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Satoru Suwa - One of the best experts on this subject based on the ideXlab platform.
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Association of onset-season with characteristics and long-term outcomes in acute myocardial infarction patients: results from the Japanese registry of acute myocardial infarction diagnosed by universal definition (J-MINUET) substudy
Heart and Vessels, 2019Co-Authors: Taishi Okuno, Kazuo Kimura, Koichi Nakao, Yukio Ozaki, Teruo Noguchi, Satoshi Yasuda, Jiro Aoki, Kengo Tanabe, Junya Ako, Satoru SuwaAbstract:It is known that incidence and short-term mortality rate of acute myocardial infarction (AMI) tend to be higher in the cold season. The aim of our study was to investigate the association of onset-season with patient characteristics and long-term prognosis of AMI. This was a prospective, multicenter, Japanese investigation of 3,283 patients with AMI who were hospitalized within 48 h of symptom onset between July 2012 and March 2014. Patients were divided into 3 seasonal groups according to admission date: cold season group (December–March), hot season group (June–September), and moderate season group (April, May, October, and November). We identified 1356 patients (41.3%) admitted during the cold season, 901 (27.4%) during the hot season, and 1026 (31.3%) during the moderate season. We investigated the seasonal effect on patient characteristics and clinical outcomes. Baseline characteristics of each seasonal group were comparable, with the exception of age, Killip Class, and conduction disturbances. The rates of higher Killip Class and complete atrioventricular block were significantly higher in the cold season group. The 3-year cumulative survival free from major adverse cardiac events (MACE) rate was the lowest in the cold season (67.1%), showing a significant difference, followed by the moderate (70.0%) and hot seasons (72.9%) ( p
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impact of acute kidney injury on in hospital outcomes of patients with acute myocardial infarction results from the japanese registry of acute myocardial infarction diagnosed by universal definition j minuet substudy
Circulation, 2017Co-Authors: Shotaro Kuji, Satoru Suwa, Masami Kosuge, Kazuo Kimura, Koichi Nakao, Yukio Ozaki, Teruo Noguchi, Satoshi Yasuda, Kazuteru Fujimoto, Yasuharu NakamaAbstract:BACKGROUND: Acute kidney injury (AKI) is associated with poor outcome after acute myocardial infarction (AMI), but whether hemodynamic status at presentation influences this prognostic significance is unknown.Methods and Results:A total of 2,798 AMI patients admitted within 48 h after symptom onset and who underwent urgent coronary angiography were enrolled in the present study. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL or ≥50% within 48 h during hospitalization. Patients were Classified into 3 groups according to Killip Class on admission: Killip 1, n=2,164; Killip 2-3, n=366; and Killip 4, n=268. AKI occurred more frequently with increasing Killip Class (Killip 1, 2-3, and 4: 6.3%, 15.3%, and 31.3%, respectively; P<0.001). AKI was associated with increased in-hospital mortality, regardless of Killip Class (non-AKI and AKI patients: 1.1% vs. 6.6% in Killip 1; 5.2% vs. 35.7% in Killip 2-3, and 28.8% vs. 45.2% in Killip 4, P<0.01 for all). On multivariate analysis, the adjusted OR of AKI for in-hospital mortality in Killip 1, Killip 2-3, and Killip 4 were 3.79 (95% CI: 1.54-9.33, P=0.004), 5.35 (95% CI: 2.67-10.7, P<0.001), and 1.48 (95% CI: 0.94-2.35, P=0.093), respectively. CONCLUSIONS: In AMI patients undergoing urgent coronary angiography, AKI was significantly associated with increased in-hospital mortality in Killip 1 as well as Killip 2-3 at presentation, but not in Killip 4.
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Abstract 15563: Prognostic Impact of Postprocedual TIMI Flow Grade in STEMI Patients With Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention - Analysis From JCS Shock Registry
Circulation, 2015Co-Authors: Tetsuya Matoba, Kazuo Sakamoto, Masahiro Mohri, Yasushi Ueki, Nobuhiro Tanaka, Yohei Hokama, Motoki Fukutomi, Katsutaka Hashiba, Rei Fukuhara, Satoru SuwaAbstract:Background: ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock, Killip Class 4, is a severe condition with high mortality, for which primary percutaneous coronary...
