Modern state of acute myocardial infarction in the interventional era: Observational case–control study—Japanese acute coronary syndrome study (JACSS)

SummaryThe Japanese acute coronary syndrome study (JACSS) is a retrospective and multicenter observational study conducted in 35 medical institutions across Japan. The JACSS database included 5325 consecutive patients hospitalized at the participating institutions within 48h after the onset of symptoms of acute myocardial infarction (AMI) between January 2001 and December 2003. The JACSS data vividly displayed the modern state of AMI in the interventional era. Percutaneous coronary intervention (PCI) including balloon angioplasty and stent implantation was performed in 80% of the patients and approximately 90% of the treated patients had successful coronary recanalization during the acute phase of MI. The results showed very low rates of all-cause mortality and cardiovascular deaths during hospitalization. Various types of novel information have been produced from JACSS data by several leading clinical researchers in Japan and this may also be helpful in making plans for a prospective study

Increased Density of the Liver and Amiodarone-Associated Phospholipidosis

This is a case report in which a 60-year-old man who suffered from ventricular tachycardia with dilated cardiomyopathy was prescribed amiodarone. After taking amiodarone, liver enzymes were increased and computed tomographic (CT) scanning of the abdomen showed a significant increase in the density of the liver without contrast medium. He was suspected as hemochromatosis and liver biopsy was performed. An abnormal high density of liver tissue may be observed in an unenhanced CT in patients treated with amiodarone and we suggest that periodic monitoring of liver function and/or liver biopsy is warranted before an irreversible stage is reached

Recurrence of angina pectoris after percutaneous coronary intervention is reduced by statins in Japanese patients

SummaryBackgroundStatins have been reported to reduce cardiovascular events in patients with coronary artery disease (CAD). Percutaneous coronary intervention (PCI) is commonly used to relieve ischemic symptoms in patients with CAD. However, there is little information on the effect of statins on cardiovascular events after PCI, even in the era of coronary stent implantation.MethodsA total of 1019 patients with acute or chronic CAD and modest total cholesterol levels (180–240mg/dl) were enrolled and randomly assigned to treatment with or without statins. We evaluated the effect of any available statin on the incidence of cardiovascular events after PCI. The primary endpoint was a composite of cardiovascular death, nonfatal acute myocardial infarction (MI), recurrent angina pectoris requiring emergency rehospitalization (rAP), heart failure, and stroke.ResultsIndications for PCI were stable angina in 54%, ST-elevation MI in 41% and non-ST-elevation MI/unstable angina pectoris in 5%. After 2 years of statin treatment, low-density lipoprotein cholesterol (LDL-C) decreased from 133 to 96mg/dl. Stents were implanted in 84% of all cases. The primary endpoint event rate was 9.5% in the statin group and 14.7% in the non-statin group (p=0.0292). Of all primary endpoint events, only rAP was significantly suppressed by statins (p=0.0027). In rAP patients, coronary angiography revealed that statins suppressed restenosis but not new lesions.ConclusionsFor Japanese CAD patients treated with PCI and stent implantation, statin therapy reduced the incidence of recurrent cardiovascular events, particularly rAP. Discretionary statin treatment to achieve LDL-C levels <100mg/dl effectively reduced restenosis causing rAP

Smoking cessation is associated with increased plasma adiponectin levels in men

SummaryObjectivesLow levels of adiponectin, an adipocytokine with anti-diabetic and anti-atherogenic properties, are associated with increased risk of future myocardial infarction in men. Previous studies have demonstrated that cigarette smoking is involved in the development of insulin resistance, and current smokers have been shown to have reduced plasma adiponectin levels. However, the influence of smoking cessation on adiponectin levels remains unknown. We sought to assess whether smoking cessation is associated with increased plasma adiponectin levels in men.MethodsThe study includes 72 men (47 non-smokers and 25 current smokers at baseline) with stable angina pectoris who underwent percutaneous coronary intervention and follow-up coronary angiography 6 months later. During the 6-month follow-up period, all 47 non-smokers remained non-smokers, while 15 men of the 25 baseline current smokers successfully quit smoking. We evaluated plasma adiponectin levels at coronary intervention and 6 months later.ResultsPlasma adiponectin levels at coronary intervention were comparable to those after 6 months in non-smokers (4.22 [3.15–6.43] vs. 4.58 [3.03–6.26]μg/mL, P=0.124) and in persistent smokers (4.77 [4.25–10.53] vs. 5.16 [4.11–8.10]μg/mL, P=0.721). Meanwhile, an increase in adiponectin level was observed in patients who quit smoking for 6 months (4.24 [3.30–5.70] vs. 5.50 [4.03–8.00]μg/mL, P=0.002). Univariate analysis revealed that the percent increase in adiponectin levels correlated positively with smoking cessation (P=0.003) and negatively with additional use of β-blockers (P=0.049). In addition, increases in adiponectin levels were closely associated with increase in high-density lipoprotein cholesterol (P=0.148), decrease in triglycerides (P=0.140), and additional use of renin–angiotensin system inhibitors (P=0.069). Multivariate analysis demonstrated that smoking cessation was an independent determinant of the increase in adiponectin (P=0.036).ConclusionsSmoking cessation is associated with increased plasma adiponectin levels in men with stable angina, suggesting that the significance of smoking cessation may be partly explained by the increase in adiponectin level

