Skip to main content

Advertisement

Log in

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

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Tegn N, Abdelnoor M, Aaberge L, Endresen K, Smith P, Aakhus S, Gjertsen E, Dahl-Hofseth O, Ranhoff AH, Gullestad L, Bendz B, Eighty After, After Eighty study investigators (2016) Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. Lancet 387:1057–1065

    Article  PubMed  Google Scholar 

  2. Kojima S, Nishihira K, Takegami M, Nakao YM, Honda S, Takahashi J, Takayama M, Shimokawa H, Sumiyoshi T, Ogawa H, Kimura K, Yasuda S, Investigators JAMIR (2018) Nationwide real-world database of 20,462 patients enrolled in the Japanese Acute Myocardial Infarction Registry (JAMIR): impact of emergency coronary intervention in a super-aging population. Int J Cardiol Heart Vasc 20:1–6

    PubMed  PubMed Central  Google Scholar 

  3. Alexander KP, Newby LK, Cannon CP, Armstrong PW, Gibler WB, Rich MW, Van de Werf F, White HD, Weaver WD, Naylor MD, Gore JM, Krumholz HM, Ohman EM, American Heart Association Council on Clinical Cardiology; Society of Geriatric Cardiology (2007) Acute coronary care in the elderly, part I: non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115:2549–2569

    Article  PubMed  Google Scholar 

  4. Alexander KP, Newby LK, Armstrong PW, Cannon CP, Gibler WB, Rich MW, Van de Werf F, White HD, Weaver WD, Naylor MD, Gore JM, Krumholz HM, Ohman EM, American Heart Association Council on Clinical Cardiology; Society of Geriatric Cardiology (2007) Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115:2570–2589

    Article  PubMed  Google Scholar 

  5. Forman DE, Maurer MS, Boyd C, Brindis R, Salive ME, Horne FM, Bell SP, Fulmer T, Reuben DB, Zieman S, Rich MW (2018) Multimorbidity in older adults with cardiovascular disease. J Am Coll Cardiol 71:2149–2161

    Article  PubMed  PubMed Central  Google Scholar 

  6. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37–43

    Article  PubMed  Google Scholar 

  7. Tinetti ME, Fried TR, Boyd CM (2012) Designing health care for the most common chronic condition-multimorbidity. JAMA 307:2493–2494

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Katus HA, Lindahl B, Morrow DA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S, Joint ESCAAHAWHFTFftUDoMI (2012) Third universal definition of myocardial infarction. Circulation 126:2020–2035

    Article  PubMed  Google Scholar 

  9. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A (1994) Myocardial infarction and coronary deaths in the World Health Organization MONICA project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90:583–612

    Article  CAS  PubMed  Google Scholar 

  10. Killip T 3rd, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20:457–464

    Article  PubMed  Google Scholar 

  11. Yasuda S, Miyamoto Y, Ogawa H (2018) Current status of cardiovascular medicine in the aging society of Japan. Circulation 138:965–967

    Article  PubMed  Google Scholar 

  12. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P, ESC Scientific Document Group (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39:119–177

    Article  PubMed  Google Scholar 

  13. Miyachi H, Takagi A, Miyauchi K, Yamasaki M, Tanaka H, Yoshikawa M, Saji M, Suzuki M, Yamamoto T, Shimizu W, Nagao K, Takayama M (2016) 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. Heart Vessels 31:1740–1751

    Article  PubMed  Google Scholar 

  14. McNamara RL, Kennedy KF, Cohen DJ, Diercks DB, Moscucci M, Ramee S, Wang TY, Connolly T, Spertus JA (2016) Predicting in-hospital mortality in patients with acute myocardial infarction. J Am Coll Cardiol 68:626–635

    Article  PubMed  Google Scholar 

  15. Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, Smith PK (2017) ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate use criteria for coronary revascularization in patients with acute coronary syndromes: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons. J Am Coll Cardiol 69:570–591

    Article  PubMed  Google Scholar 

  16. Hannan EL, Samadashvili Z, Walford G, Jacobs AK, Stamato NJ, Venditti FJ, Holmes DR Jr, Sharma S, King SB 3rd (2013) Staged versus one-time complete revascularization with percutaneous coronary intervention for multivessel coronary artery disease patients without ST-elevation myocardial infarction. Circ Cardiovasc Interv 6:12–20

    Article  PubMed  Google Scholar 

  17. Sardella G, Lucisano L, Garbo R, Pennacchi M, Cavallo E, Stio RE, Calcagno S, Ugo F, Boccuzzi G, Fedele F, Mancone M (2016) Single-staged compared with multi-staged PCI in multivessel NSTEMI Patients: the SMILE Trial. J Am Coll Cardiol 67:264–272

    Article  PubMed  Google Scholar 

  18. Rathod KS, Koganti S, Jain AK, Astroulakis Z, Lim P, Rakhit R, Kalra SS, Dalby MC, O’Mahony C, Malik IS, Knight CJ, Mathur A, Redwood S, Sirker A, MacCarthy PA, Smith EJ, Wragg A, Jones DA (2018) Complete versus culprit-only lesion intervention in patients with acute coronary syndromes. J Am Coll Cardiol 72:1989–1999

    Article  PubMed  Google Scholar 

  19. Sabatine MS, Morrow DA, Giugliano RP, Burton PB, Murphy SA, McCabe CH, Gibson CM, Braunwald E (2005) Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 111:2042–2049

    Article  CAS  PubMed  Google Scholar 

  20. Hanna EB, Chen AY, Roe MT, Wiviott SD, Fox CS, Saucedo JF (2011) Characteristics and in-hospital outcomes of patients with non-ST-segment elevation myocardial infarction and chronic kidney disease undergoing percutaneous coronary intervention. JACC Cardiovasc Interv 4:1002–1008

    Article  PubMed  PubMed Central  Google Scholar 

  21. Patti G, Ricottini E, Nenna A, Cavallari I, Antonucci E, Calabrò P, Cirillo P, Gresele P, Palareti G, Pengo V, Pignatelli P, Bisignani A, Marcucci R (2018) Impact of chronic renal failure on ischemic and bleeding events at 1 year in patients with acute coronary syndrome (from the Multicenter START ANTIPLATELET Registry). Am J Cardiol 122:936–943

    Article  PubMed  Google Scholar 

  22. Yasuda S, Nakao K, Nishimura K, Miyamoto Y, Sumita Y, Shishido T, Anzai T, Tsutsui H, Ito H, Komuro I, Saito Y, Ogawa H, on the behalf of JROAD Investigators (2016) The current status of cardiovascular medicine in Japan—analysis of a large number of health records from a nationwide claim-based database, JROAD-DPC. Circ J 80:2327–2335

    Article  PubMed  Google Scholar 

Download references

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).

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Makoto Suzuki.

Ethics declarations

Conflict of interest

There are no financial or other relationships that could lead to a conflict of interest to influence this work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

Navigation