Acute Myocardial Infarction Registry-National Institute Research Articles

Angiotensin-Converting Enzyme Inhibitors Provide Better Long-Term Survival Benefits to Patients With AMI Than Angiotensin II Receptor Blockers After Survival Hospital Discharge.

Renin-angiotensin-aldosterone system inhibitors (RASIs) are widely used in high-risk cardiovascular (CV) diseases, including acute myocardial infarction (AMI). However, it is not yet clear which class of RASIs provides specific benefits to patients with AMI. The present study aimed to evaluate whether angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) had any different effects on long-term CV and all-cause mortality in patients with AMI who received either agent from admission and were discharged alive from the hospital. We analyzed data of patients with AMI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry. Cardiovascular and all-cause mortality at 12 months after AMI were assessed. Among 12 481 patients with AMI who were discharged alive, RASI treatment was as follows: ACEIs (n = 5910), ARBs (n = 4009), and no RASI (n = 2562). After adjustment for multiple factors, compared with no RASI therapy, ACEI therapy was associated with lower hazard ratios (HRs) for 1-year CV and total mortality rates, whereas ARB therapy was not. In a direct comparison, compared with ARB treatment, ACEI treatment was associated with lower HRs (95% confidence interval) for CV and total mortality: 0.562 (0.420-0.753) and 0.567 (0.451-0.713), respectively. The superiority of ACEI to ARB was also observed across several subgroups. The mortality differences between the 2 treatment groups were reproduced in a propensity-score matched analysis (n = 2855 each). Our study of a recent AMI registry data revealed that ACEI therapy in patients with AMI was associated with better long-term survival benefits than ARB therapy.

Prevalent Prediabetes at Admission due to Acute Myocardial Infarction Does Not Affect One-Year Mortality Rates of Patients Who Were Discharged Alive

Background: Although prediabetes increases AMI risk, long-term clinical implication for prevalent prediabetes in AMI patients is not clear. The present study aimed to evaluate whether prediabetes at admission increases long-term cardiovascular (CV) and total mortalities in AMI patients who were discharged alive. Methods: We obtained AMI patient data from The Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) registry. Total and CV mortalities at 12 months after AMI were assessed. Results: A total of 13104 patients with AMI from the registry database were analyzed. 552 patients (4.2%) were destined to in-hospital mortality or hopeless discharge. We classified the remaining patients into control, prediabetes, and diabetes groups according to one of fallowing parameters: prevalent diabetes by past history, diabetes medication during hospitalization, or in the remaining cases with no diabetes history or medication data by hemoglobin A1c level at admission. Patients without any data about above-mentioned parameters were excluded in this study (n= 3583), and a total of 8969 AMI patients were available for analysis (control group, n=2379; prediabetes group, n=2321; and diabetes, n=4269). After adjustment for multiple factors, hazard ratios (HRs) (95% CI) for total mortality in prediabetic group vs. control group and diabetic group vs. control group were 1.536 (0.879-2.685, p=0.132) and 1.94 (1.184-3.190), p<0.01), respectively. However, CV mortality were not different between the three groups. Conclusions: Our results show that that prediabetic state at AMI admission do not increase CV mortality and all-cause mortalities at 1-year after survival discharge, whereas diabetes increase 1-year all-cause mortality. Disclosure I. Park: None. D. Lee: None. S. Yu: None. K. Lee: None.

A new risk score for ventricular tachyarrhythmia in acute myocardial infarction with preserved left ventricular ejection fraction

BackgroundVentricular tachycardia or fibrillation (VT/VF) is a major cause of sudden cardiac death after acute myocardial infarction (AMI). This study aims to investigate the clinical characteristics and outcomes of VT/VF, to identify the variables associated with VT/VF, and to construct a new scoring system. MethodsPatients with relatively preserved left ventricular ejection fraction (LVEF) (≥40%) included in the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were enrolled in this study. Among 13,109 patients in the registry, a total of 10,334 (78.8%) had relatively preserved LVEF after AMI. Patients were divided into two groups based on whether they experienced life-threatening VT/VF during hospitalization or not. The predictors for VT/VF during hospitalization were assessed. In-hospital mortality and complications were recorded. ResultsA total of 358 (3.5%) experienced life-threatening VT/VF. The VT/VF group was at an increased risk of in-hospital mortality (odds ratio 2.99) and cardiac death (odds ratio 3.40). Variables of diagnosis, Killip class, smoking, initial rhythm, left bundle branch block, and LVEF were significant indicators of VT/VF. A new risk score system yielded acceptable discrimination function (c-statistics=0.773). ConclusionsRelatively preserved LVEF patients could still be at risk of life-threatening VT/VF, which is related to a poor prognosis during the admission period. This new scoring system can be adopted to stratify the risk of VT/VF.

