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Asghari-Jafarabadi M, Gholipour K, Khodayari-Zarnaq R, Azmin M, Alizadeh G. Estimation of myocardial infarction death in Iran: artificial neural network. BMC Cardiovasc Disord 2022; 22:438. [PMID: 36207680 PMCID: PMC9547455 DOI: 10.1186/s12872-022-02871-8] [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] [Received: 01/16/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Examining past trends and predicting the future helps policymakers to design effective interventions to deal with myocardial infarction (MI) with a clear understanding of the current and future situation. The aim of this study was to estimate the death rate due to MI in Iran by artificial neural network (ANN). METHODS In this ecological study, the prevalence of diabetes, hypercholesterolemia over 200, hypertension, overweight and obesity were estimated for the years 2017-2025. ANN and Linear regression model were used. Also, Specialists were also asked to predict the death rate due to MI by considering the conditions of 3 conditions (optimistic, pessimistic, and probable), and the predicted process was compared with the modeling process. RESULTS Death rate due to MI in Iran is expected to decrease on average, while there will be a significant decrease in the prevalence of hypercholesterolemia 1.031 (- 24.81, 26.88). Also, the trend of diabetes 10.48 (111.45, - 132.42), blood pressure - 110.48 (- 174.04, - 46.91) and obesity and overweight - 35.84 (- 18.66, - 5.02) are slowly increasing. MI death rate in Iran is higher in men but is decreasing on average. Experts' forecasts are different and have predicted a completely upward trend. CONCLUSION The trend predicted by the modeling shows that the death rate due to MI will decrease in the future with a low slope. Improving the infrastructure for providing preventive services to reduce the risk factors for cardiovascular disease in the community is one of the priority measures in the current situation.
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Affiliation(s)
- Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Melbourne, VIC, 3144, Australia.,School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3800, Australia.,Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Tabriz Health Service Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrdad Azmin
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gisoo Alizadeh
- Tabriz Health Service Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
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Khosravi Shadmani F, Farzadfar F, Larijani B, Mirzaei M, Haghdoost AA. Trend and projection of mortality rate due to non-communicable diseases in Iran: A modeling study. PLoS One 2019; 14:e0211622. [PMID: 30763320 PMCID: PMC6375574 DOI: 10.1371/journal.pone.0211622] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 01/17/2019] [Indexed: 01/21/2023] Open
Abstract
Background Following the epidemiologic and demographic transition, non-communicable disease mortality is the leading cause of death in Iran. Projecting mortality trend can provide valuable tools for policy makers and planners. In this article, we have estimated the trend of non-communicable disease mortality during 2001–2015 and have projected it until 2030 at national and subnational levels in Iran. Methods The data employed was gathered from the Iranian death registration system and using the Spatio-temporal model, the trends of 4 major categories of non-communicable diseases (cancers, cardiovascular diseases, asthma and COPD, and diabetes) by 2030 were projected at the national and subnational levels. Results The results indicated that age standardized mortality rate for cancers, CVDs, and Asthma and COPD will continue to decrease in both sexes (cancers: from 81.8 in 2015 to 45.2 in 2030, CVDs: 307.3 to 173.0, and Asthma and COPD: from 52.1 to 46.6); however, in terms of diabetes, there is a steady trend in both sexes at national level (from 16.6 to 16.5). Age standardized mortality rates for cancers and CVDs, in males and females, were high in all provinces in 2001. The variation between the provinces is clearer in 2015, and it is expected to significantly decrease in all provinces by 2030. Conclusion Generally, the age standardized mortality rate from NCDs will decrease by 2030. Of course, given the experience of the past two decades in Iran, believing that the mortality rate will decrease may not be an easy notion to understand. However hard to believe, this decrease may be the result of better management of risk factors and early detection of patients due to more comprehensive care in all segments of society, as well as improved literacy and awareness across the country.
