title: Current characteristics and management of ST elevation and non-ST elevation myocardial infarction in the Tokyo metropolitan area: from the Tokyo CCU network registered cohort.
abstract: Limited data exists on ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) managed by a well-organized cardiac care network in a metropolitan area. We analyzed the Tokyo CCU network database in 2009-2010. Of 4329 acute myocardial infarction (AMI) patients including STEMI (n = 3202) and NSTEMI (n = 1127), percutaneous coronary intervention (PCI) was performed in 88.8 % of STEMI and 70.4 % of NSTEMI patients. Mean onset-to-door and door-to-balloon times in STEMI patients were shorter than those in NSTEMI patients (167 vs 233 and 60 vs 145 min, respectively, p < 0.001). Coronary artery bypass graft surgery was performed in 4.2 % of STEMI and 11.4 % of NSTEMI patients. In-hospital mortality was significantly higher in STEMI patients than NSTEMI patients (7.7 vs 5.1 %, p < 0.007). Independent correlates of in-hospital mortality were advanced age, low blood pressure, and high Killip classification, statin-treated dyslipidemia and PCI within 24 h were favorable predictors for STEMI. High Killip classification, high heart rate, and hemodialysis were significant predictors of in-hospital mortality, whereas statin-treated dyslipidemia was the only favorable predictor for NSTEMI. In conclusion, patients with MI received PCI frequently (83.5 %) and promptly (door-to-balloon time; 66 min), and had favorable in-hospital prognosis (in-hospital mortality; 7.0 %). In addition to traditional predictors of in-hospital death, statin-treated dyslipidemia was a favorable predictor of in-hospital mortality for STEMI and NSTEMI patients, whereas hemodialysis was the strongest predictor for NSTEMI patients.
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan. hidep-@nms.ac.jp.|Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. hidep-@nms.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Miyachi
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takagi
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Yamasaki
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Masatomo
authors.initials: M
authors.lastname: Yoshikawa
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Mike
authors.initials: M
authors.lastname: Saji
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D019033:Delivery of Health Care, Integrated; D050171:Dyslipidemias / Q000188:drug therapy / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment; D014041:Tokyo; D016896:Treatment Outcome; D019037:Urban Health Services
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: In-hospital mortality; Non-ST elevation myocardial infarction; Risk factors; ST elevation myocardial infarction