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Background: Although many studies showed the predictive factors of stent thrombosis (ST) occurrence, there are few data about clinical outcomes and recurrent ST after percutaneous coronary intervention (PCI) for ST. Furthermore, it is uncertain which factors can cause adverse clinical events including recurrent ST., Methods: This study examined the clinical outcomes after treatment for definite ST. Among 18,739 patients between June 2003 and December 2016 who underwent PCI using a drug-eluting stent (DES) or bare-metal stent (BMS), 243 consecutive patients who suffered definite ST were enrolled in this study. The overall incidence of ST was 1.3% (DES 1.4% and BMS 0.8%). The study endpoint was 1-year cardiac death or recurrent definite ST after the initial ST., Results: Study endpoint occurred in 57 patients (23.5%) during the 1-year follow-up after the initial ST. In multivariate analysis, the factors predicting 1-year endpoint were early ST [adjusted hazard ratio (HR): 2.23, 95% confidence interval (CI): 1.26-4.08, p=0.006], BMS ST (HR: 2.42, 95% CI: 1.27-4.81, p=0.045), serum level of glucose (HR: 1.03, 95% CI: 1.01-1.05, p=0.048), and ST-segment elevation myocardial infarction (STEMI) at the initial ST (HR: 3.73, 95% CI: 1.82-7.65, p<0.001)., Conclusions: Recurrent ST or cardiac death during the first year after the initial ST event occurred in ∼25% of patients treated for definite ST. BMS ST, serum level of glucose, STEMI, and early ST at the initial ST were associated with adverse cardiac events., (Copyright © 2019. Published by Elsevier Ltd.)

Background/aims: Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy., Methods: A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128)., Results: In this study population, 23% of patients presented without chest pain. After propensity score matching, the contact-to-device time (2,618 ± 381 minutes vs. 1,739 ± 241 minutes, p = 0.050), the symptoms-to-balloon time (3,426 ± 389 minutes vs. 2,366 ± 255 minutes, p = 0.024), and the door-to-balloon time (2,339 ± 380 minutes vs. 1,544 ± 244 minutes, p = 0.002) were significantly higher in the patients with atypical symptoms than in those with typical symptoms, respectively. Atypical symptoms were an independent predictor for 1-year mortality (hazard ratio, 2.820; 95% confidence interval, 1.058 to 7.515; p = 0.038). The Kaplan-Meier estimates showed higher risk for 12-month mortality in patients with atypical symptoms (p = 0.048) and no significant difference for 12-month major adverse cardiac events (p = 0.487)., Conclusion: Acute myocardial infarction patients with atypical symptoms were not rare in clinical practice and showed a high risk of delayed reperfusion therapy. After imbalance between the groups was minimized by use of propensity score matching, patients who presented atypically had a high mortality rate.

