Acute Myocardial Infarction Registry Research Articles

Acute myocardial infarction and stroke registries. The Italian experience

Cardiovascular diseases (CVD) are the leading causes of death and hospitalisation in nearly all European countries and accounted for almost 40% of all deaths in 2013. With the exception of few rigorous but limited studies carried out in some geographical areas, data available on CVD incidence and prevalence is generally limited and of poor quality, despite the magnitude of the CVD phenomenon. The EUROCISS Project, supported by the Health Monitoring Programme of the DG SANCO from 2000 to 2007, provided general guidance and updated methods for the surveillance of Acute Myocardial Infarction and Stroke. The Italian population-based registry of major coronary and cerebrovascular events was set up following EUROCISS recommendations; it also took into account the experience acquired by Italy in the MONICA project since the mid-1980s and continued with the coordination of the EUROCISS The project: “A population-based AMI register: assessing the feasibility for a pilot study to implement a surveillance system of acute myocardial infarction (AMI) in Mediterranean countries according to EUROCISS recommendations” in the framework of the EuroMed Programme, followed major practical and operative issues for the implementation of a population-based registry for coronary and cerebrovascular events, which are here described. This paper includes the definition of target population, data sources, events, indicators, quality methods, and the description of a software used to implement the registry.

Clinical and anamnestic features and the nature of medical care for patients of older age groups as factors of unfavorable prognosis of myocardial infarction

Objective: to study the features of the anamnestic background, clinical course, as well as the nature of medical care for elderly patients with acute myocardial infarction (MI) and to assess their impact on the prognosis of the disease. Material and methods: the study included patients 60 years and older who survived acute MI and registered in the «Register of Acute Myocardial Infarction»(Tomsk) (n=410). The study conducted a 5-year prospective follow-up of patients with an assessment of their vital status. The Statistica V10.0 application software package («StatSoft Inc.») was used for statistical processing of the data obtained. Results: the analysis showed that 90% of patients had a history of comorbid pathology. In almost 20% of patients, the onset of the disease was characterized by an atypical clinical picture, which in more than a third of cases was represented by a low-symptomatic form. The presence of atypical MI manifestation lengthened the prehospital stage of medical care due to the late treatment of patients for medical help (120 [49; 311.5] minutes), as well as longer time before the first medical contact (26.5 [20;40] minutes (p=0.005)). A fifth of patients were treated for acute MI in non-core hospitals, where the hospital mortality rate among elderly patients reached 65.7%, which was 3 times higher than the same indicator in specialized cardiology departments (19.7%, p<0.001). Conclusion: the main factors affecting the long-term postinfarction period in elderly patients were: isolated systolic arterial hypertension, diabetes mellitus, impaired renal function, a history of myocardial infarction and acute cerebrovascular accident.

Outcomes of Nonagenarians with Acute Myocardial Infarction with or without Coronary Intervention.

Percutaneous coronary intervention (PCI) is the mainstay treatment of acute myocardial infarction (AMI); however, many clinicians are reluctant to perform PCI in the elderly population. This study aimed to compare the clinical outcomes of PCI versus medical therapy in nonagenarian Korean patients with AMI. We compared the clinical outcomes of nonagenarian patients with AMI with or without PCI. From the pooled data, based on a series of Korean AMI registries during 2005–2020, 467 consecutive patients were selected and categorized into two groups: the PCI and no-PCI groups. The primary endpoint was 1-year major adverse cardiac event (MACE), a composite of all-cause death, non-fatal myocardial infarction, and any revascularization. Among the 467 participants, 68.5% received PCI. The PCI group had lower proportions of Killip classes III-IV, previous heart failure, and left ventricular ejection fraction <40%, but had higher proportions of all prescribed medications and STEMI diagnosis. The 1-year MACE and all-cause death were higher in the no-PCI group, although partially attenuated post-IPTW. Our study showed that nonagenarian patients with AMI undergoing PCI had better clinical outcomes than those without PCI. Nonetheless, further investigation is needed in the future to elucidate whether PCI is beneficial for this population.

New model predicts in-hospital complications in myocardial infarction.

