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Emergency Care of Acute Myocardial Infarction during the Great East Japan Earthquake Disaster–Report from the Miyagi AMI Registry Study-
S154 Journal of Cardiac Failure Vol. 19 No. 10S October 2013 O-124 Impact of Primary Percutaneous Coronary Intervention Strategy on Short-term Survival of Elderly Patients with ST-Segment-Elevation Myocardial Infarction YASUMORI SUJINO Division of Cardiology, Saitama Medical University International Medical Center
unloading reduces preload and increases afterload, hence doesn’t decrease much the LV pressure-volume area (PVA), an index of LV oxygen consumption. In contrast, the total-unloading markedly decreases the oxygen consumption, thereby would decrease the infarct size. Methods/Results: We allocated 13 dogs into CONT, PARTIAL and TOTAL unloading. We assessed the infarct size at 90min after ischemia and 300min after reperfusion. LVAD significantly reduced the infarct size. The reduction was by far lager in TOTAL than in PARTIAL. Conclusions: TOTAL unloading maximizes myocardial salvage.
O-121 A Case Report of a Twelve-year-old Boy with Advanced Heart Failure Requiring LVAD as Bridge to Decision NORITSUGU NAITO Department of Cardiovascular Surgery, Gunma Cardiovascular Center The patient is a twelve-year-old boy. He was physically in good health until he noticed digestive symptoms. He went to his general physician, and underwent upper gastrointestinal endoscopy which revealed no abnormality. Two months later, he was transferred to a local hospital due to sudden onset of dyspnea and altered mental status. He was referred to a children’s medical center for treatment of cardiogenic shock. Veno-arterial ECMO was established to stabilize him. Even with ECMO support for three days, his heart function didn’t get better. He was referred to our department for implantation of LVAD. We attached an inflow cannula to the apex of left ventricule and an outflow cannula to the ascending aorta which were connected to a centrifugal pump. CPB was weaned off with LVAD support and inhalation of NO. Pathological examinations showed the signs of DCM. After he got hemodynamically stable, the pump was exchanged to a pulsatile pump on POD 9. He was extubated on POD 18, administration of catecholamine was stopped on POD 20, and oral intake was started on POD 22. Considering his heart function was not improved with LVAD support for three months, withdrawal of LVAD is difficult for him. Even though pediatric heart transplant is still difficult in Japan, we are going to place him on a waiting list for donor heart.
O-123 Emergency Care of Acute Myocardial Infarction during the Great East Japan Earthquake DisastereReport from the Miyagi AMI Registry StudyKIYOTAKA HAO1, JUN TAKAHASHI1, SATOSHI MIYATA1, YASUHARU SAKATA1, RYUJI TSUBURAYA1, TAKASHI SHIROTO1, YASUHARU MATSUMOTO1, KENTA ITO1, SATOSHI YASUDA2, HIROAKI SHIMOKAWA1 1 Department of Cardiovascular Medicine, Tohoku University Hospital, 2Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Backgrounds: Although emergency care of acute myocardial infarction (AMI) could be theoretically further improved through improved chain of survival, especially “patient delay”, this notion remains to be confirmed in a large community. In this study, we examined how the emergency care of AMI was operated during the Great East Japan Earthquake Disaster in our Miyagi prefecture. Methods and Results: The Miyagi AMI Registry Study has prospectively registered all AMI patients in Miyagi prefecture for 34 years since 1979. We analyzed the data registered in our Registry during 20082011 (total n53,937, M/F 2,846/1,091, 69.3613.4 [SD] yrs.). We found that during the first 2 months after the Earthquake of March 11, 2011, the number of patients with early admission (!3 hours from onset) was significantly increased (P!0.05) and their prognosis was better (P50.02) associated with lower prevalence of heart failure with Killip class $2 on admission (P50.02) and higher performance rate of primary PCI (P!0.01). In contrast, no difference was noted for door-to-balloon time and the ambulance use rate between 2011 and the previous 3 years. Conclusions: These results indicate that the emergency care of AMI worked better soon after the Earthquake than in ordinary times, for which several factors, including improved elapsing time from the onset to admission and higher performance rate of primary PCI, may be involved.