Background: Successful percutaneous coronary intervention (PCI) of the occluded infarct-related artery (IRA) in latecomers may improve long-term survival mainly by reducing left ventricular remodeling. It is not clear whether inhibition of renin-angiotensin system (RAS) brings additional better clinical outcomes in this specific population subset., Methods: Between January 2008 and June 2013, 669 latecomer patients with acute ST-segment elevation myocardial infarction (STEMI) (66.2±12.1 years, 71.0% males) in Korea Acute Myocardial Infarction Registry (KAMIR) who underwent a successful PCI were enrolled. The study population underwent a successful PCI for a totally occluded IRA. They were divided into two groups according to whether they were prescribed RAS inhibitors at the time of discharge: group I (RAS inhibition, n=556), and group II (no RAS inhibition, n=113)., Results: During the one-year follow-up, major adverse cardiac events (MACE), which consist of cardiac death and myocardial infarction, occurred in 71 patients (10.6%). There were significantly reduced incidences of MACE in the group I (hazard ratio=0.34, 95% confidence interval 0.199-0.588, p=0.001). In subgroup analyses, RAS inhibition was beneficial in patients with male gender, history of hypertension or diabetes mellitus, and even in patients with left ventricular ejection fraction (LVEF) ≥40%. In the baseline and follow-up echocardiographic data, benefit in changes of LVEF and left ventricular end-systolic volume was noted in group I., Conclusions: In latecomers with STEMI, RAS inhibition improved long-term clinical outcomes after a successful PCI, even in patients with low risk who had relatively preserved LVEF., (Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Background: Acute myocardial infarction (AMI) is a risk factor for contrast-induced nephropathy (CIN). We investigated whether pretreatment with statin, N-acetylcysteine (NAC) and sodium bicarbonate (NaHCO3) reduces the risk of CIN., Methods: We conducted a prospective trial and enrolled a total of 334 ST-segment elevation myocardial infarction (STEMI) patients. Patients were divided into four groups: Group I (statin 40mg), Group II (statin 80mg), Group III (statin 80mg plus NAC 1200mg) and Group IV (regimen of group III plus NaHCO3 154mEq/L). CIN was defined as ≥25% or ≥0.5mg/dL increase in serum creatinine from the baseline within the 72h after PCI., Results: CIN occurred in 72 (21.6%) patients. The incidence of CIN was the lowest in the group III (14.3%), and multivariate analysis showed the lower incidence of CIN in group III compared to Group I [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.13-0.64, p=0.002]. Admission hyperglycemia [(AHG)>198mg/dL] (OR 2.20, 95% Cl 1.20-3.68, p=0.011) and the use of intra-aortic balloon pump (IABP) (OR 4.20, 95% CI 1.38-12.78, p=0.016) were independent predictors for CIN. The CIN (OR 9.00, 95% CI 1.30-62.06, p=0.026) was an independent predictor for in-hospital mortality., Conclusions: Combination of high-dose statin plus NAC was associated with lower incidence of CIN in patients with STEMI who underwent primary PCI compared to statin only., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background/aims: The aim of this study was to compare the risk of complications and outcome between infarct-related artery (IRA)-only revascularization and multivessel (MV) revascularization in patients with acute myocardial infarction (MI) with renal insufficiency and MV disease., Methods: A total of 1,031 acute MI patients with renal insufficiency and MV disease who were registered in the Korea Working Group on Myocardial Infarction were enrolled. They were divided into two groups (IRA-only revascularization group, n = 404; MV revascularization group, n = 627), and investigated the cumulative incidence of major adverse cardiac events (MACE) and the incidence of complications after percutaneous coronary intervention (PCI)., Results: Complications after PCI occurred in 19.9% of all patients (206/1,031). Complications after PCI occurred more frequently in the MV revascularization group compared with the IRA-only revascularization group (20.1% [126/627] vs. 15.3% [62/404], respectively; p = 0.029]. The overall in-hospital mortality rate was 6.3%, and there was no significant difference between the groups (5.2% in the IRA-only revascularization group vs. 7.0% in the MV revascularization group; p = 0.241). The total incidence of MACE was 11.1%, and there was no significant difference between the groups (11.6% in the IRA-only revascularization group vs. 10.7% in the MV revascularization group; p = 0.636)., Conclusions: The incidence of complications after PCI was significantly lower in the IRA-only revascularization group compared with the MV revascularization group. However, there were no significant difference in the 12-month outcomes between groups in patients with acute MI and renal insufficiency with MV disease.

The aim of this study was to evaluate whether the clinical outcomes were associated with socioeconomic status (SES) in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). The author analyzed 2,358 patients (64.9 ± 12.3 yr old, 71.5% male) hospitalized with AMI between November 2005 and June 2010. SES was measured by the self-reported education (years of schooling), the residential address (social deprivation index), and the national health insurance status (medical aid beneficiaries). Sequential multivariable modeling assessed the relationship of SES factors with 3-yr major adverse cardiovascular events (MACEs) and mortality after the adjustment for demographic and clinical factors. During the 3-yr follow-up, 630 (26.7%) MACEs and 322 (13.7%) all-cause deaths occurred in 2,358 patients. In multivariate Cox proportional hazards regression modeling, the only lower education of SES variables was associated with MACEs (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.04-1.91) and mortality (HR, 1.93; 95% CI, 1.16-3.20) in the patients with AMI who underwent PCI. The study results indicate that the lower education is a significant associated factor to increased poor clinical outcomes in patients with AMI who underwent PCI.

