RISK STRATIFICATION AND EFFECTS OF PERCUTANEOUS CORONARY INTERVENTION AND THE PHARMACOTHERAPY INITIATED IN THE FIRST 24 HOURS ON IN-HOSPITAL MORTALITY IN PATIENTS WITH THE FIRST MYOCARDIAL INFARCTION

Abstract Background Despite progress in acute myocardial infarction (MI) treatment, data on geographical disparities in its care remain limited. Purpose We aimed to assess the discrepancy by population density (PD) on the quality and clinical outcomes of patients with primary percutaneous coronary intervention (PCI) after ST-segment elevation MI (STEMI). Methods The J-PCI registry is a prospective procedural registry conducted by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) to assure the quality of delivered care. Between January 2014 and December 2018, 209,521 patients underwent PCI for STEMI in 1,126 institutes. Population of administrative municipal-level districts was determined through the complete population census. The patients were divided into tertiles according to the PD of the PCI institution location (low: <951.7/km2, n=69,797; middle: 951.7–4,729.7/km2, n=69,750; high: ≥4,729.7/km2, n=69,974). Results Patients treated in high PD administrative districts were younger (low: 69.1±12.9, middle: 68.7±12.9, high: 68.0±13.1) and likely to be male (low: 75.6%, middle: 76.0%, high: 76.6%). No significant correlation was observed between PD and door-to-balloon time (DTB: regression coefficients: 0.036 per 1000 people/km2, 95% CI: −0.232 to 0.304, P=0.79). Patients treated in low PD areas had higher crude in-hospital mortality rates than those treated in high PD areas (low: 2.89%, middle: 2.60%, high: 2.38%; P<0.001). Moreover, PD and in-hospital mortality had a significantly inverse association, before and after adjusting for baseline characteristics (crude odds ratio [OR]: 0.983 per 1,000/km2, 95% confidence interval [CI]: 0.973–0.992, P<0001; adjusted OR: 0.980 per 1,000/km2, 95% CI: 0.964–0.996, P=0.01, respectively). Higher PD districts had more operators per institute (low: 6, interquartile range [IQR] 3–10; middle: 7, IQR 3–13; high: 8, IQR 5–13, P<0.001), suggesting an inverse association with in-hospital mortality (OR: 0.992, 95% CI: 0.986–0.999, P=0.03). Conclusions Marked geographical inequality was observed in immediate case fatality; patients treated in population-dense areas had a lower in-hospital mortality than those treated in less dense areas. Variation in the number of operators per institute, rather than traditional quality indicators (e.g. DTB) may explain the difference in in-hospital mortality. Funding Acknowledgement Type of funding source: None

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Outcomes of Early Risk Stratification and Targeted Implantable Cardioverter-Defibrillator Implantation After ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Yearbook of Cardiology ◽

10.1016/s0145-4145(09)79734-5 ◽

2010 ◽

Vol 2010 ◽

pp. 333-335

Author(s):

B.J. Gersh

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Risk Stratification ◽

Implantable Cardioverter Defibrillator ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Cardioverter Defibrillator ◽

Early Risk ◽

Percutaneous Coronary ◽

St Elevation

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Risk stratification model for in-hospital death in patients undergoing percutaneous coronary intervention: a nationwide retrospective cohort study in Japan

BMJ Open ◽

10.1136/bmjopen-2018-026683 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026683 ◽

Cited By ~ 7

Author(s):

Taku Inohara ◽

Shun Kohsaka ◽

Kyohei Yamaji ◽

Hideki Ishii ◽

Tetsuya Amano ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cohort Study ◽

Risk Stratification ◽

Hospital Mortality ◽

Retrospective Cohort ◽

Validation Cohort ◽

Coronary Intervention ◽

Hospital Death ◽

Risk Models ◽

Percutaneous Coronary

ObjectivesTo provide an accurate adjustment for mortality in a benchmark, developing a risk prediction model from its own dataset is mandatory. We aimed to develop and validate a risk model predicting in-hospital mortality in a broad spectrum of Japanese patients after percutaneous coronary intervention (PCI).DesignA retrospective cohort study was conducted.SettingThe Japanese-PCI (J-PCI) registry includes a nationally representative retrospective sample of patients who underwent PCI and covers approximately 88% of all PCIs in Japan.ParticipantsOverall, 669 181 patients who underwent PCI between January 2014 and December 2016 in 1018 institutes.Main outcome measuresIn-hospital death.ResultsThe study population (n=669 181; mean (SD) age, 70.1(11.0) years; women, 24.0%) was divided into two groups: 50% of the sample was used for model derivation (n=334 591), while the remaining 50% was used for model validation (n=334 590). Using the derivation cohort, both ‘full’ and ‘preprocedure’ risk models were developed using logistic regression analysis. Using the validation cohort, the developed risk models were internally validated. The in-hospital mortality rate was 0.7%. The preprocedure model included age, sex, clinical presentation, previous PCI, previous coronary artery bypass grafting, hypertension, dyslipidaemia, smoking, renal dysfunction, dialysis, peripheral vascular disease, previous heart failure and cardiogenic shock. Angiographic information, such as the number of diseased vessel and location of the target lesion, was also included in the full model. Both models performed well in the entire validation cohort (C-indexes: 0.929 and 0.926 for full and preprocedure models, respectively) and among prespecified subgroups with good calibration, although both models underestimated the risk of mortality in high-risk patients with the elective procedure.ConclusionsThese simple models from a nationwide J-PCI registry, which is easily applicable in clinical practice and readily available directly at the patients’ presentation, are valid tools for preprocedural risk stratification of patients undergoing PCI in contemporary Japanese practice.

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