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| 1.
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論文
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Kojima, Sunao ; Matsui, Kunihiko ; Sakamoto, Tomohiro ; Ishihara, Masaharu ; Kimura, Kazuo ; Miyazaki, Shunichi ; Yamagishi, Masakazu ; Tei, Chuwa ; Hiraoka, Hisatoyo ; Sonoda, Masahiro ; Tsuchihashi, Kazufumi ; Shimoyama, Nobuo ; Honda, Takashi ; Ogata, Yasuhiro ; Ogawa, Hisao ; The Japanese Acute Coronary Syndrome Study (JACSS) Investigators ; 山岸, 正和
概要:
Background There is conflicting information about whether nitrate treatment aggravates long-term prognosis, so the prese
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nt retrospective study was designed to determine the effects of long-term nitrate therapy on major adverse events after acute myocardial infarction (AMI) in the coronary interventional era. Methods and Results Using the Japanese Acute Coronary Syndrome Study database, 1,236 consecutive patients who were hospitalized within 48 h of onset of symptoms of AMI from January to December 2003 were evaluated. All-cause mortality, cardiac events and cardiovascular events were lower in patients treated with nitrates than in the untreated controls. However, these crude comparisons included several confounding factors on nitrate prescription. To minimize the effect of selection bias on outcomes, the technique of propensity score matching for clinical characteristics was used and distortion of effective nitrate treatment was excluded as much as possible. The results of propensity score matching showed that nitrate therapy had no impact on all-cause mortality, cardiac events and cardiovascular events at 30, 60 or 90 days, 6 months, 1 year, and 2 years follow-up. Conclusions Long-term nitrate therapy after AMI neither improves nor aggravates prognosis. Prospective randomized clinical trials are warranted to determine the effects of long-term nitrate therapy for secondary prevention of AMI. (Circ J 2007; 71: 301 - 307)<br />出版者照会後に全文公開
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| 2.
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Kosuge, Masami ; Kimura, Kazuo ; Kojima, Sunao ; Sakamoto, Tomohiro ; Ishihara, Masaharu ; Asada, Yujiro ; Tei, Chuwa ; Miyazaki, Shunichi ; Sonoda, Masahiro ; Tsuchihashi, Kazufumi ; Yamagishi, Masakazu ; Shirai, Mutsunori ; Hiraoka, Hisatoyo ; Honda, Takashi ; Ogata, Yasuhiro ; Ogawa, Hisao ; The Japanese Acute Coronary Syndrome Study (JACSS) Investigators ; 山岸, 正和
概要:
Background The impact of body mass index (BMI) on outcomes after primary percutaneous coronary intervention (PCI) for ac
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ute myocardial infarction (AMI) remains unclear. Methods and Results A total of 3,076 patients undergoing PCI for AMI within 48 h after symptom onset were studied. Patients were divided into 4 groups according to baseline BMI: lean (<20 kg/m2), normal weight (20.0-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2). Obese patients were younger and had a higher frequency of diabetes mellitus, hyperlipidemia, hypertension and smoking. Lean patients were older, usually women and had a lower frequency of the aforementioned risk factors. Killip class on admission, renal insufficiency, and final Thrombolysis In Myocardial Infarction (TIMI) flow grade did not differ among the 4 groups. In lean, normal weight, overweight and obese patients, in-hospital mortality was 9.2%, 4.4%, 2.5% and 1.8%, respectively (p<0.01). Multivariate analysis showed that compared with normal weight patients, odds ratios for in-hospital death in lean, overweight and obese patients were 1.92, 0.79 and 0.40, respectively (p=NS). Independent predictors were age, Killip class on admission, renal insufficiency and final TIMI flow grade. Conclusion BMI itself had no impact on in-hospital mortality in patients undergoing primary PCI for AMI. The phenomenon `obesity paradox' may be explained by the fact that obese patients were younger at presentation. (Circ J 2008; 72: 521 - 525)<br />出版者照会後に全文公開
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3. Weekend onset of acute myocardial infarction does not have a negative impact on outcome in Japan.
Matsui, Kunihiko ; Kojima, Sunao ; Sakamoto, Tomohiro ; Ishihara, Masaharu ; Kimura, Kazuo ; Miyazaki, Shunichi ; Yamagishi, Masakazu ; Tei, Chuwa ; Hiraoka, Hisatoyo ; Sonoda, Masahiro ; Tsuchihashi, Kazufumi ; Ooie, Tatsuhiko ; Honda, Takashi ; Ogata, Yasuhiro ; Ogawa, Hisao ; The Japanese Acute Coronary Syndrome Study (JACSS) Investigators ; 山岸, 正和
概要:
Background Studies from North America indicate that patients admitted during the weekend with acute myocardial infarctio
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n (AMI) have a worse outcome than weekday-admitted patients, probably reflecting a lower rate of invasive procedures. However, it is unclear whether the same is true in Japan, which has a different healthcare system. Methods and Results Using the Japanese Acute Coronary Syndrome Study (JACSS) database, this study included 4,805 consecutive patients who were admitted within 48 h of onset of AMI (3,526 [73.4%] patients with weekday onset [Monday through Friday] and 1,279 [26.6%] with weekend onset [Saturday and Sunday]). There were no significant differences between the 2 groups in patient background and clinical features. The proportions of patients who underwent emergency catheterization (88.4% vs 88.0%) and reperfusion therapy (81.5% vs 81.4%) were also similar. There were no differences between the 2 groups in the in-hospital, 30-day, and 1-year mortality rates. Even after various adjustments, there was no difference in the risk of death associated with weekend versus weekday onset of AMI. Conclusion There were no obvious differences in outcome for Japanese AMI patients in the weekday- or weekend-onset group, suggesting the quality of the Japanese healthcare system is similar for the entire week. (Circ J 2007; 71: 1841 - 1844)<br />出版者照会後に全文公開
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