Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort study
Objective To evaluate changes in demographics, clinical practices and long-term clinical outcomes of patients with ST segment-elevation myocardial infarction (STEMI) before and beyond 2010.Design Multicentre retrospective cohort study.Setting The Coronary Revascularization Demonstrating Outcome Stud...
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2021-03-01
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| author | Yutaka Furukawa Kenji Nakatsuma Takeshi Morimoto Hiroki Shiomi Kenji Ando Tsukasa Inada Moriaki Inoko Katsuhisa Ishii Kenji Minatoya Takeshi Kimura Kyohei Yamaji Kazushige Kadota Takashi Yamamoto Hidenori Yaku Erika Yamamoto Yusuke Yoshikawa Yoshihisa Nakagawa Yukihito Sato Yasuaki Takeji Ryoji Taniguchi Yugo Yamashita Yukiko Mutsumura-Nakano Ko Yamamoto Junichi Tazaki Satoru Suwa Teruki Takeda Manabu Shirotani Natsuhiko Ehara Tomoya Onodera Eiji Shinoda Hiroki Sakamoto Yoshiharu Soga Tatsuhiko Komiya Eri Toda Kato Hirotoshi Watanabe Masayuki Fuki Toshihiro Tamura Hiroki Watanabe |
| author_facet | Yutaka Furukawa Kenji Nakatsuma Takeshi Morimoto Hiroki Shiomi Kenji Ando Tsukasa Inada Moriaki Inoko Katsuhisa Ishii Kenji Minatoya Takeshi Kimura Kyohei Yamaji Kazushige Kadota Takashi Yamamoto Hidenori Yaku Erika Yamamoto Yusuke Yoshikawa Yoshihisa Nakagawa Yukihito Sato Yasuaki Takeji Ryoji Taniguchi Yugo Yamashita Yukiko Mutsumura-Nakano Ko Yamamoto Junichi Tazaki Satoru Suwa Teruki Takeda Manabu Shirotani Natsuhiko Ehara Tomoya Onodera Eiji Shinoda Hiroki Sakamoto Yoshiharu Soga Tatsuhiko Komiya Eri Toda Kato Hirotoshi Watanabe Masayuki Fuki Toshihiro Tamura Hiroki Watanabe |
| author_sort | Yutaka Furukawa |
| collection | DOAJ |
| description | Objective To evaluate changes in demographics, clinical practices and long-term clinical outcomes of patients with ST segment-elevation myocardial infarction (STEMI) before and beyond 2010.Design Multicentre retrospective cohort study.Setting The Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) AMI Registries Wave-1 (2005–2007, 26 centres) and Wave-2 (2011–2013, 22 centres).Participants 9001 patients with STEMI who underwent coronary revascularisation (Wave-1: 4278 patients, Wave-2: 4723 patients).Primary and secondary outcome measures The primary outcome was all-cause death at 3 years. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, target vessel revascularisation, ischaemia-driven target vessel revascularisation, any coronary revascularisation and any ischaemia-driven coronary revascularisation.Results Patients in Wave-2 were older, more often had comorbidities and more often presented with cardiogenic shock than those in Wave-1. Patients in Wave-2 had shorter onset-to-balloon time and door-to-balloon time, were more frequently implanted drug-eluting stents, and received guideline-directed medication than those in Wave-1. The cumulative 3-year incidence of all-cause death was not significantly different between Wave-1 and Wave-2 (15.5% and 15.7%, p=0.77). The adjusted risk of all-cause death in Wave-2 relative to Wave-1 was not significant at 3 years (HR 0.92, 95% CI 0.83 to 1.03, p=0.14), but lower beyond 30 days (HR 0.86, 95% CI 0.75 to 0.98, p=0.03). The adjusted risks of Wave-2 relative to Wave-1 were significantly lower for definite stent thrombosis (HR 0.59, 95% CI 0.43 to 0.81, p=0.001) and for any coronary revascularisation (HR 0.75, 95% CI 0.69 to 0.81, p<0.001), but higher for major bleeding (HR 1.34, 95% CI 1.20 to 1.51, p=0.005).Conclusions We could not demonstrate improvement in 3-year mortality risk from Wave-1 to Wave-2, but we found reduction in mortality risk beyond 30 days. We also found risk reduction for definite stent thrombosis and any coronary revascularisation, but an increase in the risk of major bleeding from Wave-1 to Wave-2. |
| format | Article |
| id | doaj-art-23dc85c1bf0c4d72bc5c68f7d95c3df2 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-23dc85c1bf0c4d72bc5c68f7d95c3df22024-11-20T08:25:07ZengBMJ Publishing GroupBMJ Open2044-60552021-03-0111310.1136/bmjopen-2020-043683Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort studyYutaka Furukawa0Kenji Nakatsuma1Takeshi Morimoto2Hiroki Shiomi3Kenji Ando4Tsukasa Inada5Moriaki Inoko6Katsuhisa Ishii7Kenji Minatoya8Takeshi Kimura9Kyohei Yamaji10Kazushige Kadota11Takashi Yamamoto12Hidenori Yaku13Erika Yamamoto14Yusuke Yoshikawa15Yoshihisa Nakagawa16Yukihito Sato17Yasuaki Takeji18Ryoji Taniguchi19Yugo Yamashita20Yukiko Mutsumura-Nakano21Ko Yamamoto22Junichi Tazaki23Satoru Suwa24Teruki Takeda25Manabu Shirotani26Natsuhiko Ehara27Tomoya Onodera28Eiji Shinoda29Hiroki Sakamoto30Yoshiharu Soga31Tatsuhiko Komiya32Eri Toda Kato33Hirotoshi Watanabe34Masayuki Fuki35Toshihiro Tamura36Hiroki Watanabe37Department of Neurology and Neurobiology of Aging, Kanazawa University, Kanazawa, Ishikawa, JapanDepartment of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, JapanDepartment of Ophthalmology, Osaka University Graduate School of Medicine, Suita, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiology, Kokura Memorial Hospital, Fukuoka, JapanDepartment of