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Affiliation(s)
- Fatemeh Khosravi Shadmani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Clinical Sciences Institute of Tehran University of medical sciences, Tehran, Iran
| | - Moghadameh Mirzaei
- Department of biostatistics and epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- * E-mail:
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Aggarwal A, Aggarwal S, Sharma V. Cardiovascular Risk Factors in Young Patients of Coronary Artery Disease: Differences over a Decade. J Cardiovasc Thorac Res 2014; 6:169-73. [PMID: 25320664 PMCID: PMC4195967 DOI: 10.15171/jcvtr.2014.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/20/2014] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Studies evaluating temporal trends of Coronary artery disease (CAD) in young patients, from the India, are still lacking. The aim of this study was to evaluate temporal differences in risk factors of young patients of CAD over a decade. METHODS This is a single centre retrospective study performed in a tertiary care teaching institution in North India. Case records of young patients (≤40 years) with acute coronary syndrome between January 2000 to December 2001 and January 2009 to December 2010 were obtained. Records were sought for active smoking, family history, waist size, blood pressure, hypertension, fasting and postprandial blood sugar and lipid profile for both groups and analyzed using SPSS v.17. For the purpose of the study, p value <0.05 was considered statistically significant. RESULTS Medical records of a total of 79 and 83 patients with young CAD (≤40 years) were obtained for 2000-01 and 2009-10 period respectively. An increase in proportion of female patients, hypertension (p=0.004), dysglycemia (p<0.001), family history (p=0.01), metabolic syndrome (p<0.001), low high density lipoprotein (HDL) (p=0.07) and mean waist size (0.03) was noted over the years. Among males, increase in number of dysglycemics (p=0.0002), positive family history (p<0.0001) and mean waist size (0.032) was statistically significant. CONCLUSION Over a decade the patients with young CAD in our study, there was an increase in proportion of patients with metabolic syndrome, dysglycemia and low HDL.
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Affiliation(s)
- Amitesh Aggarwal
- Department of Medicine, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
| | - Sourabh Aggarwal
- Department of Medicine, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
| | - Vishal Sharma
- Department of Medicine, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
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Longitudinal extent of lipid pool assessed by optical coherence tomography predicts microvascular no-reflow after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Cardiol 2013; 62:71-6. [DOI: 10.1016/j.jjcc.2013.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 02/15/2013] [Accepted: 03/18/2013] [Indexed: 11/20/2022]
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Ishihara M, Sato H. Thirty years trend in acute myocardial infarction undergoing coronary angiography at a tertiary emergency center in Japan. J Cardiol 2012; 59:243-8. [DOI: 10.1016/j.jjcc.2011.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/04/2011] [Accepted: 10/27/2011] [Indexed: 10/28/2022]
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Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Miura F, Nakama Y, Dai K, Ootani T, Ooi K, Ikenaga H, Miki T, Nakamura M, Kishimoto S, Sumimoto Y. Comparison of gender-specific mortality in patients < 70 years versus ≥ 70 years old with acute myocardial infarction. Am J Cardiol 2011; 108:772-5. [PMID: 21726840 DOI: 10.1016/j.amjcard.2011.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 04/29/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
Abstract
The aim of the present study was to investigate the gender-specific mortality after acute myocardial infarction in those aged < 70 years versus ≥ 70 years. The present study consisted of 2,677 consecutive patients with acute myocardial infarction who had undergone coronary angiography within 24 hours after the onset of symptoms. The patients were divided into 2 groups: 1,810 patients < 70 years old and 867 patients ≥ 70 years old. Women were older and had a greater incidence of hypertension and diabetes mellitus and a lower incidence of current smoking and previous myocardial infarction in both groups. The in-hospital mortality rate was significantly greater in women ≥ 70 years old age than in men ≥ 70 years old (16.2% vs 9.3%, respectively; p = 0.003) but was comparable between women and men in patients < 70 years old (5.7% vs 4.9%, respectively; p = 0.59). On multivariate analysis, the association between female gender and in-hospital mortality in patients ≥ 70 years old remained significant (odds ratio 1.78, 95% confidential interval 1.05 to 3.00), but the gender difference was not observed in patients < 70 years old (odds ratio 1.09, 95% confidence interval 0.53 to 2.24). In conclusion, female gender was associated with in-hospital mortality after acute myocardial infarction in patients ≥ 70 years old but not in patients < 70 years old.
