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Matsushita K, Harada K, Kohno T, Nakano H, Kitano D, Matsuda J, Takei M, Yoshino H, Yamamoto T, Nagao K, Takayama M. Prevalence and clinical characteristics of diabetic cardiomyopathy in patients with acute heart failure. Nutr Metab Cardiovasc Dis 2024; 34:1325-1333. [PMID: 38218713 DOI: 10.1016/j.numecd.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND AND AIMS Diabetic cardiomyopathy refers to cases of diabetes mellitus (DM) complicated by cardiac dysfunction in the absence of cardiovascular disease and hypertension. Its epidemiology remains unclear due to the high rate of coexistence between DM and hypertension. Therefore, this study aimed to examine the prevalence and clinical characteristics of diabetic cardiomyopathy among patients with acute heart failure (HF). METHODS AND RESULTS This multicenter, retrospective study included 17,614 consecutive patients with acute HF. DM-related HF was defined as HF complicating DM without known manifestations of coronary artery disease, significant valvular heart disease, or congenital heart disease, while diabetic cardiomyopathy was defined as DM-related HF without hypertension. Univariable and multivariable logistic regression analyses were performed to identify factors associated with in-hospital mortality. Diabetic cardiomyopathy prevalence was 1.6 % in the entire cohort, 5.2 % in patients with acute HF complicating DM, and 10 % in patients with DM-related HF. Clinical characteristics, including the presence of comorbidities, laboratory data on admission, and factors associated with in-hospital mortality, significantly differed between the diabetic cardiomyopathy group and the DM-related HF with hypertension group. The in-hospital mortality rate was significantly higher in patients with diabetic cardiomyopathy than in patients with DM-related HF with hypertension (7.7 % vs. 2.8 %, respectively; P < 0.001). CONCLUSION The prevalence of diabetic cardiomyopathy was 1.6 % in patients with acute HF, and patients with diabetic cardiomyopathy were at high risk for in-hospital mortality. The clinical characteristics of patients with diabetic cardiomyopathy were significantly different than those of patients with DM-related HF with hypertension.
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Affiliation(s)
| | | | - Takashi Kohno
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Hiroki Nakano
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Junya Matsuda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Makoto Takei
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Akutsu K, Yoshino H, Shimokawa T, Ogino H, Kunihara T, Takahashi T, Usui M, Watanabe K, Yamasaki M, Fujii T, Kawata M, Watanabe Y, Yamamoto T, Kohsaka S, Nagao K, Takayama M. Clinical Features of 544 Patients With Ruptured Aortic Aneurysm - A Report From the Tokyo Acute Aortic Super Network Database. Circ J 2024:CJ-23-0636. [PMID: 38417888 DOI: 10.1253/circj.cj-23-0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
BACKGROUND Epidemiological data on ruptured aortic aneurysms from large-scale studies are scarce. The aims of this study were to: clarify the clinical course of ruptured aortic aneurysms; identify aneurysm site-specific therapies and outcomes; and determine the clinical course of patients receiving conservative therapy.Methods and Results: Using the Tokyo Acute Aortic Super Network database, we retrospectively analyzed 544 patients (mean [±SD] age 78±10 years; 70% male) with ruptured non-dissecting aortic aneurysms (AAs) after excluding those with impending rupture. Patient characteristics, status on admission, therapeutic strategy, and outcomes were evaluated. Shock or pulselessness on admission were observed in 45% of all patients. Conservative therapy, endovascular therapy (EVT), and open surgery (OS) accounted for 32%, 23%, and 42% of cases, respectively, with corresponding mortality rates of 93%, 30%, and 29%. The overall in-hospital mortality rate was 50%. The prevalence of pulselessness was highest (48%) in the ruptured ascending AA group, and in-hospital mortality was the highest (70%) in the ruptured thoracoabdominal AA group. Multivariable logistic regression analysis indicated in-hospital mortality was positively associated with pulselessness (odds ratio [OR] 10.12; 95% confidence interval [CI] 4.09-25.07), and negatively associated with invasive therapy (EVT and OS; OR 0.11; 95% CI 0.06-0.20). CONCLUSIONS The outcomes of ruptured AAs remain poor; emergency invasive therapy is essential to save lives, although it remains challenging to reduce the risk of death.
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Affiliation(s)
- Koichi Akutsu
- Tokyo CCU Network Scientific Committee
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee
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Yagi T, Nagao K, Yonemoto N, Gaieski DF, Tachibana E, Ito N, Shirai S, Tahara Y, Nonogi H, Ikeda T. Impact of Updating the Cardiopulmonary Resuscitation Guidelines on Out-of-Hospital Shockable Cardiac Arrest: A Population-Based Cohort Study in Japan. J Am Heart Assoc 2024; 13:e031394. [PMID: 38362855 PMCID: PMC11010103 DOI: 10.1161/jaha.123.031394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND International consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science and treatment recommendations (CoSTR) have reported updates on CPR maneuvers every 5 years since 2000. However, few national population-based studies have investigated the comprehensive effectiveness of those updates for out-of-hospital cardiac arrest due to shockable rhythms. The primary objective of the present study was to determine whether CPR based on CoSTR 2005 or 2010 was associated with improved outcomes in Japan, as compared with CPR based on Guidelines 2000. METHODS AND RESULTS From the All-Japan Utstein Registry between 2005 and 2015, we included 73 578 adults who had shockable out-of-hospital cardiac arrest witnessed by bystanders or emergency medical service responders. The study outcomes over an 11-year period were compared between 2005 of the Guidelines 2000 era, from 2006 to 2010 of the CoSTR 2005 era, and from 2011 to 2015 of the CoSTR 2010 era. In the bystander-witnessed group, the adjusted odds ratios for favorable neurological outcomes at 30 days after out-of-hospital cardiac arrest by enrollment year increased year by year (1.19 in 2006, and 3.01 in 2015). Similar results were seen in the emergency medical service responder-witnessed group and several subgroups. CONCLUSIONS Compared with CPR maneuvers for shockable out-of-hospital cardiac arrest recommended in the Guidelines 2000, CPR maneuver updates in CoSTR 2005 and 2010 were associated with improved neurologically intact survival year by year in Japan. Increased public awareness and greater dissemination of basic life support may be responsible for the observed improvement in outcomes. REGISTRATION URL: https://www.umin.ac.jp/ctr/; Unique identifier: 000009918.
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Affiliation(s)
- Tsukasa Yagi
- Department of CardiologyNihon University HospitalTokyoJapan
| | - Ken Nagao
- Department of CardiologyNihon University HospitalTokyoJapan
| | | | - David F. Gaieski
- Department of Emergency MedicineSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPA
| | - Eizo Tachibana
- Department of CardiologyKawaguchi Municipal Medical CenterKawaguchiJapan
| | - Noritoshi Ito
- Department of CardiologyKawasaki Saiwai HospitalKawasakiJapan
| | - Shinichi Shirai
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Yoshio Tahara
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular Center HospitalSuitaJapan
| | - Hiroshi Nonogi
- Faculty of Health ScienceOsaka Aoyama UniversityMinooJapan
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Faculty of Medicine/Medical CenterTokyoJapan
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Jimba T, Kodera S, Kohsaka S, Otsuka T, Harada K, Shindo A, Shiraishi Y, Kohno T, Takei M, Nakano H, Matsuda J, Yamamoto T, Nagao K, Takayama M. Forecasting the Acute Heart Failure Admissions: Development of Deep Learning Prediction Model Incorporating the Climate Information. J Card Fail 2024; 30:404-409. [PMID: 37952642 DOI: 10.1016/j.cardfail.2023.10.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Climate is known to influence the incidence of cardiovascular events. However, their prediction with traditional statistical models remains imprecise. METHODS AND RESULTS We analyzed 27,799 acute heart failure (AHF) admissions within the Tokyo CCU Network Database from January 2014 to December 2019. High-risk AHF (HR-AHF) day was defined as a day with the upper 10th percentile of AHF admission volume. Deep neural network (DNN) and traditional regression models were developed using the admissions in 2014-2018 and tested in 2019. Explanatory variables included 17 meteorological parameters. Shapley additive explanations were used to evaluate their importance. The median number of incidences of AHF was 12 (9-16) per day in 2014-2018 and 11 (9-15) per day in 2019. The predicted AHF admissions correlated well with the observed numbers (DNN: R2 = 0.413, linear regression: R2 = 0.387). The DNN model was superior in predicting HR-AHF days compared with the logistic regression model [c-statistics: 0.888 (95% CI: 0.818-0.958) vs 0.827 (95% CI: 0.745-0.910): P = .0013]. Notably, the strongest predictive variable was the 7-day moving average of the lowest ambient temperatures. CONCLUSIONS The DNN model had good prediction ability for incident AHF using climate information. Forecasting AHF admissions could be useful for the effective management of AHF.
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Affiliation(s)
- Takahiro Jimba
- Tokyo CCU Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Satoshi Kodera
- Tokyo CCU Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shun Kohsaka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Toshiaki Otsuka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan; Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | | | - Akito Shindo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Takashi Kohno
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Makoto Takei
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Hiroki Nakano
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Junya Matsuda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Watanabe Y, Yoshikawa T, Isogai T, Sakata K, Yamaguchi T, Arao K, Takaoka Y, Inohara T, Imori Y, Mochizuki H, Yamamoto T, Asai K, Nagao K, Takayama M. Impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome: A multicenter registry of the Tokyo Cardiovascular Care Unit Network. J Cardiol 2023; 82:356-362. [PMID: 37343932 DOI: 10.1016/j.jjcc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Hypoalbuminemia is common in critically ill patients and is associated with poor outcomes. However, the relationship between serum albumin levels and clinical outcomes in patients with takotsubo syndrome remains unclear. We examined the impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome. METHODS Using the multicenter registry of the Tokyo Cardiovascular Care Unit Network between January 2017 and December 2020, we identified 631 eligible patients with takotsubo syndrome (median age, 78 years; male proportion, 22 %) and documented serum albumin levels at admission, which were used to allocate patients to hypoalbuminemia (serum albumin <3.5 g/dL) or normal albumin (serum albumin ≥3.5 g/dL) groups. Patient characteristics and in-hospital mortality were compared between the groups. RESULTS Hypoalbuminemia was detected in 200 (32 %) patients at admission. The hypoalbuminemia group was older and had a higher proportion of men and preceding physical triggers than the normal albumin group. In-hospital all-cause mortality was greater in the hypoalbuminemia group than in the normal albumin group (9.5 % vs. 1.9 %, p < 0.001). Both cardiac (3.0 % vs. 0.5 %, p = 0.015) and non-cardiac (6.5 % vs. 1.4 %, p = 0.002) mortality was greater in the hypoalbuminemia group. In multivariable logistic regression analysis, hypoalbuminemia was independently associated with increased in-hospital mortality, even after adjusting for confounders, including age, sex, and triggering events (odds ratio, 3.23; 95 % confidence interval, 1.31-7.95; p = 0.011). CONCLUSIONS In patients with takotsubo syndrome, hypoalbuminemia is a common comorbidity and is associated with a substantial risk of in-hospital death. Close monitoring and comprehensive critical care are required in these patients.
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Affiliation(s)
- Yukihiro Watanabe
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
| | - Tsutomu Yoshikawa
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Toshiaki Isogai
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Konomi Sakata
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Kenshiro Arao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Taku Inohara
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoichi Imori
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroki Mochizuki
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Ken Nagao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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Nara S, Bunya N, Ohnishi H, Sawamoto K, Uemura S, Kokubu N, Hase M, Narimatsu E, Asai Y, Tahara Y, Atsumi T, Nagao K, Morimura N, Sakamoto T. Long-term prognostic significance of gasping in out-of-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation: a post hoc analysis of a multi-center prospective cohort study. J Intensive Care 2023; 11:43. [PMID: 37803414 PMCID: PMC10559458 DOI: 10.1186/s40560-023-00692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Gasping during resuscitation has been reported as a favorable factor for out-of-hospital cardiac arrest. We examined whether gasping during resuscitation is independently associated with favorable neurological outcomes in patients with refractory ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) undergoing extracorporeal cardiopulmonary resuscitation ECPR. METHODS Data from a 2014 study on advanced cardiac life support for ventricular fibrillation with extracorporeal circulation in Japan (SAVE-J), which examined the efficacy of ECPR for refractory VF/pVT, were analyzed. The primary endpoint was survival with a 6-month favorable neurological outcome in patients who underwent ECPR with or without gasping during resuscitation. Multivariate logistic regression analysis was performed to evaluate the association between gasping and outcomes. RESULTS Of the 454 patients included in the SAVE-J study, data from 212 patients were analyzed in this study after excluding those with missing information and those who did not undergo ECPR. Gasping has been observed in 47 patients during resuscitation; 11 (23.4%) had a favorable neurological outcome at 6 months. Multivariate logistic regression analysis showed that gasping during resuscitation was independently associated with a favorable neurological outcome (odds ratio [OR], 10.58 [95% confidence interval (CI) 3.22-34.74]). The adjusted OR for gasping during emergency medical service transport and on arrival at the hospital was 27.44 (95% CI 5.65-133.41). CONCLUSIONS Gasping during resuscitation is a favorable factor in patients with refractory VF/pVT. Patients with refractory VF/pVT with continuously preserved gasping during EMS transportation to the hospital are expected to have more favorable outcomes.
