title: Impact of the Japan earthquake disaster with massive Tsunami on emergency coronary intervention and in-hospital mortality in patients with acute ST-elevation myocardial infarction.
abstract: OBJECTIVE
  The aims of this study were to evaluate reperfusion rate, therapeutic time course and in-hospital mortality pre- and post-Japan earthquake disaster, comparing patients with ST-elevation myocardial infarction (STEMI) treated in the inland area or the Tsunami-stricken area of Iwate prefecture.
  
  
  RESULTS
  Subjects were 386 consecutive STEMI patients admitted to the four percutaneous coronary intervention (PCI) centers in Iwate prefecture in 2010 and 2011. Patients were divided into two groups: those treated in the inland or Tsunami-stricken area. We compared clinical characteristics, time course and in-hospital mortality in both years in the two groups. PCI was performed in 310 patients (80.3%). Door-to-balloon (D2B) time in the Tsunami-stricken area in 2011 was significantly shorter than in 2010 in patients treated with PCI. However, the rate of PCI performed in the Tsunami-stricken area in March-April 2011 was significantly lower than that in March-April 2010 (41.2% vs 85.7%; p=0.03). In-hospital mortality increased three-fold from 7.1% in March-April 2010 to 23.5% in March-April 2011 in the Tsunami-stricken area. Standardized mortality ratio (SMR) in March-April 2011 in the Tsunami-stricken area was significantly higher than the control SMR (SMR 4.72: 95% confidence interval (CI): 1.77-12.6: p=0.007).
  
  
  CONCLUSIONS
  The rate of PCI decreased and in-hospital mortality increased immediately after the Japan earthquake disaster in the Tsunami-stricken area. Disorder in hospitals and in the distribution systems after the disaster impacted the clinical care and outcome of STEMI patients.
authors.affiliation: Division of Cardiology, Iwate Medical University, Japan tomoitoh@iwate-med.ac.jp.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Itoh
authors.affiliation: Division of Cardiology, Iwate Medical University, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Division of Cardiovascular Medicine, Nephrology and Endocrinology, Iwate Medical University, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Tanaka
authors.affiliation: Iwate Prefectural Ninohe Hospital, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishiyama
authors.affiliation: Iwate Prefectural Kuji Hospital, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Iwate Prefectural Ofunato Hospital, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Endo
authors.affiliation: Iwate Prefectural Ninohe Hospital, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Division of Cardiovascular Medicine, Nephrology and Endocrinology, Iwate Medical University, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Division of Cardiology, Iwate Medical University, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Morino
mesh_terms: D000368:Aged; D004190:Disasters / Q000706:statistics & numerical data*; D055866:Earthquakes / Q000401:mortality*; D004638:Emergency Treatment / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D015425:Myocardial Reperfusion / Q000401:mortality / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D057192:Tsunamis / Q000706:statistics & numerical data*
keywords: Japan earthquake disaster; ST-elevation myocardial infarction; Tsunami; mortality; percutaneous coronary intervention