Cardiovascular Medicine, Osaka Red Cross Hospital, Osaka, JapanCardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, JapanDepartment of Cardiovascular Medicine, Kansai Denryoku Hospital, Osaka, JapanDepartment of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDivision of Cardiology, Kokura Memorial Hospital, Kitakyushu, JapanDepartment of Cardiology, Kurashiki Central Hospital, Kurashiki, JapanDepartment of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, JapanDepartment of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, JapanDepartment of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDivision of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, JapanDepartment of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Faculty of Medicine, Kyoto, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, JapanDepartment of Cardiology, Koto Memorial Hospital, Higashiomi, JapanDivision of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, JapanCardiology, Kobe City Medical Center General Hospital, Kobe, JapanDepartment of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, JapanDepartment of Cardiovascular Medicine, Hamamatsu Rosai Hospital, Hamamatsu, JapanDepartment of Cardiology, Shizuoka General Hospital, Shizuoka, JapanDivision of Cardiovascular surgery, Kokura Memorial Hospital, Kitakyushu, JapanDepartment of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanCardiovascular Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiology, Tenri Hospital, Tenri, JapanDepartment of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, JapanObjective To evaluate changes in demographics, clinical practices and long-term clinical outcomes of patients with ST segment-elevation myocardial infarction (STEMI) before and beyond 2010.Design Multicentre retrospective cohort study.Setting The Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) AMI Registries Wave-1 (2005–2007, 26 centres) and Wave-2 (2011–2013, 22 centres).Participants 9001 patients with STEMI who underwent coronary revascularisation (Wave-1: 4278 patients, Wave-2: 4723 patients).Primary and secondary outcome measures The primary outcome was all-cause death at 3 years. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, target vessel revascularisation, ischaemia-driven target vessel revascularisation, any coronary revascularisation and any ischaemia-driven coronary revascularisation.Results Patients in Wave-2 were older, more often had comorbidities and more often presented with cardiogenic shock than those in Wave-1. Patients in Wave-2 had shorter onset-to-balloon time and door-to-balloon time, were more frequently implanted drug-eluting stents, and received guideline-directed medication than those in Wave-1. The cumulative 3-year incidence of all-cause death was not significantly different between Wave-1 and Wave-2 (15.5% and 15.7%, p=0.77). The adjusted risk of all-cause death in Wave-2 relative to Wave-1 was not significant at 3 years (HR 0.92, 95% CI 0.83 to 1.03, p=0.14), but lower beyond 30 days (HR 0.86, 95% CI 0.75 to 0.98, p=0.03). The adjusted risks of Wave-2 relative to Wave-1 were significantly lower for definite stent thrombosis (HR 0.59, 95% CI 0.43 to 0.81, p=0.001) and for any coronary revascularisation (HR 0.75, 95% CI 0.69 to 0.81, p<0.001), but higher for major bleeding (HR 1.34, 95% CI 1.20 to 1.51, p=0.005).Conclusions We could not demonstrate improvement in 3-year mortality risk from Wave-1 to Wave-2, but we found reduction in mortality risk beyond 30 days. We also found risk reduction for definite stent thrombosis and any coronary revascularisation, but an increase in the risk of major bleeding from Wave-1 to Wave-2.https://bmjopen.bmj.com/content/11/3/e043683.full |
| spellingShingle | Yutaka Furukawa Kenji Nakatsuma Takeshi Morimoto Hiroki Shiomi Kenji Ando Tsukasa Inada Moriaki Inoko Katsuhisa Ishii Kenji Minatoya Takeshi Kimura Kyohei Yamaji Kazushige Kadota Takashi Yamamoto Hidenori Yaku Erika Yamamoto Yusuke Yoshikawa Yoshihisa Nakagawa Yukihito Sato Yasuaki Takeji Ryoji Taniguchi Yugo Yamashita Yukiko Mutsumura-Nakano Ko Yamamoto Junichi Tazaki Satoru Suwa Teruki Takeda Manabu Shirotani Natsuhiko Ehara Tomoya Onodera Eiji Shinoda Hiroki Sakamoto Yoshiharu Soga Tatsuhiko Komiya Eri Toda Kato Hirotoshi Watanabe Masayuki Fuki Toshihiro Tamura Hiroki Watanabe Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort study BMJ Open |
| title | Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort study |
| title_full | Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort study |
| title_fullStr | Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort study |
| title_full_unstemmed | Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort study |
| title_short | Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort study |
| title_sort | changes in demographics clinical practices and long term outcomes of patients with st segment elevation myocardial infarction who underwent coronary revascularisation in the past two decades cohort study |
| url | https://bmjopen.bmj.com/content/11/3/e043683.full |
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