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Background Cardiac rupture (CR) is a catastrophic complication of acute myocardial infarction. Primary percutaneous coronary intervention (pPCI) reduces the incidence of CR. This study aimed to investigate the clinical risk factors and characteristics of CR after pPCI. Methods This was a retrospective, case-control, multicenter study. We enrolled 2444 consecutive patients with ST-elevation myocardial infarction (STEMI) who had undergone pPCI between 2009 and 2015; 33 patients experienced CR (1.35%): 19 were assigned as early CR (≤72 h) and 14 as late CR (>72 h). The 132 controls were randomly selected from the 2411 STEMI patients without CR, by matching institutions at a 1:4 ratio. Results : Multivariate logistic regression revealed that female sex, acute hyperglycemia, thrombocytopenia (platelets 1, and post-PCI TIMI 1 and thrombocytopenia were strongly associated with late CR. Early CR occurred more frequently between 12:00 and 21:00 h, whereas the peak incidence of late CR was bimodal between 6:00–12:00 and 21:00–24:00 h. Conclusions In STEMI patients after pPCI, acute hyperglycemia and thrombocytopenia are new risk factors for early and late CR, respectively. Clinical risk factors and time of occurrence of early and late CR may differ in the PCI era.

SummaryBackgroundData regarding the relationship between systolic blood pressure (SBP) at admission and in-hospital outcome in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are still lacking in Japan.Methods and resultsA total of 1475 primary PCI-treated AMI patients were classified into quintiles based on admission SBP (

SummaryBackgroundSeveral clinical studies have demonstrated an inverse relationship between systolic blood pressure (SBP) at admission and in-hospital mortality in patients hospitalized for acute myocardial infarction (AMI). However, data on the relation between admission SBP and in-hospital prognosis in AMI patients are still lacking in Japan.Methods and resultsA total of 1211 AMI patients were classified into quintiles based on SBP at hospital admission (

Summary Background Prolonged pre-hospital time for acute myocardial infarction (AMI) is associated with decreased indication for primary percutaneous coronary intervention (PCI). However, the efficacy of primary PCI in AMI patients with prolonged pre-hospital time has not been fully investigated in Japan. Methods and results A total of 3010 consecutive AMI patients admitted to AMI-Kyoto Multi-Center Risk Study Group hospitals were retrospectively analyzed, and the clinical characteristics and in-hospital prognosis of these patients were reviewed. Patients with pre-hospital delay [elapsed time (ET) > 12 h] had a lower frequency of Killip ≥ 3 (9.3%) and less frequently received primary PCI (77.7%) compared with patients with ET ≤ 12 h. In the ET > 12 h group, older patients or patients with MI history tended to be complicated by heart failure. Primary PCI was performed for patients with ET > 12 h, irrespective of the severity of heart failure [Killip 1 (78.7%) vs Killip ≥ 2 (74.0%); p = 0.3827]. On multivariate logistic regression analysis, age [odds ratio (OR) 1.053], MI history (OR 2.860), Killip ≥ 2 (OR 10.235), and multi-vessels or left main coronary artery as culprit (OR 11.712) were significant independent positive predictors of in-hospital mortality for patients with ET > 12 h. Practice of primary PCI was not a significant negative predictor for patients with ET > 12 h (OR 0.812), but it was for patients with ET ≤ 12 h (OR 0.425). Conclusions These findings indicate that patients with ET > 12 h have a less severe condition and less frequently receive primary PCI compared with patients with ET ≤ 12 h. Although primary PCI is often performed for these patients irrespective of the severity of heart failure, no preferable effect of primary PCI on the in-hospital mortality is demonstrated. In contrary, practice of primary PCI is a significant negative predictor of in-hospital mortality for patients with ET ≤ 12 h.

A 71-year-old man was admitted to our hospital because of swelling and pain in his right calf developing after acupuncture for intermittent claudication. Computed tomography with contrast medium revealed a large hematoma with contrast medium leakage in his right calf. Emergent angiography demonstrated a pseudoaneurysm of the right popliteal artery with severe stenosis. Intravascular ultrasound showed lumen narrowing with a large amount of concentric plaque and disruption of the vessel wall communicating to a large cavity outside. A polytetrafluoroethylene-covered Jostent graft was deployed into the stenotic lesion across the opening into the pseudoaneurysm cavity. Subsequent angiography showed no leakage of contrast medium. This unique case of pseudoaneurysm caused by acupuncture in the popliteal artery was treated successfully by endovascular repair.