Background: The elderly have a higher likelihood of death and heart failure after ST-segment-elevation myocardial infarction (STEMI). However elderly patients with STEMI do not receive reperfusion therapy due to potential complications. This study investigated as to whether primary percutaneous coronary intervention (PCI) strategy for the elderly with STEMI improved short-term prognosis as compared with conservative strategy. Methods and Results: We enrolled 109 consecutive patients aged 80 or older with STEMI who were admitted to our hospital from April 2007 to March 2013; 83 patients underwent primary PCI strategy (PCI-group) and 26 patients underwent conservative strategy without reperfusion therapy (CONSERVATIVE-group). Death in 30 days was 14.5% in PCI-group and 34.6% in CONSERVATIVE-group (p50.02), while heart failure in 30-day was 24.1% in PCI-group and 26.9% in CONSERVATIVE-group (p50.37). Kaplan-Meier 30-day survival curve showed a significant difference between two groups [85.5% (PCI-group) vs. 65.4% (CONSERVATIVE-group), log-rank p50.03]. On multivariate analysis, primary PCI strategy was associated with a significantly decreased risk of 30-day mortality (odds ratio 0.18, p 5 0.03) and Troponin-I was associated with a significantly increased risk of 30-day mortality (odds ratio 1.02, p 5 0.03). Conclusion: The primary PCI strategy can improve short-term survival in elderly patients with STEMI as compared with conservative strategy. Besides primary PCI, baseline Troponin-I may be an independent predictor of 30-day mortality.
O-125 Detection of Post-systolic Shortening by Tissue Doppler Imaging for the Risk Stratification for Chest Pain in Emergency Department Settings TETSUYA WATANABE Cardiovascular Center, Kansai Rosai Hospital Background: A progression of myocardial ischemia (MI) may result a fatal ventricular arrhythmia and heart failure. Risk stratification for chest pain in emergency department (ED) settings is an important issue in cardiology practice. Post-systolic shortening (PSS) is a sensitive maker of myocardial ischemia. Methods: PSS was detected by using tissue Doppler displacement timing analysis. In this method, end-systole was automatically determined from tissue velocity, and delays of the displacement peaks from the endsystole were displayed from green to red on the left ventricular apical views. Routine echocardiography was done at first to detect wall motion abnormalities. Additionally, tissue Doppler mapping technique was done in patients with normal LV wall motion. Tissue Doppler was performed in consecutive 35 patients (male520) who visited ED complaining of chest pain were enrolled. ACS was confirmed by biochemical markers for myocardial necrosis and coronary angiography or coronary multidetector computed tomography. Results: ACS was present in 5 patients (14%). DADI predicted ACS with sensitivity of 80%, specificity of 76.6%, negative predictive value of 95.8%. Conclusion: DADI was useful in making objective judgment by readily portraying the presence of PSS, a marker of ACS, on 2-dimensional echocardiograms in patients with chest pain in ED settings.
O-126 Eicosapentaenoic Acid Attenuates Coronary Atherosclerotic Plaque Volume in Patients with Coronary Artery Disease ATSUSHI KATOH, TOMOKO TSURU, MEGUMI WATANABE, HIROSHI NIIYAMA, HARUHITO HARADA, YASUHIRO NISHIYAMA, NORIKO YOSHIDA, MASAYOSHI YOH, HISAO IKEDA Cardiovascular Medicine, Kurume University Medical Center Although eicosapentaenoic acid (EPA) has been shown to reduce cardiovascular events, its mechanisms are unknown. The aim of this study was to investigate the effects of EPA on atherosclerotic plaque volume in patients with coronary artery disease. 20 patients were enrolled in this study. 11 patients were administrated EPA as EPA group and 9 patients without EPA administration were served as control group. The plasma concentrations of EPA and arachidonic acid (AA), adiponectin and cholesterol profiles were examined before and after observation. The coronary plaque and lumen volumes were quantitatively determined by intravascular ultrasound imaging before and after observation. The plasma EPA/AA ratio significantly increased in EPA group, but not in control group. In EPA group the coronary plaque volume in proximal segments significantly decreased, but not in distal segments. In control group, the coronary plaque volume of proximal and distal segments did not significantly change after observation. In both groups, the coronary lumen volume of proximal and distal segments did not change during the observation period. EPA/AA ratio after treatment significantly correlated with % changes in coronary plaque volume. Moreover plasma EPA/AA ratio after observation significantly
unloading reduces preload and increases afterload, hence doesn’t decrease much the LV pressure-volume area (PVA), an index of LV oxygen consumption. In contrast, the total-unloading markedly decreases the oxygen consumption, thereby would decrease the infarct size. Methods/Results: We allocated 13 dogs into CONT, PARTIAL and TOTAL unloading. We assessed the infarct size at 90min after ischemia and 300min after reperfusion. LVAD significantly reduced the infarct size. The reduction was by far lager in TOTAL than in PARTIAL. Conclusions: TOTAL unloading maximizes myocardial salvage.
