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Clinical profiles and outcomes in the treatment of acute myocardial infarction in Japan of aging society

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Abstract

To address many uncertainties in the acute care of patients with acute myocardial infarction (AMI) in proportion to increasing age, we underwent the nationwide current survey consisted of 11,676 patients with AMI based on the database of the Japanese Acute Myocardial Infarction Registry between January 2011 and December 2013 to figure out how difference of clinical profiles and outcomes between coronary revascularization and conservative treatments for AMI. Clinical profiles in a total of 763 patients with AMI with conservative treatments (7% of all) were characterized as more elderly women (median age, 71 yeas vs. 68 years, p < 0.0001, male, 71% vs. 76%, p = 0.0008), high Killip class (Killip class I, 61% vs. 75%, p < 0.0001), and non-ST-segment elevation AMI (37% vs. 27%, p < 0.0001) as compared with 10,913 with coronary revascularization, with a consequence of more than twofold higher in-hospital mortality (12% vs. 5%, p < 0.0001). When compared with conservative treatments, highly effective of coronary revascularization to decrease in-hospital mortality was found in patients with ST-segment elevation AMI (6% vs. 16%, p < 0.0001), while these advantages were not evident in those with non-ST-segment elevation AMI (4% vs. 6%, p = 0.1107), especially with high Killip class, regardless of whether or not propensity score matching of clinical characteristics. A risk-adapted allocation of invasive management therefore may have the potential of benefiting patients with non-ST-segment elevation AMI, in particular elders.

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Acknowledgements

We are sincerely appreciative of all of the JAMIR investigators mentioned below for their contributions to this study.

Sapporo ACS Network: Takashi Takenaka (Hokkaido Medical Center), Daisuke Hotta (Hokkaido Cardiovascular Hospital); Iwate ACS Registry: Tomonori Itoh (IwateMedical University School of Medicine);Yamagata AMI Registry: Tetsu Watanabe (Yamagata University School of Medicine); Miyagi AMI Registry Study: Kiyotaka Hao (Tohoku University); Jichi Medical University: Kazuomi Kario; Tokyo CCU Network: Takeshi Yamamoto (Nippon Medical School Hospital); Naoki Sato.

(Nippon Medical School Musashi-Kosugi Hospital); Atsuo Namiki (Kanto Rosai Hospital); Hiroshi Suzuki (Showa University Fujigaoka Hospital); Yokohama Cardiovascular Workshop: Masami Kosuge (Yokohama City University Medical Center); Mie ACS Registry Masaaki Ito (Mie University); Takashi Tanigawa (Matsusaka Chuo Hospital); NCVC AMI Registry: Yasuhide Asaumi (National Cerebral and Cardiovascular Center); Kumamoto Acute Coronary Events Study: Kenichi Tsujita (Kumamoto University); JAMIR data center: Yoshihiro Miyamaoto (National Cerebral and Cardiovascular Center).

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Authors and Affiliations

  1. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi, Fuchu, Tokyo, 183-0003, Japan

    Makoto Suzuki, Morimasa Takayama & Tetsuya Sumiyoshi

  2. Department of Cardiovascular Medicine, Miyazaki Medical Association Hospital, Miyazaki, Japan

    Kensaku Nishihira

  3. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan

    Misa Takegami

  4. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan

    Satoshi Honda, Hisao Ogawa & Satoshi Yasuda

  5. Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan

    Sunao Kojima

  6. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

    Kazuo Kimura

Authors
  1. Makoto Suzuki
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  2. Kensaku Nishihira
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  3. Misa Takegami
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  4. Satoshi Honda
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  5. Sunao Kojima
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  7. Tetsuya Sumiyoshi
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  8. Hisao Ogawa
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  9. Kazuo Kimura
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Consortia

on behalf of the JAMIR Investigators

  • Takashi Takenaka
  • , Daisuke Hotta
  • , Tomonori Itoh
  • , Tetsu Watanabe
  • , Kiyotaka Hao
  • , Kazuomi Kario
  • , Takeshi Yamamoto
  • , Naoki Sato
  • , Atsuo Namiki
  • , Hiroshi Suzuki
  • , Masami Kosuge
  • , Takashi Tanigawa
  • , Yasuhide Asaumi
  • , Kenichi Tsujita
  •  & Yoshihiro Miyamaoto

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Correspondence to Makoto Suzuki.

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The members of the JAMIR Investigators group mentioned in Acknowledgements section.

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Suzuki, M., Nishihira, K., Takegami, M. et al. Clinical profiles and outcomes in the treatment of acute myocardial infarction in Japan of aging society. Heart Vessels 35, 1681–1688 (2020). https://doi.org/10.1007/s00380-020-01654-5

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  • DOI: https://doi.org/10.1007/s00380-020-01654-5

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