Obesity is an established risk factor for coronary heart disease. However, data on the relationship between obesity and prognosis following acute myocardial infarction (AMI) are still lacking in Japan.In the present study, 1,458 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2003. Among survivors of hospitalized AMI, clinical characteristics and medium-term prognosis were retrospectively compared between 240 normal weight male patients [body mass index (BMI) 18.5-25.0 kg/m2, normal weight group], and 116 obese male patients (BMIor = 25.0 kg/m2, obese group), who could be followed up after hospital discharge. The obese group were younger and had higher prevalence of smoking and hypercholesterolemia than the normal weight group. The two groups had similar angiographic findings and outcomes of primary percutaneous coronary intervention. During the follow-up period (mean 2.18 years for normal weight, 2.15 years for obese), overall mortality rate as well as event-free survival rate did not differ significantly between the two groups. Multivariate analysis showed the presence of previous myocardial infarction, diabetes mellitus, and age were predictors of medium-term mortality, but BMI was not.These results suggest that obesity is not associated with increased medium-term mortality and cardiac morbidity in Japanese male survivors hospitalized for AMI.

Patients receiving chronic hemodialysis develop complicated coronary lesions with tortuosity and calcification, which make stent delivery or expansion difficult. Restenosis rates are also higher than in patients without hemodialysis. Furthermore, there is a risk of polymer rubbing from the surface of a sirolimus-eluting stent(SES)placed across a calcified lesion. This study investigated the efficacy of SES for patients on hemodialysis compared with bare metal stent (BMS).Forty-two patients on hemodialysis underwent percutaneous coronary intervention for 46 de novo lesions treated with SES (SES group). Seventy-four patients with 78 de novo lesions were treated with BMS (BMS group). The mean age was 65.8 +/- 9.3 yr in the SES group, and 65.0 +/- 8.7 yr in the BMS group. The mean hemodialysis period was significantly longer in the SES group (9.2 +/- 7.9 vs 6.5 +/- 7.7 yr, p0.01). Angiographic characteristics and acute results showed no significant difference between the two groups. At 6 months follow-up, late loss was significantly smaller in the SES group (0.60 +/- 0.97 vs 1.60 +/- 1.15 mm, p0.05). Binary restenosis and target lesion revascularization were similar (34% vs 43%, 25% vs 36%, respectively, p = NS). Major adverse cardiac events, composite of death, myocardial infarction, and target vessel revascularization were also similar (23% vs 36%, p = NS).Our study could not demonstrate the superiority of SES implantation in patients with hemodialysis compared to BMS implantation, which suggests the limitations of using SES.

SummaryBackgroundPredictors of suboptimal coronary flow in the infarct-related artery (IRA) after stent-based primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) have not been fully investigated.Methods and resultsUsing the AMI-Kyoto Multi-Center Risk Study database, we retrospectively compared clinical manifestations and in-hospital prognosis between AMI patients undergoing stent-based primary PCI with final Thrombolysis In Myocardial Infarction (TIMI) grade ≤2 in the IRA (nonoptimal group, n=69) and those with final TIMI grade 3 (optimal group, n=1200). The nonoptimal group had higher prevalence of Killip class ≥3 at admission, higher frequency of mechanical support devices during procedures, larger value of maximal creatine phosphokinase, and a significantly higher in-hospital mortality rate (27.5% for nonoptimal vs. 9.0% for optimal, P

Summary Background Recurrent acute myocardial infarction (AMI) is a disastrous condition with high in-hospital morbidity and mortality. However, the relation between location of previous myocardial infarction (MI) and in-hospital outcome in repeat-AMI patients undergoing primary percutaneous coronary intervention (PCI) remains unclear. Methods and results Using the AMI-Kyoto Multi-Center Risk Study database, clinical background, angiographic findings, results of primary PCI, and in-hospital prognosis were retrospectively compared between primary PCI-treated AMI patients with previous anterior MI (anterior group, n = 151) and those with previous non-anterior MI (non-anterior group, n = 157). Clinical backgrounds, angiographic findings, results of primary PCI, and in-hospital outcome did not differ significantly between the two groups. On multivariate analysis, Killip class ≥3 at admission, number of diseased vessels ≥2 or diseased left main trunk at initial coronary angiography, and age were the independent predictors of in-hospital mortality in the recurrent-AMI patients, but not the anterior location of previous MI. Conclusions These results suggest that among recurrent-AMI patients undergoing primary PCI, in-hospital prognosis mostly depends on the severity of acute heart failure at the onset and the residual myocardial ischemia rather than previous MI sites.