O-121 A Case Report of a Twelve-year-old Boy with Advanced Heart Failure Requiring LVAD as Bridge to Decision NORITSUGU NAITO Department of Cardiovascular Surgery, Gunma Cardiovascular Center The patient is a twelve-year-old boy. He was physically in good health until he noticed digestive symptoms. He went to his general physician, and underwent upper gastrointestinal endoscopy which revealed no abnormality. Two months later, he was transferred to a local hospital due to sudden onset of dyspnea and altered mental status. He was referred to a children’s medical center for treatment of cardiogenic shock. Veno-arterial ECMO was established to stabilize him. Even with ECMO support for three days, his heart function didn’t get better. He was referred to our department for implantation of LVAD. We attached an inflow cannula to the apex of left ventricule and an outflow cannula to the ascending aorta which were connected to a centrifugal pump. CPB was weaned off with LVAD support and inhalation of NO. Pathological examinations showed the signs of DCM. After he got hemodynamically stable, the pump was exchanged to a pulsatile pump on POD 9. He was extubated on POD 18, administration of catecholamine was stopped on POD 20, and oral intake was started on POD 22. Considering his heart function was not improved with LVAD support for three months, withdrawal of LVAD is difficult for him. Even though pediatric heart transplant is still difficult in Japan, we are going to place him on a waiting list for donor heart.
O-123 Emergency Care of Acute Myocardial Infarction during the Great East Japan Earthquake DisastereReport from the Miyagi AMI Registry StudyKIYOTAKA HAO1, JUN TAKAHASHI1, SATOSHI MIYATA1, YASUHARU SAKATA1, RYUJI TSUBURAYA1, TAKASHI SHIROTO1, YASUHARU MATSUMOTO1, KENTA ITO1, SATOSHI YASUDA2, HIROAKI SHIMOKAWA1 1 Department of Cardiovascular Medicine, Tohoku University Hospital, 2Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Backgrounds: Although emergency care of acute myocardial infarction (AMI) could be theoretically further improved through improved chain of survival, especially “patient delay”, this notion remains to be confirmed in a large community. In this study, we examined how the emergency care of AMI was operated during the Great East Japan Earthquake Disaster in our Miyagi prefecture. Methods and Results: The Miyagi AMI Registry Study has prospectively registered all AMI patients in Miyagi prefecture for 34 years since 1979. We analyzed the data registered in our Registry during 20082011 (total n53,937, M/F 2,846/1,091, 69.3613.4 [SD] yrs.). We found that during the first 2 months after the Earthquake of March 11, 2011, the number of patients with early admission (!3 hours from onset) was significantly increased (P!0.05) and their prognosis was better (P50.02) associated with lower prevalence of heart failure with Killip class $2 on admission (P50.02) and higher performance rate of primary PCI (P!0.01). In contrast, no difference was noted for door-to-balloon time and the ambulance use rate between 2011 and the previous 3 years. Conclusions: These results indicate that the emergency care of AMI worked better soon after the Earthquake than in ordinary times, for which several factors, including improved elapsing time from the onset to admission and higher performance rate of primary PCI, may be involved.