Lower In-Hospital Ventricular Tachyarrhythmia in Patients With Acute Myocardial Infarction Receiving Prior Statin Therapy.

We evaluated whether prior statin therapy reduces in-hospital ventricular tachycardia/ventricular fibrillation (VT/VF) in percutaneous coronary intervention (PCI) patients with acute myocardial infarction (MI). Among the 1177 patients from the Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH), 823 (70%) patients received prior statin therapy. Prior statin therapy was associated with a reduced risk of VT/VF events in both adjusted propensity score analysis (odds ratio [OR] 0.414, 95% confidence interval [CI], 0.198-0.865, P = .019) and adjusted inverse probability of treatment weight analysis (OR 0.463, 95% CI, 0.216-0.994, P = .048). The risk of in-hospital death did not differ significantly between those with or without prior statin therapy (hazard ratio [HR] 0.416, 95% CI, 0.112-1.548, P = .191). Major adverse cardiac events occurred in 116 (8.9%) patients during follow-up. Prior statin therapy was associated with a lower risk of major adverse cardiac events during the follow-up period (HR 0.486, 95% CI, 0.243-0.974, P = .042); however, this was mainly driven by reduced noncardiac death. Prior statin therapy might reduce the incidence of serious cardiac tachyarrhythmia, such as VT/VF, in patients with MI undergoing PCI. However, the reduction in VT/VF due to prior statin therapy did not improve short- and long-term clinical outcomes.

Influence of obesity and metabolic syndrome on clinical outcomes of ST-segment elevation myocardial infarction in men undergoing primary percutaneous coronary intervention

BackgroundThe correlation between obesity and metabolic syndrome (MetS) and its impact on cardiovascular disease remains unclear. This study aims to investigate the impact of metabolic status and obesity on clinical outcomes of male patients with ST-segment elevation myocardial infarction (STEMI). MethodsData from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were used to evaluate the impact of obesity and MetS on patients undergoing primary percutaneous coronary intervention (PPCI) from November 2005 to November 2015. Patients were grouped according to the presence or absence of obesity and MetS (‘obese−/MetS−’, ‘obese−/MetS+’, ‘obese+/MetS−’, or ‘obese+/MetS+’, respectively). All-cause death and major adverse cardiac events (MACE) were recorded during 12 months of follow-up. ResultsA total of 14,357 patients were included. Multivariate analysis showed that the presence of MetS was an independent risk factor for all-cause death (HR 2.08, 95% CI 1.30–3.31, p=0.002) and cardiovascular death (HR 2.44, 95% CI 1.33–4.46, p=0.004) at 12 months among normal weight patients. The protective effect of obesity was observed, compared with the obese−/MetS+ group, in terms of all-cause death (HR 0.50, 95% CI 0.31–0.81, p=0.005) and cardiovascular death (HR 0.52, 95% CI 0.28–0.96, p=0.038; vs. total obese individuals), but it might have disappeared compared with the obese−/MetS− group. The rate of MACE did not differ significantly according to category by obesity and MetS. ConclusionsThe obesity paradox has not been observed between obese and normal weight patients without MetS. Risk stratification on the basis of the presence or absence of MetS is not a clinically useful indicator of outcome in obese male patients with STEMI after PPCI.

Optimal Timing of Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Myocardial Infarction Complicated by Acute Decompensated Heart Failure (from the Korea Acute Myocardial Infarction Registry-National Institutes of Health [KAMIR-NIH

The optimal timing of percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI), complicated by acute decompensated heart failure (ADHF), is unclear. A total of 1,027 patients with NSTEMI complicated by ADHF who underwent successful PCI were analyzed using a Korean multicenter registry. All patients were divided into 4 groups by the timing of PCI: group 1 (PCI < 2 hour after admission, n = 149), group 2 (2 to 24 hours, n = 577), group 3 (24 to 72 hours, n = 189), and group 4 (≥72 hours, n = 112). We analyzed the incidences of 12-month mortality, nonfatal myocardial infarction (MI), target-vessel revascularization, and rehospitalization because of HF. The prevalence of ADHF in patients with NSTEMI was 15.2% at initial presentation, and in-hospital mortality was higher in group 1 than in the other groups. There were no significant differences in mortality, nonfatal MI, target-vessel revascularization, or rehospitalization for HF during the 12-month follow-up between groups, regardless of initial PCI timing, except for a higher 12-month mortality in patients who received PCI within 24 hours (vs ≥24 hours) (hazard ratio 1.52, 95% confidence interval 1.09 to 2.29, p = 0.046). Early PCI did not reduce adverse clinical outcomes in patients with NSTEMI complicated by ADHF. Delayed PCI after stabilization may be reasonable in such high-risk patients.