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Affiliation(s)
- Satoshi Nara
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan.
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University, Sapporo, Japan
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan
| | - Mamoru Hase
- Cardiovascular Center, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yasufumi Asai
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Emergency, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takahiro Atsumi
- Department of Emergency Medicine, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Ken Nagao
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Naoto Morimura
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Arao K, Yoshikawa T, Isogai T, Imori Y, Mochizuki H, Sakata K, Takaoka Y, Yamaguchi T, Nagao K, Yamamoto T, Takayama M. A study of takotsubo syndrome over 9 years at the Tokyo Cardiovascular Care Unit Network Registry. J Cardiol 2023; 82:93-99. [PMID: 36640906 DOI: 10.1016/j.jjcc.2022.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/04/2022] [Accepted: 12/17/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is an acute cardiovascular disease with clinical manifestations similar to those of acute myocardial infarction (AMI), and TTS sometimes occurs just after catastrophes. Large-scale studies of TTS in Japan are scarce, so we examined data over 9 years from Tokyo metropolitan acute cardiovascular care hospital network registry. METHODS A total of 1626 patients were diagnosed with TTS between 2010 and 2018 at Tokyo Cardiovascular Care Unit Network facilities, and data from all these patients were analyzed. We investigated annual and monthly captured incidence of TTS, temporal trend of the captured incidence proportion of TTS versus AMI, the occurrence of TTS on the day of the great earthquake, and we elucidated the prognostic factors for in-hospital death. RESULTS The annual incidence proportion of TTS versus AMI increased from 2.3 % to 4.5 % (p < 0.001) over 9 years. The mean TTS patient age was 74.4 years: the peak incidence of TTS was at 80 to 84 years of age for both male and female; females accounted for 78.5 % of patients. The monthly variation of the incidence of TTS was found (p = 0.009). In 2011, a total of 137 cases of TTS occurred, with as many as 6 occurring on March 11, the day of the Great East Japan Earthquake. There was a definable trigger for TTS in 64 % (physical: 36 %; emotional: 27 %; others: 2 %). All-cause in-hospital mortality was 5.3 % and was higher in males than in females (10.3 % vs 3.9 %; p < 0.001). Non-cardiac causes accounted for 62 % of in-hospital mortality. Factors at presentation that were associated with in-hospital all-cause mortality were male sex, low body mass index, and a high C-reactive protein level. CONCLUSIONS This study elucidated the clinical features, in-hospital outcomes, and their attributed factors in patients with TTS in real-world clinical practice in Japan.
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Affiliation(s)
- Kenshiro Arao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Division of Cardiovascular Medicine, Nerima-Hikarigaoka Hospital, Tokyo, Japan.
| | - Tsutomu Yoshikawa
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Toshiaki Isogai
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoichi Imori
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Hiroki Mochizuki
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Konomi Sakata
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Ken Nagao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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Yamamoto T, Harada K, Yoshino H, Nakamura M, Kobayashi Y, Yoshikawa T, Maejima Y, Otsuka T, Nagao K, Takayama M. Impact of the COVID-19 pandemic on incidence and mortality of emergency cardiovascular diseases in Tokyo. J Cardiol 2023; 82:134-139. [PMID: 36682714 PMCID: PMC9851953 DOI: 10.1016/j.jjcc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The impact of the coronavirus disease 2019 (COVID-19) pandemic on the incidence and in-hospital mortality of emergency cardiovascular disease (CVD) has not been clarified in Japan. METHODS We compared the number of admissions and in-hospital mortality for emergency CVD during the pandemic (from January to December 2020) with those of pre-pandemic periods (from January 2018 to December 2019), using quarterly data from the Tokyo Cardiovascular Care Unit Network. The incidence rate in 2020 is compared with the average incidence rate observed in the same quarter of 2018 and 2019 and is presented as an incidence rate ratio (IRR) with 95 % confidence interval (CI). RESULTS The number of admissions for acute myocardial infarction during the pandemic was significantly lower than before the pandemic, with an IRR of 0.93 (95 % CI; 0.88-0.98). Similarly, the IRR for unstable angina was 0.78 (95 % CI; 0.72-0.83), for acute heart failure was 0.84 (95 % CI; 0.76-0.91), for acute aortic dissection was 0.88 (95 % CI; 0.78-0.98), and for ruptured aortic aneurysm was 0.75 (95 % CI; 0.62-0.88). In quarterly comparisons, the numbers of acute aortic diseases and emergency arrhythmia significantly decreased from July to September 2020, while those of other emergency CVDs significantly declined in the 2020 April-June period, which includes the first wave period in Japan. In-hospital mortality of emergency CVDs was unchanged from the pre-pandemic period, except for acute aortic dissection, which increased in odds ratio of 1.31 (95 % CI 1.10-1.57). CONCLUSIONS The COVID-19 pandemic significantly reduced the number of admissions for all emergency CVDs in all or part of the year. In-hospital mortality was unchanged from the pre-pandemic period, except for acute aortic dissection, which increased.
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Affiliation(s)
- Takeshi Yamamoto
- Tokyo CCU Network Council, Tokyo, Japan; Tokyo CCU Network Scientific Committee, Tokyo, Japan.
| | | | | | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo CCU Network Council, Tokyo, Japan; Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Wakabayashi K, Higuchi S, Miyachi H, Minatsuki S, Ito R, Kondo S, Miyauchi K, Yamasaki M, Tanaka H, Yamashita J, Kishi M, Abe K, Mase T, Yahagi K, Asano T, Saji M, Iwata H, Mitsuhashi Y, Nagao K, Yamamoto T, Shinke T, Takayama M. Clinical features and predictors of non-cardiac death in patients hospitalised for acute myocardial infarction: Insights from the Tokyo CCU network multicentre registry. Int J Cardiol 2023; 378:1-7. [PMID: 36791966 DOI: 10.1016/j.ijcard.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) commonly have multiple comorbidities, and some die in hospitals due to causes other than cardiac complications. However, limited information is available on noncardiac death in patients hospitalised for AMI. Therefore, the present study was performed to determine the incidence, annual trend, clinical characteristics, and predictors of in-hospital non-cardiac death in patients with AMI using the Tokyo Cardiovascular Care Unit (CCU) network registry. METHODS The registry included 38,589 consecutive patients with AMI who were admitted to the CCU between 2010 and 2019. The primary endpoint was in-hospital noncardiac death. Further, predictors of cardiac and non-cardiac death were identified. RESULTS The incidence of all-cause in-hospital mortality was 7.0% (n = 2700), and the proportion of mortality was 15.6% (n = 420) and 84.4% (n = 2280) for noncardiac and cardiac causes, respectively. The proportion of noncardiac deaths did not change annually over the last decade (p = 0.66). After adjusting for all variables, age, Killip classification grade, peak creatine kinase, hemoglobin, serum creatinine, and C-reactive protein were common predictors of cardiac and non-cardiac deaths. Indicators of malnutrition, such as lower body mass index (kg/m2) [odds 0.94, 95%CI (0.90-0.97), p < 0.001] and serum low-density lipoprotein cholesterol level (per 10 mg/dl) [odds 0.92, 95%CI (0.89-0.96), p < 0.001] were the specific predictors for non-cardiac deaths. CONCLUSIONS The incidence of in-hospital noncardiac death was significant in patients with AMI, accounting for 15.6% of all in-hospital mortalities. Thus, prevention and management of non-cardiac complications are vital to improve acute-phase outcomes, especially those with predictors of non-cardiac death.
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Affiliation(s)
- Kohei Wakabayashi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan; Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
| | | | | | | | - Ryosuke Ito
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Seita Kondo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | - Jun Yamashita
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Mikio Kishi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Kaito Abe
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Takaaki Mase
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Taku Asano
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Mike Saji
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Hiroshi Iwata
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Yamasaki M, Yoshino H, Kunihara T, Akutsu K, Shimokawa T, Ogino H, Kawata M, Takahashi T, Usui M, Watanabe K, Fujii T, Yamamoto T, Nagao K, Takayama M. Outcomes of type A acute aortic dissection with cardiopulmonary arrest: Tokyo Acute Aortic Super-network Registry. Eur J Cardiothorac Surg 2023; 63:ezad056. [PMID: 36806920 DOI: 10.1093/ejcts/ezad056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/06/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES Preventing loss of life in patients with type A acute aortic dissection (AAD) who present with cardiopulmonary arrest (CPA) can be extremely difficult. Thus, we investigated the early outcomes in these patients. METHODS Patients with type A AAD who were transported to hospitals belonging to the Tokyo Acute Aortic Super-network between January 2015 and December 2019 were considered for this study. We assessed the early mortality of these patients presenting with CPA and also investigated the differences in outcomes between patients with out-of-hospital and in-hospital CPA. RESULTS A total of 3307 patients with type A AAD were transported, 434 (13.1%) of whom presented with CPA. The overall mortality of patients presenting with CPA was 88.2% (383/434), of which 94.5% (240/254) experienced out-of-hospital CPA and 79.4% (143/180) experienced in-hospital CPA (P < 0.001). Multivariable analysis revealed that aortic surgery [odds ratio (OR), 0.022; 95% confidence interval (CI), 0.008-0.060; P < 0.001] and patient age over 80 years (OR, 2.946; 95% CI, 1.012-8.572; P = 0.047) were related with mortality in patients with type A AAD and CPA. Between in-hospital and out-of-hospital CPA, the proportions of DeBakey type 1 (OR, 2.32; 95% CI, 1.065-5.054; P = 0.034), cerebral malperfusion (OR, 0.188; 95% CI, 0.056-0.629; P = 0.007), aortic surgery (OR, 0.111; 95% CI, 0.045-0.271; P = 0.001), age (OR, 0.969; 95% CI, 0.940-0.998; P = 0.039) and the time from symptom onset to hospital admission (OR, 1.122; 95% CI, 1.025-1.228; P = 0.012) were significantly different. CONCLUSIONS Patients with type A AAD presenting with CPA exhibited extremely high rates of death. Patient outcomes following in-hospital CPA tended to be better than those following out-of-hospital CPA; however, this difference was not significantly different. To prevent deaths, aortic surgery, when possible, should be considered in patients with type A AAD who sustained CPA.
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Affiliation(s)
- Manabu Yamasaki
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
- Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Hideaki Yoshino
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takashi Kunihara
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Koichi Akutsu
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tomoki Shimokawa
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Hitoshi Ogino
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Mitsuhiro Kawata
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | | | - Michio Usui
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Kazuhiro Watanabe
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshiro Fujii
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Ken Nagao
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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11
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Tateishi K, Saito Y, Kitahara H, Shiko Y, Kawasaki Y, Nonogi H, Tahara Y, Yonemoto N, Nagao K, Ikeda T, Sato N, Kobayashi Y. Impact of Number of Defibrillation Attempts on Neurologically Favourable Survival Rate in Patients with Out-of-Hospital Cardiac Arrest. Resuscitation 2023; 186:109779. [PMID: 36963560 DOI: 10.1016/j.resuscitation.2023.109779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
AIM of the study: Defibrillation plays a crucial role in early return of spontaneous circulation (ROSC) and survival of patients with out-of-hospital cardiac arrest (OHCA) and shockable rhythm. Prehospital adrenaline administration increases the probability of prehospital ROSC. However, little is known about the relationship between number of prehospital defibrillation attempts and neurologically favourable survival in patients treated with and without adrenaline. METHODS Using a nationwide Japanese OHCA registry database from 2006 to 2020, 1,802,084 patients with OHCA were retrospectively analysed, among whom 81,056 with witnessed OHCA and initial shockable rhythm were included. The relationship between the number of defibrillation attempts before hospital admission and neurologically favourable survival rate (cerebral performance category score of 1 or 2) at 1 month was evaluated with subgroup analysis for patients treated with and without adrenaline. RESULTS At 1 month, 18,080 (22.3%) patients had a cerebral performance category score of 1 or 2. In the study population, the probability of prehospital ROSC and favourable neurological survival rate were inversely associated with number of defibrillation attempts. Similar trends were observed in patients treated without adrenaline, whereas a greater number of defibrillation attempts was counterintuitively associated with favourable neurological survival rate in patients treated with prehospital adrenaline. CONCLUSIONS Overall, a greater number of prehospital defibrillation attempts was associated with lower neurologically favourable survival at 1 month in patients with OHCA and shockable rhythm. However, an increasing number of shocks (up to the 4th shock) was associated with better neurological outcomes when considering only patients treated with adrenaline.
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Affiliation(s)
- Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan.