We compared clinical characteristics, management, and clinical outcomes of nonagenarian acute myocardial infarction (AMI) patients (n=270, 92.3 ± 2.3 yr old) with octogenarian AMI patients (n=2,145, 83.5 ± 2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to be prescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared with octogenarians. Although percutaneous coronary intervention (PCI) was preferred in octogenarians than nonagenarians, the success rate of PCI between the two groups was comparable. In-hospital mortality, the composite of in-hospital adverse outcomes and one year mortality were higher in nonagenarians than in octogenarians. However, the composite of the one year major adverse cardiac events (MACEs) was comparable between the two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality (adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P<0.001) and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P<0.001) without significant complications both in nonagenarians and octogenarians. In conclusion, nonagenarians had similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality compared with octogenarian AMI patients. PCI in nonagenarian AMI patients was associated to better 1-yr clinical outcomes.

Background and Purpose: Octogenarians (age ≥ 80 years) with coronary artery disease constitute a high-risk group. However, octogenarian patients with acute myocardial infarction (AMI) in the drug-eluting stents (DES) era have not been widely reported. We aimed to identify clinical outcomes in octogenarian compared with non-octogenarian AMI patients., Methods and Subjects: We retrospectively analyzed 9877 patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and who were enrolled in the Korean Acute Myocardial Infarction Registry (KAMIR). They were divided into 2 groups, octogenarians (n=1494) and non-octogenarians (n=8383), in order to compare the incidence of 1-year all-cause death and 1-year major adverse cardiac events (MACE), where MACE included all-cause death, recurrent myocardial infarction, target vessel revascularization (TVR), target lesion revascularization (TLR), and coronary artery bypass grafting (CABG)., Results: The clinical status was significantly inferior in octogenarians compared to non-octogenarians: Killip class ≥ II (34.8% vs. 22.5%, p<0.001), multivessel disease (65.8% vs. 53.7%, p<0.001). Rates of 1-year all-cause death were significantly higher in octogenarians than in non-octogenarians (22.3% vs. 6.5%, p<0.001). However, the rates of 1-year recurrent myocardial infarction (1.3% vs. 0.9%, p=0.68), TLR (2.4% vs. 3.1%, p=0.69), TVR (3.6% vs. 4.3%, p=0.96), and CABG (0.9% vs. 0.9%, p=0.76) did not differ significantly between the 2 groups., Conclusions: Octogenarian AMI patients have higher rates of mortality and MACE even in the DES era. According to KAMIR subgroup analysis, the TLR/TVR rates in octogenarians were comparable to those in non-octogenarian AMI patients., (Copyright © 2013. Published by Elsevier Ltd.)

Background: No-reflow phenomenon is a serious complication of percutaneous coronary intervention (PCI) and associated with poor prognosis. The aim of this study was to determine whether triple anti-platelet therapy could improve clinical outcome in patients with acute myocardial infarction (AMI) who had no-reflow phenomenon during PCI compared with dual anti-platelet therapy., Methods and Results: A total of 727 eligible patients received either dual anti-platelet therapy (aspirin and clopidogrel; dual group, n=532) or triple anti-platelet therapy (aspirin, clopidogrel, and cilostazol; triple group, n=195). The triple group received additional cilostazol for at least 1 month. One-year major adverse cardiac events (MACE) including death, myocardial infarction (MI), target vessel revascularization (TVR) and coronary artery bypass graft (CABG) were evaluated. The triple group had a similar incidence of major bleeding and in-hospital mortality compared with the dual group. At 1 year, the triple group had significantly lower cardiac mortality (17.7% vs. 11.8%, log-rank P=0.039), lower all-cause mortality (19.0% vs. 12.3%, log-rank P=0.035), and lower incidence of composite MACE (25.9% vs. 16.9%, adjusted hazard ratio, 0.50; 95% confidence interval: 0.31-0.80, P=0.004) compared with the dual group with no differences in MI and TVR., Conclusions: Triple anti-platelet therapy seems to be superior to dual anti-platelet therapy in patients with AMI who had no-reflow phenomenon during PCI.