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Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nakama Y, Maruhashi T, Kagawa E, Dai K, Matsushita J, Ikenaga H. Trends in gender difference in mortality after acute myocardial infarction. J Cardiol 2008; 52:232-8. [PMID: 19027601 DOI: 10.1016/j.jjcc.2008.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Revised: 07/05/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Progress in management of acute myocardial infarction (AMI) might have changed the effect of gender on mortality. METHODS From May 1981 to November 2002, 1984 consecutive patients with AMI underwent emergency coronary angiography. They were divided into three groups in chronological order: group I (1981-1988, n=564); group II (1989-1995, n=678); and group III (1997-2002, n=742). Multi-variable analysis was performed using Cox's proportional hazard regression, adjusting baseline clinical and angiographical variables. RESULTS There were 405 women (20%). Thrombolysis was most frequently performed in group I (50%), balloon angioplasty in group II (71%), and stent in group III (66%), with no difference in the allocation of reperfusion therapy between men and women. Three-year mortality was significantly higher in women than in men in group I (27% vs 18%, p=0.03) and group II (23% vs 15%, p=0.048). In group III, there was no significant difference in 3-year mortality (12% vs 10%, p=0.66) between women and men. Women were associated with higher age, more diabetes, more hypertension, fewer current smokers, and less previous infarction than men. Multi-variable analysis showed that sex was not an independent predictor of 3-year mortality in the three groups. CONCLUSIONS Women with AMI who were treated mostly with primary intervention using stent in the contemporary era had similar mortality to men.
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Affiliation(s)
- Masaharu Ishihara
- Department of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan.
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Hirakawa Y, Masuda Y, Kuzuya M, Kimata T, Iguchi A, Uemura K. Factors associated with use of percutaneous coronary intervention among very elderly patients with acute myocardial infarction: Lessons from the Tokai Acute Myocardial Infarction Study (TAMIS). Geriatr Gerontol Int 2007. [DOI: 10.1111/j.1447-0594.2007.00408.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ishihara M, Kagawa E, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nakama Y, Maruhashi T, Ookawa K, Dai K, Aokage Y. Impact of admission hyperglycemia and diabetes mellitus on short- and long-term mortality after acute myocardial infarction in the coronary intervention era. Am J Cardiol 2007; 99:1674-9. [PMID: 17560874 DOI: 10.1016/j.amjcard.2007.01.044] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 01/29/2007] [Accepted: 01/29/2007] [Indexed: 01/08/2023]
Abstract
The influence of admission hyperglycemia and diabetes on short- and long-term mortality of patients with acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era was investigated. From 1996 to 2003, a total of 802 consecutive patients with AMI underwent coronary angiography. Primary PCI was performed in 724 patients (90%). Three-year mortality curves were constructed using the Kaplan-Meier method. Cox proportional hazard regression was used to identify independent predictors of 30-day mortality and mortality from 30 days to 3 years. There were 261 patients with admission hyperglycemia (admission glucose>or=11.1 mmol/L) and 212 patients with diabetes. Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (8.4% vs 2.4%, p<0.001). However, there was no significant difference in 30-day mortality rates between diabetic and nondiabetic patients (5.7% vs 3.9%, p=0.29). Conversely, diabetes significantly increased mortality from 30 days to 3 years (10.0% vs 5.5%, p=0.03), but admission hyperglycemia did not (8.4% vs 5.9%, p=0.19). Multivariate analysis showed that hyperglycemia was an independent predictor of 30-day mortality (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.13 to 2.61, p=0.01), but diabetes was not (OR 0.84, 95% CI 0.55 to 1.27, p=0.42). Diabetes was independently associated with mortality from 30 days to 3 years (OR 1.43, 95% CI 1.02 to 1.97, p=0.04), but hyperglycemia had a neutral effect (OR 0.98, 95% CI 0.70 to 1.36, p=0.92). In conclusion, in the PCI era, admission hyperglycemia was associated with short-term mortality, whereas diabetes increased long-term mortality after convalescence in patients with AMI. Admission hyperglycemia and diabetes should be treated as 2 distinct disease states.