Sea Hing Ong - One of the best experts on this subject based on the ideXlab platform.
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COMPARING UTILIZATION OF TIMI RISK INDEX VERSUS Killip Class AT PRESENTATION IN DETERMINING THE NEED OF ADMISSION TO CORONARY CARE UNIT FOR ACUTE ST ELEVATION MYOCARDIAL INFARCTION PATIENT AFTER SUCCESSFUL PRIMARY PERCUTANEOUS CORONARY INTERVENTION:
Journal of the American College of Cardiology, 2011Co-Authors: Vern Hsen Tan, Chong Hiok Tan, Jeremy Chow, Kok Soon Tan, Jayaram Lingamanaicker, Victor Lim, Khim Leng Tong, Gerard Leong, Hwa Wooi Gan, Sea Hing OngAbstract:Background: With the ever-increasing number of acutely ill patients with cardiac disease that need intensive monitoring and limited resources in coronary care unit (CCU), there is a need to ensure appropriate admission to CCU. Studies have shown that Killip 1 patients who had successful primary percutaneous coronary intervention (PPCI) for ST Elevation Myocardial Infarction (STEMI) can be admitted safely to a step-down unit. However, Killip Class was a subjective assessment. We attempt to compare TIMI risk index {TRI = [heart rate X (age/10)2]/systolic blood pressure} versus Killip Class at presentation in determining the need of admission to CCU for STEMI patient after successful PPCI. TRI was a robust predictor (for STEMI patients on irst arrival in hospital) and high discriminatory capacity of in-hospital events in each of the ive risk subgroups.
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Transradial percutaneous coronary intervention in acute ST elevation myocardial infarction and high-risk patients: experience in a single centre without cardiothoracic surgical backup
Singapore medical journal, 2011Co-Authors: Jeremy Chow, Vern Hsen Tan, Chong Hiok Tan, Hwa Wooi Gan, Sea Hing Ong, Yew Seong Goh, Siang Chew ChaiAbstract:Introduction: Primary transradial percutaneous coronary intervention (TRI) is shown to be efficacious in stable patients with acute coronary syndrome. We aimed to evaluate the application of primary TRI for acute ST elevation myocardial infarction (STEMI), including among high-risk patients from our registry. Methods: This was a single-centre case series comprising 138 patients who underwent primary TRI for STEMI between May 2007 and June 2008. TRI was attempted with a 6-Fr guiding catheter in all patients regardless of Killip Class status. Outcome measures were success rates of primary TRI, door-to-balloon time, procedure duration and volume of contrast used. All patients were followed up for major adverse cardiac events in-hospital, at 30 days and six months. Results: A total of 138 patients had primary TRI attempted for STEMI. Four patients failed primary TRI and required a femoral approach. The remaining 134 patients underwent primary TRI. The mean patient age was 56.4 years. Most patients with acute STEMI presented in Killip Class I and II (91.8 percent). Only 8.2 percent were in Killip Class III or IV on admission. 50 percent of patients presented with anterior STEMI. The median door-to-balloon time for this group was 92 (interquartile range [IQR] 77-121) minutes, with a median procedure time of 39 (IQR 29-51) minutes. The success rate of primary TRI was 97.1 percent. Conclusion: Success rate, procedural and radiation time for TRI are comparable to those achieved via the femoral approach. Primary TRI is therefore a feasible and effective approach for acute STEMI, even in high-risk patients.
Harry Suryapranata - One of the best experts on this subject based on the ideXlab platform.