INTRODUCTION AND OBJECTIVES: Ischemic cardiopathy constitutes the leading cause of death worldwide. Our aim was to evaluate the prognostic capacity of the leukoglycemic index as well as to create a predictive model of in-hospital complications in patients with ST elevation myocardial infarction. MATERIALS AND METHODS: This was a multicentral and cohort study, which included patients inserted in the Cuban Registry of acute myocardial infarction. The study investigated 900 patients with a validation population represented by 233 external subjects. In order to define the performance of the leukoglycemic index were evaluated the discrimination with the statistical C and the calibration by Hosmer – Lemeshow test. A model of logistic binary regression was employed in order to define the predictive factors. RESULTS: Optimal cut point of the leukoglycemic index to predict in-hospital complications was 1188 (sensibility 60%; specificity 61.6%; area under the curve 0.623; p < 0.001). In-hospital complications were significantly higher in the group with the leukoglycemic index ≥ 1188; a higher value was significantly associated with a higher risk to develop an in-hospital complication [RR (IC 95%) = 2.4 (1.804–3.080); p<0.001]. The predictive model proposed is composed by the following factors: age ≥ 66 years, leukoglycemic index ≥ 1188, Killip-Kimball classification ≥ II and medical history of hypertension. This scale had a good discrimination in both, the training and the validation population. CONCLUSION: The leukoglycemic index possesses a low performance when used to assess the risks for in hospital complications in patients with ST elevation myocardial infarction. The new predictive model has a good performance, which can be applied to estimate risk of in-hospital complications. This model would be able to contribute to the health systems of developing countries without additional cost; it enables prediction of the patients having a higher risk of complications and a negative outcome during the hospitable admission.

Impact of atrial fibrillation and the clinical outcomes in patients with acute myocardial infarction from the K-ACTIVE registry

BackgroundThe clinical incidence and impact of atrial fibrillation (AF) in Japanese acute myocardial infarction (AMI) patients is not fully understood. MethodsTo elucidate the clinical incidence and impact of AF on in-hospital mortality in AMI patients, we analyzed a Japanese observational prospective multicenter registry of acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardIoVascular rEgistry), which spans 2015 to 2019. A major adverse cardiac event (MACE) was defined as cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. For assessing bleeding events, Bleeding Academic Research Consortium (BARC) type 3 or 5 was used. MACE plus BARC type 3 or 5 bleeding were considered as composite events. The clinical outcomes were followed for 1 year. ResultsThe total of 5059 patients included 531 patients with AF (10.5%) and 4528 patients with sinus rhythm (SR; 89.5%). AF patients were significantly older and tended to have more comorbidities than SR patients. Oral anticoagulation therapy (OAC) was used in 44% of AF patients while single antiplatelet therapy was selected for 52% of patients with OAC. Crude in-hospital mortality was significantly greater in AF patients than in SR patients (10.4%, 5.0%, respectively, p < 0.01). The multivariate analysis was adjusted for age, sex, diabetes, hypertension, hemodialysis, smoking, previous MI, body mass index, Killip classification, out of hospital cardiac arrest, and OAC. In-hospital mortality was still significantly greater in AF patients than in SR patients in the logistic regression analysis [adjusted odds ratio 2.02 (1.31–3.14)]. AF was an independent risk factor for MACE and composite events in the Cox proportional hazards model [adjusted risk ratio (ARR) 1.91 (1.36–2.69), p < 0.01; ARR 1.72 (1.25–2.36), p < 0.01]. In contrast, AF was not an independent risk factor for bleeding [ARR 1.71 (0.79–3.71), p = 0.18]. ConclusionIn Japanese AMI patients, AF was often observed and was associated with worse MACE but not worse bleeding.

Short- and Long-Term Outcomes in Patients With Right Ventricular Infarction According to Modalities of Reperfusion Strategies in China: Data From China Acute Myocardial Infarction Registry.