Background: The synergistic effect of diabetes mellitus (DM) and hypertension on mid-term outcome among acute myocardial infarction (MI) patients undergoing percutaneous coronary intervention (PCI) is still controversial., Methods: A total of 2438 patients with acute MI who underwent PCI from January 2007 to November 2010 were studied. Patients were stratified to four groups according to the presence of DM or hypertension and followed up during 12 months. We analyzed the influence of hypertension and DM on major adverse cardiac events (MACE: death, recurrent MI, repeated coronary artery revascularization)., Results: No history of hypertension or DM was found in 35.0%, a history of hypertension in 27.2%, a history of DM in 15.0%, and a history of both disease entities in 22.8%. The rate of MACE was significantly higher in hypertensive DM group (15.9% vs. 22.9% vs. 28.8% vs. 37.0%, log-rank p<0.001). In multivariate analysis, hypertension and DM were meaningful predictors of mid-term mortality, and the combination of the two was a stronger predictor (hazard ratio=1.790; 95% confidence interval=1.313-2.442; p<0.001)., Conclusions: After PCI, acute MI patients with a history of DM or hypertension had a higher mid-term mortality than acute MI patients without such a history. The combination of DM and hypertension appeared to be more strongly associated with mortality than DM or hypertension alone., (Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Abstract: Background: In patients with non-ST-elevation myocardial infarction (NSTEMI), current guidelines did not recommend optimal revascularization management in multivessel coronary artery disease. We compared clinical outcomes between multivessel revascularization and culprit-only revascularization in this setting. Methods: A total of 1919 patients with multivessel disease (1011 patients; multivessel revascularization group, 908 patients; culprit-only revascularization group) diagnosed as NSTEMI was enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008. The primary end-points were major adverse cardiac events (MACE), all-causes of deaths, myocardial infarction (MI), and repeated percutaneous coronary intervention (PCI) during 1-year clinical follow-up. Also, subgroup analysis was performed in patients with high TIMI (Thrombolysis In Myocardial Infarction) risk score (≥4) to find efficacy of multivessel PCI in high-risk patients. Results: Baseline clinical characteristics and the risk factors of coronary artery disease were similar between both groups. In angiography, three-vessel lesion was more presented in the multivessel group (46.1% vs. 40.9%, p =0.024) and rates of left anterior descending and left main stem coronary artery as culprit vessel were higher in the multivessel group (p =0.003 and p =0.001 respectively). In-hospital mortality was higher in the culprit-only group (1.4% vs. 2.9%, p =0.025). Primary end-points occurred in 241 patients (15.5%) during 1-year follow-up. Multivessel revascularization reduced MACEs [hazard ratio (HR) 0.658, 95% confidence interval (CI) 0.45 to 0.96, p =0.031], death or myocardial infarction (HR 0.58, 95% CI 0.35 to 0.97, p =0.037) and non-target vessel revascularization (HR 0.44, 95% CI 0.24 to 0.81, p =0.008). There were no significant differences in target lesion revascularization (TLR; HR 1.38, 95% CI 0.51 to 3.71, p =0.529) and target vessel revascularization (TVR; HR 0.28, 95% CI 0.05 to 1.47, p =0.131). In subgroup analysis in patients with a higher TIMI risk score, similar results were presented. Conclusion: Multivessel revascularization in multivessel coronary artery disease presenting with NSTEMI showed better clinical outcomes without significant in-stent restenosis and progression of diseased-vessel compared to culprit-only revascularization. [Copyright &y& Elsevier]

