The association between symptom interpretation and prognosis has not been investigated well among patients with acute coronary syndrome (ACS). As such, the present study evaluated the effect of heart disease awareness among patients with ACS on in-hospital mortality.
We performed a post hoc analysis of 1,979 consecutive patients with ASC with confirmed symptom interpretation on admission between 2014 and 2018, focusing on patient characteristics, recanalization time, and clinical outcomes. Upon admission, 1,264 patients interpreted their condition as cardiac disease, whereas 715 did not interpret their condition as cardiac disease. Although no significant difference was observed in door-to-balloon time between the 2 groups, onset-to-balloon time was significantly shorter among those who interpreted their condition as cardiac disease (254 vs. 345 min; P<0.001). Moreover, the hazard ratio (HR) for in-hospital mortality was significantly higher among those who did not interpret their condition as cardiac disease based on the Cox regression model adjusted for established risk factors (HR 1.73; 95% confidence interval 1.08-2.76; P=0.022).
This study demonstrated that prehospital symptom interpretation was significantly associated with in-hospital clinical outcomes among patients with ACS. Moreover, the observed differences in clinical prognosis were not related to door-to-balloon time, but may be related to onset-to-balloon time.

Excimer laser coronary angioplasty (ELCA) vaporizes plaques and thrombi, provides better microcirculation, and reduces peripheral embolism when treating acute coronary syndrome. Studies on the efficacy of ELCA for long onset-to-balloon time ST-segment elevation myocardial infarction (STEMI) are limited. Thus, we aimed to examine the efficacy of ELCA for STEMI using the onset-to-balloon time (OBT). A total of 319 patients with STEMI who underwent percutaneous coronary intervention from 2009 to 2012 and from 2015 to 2019 were enrolled. Patients who underwent PCI in 2009-2012 were considered the conventional group, and those treated with ELCA in 2015-2019 were considered the ELCA group. Patients were stratified by OBT. The endpoints were the final thrombolysis in myocardial infarction (TIMI) grade, myocardial blush grade (MBG), and slow-flow or no-reflow phenomenon during the procedure. The ELCA group had 167 patients, and the conventional group had 123. There was no significant difference in achieving final TIMI 3 between the groups. The acquisition rate of final MBG 3 was significantly higher in the ELCA than in the conventional group (79.6% vs. 65.9%; P = 0.01). There was a significant difference between the groups with OBT 12-72 h (82.1% vs. 56.0%; P = 0.031). The slow- or no-reflow incidence during the procedure was significantly lower in the ELCA than in the conventional group with OBT 12-72 h (17.8% vs. 52.2%; P = 0.019). ELCA improves the MBG and reduces intraoperative slow- or no-reflow phenomenon in patients with STEMI, 12-72 h after onset. ELCA will be useful in preventing peripheral embolism in patients with long onset-to-balloon time STEMI.

There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan.Methods and Results:In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ishikawa, Aomori, Ehime and Mie), a total of 1,695 consecutive AMI patients were registered in 2013. Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P<0.01), which resulted in a longer onset-to-balloon time (OTB: 225 vs. 210 min, P=0.02) and lower prevalence of PPCI in a timely fashion (OTB ≤2 h: 11.5% vs. 20.7%, P<0.01) in the Rural group. Multivariate analysis revealed that direct ambulance transport was the strongest predictor for PPCI in a timely fashion (odds ratio=4.13, P<0.001).
AMI patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in time delay to PPCI compared with those in metropolitan areas.

暂无摘要。

UNASSIGNED: Cardiogenic shock remained the leading cause of death in ST-segment elevation acute myocardial infarction (STEMI) patients even in the primary percutaneous coronary intervention era.
UNASSIGNED: Among 3942 STEMI patients with primary percutaneous coronary intervention within 24 h after symptom-onset in the Coronary Revascularization Demonstrating Outcome Study in Kyoto acute myocardial infarction registry, the study population of the current analysis consisted of 466 STEMI patients who were complicated by cardiogenic shock due to acute pump failure.
UNASSIGNED: The cumulative incidence of all-cause death of cardiogenic shock due to acute pump failure was 25.4% at 30 days, 38.7% at one year, and 51.4% at five years. Cumulative five-year incidence of all-cause death in patients with left main coronary artery culprit lesion was extremely high (left main coronary artery: 70.4%, left anterior descending artery: 52.5%, left circumflex artery: 50.6%, and right coronary artery; 44.3%, respectively, log-rank p<0.001). The cumulative five-year incidence of all-cause death in patients with onset-to-balloon time ⩽3 h as well as those with door-to-balloon time ⩽90 min were significantly lower than those without (43.3% versus 55.5%, log-rank p=0.008, and 44.9% versus 55.8%, log-rank p=0.003, respectively). After adjusting for confounders, onset-to-balloon time ⩽3 h and door-to-balloon time ⩽90 min were independently associated with lower long-term risk for all-cause death (hazard ratio: 0.69, 95% confidence interval: 0.49-0.96, p=0.03, and hazard ratio: 0.73, 95% confidence interval: 0.53-0.98, p=0.04, respectively).
UNASSIGNED: The long-term mortality of STEMI patients complicated by cardiogenic shock due to acute pump failure remains high even in the current clinical practice. In this high-risk category of patients, shorter onset-to-balloon and door-to-balloon time were associated with significantly lower long-term risk for mortality.