Clinical Presentation, Management and Outcome of Japanese Patients With Acute Myocardial Infarction in the Troponin Era - Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) - .
BACKGROUND
New criteria for diagnosis of acute myocardial infarction (AMI) were proposed in 2000 as a universal definition, in which cardiac troponin (cTn) was the preferred biomarker. A large number of patients formerly classified by creatine kinase (CK) as unstable angina are now ruled-in by cTn as non-ST-elevation myocardial infarction (NSTEMI).


RESULTS
The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry conducted in 28 institutions. We enrolled 3,283 consecutive patients with AMI diagnosed by cTn-based criteria who were admitted to participating institutions within 48 h of symptom onset. There were 2,262 patients (68.9%) with STEMI and 1,021 (31.1%) with NSTEMI. CK was not elevated more than twice the upper limit of normal in 458 patients (44.9%) with NSTEMI (NSTEMI-CK). Although there was no significant difference in the in-hospital mortality of STEMI and NSTEMI with CK elevation (NSTEMI+CK) patients (7.1% vs. 7.8%, P=0.57), it was significantly lower in patients with NSTEMI-CK than in those with STEMI or NSTEMI+CK (1.7%, P<0.001 for each).


CONCLUSIONS
J-MINUET revealed the clinical presentation, management and outcomes of Japanese patients with AMI in the current cTn era. We should be aware of the difference between AMI diagnosed by CK-based criteria and AMI diagnosed by cTn-based criteria when using universal definitions for the diagnosis of AMI.
Division of Coronary Artery Disease, Department of Internal Medicine, Hyogo College of Medicine.
Masaharu
M
Ishihara
Masashi
M
Fujino
Hisao
H
Ogawa
Satoshi
S
Yasuda
Teruo
T
Noguchi
Koichi
K
Nakao
Yukio
Y
Ozaki
Kazuo
K
Kimura
Satoru
S
Suwa
Kazuteru
K
Fujimoto
Yasuharu
Y
Nakama
Takashi
T
Morita
Wataru
W
Shimizu
Yoshihiko
Y
Saito
Kennichi
K
Tsujita
Kunihiko
K
Nishimura
Yoshihiro
Y
Miyamoto
D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003402:Creatine Kinase / Q000097:blood; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012907:Smoking / Q000453:epidemiology; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T; D003402:Creatine Kinase