Background: The elderly have a higher likelihood of death and heart failure after ST-segment-elevation myocardial infarction (STEMI). However elderly patients with STEMI do not receive reperfusion therapy due to potential complications. This study investigated as to whether primary percutaneous coronary intervention (PCI) strategy for the elderly with STEMI improved short-term prognosis as compared with conservative strategy. Methods and Results: We enrolled 109 consecutive patients aged 80 or older with STEMI who were admitted to our hospital from April 2007 to March 2013; 83 patients underwent primary PCI strategy (PCI-group) and 26 patients underwent conservative strategy without reperfusion therapy (CONSERVATIVE-group). Death in 30 days was 14.5% in PCI-group and 34.6% in CONSERVATIVE-group (p50.02), while heart failure in 30-day was 24.1% in PCI-group and 26.9% in CONSERVATIVE-group (p50.37). Kaplan-Meier 30-day survival curve showed a significant difference between two groups [85.5% (PCI-group) vs. 65.4% (CONSERVATIVE-group), log-rank p50.03]. On multivariate analysis, primary PCI strategy was associated with a significantly decreased risk of 30-day mortality (odds ratio 0.18, p 5 0.03) and Troponin-I was associated with a significantly increased risk of 30-day mortality (odds ratio 1.02, p 5 0.03). Conclusion: The primary PCI strategy can improve short-term survival in elderly patients with STEMI as compared with conservative strategy. Besides primary PCI, baseline Troponin-I may be an independent predictor of 30-day mortality.
O-125 Detection of Post-systolic Shortening by Tissue Doppler Imaging for the Risk Stratification for Chest Pain in Emergency Department Settings TETSUYA WATANABE Cardiovascular Center, Kansai Rosai Hospital Background: A progression of myocardial ischemia (MI) may result a fatal ventricular arrhythmia and heart failure. Risk stratification for chest pain in emergency department (ED) settings is an important issue in cardiology practice. Post-systolic shortening (PSS) is a sensitive maker of myocardial ischemia. Methods: PSS was detected by using tissue Doppler displacement timing analysis. In this method, end-systole was automatically determined from tissue velocity, and delays of the displacement peaks from the endsystole were displayed from green to red on the left ventricular apical views. Routine echocardiography was done at first to detect wall motion abnormalities. Additionally, tissue Doppler mapping technique was done in patients with normal LV wall motion. Tissue Doppler was performed in consecutive 35 patients (male520) who visited ED complaining of chest pain were enrolled. ACS was confirmed by biochemical markers for myocardial necrosis and coronary angiography or coronary multidetector computed tomography. Results: ACS was present in 5 patients (14%). DADI predicted ACS with sensitivity of 80%, specificity of 76.6%, negative predictive value of 95.8%. Conclusion: DADI was useful in making objective judgment by readily portraying the presence of PSS, a marker of ACS, on 2-dimensional echocardiograms in patients with chest pain in ED settings.
O-126 Eicosapentaenoic Acid Attenuates Coronary Atherosclerotic Plaque Volume in Patients with Coronary Artery Disease ATSUSHI KATOH, TOMOKO TSURU, MEGUMI WATANABE, HIROSHI NIIYAMA, HARUHITO HARADA, YASUHIRO NISHIYAMA, NORIKO YOSHIDA, MASAYOSHI YOH, HISAO IKEDA Cardiovascular Medicine, Kurume University Medical Center Although eicosapentaenoic acid (EPA) has been shown to reduce cardiovascular events, its mechanisms are unknown. The aim of this study was to investigate the effects of EPA on atherosclerotic plaque volume in patients with coronary artery disease. 20 patients were enrolled in this study. 11 patients were administrated EPA as EPA group and 9 patients without EPA administration were served as control group. The plasma concentrations of EPA and arachidonic acid (AA), adiponectin and cholesterol profiles were examined before and after observation. The coronary plaque and lumen volumes were quantitatively determined by intravascular ultrasound imaging before and after observation. The plasma EPA/AA ratio significantly increased in EPA group, but not in control group. In EPA group the coronary plaque volume in proximal segments significantly decreased, but not in distal segments. In control group, the coronary plaque volume of proximal and distal segments did not significantly change after observation. In both groups, the coronary lumen volume of proximal and distal segments did not change during the observation period. EPA/AA ratio after treatment significantly correlated with % changes in coronary plaque volume. Moreover plasma EPA/AA ratio after observation significantly