Urinary biopyrrins levels are elevated in relation to severity of heart failure

AbstractObjectivesWe investigated the relationship between the urinary levels of biopyrrins and the severity of heart failure (HF).BackgroundOxidative stress is evident in heart disease and contributes to the development of ventricular dysfunction in patients with HF. Biopyrrins, oxidative metabolites of bilirubin, have been discovered as potential markers of oxidative stress.MethodsWe measured the levels of urinary biopyrrins and plasma B-type natriuretic peptide (BNP) in 94 patients with HF (59 men; mean age 65 years) and 47 control subjects (30 men; mean age 65 years). Urine and blood samples were taken after admission in all subjects. Further urine samples were obtained from 40 patients after treatment of HF.ResultsThe urinary biopyrrins/creatinine levels (μmol/g creatinine) were the highest in patients in New York Heart Association (NYHA) class III/IV (n = 26; 17.05 [range 7.85 to 42.91]). The urinary biopyrrins/creatinine levels in patients in NYHA class I (n = 35; 3.46 [range 2.60 to 5.42]) or II (n = 33; 5.39 [range 3.37 to 9.36]) were significantly higher than those in controls (2.38 [range 1.57 to 3.15]). There were significant differences in urinary biopyrrins/creatinine levels among each group. The treatment of HF significantly decreased both urinary biopyrrins/creatinine levels (from 7.43 [range 3.84 to 17.05] to 3.07 [range 2.21 to 5.71]) and NYHA class (from 2.5 ± 0.1 to 1.7 ± 0.1). Log biopyrrins/creatinine levels were positively correlated with log BNP levels (r = 0.650, p < 0.001).ConclusionsThese results indicate that urinary biopyrrins levels are increased in patients with HF and are elevated in proportion to its severity

Three-year follow-up of the impact of Kumamoto Earthquake on acute myocardial infarctions: An interrupted time series analysis

Study objective: This study aimed to investigate whether the incidence of acute myocardial infarction (AMI) and subsequent outcomes over the three years after the Kumamoto earthquake differed from the underlying trend before the earthquake. Design: Quasi-experimental design. Setting: Twenty-one institutions participating from the Kumamoto Prefecture and capable of receiving AMI patients and performing coronary angiography and interventions. Participants: In total 6553 consecutive patients with AMI between 2013 and 2019 were included in this study. Interventions: Interrupted time series analysis. Main outcome measure(s): AMI incidence and following cardiac events after the earthquake. Results: The rate ratio (RR) for AMI incidence after the earthquake was 1.12 (95 % confidence interval [CI]: 1.00–1.25) with reference to that before the earthquake. AMI rates increased among people with diabetes mellitus (RR: 1.20, 95 % CI: 1.01–1.44), those with current smoking (RR: 1.27, 95 % CI: 1.03–1.56), and those with a body mass index >25 kg/m2 (RR: 1.27, 95 % CI: 1.06–1.52). Increased number of AMI patients with onset-to-door time >12 h (RR: 1.46, 95 % CI: 1.02–2.08), a high Killip class on hospital admission (RR: 1.37, 95 % CI: 1.13–1.67), and unperformed emergent coronary angiography (RR: 1.40, 95 % CI: 1.02–1.91) were frequently observed after the earthquake, which may affect following in-hospital cardiac events (RR: 1.49, 95 % CI: 1.03–2.15). Conclusions: The Kumamoto earthquake had an impact on the increase in the incidence of AMI and the following in-hospital cardiac outcomes. Emergency medical care should be ensured in such a way that high-risk patients are managed as usual, especially immediately after earthquake