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Ishii M, Marume K, Nakai M, Ogata S, Kaichi R, Ikebe S, Mori T, Komaki S, Kusaka H, Toida R, Kurogi K, Ogawa H, Iwanaga Y, Miyamoto Y, Yamamoto N, Tsujita K. Risk Prediction Score for Cancer Development in Patients With Acute Coronary Syndrome. Circ J 2024; 88:234-242. [PMID: 34078839 DOI: 10.1253/circj.cj-21-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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 Cancer is a known prognostic factor in patients with acute coronary syndrome (ACS), but few risk assessments of cancer development after ACS have been established. METHODS AND RESULTS Of the 573 consecutive ACS admissions between January 2015 and March 2018 in Nobeoka City, Japan, 552 were analyzed. Prevalent cancer was defined as a treatment history of cancer, and incident cancer as post-discharge cancer incidence. The primary endpoint was post-discharge cancer incidence, and the secondary endpoint was all-cause death during follow-up. All-cause death occurred in 9 (23.1%) patients with prevalent cancer, and in 17 (3.5%) without cancer. In the multivariable analysis, prevalent cancer was associated with all-cause death. To develop the prediction model for cancer incidence, 21 patients with incident cancer and 492 without cancer were analyzed. We compared the performance of D-dimer with that of the prediction model, which added age (≥65 years), smoking history, and high red blood cell distribution width to albumin ratio (RAR) to D-dimer. The areas under the receiver-operating characteristics curves of D-dimer and the prediction model were 0.619 (95% confidence interval: 0.512-0.725) and 0.774 (0.676-0.873), respectively. Decision curve analysis showed superior net benefits of the prediction model. CONCLUSIONS By adding elderly, smoking, and high RAR to D-dimer to the prediction model it became clinically useful for predicting cancer incidence after ACS.
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Affiliation(s)
- Masanobu Ishii
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Kyohei Marume
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | | | | | - Ryota Kaichi
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Sou Ikebe
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Takayuki Mori
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Soichi Komaki
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Hiroaki Kusaka
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Reiko Toida
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Kazumasa Kurogi
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | | | | | | | - Nobuyasu Yamamoto
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University Hospital
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Jiang Q, Zhang N, Zhang H, Xiao Y, Zhang X, Gao J, Liu Y. Impact of off-hour admission on the MACEs of patients with acute myocardial infarction. Clin Exp Hypertens 2023; 45:2186317. [PMID: 36890705 DOI: 10.1080/10641963.2023.2186317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
BACKGROUND In China, on more than 100 weekends or holidays, only on-duty cardiologists are available during admissions. This study aimed to analyze the impact of admission time on major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction (AMI). METHODS This prospective observational study enrolled patients with AMI between October 2018 and July 2019. The patients were assorted into off-hour (admitted on weekends or national holidays) and on-hour groups. The outcome was MACEs at admission and 1 year after discharge. RESULTS A total of 485 patients with AMI were enrolled in this study. The occurrence of MACEs was significantly higher in the off-hour group compared with the on-hour group (P < .05). Multivariate regression analysis showed that age (HR = 1.047, 95% CI: 1.021-1.073), blood glucose level (HR = 1.029, 95% CI: 1.009-1.050), multivessel disease (HR = 1.904, 95% CI: 1.074-3.375), and off-hour hospital admission (HR = 1.849, 95% CI: 1.125-3.039) were all independent risk factors for in-hospital MACEs, while percutaneous coronary intervention (HR = 0.210, 95% CI: 0.147-0.300) and on-hour admission (HR = 0.723, 95% CI: 0.532-0.984) were protective factors for MACEs 1 year after discharge. CONCLUSION The "off-hour effect" still existed in patients with AMI, and the risk of MACEs in the hospital and 1 year after discharge was higher for off-hour admission.