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Impaired Myocardial Perfusion Is a Major Explanation of the Poor Outcome Observed in Patients Undergoing Primary Angioplasty for ST-Segment–Elevation Myocardial Infarction and Signs of Heart Failure
Circulation, 2004Co-Authors: Giuseppe De Luca, Felix Zijlstra, Menko-jan De Boer, Arnoud W J Van 't Hof, A T Marcel Gosselink, Jan-henk E. Dambrink, Jan C.a. Hoorntje, Jan Paul Ottervanger, Harry SuryapranataAbstract:Background— The aim of the present study was to investigate the prognostic implication of myocardial perfusion in patients with ST-segment–elevation myocardial infarction (STEMI) and signs of heart failure, treated with primary angioplasty. Methods and Results— Our population is represented by 1548 consecutive patients undergoing primary angioplasty for STEMI. Congestive heart failure was defined as Killip Class >1 at admission. Killip Class was linearly associated with myocardial perfusion, enzymatic infarct size, predischarge ejection fraction, and 1-year mortality rate. Myocardial blush was an independent predictor of 1-year mortality (RR [95% CI]=2.92 [1.37 to 6.23], P=0.005) in patients with advanced Killip Class at presentation. Conclusions— Our study shows that patients with heart failure complicating STEMI have impaired myocardial perfusion, which accounts for the poor outcome observed in these patients. Further efforts should be aimed at improving myocardial perfusion, beyond epicardial recanaliz...
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glucose insulin potassium infusion inpatients treated with primary angioplasty for acute myocardial infarction the glucose insulin potassium study a randomized trial
Journal of the American College of Cardiology, 2004Co-Authors: Iwan C C Van Der Horst, Felix Zijlstra, Menko-jan De Boer, Arnoud W J Van 't Hof, Jan-henk E. Dambrink, Harry Suryapranata, Jan C.a. Hoorntje, Catharina Jacoba Maria Doggen, Rijk O B Gans, Henk J G BiloAbstract:Abstract Objectives In this study we considered the question of whether adjunction of glucose-insulin-potassium (GIK) infusion to primary coronary transluminal angioplasty (PTCA) is effective in patients with an acute myocardial infarction (MI). Background A combined treatment of early and sustained reperfusion of the infarct-related coronary artery and the metabolic modulation with GIK infusion has been proposed to protect the ischemic myocardium. Methods From April 1998 to September 2001, 940 patients with an acute MI and eligible for PTCA were randomly assigned, by open-label, to either a continuous GIK infusion for 8 to 12 h or no infusion. Results The 30-day mortality was 23 of 476 patients (4.8%) receiving GIK compared with 27 of 464 patients (5.8%) in the control group (relative risk [RR] 0.82, 95% confidence interval [CI] 0.46 to 1.46). In 856 patients (91.1%) without signs of heart failure (HF) (Killip Class 1), 30-day mortality was 5 of 426 patients (1.2%) in the GIK group versus 18 of 430 patients (4.2%) in the control group (RR 0.28, 95% CI 0.1 to 0.75). In 84 patients (8.9%) with signs of HF (Killip Class ≥2), 30-day mortality was 18 of 50 patients (36%) in the GIK group versus 9 of 34 patients (26.5%) in the control group (RR 1.44, 95% CI 0.65 to 3.22). Conclusions Glucose-insulin-potassium infusion as adjunctive therapy to PTCA in acute MI did not result in a significant mortality reduction in all patients. In the subgroup of 856 patients without signs of HF, a significant reduction was seen. The effect of GIK infusion in patients with signs of HF (Killip Class ≥2) at admission is uncertain.
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The prognostic importance of heart failure and age in patients treated with primary angioplasty.
European journal of heart failure, 2003Co-Authors: José P.s. Henriques, Felix Zijlstra, Menko-jan De Boer, Arnoud W J Van 't Hof, A T Marcel Gosselink, Jan-henk E. Dambrink, Harry Suryapranata, Jan C.a. HoorntjeAbstract:Background: Effective risk stratification is essential in the management of patients with acute myocardial infarction. Available models have not yet been studied and validated in patients treated with primary angioplasty for acute myocardial infarction. Methods: The prognostic value of heart failure defined by Killip Class and age upon admission and the impact of success and failure of the angioplasty procedure was studied in 1702 consecutive patients treated with primary angioplasty. Findings: The combination of Killip Class and age is a strong predictor of 30-day mortality and categorizes patients in subgroups with 30-day mortality risk ranging from 0.5 to 70%. Angioplasty failure results in a high 30-day mortality, in particular in patients with Killip Class ≥II and/or age ≥70 years. A large majority of patients (72%), characterized by Killip Class I and age
Giuseppe De Luca - One of the best experts on this subject based on the ideXlab platform.