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Affiliation(s)
- Masaharu Ishihara
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
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Hirakawa Y, Masuda Y, Kuzuya M, Iguchi A, Kimata T, Uemura K. Influence of diabetes mellitus on in-hospital mortality in patients with acute myocardial infarction in Japan: a report from TAMIS-II. Diabetes Res Clin Pract 2007; 75:59-64. [PMID: 16762440 DOI: 10.1016/j.diabres.2006.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 04/24/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The relation between diabetes mellitus (DM) and mortality among patients with acute myocardial infarction is still controversial. We evaluated the influence of DM on the in-hospital mortality of acute myocardial infarction (AMI) patients using data from the Tokai Acute Myocardial Infarction Study-II, a multi-hospital prospective study performed in Japan. METHODS All of the study subjects were patients hospitalized for newly diagnosed AMI at 1 of 13 acute care hospitals between January of 2001 and December of 2003. We abstracted the baseline and procedural characteristics from detailed chart reviews. Multivariate analysis was performed, controlling for the variables found to be significantly different between AMI patients with and without DM by chi-square test or unpaired t-test. We evaluated a total of 940 DM and 2284 non-DM patients. RESULTS DM patients had roughly twice the in-hospital mortality rate of non-DM patients, with an unadjusted odds ratio of 1.77 (95% CI, 1.37-2.30). However, according to the multivariate analysis, DM was not identified as an independent predictor of in-hospital death, with an adjusted odds ratio of 5.73 (95% CI, 0.97-33.88). CONCLUSIONS DM is not an independent predictor of in-hospital mortality, and that there is a need for additional studies to confirm our conclusion.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
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Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Hata T, Mitsuba N, Kisaka T. Impact of prodromal angina pectoris and white blood cell count on outcome of patients with acute myocardial infarction. Int J Cardiol 2005; 103:150-5. [PMID: 16080973 DOI: 10.1016/j.ijcard.2004.08.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Revised: 06/22/2004] [Accepted: 08/07/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Elevation of white blood cell (WBC) count at admission is associated with adverse outcome after acute myocardial infarction (AMI). Prodromal angina, by the mechanism of ischemic preconditioning, improves left ventricular (LV) function and survival after reperfusion therapy in patients with AMI. Recent experimental studies have reported that preconditioning has anti-inflammatory effect. METHODS This study consisted of 598 patients with first anterior wall AMI who underwent coronary angiography within 12 h after symptom onset. WBC count was measured at the time of hospital admission. Prodromal angina was defined as angina occurring within 24 h before the onset of AMI. Serial measurements of LV ejection fraction (EF) were obtained before reperfusion therapy and before discharge in 421 patients (71%). RESULTS High WBC count (>10.2 x 103/mm3, n=297) was associated with higher 30-day mortality (8% vs. 4%, p=0.02) and lower predischarge LVEF (51+/-15% vs. 57+/-14%, p<0.001), although there was no significant difference in acute LVEF (47+/-10% vs. 49+/-11%, p=0.07). High WBC count was an independent predictor of 30-day mortality (p=0.009) and predischarge LVEF (p=0.002). Prodromal angina was associated with lower 30-day mortality (3% vs. 7%, p=0.02) and preserved predischarge LVEF (57+/-15% vs. 53+/-14%, p=0.006). Patients with prodromal angina had lower WBC count (10.0+/-3.3 x 10(3)/mm3 vs. 11.0+/-3.9 x 10(3)/mm3, p=0.001) and prodromal angina was an independent predictor of WBC count (p<0.001). CONCLUSIONS Elevation of WBC count and lack of prodromal angina were associated with impaired LV function and mortality after reperfusion in patients with AMI. Prodromal angina might have contributed to favorable outcome after AMI through its anti-inflammatory effect.
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Affiliation(s)
- Masaharu Ishihara
- Department of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan.
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Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Hata T, Mitsuba N, Kisaka T, Nakama H, Kijima Y. Comparison of the cardioprotective effect of prodromal angina pectoris and collateral circulation in patients with a first anterior wall acute myocardial infarction. Am J Cardiol 2005; 95:622-5. [PMID: 15721104 DOI: 10.1016/j.amjcard.2004.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Revised: 11/05/2004] [Accepted: 11/05/2004] [Indexed: 10/25/2022]
Abstract
To compare the cardioprotective effect of prodromal angina pectoris and collateral circulation, 245 patients with first anterior acute myocardial infarction who underwent coronary angioplasty within 12 hours of symptoms were studied. Prodromal angina pectoris and collateral circulation were independently associated with higher predischarge left ventricular ejection fraction (LVEF), and a combination of prodromal angina pectoris and collateral circulation afforded cumulative improvement in LVEF in patients without diabetes mellitus. In patients with diabetes mellitus, collateral circulation, but not prodromal angina pectoris, was associated with higher predischarge LVEF.