Effects of Statin Intensity on Clinical Outcome in Acute Myocardial Infarction Patients.

There has been debate regarding the added benefit of high-intensity statins compared with low-moderate-intensity statins, especially in patients with acute myocardial infarction (AMI).Methods and Results:The Korea Acute Myocardial Infarction Registry-National Institutes of Health consecutively enrolled 13,104 AMI patients. Of these, a total of 12,182 patients, who completed 1-year follow-up, were included in this study, and all patients were classified into 3 groups (no statin; low-moderate-intensity statin; and high-intensity statin). The primary outcome was major adverse cardiac event (MACE) including cardiac death, non-fatal MI, and repeat revascularization at 1 year. Both low-moderate-intensity and high-intensity statin significantly reduced low-density lipoprotein cholesterol (LDL-C; all P<0.001). Compared with the no statin group, both statin groups had significantly lower risk of MACE (low-moderate intensity: HR, 0.506; 95% CI: 0.413-0.619, P<0.001; high intensity: HR, 0.464; 95% CI: 0.352-0.611, P<0.001). The risk of MACE, however, was similar between the low-moderate- and high-intensity statin groups (HR, 0.917; 95% CI: 0.760-1.107, P=0.368). Multivariable adjustment, propensity score matching, and inverse probability weighted analysis also produced the same results. When adequate LDL-C level is achieved, patients on a low-moderate-intensity statin dose have similar cardiovascular outcomes to those on high-intensity statins.

Abstract 21117: Comparison of Clinical Outcomes Between Clopidogrel and New P2Y12 Antagonist in Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention

Background: Recent studies have suggested new P2Y12 antagonists (prasugrel /ticagrelor) are more effective in high thrombotic conditions than conventional clopidogrel The aim of this study was to compare the clinical outcomes between clopidogrel abd new P2Y12 antagonist in acute myocardial infarction patients treated with percutaneous coronary intervention (PCI). Methods: Between November 2011 and January 2016, a total of 11,731 AMI patients treated with PCI (7580 patients were prescribed clopidogrel and 4151 patients new P2Y12 antagonists) were enrolled in the Korean Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) database. Propensity score matching was performed to adjust for differences in baseline clinical variables. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of cardiac death, myocardial infarction, target-lesion revascularization (TLR), and stroke. Results: After propensity matching (4151 pairs), the rate of MACCEs were more frequently occurred in the clopidogrel group than in the new P2Y12 (8.2% vs. 6.4%, p=0.002). The difference in MACCE between two groups was driven by cardiac death (4.7% vs. 3.3%, p&lt;0.001). There was no significant difference in myocardial infarction (0.7% vs. 0.6%, p=0.783), TLR (2.4% vs. 1.8%, p=0.337), and stroke (0.8% vs. 0.7%, p=0.336). However, the incidences of Thrombolysis In Myocardial Infarction (TIMI) minor bleeding showed a trend toward a lower incidence in the clopidogrel group (13.8% vs. 17.3%, p=0.057). Conclusion: Our study shows that new P2Y12 antagonist was associated lower rate of MACCE and cardiac mortality in AMI patients treated with PCI.

Comparison of prasugrel versus clopidogrel in Korean patients with acute myocardial infarction undergoing successful revascularization

BackgroundAlthough there have been several reports that prasugrel can improve clinical outcomes, the efficacy and safety of prasugrel is unknown in Korean patients with acute myocardial infarction (AMI) undergoing successful revascularization. MethodsA total of 4421 patients [637 patients were prescribed prasugrel (60/10 or 5mg, loading/maintenance dose) and 3784 patients clopidogrel (600 or 300/75mg)] with AMI undergoing successful revascularization were enrolled from the core clinical cohort of Korea Acute Myocardial Infarction Registry-National Institute of Health. ResultsAfter propensity score matching (637 pairs), there were no significant differences in baseline clinical and procedural characteristics and in-hospital medications between the two groups. The primary efficacy endpoint, defined as the composite of cardiac death, MI, stroke, or target vessel revascularization at 6 months showed no significant difference between prasugrel and clopidogrel (2.4% vs. 2.9%, p=0.593). Also, no difference was observed in the composite of cardiac death, MI, or stroke during hospitalization between two groups (0.8% vs. 0.9%, p=0.762). However, the incidence of in-hospital Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding was significantly higher in prasugrel compared with clopidogrel (5.3% vs. 2.7%, p=0.015). In multivariate linear regression analysis, trans-femoral intervention, use of glycoprotein IIb/IIIa inhibitors, use of calcium channel blocker, and use of prasugrel were independent predictors of in-hospital TIMI major or minor bleeding [odds ratio (OR)=6.918; 95% confidence interval (CI)=2.453–19.510, OR=2.577; 95% CI=1.406–4.724, OR=4.016; 95% CI=1.382–11.668, OR=2.022; 95% CI=1.101–3.714]. ConclusionsOur study shows that the recommended dose of prasugrel had significantly higher in-hospital bleeding complications without reducing ischemic events compared with clopidogrel. However, further large-scale, long-term, randomized clinical trials are required to accurately assess the efficacy and safety of prasgurel and to find out the optimal dose for Korean AMI patients.

Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients

BackgroundAcute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate. MethodsA total of 12,625 AMI patients (64.0±12.6years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4±11.6years, 30.4% female) and 8228 non-diabetes (63.3±13years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status. ResultsIn diabetic patients, independent predictors of in-hospital mortality were old age, high HbA1C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction<40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (≥200mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction<40%, cardiogenic shock, stent thrombosis and decreased Hb≥5g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, p<0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, p<0.001). Comorbidity including cardiogenic shock (p<0.001), cerebral hemorrhage (p=0.012), decreased Hb≥5g/dL (p=0.013), atrioventricular block (p<0.001) and ventricular tachycardia (p=0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients. ConclusionsThese findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients.

Comparison of short-term clinical outcomes between ticagrelor versus clopidogrel in patients with acute myocardial infarction undergoing successful revascularization; from Korea Acute Myocardial Infarction Registry—National Institute of Health

BackgroundAlthough ticagrelor has been well-known to improve clinical outcomes in patients with acute myocardial infarction (AMI) without increased bleeding risk, its clinical impacts have not been well established in East Asian patients. MethodsBetween November 2011 and June 2015, a total of 8010 patients (1377 patients were prescribed ticagrelor and 6633 patients clopidogrel) undergoing successful revascularization were analyzed from Korea Acute Myocardial Infarction Registry—National Institute of Health. The patients who discontinued or occurred in-hospital switching between two antiplatelet agents were excluded. ResultsAfter propensity score matching (1377 pairs), no difference in the composite of cardiac death, MI, stroke, or target vessel revascularization at 6months was observed between two groups (4.2% vs. 4.9%, p=0.499). However, the incidences of in-hospital Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding were higher in ticagrelor than clopidogrel (2.6% vs. 1.2%, p=0.008; 3.8% vs. 2.5%, p=0.051). The in-hospital mortality was higher in patients with than those without TIMI major bleeding (11.3% vs. 0.9%, p<0.001). In a subgroup analysis, a higher risk for in-hospital TIMI major bleeding with ticagrelor was observed in patients≥75years or with body weight<60kg (odd ratio [OR]=3.209; 95% confidence interval [CI]=1.356–7.592) and in those received trans-femoral intervention (OR=1.996; 95% CI=1.061–3.754). ConclusionsOur study shows that ticagrelor did not reduce ischemic events yet, however, was associated with increased risk of bleeding complications compared with clopidogrel. Further large-scale, long-term, randomized trials should be required to assess the outcomes of ticagrelor for East Asian patients with AMI.

Multicenter Cohort Study of Acute Myocardial Infarction in Korea - Interim Analysis of the Korea Acute Myocardial Infarction Registry-National Institutes of Health Registry.

The Korea Acute Myocardial Infarction Registry (KAMIR)-National Institutes of Health (NIH) registry has the aim of evaluating the clinical characteristics, management, and long-term outcomes of patients with acute myocardial infarction (AMI) in Korea. Patients hospitalized for AMI in 20 tertiary university hospitals in Korea have been enrolled since November 2011. The study is expected to complete the scheduled enrollment of approximately 13,000 patients in October 2015, and follow-up duration is up to 5 years for each patient. As of October 2015, an interim analysis of 13,623 subjects was performed to understand the baseline clinical profiles of the study population. The mean age was 64.1 years; 73.5% were male; and 48.2% were diagnosed with ST-segment elevation AMI. Hypertension is a leading cause of AMI in Korea (51.2%), followed by smoking (38.5%) and diabetes mellitus (28.6%). Percutaneous coronary intervention was performed in 87.4% and its success rate was very high (99.4%). In-hospital, 1-year, and 2-year mortality rates were 3.9%, 4.3%, and 8.6%, respectively. The rates of major adverse cardiac events at 1 and 2 years were 9.6% and 18.8%, respectively. This analysis demonstrated the clinical characteristics of Korean AMI patients in comparison with those of other countries. It is necessary to develop guidelines for Asian populations to further improve their prognosis. (Circ J 2016; 80: 1427-1436).