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Yohei Kawasaki
- Statistics Section, Institute for Assistance of Academic and Education, 3-10-6 Nakamachi, Machida, Tokyo 194-0021, Japan
| | - Hiroshi Nonogi
- Faculty of Health Science, Osaka Aoyama University, 2-11-1 Niina, Mino, Osaka 562-8580, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Naohiro Yonemoto
- Department of Public Health, Juntendo University school of medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ken Nagao
- Cardiovascular Center, Nihon University Hospital, 1-1-6 Kanda Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan
| | - Naoki Sato
- Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, 1-1-51 Maekawa, Kawaguchi, Saitama 333-0842, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
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12
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Sakamoto K, Matoba T, Nakai M, Tahara Y, Nakashima T, Hosoda H, Miyamoto Y, Nishimura K, Sumita Y, Yagi T, Ichimura K, Yonemoto N, Tachibana E, Nagao K, Ikeda T, Sato N, Tsutsui H. Clinical picture of the duration of venoarterial extracorporeal membrane oxygenation: analysis from JROAD-DPC. Heart Vessels 2023; 38:228-235. [PMID: 36173448 DOI: 10.1007/s00380-022-02158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/18/2022] [Indexed: 01/10/2023]
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used for critically ill patients all over the world; however, comprehensive survey regarding the relationship between VA-ECMO duration and prognosis is limited. We conducted a survey of VA-ECMO patients in the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC), which was a health insurance claim database study among cardiovascular centers associated with the Japan Circulation Society, between April 2012 and March 2016. Out of 13,542 VA-ECMO patients, we analyzed 5766 cardiovascular patients treated with VA-ECMO. 68% patients used VA-ECMO only for 1 day and 93% had VA-ECMO terminated within 1 week. In multivariate analysis, the hazard ratio of 1-day support was significantly high at 1.72 (95% confidence intervals; 95% CI 1.53-1.95) (p < 0.001), while that of 2-day [0.60 (95% CI 0.49-0.73)], 3-day [0.75 (95% CI 0.60-0.94)], 4-day [0.43 (95% CI 0.31-0.60)] and 5-day support [0.62 (95% CI 0.44-0.86)] was significantly low. Comprehensive database analysis of JROAD-DPC revealed that cardiovascular patients who were supported with VA-ECMO for 2-5 days showed lower mortality. The optimal VA-ECMO support window should be investigated in further studies.
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Affiliation(s)
- Kazuo Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takahiro Nakashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Preventive Medicine and Epidemiology Informatics, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoko Sumita
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tsukasa Yagi
- Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Kenzo Ichimura
- Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Eizo Tachibana
- Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Ken Nagao
- Cardiovascular Centre, Nihon University Hospital, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Naoki Sato
- Department of Cardiology, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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13
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Endo T, Gaieski DF, Nagao K, Nonogi H, Kikuchi M, Arimoto H, Hase M, Kasaoka S, Takeda S, Hanada H, Tahara Y, Takahashi H, Kuroda Y, Masao N, Matsushima H. Development, implementation, and refinement of a comprehensive postcardiac arrest care training course in Japan. Acute Med Surg 2022; 9:e794. [PMID: 36285106 PMCID: PMC9585041 DOI: 10.1002/ams2.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022] Open
Abstract
Aim In Japan, no training course is dedicated to postcardiac arrest care (PCAC), including venoarterial extracorporeal membrane oxygenation (VA-ECMO); thus, faculty members of the Japanese Circulation Society developed an original, comprehensive PCAC training course. This report reviews the development, implementation, and refinement of this PCAC training course. Methods We examined the preserved data from the Japanese Circulation Society PCAC training courses between 2014 and 2020. Data related to the learning content and number of the attendees and instructors were collected and summarized. Results Sixteen courses were held between August 2014 and February 2020, before the coronavirus disease 2019 (COVID-19) pandemic. A total of 677 health care providers participated: 351 doctors, 225 nurses, 62 perfusionists, five emergency medical professionals, and two pharmacists. Thirty-two attendees' data were missing. The core learning contents of all the courses included a standardized postcardiac arrest algorithm, targeted temperature management, VA-ECMO cannulation skills, and postcannulation management. Concerning curriculum evolution, extracorporeal cardiopulmonary resuscitation simulation, postarrest neurological examination and monitoring, and ultrasound-guided Seldinger technique training were added in the 4th, 5th, and 13th courses, respectively. Conclusion The Japanese Circulation Society PCAC training course has been developed and refined to provide an organized, comprehensive opportunity for health care providers to acquire specific knowledge and skills in PCAC and VA-ECMO.
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Affiliation(s)
- Tomoyuki Endo
- Tohoku Medical and Pharmaceutical University Hospital Emergency MedicineSendaiJapan
| | - David F. Gaieski
- Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ken Nagao
- Nihon University Hospital Cardiovascular CenterTokyoJapan
| | | | - Migaku Kikuchi
- Department of Cardiovascular Medicine, Emergency and Critical Care CenterDokkyo Medical UniversityTochigiJapan
| | - Hideki Arimoto
- Department of Emergency Medicine and Critical CareIseikai HospitalOsakaJapan
| | - Mamoru Hase
- Sapporo Teishinkai Hospital Cardiovascular CenterSapporoJapan
| | - Shunji Kasaoka
- Disaster Medical Education and Research CenterKumamoto University HospitalJapan
| | | | - Hiroyuki Hanada
- Hirosaki University Graduate School of MedicineEmergency and Disaster MedicineAomoriJapan
| | - Yoshio Tahara
- National Cerebral and Cardiovascular Center Department of Cardiovascular MedicineOsakaJapan
| | - Hiroshi Takahashi
- Steel Memorial Muroran Hospital Cardiovascular DepartmentMuroranJapan
| | - Yasuhiro Kuroda
- Kagawa University Hospital Emergency, DisasterCritical Care MedicineKagawaJapan
| | - Nagayama Masao
- Graduate School of Medicine Department of NeurologyInternational University of Health and WelfareChibaJapan
| | - Hisao Matsushima
- Department of Emergency and Critical Care MedicineDokkyo Medical University Saitama Medical CenterSaitamaJapan
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14
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Miyachi H, Yamamoto T, Takayama M, Miyauchi K, Yamasaki M, Tanaka H, Yamashita J, Kishi M, Higuchi S, Abe K, Mase T, Shinke T, Yahagi K, Wakabayashi K, Asano T, Minatsuki S, Saji M, Iwata H, Mitsuhashi Y, Ito R, Kondo S, Shimizu W, Nagao K. 10-Year Temporal Trends of In-Hospital Mortality and Emergency Percutaneous Coronary Intervention for Acute Myocardial Infarction. JACC: Asia 2022; 2:677-688. [PMID: 36444314 PMCID: PMC9700040 DOI: 10.1016/j.jacasi.2022.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
Background The mortality rate of acute myocardial infarction (AMI) has improved dramatically because of reperfusion therapy during the last 40 years; however, recent temporal trends for AMI have not been fully clarified in Japan. Objectives The purpose of this study was to elucidate the temporary trend in in-hospital mortality and treatment of AMI for the last decade in the Tokyo Metropolitan area. Methods We enrolled 30,553 patients from the Tokyo Cardiovascular Care Unit Network Registry, diagnosed with AMI from 2007 to 2016, as part of an ongoing, multicenter, cohort study. We analyzed the temporal trends in basic characteristics, treatment, and in-hospital mortality of AMI. Results The overall emergency percutaneous coronary intervention (PCI) rate significantly increased (P < 0.001). In particular, it remarkably increased in patients older than 80 years of age (58.3% to 70.3%, P < 0.001) and patients with Killip III or IV (Killip III, 46.9% to 65.7%; Killip IV, 65.2% to 76.6%, P < 0.001 for both). The crude and age-adjusted in-hospital mortality remained low (5.2% to 8.2% and 3.4% to 5.5%, respectively) and significantly decreased during the decade (P < 0.001). The in-hospital mortality remarkably decreased in patients older than 80 years of age (17.3% to 12.7%, P < 0.001) and in those with cardiogenic shock (38.5% to 27.3%, P < 0.001). Conclusions This large cohort study from Tokyo revealed that in-hospital mortality of AMI significantly decreased with the increase in emergency percutaneous coronary intervention rate over the decade, particularly for high-risk patients such as older patients and those with cardiogenic shock.
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15
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Sakamoto K, Nagao K. 517 Distinct transcriptomic shifts in keratinocyte subsets induced by type I interferon. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Schmitzberger FF, Haas NL, Coute RA, Bartos J, Hackmann A, Haft JW, Hsu CH, Hutin A, Lamhaut L, Marinaro J, Nagao K, Nakashima T, Neumar R, Pellegrino V, Shinar Z, Whitmore SP, Yannopoulos D, Peterson WJ. ECPR 2: Expert Consensus on PeRcutaneous Cannulation for Extracorporeal CardioPulmonary Resuscitation. Resuscitation 2022; 179:214-220. [PMID: 35817270 DOI: 10.1016/j.resuscitation.2022.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 12/22/2022]
Abstract
AIM Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising resuscitation strategy for select patients suffering from refractory out-of-hospital cardiac arrest (OHCA), though limited data exist regarding the best practices for ECPR initiation after OHCA. METHODS We utilized a modified Delphi process consisting of two survey rounds and a virtual consensus meeting to systematically identify detailed best practices for ECPR initiation following adult non-traumatic OHCA. A modified Delphi process builds content validity and is an accepted method to develop consensus by eliciting expert opinions through multiple rounds of questionnaires. Consensus was achieved when items reached a high level of agreement, defined as greater than 80% responses for a particular item rated a 4 or 5 on a 5-point Likert scale. RESULTS Snowball sampling generated a panel of 14 content experts, composed of physicians from four continents and five primary specialties. Seven existing institutional protocols for ECPR cannulation following OHCA were identified and merged into a single comprehensive list of 207 items. The panel reached consensus on 101 items meeting final criteria for inclusion: Prior to Patient Arrival (13 items), Inclusion Criteria (8), Exclusion Criteria (7), Patient Arrival (8), ECPR Cannulation (21), Go On Pump (18), and Post-Cannulation (26). CONCLUSION We present a list of items for ECPR initiation following adult nontraumatic OHCA, generated using a modified Delphi process from an international panel of content experts. These findings may benefit centers currently performing ECPR in quality assurance and serve as a template for new ECPR programs.
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Affiliation(s)
| | - Nathan L Haas
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA
| | - Ryan A Coute
- Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jason Bartos
- Division of Cardiology, Department of Medicine, Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Amy Hackmann
- Department of Cardiovascular and Thoracic Surgery, UTSouthwestern, Parkland Hospital, Dallas, TX, USA
| | - Jonathan W Haft
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Cindy H Hsu
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA
| | - Alice Hutin
- SAMU de Paris, Assistance Publique - Hôpitaux de Paris, Necker University Hospital, Paris, France
| | - Lionel Lamhaut
- SAMU de Paris, Assistance Publique - Hôpitaux de Paris, Necker University Hospital, Paris, France
| | - Jon Marinaro
- Department of Emergency Medicine, Division of Critical Care, University of New Mexico, Albuquerque, NM, USA
| | - Ken Nagao
- Department of Cardiology, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
| | - Takahiro Nakashima
- Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA
| | - Robert Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA
| | | | - Zack Shinar
- Department of Emergency Medicine, Sharp Memorial Hospital, San Diego CA, USA
| | - Sage P Whitmore
- Critical Care Medicine, TriStar Centennial Medical Center, Nashville, TN, USA
| | - Demetri Yannopoulos
- Division of Cardiology, Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN
| | - William J Peterson
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
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17
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Jimba T, Kohsaka S, Yamasaki M, Otsuka T, Harada K, Shiraishi Y, Koba S, Takei M, Kohno T, Matsushita K, Miyazaki T, Kodera S, Tsukamoto S, Iida K, Shindo A, Kitano D, Yamamoto T, Nagao K, Takayama M. Association of ambient temperature and acute heart failure with preserved and reduced ejection fraction. ESC Heart Fail 2022; 9:2899-2908. [PMID: 35719026 DOI: 10.1002/ehf2.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/07/2022] Open
Abstract
AIMS Evidence on the association between ambient temperature and the onset of acute heart failure (AHF) is scarce and mixed. We sought to investigate the incidence of AHF admissions based on ambient temperature change, with particular interest in detecting the difference between AHF with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF). METHODS AND RESULTS Individualized AHF admission data from January 2015 to December 2016 were obtained from a multicentre registry (Tokyo CCU Network Database). The primary event was the daily number of admissions. A linear regression model, using the lowest ambient temperature as the explanatory variable, was selected for the best-estimate model. We also applied the cubic spline model using five knots according to the percentiles of the distribution of the lowest ambient temperature. We divided the entire population into HFpEF + HFmrEF and HFrEF for comparison. In addition, the in-hospital treatment and mortality rates were obtained according to the interquartile ranges (IQRs) of the lowest ambient temperature (IQR1 <5.5°C; IQR25.5-13.3°C; IQR3 13.3-19.7°C; and IQR4 >19.7°C). The number of admissions for HFpEF, HFmrEF and HFrEF were 2736 (36%), 1539 (20%), and 3354 (44%), respectively. The lowest ambient temperature on the admission day was inversely correlated with the admission frequency for both HFpEF + HFmrEF and HFrEF patients, with a stronger correlation in patients with HFpEF + HFmrEF (R2 = 0.25 vs. 0.05, P < 0.001). In the sensitivity analysis, the decrease in the ambient temperature was associated with the greatest incremental increases in HFpEF, followed by HFmrEF and HFrEF patients (3.5% vs. 2.8% vs. 1.5% per -1°C, P < 0.001), with marked increase in admissions of hypertensive patients (systolic blood pressure >140 mmHg vs. 140-100 mmHg vs. <100 mmHg, 3.0% vs. 2.0% vs. 0.8% per -1°C, P for interaction <0.001). A mediator analysis indicated the presence of the mediator effect of systolic blood pressure. The in-hospital mortality rate (7.5%) did not significantly change according to ambient temperature (P = 0.62). CONCLUSIONS Lower ambient temperature was associated with higher frequency of AHF admissions, and the effect was more pronounced in HFpEF and HFmrEF patients than in those with HFrEF.