Introduction: Mortality is very high in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) or cardiac arrest despite intensive use of percutaneous coronary intervention (PCI). Although current guidelines still recommend rapid revascularization in these high-risk patients, several studies showed the benefit of extracorporeal membrane oxygenation (ECMO)-assisted PCI. Hypothesis: ECMO support before revascularization might be beneficial in patients with AMI complicated by profound CS after resuscitated cardiac arrest. Methods: Among 116,374 patients experiencing out-of-hospital cardiac arrest in all emergency medical service of South Korea between 2013 and 2016, a total of 147 resuscitated patients with AMI complicated by profound CS who were treated with both PCI and ECMO were enrolled. Exclusion criteria were as follows: non-cardiac arrest, duration of cardiopulmonary resuscitation < 20 minutes, patients without restoration of spontaneous circulation, patients treated with thrombolysis, patients who did not receive PCI, patients did not receive ECMO treatment, and cases of failed PCI. Enrolled patients were divided into two groups according to timing of ECMO; pre-PCI ECMO group (n = 82) vs. post-PCI ECMO group (n = 65). We compared 30-day mortality between two groups. Results: Age and proportion of male gender were similar between 2 groups. The rate of bystander CPR (29.3% vs. 29.2%, p = 0.996) and shockable rhythm at emergency room (26.8% vs. 26.2%, p = 0.927) were also comparable in 2 groups. Although total duration of CPR was similar between 2 groups (57.4±27.6 vs. 52.0±28.8 minutes, p = 0.313), door to revascularization time was significantly longer in pre-PCI ECMO group than post-PCI ECMO group (123.7±57.6 vs. 105.5±39.1 minutes, p = 0.030). At 30-days, overall mortality was 80.3% (118 patients) in study population, and it was significantly lowered in pre-PCI ECMO group (72.0% vs. 90.8%, p = 0.004). In multivariate Cox-regression analysis, pre-PCI ECMO reduced 30-day mortality compared to post-PCI ECMO (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.47-0.98, p = 0.041). Bystander CPR , shockable rhythm at emergency room and successful therapeutic hypothermia were also associated with reduced 30-day mortality. Conclusions: ECMO treatment before PCI was associated with reduced 30-day mortality compared to ECMO after revascularization in patients with AMI complicated by profound CS after resuscitated cardiac arrest. [ABSTRACT FROM AUTHOR]

Introduction: Triple therapy composed of oral anticoagulants and dual anti-platelet therapy is needed to prevent thromboembolism and stent thrombosis in atrial fibrillation (AF) patients experiencing acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI). Current guidelines prefer non-vitamin K antagonist oral anticoagulants (NOACs) instead of warfarin with merit of major bleeding risk reduction. Hypothesis: Although NOACs is expected to be superior to warfarin, little has been proven for efficacy and safety in AF patients experiencing AMI with PCI. We aimed to compare NOACs and warfarin in AF patients undergoing PCI due to AMI. Methods: We analyzed 6,580 AMI patients enrolled in Korean AMI Registry from Jan 2011 to Dec 2017. A total of 5,145 (78.2%) patients underwent PCI and 605 (9.2%) patients presented AF. Among 480 AF patients undergoing PCI, a total of 183 patients received triple therapy. One-year clinical outcomes were compared between warfarin group (n=92) and NOACs group (n=91) in survived patients at hospital discharge. Primary end-point was defined as major adverse cardiac and cerebral events (MACCE), composed of death, recurrent MI, repeated PCI, and coronary artery bypass grafting (CABG), and new-onset stroke. Secondary end-point was defined as the composite of MACCE and major bleeding, Results: There were no differences in baseline clinical characteristics between the 2 groups. CHA2DS2-VASc score was higher in NOACs group (3.2±1.6 vs. 2.3±1.9, p=0.003). There were no differences in the one-year MI, repeated PCI, and CABG between the 2 groups. However, one-year mortality was higher in warfarin group (4.2% vs. 1.1%, p=0.087). Event rates of ischemic stroke (2.0% vs. 3.4%, p=0.634) and major bleeding (4.3% vs. 2.9%, p=0.638) were not different between the 2 groups. Primary end-point (3.1% vs. 7.4%, p=0.041) was significantly lower in NOACs group, whereas secondary end-point (7.2% vs. 9.6%, p=0.345) was not different between the 2 groups. Cox-regression analysis adjusting CHA2DS2-VASc score and clinically significant variables demonstrated that warfarin and NOACs had similar outcomes on the primary and secondary end-points. Conclusions: NOACs significantly reduced one-year mortality in AF patients with AMI undergoing PCI. However, composite clinical outcomes were similar between NOACs and warfarin group. Further clinical trials are warranted to prove comparative efficacy and safety between NOACs and warfarin in AF patients experiencing AMI with PCI. [ABSTRACT FROM AUTHOR]