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Affiliation(s)
- Qiuhong Jiang
- Department of Cardiology, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Nan Zhang
- Department of Cardiovascular Medicine CCU, Tianjin Chest Hospital, Tianjin, China
| | - Hongyu Zhang
- Department of Cardiology, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Yongjian Xiao
- Department of Cardiovascular Medicine CCU, Tianjin Chest Hospital, Tianjin, China
| | - Xia Zhang
- Department of Cardiology, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Jing Gao
- Department of cardiovascular medicine institute, Tianjin Chest Hospital, Tianjin, China
| | - Yin Liu
- Department of Cardiovascular Medicine CCU, Tianjin Chest Hospital, Tianjin, China
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Ilic I, Radunovic A, Matic M, Zugic V, Ostojic M, Stanojlovic M, Kojic D, Boskovic S, Borzanovic D, Timcic S, Radoicic D, Dobric M, Tomovic M. Acute Coronary Syndrome Presenting during On- and Off-Hours: Is There a Difference in a Tertiary Cardiovascular Center? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1420. [PMID: 37629710 PMCID: PMC10456505 DOI: 10.3390/medicina59081420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: ACS presents an acute manifestation of coronary artery disease and its treatment is based on timely interventional diagnostics and PCI. It has been known that the treatment and the outcomes are not the same for all the patients with ACS during the working day, depending on the availability of the procedures and staff. The aim of the study was to explore the differences in clinical characteristics and outcomes in patients admitted for ACS during on- and off-hours. Materials and Methods: The retrospective study included 1873 consecutive ACS patients admitted to a tertiary, university hospital that underwent coronary angiography and intervention. On-hours were defined from Monday to Friday from 07:30 h to 14:30 h, while the rest was considered off-hours. Results: There were more males in the off-hours group (on-hours 475 (56%) vs. off-hours 635 (62%); p = 0.011), while previous MI was more frequent in the on-hours group (on 250 (30%) vs. off 148 (14%); p < 0.001). NSTEMI was more frequent during on-hours (on 164 (19%) vs. off 55 (5%); p < 0.001), while STEMI was more frequent during off-hours (on 585 (69%) vs. off 952 (93%); p < 0.001). Patients admitted during on-hours had more multivessel disease (MVD) (on 485 (57%) vs. off 489 (48%); p = 0.006), as well as multivessel PCI (on 187 (22%) vs. off 171 (16%); p = 0.002), while radial access was preferred in off-hours patients (on 692 (82%) vs. off 883 (86%); p = 0.004). Left main PCI was performed with similar frequency in both groups (on 37 (4%) vs. off 35 (3%); p = 0.203). Death occurred with similar frequency in both groups (on 17 (2.0%) vs. off 26 (2.54%); p = 0.404), while major adverse cardio-cerebral events (MACCEs) were more frequent in the on-hours group (on 105 (12.4%) vs. off 70 (6.8%); p = 0.039) probably due to the more frequent repeated PCI (on 49 (5.8%) vs. off 27 (2.6%); p = 0.035). Conclusions: Patients admitted for ACS during working hours in a tertiary hospital present with more complex CAD, have more demanding interventions, and experience more MACCEs during follow-up mostly due to myocardial infarctions and repeated procedures.
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Affiliation(s)
- Ivan Ilic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Anja Radunovic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Milica Matic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Vasko Zugic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Miljana Ostojic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Milica Stanojlovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Dejan Kojic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Srdjan Boskovic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Dusan Borzanovic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Stefan Timcic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Dragana Radoicic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Milan Dobric
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Milosav Tomovic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
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Oh S, Hyun DY, Cho KH, Kim JH, Jeong MH. Long-term outcomes in ST-elevation myocardial infarction patients treated according to hospital visit time. Korean J Intern Med 2022; 37:605-617. [PMID: 34781424 PMCID: PMC9082432 DOI: 10.3904/kjim.2021.204] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS Rapid percutaneous coronary intervention (PCI) is the cornerstone of treatment for ST-elevation myocardial infarction (STEMI). However, there have been conflicting results regarding the differences in clinical outcomes between on-hours and off-hours presentation in STEMI patients. We aimed to examine the difference in long-term outcomes between off-hours and on-hours PCI in patients with STEMI. METHODS The characteristics and clinical outcomes of 5,364 STEMI patients between November 2011 and June 2015 from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) registry were analyzed. Patients were divided into two groups: the off-hours group (weekdays from 6:01 PM to 7:59 AM, weekends, and legal holidays) and the on-hours group (weekdays from 8:00 AM to 6:00 PM). Major adverse cardiac and cerebrovascular events (MACCEs) were defined as a composite of allcause mortality, non-fatal myocardial infarction, any revascularization, cerebrovascular accident, and stent thrombosis. The primary endpoint was the occurrence of MACCEs, and all other clinical outcomes were analyzed. RESULTS A total of 3,119 patients (58.1%) underwent primary PCI due to STEMI during off-hours and 2,245 patients (41.9%) during on-hours. At 36 months, the clinical outcomes of the off-hours group were similar to those of the on-hours group in both the unadjusted and propensity score weighting-adjusted analyses. CONCLUSION Our analysis revealed that the long-term outcomes in STEMI patients admitted to hospitals during off-hours were similar to outcomes of those admitted during on-hours.