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Affiliation(s)
- Takahiro Jimba
- Tokyo CCU Network Scientific Committee/NTT Medical Center Tokyo, Tokyo, Japan
| | - Shun Kohsaka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Masao Yamasaki
- Tokyo CCU Network Scientific Committee/NTT Medical Center Tokyo, Tokyo, Japan
| | - Toshiaki Otsuka
- Tokyo CCU Network Scientific Committee/Nippon Medical School, Tokyo, Japan
| | | | | | - Shinji Koba
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Makoto Takei
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Takashi Kohno
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | | | - Kiyoshi Iida
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Akito Shindo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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18
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Suematsu Y, Kuwano T, Yamashita M, Tsutsui H, Sato N, Ikeda T, Nagao K, Yonemoto N, Tahara Y, Saku K, Miura SI. Adult influenza epidemic is associated with out-of-hospital cardiac arrest: From the All-Japan Utstein Registry, a prospective, nationwide, population-based, observational registry. Medicine (Baltimore) 2022; 101:e29535. [PMID: 35713463 PMCID: PMC9276275 DOI: 10.1097/md.0000000000029535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
It has been reported that influenza infection is associated with out-of-hospital cardiac arrest of cardiac origin (OHCA-CA). However, the association between OHCA-CA and influenza epidemics in adults has not been well investigated.We analyzed data from the All-Japan Utstein Registry, a prospective, nationwide, population-based, observational study, regarding OHCA-CA cases and the Infectious Diseases Weekly Report for influenza cases: 17,710 OHCA-CA cases and 764,808 influenza cases were recorded between 2005 and 2015 in Fukuoka, Japan. The weekly average number of OHCA-CA cases was positively associated with the number of patients with influenza infection (r = 0.70, P < .0001). To eliminate the effects of season and age, we investigated only adults in winter. The weekly number of OHCA-CA cases was positively associated with the number of patients with influenza infection in weeks when there was a high frequency of influenza infection in adults (r = 0.36, P = .006), but not in weeks with a medium (r = 0.26, P = .05) or low frequency of influenza infection (r = 0.003, P = 1.0). In weeks during which there was a high frequency of influenza infection, the weekly number of OHCA-CA cases was positively associated with the number of influenza infections in males (r = 0.37, P = .006), but not females (r = 0.18, P = .2).The number of OHCA-CA cases was positively associated with the number of influenza infections in adult males during weeks in which there was a high frequency of influenza infections. To help prevent OHCA-CA in males, it might be beneficial to announce influenza epidemics specifically in adults, in addition to all ages.
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Affiliation(s)
- Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Motoki Yamashita
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan
| | - Naoki Sato
- Cardiology, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ken Nagao
- Cardiovascular Center, Nihon University Hospital, Tokyo, Japan
| | | | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
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Takahashi T, Yoshino H, Akutsu K, Shimokawa T, Ogino H, Kunihara T, Usui M, Watanabe K, Kawata M, Masuhara H, Yamasaki M, Yamamoto T, Nagao K, Takayama M. In-Hospital Mortality of Patients With Acute Type A Aortic Dissection Hospitalized on Weekends Versus Weekdays. JACC Asia 2022; 2:369-381. [PMID: 36338400 PMCID: PMC9627801 DOI: 10.1016/j.jacasi.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND In acute aortic dissection, weekend admissions are reported to be associated with increased mortality compared with weekday admissions. OBJECTIVE This study aimed to determine whether patients with acute type A aortic dissection (ATAAD) admitted on weekends had higher in-hospital mortality than those admitted on weekdays in the Tokyo metropolitan area, where we developed a patient-transfer system for aortic dissection. METHODS Data were collected during the first year after our transfer system began (cohort I) and in the subsequent years from 2013 to 2015 (cohort II). RESULTS We studied 2,339 patients (500 in cohort I; 1,839 in cohort II) with ATAAD. Patients with weekend admissions had higher in-hospital mortality than those with weekday admissions in cohort I. In association with increased interfacility transfer during weekends and reduced mortality at non-high-volume centers, the in-hospital mortality in the weekend group improved from 37.2% in cohort I to 22.2% in cohort II (P < 0.001). After inverse probability weighting adjustment, weekend admission was associated with higher in-hospital mortality in cohort I (odds ratio: 2.28; 95% confidence interval: 1.48 to 3.52; P < 0.001), but not in cohort II (odds ratio: 0.96; 95% confidence interval: 0.75 to 1.22; P = 0.731). On multivariable analyses, weekend admission was associated with higher in-hospital mortality in combined cohort I+II; the associations between weekend admission and mortality were not significant in cohort II. CONCLUSIONS We found a significant reduction in in-hospital mortality in patients with weekend admissions for ATAAD. No mortality difference between weekend and weekday admissions was observed in the later years of the study.
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Affiliation(s)
- Toshiyuki Takahashi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Koichi Akutsu
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Hitoshi Ogino
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Michio Usui
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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20
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Takahashi T, Yoshino H, Akutsu K, Shimokawa T, Ogino H, Kunihara T, Usui M, Watanabe K, Kawata M, Masuhara H, Yamasaki M, Yamamoto T, Nagao K, Takayama M. Sex‐Related Differences in Clinical Features and In‐Hospital Outcomes of Type B Acute Aortic Dissection: A Registry Study. J Am Heart Assoc 2022; 11:e024149. [PMID: 35492000 PMCID: PMC9238608 DOI: 10.1161/jaha.121.024149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The association between female sex and poor outcomes following surgery for type A acute aortic dissection has been reported; however, sex‐related differences in clinical features and in‐hospital outcomes of type B acute aortic dissection, including classic aortic dissection and intramural hematoma, remain to be elucidated. Methods and Results We studied 2372 patients with type B acute aortic dissection who were enrolled in the Tokyo Acute Aortic Super‐Network Registry. There were fewer and older women than men (median age [interquartile range]: 76 years [66–84 years], n=695 versus 68 years [57–77 years], n=1677; P<0.001). Women presented to the aortic centers later than men. Women had a higher proportion of intramural hematoma (63.7% versus 53.7%, P<0.001), were medically managed more frequently (90.9% versus 86.3%, P=0.002), and had less end‐organ malperfusion (2.4% versus 5.7%, P<0.001) and higher in‐hospital mortality (5.3% versus 2.7%, P=0.002) than men. In multivariable analysis, age (per year, odds ratio [OR], 1.06 [95% CI, 1.03–1.08]; P<0.001), hyperlipidemia (OR, 2.09 [95% CI, 1.13–3.88]; P=0.019), painlessness (OR, 2.59 [95% CI, 1.14–5.89]; P=0.023), shock/hypotension (OR, 2.93 [95% CI, 1.21–7.11]; P=0.017), non–intramural hematoma (OR, 2.31 [95% CI, 1.32–4.05]; P=0.004), aortic rupture (OR, 26.6 [95% CI, 14.1–50.0]; P<0.001), and end‐organ malperfusion (OR, 4.61 [95% CI, 2.11–10.1]; P<0.001) were associated with higher in‐hospital mortality, but was not female sex (OR, 1.67 [95% CI, 0.96–2.91]; P=0.072). Conclusions Women affected with type B acute aortic dissection were older and had more intramural hematoma, a lower incidence of end‐organ malperfusion, and higher in‐hospital mortality than men. However, female sex was not associated with in‐hospital mortality after multivariable adjustment.
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Affiliation(s)
- Toshiyuki Takahashi
- Tokyo CCU Network Scientific Committee Tokyo Japan
- Department of Cardiology Tokyo Saiseikai Central Hospital Tokyo Japan
| | | | | | | | | | | | - Michio Usui
- Tokyo CCU Network Scientific Committee Tokyo Japan
| | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee Tokyo Japan
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21
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Ozaki Y, Tomoe H, Kuwajima M, Ninomiya N, Sekiguchi Y, Sato Y, Nagao K, Takahashi S. Prevalence of genitourinary syndrome of menopause in Japanese peri- and post-menopausal women: A cross-sectional online survey. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Nagao K, Nakajima K. Penile implants in Japan. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Jimba T, Kodera S, Kohsaka S, Harada K, Shiraishi Y, Koba S, Takei M, Kohno T, Matsushita K, Nakano H, Miyazaki T, Tsukamoto S, Matsuda J, Shindo A, Kitano D, Yamamoto T, Nagao K, Takayama M. DEEP LEARNING MODELS FOR PREDICTION OF HEART FAILURE ADMISSIONS WITH INCORPORATION OF CLIMATE INFORMATION: SUGGESTION TOWARDS AN ADMISSION ‘FORECASTING’ SYSTEM. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Kuroki N, Nagao K, Otsuka T, Kuwabara M, Nakata J, Takayama T, Hosokawa Y, Ashida T, Suzuki K, Yamamoto T, Takayama M. Combined use of venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump after cardiac arrest. Resuscitation 2021; 167:345-354. [PMID: 34314778 DOI: 10.1016/j.resuscitation.2021.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVES We investigated whether intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) was associated with favourable neurological outcomes for patients after the return of spontaneous circulation (ROSC). Moreover, we evaluated the aetiology of cardiac arrest on the effectiveness of this therapy in a sub-study. BACKGROUND There is insufficient research on the optimal combination of machines for patients after ROSC is not established. METHODS This is a large-scale, multicentre, 30-day cohort study. Among 80,716 patients who delivered to the emergency room, 935 patients treated with VA-ECMO after ROSC were included using the data from the Tokyo Cardiovascular Care Unit Network Registry between 2010 and 2017. The study patients were stratified according to the use of IABP [the ECMO + IABP group (n = 762) vs. the ECMO-alone group (n = 173)]. We also evaluated the cause of cardiac arrest [acute coronary syndrome (ACS) and non-ACS] in the sub-study. To adjust the patients' backgrounds, we used the propensity score matching for additional analyses. The endpoint was 30-day favourable neurological outcome. RESULTS The ECMO + IABP group showed significantly better neurological outcomes than the ECMO-alone group (crude; 35% vs. 25%; log-lank P < 0.001). In the ACS subgroup, the ECMO + IABP group showed significantly better neurological outcome (crude; 34% vs. 18%; log-lank P < 0.001), but not in the non-ACS subgroup (crude; 38% vs. 32%; log-lank P = 0.11). These results are similar after adjustments to their backgrounds using propensity matching. CONCLUSIONS Compared to VA-ECMO alone, the combined use of VA-ECMO and IABP is associated with better neurological outcomes after ROSC, especially in complicated ACS.
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Affiliation(s)
- Norihiro Kuroki
- Tokyo CCU Network, Scientific Committee, Tokyo, Japan; Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
| | - Ken Nagao
- Tokyo CCU Network, Scientific Committee, Tokyo, Japan
| | - Toshiaki Otsuka
- Tokyo CCU Network, Scientific Committee, Tokyo, Japan; Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | | | - Jun Nakata
- Tokyo CCU Network, Scientific Committee, Tokyo, Japan
| | | | | | | | - Kou Suzuki
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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25
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Matsuzaki M, Matsumoto N, Nagao K, Sawano H, Yokoyama H, Tahara Y, Hase M, Shirai S, Hazui H, Arimoto H, Kashiwase K, Kasaoka S, Motomura T, Kuroda Y, Yasuga Y, Yonemoto N, Nonogi H. Impact of Induced Therapeutic Hypothermia by Intravenous Infusion of Ice-Cold Fluids After Hospital Arrival in Comatose Survivors of Out-of-Hospital Cardiac Arrest With Initial Shockable Rhythm. Circ J 2021; 85:1842-1848. [PMID: 34261843 DOI: 10.1253/circj.cj-20-0793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of in-hospital rapid cooling by intravenous ice-cold fluids for comatose survivors of out-of-hospital cardiac arrest (OHCA) is unclear.Methods and Results:From the J-PULSE-HYPO study registry, data for 248 comatose survivors with return of spontaneous circulation (ROSC) who were treated with therapeutic hypothermia (34℃ for 12-72 h) after witnessed shockable OHCA were extracted. Patients were divided into 2 groups by the median collapse-to-ROSC interval (18 min), and then into 2 groups by cooling method (rapid cooling by intravenous ice-cold fluids vs. standard cooling). The primary endpoint was favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after OHCA. In the whole cohort, the shorter collapse-to-ROSC interval group had significantly higher favorable neurological outcome than the longer collapse-to-ROSC interval group (78.2% vs. 46.8%, P<0.001). In the shorter collapse-to-ROSC interval group, no significant difference was observed in favorable neurological outcome between the 2 cooling groups (rapid cooling group: 79.4% vs. standard cooling group: 77.0%, P=0.75). In the longer collapse-to-ROSC interval group, however, favorable neurological outcome was significant higher in the rapid cooling group than in the standard cooling group (60.7% vs. 33.3%, P<0.01) and the adjusted odds ratio after rapid cooling was 3.069 (95% confidence interval 1.423-6.616, P=0.004). CONCLUSIONS In-hospital rapid cooling by intravenous ice-cold fluids improved neurologically intact survival in comatose survivors whose collapse-to-ROSC interval was delayed over 18 min after shockable OHCA.
