Unrestricted Use of 2 New-Generation Drug-Eluting Stents in Patients With Acute Myocardial Infarction

KAMIR Investigators,Chen, K.Y.,Rha, S.W.,Wang, L.,Li, Y.J.,Li, G.P.,Poddar, K.L.,Park, J.Y.,Choi, C.U.,Park, C.G.,Seo, H.S.,Oh, D.J.,Jeong, M.H.,Ahn, Y.K.,Hong, T.J.,Kim, Y.J.,Hur, S.H.,Seong, I.W.,Ch Elsevier 2012 JACC. Cardiovascular interventions Vol.5 No.9

Objectives: This study sought to compare everolimus-eluting stents (EES) with zotarolimus-eluting stents (ZES) in patients with acute myocardial infarction (AMI). Background: There is a paucity of data to exclusively evaluate the safety and efficacy of second-generation drug-eluting stents (DES) in the setting of AMI. Methods: The present study enrolled 3,309 AMI patients treated with ZES (n = 1,608) or EES (n = 1,701) in a large-scale, prospective, multicenter registry-KAMIR (Korea Acute Myocardial Infarction Registry). Propensity score matching was applied to adjust for differences in baseline clinical and angiographic characteristics, producing a total of 2,646 patients (1,343 receiving ZES, and 1,343 receiving EES). Target lesion failure (TLF) was defined as the composite of cardiac death, recurrent nonfatal myocardial infarction, or target lesion revascularization. Major clinical outcomes at 1 year were compared between the 2 propensity score-matched groups. Results: After propensity score matching, baseline clinical and angiographic characteristics were similar between the 2 groups. Clinical outcomes of the propensity score-matched patients showed that, despite similar incidences of recurrent nonfatal myocardial infarction and in-hospital and 1-year mortality, patients in the EES group had significantly lower rates of TLF (6.5% vs. 8.7%, p = 0.029) and probable or definite stent thrombosis (0.3% vs. 1.6%, p < 0.001), compared with those in the ZES group. Furthermore, there was a numerically lower rate of target lesion revascularization (1.2% vs. 2.2%, p = 0.051) in the EES group than in the ZES group. Conclusions: In this propensity-matched comparison, EES seems to be superior to ZES in reducing TLF and stent thrombosis in patients with AMI.

One-year clinical impact of cardiac arrest in patients with first onset acute ST-segment elevation myocardial infarction

KAMIR Investigators,Lee, K.H.,Jeong, M.H.,YoungkeunAhn,Kim, S.S.,Rhew, S.H.,Jeong, Y.W.,Jang, S.Y.,Cho, J.Y.,Jeong, H.C.,Park, K.H.,Yoon, N.S.,Sim, D.S.,Yoon, H.J.,Kim, K.H.,Hong, Y.J.,Park, H.W.,Kim, Elsevier/North-Holland Biomedical Press 2014 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.175 No.1

Background: Cardiac arrest complicating acute ST elevation myocardial infarction (STEMI) is known to be associated with increased in-hospital mortality. However, little is known about the long-term outcomes after cardiac arrest complicating first onset STEMI in contemporary percutaneous coronary intervention (PCI) era. Methods: We analyzed 7942 consecutive patients who were diagnosed with STEMI and had no previous history of MI. They were divided into two groups according to the presence of cardiac arrest (group I, patients with cardiac arrest; n=481, group II, patients without cardiac arrest; n=7641). Results: In a stepwise multivariate model, previous history of chronic kidney disease, high serum level of glucose and low high density lipoprotein-cholesterol was an independent predictor of cardiac arrest complicating STEMI. Group I had significantly higher in-hospital mortality (adjusted hazard ratio [HR] 3.06, 95% confidence interval [CI] 2.08-4.51, p<0.001) and 30-day mortality after hospital discharge (adjusted HR 2.92, 95% CI 1.86-4.58, log-rank p<0.001). However, there was no significant increase in mortality beyond 30days (6-month, adjusted HR 1.46, 95% CI 0.45-4.77, log rank p=0.382; 1-year, adjusted HR 1.84, 95% CI 0.83-4.05, log-rank p=0.107). Also, there were no significant differences in 6-month and 1-year major adverse cardiac events in 30-day survivors. Performing PCI was associated with decreased 12-month mortality in 30-day survivors. Conclusions: Although patients with cardiac arrest complicating first onset STEMI had higher in-hospital and 30-day mortality after hospital discharge, cardiac arrest itself did not have any residual impact on mortality as well as clinical outcomes.