PurposeWe sought to investigate the short- and long-term outcomes in patients with right ventricular infarction in China.MethodsData from China Acute Myocardial Infarction (CAMI) Registry for patients with right ventricular infarction between January 2013 and September 2014 were analyzed.ResultsOf the 1,988 patients with right ventricular infarction, 733 patients did not receive reperfusion therapy, 281 patients received thrombolysis therapy, and 974 patients underwent primary PCI. Primary PCI and thrombolysis were all associated with lower risks of in-hospital (3.1 vs. 12.6%; adjusted OR: 0.48; 95% CI: 0.27–0.87; P = 0.0151 and 5.7 vs. 12.6%; adjusted OR: 0.43; 95% CI: 0.22–0.85; P = 0.0155, respectively), and 2-year all-cause mortality (6.3 vs. 20.9%; adjusted HR: 0.50; 95% CI: 0.34–0.73; P = 0.0003 and 11.0 vs. 20.9%; adjusted HR: 0.59; 95% CI: 0.38–0.92; P = 0.0189, respectively), compared with no reperfusion therapy. Meanwhile, primary PCI was superior to thrombolysis in reducing the risks of in-hospital atrial-ventricular block (4.2 vs. 8.9%; adjusted OR: 0.46; 95% CI: 0.23–0.91; P = 0.0257), cardiogenic shock (5.3 vs. 13.9%; adjusted OR: 0.43; 95% CI: 0.23–0.83; P = 0.0115), and heart failure (8.5 vs. 23.5%; adjusted OR: 0.35; 95% CI: 0.22–0.56; P < 0.0001). Primary PCI could reduce the risk of 2-year major adverse cardiac and cerebrovascular event (19.1 vs. 33.3%; adjusted HR: 0.72; 95% CI: 0.56–0.92; P = 0.0092) relative to no reperfusion therapy, whereas thrombolysis may increase the risk of 2-year revascularization (15.5 vs. 8.7%; adjusted HR: 1.90; 95% CI: 1.15–3.16; P = 0.0124) compared with no reperfusion therapy.ConclusionsTimely reperfusion therapy is essential for patients with right ventricular infarction. Primary PCI may be considered as the default treatment strategy for patients with right ventricular infarction in the contemporary primary PCI era.

Short- and long-term outcomes in patients with right ventricular infarction according to modalities of reperfusion strategies in China: data from China Acute Myocardial Infarction (CAMI) Registry

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Twelfth Five-Year Planning Project of the Scientific and Technological Department of China Purpose We sought to investigate the short- and long-term outcomes in patients with right ventricular infarction in China. Methods Data from China Acute Myocardial Infarction (CAMI) Registry for patients with right ventricular infarction between January 2013 and September 2014 were analyzed. Results Of the 1,988 patients with right ventricular infarction, 733 patients did not receive reperfusion therapy, 281 patients received thrombolysis therapy, and 974 patients underwent primary PCI. Primary PCI and thrombolysis were all associated with lower risks of in-hospital (3.1% vs 12.6%; adjusted OR: 0.48; 95% CI: 0.27–0.87; P = 0.0151 and 5.7% vs 12.6%; adjusted OR: 0.43; 95% CI: 0.22–0.85; P = 0.0155, respectively) and two-year all-cause mortality (6.3% vs 20.9%; adjusted HR: 0.50; 95% CI: 0.34–0.73; P = 0.0003 and 11.0% vs 20.9%; adjusted HR: 0.59; 95% CI: 0.38–0.92; P = 0.0189, respectively) compared with no reperfusion therapy. Meanwhile, primary PCI was superior to thrombolysis in reducing the risks of in-hospital atrial-ventricular block (4.2% vs 8.9%; adjusted OR: 0.46; 95% CI: 0.23–0.91; P = 0.0257), cardiogenic shock (5.3% vs 13.9%; adjusted OR: 0.43; 95% CI: 0.23–0.83; P = 0.0115), and heart failure (8.5% vs 23.5%; adjusted OR: 0.35; 95% CI: 0.22–0.56; P &amp;lt; 0.0001). Primary PCI could reduce the risk of two-year major adverse cardiac and cerebrovascular event (19.1% vs 33.3%; adjusted HR: 0.72; 95% CI: 0.56–0.92; P = 0.0092) relative to no reperfusion therapy, whereas thrombolysis may increase the risk of two-year revascularization (15.5% vs 8.7%; adjusted HR: 1.90; 95% CI: 1.15–3.16; P = 0.0124) compared with no reperfusion therapy. Conclusions Timely reperfusion therapy is essential for patients with right ventricular infarction. Primary PCI should be considered as the default treatment strategy for patients with right ventricular infarction in the contemporary primary PCI era.

CRT-100.39 The Predictors of New-Onset Heart Failure Hospitalization in the Elderly With Acute Myocardial Infarction: From the Korea Acute Myocardial Infarction Registry – National Institutes of Health (KAMIR-NIH)

CRT-100.39 The Predictors of New-Onset Heart Failure Hospitalization in the Elderly With Acute Myocardial Infarction: From the Korea Acute Myocardial Infarction Registry – National Institutes of Health (KAMIR-NIH)

Current Status and Hospital-Level Differences in Care and Outcomes of Patients With Acute Non-ST-Segment Elevation Myocardial Infarction in China: Insights From China Acute Myocardial Infarction Registry.