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Association between advanced Killip Class at presentation and impaired myocardial perfusion among patients with ST-segment elevation myocardial infarction treated with primary angioplasty and adjunctive glycoprotein IIb-IIIa inhibitors
American heart journal, 2009Co-Authors: Giuseppe De Luca, C. Michael Gibson, Kurt Huber, Uwe Zeymer, Dariusz Dudek, Donald E. Cutlip, Francesco Bellandi, Marko Noc, Ayşe Emre, Simona ZormanAbstract:Background Although primary angioplasty has been shown to improve survival as compared with thrombolysis, the outcome is still unsatisfactory in subsets of patients such as those with signs of heart failure at presentation. In fact, although primary angioplasty is able to restore TIMI 3 flow in most patients, suboptimal myocardial reperfusion is observed in a relatively large proportion of patients. The aim of this study was to investigate among patients with ST-segment elevation myocardial infarction undergoing primary angioplasty the association between heart failure at presentation and myocardial perfusion and its implications in terms of survival. Methods Our population is represented by patients undergoing primary angioplasty who are included in the EGYPT database. Congestive heart failure was defined as Killip Class >1 at admission. Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Follow-up data were collected between 30 days and 1 year after primary angioplasty. Results Detailed data on Killip Class at presentation were available in 1,427 of 1,662 patients (86% of the initial population) who represent the final population of this study. Killip Class was associated with myocardial perfusion, distal embolization, enzymatic infarct size, predischarge ejection fraction, and 1-year mortality rate. Myocardial blush was an independent predictor of 1-year mortality (hazard ratio 7.44, 95% CI 1.82-30.4, P = .005) in patients with advanced Killip Class at presentation. Conclusions Our study shows that patients with heart failure complicating ST-segment elevation myocardial infarction have impaired myocardial perfusion, which accounts for the poor outcome observed in these patients. Further efforts should be aimed at improving myocardial perfusion, beyond epicardial recanalization, to further improve the outcome of these high-risk patients.
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Impaired Myocardial Perfusion Is a Major Explanation of the Poor Outcome Observed in Patients Undergoing Primary Angioplasty for ST-Segment–Elevation Myocardial Infarction and Signs of Heart Failure
Circulation, 2004Co-Authors: Giuseppe De Luca, Felix Zijlstra, Menko-jan De Boer, Arnoud W J Van 't Hof, A T Marcel Gosselink, Jan-henk E. Dambrink, Jan C.a. Hoorntje, Jan Paul Ottervanger, Harry SuryapranataAbstract:Background— The aim of the present study was to investigate the prognostic implication of myocardial perfusion in patients with ST-segment–elevation myocardial infarction (STEMI) and signs of heart failure, treated with primary angioplasty. Methods and Results— Our population is represented by 1548 consecutive patients undergoing primary angioplasty for STEMI. Congestive heart failure was defined as Killip Class >1 at admission. Killip Class was linearly associated with myocardial perfusion, enzymatic infarct size, predischarge ejection fraction, and 1-year mortality rate. Myocardial blush was an independent predictor of 1-year mortality (RR [95% CI]=2.92 [1.37 to 6.23], P=0.005) in patients with advanced Killip Class at presentation. Conclusions— Our study shows that patients with heart failure complicating STEMI have impaired myocardial perfusion, which accounts for the poor outcome observed in these patients. Further efforts should be aimed at improving myocardial perfusion, beyond epicardial recanaliz...
Jan C.a. Hoorntje - One of the best experts on this subject based on the ideXlab platform.