Benefit of Early Statin Therapy in Patients With Acute Myocardial Infarction Who Have Extremely Low Low-Density Lipoprotein Cholesterol

KAMIR Investigators,Lee, K.H.,Jeong, M.H.,Kim, H.M.,Ahn, Y.,Kim, J.H.,Chae, S.C.,Kim, Y.J.,Hur, S.H.,Seong, I.W.,Hong, T.J.,Choi, D.H.,Cho, M.C.,Kim, C.J.,Seung, K.B.,Chung, W.S.,Jang, Y.S.,Rha, S.W. Elsevier Biomedical 2011 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY - Vol.58 No.16

Objectives: We investigated whether statin therapy could be beneficial in patients with acute myocardial infarction (AMI) who have baseline low-density lipoprotein cholesterol (LDL-C) levels below 70 mg/dl. Background: Intensive lipid-lowering therapy with a target LDL-C value <70 mg/dl is recommended in patients with very high cardiovascular risk. However, whether to use statin therapy in patients with baseline LDL-C levels below 70 mg/dl is controversial. Methods: We analyzed 1,054 patients with AMI who had baseline LDL-C levels below 70 mg/dl and survived at discharge from the Korean Acute MI Registry between November 2005 and December 2007. They were divided into 2 groups according to the prescribing of statins at discharge (statin group n = 607; nonstatin group n = 447). The primary endpoint was the composite of 1-year major adverse cardiac events, including death, recurrent MI, target vessel revascularization, and coronary artery bypass grafting. Results: Statin therapy significantly reduced the risk of the composite primary endpoint (adjusted hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.34 to 0.89; p = 0.015). Statin therapy reduced the risk of cardiac death (HR: 0.47; 95% CI: 0.23 to 0.93; p = 0.031) and coronary revascularization (HR: 0.45, 95% CI: 0.24 to 0.85; p = 0.013). However, there were no differences in the risk of the composite of all-cause death, recurrent MI, and repeated percutaneous coronary intervention rate. Conclusions: Statin therapy in patients with AMI with LDL-C levels below 70 mg/dl was associated with improved clinical outcome.

Statin therapy to reduce stent thrombosis in acute myocardial infarction patients with elevated high-sensitivity C-reactive protein

Other KAMIR Investigators,Jeong, H.C.,Ahn, Y.,Hong, Y.J.,Kim, J.H.,Jeong, M.H.,Kim, Y.J.,Chae, S.C.,Cho, M.C. Elsevier/North-Holland Biomedical Press 2013 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.167 No.5

Objective: We investigated whether statin therapy and high-sensitivity C-reactive protein (hs-CRP) levels were associated with the risk of stent thrombosis (ST) in acute myocardial infarction (AMI) patients. Methods: A total of 9,162 AMI patients who underwent coronary stent implantation were analyzed in the Korean Acute Myocardial Infarction Registry. The study population was divided into four groups according to level of hs-CRP and peri-procedural statin treatment: low hs-CRP (@?2.0mg/L) and high hs-CRP (>2mg/L) with or without statin therapy. We compared the incidence of early ST among the groups. Results: Statin therapy did not significantly affect the development of early ST in the low hs-CRP group. In the high hs-CRP group, however, the incidence of early ST was significantly decreased with statin treatment. In a subgroup analysis of the high hs-CRP group, patients aged less than 65years, without diabetes, with a high body mass index, and with a high Killip class seemed to benefit more from statin therapy. In a multivariable Cox regression analysis of the high hs-CRP group, lack of statin therapy was a significant predictor of ST incidence. Conclusions: Peri-procedural statin treatment had an effect on reduced incidence of early ST in AMI patients with high levels of hs-CRP.

Comparison of the effects of two low-density lipoprotein cholesterol goals for secondary prevention after acute myocardial infarction in real-world practice: ≥50% reduction from baseline versus <70mg/dL

for the KAMIR Investigators,Cho, K.H.,Jeong, M.H.,Park, K.W.,Kim, H.S.,Lee, S.R.,Chae, J.K.,Hong, Y.J.,Kim, J.H.,Ahn, Y.,Cho, J.G.,Park, J.C. Elsevier/North-Holland Biomedical Press 2015 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.187 No.-