BackgroundWith the growing burden of non-ST-elevation myocardial infarction (NSTEMI), developing countries face great challenges in providing equitable treatment nationwide. However, little is known about hospital-level disparities in the quality of NSTEMI care in China. We aimed to investigate the variations in NSTEMI care and patient outcomes across the three hospital levels (province-, prefecture- and county-level, with decreasing scale) in China.MethodsData were derived from the China Acute Myocardial Infarction Registry on patients with NSTEMI consecutively registered between January 2013 and November 2016 from 31 provinces and municipalities throughout mainland China. Patients were categorized according to the hospital level they were admitted to. Multilevel generalized mixed models were fitted to examine the relationship between the hospital level and in-hospital mortality risk.ResultsIn total, 8,054 patients with NSTEMI were included (province-level: 1,698 patients; prefecture-level: 5,240 patients; county-level: 1,116 patients). Patients in the prefecture- and county-level hospitals were older, more likely to be female, and presented worse cardiac function than those in the province-level hospitals (P <0.05). Compared with the province-level hospitals, the rate of invasive strategies was significantly lower in the prefecture- and county-level hospitals (65.3, 43.3, and 15.4%, respectively, P <0.001). Invasive strategies were performed within the guideline-recommended timeframe in 25.4, 9.7, and 1.7% of very-high-risk patients, and 16.4, 7.4, and 2.4% of high-risk patients in province-, prefecture- and county-level hospitals, respectively (both P <0.001). The use of dual antiplatelet therapy in the county-level hospitals (87.2%) remained inadequate compared to the province- (94.5%, P <0.001) and prefecture-level hospitals (94.5%, P <0.001). There was an incremental trend of in-hospital mortality from province- to prefecture- to county-level hospitals (3.0, 4.4, and 6.9%, respectively, P-trend <0.001). After stepwise adjustment for patient characteristics, presentation, hospital facilities and in-hospital treatments, the hospital-level gap in mortality risk gradually narrowed and lost statistical significance in the fully adjusted model [Odds ratio: province-level vs. prefecture-level: 1.23 (0.73–2.05), P = 0.441; province-level vs. county-level: 1.61 (0.80–3.26), P = 0.182; P-trend = 0.246].ConclusionsThere were significant variations in NSTEMI presentation and treatment patterns across the three hospital levels in China, which may largely explain the hospital-level disparity in in-hospital mortality. Quality improvement initiatives are warranted, especially among lower-level hospitals.

Long-term outcomes in inferior ST-segment elevation myocardial infarction patients with right ventricular myocardial infarction

ObjectiveTo evaluate the prognostic influence of the presence of right ventricular myocardial infarction (RVMI) on patients with inferior ST-segment elevation myocardial infarction (STEMI) in the contemporary reperfusion era. Methods9308 patients with inferior STEMI were included from the prospective, nationwide, multicenter China Acute Myocardial Infarction Registry, including 1745 (18.75%) patients with RVMI and 7563 (81.25%) patients without RVMI. The primary outcome was two-year all-cause mortality. The secondary outcome was major adverse cardiac and cerebrovascular event (MACCE) defined as a composite of all-cause mortality, recurrent MI, revascularization, stroke, and major bleeding. ResultsAfter two-year follow up, there were no significant differences between inferior STEMI patients with or without RVMI in all-cause mortality (12.0% vs 11.3%; adjusted HR: 1.05; 95% CI: 0.90 to 1.24; P = 0.5103). Inferior STEMI with RVMI was associated with higher risk of MACCE (25.6% vs 22.0%; adjusted HR: 1.17; 95% CI: 1.05 to 1.31; P = 0.0038), revascularization (10.3% vs 8.1%; adjusted HR: 1.23; 95% CI: 1.03 to 1.48; P = 0.0218), and major bleeding (4.6% vs 2.7%; adjusted HR: 1.56; 95% CI: 1.18 to 2.07; P = 0.0019). Primary percutaneous coronary intervention (PCI) and thrombolysis were independent predictors to decrease all-cause mortality. For patients who received timely reperfusion, RVMI involvement did not increase all-cause mortality, whereas for those who did not undergo reperfusion, RVMI increased all-cause mortality (20.3% vs 15.7%; HR: 1.34; 95% CI: 1.10 to 1.63). ConclusionRVMI did not increase all-cause mortality for inferior STEMI patients in contemporary reperfusion era, whereas the risk was increased for patients with no reperfusion treatment.