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Affiliation(s)
| | | | - Ken Nagao
- Department of Cardiology, Nihon University Hospital
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Saiseikai Senri Hospital
| | | | | | - Mamoru Hase
- Emergency and Critical Care Center, Sapporo City University Hospital
| | | | - Hiroshi Hazui
- Emergency Medicine, Osaka Mishima Emergency and Critical Care Center
| | - Hideki Arimoto
- Emergency and Critical Care Medical Center, Osaka City General Hospital
| | | | - Shunji Kasaoka
- Disaster Medical Education and Research Center, Kumamoto University Hospital
| | | | - Yasuhiro Kuroda
- Emergency and Critical Care Center, Kagawa University Hospital
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26
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Nakashima T, Ogata S, Noguchi T, Tahara Y, Onozuka D, Kato S, Yamagata Y, Kojima S, Iwami T, Sakamoto T, Nagao K, Nonogi H, Yasuda S, Iihara K, Neumar R, Nishimura K. Machine learning model for predicting out-of-hospital cardiac arrests using meteorological and chronological data. Heart 2021; 107:1084-1091. [PMID: 34001636 PMCID: PMC8223656 DOI: 10.1136/heartjnl-2020-318726] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate a predictive model for robust estimation of daily out-of-hospital cardiac arrest (OHCA) incidence using a suite of machine learning (ML) approaches and high-resolution meteorological and chronological data. METHODS In this population-based study, we combined an OHCA nationwide registry and high-resolution meteorological and chronological datasets from Japan. We developed a model to predict daily OHCA incidence with a training dataset for 2005-2013 using the eXtreme Gradient Boosting algorithm. A dataset for 2014-2015 was used to test the predictive model. The main outcome was the accuracy of the predictive model for the number of daily OHCA events, based on mean absolute error (MAE) and mean absolute percentage error (MAPE). In general, a model with MAPE less than 10% is considered highly accurate. RESULTS Among the 1 299 784 OHCA cases, 661 052 OHCA cases of cardiac origin (525 374 cases in the training dataset on which fourfold cross-validation was performed and 135 678 cases in the testing dataset) were included in the analysis. Compared with the ML models using meteorological or chronological variables alone, the ML model with combined meteorological and chronological variables had the highest predictive accuracy in the training (MAE 1.314 and MAPE 7.007%) and testing datasets (MAE 1.547 and MAPE 7.788%). Sunday, Monday, holiday, winter, low ambient temperature and large interday or intraday temperature difference were more strongly associated with OHCA incidence than other the meteorological and chronological variables. CONCLUSIONS A ML predictive model using comprehensive daily meteorological and chronological data allows for highly precise estimates of OHCA incidence.
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Affiliation(s)
- Takahiro Nakashima
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral Cardiovascular Centre, Suita, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral Cardiovascular Centre, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Daisuke Onozuka
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral Cardiovascular Centre, Suita, Japan
| | | | | | - Sunao Kojima
- Department of General Internal Medicine 3, Kawasaki Medical School, Kurashiki, Japan
| | - Taku Iwami
- Health Service, Kyoto University, Kyoto, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University, Itabashi-ku, Japan
| | - Ken Nagao
- Cardiovascular Centre, Nihon University Hospital, Tokyo, Japan
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Iihara
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Robert Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral Cardiovascular Centre, Suita, Japan
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27
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Yagi T, Nagao K, Tachibana E, Yonemoto N, Sakamoto K, Ueki Y, Imamura H, Miyamoto T, Takahashi H, Hanada H, Chiba N, Tani S, Matsumoto N, Okumura Y. Treatment With Vasopressor Agents for Cardiovascular Shock Patients With Poor Renal Function; Results From the Japanese Circulation Society Cardiovascular Shock Registry. Front Med (Lausanne) 2021; 8:648824. [PMID: 34012971 PMCID: PMC8126606 DOI: 10.3389/fmed.2021.648824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
According to the guidelines for cardiogenic shock, norepinephrine is associated with fewer arrhythmias than dopamine and may be the better first-line vasopressor agent. This study aimed to evaluate the utility of norepinephrine vs. dopamine as first-line vasopressor agent for cardiovascular shock depending on the presence and severity of renal dysfunction at hospitalization. This was a secondary analysis of the prospective, multicenter Japanese Circulation Society Cardiovascular Shock Registry (JCS Shock Registry) conducted between 2012 and 2014, which included patients with shock complicating emergency cardiovascular disease at hospital arrival. The analysis included 240 adult patients treated with norepinephrine alone (n = 98) or dopamine alone (n = 142) as the first-line vasopressor agent. Primary endpoint was mortality at 30 days after hospital arrival. The two groups had similar baseline characteristics, including estimated glomerular filtration rate (eGFR), and similar 30-day mortality rates. The analysis of the relationship between 30-day mortality rate after hospital arrival and vasopressor agent used in patients categorized according to the eGFR-based chronic kidney disease classification revealed that norepinephrine as the first-line vasopressor agent might be associated with better prognosis of cardiovascular shock in patients with mildly compromised renal function at admission (0.0 vs. 22.6%; P = 0.010) and that dopamine as the first-line vasopressor agent might be beneficial for cardiovascular shock in patients with severely compromised renal function [odds ratio; 0.22 (95% confidence interval 0.05-0.88; P = 0.032)]. Choice of first-line vasopressor agent should be based on renal function at hospital arrival for patients in cardiovascular shock. Clinical Trial Registration: http://www.umin.ac.jp/ctr/, Unique identifier: 000008441.
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Affiliation(s)
- Tsukasa Yagi
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan.,Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Ken Nagao
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Eizo Tachibana
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Naohiro Yonemoto
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Kazuo Sakamoto
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yasushi Ueki
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Emergency and Critical Care Center, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Imamura
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Emergency and Critical Care Center, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takamichi Miyamoto
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Musashino Red Cross Hospital, Musashino, Japan
| | - Hiroshi Takahashi
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Hiroyuki Hanada
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Emergency and Critical Care Center, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Nobutaka Chiba
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo, Japan
| | - Shigemasa Tani
- Japanese Circulation Society (JCS) Shock Registry Scientific Committee, Tokyo, Japan.,Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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28
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yamasaki M, Yoshino H, Kunihara T, Akutsu K, Shimokawa T, Ogino H, Kawata M, Takahashi T, Usui M, Watanabe K, Masuhara H, Yamamoto T, Nagao K, Takayama M. Risk analysis for early mortality in emergency acute type A aortic dissection surgery: experience of Tokyo Acute Aortic Super-network. Eur J Cardiothorac Surg 2021; 60:957-964. [PMID: 33829258 DOI: 10.1093/ejcts/ezab146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/17/2020] [Accepted: 02/24/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We investigated the various pre- and postoperative complications related to early (30-day) mortality after open surgery for acute type A aortic dissection. METHODS Data from the Tokyo Acute Aortic Super-network database spanning January 2015 to December 2017 were retrospectively reviewed. Pre- and postoperative factors related to early postoperative mortality were assessed in 1504 of 2058 (73.0%) consecutive patients [age: 66.6 (SD: 13.5) years, male: 52.9%] who underwent acute type A aortic dissection repair. RESULTS The early mortality rate following surgical repair was 8.9%. According to multivariable analysis, male sex [odds ratio (OR) 1.670, 95% confidence interval (CI) 1.063-2.624, P = 0.026], use of percutaneous circulatory assist devices (n = 116, 7.7%) including extracorporeal membrane oxygenators or intra-aortic balloon pumps (OR 4.857, 95% CI 2.867-8.228, P < 0.001), shock (n = 162, 10.8%) (OR 3.06, 95% CI 1.741-5.387, P < 0.001), cardiopulmonary arrest (n = 41, 2.7%) (OR 7.534, 95% CI 3.407-16.661, P < 0.001), coronary ischaemia (n = 36, 2.3%) (OR 2.583, 95% CI 1.042-6.404, P = 0.041) and cerebral ischaemia (n = 59, 3.9%) (OR 2.904, 95% CI 1.347-6.261, P = 0.007) were independent preoperative risk factors for early mortality, while cardiac tamponade (n = 34, 2.3%) (OR 10.282, 95% CI 4.640-22.785, P < 0.001), cerebral ischaemia (n = 80, 5.3%) (OR 2.409, 95% CI 1.179-4.923, P = 0.016) and mesenteric ischaemia (n = 15, 1.0%) (OR 44.763, 95% CI 13.027-153.808, P < 0.001) were independent postoperative risk factors. CONCLUSIONS Not only critical preoperative conditions but also postoperative cardiac tamponade and vital organ ischaemia are risk factors for early mortality after acute type A aortic dissection repair.
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Affiliation(s)
- Manabu Yamasaki
- Tokyo CCU Network Scientific Committee, Tokyo, Japan.,Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan
| | | | | | - Koichi Akutsu
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Hitoshi Ogino
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | - Michio Usui
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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30
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Yoshie K, Yamasaki M, Yokoyama M, Ueki Y, Tachibana E, Yonemoto N, Nagao K. Prognostic benefits of prior amiodarone or β-blocker use before the onset of ventricular arrhythmia with hemodynamic collapse. Heart Vessels 2021; 36:1430-1437. [PMID: 33721036 DOI: 10.1007/s00380-021-01821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
Although antiarrhythmic drugs have long been used for the suppression of various types of arrhythmias, their prior use before the onset of ventricular arrhythmia with hemodynamic collapse and the effect on prognosis is not well known. Data from 1004 consecutive patients with cardiovascular shock in the Japanese Circulation Society's Shock Registry were analyzed. Eighty-four cases of ventricular arrhythmia-induced shock and ROSC (return of spontaneous circulation) were divided into the prior amiodarone or β-blockers use group (Aβ group, n = 27) and the non-amiodarone and non-β-blockers use group (non-Aβ group; n = 57) based on treatment before the onset of those arrhythmias. Clinical outcomes related to hemodynamic collapse such as OHCA (out-of-hospital cardiovascular arrest) was less in the Aβ group [Aβ group, 11/26 (42%) vs. non-Aβ group, 41/56 (73%); p = 0.007]. Similarly, syncope was less common in the Aβ group than in the non-Aβ group [Aβ group 4/27 (15%) vs. non-Aβ group 27/57 (47%); p = 0.004]. Furthermore, prior amiodarone or β-blockers use before the onset of ventricular arrhythmias was strongly associated with both survival at discharge (odds ratio 3.19; 95% confidence interval 1.06-9.67; p = 0.040) and neurological outcomes at discharge (odds ratio 3.96; 95% confidence interval 1.32-11.85; p = 0.014) based on multivariate logistic regression analysis. Prior amiodarone or β-blockers use before the onset of malignant ventricular arrhythmia and maintaining appropriate blood concentrations in advance is associated with a good survival rate and better neurological outcomes after recovery from ventricular arrhythmia with hemodynamic collapse.
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Affiliation(s)
- Koji Yoshie
- JCS Shock Registry Scientific Committee, Tokyo, Japan.
- Department of Emergency and Intensive Care Center, Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
| | | | | | - Yasushi Ueki
- JCS Shock Registry Scientific Committee, Tokyo, Japan
| | | | | | - Ken Nagao
- JCS Shock Registry Scientific Committee, Tokyo, Japan
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31
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Kato Y, Miura SI, Hirayama A, Izumi C, Yasuda S, Tahara Y, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H, Kobayashi Y. Comparison of clinical outcomes between patients with pulseless-ventricular tachycardia and ventricular fibrillation in out-of-hospital cardiac arrest. Resusc Plus 2021; 6:100107. [PMID: 34223368 PMCID: PMC8244523 DOI: 10.1016/j.resplu.2021.100107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 10/28/2022] Open
Abstract
Aim While previous studies have shown that the initial documented rhythm is associated with clinical outcomes in out-of-hospital cardiac arrest (OHCA), little is known about the difference in clinical outcomes between pulseless ventricular tachycardia (p-VT) and ventricular fibrillation (VF). Methods From a nationwide, prospective population-based database of OHCA from 2011 to 2015, we selected bystander-witnessed adult patients who were not treated with a public automated external defibrillator. The outcomes examined were favorable 30-day neurological survival rates, 30-day survival rates, and prehospital return of spontaneous circulation (ROSC) rates. To determine the association of the initial documented rhythm with outcome, we used a logistic regression model while adjusting for patient factors and prehospital care-related factors. Results A total of 19,594 bystander-witnessed OHCA patients who had a shockable rhythm were included: 454 (2.3%) were p-VT and 19,140 (97.7%) were VF. Compared to VF patients, p-VT patients were older, less likely to have a cardiogenic cause, and had shorter resuscitation-related time intervals (collapse to bystander cardiopulmonary resuscitation, collapse to emergency medical services contact, collapse to first ROSC, and first defibrillation to first ROSC). After adjustment for covariates, p-VT was associated with high favorable 30-day neurological survival rates (adjusted odds ratio [OR], 1.85; 95% confidence interval [CI], 1.30-2.64, p = 0.001), 30-day survival rates (adjusted OR, 1.41; 95% CI, 1.03-1.95, p = 0.037), and prehospital ROSC rates (adjusted OR, 1.90; 95% CI, 1.42-2.55, p < 0.001). Conclusion In this study, patients with p-VT as the initial documented rhythm had significantly better outcomes than those with VF.
