title: Comparison of the efficacy of reperfusion therapies for early mortality from acute myocardial infarction in Japan: registry of Miyagi Study Group for AMI (MsAMI).
abstract: The current reperfusion strategy in Japan for acute myocardial infarction (AMI) is that the majority of early arrival patients are treated with primary percutaneous coronary intervention (PCI). However, the efficacy of primary PCI, intravenous thrombolysis (IV-T), intracoronary thrombolysis (IC-T) and rescue PCI has not been compared in the clinical situation. In the present study, 3,258 cases of AMI in 1992-2000 from the data base of the Miyagi Study Group for AMI were analyzed. These patients were hospitalized within 6 h of the onset of symptoms. IV-T and IC-T were initially performed in 120 and 441 patients, respectively, and 41 and 199 rescue PCI procedures, respectively, were needed. Primary PCI was performed in 1,822 cases, and no reperfusion therapy was done in 875 patients. The crude 30-day in-hospital mortality was 12.7% for IV-T, 3.7% for IC-T, 4.8% for primary PCI, 7.9% for rescue PCI, and 14.1% in patients who did not undergo reperfusion therapy. The covariate-adjusted odds ratio (95% confidence interval) was 0.38 (0.28-0.52) for primary PCI, 0.30 (0.15-0.60) for IC-T, 1.04 (0.51-2.10) for IV-T and 0.77 (0.46-1.30) for rescue PCI. The present data verify that primary PCI is superior to other reperfusion strategies in the real clinical situation and justifies the current unique strategy of reperfusion therapy for AMI used in Japan.
authors.affiliation: Cardiovascular Medicine, Sendai National Hospital, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Sakurai
authors.forename: Jun
authors.initials: J
authors.lastname: Watanabe
authors.forename: Kaoru
authors.initials: K
authors.lastname: Iwabuchi
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Koseki
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kon-no
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Fukuchi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Komaru
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shinozaki
authors.forename: Masahito
authors.initials: M
authors.lastname: Miura
authors.forename: Masahito
authors.initials: M
authors.lastname: Sakuma
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kagaya
authors.forename: Shigenori
authors.initials: S
authors.lastname: Kitaoka
authors.forename: Kunio
authors.initials: K
authors.lastname: Shirato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D003657:Decision Making; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D016017:Odds Ratio; D012042:Registries; D015912:Thrombolytic Therapy