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Ogata S, Marume K, Nakai M, Kaichi R, Ishii M, Ikebe S, Mori T, Komaki S, Kusaka H, Toida R, Kurogi K, Iwanaga Y, Yano T, Yamamoto N, Miyamoto Y. Incidence Rate of Acute Coronary Syndrome Including Acute Myocardial Infarction, Unstable Angina, and Sudden Cardiac Death in Nobeoka City for the Super-Aged Society of Japan. Circ J 2021; 85:1722-1730. [PMID: 34121054 DOI: 10.1253/circj.cj-20-1207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to calculate incidence rates (IR) of acute coronary syndrome (ACS) including acute myocardial infarction (AMI), unstable angina (UAP), and sudden cardiac death (SCD) in Nobeoka city, Japan.Methods and Results:This was an observational study based on a city-wide comprehensive registration between 2015 and 2017 in Nobeoka city, Japan, using 2 databases: all patients with cardiogenic out-of-hospital cardiac arrest in Nobeoka city and hospitalized ACS patients from Miyazaki Prefectural Nobeoka Hospital in which all ACS patients in Nobeoka city were hospitalized except for possible rare cases of patients highly unlikely to be hospitalized elsewhere. The IRs of ACS based on the population size of Nobeoka city (125,000 persons), and their age-adjusted IRs by using the direct method and the 2015 model population of Japan were calculated. There were 260 eligible patients hospitalized with first-onset ACS (age [SD]=71.1 [12.4], 34.2% women) and 107 eligible SCD patients. Crude IRs of hospitalized ACS and SCD patients, and hospitalized AMI and SCD patients, respectively, were 130.2 (183.3 for men, 85.6 for women) and 107.5 (148.4 for men, 73.2 for women) per 100,000. Crude IRs of hospitalized ACS, AMI, and UAP patients, respectively, were 92.3 (132.8 for men, 58.1 for women), 69.6 (97.9 for men, 45.7 for women), and 22.7 (35.0 for men, 12.4 for women) per 100,000. CONCLUSIONS The calculated IRs can be useful in building a health strategy for treating ACS.
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Affiliation(s)
- Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center
| | - Kyohei Marume
- Miyazaki Prefectural Nobeoka Hospital.,Department of Sport Science, University of Innsbruck
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | | | | | - Sou Ikebe
- Miyazaki Prefectural Nobeoka Hospital
| | | | | | | | | | | | - Yoshitaka Iwanaga
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | | | | | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
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Yamamoto T, Otsuka T, Yoshida N, Kobayashi Y, Komiyama N, Hara K, Nakamura M, Ohira H, Shibata T, Shimokawa T, Takayama T, Tejima T, Ueda T, Harada K, Nagao K, Takayama M. Hospital performance in a large urban acute myocardial infarction emergency care system: Tokyo Cardiovascular Care Unit network. J Cardiol 2021; 78:177-182. [PMID: 33934931 DOI: 10.1016/j.jjcc.2021.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND An ideal urban network system for improving regional acute myocardial infarction (AMI) outcomes should be geographically balanced and uniform according to regional population in performance of participating hospitals. The objective of our study is to evaluate whether there is a major difference in risk-adjusted in-hospital mortality between the Tokyo Cardiovascular Care Unit (CCU) network hospitals, which cover the whole population of large cities. METHODS The study subjects were all AMI patients without cardiac arrest on arrival admitted to the Tokyo CCU network hospitals from 2009 to 2017. Risk-adjusted in-hospital mortality rates (RAMRs) were compared between the categories of each hospital-level factor. A hospital-level multivariable linear regression was modeled to analyze the association between RAMRs and hospital-level factors. A funnel plot was constructed by plotting RAMRs against hospital volumes. RESULTS From 2009 to 2017, there were 42,123 hospitalizations for AMI in Tokyo CCU network hospitals (n=72, as of December, 2017). There were no significant differences in RAMRs in the comparison of hospital backgrounds. Each hospital background was not significantly associated with the RAMR. Considering the 99% CI in funnel plots, only five hospitals (7.2%) were located outside the control limits. CONCLUSIONS There was no major difference in the RAMRs between the participating hospitals within the Tokyo CCU network, despite the different hospital backgrounds.
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Affiliation(s)
| | - Toshiaki Otsuka
- Tokyo Cardiovascular Care Unit Network Council, Tokyo, Japan
| | - Nobuko Yoshida
- Tokyo Cardiovascular Care Unit Network Council, Tokyo, Japan
| | | | | | - Kazuhiro Hara
- Tokyo Cardiovascular Care Unit Network Council, Tokyo, Japan
| | - Masato Nakamura
- Tokyo Cardiovascular Care Unit Network Council, Tokyo, Japan
| | - Hiroshi Ohira
- Tokyo Cardiovascular Care Unit Network Council, Tokyo, Japan
| | | | | | | | - Tamotsu Tejima
- Tokyo Cardiovascular Care Unit Network Council, Tokyo, Japan
| | - Tetsuro Ueda
- Tokyo Cardiovascular Care Unit Network Council, Tokyo, Japan
| | - Kazumasa Harada
- Tokyo Cardiovascular Care Unit Network Council, Tokyo, Japan
| | - Ken Nagao
- Tokyo Cardiovascular Care Unit Network Council, Tokyo, Japan
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