Role of ST-Segment Resolution Alone and in Combination with Thrombolysis in Myocardial Infarction Flow in Patients Treated with Primary Percutaneous Coronary Intervention: 2-Year Results from the China Acute Myocardial Infarction Registry

Role of ST-Segment Resolution Alone and in Combination with Thrombolysis in Myocardial Infarction Flow in Patients Treated with Primary Percutaneous Coronary Intervention: 2-Year Results from the China Acute Myocardial Infarction Registry

Optimal low-density lipoprotein cholesterol target level in Korean acute myocardial infarction patients (

BackgroundCurrent treatment guidelines for acute myocardial infarction (AMI) recommend lowering low density lipoprotein cholesterol (LDL-C). However, previous clinical studies among East Asian AMI patients failed to prove its clinical efficacy of lipid lowering therapy based on Western target LDL-C level. Thus, the purpose of this study is directly to compare the clinical outcomes of target LDL-C < 70 mg/dL and < 55 mg/dL and identify optimal target LDL-C level and in Korean AMI patients. Methods and resultsA total of 2198 AMI patients in Korea AMI Registry – National Institute of Health were enrolled. Patients were initially divided into LDL-C non-target group (n = 1115) and target group (n = 1083). Successful achievement of follow up target LDL-C was defined as <70 mg/dL and ≥ 50% reduction from baseline. Target group patients were additionally divided to <70 mg/dL group (n = 698) and <55 mg/dL group (n = 385). Propensity score matching analysis was done in non-target vs. target group and <70 mg/dL vs. <55 mg/dL group. In the matched population, the risk of 3 years major adverse cardiac event (MACE) (13.0% vs 9.8%, HR: 0.73; 95% CI: 0.56–0.96; p = 0.025) was higher in non-target group patients. However, the risk of MACE was similar in <70 mg/dL and < 55 mg/dL group patients (10.0% vs 8.1%, HR: 0.75, 95% CI: 0.46–1.22; p = 0.247). ConclusionIn the present study, target LDL-C level of <70 mg/dL and ≥ 50% reduction from baseline level was associated with better clinical outcomes in Korean AMI patients. However, further lowering target LDL-C level of <55 mg/dL showed no additional benefits.

Renal Function Effect on the Association Between Body Mass Index and Mortality Risk After Acute Myocardial Infarction.

Background: Body mass index (BMI) is a critical determinant of mortality after acute myocardial infarction (AMI), and higher BMI is associated with survival benefit in patients with renal impairment. However, there are no studies investigating the interactive effects of BMI and renal function on mortality risk after AMI occurrence.Methods: We enrolled 12,647 AMI patients from Korea Acute Myocardial Infarction Registry between November 2011 and December 2015. Patients were categorized based on estimated Glomerular Filtration Rate (eGFR) and BMI. The primary endpoint was all-cause mortality after AMI treatment.Results: Within each renal function category, the absolute mortality rate was decreased in patients with higher BMI. However, the adjusted hazard ratio (HR) of all-cause mortality for higher BMI was decreased as renal function worsened [adjusted HR (95% confidence interval) at BMI ≥ 25 kg/m2: 0.63 (0.41–0.99), 0.76 (0.59–0.97), and 0.84 (0.65–1.08) for patients with eGFR ≥ 90, 90–45, and <45 mL/min/1.73 m2, respectively]. There was a significant interaction between BMI and renal function (P for interaction = 0.010). The protective effect of higher BMI was preserved against non-cardiac death and it was also decreased with lowering eGFR in competing risks models [adjusted HR at BMI ≥25 kg/m2: 0.38 (0.18–0.83), 0.76 (0.59–0.97), and 0.84 (0.65–1.08) for patients with eGFR ≥ 90, 90–45, and <45 mL/min/1.73 m2, respectively; P for interaction = 0.03]. However, renal function did not significantly affect the association between BMI and risk of cardiac death (P for interaction = 0.20).Conclusions: The effect of BMI on the mortality risk after AMI was dependent on renal function. The association between greater BMI and survival benefit was weakened as renal function was decreased. In addition, the negative effect of renal function on the BMI – mortality association was pronounced in the non-cardiac death.