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Affiliation(s)
- Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Hirayama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naohiro Yonemoto
- Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Nonogi
- Faculty of Health Science, Osaka Aoyama University, Osaka, Japan
| | - Ken Nagao
- Cardiovascular Center, Nihon University Hospital, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Naoki Sato
- Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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32
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Kojima S, Michikawa T, Matsui K, Ogawa H, Yamazaki S, Nitta H, Takami A, Ueda K, Tahara Y, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Kobayashi Y. Fine particulate matter and out-of-hospital cardiac arrest of respiratory origin. Eur Respir J 2021; 57:13993003.04299-2020. [PMID: 33632797 PMCID: PMC8176347 DOI: 10.1183/13993003.04299-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/31/2021] [Indexed: 12/03/2022]
Abstract
Exposure to ambient air pollution increases mortality and is a leading contributor to the global disease burden [1]. Epidemiological studies have elucidated a relationship between out-of-hospital cardiac arrests (OHCAs) and air pollutants, especially particulate matter (diameter ≤2.5 μm; PM2.5) [2, 3]. The causes of OHCA are broadly categorised as cardiac and non-cardiac [4]. A 10 µg·m−3 increase in PM2.5 exposure yielded a 1.6% increase in the incidence of cardiac origin OHCA [3, 5]. However, few studies on OHCAs of non-cardiac origin, including intrinsic respiratory diseases (COPD/pneumonia/asthma) are available. We examined the association between short-term exposure to PM2.5 and bystander-witnessed respiratory origin OHCAs, including eventual prognosis. We also investigated differences between PM2.5 exposure-related cardiac and respiratory origin OHCAs. Particulate matter is a potential risk factor for out-of-hospital cardiac arrests (OHCAs) of respiratory origin. The percent increase in incidence of OHCA of respiratory origin is equivalent to that of PM2.5 exposure-related OHCAs of cardiac origin.http://bit.ly/3tDXym0
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Affiliation(s)
- Sunao Kojima
- Dept of General Internal Medicine 3, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Takehiro Michikawa
- Dept of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Kunihiko Matsui
- Dept of General Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shin Yamazaki
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Hiroshi Nitta
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Akinori Takami
- Centre for Regional Environmental Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Kayo Ueda
- Environmental Health Sciences, Kyoto University Graduate School of Global Environmental Studies, Kyoto, Japan
| | - Yoshio Tahara
- Dept of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naohiro Yonemoto
- Dept of Public Health, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Nonogi
- Faculty of Health Science, Osaka Aoyama University, Mino, Japan
| | - Ken Nagao
- Dept of Cardiovascular Center, Nihon University Hospital, Tokyo, Japan
| | - Takanori Ikeda
- Dept of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yoshio Kobayashi
- Dept of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Takahashi T, Yoshino H, Akutsu K, Shimokawa T, Ogino H, Kunihara T, Usui M, Watanabe K, Kawata M, Masuhara H, Yamasaki M, Hagiya K, Yamamoto T, Nagao K, Takayama M. Sex-related differences in clinical features and in-hospital outcomes of acute aortic dissection type b. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute aortic dissection (AAD) is a life-threatening medical condition with high morbidity and mortality. The association between female sex and poorer outcomes following surgery for AAD type A has been reported; however, the sex-related differences in clinical features and in-hospital outcomes of AAD type B remain to be elucidated.
Methods
We studied a total of 1877 patients with AAD type B who were enrolled in the Tokyo Acute Aortic Super-network from January 2013 to December 2016. Clinical features and in-hospital outcomes were compared between sexes. Independent predictors of in-hospital mortality were assessed using a multivariable analysis.
Results
The mean age of the patients was 69±13 years and 549 (29%) were females. Female patients were older than males (74±13 years vs 67±13 years; p<0.001). Females had lower systolic blood pressure on admission (158±37 mmHg vs 164±38 mmHg; p=0.007) and were more likely to have altered consciousness level at presentation (8.7% vs 3.9%; p<0.001), intramural hematoma (IMH)-type AAD (62.7% vs 53.6%; p<0.001), and DeBakey type IIIa (28.4% vs 21.8%; p=0.002) compared with males. Females were treated with medical therapy alone more frequently (90.3% vs 85.9%; p=0.009) and had a higher in-hospital mortality rate (5.3% vs 2.6%; p=0.036). A multivariable analysis revealed that age [per year, odds ratio (OR) 1.06; 95% CI 1.04–1.09; p<0.001], altered consciousness level (OR 3.28; 95% CI 1.54–6.98; p=0.002), shock/hypotension (OR 14.0; 95% CI 5.92–33.1; p<0.001), classic-type AAD (OR 2.54; 95% CI 1.36–4.73; p=0.003), and medical therapy alone (OR 0.28; 95% CI 0.15–0.54; p<0.001) were independent predictors of in-hospital mortality, whereas female sex was not predictive of in-hospital mortality (OR 1.64; 95% CI 0.91–2.96; p=0.10).
Conclusion
In AAD type B, females were older and had altered consciousness level, IMH-type, and a less widespread dissection more frequently than males. The overall in-hospital mortality was higher in females; however, female sex was not associated with in-hospital mortality after multivariable adjustment.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | | | | | - H Ogino
- Tokyo CCU Network, Tokyo, Japan
| | | | - M Usui
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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Watanabe K, Yoshino H, Takahashi T, Usui M, Akutsu K, Shimokawa T, Kunihara T, Kawata M, Masuhara H, Ogino H, Yamasaki M, Hagiya K, Yamamoto T, Nagao K, Takayama M. Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment.
The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database.
We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded.
We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively.
In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Watanabe
- Nihon University, Tokyo CCU Network, Tokyo, Japan
| | | | | | - M Usui
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | | | - H Ogino
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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Seko Y, Kato T, Yamamoto E, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, Yoshikawa Y, Nagao K, Kawase Y, Kuwahara K, Kimura T. A decrease in tricuspid regurgitation pressure gradient during follow-up in patients with heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
This study aimed to investigate the prognostic impact of the decrease in tricuspid regurgitation pressure gradient (TRPG) at 6-month follow-up in patients after discharge with heart failure (HF).
Background
No previous study has reported the association between TRPG decrease during follow-up and clinical outcomes in HF.
Methods
Among 748 patients with 6-months follow-up echocardiography after discharge from the acute decompensated heart failure in 19 centers in Japan, we analyzed 721 patients with available TRPG data and divided into two groups: the decrease in TRPG group (N=179) and no decrease in TRPG group (N=542). We defined the decrease in TRPG as >10mmHg decrease compared in the initial hospitalization. The primary outcome measure was a composite of all cause deaths and hospitalization due to HF.
Results
The patients in the decrease in TRPG group had a lower prevalence of hypertension, dyslipidemia, atrial fibrillation, and a reduced EF, higher levels of blood albumin and lower levels of sodium than those in no decrease in TRPG group. The median follow-up duration after the follow up echocardiography was 302 (inter quartile range: 206–490), with a 90.9% follow up rate at 6-month. The cumulative 6-month incidence of the primary outcome measure was significantly lower in the decrease in TRPG group than in no decrease in TRPG group (12.2% vs. 18.9%, P=0.0011). After adjusting confounders, the excess risk of the decrease in TRPG relative to no decrease in TRPG for the primary outcome measure remained significant (HR: 0.60, 95% CI 0.34–0.99). There were no significant interactions between the subgroup factors and the effect of the decrease in TRPG for primary outcomes.
Conclusions
HF patients with the decrease in TRPG at 6-month after discharge had a lower risk of clinical outcome than those without decrease in TRPG.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Seko
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Kato
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - E Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - H Yaku
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Morimoto
- Hyogo Medical University, Nishinomiya, Japan
| | - Y Inuzuka
- Shiga general hospital, Moriyama, Japan
| | | | - N Ozasa
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Y Yoshikawa
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Nagao
- Osaka Red Cross Hospital, Osaka, Japan
| | - Y Kawase
- Kurashiki Central Hospital, Kurashiki, Japan
| | - K Kuwahara
- Shinshu University Hospital, Matsumoto, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Asano T, Mitsuhashi Y, Yamashita J, Ito R, Saji M, Wakabayashi K, Yahagi K, Shinke T, Mase T, Miyachi H, Higuchi S, Miyauchi K, Yamamoto T, Nagao K, Takayama M. Relationship between age and the impact of revascularization on mortality in patients with non-ST-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
It is known that the early coronary revascularization in patients with non-ST-elevation myocardial infarction (NSTEMI) was associated with favorable clinical outcomes. However, it is still unclear whether this efficacy is equivalent over all the ages of the patients.
Methods
Patients with NSTEMI were screened from the database of the Tokyo CCU network registry. Of those, the patients treated without revascularization (medical treatment) were matched with the patients receiving revascularization by propensity score matching. The probabilities of in-hospital death were calculated in the logistic regression model. In two subgroups stratified according to median of the age (elderly and non-elderly subgroups), the odds ratios of revascularization for in-hospital death were calculated.
Results
In the patients registered between 2013 and 2017, 4,851 patients with NSTEMI were identified. After the screening, 370 patients with medical treatment were matched with 370 patients treated with revascularization. The incidence of in-hospital death was significantly higher in the patients with medical treatment (20.3% vs 13.0%, P=0.01). The two probability curves of in-hospital death in patients with and without revascularization converged as age increased. In the elderly subgroup, the revascularization was not significantly associated with favorable outcome of mortality, whereas it had a significant impact on mortality in the non-elderly subgroup (odds ratio: 0.47 [95% CI 0.23–0.95]).
Conclusion
The impact of revascularization on short-term mortality in patients with NSTEMI tended to be reduced as age increased.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Asano
- Tokyo CCU Network, Tokyo, Japan
| | | | | | - R Ito
- Tokyo CCU Network, Tokyo, Japan
| | - M Saji
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | - T Mase
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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Yagi T, Nagao K, Tachibana E, Yonemoto N, Tahara Y, Nonogi H, Ikeda T, Sato N, Tsutsui H. Assessment of the 2015 cardiopulmonary resuscitation guidelines for patients with out-of-hospital cardiac arrest: results from the All-Japan Utstein registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA).
Methods
From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2015 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines or 2015 CPR guidelines. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR in this registry. Study patients were divided into five groups based on different years (figure). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, instructed by dispatcher or not, and time interval from call EMS to scene.
Results
The figure showed favorable neurological outcomes at 30 days. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in 2016 as compared to in 2011 was 1.32 (95% CI: 1.04–1.68, p=0.022). On the other hands, there were no significant differences from 2011 to 2014.
Conclusion
In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Yagi
- Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - K Nagao
- Nihon University, Tokyo, Japan
| | - E Tachibana
- Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | | | - Y Tahara
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - H Nonogi
- Shizuoka General Hospital, Shizuoka, Japan
| | - T Ikeda
- Toho University, Tokyo, Japan
| | - N Sato
- Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
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39
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Kataoka S, Kobayashi Y, Isogai T, Tanno K, Fukamizu S, Watanabe N, Ueno A, Yamamoto T, Takayama M, Nagao K. Permanent pacemaker implantation and its predictors in patients admitted for complete atrioventricular block: a report from the Tokyo Cardiovascular Care Unit Network multi-center registry. Heart Vessels 2020; 35:1573-1582. [PMID: 32500173 DOI: 10.1007/s00380-020-01642-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
Little is known about the permanent pacemaker implantation rate and predictors of permanent pacemaker implantation in patients admitted for complete atrioventricular block (cAVB). The present study was a retrospective analysis based on a multicenter cohort of 797 patients with cAVB (mean age: 79.6 ± 10.7 years; males: 48.4%) registered with the Tokyo Cardiovascular Care Unit Network multicenter registry between 2013 and 2016. Secondary cAVB due to acute coronary syndrome was excluded. The permanent pacemaker implantation rate was 82.9%. Multivariable logistic regression analysis revealed that systolic blood pressure (SBP) > 140 mmHg [odds ratio (OR) 2.10; 95% confidence interval (CI) 1.38-3.22; P < 0.001], male gender (OR 1.63; 95% CI 1.07-2.49; P = 0.023), and left ventricular ejection fraction (LVEF) ≥ 50% (OR 2.19; 95% CI 1.16-2.06; P = 0.016) were predictors of permanent pacemaker implantation while pre-admission β-blocker use (OR 0.28; 95% CI 0.17-0.47; P < 0.001) was associated with a lower risk of permanent pacemaker implantation. Reversible cAVB was not rare in patients admitted for cAVB. Data on SBP on admission, gender, LVEF, and pre-admission β-blocker use may be important for assessing the requirement for permanent pacemaker implantation in the emergency care setting.
