD, Tomey MI, Tamis-Holland JE, Thiele H, Rao SV, Menon V, Klein DG, Naka Y, Piña IL, Kapur NK, Dangas GD. Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e815-e829. [DOI: 10.1161/cir.0000000000000959] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiogenic shock (CS) remains the most common cause of mortality in patients with acute myocardial infarction. The SHOCK trial (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) demonstrated a survival benefit with early revascularization in patients with CS complicating acute myocardial infarction (AMICS) 20 years ago. After an initial improvement in mortality related to revascularization, mortality rates have plateaued. A recent Society of Coronary Angiography and Interventions classification scheme was developed to address the wide range of CS presentations. In addition, a recent scientific statement from the American Heart Association recommended the development of CS centers using standardized protocols for diagnosis and management of CS, including mechanical circulatory support devices (MCS). A number of CS programs have implemented various protocols for treating patients with AMICS, including the use of MCS, and have published promising results using such protocols. Despite this, practice patterns in the cardiac catheterization laboratory vary across health systems, and there are inconsistencies in the use or timing of MCS for AMICS. Furthermore, mortality benefit from MCS devices in AMICS has yet to be established in randomized clinical trials. In this article, we outline the best practices for the contemporary interventional management of AMICS, including coronary revascularization, the use of MCS, and special considerations such as the treatment of patients with AMICS with cardiac arrest.
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9
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Walsh KA, Plunkett T, O'Brien KK, Teljeur C, Smith SM, Harrington P, Ryan M. The relationship between procedural volume and patient outcomes for percutaneous coronary interventions: a systematic review and meta-analysis. HRB Open Res 2021; 4:10. [PMID: 33842830 PMCID: PMC8008355 DOI: 10.12688/hrbopenres.13203.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The relationship between procedural volume and outcomes for percutaneous coronary interventions (PCI) is contentious, with previous reviews suggesting an inverse volume-outcome relationship. The aim of this study was to systematically review contemporary evidence to re-examine this relationship. METHODS A systematic review and meta-analysis was undertaken to examine the relationship between PCI procedural volume (both at hospital- and operator-levels) and outcomes in adults. The primary outcome was mortality. The secondary outcomes were complications, healthcare utilisation and process outcomes. Searches were conducted from 1 January 2008 to 28 May 2019. Certainty of the evidence was assessed using 'Grading of Recommendations, Assessment, Development and Evaluations' (GRADE). Screening, data extraction, quality appraisal and GRADE assessments were conducted independently by two reviewers. RESULTS Of 1,154 unique records retrieved, 22 observational studies with 6,432,265 patients were included. No significant association was found between total PCI hospital volume and mortality (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.69-1.03, I 2 = 86%). A temporal trend from significant to non-significant pooled effect estimates was observed. The pooled effect estimate for mortality was found to be significantly in favour of high-volume operators for total PCI procedures (OR: 0.77, 95% CI: 0.63-0.94, I 2 = 93%), and for high-volume hospitals for primary PCI procedures (OR: 0.77, 95% CI: 0.62-0.94, I 2 = 78%). Overall, GRADE certainty of evidence was 'very low'. There were mixed findings for secondary outcomes. CONCLUSIONS A volume-outcome relationship may exist in certain situations, although this relationship appears to be attenuating with time, and there is 'very low' certainty of evidence. While volume might be important, it should not be the only standard used to define an acceptable PCI service and a broader evaluation of quality metrics should be considered that encompass patient experience and clinical outcomes. Systematic review registration: PROSPERO, CRD42019125288.
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Affiliation(s)
- Kieran A. Walsh
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Thomas Plunkett
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Kirsty K. O'Brien
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Conor Teljeur
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Susan M. Smith
- Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Patricia Harrington
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Máirín Ryan
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin 8, Ireland
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10
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Ishihara T, Yamaji K, Iida O, Kohsaka S, Inohara T, Shinke T, Ando H, Amano T, Sakata Y, Mano T, Ikari Y. Impact of peripheral artery disease on short-term outcomes after percutaneous coronary intervention: A report from Japanese nationwide registry. PLoS One 2020; 15:e0240095. [PMID: 33021993 PMCID: PMC7537874 DOI: 10.1371/journal.pone.0240095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
Atherosclerosis is a systemic process. As the population ages, increasingly more patients who undergo coronary revascularization are complicated with peripheral artery disease (PAD). However, the large body of evidence in this area has not been limited to analysis from trial-based data from younger and relatively uncomplicated patients in Western countries. The impact of PAD on the outcomes can differ by patient characteristics, and integrated analysis of large-scale data is necessary. J-PCI is a universal (all-comer) nationwide registration system in Japan, regulated and audited by professional society that controls national board-certification system. For the present study, we extracted data of 894,014 percutaneous coronary intervention (PCI) cases performed between 2014 and 2017 (mean age 70.2 years [standard deviation 11.0]). In-hospital outcomes of PAD and Non-PAD patients were compared. PAD was defined as a previous history of stenosis of peripheral arteries or abdominal aortic aneurysm. Primary outcome was in-hospital mortality, and multivariable modeling was performed. A total of 66,891 patients (8.1%) had PAD. Crude in-hospital mortality rate was higher in this group (0.99% vs. 0.67% in Non-PAD group). PAD was associated with an increased risk of in-hospital mortality (odds ratio [OR] 1.383 [95% confidence interval 1.251-1.528]). However, the impact of PAD differed by kidney condition (OR 1.578 [1.370-1.821] for patients with chronic kidney disease [CKD] and OR 1.234 [1.076-1.416] without CKD: P for interaction 0.005), and by clinical presentation: PAD was not associated with an increased risk of in-hospital mortality in patients undergoing PCI for silent ischemia (OR 1.211 [0.8701-1.685]: P for interaction 0.002). Presence of PAD was independently associated with in-hospital mortality in patients receiving PCI. However, its impact varied substantially by the patient background or indication of the procedure.