Outcome of early versus delayed invasive strategy in patients with non-ST-segment elevation myocardial infarction and chronic kidney disease not on dialysis

Because of paucity of published data, we evaluated the 2-year major clinical outcomes between early invasive (EI) and delayed invasive (DI) strategies according to the stage of chronic kidney disease (CKD) in patients with non-ST-segment elevation myocardial infarction (NSTEMI), who underwent a successful newer-generation drug-eluting stent (DES) implantation. A total of 8241 NSTEMI patients were recruited from the Korea Acute Myocardial Infarction Registry (KAMIR). Based on baseline estimated glomerular filtration rate (eGFR; ≥90, 60-89, 30-59, and <30mL/min/1.73m2), the patients were classified into groups A (n=3498), B (n=3109), C (n=1178), and D (n=1178). Thereafter, these 4 groups were sub-classified into the EI and DI groups. Major adverse cardiac events (MACE), defined as all-cause death, recurrent MI (re-MI), and any repeat revascularization, were evaluated. After multivariable-adjusted and propensity score-adjusted analyses, the cumulative incidence of MACE (group A, p=0.139 and p=0.103, respectively; group B, p=0.968 and p=0.608, respectively; group C, p=0.111 and p=0.196, respectively; group D, p=0.882 and p=0.571, respectively), all-cause death, re-MI, and any repeat revascularization was similar between the EI and DI groups in the 4 different renal function groups. In the era of newer-generation DES, EI and DI strategies showed comparable major clinical outcomes in patients with NSTEMI and CKD during a 2-year follow-up period. However, to confirm these results, further randomized, large-scale, long-term follow-up studies are needed.

J-curve relationship between long term glycemic control and mortality in diabetic patients with acute myocardial infarction undergoing percutaneous coronary intervention

BackgroundIntensive glycemic control is generally recommended for diabetic patients to reduce complications. However, the role of glycemic control in the mortality in diabetic patients with acute myocardial infarction (AMI) remained unclear.MethodsWe selected diabetic patients who measured HbA1c more than 3 times after AMI among 10,719 patients enrolled in the multicenter AMI registry. Patients (n = 1384) were categorized into five groups: according to mean HbA1c level: ≤ 6.5%, > 6.5 to ≤ 7.0%, > 7.0 to ≤ 7.5%, > 7.5 to ≤ 8.0% and > 8.0%. The primary endpoint was all-cause mortality.ResultsDuring a median follow-up of 6.2 years, the patients with a mean HbA1c of 6.5 to 7.0% had the lowest all-cause mortality. Compared to patients with mean HbA1c of 6.5 to 7.0%, the risk of all-cause mortality increased in subjects with mean HbA1c ≤ 6.5% (adjusted hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.02–3.95) and in those with mean HbA1c > 8.0% (adjusted HR 3.35, 95% CI 1.78–6.29). In the subgroup analysis by age, the J-curve relationship between mean HbA1c and all-cause mortality was accentuated in elderly patients (age ≥ 65 years), while there was no difference in all-cause mortality across the HbA1c groups in younger patients (age < 65 years).ConclusionsThe less strict glycemic control in diabetic patients with AMI would be optimal for preventing mortality, especially in elderly patients.

Abstract 11722: Assessing Disparity of Performance Measure by Door-to-Balloon Time Between Rural and Urban Area for Management of Patients with ST-Segment Elevation Myocardial Infarction -Insights from the Nationwide Japan Acute Myocardial Infarction Registry-

Background: Door to balloon time (D2B) ≤90 minutes is a key indicator of quality of care for ST-segment elevation myocardial infarction (STEMI). The development of standardized management for STEMI may narrow the performance gap between rural and urban hospitals. However, there are few studies to explore the disparity of D2B and outcomes between rural and urban areas. Methods and Results: The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide, real-world registry study. We retrospectively analyzed 17,938 STEMI patients (68±13 years, female 22.4%) treated with percutaneous coronary intervention, who were divided into the following two groups according to population density of 1147 persons/km 2 ; patients hospitalized in rural area and those in urban area. Overall, the median D2B was 72 mins and 73% achieved the target D2B ≤90 mins. Patients with D2B ≤90 mins had a lower in-hospital mortality compared with those with D2B &gt;90 mins (4.7% vs. 8,4%, P&lt;0.001). Rural patients were characterized by higher age, more accumulation of coronary risk factors and a higher prevalence of Killip class ≥2 at presentation compared with urban patients. The median D2B was longer (70 mins vs. 62 mins, P&lt;0.001) and achievement rate for D2B ≤90 mins was lower (70% vs. 75%, P&lt;0.001) in rural group than urban group ( Figure A ). In-hospital mortality tended to be higher in rural group (6.1% vs. 5.5%, P=0.06), whereas the benefit in shortening of D2B was noted equally in both groups ( Figure B ). Conclusions: The real-world nationwide study of JAMIR demonstrated that shortening of D2B time was significantly associated with survival benefit of STEMI in both rural and urban area.