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Affiliation(s)
- Shohei Kataoka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan. .,Department of Cardiology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.
| | | | - Toshiaki Isogai
- Tokyo CCU Network Scientific Committee, Tokyo, Japan.,Department of Cardiology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Kaoru Tanno
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | - Akira Ueno
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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40
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Mitsuhashi Y, Tanaka H, Saji M, Miyachi H, Yamamoto T, Nagao K, Takayama M. Predictors of in-hospital mortality in patients with acute myocardial infarction due to unprotected left main trunk lesion: insight from the Tokyo Cardiovascular Care Unit network multicenter registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Acute myocardial infarction (AMI) due to unprotected left main trunk (LMT) lesion remains a clinical challenge because it requires prompt and efficient revascularization in catastrophic clinical presentation. However, predictors of in-hospital prognosis in patients with LMT-AMI are still not fully understood.
Purpose
To examine the predictors of in-hospital mortality in patients with LMT-AMI.
Methods
From 20,257 AMI patients in the Tokyo Cardiovascular Care Unit network registry (comprising 72 hospitals) from 2013 to 2017, we identified 371 (1.8%) eligible LMT-AMI patients without a history of coronary artery bypass grafting (CABG) and divided them into two groups: 254 survivors and 117 non-survivors. Measured variables included patient demographics, vital signs, laboratory data on admission, and in-hospital treatment. The outcome was in-hospital mortality. We performed a multivariable logistic regression analysis for in-hospital mortality with adjustment for the following 9 potential confounders, based on previous studies: (1) age, (2) sex, (3) Killip class, (4) ST elevation, (5) wide QRS (>120 msec), (6) the Thrombolysis in Myocardial Infarction (TIMI) grade on initial coronary angiography, (7) number of vessels with significant stenosis other than LMT, (8) renal dysfunction on admission, and (9) plasma glucose on admission.
Results
Overall, mean age was 70.6±11.8 years and 81.9% were male. ST-elevation myocardial infarction accounted for 61.8%. Cardiac arrest was observed in 102 (33.6%) patients. Percutaneous coronary intervention and CABG were performed in 302 (81.8%) and 63 (17.0%) patients, respectively. Intra-aortic balloon pumping and veno-arterial extracorporeal membranous oxygenation were used in 288 (77.8%) and 81 (21.9%) patients, respectively. In-hospital mortality was 31.5%. Multivariable logistic regression analysis showed that higher in-hospital mortality was significantly associated with Killip class IV (adjusted odds ratio 3.41 [95% confidence interval 1.36–8.56]; reference: Killip I), TIMI grade 0 (3.51 [1.22–10.14]; reference: TIMI grade 3), renal dysfunction (estimated glomerular filtration <60 mL/min/1.73m2; 6.48 [2.53–16.57]), and high plasma glucose on admission (>150 mg/dl; 3.64 [1.33–9.97]). Age, sex, ST-elevation, wide QRS, and multi-vessel disease were not significantly associated with in-hospital mortality.
Conclusions
LMT-AMI remains life-threatening in the current era of widely available revascularization. Our results showed that haemodynamic compromise, no coronary flow, renal dysfunction, and high plasma glucose on admission were strong predictors of in-hospital mortality after LMT-AMI. Given the high cardiac arrest rate, more aggressive therapeutic measures including mechanical circulatory support may be required to improve the prognosis of LMT-AMI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Mitsuhashi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - H Tanaka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - M Saji
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - H Miyachi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - T Yamamoto
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - K Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - M Takayama
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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41
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Asano T, Mitsuhashi Y, Sachi M, Wakabayashi K, Yahagi K, Shinke T, Mase T, Miyachi H, Tujiguchi S, Yamashita J, Yamazaki M, Miyauchi K, Yamamoto T, Nagao K, Takayama M. The impact of low diastolic blood pressure on 30-day mortality of patients with acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
It is known that low diastolic blood pressure (DBP) is associated with long-term cardiovascular events after acute myocardial infarction (AMI). However, the impact of low diastolic blood pressure on short-term outcome has not yet been well investigated.
Methods and results
We included 15,208 patients who were hospitalized for AMI and registered in the Tokyo CCU network registry between 2013 and 2016. Thirty-day in-hospital mortality rate was 4.8% (728/15,208). To assess the relationship between DBP at the time of admission and 30-day mortality non-linearly, spline regression model was applied with the stratification of the cohort according to tercile of systolic blood pressure (SBP, low:≤122 mmHg, intermediate:123–148 mmHg, high:≥149 mmHg) and J-curve phenomenon was observed in the low and high SBP groups. In multivariate logistic regression analysis, adjusted odds ratio of the lowest quintile of DBP (≤64 mmHg) was 1.65 (95% CI:1.02–2.66) in low SBP group and 4.55 (95% CI:1.72–12.00) in high SBP group.
Conclusion
Low DBP was associated with increased 30-day in-hospital mortality rate after AMI even in patients with high SBP.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Asano
- Tokyo CCU Network, Tokyo, Japan
| | | | - M Sachi
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | - T Mase
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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42
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Matsuoka Y, Goto R, Atsumi T, Morimura N, Nagao K, Tahara Y, Asai Y, Yokota H, Ariyoshi K, Yamamoto Y, Sakamoto T. Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A multi-centre prospective cohort study. Resuscitation 2020; 157:32-38. [PMID: 33080369 DOI: 10.1016/j.resuscitation.2020.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
AIM Extracorporeal cardiopulmonary resuscitation (ECPR) is an evolving resuscitative method for refractory cardiopulmonary arrests. However, considering the substantial healthcare costs and resources involved, there is an urgent need for a full economic evaluation. We therefore assessed the cost-effectiveness of ECPR for refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT). METHODS We developed a decision model to estimate lifetime costs and outcomes for out-of-hospital cardiac arrest patients with VF/pVT who received either ECPR or conventional cardiopulmonary resuscitation. Quality-adjusted life-years (QALY) was used as the main outcome measure. This model was a combination of a decision tree model for the acute phase based on a prospective observational study (SAVE-J study), together with a Markov model for long-term follow-up periods extrapolated from published data. To evaluate the robustness of this model, we conducted a comprehensive deterministic sensitivity analysis (DSA) and a probabilistic sensitivity analysis (PSA). RESULTS ECPR was cost-effective, with an incremental cost of ¥3,521,189 (Є30,227), an incremental effectiveness of 1.34 QALY, and an incremental cost-effectiveness ratio of ¥2,619,692 (Є22,489) per QALY gained. DSA revealed that the present model was most sensitive to probability of Cerebral Performance Category 1 after ECPR (¥2,153,977/QALY to ¥3,186,475/QALY), patient age (¥2,170,112/QALY to ¥3,334,252/QALY), and long-term medical cost for modified Rankin Scale 0 (¥2,280,352/QALY to ¥2,855,330/QALY). PSA indicated ECPR to be cost-effective and below the willingness-to-pay threshold of ¥5,000,000 with an 86.7 % possibility. CONCLUSIONS ECPR was an economically acceptable resuscitative strategy, and the results of the present study were robust even when considering the uncertainty of all parameters.
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Affiliation(s)
- Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan; Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Rei Goto
- Graduate School of Business Administration, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-8526, Japan
| | - Takahiro Atsumi
- Department of Emergency Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka 430-8558, Japan
| | - Naoto Morimura
- Department of Acute Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ken Nagao
- Cardiovascular Center, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Yasufumi Asai
- Department of Traumatology and Critical Care Medicine, School of Medicine, Sapporo Medical University, S1W17, Chuo-ku, Sapporo, Hokkaido 060-8556, Japan
| | - Hiroyuki Yokota
- Graduate School of Medical and Health Science, Nippon Sports Science University, 1221-1 Kamoshida-cho, Aoba-ku, Yokohama, Kanagawa 227-0033, Japan
| | - Koichi Ariyoshi
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan
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Kimura A, Yoshikawa T, Isogai T, Tanaka H, Ueda T, Yamaguchi T, Imori Y, Maekawa Y, Sakata K, Murakami T, Arao K, Nagao K, Yamamoto T, Takayama M. Impact of body temperature at admission on inhospital outcomes in patients with takotsubo syndrome: insights from the Tokyo Cardiovascular Care Unit Network Registry. European Heart Journal. Acute Cardiovascular Care 2020; 9:703-710. [DOI: 10.1177/2048872619886313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background:
Takotsubo syndrome occasionally occurs in patients with fever due to underlying diseases. However, the impact of body temperature on inhospital prognosis of patients with takotsubo syndrome remains unknown.
Methods:
Using the patient cohort in the Tokyo Cardiovascular Care Unit Network Registry from 2013 to 2015, we identified 421 eligible patients whose data on body temperature at admission were available and classified them into three groups: high body temperature group (≥37.5°C; n=27), normal body temperature group (36.0–37.4°C; n=319), and low body temperature group (≤35.9°C; n=75). We compared the patient characteristics and inhospital outcomes among the three groups.
Results:
On admission, the high body temperature group showed a higher proportion of men and preceding physical triggers, higher heart and respiratory rates, and higher C-reactive protein level than the other groups. Inhospital all-cause mortality was significantly higher in the high body temperature group than in the normal or low body temperature group (18.5% vs. 2.2% vs. 4.0%, respectively, P<0.001). Both cardiac mortality (11.1% vs. 1.3% vs. 1.3%, P=0.001) and non-cardiac mortality (7.4% vs. 0.9% vs. 2.7%, P=0.031) were also significantly higher in the high body temperature group. Multivariable logistic regression analysis showed that high body temperature (reference: normal body temperature) was significantly associated with higher inhospital mortality (adjusted odds ratio 4.22; 95% confidence interval 1.15–15.51; P=0.030).
Conclusions:
Our findings suggest that high body temperature at admission is a strong predictor of inhospital mortality in patients with takotsubo syndrome. Febrile takotsubo syndrome patients may need to be managed with recognition of life-threatening conditions from the time of diagnosis, no matter what the causes of fever are.
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Affiliation(s)
| | | | - Toshiaki Isogai
- Tokyo CCU Network Scientific Committee, Japan
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Hiroyuki Tanaka
- Tokyo CCU Network Scientific Committee, Japan
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Japan
| | | | | | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Japan
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44
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Yamazaki Y, Thongchankaew-Seo U, Nagao K, Mekata H, Yamazaki W. Development and evaluation of a point-of-care test with a combination of EZ-Fast DNA extraction and real-time PCR and LAMP detection: evaluation using blood samples containing the bovine leukaemia DNA. Lett Appl Microbiol 2020; 71:560-566. [PMID: 32852051 DOI: 10.1111/lam.13376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 02/03/2023]
Abstract
Along with progress in globalization of society, the spread of infectious diseases has accelerated worldwide. The deployment of highly sensitive genetic tests is essential for early diagnosis and early containment of potential outbreaks and epidemics, as well as routine surveillance, although tedious and expensive nucleic acid extraction steps represent a major drawback. Here we developed a simple and rapid DNA extraction method, named as an EZ-Fast kit, applicable to the field setting. The kit does not require advanced laboratory equipment or expensive DNA extraction kits and achieves crude DNA extraction within 10 min at extremely low cost and can easily be performed in field settings. When combined with real-time PCR and LAMP analyses, the performance of the POCT, using 183 bovine blood samples, was similar to that of the existing DNA extraction method: 92·5% (135/146) (real-time PCR) and 93·7% (133/142) (LAMP) diagnostic sensitivities, and 100% diagnostic specificities. The developed POCT provides a powerful tool to facilitate on-site diagnosis in a field setting.
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Affiliation(s)
- Y Yamazaki
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | | | - K Nagao
- Department of Veterinary Science, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - H Mekata
- Organization for Promotion of Tenure Track, University of Miyazaki, Miyazaki, Japan
| | - W Yamazaki
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan.,Graduate School of Medicine, Kyoto University, Kyoto, Japan.,School of Public Health, Kyoto University, Kyoto, Japan
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45
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Takei M, Harada K, Shiraishi Y, Matsuda J, Iwasaki Y, Yamamoto Y, Matsushita K, Miyazaki T, Miyamoto T, Iida K, Tanimoto S, Nagatomo Y, Hosoda T, Kohsaka S, Yamamoto T, Nagao K, Takayama M. Delay in seeking treatment before emergent heart failure readmission and its association with clinical phenotype. J Intensive Care 2020; 8:65. [PMID: 32864143 PMCID: PMC7448509 DOI: 10.1186/s40560-020-00482-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background Many patients with emergent heart failure (HF) readmission have a delay between symptom onset and hospitalization. The present study aimed to characterize the interval between symptom onset and hospitalization in patients being readmitted for HF and to compare the clinical phenotypes of patients with delay before emergent readmission with those who presented to the hospital earlier. Methods Data for a total of 2073 consecutive patients was collected from the Tokyo CCU Network database; the patients were divided into delayed (those who sought medical help > 2 days after symptom onset; n = 271) and early groups (remaining patients; n = 1802), and their clinical characteristics and mode of presentation were compared. Results Age, sex, and laboratory findings including brain natriuretic peptide and serum creatinine levels were not significantly different between the two groups. Patients in the delayed group had greater chronic fluid retention and symptoms not associated with respiratory failure, whereas those in the early group were more likely to have acute respiratory distress, faster heart and respiration rates, and higher systolic blood pressure. Conclusions More than one in ten patients with HF readmission delay seeking treatment > 2 days after symptom onset. Patients who delayed seeking treatment showed the phenotype of chronic fluid retention, whereas those who presented to the hospital earlier had the phenotype of acute respiratory failure.
