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on behalf of KAMIR-NIH registry investigators,Park, K.H.,Jeong, M.H.,Ahn, Y.,Ahn, T.H.,Seung, K.B.,Oh, D.J.,Choi, D.J.,Kim, H.S.,Gwon, H.C.,Seong, I.W.,Hwang, K.K.,Chae, S.C.,Kim, K.B.,Kim, Y.J.,Cha, Elsevier/North-Holland Biomedical Press 2016 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.215 No.-
<P>Background: Although 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. Methods: Between 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. Results: After propensity score matching (1377 pairs), no difference in the composite of cardiac death, MI, stroke, or target vessel revascularization at 6 months 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 = 75 years or with body weight < 60 kg (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). Conclusions: Our 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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.</P>
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김유리,정명호,안민정,Xiongyi Han,조경훈,심두선,홍영준,김주한,안영근,KAMIR-NIH Registry Investigators 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.2
Purpose: This study aimed to compare long-term clinical outcomes according to the use of emergency medical services (EMS) inpatients with ST-segment elevation myocardial infarction (STEMI) who arrived at the hospital within 12 hr of symptom onset. Materials and Methods: A total of 13104 patients with acute myocardial infarction were enrolled in the Korea Acute MyocardialInfarction Registry–National Institutes of Health from October 2011 to December 2015. Of them, 2416 patients with STEMI whoarrived at the hospital within 12 hr were divided into two groups: 987 patients in the EMS group and 1429 in the non-EMS group. Propensity score matching (PSM) was performed to reduce bias from confounding variables. After PSM, 796 patients in the EMSgroup and 796 patients in the non-EMS group were analyzed. The clinical outcomes during 3 years of clinical follow-up werecompared between the two groups according to the use of EMS. Results: The symptom-to-door time was significantly shorter in the EMS group than in the non-EMS group. The EMS group hadmore patients with high Killip class compared to the non-EMS group. The rates of all-cause death and major adverse cardiac events(MACE) were not significantly different between the two groups. After PSM, the rate of all-cause death and MACE were still notsignificantly different between the EMS and non-EMS groups. The predictors of mortality were high Killip class, renal dysfunction,old age, long door-to-balloon time, long symptom-to-door time, and heart failure. Conclusion: EMS utilization was more frequent in high-risk patients. The use of EMS shortened the symptom-to-door time, butdid not improve the prognosis in this cohort.
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Seung Jin Jun,,정명호,Kyung Hoon Cho,,안영근,김주한,조정관,Shung Chull Chae,Young Jo Kim,In Whan Seong,채제건,Hyo-Soo Kim,KAMIR-NIH 한국지질동맥경화학회 2018 지질·동맥경화학회지 Vol.7 No.1
Objective: The complete blood count is the most widely available laboratory data in the early in-hospital period after acute myocardial infarction. We assessed the clinical utility of the combined use of hemoglobin (Hb) level and neutrophil to lymphocyte ratio (N/L) for early risk stratification in patients with non-ST-elevation myocardial infarction (STEMI). Methods: We analyzed 6,157 consecutive patients with non-STEMI (65±12.4 years, male 69%) were included in the final analysis. Patients were categorized into 3 groups by using the median value of N/L (4.42) and the presence of anemia (Hb <13 mg/dL in men and <12 mg/dL in women): group I, low N/L & no anemia (n=3,170); group II, no group I or III (n=2,168); group III, high N/L & anemia (n=819). Results: There were significant differences on clinical outcomes during 180-day follow-up among 3 groups. The prognostic discriminatory capacity of the combined use of Hb level and N/L was also significant in high-risk subgroups, such as patients with a renal dysfunction, multivessel coronary disease, low ejection fraction, and even in those having higher mortality risk based on the thrombolysis in myocardial infarction risk score. In a multi-variate logistic regression, after adjusting for multiple covariates, group III had higher incidence of major adverse cardiac events at 180-day (hazard ratio, 2.4; 95% confidence interval, 1.5–4.0;p≤0.001) compared with group I. Conclusions: The combined use of Hb level and N/L provides valuable timely information for early risk stratification in patients with non-STEMI.
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