Abstract 11193: Incremental Diabetogenic Effect of Statin According to Its Intensity in Acute Myocardial Infarction Patients Following Successful Percutaneous Coronary Intervention

Introduction: Although statin therapy is strongly recommended in acute myocardial infarction (AMI) patients, there has been consistent concern regarding the development of new onset diabetes mellitus (NODM). Currently, there has been no data whether diabetogenic effect of statin is intensity dependent. In this study, we investigated the impact of different statin intensity on incidence of NODM up to 3 years. Methods: Among 13,104 AMI patients enrolled in the Korea AMI Registry (KAMIR) between November 2011 and May 2015, we enrolled the 5,906 patients without diabetes mellitus and successful percutaneous coronary intervention (PCI). There were 22.8% (1,349/5,906) of patients received high intensity stain and 76.0% (4,488/5,906) patients received moderate intensity, and only 1.2% (69/5,906) patients received low intensity statin. The incidence of NODM were investigated among three different intensity of statins up to 3 years. Results: At baseline, high intensity statin group showed higher baseline LDL cholesterol level, body mass index, and abdominal circumference compared to other groups. In Kaplan-Meier curve, the cumulative incidence of NODM was significantly higher in high intensity group than mild and moderate intensity group (7.8% vs. 1.5% vs. 5.9% respectively, Log rank p-value = 0.002, Figure 1A). The incremental diabetogenic tendency was observed in each individual statin in dose-dependant manner (Figure 1B). In Cox regression, the intensity of statin was statistically significant prognostic factor of NODM after adjusting age, and other metabolic variables, such as body mass index, abdominal circumstance, and level of serum triglyceride. Conclusions: Among the AMI patients underwent successful PCI, higher intensity statin was associated with higher incidence of NODM, showing the diabetogenic effect of statin intensity.

Impact of Intravascular Ultrasound on Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction.

The aim of this study was to examine the impact of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) on long-term clinical outcomes in patients with acute myocardial infarction (AMI). IVUS-guided PCI has been associated with improved cardiovascular outcomes. However, the beneficial effect of IVUS-guided PCI in patients with AMI in the drug-eluting stent era remains unclear. Patients who underwent PCI with drug-eluting stents were selected from 10,719 patients enrolled in a multicenter AMI registry. The included patients were classified into 2 groups according to the use or nonuse of IVUS. The primary outcome was a composite of major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, and target lesion revascularization, during long-term follow-up. A total of 9,846 patients were treated with IVUS-guided PCI (n=2,032) or angiography-guided PCI (n=7,814). IVUS-guided PCI was associated with reduced MACE (HR: 0.779; 95% CI: 0.689-0.880; P< 0.001). The results were consistent after multivariable regression and propensity score matching. One-year landmark analysis showed a lower risk for MACE within 1 year (HR: 0.766; 95%CI: 0650-0.903; P=0.002) and beyond 1 year (HR: 0.796; 95%CI: 0663-0.956; P=0.014) after index PCI. The use of IVUS was associated with better long-term cardiovascular outcomes. The clinical benefit of IVUS was maintained both within and beyond 1 year after index PCI. The use of IVUS in PCI should be considered forpatients with AMI.