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Affiliation(s)
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University Hospital, Isehara, Japan
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11
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Uemura Y, Ishikawa S, Takemoto K, Negishi Y, Tanaka A, Takagi K, Yoshioka N, Tashiro H, Umemoto N, Inoue Y, Morishima I, Shimizu K, Shibata N, Asano H, Ishii H, Watarai M, Murohara T. Improved Renal Function After Percutaneous Coronary Intervention in Non-Dialysis Patients With Acute Coronary Syndrome and Advanced Renal Dysfunction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 24:26-30. [PMID: 32952075 DOI: 10.1016/j.carrev.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The deterioration of renal function is a strong prognostic predictor in patients with coronary artery disease. Although percutaneous coronary intervention (PCI) has sometimes resulted in improved renal function (IRF) in acute coronary syndrome (ACS) patients, its clinical implications have not been fully elucidated. This study aimed to investigate the prevalence and predictors of IRF after PCI and its relationship with long-term renal outcomes. METHODS In this retrospective observational cohort study, we examined data from 177 ACS patients with non-dialysis advanced renal dysfunction (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2) who underwent PCI. Patients with and without IRF were compared in terms of baseline demographic, clinical, and procedural characteristics and renal outcomes. IRF was defined as a 20% increase in eGFR from baseline at 7 or 30 days after the index PCI. RESULTS IRF was observed in 66 (37.3%) patients. ST-elevation myocardial infarction and shock during PCI were independent predictors of IRF. Patients were followed up for a median of 695 days. Kaplan-Meier analyses demonstrated that patients with IRF had the lower incidence of initiation of permanent dialysis than those without IRF (Log-rank P = 0.015). CONCLUSIONS IRF was relatively common in non-dialysis patients with ACS and advanced renal dysfunction who underwent PCI. ST-elevation myocardial infarction and shock, which may be indicative of hemodynamic instability during PCI, were independent predictors of IRF. Further, IRF was associated with favorable renal outcomes. Hemodynamic stabilization may be important for improving the short-term and long-term renal outcomes of high-risk patients.
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Affiliation(s)
- Yusuke Uemura
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan.
| | - Shinji Ishikawa
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Kenji Takemoto
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yosuke Inoue
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Naoki Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Masato Watarai
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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12
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Sawano M, Yamaji K, Kohsaka S, Inohara T, Numasawa Y, Ando H, Iida O, Shinke T, Ishii H, Amano T. Contemporary use and trends in percutaneous coronary intervention in Japan: an outline of the J-PCI registry. Cardiovasc Interv Ther 2020; 35:218-226. [PMID: 32440831 PMCID: PMC7295726 DOI: 10.1007/s12928-020-00669-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/16/2022]
Abstract
Cardiovascular interventions have achieved a level of excellence, with many outstanding advanced techniques and results. The mission of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) is to further our understanding of cardiovascular intervention and establish its procedural safety. [1] The Japanese Percutaneous Coronary Intervention (J-PCI) registry was established and sponsored by CVIT, and aims to provide basic statistics on the performance of percutaneous coronary interventions (PCI) in Japan. Today, the database has grown to become one of the largest healthcare procedural database with more than 200,000 cases registered annually from approximately 900 institutions in Japan representing over 90% of all PCI hospitals in the nation. Importantly, case registrations in the J-PCI registry are essential for coronary interventionalist and educating hospital certification. The present manuscript aimed to summarize the history of the J-PCI registry and outline the definitions of various items.
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Affiliation(s)
- Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taku Inohara
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Osamu Iida
- Department of Cardiology, Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Toshiro Shinke
- Department of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan.
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