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Kinoshita N, Imai K, Kinjo K, Naka M. Longitudinal Study of Acute Myocardial Infarction in the Southeast Osaka District From 1988 to 2002. Circ J 2005; 69:1170-5. [PMID: 16195611 DOI: 10.1253/circj.69.1170] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Data on clinical characteristics, long-term mortality rates, and factors influencing outcome of acute myocardial infarction (AMI) based on an unselected cohort in the percutaneous coronary intervention (PCI) era are still limited in Japan. METHODS AND RESULTS In the present study 415 consecutive patients with AMI who were admitted to hospital within 24 h of symptom onset between January 1988 and December 2002 were studied. There was a marked seasonal variation of AMI with a minimum in summer and a maximum in winter, as well as a marked circadian variation with a significant morning peak. Overall, 45.8% of patients were treated with primary PCI. Increased age and female sex were negatively associated with the probability of undergoing PCI. During the follow-up period (mean duration, 4.01+/-3.41 years), the unadjusted long-term all-cause mortality rate was 21.4%. Multivariate Cox regression analysis showed that age, prior cerebrovascular disease, renal failure, Killip > or =2, and ventricular tachycardia/fibrillation were independent predictors of worse long-term mortality after AMI. Furthermore, the use of PCI was independently associated with favorable long-term survival after AMI. CONCLUSIONS Although PCI was associated with a favorable long-term mortality, it remains underused in subsets of patients and increased use may further reduce the long-term mortality rate in Japanese AMI patients.
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Imamura H, Izawa A, Kai R, Yokoseki O, Uchikawa SI, Yazaki Y, Kinoshita O, Hongo M, Kubo K. Trends over the last 20 years in the clinical background of young Japanese patients with coronary artery disease. Circ J 2004; 68:186-91. [PMID: 14993770 DOI: 10.1253/circj.68.186] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prevalence, pathogenesis, and clinical background of coronary artery disease (CAD) in patients aged 40 years or less in Japan are not well understood. METHODS AND RESULTS Temporal trends in the clinical background, including growth from childhood, of young patients with CAD over the last 20 years were examined. The study group comprised 38 patients who were 40 years of age or less (7 patients in 1980-84, phase I; 10 patients in 1985-89, phase II; 10 patients in 1990-94, phase III; 11 patients in 1995-99, phase IV). Among the classic coronary risk factors, obesity significantly increased in prevalence. An increase in patients with multiple risk factors was seen (0, 10%, 20%, and 36% in phases I, II, III, and IV, respectively). There was no significant change in the prevalence of familial hypercholesterolemia, sequelae of Kawasaki disease or vasospastic angina. All phase III and IV patients with multiple risk factors had moderate to severe obesity, and 83% had been overweight since childhood. CONCLUSIONS These results suggest that the number of young patients with CAD because of multiple risk factors has been increasing, and most of them have been overweight since childhood. Thus, for primary prevention it is essential to control cardiovascular risk factors in overweight children.
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Affiliation(s)
- Hiroshi Imamura
- Department of Emergency and Intensive Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
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Pyo R, Jensen KK, Wiekowski MT, Manfra D, Alcami A, Taubman MB, Lira SA. Inhibition of intimal hyperplasia in transgenic mice conditionally expressing the chemokine-binding protein M3. THE AMERICAN JOURNAL OF PATHOLOGY 2004; 164:2289-97. [PMID: 15161661 PMCID: PMC1615775 DOI: 10.1016/s0002-9440(10)63785-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chemokines have been implicated in the pathogenesis of a wide variety of diseases. This report describes the generation of transgenic mice that conditionally express M3, a herpesvirus protein that binds and inhibits chemokines. In response to doxycycline, M3 expression was induced in a variety of tissues and M3 was detectable in the blood by Western blotting. No gross or histological abnormalities were seen in mice expressing M3. To determine whether M3 expression could modify a significant pathophysiological response, we examined its effect on the development of intimal hyperplasia in response to femoral arterial injury. Intimal hyperplasia is thought to play a critical role in the development of restenosis after percutaneous transluminal coronary angioplasty and in the progression of atherosclerosis. Induction of M3 expression resulted in a 67% reduction in intimal area and a 68% reduction in intimal/medial ratio after femoral artery injury. These data support a role for chemokines in regulating intimal hyperplasia and suggest that M3 may be effective in attenuating this process. This transgenic mouse model should be a valuable tool for investigating the role of chemokines in a variety of pathological states.