Clinical characteristics and outcomes in young patients with myocardial infarction

Abstract Background Young people hold a stable or increasing percentage of patients with acute myocardial infarction in many countries. However, data on clinical characteristics and outcomes in young patients are lacking. Purpose To compare clinical characteristics and outcomes between patients aged ≤45 years and those aged &amp;gt;45 years with acute myocardial infarction. Methods A total of 24125 patients with acute myocardial infarction between January 2013 and September 2014 from China Acute Myocardial Infarction (CAMI) registry were included in this study. Clinical characteristics, in-hospital and 2-year outcomes were compared between patients aged ≤45 years (young) and those aged &amp;gt;45 years (older). Gender disparity in prognosis of myocardial infarction was analyzed among young patients. Results Of 24125 patients, 2042 (8.5%, 116 female) were aged ≤45 years. Compared with patients aged &amp;gt;45 years, young patients were more often male, current smokers, having medical history of hyperlipidemia and family history of premature coronary artery disease. Young patients were significantly more likely to have clear trigger factor, present with persistent chest pain and suffer ST-segment elevation myocardial infarction. Symptom onset to admission time was shorter in patients aged ≤45 years. For patients undergoing emergency coronary angiography, those aged ≤45 years were more likely to suffer left anterior descending coronary artery related myocardial infarction. Young patients were significantly more likely to receive percutaneous coronary intervention and other medications at discharge, including dual antiplatelet therapy, statins, angiotensin converting enzyme inhibitors or angiotensin II receptor blockers and β blockers. Compared with patients aged &amp;gt;45 years, young patients experienced significantly lower in-hospital and 2-year mortality and major adverse cardiac and cerebrovascular events (MACCE, a composite of death, reinfarction and stroke) rates (Table 1). Among young patients, women experienced higher in-hospital mortality and MACCE rates than men (Table 2). Women who survived at discharge experienced significantly higher 2-year mortality (1.4% vs 3.8%, Log-rank P=0.0412, Table 2). Conclusions Compared with the older patients, young patients were more likely to present with typical symptoms and receive guideline-recommended medications. Clinical outcomes of patients aged ≤45 years were significantly better than older patients. However, our results showed significant gender disparity in both short- and long-term outcomes of young patients. More efforts are needed to improve prognosis in young patients with acute myocardial infarction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Twelfth Five-Year Planning Project of the Scientific and Technological Department of China

Association of quality indicators for acute myocardial infarction and mortality: feasibility and validation study using linked nationwide registry data

BackgroundQuality indicators (QIs) have been increasingly used as tools to assess and improve the quality of care for acute myocardial infarction (AMI). However, it is not known if it is feasible to use the 2020 iteration of international AMI QIs using routinely collected data and, if so, whether higher performance is associated with improved outcomes.ObjectiveTo investigate if routine data are available to measure care quality against the 2020 European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) QIs for AMI, investigate whether higher performance is associated with reduced mortality, and to report quality of care during the COVID-19 pandemic.MethodsCohort study of linked data from the AMI and percutaneous coronary intervention (PCI) registries in England and Wales with outcome data from the Civil Registration of Deaths Register between 2017 and 2020 (representing 236 743 patients from 186 hospitals). Baseline ischaemic risk was estimated using the Global Registry of Acute Coronary Events (GRACE) risk score. The likelihood of attainment for each QI based on GRACE risk was quantified using logistic regression and the association with mortality at 30 days, 6 months, 1 year and long-term (maximum 1243 days) was obtained from Cox proportional hazard models.ResultsOf 26 QIs, 17 (65.3%) could be directly measured using nationwide registry data and were each inversely associated with risk-adjusted 1-year and long-term mortality. At 30 days, the measured QIs with exception of early invasive coronary angiography for non-ST elevation myocardial infarction, were associated with improved survival, and the QIs that had the greatest magnitude for a reduction in mortality were the prescription of secondary prevention medications at discharge; hazard ratio 0.13 (95% CI 0.12–0.14) for statins, 0.16 (95% CI 0.15–0.18) for adequate P2Y12 inhibition, and 0.18 (95% CI 0.17–0.20) for dual antiplatelet therapy (Figure 1). The magnitude of association between the composite QI (CQI) and survival attenuated over time, with greater long-term survival gains observed for the high GRACE risk compared with low- and intermediate-risk (Figure 2). During the first UK lockdown there was an improvement in the attainment for 62.5% of the measured QIs compared with before the COVID-19 pandemic, with a higher attainment for the CQI (43.8% to 45.2%, odds ratio 1.06, 95% CI 1.02–1.10).ConclusionCare quality for AMI may be evaluated using routinely collected clinical data from the national registries, whereby higher performance is associated with reduced mortality. Such QIs will have a role in monitoring hospital care as demonstrated for COVID-19.Funding AcknowledgementType of funding sources: None. Figure 2. QI association with long-term mortality