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Impaired Myocardial Perfusion Is a Major Explanation of the Poor Outcome Observed in Patients Undergoing Primary Angioplasty for ST-Segment–Elevation Myocardial Infarction and Signs of Heart Failure
Circulation, 2004Co-Authors: Giuseppe De Luca, Felix Zijlstra, Menko-jan De Boer, Arnoud W J Van 't Hof, A T Marcel Gosselink, Jan-henk E. Dambrink, Jan C.a. Hoorntje, Jan Paul Ottervanger, Harry SuryapranataAbstract:Background— The aim of the present study was to investigate the prognostic implication of myocardial perfusion in patients with ST-segment–elevation myocardial infarction (STEMI) and signs of heart failure, treated with primary angioplasty. Methods and Results— Our population is represented by 1548 consecutive patients undergoing primary angioplasty for STEMI. Congestive heart failure was defined as Killip Class >1 at admission. Killip Class was linearly associated with myocardial perfusion, enzymatic infarct size, predischarge ejection fraction, and 1-year mortality rate. Myocardial blush was an independent predictor of 1-year mortality (RR [95% CI]=2.92 [1.37 to 6.23], P=0.005) in patients with advanced Killip Class at presentation. Conclusions— Our study shows that patients with heart failure complicating STEMI have impaired myocardial perfusion, which accounts for the poor outcome observed in these patients. Further efforts should be aimed at improving myocardial perfusion, beyond epicardial recanaliz...
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glucose insulin potassium infusion inpatients treated with primary angioplasty for acute myocardial infarction the glucose insulin potassium study a randomized trial
Journal of the American College of Cardiology, 2004Co-Authors: Iwan C C Van Der Horst, Felix Zijlstra, Menko-jan De Boer, Arnoud W J Van 't Hof, Jan-henk E. Dambrink, Harry Suryapranata, Jan C.a. Hoorntje, Catharina Jacoba Maria Doggen, Rijk O B Gans, Henk J G BiloAbstract:Abstract Objectives In this study we considered the question of whether adjunction of glucose-insulin-potassium (GIK) infusion to primary coronary transluminal angioplasty (PTCA) is effective in patients with an acute myocardial infarction (MI). Background A combined treatment of early and sustained reperfusion of the infarct-related coronary artery and the metabolic modulation with GIK infusion has been proposed to protect the ischemic myocardium. Methods From April 1998 to September 2001, 940 patients with an acute MI and eligible for PTCA were randomly assigned, by open-label, to either a continuous GIK infusion for 8 to 12 h or no infusion. Results The 30-day mortality was 23 of 476 patients (4.8%) receiving GIK compared with 27 of 464 patients (5.8%) in the control group (relative risk [RR] 0.82, 95% confidence interval [CI] 0.46 to 1.46). In 856 patients (91.1%) without signs of heart failure (HF) (Killip Class 1), 30-day mortality was 5 of 426 patients (1.2%) in the GIK group versus 18 of 430 patients (4.2%) in the control group (RR 0.28, 95% CI 0.1 to 0.75). In 84 patients (8.9%) with signs of HF (Killip Class ≥2), 30-day mortality was 18 of 50 patients (36%) in the GIK group versus 9 of 34 patients (26.5%) in the control group (RR 1.44, 95% CI 0.65 to 3.22). Conclusions Glucose-insulin-potassium infusion as adjunctive therapy to PTCA in acute MI did not result in a significant mortality reduction in all patients. In the subgroup of 856 patients without signs of HF, a significant reduction was seen. The effect of GIK infusion in patients with signs of HF (Killip Class ≥2) at admission is uncertain.
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The prognostic importance of heart failure and age in patients treated with primary angioplasty.
European journal of heart failure, 2003Co-Authors: José P.s. Henriques, Felix Zijlstra, Menko-jan De Boer, Arnoud W J Van 't Hof, A T Marcel Gosselink, Jan-henk E. Dambrink, Harry Suryapranata, Jan C.a. HoorntjeAbstract:Background: Effective risk stratification is essential in the management of patients with acute myocardial infarction. Available models have not yet been studied and validated in patients treated with primary angioplasty for acute myocardial infarction. Methods: The prognostic value of heart failure defined by Killip Class and age upon admission and the impact of success and failure of the angioplasty procedure was studied in 1702 consecutive patients treated with primary angioplasty. Findings: The combination of Killip Class and age is a strong predictor of 30-day mortality and categorizes patients in subgroups with 30-day mortality risk ranging from 0.5 to 70%. Angioplasty failure results in a high 30-day mortality, in particular in patients with Killip Class ≥II and/or age ≥70 years. A large majority of patients (72%), characterized by Killip Class I and age