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Affiliation(s)
- Robert Pyo
- Department of Medicine, and the Immunobiology Center, Mount Sinai School of Medicine, New York, New York 10029-6574, USA
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Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nishioka K, Umemura T, Nakamura S, Yoshida M. Effect of acute hyperglycemia on the ischemic preconditioning effect of prodromal angina pectoris in patients with a first anterior wall acute myocardial infarction. Am J Cardiol 2003; 92:288-91. [PMID: 12888134 DOI: 10.1016/s0002-9149(03)00627-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acute hyperglycemia abolishes the ischemic preconditioning effect of prodromal angina pectoris in patients with acute myocardial infarction. We investigated a potential explanation for the association between acute hyperglycemia and adverse outcomes after acute myocardial infarction.
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Affiliation(s)
- Masaharu Ishihara
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
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Igarashi Y, Aizawa Y, Satoh T, Konno T, Ojima K, Aizawa Y. Predictors of adverse long-term outcome in acute myocardial infarction patients undergoing primary percutaneous transluminal coronary angioplasty: with special reference to the admission concentration of lipoprotein (a). Circ J 2003; 67:605-11. [PMID: 12845184 DOI: 10.1253/circj.67.605] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The predictive values for long-term outcome in 127 consecutive patients with acute myocardial infarction (AMI) after successful primary percutaneous transluminal coronary angioplasty (PTCA) were prospectively investigated in the present study. The primary endpoint was a composite of cardiac death, nonfatal AMI, and recurrent angina. Follow-up angiography was performed in 120 patients to assess restenosis. The primary endpoint occurred in 21 patients during a follow-up period of 35+/-24 months. These patients had a higher lipoprotein(a) [Lp(a)] concentration (p=0.0105) and more prevalence of multivessel disease (p=0.0028) than the other patients. The subjects were divided into 2 groups at the 75th percentile Lp(a) value: group A had an Lp(a) concentration >or=47 mg/dl and group B <47 mg/dl. Kaplan-Meier analysis showed a lower cardiac event-free survival rate in group A (p=0.0007) and in patients with multivessel disease (p=0.001). In Cox proportional hazards regression analysis, an Lp(a) level >or=47 mg/dl (relative risk[RR] 5.5, 95% confidence interval [CI] 2.0-15.0, p=0.0007) and multivessel disease (RR 5.3, 95% CI 2.0-13.7, p=0.0006) were independent predictors of the primary endpoint. An elevated Lp(a) concentration on admission and multivessel disease are significant predictors for long-term adverse outcome in AMI patients treated by primary PTCA.
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Affiliation(s)
- Yutaka Igarashi
- Division of Cardiology, Department of Medicine, Shonai Municipal Hospital, Tsuruoka, Yamagata, Japan.
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Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, Umemura T, Nakamura S, Yoshida M. Does coronary stenting affect microvascular circulation in patients with anterior acute myocardial infarction? Comparison with balloon angioplasty. Circ J 2002; 66:917-20. [PMID: 12381085 DOI: 10.1253/circj.66.917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The impact of coronary stenting on microvascular circulation in the infarct area was compared with that of balloon angioplasty in 94 patients with acute myocardial infarction (AMI) who underwent coronary revascularization within 6h of onset: 49 patients were treated with balloon angioplasty alone, and 45 were treated with coronary stenting. Microvascular circulation after revascularization was assessed by Thrombolysis in Myocardial Infarction (TIMI) flow grade analysis and ST segment analysis. TIMI flow grade was assessed on the final angiographic image after coronary intervention, and the ST segment was assessed on the 12-lead electrocardiogram recordings just before revascularization and on return to the coronary care unit. The distributions of TIMI flow grade and change in sigmaST (5.1 +/- 10.8 vs 5.1 +/- 9.9mm) were similar between the 2 groups. Predischarge left ventricular ejection fraction (54 +/- 14 vs 54 +/- 15%) and in-hospital outcome were also similar between the 2 groups. The data suggest that coronary stenting did not influence microvascular circulation (improvement or detriment) in patients with reperfused AMI.
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Affiliation(s)
- Satoshi Kurisu
- Division of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
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