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Affiliation(s)
- Makoto Takei
- Tokyo CCU Network Scientific Committee, Tokyo, Japan.,Department of Cardiology, Saiseikai Central Hospital, Mita 1-4-17, Minato-ku, Tokyo, 108-0073 Japan
| | | | | | - Junya Matsuda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | | | | | - Kiyosi Iida
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Yuji Nagatomo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Toru Hosoda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Shun Kohsaka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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46
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Ito R, Yamashita J, Chikamori T, Kondo S, Mitsuhashi Y, Iwata H, Saji M, Asano T, Wakabayashi K, Yahagi K, Shinke T, Mase T, Abe K, Miyachi H, Higuchi S, Kishi M, Tanaka H, Yamasaki M, Miyauchi K, Yamamoto T, Nagao K, Takayama M. Clinical Differences of Recent Myocardial Infarction Compared With Acute Myocardial Infarction - Insights From the Tokyo CCU Network Multicenter Registry. Circ J 2020; 84:1511-1518. [PMID: 32713883 DOI: 10.1253/circj.cj-20-0333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Characteristics and treatment outcomes of acute myocardial infarction (AMI) patients have been studied; however, those of recent myocardial infarction (RMI) patients remain unclear. This study aimed to clarify characteristics, treatment strategy, and in-hospital outcomes of RMI patients in the Tokyo CCU network database.Methods and Results:In total, 1,853 RMI and 12,494 AMI patients from the Tokyo CCU network database during 2013-2016 were compared. Both RMI and AMI were redefined by onset times of 2-28 days and ≤24 h, respectively. The RMI group had a higher average age (70.4±12.9 vs. 68.0±13.4 years, P<0.001), more women (27.6% vs. 23.6%, P<0.001), lower proportion of patients with chest pain as the chief complaint (75.2% vs. 83.6%, P<0.001), higher prevalence of diabetes mellitus (35.9% vs. 31.0%, P<0.001), and higher mechanical complication incidence (3.0% vs. 1.5%, P<0.001) than did the AMI group. Thirty-day mortality was comparable (5.3% vs. 5.8%, P=0.360); major causes of death were cardiogenic shock and mechanical complications in the AMI and RMI groups, respectively. Death from mechanical complications (not onset time) in the AMI group plateaued almost 1 week after hospitalization, whereas it continued to increase in the RMI group. CONCLUSIONS Both RMI and AMI patients have distinctive clinical features, sequelae, and causes of death. Although treatment of RMI patients adhered to guidelines, it was insufficient, and death from mechanical complications continues to increase.
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Affiliation(s)
- Ryosuke Ito
- Tokyo CCU Network Scientific Committee.,Department of Cardiology, Tokyo Medical University Hospital
| | | | | | | | | | | | - Mike Saji
- Tokyo CCU Network Scientific Committee
| | | | | | | | | | | | - Kaito Abe
- Tokyo CCU Network Scientific Committee
| | | | | | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee
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47
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Hifumi T, Inoue A, Arimoto H, Yonemoto N, Kuroda Y, Tahara Y, Kawakita K, Yokoyama H, Nagao K, Nonogi H. The association between neuromuscular blockade use during target temperature management and neurological outcomes. Am J Emerg Med 2020; 46:289-294. [PMID: 33051089 DOI: 10.1016/j.ajem.2020.07.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To date, no study has comprehensively analyzed the association between neuromuscular blockade (NMB) during target temperature management (TTM) and the neurological outcomes after out-of-hospital cardiac arrest (OHCA) using a multicenter dataset. We aimed to examine the association between NMB during TTM after cardiac arrest and neurological outcomes after OHCA. METHODS This study was a secondary analysis of the Japanese Population-based Utstein-style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia (J-PULSE-HYPO) study registry. The exposure of the current study was the use of NMB during TTM. The primary outcome was favorable neurological outcome, i.e., a cerebral performance category of 1-2, at hospital discharge. RESULTS Of the 452 patients with OHCA enrolled in the J-PULSE-HYPO study, 431 were analyzed. NMB was used in 353 patients (81.9%). Multivariable logistic regression analysis revealed that NMB use was not independently associated with favorable outcomes [odds ratio (OR), 0.96; 95% confidence interval (CI), 0.42-2.18; p = .918)] or survival at discharge (OR, 0.83; 95% CI, 0.31-2.02; p = .688). After adjusting the covariates, the predicted probabilities did not reveal significant differences between NMB use and non-NMB use in the respective mean (95% CI) values for favorable neurological outcomes [53.6 (50.2-57.0) % vs. 58.0 (50.4-65.6) %, p = .304], and survival rates [77.1 (74.7-79.5) % vs. 75.8 (70.5-81.0) %, p = .647]. CONCLUSIONS The NMB use during TTM was not associated with favorable neurological outcomes and survival rate in patients with OHCA.
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Affiliation(s)
- Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan; Emergency Medical Center, Kagawa University Hospital, Japan.
| | - Akihiko Inoue
- Emergency Medical Center, Kagawa University Hospital, Japan; Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Japan
| | - Hideki Arimoto
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University School of Public Health, Japan
| | | | - Yoshio Tahara
- Division of Cardiovascular Care Unit, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, Japan
| | | | - Ken Nagao
- Cardiovascular Center, Nihon University Hospital, Japan
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48
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Otsuki S, Aiba T, Tahara Y, Nakajima K, Kataoka N, Kamakura T, Wada M, Ishibashi K, Yamagata K, Inoue Y, Miyamoto K, Nagase S, Noda T, Izumi C, Noguchi T, Nishimura K, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H, Yasuda S, Kusano K. Intra-day change in occurrence of out-of-hospital ventricular fibrillation in Japan: The JCS-ReSS study. Int J Cardiol 2020; 318:54-60. [PMID: 32569698 DOI: 10.1016/j.ijcard.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/17/2020] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Real-world evidence of out-of-hospital ventricular fibrillation (VF), especially regarding intra-day change, remains unclear. We aimed to investigate that age- and gender-dependent difference of intra-day change of VF occurrence. METHOD We enrolled 71,692 patients (males: 56,419 [78.7%], females: 15,273 [21.3%]) in whom cardiac VF had been documented from the 2005-2015 All-Japan Utstein Registry data. Subjects were divided into four groups: group-I (<18 years old), group-II (18-39), group-III (40-69), and group-IV (≥70). Among four groups in each of male and female, we compared the intra-day change of VF occurrence, and evaluated the risk factors of the unfavorable neurologic outcomes at 1 month after VF. RESULTS Regardless of age, the incidence of VF was significantly greater in male than in female subjects. In male subjects, VF in group-I, III and IV occurred higher at daytime, however, group-II had no intra-day difference because group-II had a higher VF events at midnight~ early morning compared with other aged groups (Poisson regression analysis, p = .03). While in female, each group showed similar intra-day pattern of VF occurrence. Logistic regression analysis revealed that some of the clinical parameters such as time periods from call receipt to first shock and the presence of bystander cardiopulmonary resuscitation were important for risk of 30-day neurologically unfavorable outcomes. CONCLUSIONS The intra-day change of VF occurrence was age-dependently different in males but not in females, suggesting age- and gender-dependent differences in underlying cardiac diseases. These might affect the significant difference in unfavorable neurologic outcome.
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Affiliation(s)
- Sou Otsuki
- National Cerebral and Cardiovascular Center, Suita, Japan; Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Takeshi Aiba
- National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Yoshio Tahara
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Naoya Kataoka
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Mitsuru Wada
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | - Yuko Inoue
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Miyamoto
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Nagase
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chisato Izumi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | | | | | | | | | | | - Satoshi Yasuda
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Suita, Japan
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49
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Naito H, Yumoto T, Yorifuji T, Tahara Y, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H. Improved outcomes for out-of-hospital cardiac arrest patients treated by emergency life-saving technicians compared with basic emergency medical technicians: A JCS-ReSS study report. Resuscitation 2020; 153:251-257. [PMID: 32422240 DOI: 10.1016/j.resuscitation.2020.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Emergency life-saving technicians (ELSTs) are specially trained prehospital medical providers believed to provide better care than basic emergency medical technicians (BEMTs). ELSTs are certified to perform techniques such as administration of advanced airways or adrenaline and are considered to have more knowledge; nevertheless, ELSTs' effectiveness over BEMTs regarding out-of-hospital cardiac arrest (OHCA) remains unclear. We investigated whether the presence of an ELST improves OHCA patient outcomes. METHODS In a retrospective study of adult OHCA patients treated in Japan from 2011 to 2015, we compared two OHCA patient groups: patients transported with at least one ELST and patients transported by only BEMTs. The primary outcome measure was one-month favorable neurological outcomes, defined as Cerebral Performance Category ≤ 2. A multivariable logistic regression model was used to calculate odds ratios (ORs) and their confidence intervals (CIs) to evaluate the effect of ELSTs. RESULTS Included were 552,337 OHCA patients, with 538,222 patients in the ELST group and 14,115 in the BEMT group. The ELST group had a significantly higher odds of favorable neurological outcomes (2.5% vs. 2.1%, adjusted OR 1.39, 95% CI 1.17-1.66), one-month survival (4.9% vs. 4.1%, adjusted OR 1.37, 95% CI 1.22-1.54), and return of spontaneous circulation (8.1% vs. 5.1%, adjusted OR 1.90, 95% CI 1.72-2.11) compared with the BEMT group. However, ELSTs' limited procedure range (adrenaline administration or advanced airway management) did not promote favorable neurological outcomes. CONCLUSIONS Compared with the BEMT group, transport by the ELST group was associated with better neurological outcomes in OHCA.
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Affiliation(s)
- Hiromichi Naito
- Okayama University Hospital, Advanced Emergency and Critical Care Medical Center, Japan.
| | - Tetsuya Yumoto
- Okayama University Hospital, Advanced Emergency and Critical Care Medical Center, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yoshio Tahara
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Japan
| | | | | | - Ken Nagao
- Nihon University Hospital, Cardiovascular Center, Japan
| | - Takanori Ikeda
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Japan
| | - Naoki Sato
- Kawaguchi Cardiovascular and Respiratory Hospital, Cardiovascular Medicine, Japan
| | - Hiroyuki Tsutsui
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine, Japan
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50
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Maekawa T, Kaneda K, Tsuruta R, Kuroda Y, Nagao K, Rinka H, Takahashi T, Yokota H, Shirai SI, Hase M, Kotani J, Endo S. Precision and Safety of an Intravascular Temperature Management System for Postcardiac Arrest Syndrome Patients: A Multicenter Clinical Trial (COOL-ARREST JP). Ther Hypothermia Temp Manag 2020; 10:179-185. [PMID: 32348714 PMCID: PMC7482718 DOI: 10.1089/ther.2019.0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rapid induction and maintaining a target temperature of 32.0–36.0°C within a narrow range for <24 hours are essential, but those are very hard to perform in postcardiac arrest syndrome (PCAS) patients. We investigated the usability of an intravascular temperature management (IVTM) system with neurolept-anesthesia (NLA; droperidol and fentanyl). Single-arm, prospective multicenter trial was carried out in the seven university and the three affiliated hospitals. In the 24 comatose PCAS patients, the target temperature (33.0°C) was rapidly induced and maintained for 24 hours using an IVTM system with NLA. The rewarming speed was 0.1°C/h until 36.5°C and was maintained for 24 hours. The primary end point was the ability to achieve ≤34.0°C for <3 hours after starting cooling, and the secondary end points were the cooling rate, deviation from the target temperature, and adverse events. Cerebral Performance Category (CPC) score at 14 days was also evaluated. Statistical analyses were performed by SPSS software, using the intention-to-treat data sets. The target temperature of ≤34.0°C was reached by 45 minutes (35–73 minutes) and was within 3 hours in all patients. The cooling rate from 36.4°C to 33.0°C was 2.7°C/h (2.4–3.6°C/h). The temperature of 33.1°C (33.1–33.1°C) and 36.7°C (36.6–36.9°C) for 24 hours each was held during the maintenance and the after rewarming phases, respectively. Temperature deviations >0.2°C from 33.0°C in the maintenance phase occurred once each in two patients. The favorable neurological outcomes (CPC1, 2) were relatively good (50%). Five patients experienced serious adverse events; none was device related. We rapidly achieved therapeutic hypothermia within a narrow temperature range without major complications using the IVTM system with NLA in PCAS patients.
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Affiliation(s)
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Medicine, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Medicine, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, Miki, Japan
| | - Ken Nagao
- Cardiovascular Disease Center, Nihon University Hospital (Surugadai), Nihon University Hospital, Tokyo, Japan
| | - Hiroshi Rinka
- Emergency and Critical Medical Care Center, Osaka City General Hospital, Osaka, Japan
| | | | - Hiroyuki Yokota
- Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Shin-Ichi Shirai
- Cardio-Vascular Center, Kokura Memorial Hospital, Fukuoka, Japan
| | - Mamoru Hase
- Department of Traumatology and Critical Care Medicine, Sapporo Medical University Hospital, Sapporo, Japan
| | - Joji Kotani
- Center for Emergency and Critical Care Medicine, Kobe University Hospital, Kobe University Hospital, Kobe, Japan
| | - Shigeatsu Endo
- Advanced Emergency and Critical Care Center, Iwate Medical University Hospital, Morioka, Japan
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