<P>Background: The present study compared the effects of two low-density lipoprotein cholesterol (LDL-C) goals for secondary prevention after acute myocardial infarction (AMI) in real-world practice. Methods and results: Of 3091 consecutive patients with AMI who had baseline LDL-C levels >= 70 mg/dL and underwent successful percutaneous coronary intervention, 1305 eligible patients who received discharge statin prescriptions were analyzed. Patients were categorized into 2 groups according to the values of LDL-C at 1 year in two different manners using percent reduction from baseline (>= 50% reduction, n = 428 versus <50% reduction, n = 877) and fixed levels (<70 mg/dL, n = 625 versus = 70 mg/dL, n = 680). The primary outcome was defined by the composite of 2-year major cardiac events including cardiac death, non-fatal myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting after hospital discharge. At 2 years, major cardiac events occurred in 139 patients (10.7%). Compared with <50% LDL-C reduction from baseline, patients with >= 50% LDL-C reduction had a 47% risk reduction in major cardiac events (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79; P = 0.002). But, compared with LDL-C levels = 70 mg/dL at 1 year, patients with LDL-C levels <70 mg/dL at 1 year had a similar risk of major cardiac events (adjusted hazard ratio, 0.96; 95% confidence interval, 0.68 to 1.34; P = 0.793). Conclusions: Obtaining a = 50% reduction in LDL-C was associated with better clinical outcomes after AMI in real-world practice, whereas achieving a <70 mg/dL was not. (C) 2015 Elsevier Ireland Ltd. All rights reserved.</P>

Comparison of short-term clinical outcomes between ticagrelor versus clopidogrel in patients with acute myocardial infarction undergoing successful revascularization; from Korea Acute Myocardial Infarction Registry-National Institute of Health

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>

Clinical Outcomes of Elderly Patients with Non ST-Segment Elevation Myocardial Infarction Undergoing Coronary Artery Bypass Surgery

Woo Jin Kim,정명호,강동구,이승욱,조상기,안영근,김영조,Chong Jin Kim,조명찬,KAMIR (Korea Acute Myocardial Infarction Registry) Investigators 전남대학교 의과학연구소 2018 전남의대학술지 Vol.54 No.1

The aim of this study is to investigate the clinical outcomes of the elderly patients withNon ST-segment elevation myocardial infarction (NSTEMI) undergoing coronary arterybypass surgery (CABG) compared to non-elderly patients. Patients with NSTEMIand undergoing CABG (n=451) who were registered in the Korea Acute MyocardialInfarction Registry between December 2003 and August 2012 were divided into twogroups.; the non-elderly group (<75 years, n=327) and the elderly group (≥75 years,n=124). In-hospital mortality was higher in the elderly group (4.9% vs. 11.3%, p=0.015),but cardiac death, myocardial infarction, and major adverse cardiovascular events(MACE) including cardiac death, myocardial infarction, percutaneous revascularization,and redo-CABG after a one-year follow up were not different between the twogroups. Predictors of in-hospital mortality in patients with NSTEMI undergoing CABGwere left ventricular (LV) dysfunction (ejection fraction ≤40%) [hazard ratio (HR):2.76, 95% confidence interval (CI): 1.16-6.57, p=0.022] and age (HR: 1.05, 95% CI:1.01-1.10, p=0.047). So elderly NSTEMI patients should be considered for CABG if appropriate,but careful consideration for surgery is required, especially if the patientshave severe LV systolic dysfunction.

Comparison of Prognosis According to the Use of Emergency Medical Services in Patients with ST-Segment Elevation Myocardial Infarction

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.

Characteristics, In-Hospital and Long-Term Clinical Outcomes of Nonagenarian Compared with Octogenarian Acute Myocardial Infarction Patients

이기홍,안영근,김성수,류시현,정영욱,장수영,조재영,정해창,박근호,윤남식,심두선,윤현주,김계훈,홍영준,박형욱,김주한,조정관,박종춘,정명호,조명찬,김종진,김영조,KAMIR (Korea Acute Myocardial Infarction Registry) Investigators 대한의학회 2014 Journal of Korean medical science Vol.29 No.4

We compared clinical characteristics, management, and clinical outcomes of nonagenarianacute myocardial infarction (AMI) patients (n = 270, 92.3 ± 2.3 yr old) with octogenarianAMI patients (n = 2,145, 83.5 ± 2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to beprescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared withoctogenarians. Although percutaneous coronary intervention (PCI) was preferred inoctogenarians than nonagenarians, the success rate of PCI between the two groups wascomparable. In-hospital mortality, the composite of in-hospital adverse outcomes and oneyear mortality were higher in nonagenarians than in octogenarians. However, thecomposite of the one year major adverse cardiac events (MACEs) was comparable betweenthe two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality(adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P < 0.001)and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P < 0.001) without significantcomplications both in nonagenarians and octogenarians. In conclusion, nonagenarianshad similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality comparedwith octogenarian AMI patients. PCI in nonagenarian AMI patients was associated tobetter 1-yr clinical outcomes.