Primary percutaneous coronary intervention in elderly patients with acute myocardial infarction — An analysis from a Japanese nationwide claim-based database

Shiro Uemura, Hiroshi Okamoto, Michikazu Nakai, Kunihiro Nishimura, Yoshihiro Miyamoto, Satoshi Yasuda, Nobuhiro Tanaka, Shun Kohsaka, Kazushige Kadota, Yoshihiko Saito, Hiroyuki Tsutsui, Issei Komuro, Yuji Ikari, Hisao Ogawa, Masato Nakamura

研究成果: ジャーナルへの寄稿記事

抄録

Background: Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear. Methods and Results: The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6%), and received pPCI less frequently (62.2%) than younger patients (79.2%, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7%) than in younger patients (3.8%, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI. Conclusions: Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.

元の言語英語
ページ(範囲)1229-1238
ページ数10
ジャーナルCirculation Journal
83
発行部数6
DOI
出版物ステータス出版済み - 1 1 2019

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Percutaneous Coronary Intervention
Myocardial Infarction
Databases
Mortality
Propensity Score
Registries
Hospitalization
Cardiovascular Diseases

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

これを引用

Primary percutaneous coronary intervention in elderly patients with acute myocardial infarction — An analysis from a Japanese nationwide claim-based database. / Uemura, Shiro; Okamoto, Hiroshi; Nakai, Michikazu; Nishimura, Kunihiro; Miyamoto, Yoshihiro; Yasuda, Satoshi; Tanaka, Nobuhiro; Kohsaka, Shun; Kadota, Kazushige; Saito, Yoshihiko; Tsutsui, Hiroyuki; Komuro, Issei; Ikari, Yuji; Ogawa, Hisao; Nakamura, Masato.

:: Circulation Journal, 巻 83, 番号 6, 01.01.2019, p. 1229-1238.

研究成果: ジャーナルへの寄稿記事

Uemura, S, Okamoto, H, Nakai, M, Nishimura, K, Miyamoto, Y, Yasuda, S, Tanaka, N, Kohsaka, S, Kadota, K, Saito, Y, Tsutsui, H, Komuro, I, Ikari, Y, Ogawa, H & Nakamura, M 2019, 'Primary percutaneous coronary intervention in elderly patients with acute myocardial infarction — An analysis from a Japanese nationwide claim-based database', Circulation Journal, 巻. 83, 番号 6, pp. 1229-1238. https://doi.org/10.1253/circj.CJ-19-0004
Uemura, Shiro ; Okamoto, Hiroshi ; Nakai, Michikazu ; Nishimura, Kunihiro ; Miyamoto, Yoshihiro ; Yasuda, Satoshi ; Tanaka, Nobuhiro ; Kohsaka, Shun ; Kadota, Kazushige ; Saito, Yoshihiko ; Tsutsui, Hiroyuki ; Komuro, Issei ; Ikari, Yuji ; Ogawa, Hisao ; Nakamura, Masato. / Primary percutaneous coronary intervention in elderly patients with acute myocardial infarction — An analysis from a Japanese nationwide claim-based database. :: Circulation Journal. 2019 ; 巻 83, 番号 6. pp. 1229-1238.
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abstract = "Background: Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear. Methods and Results: The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6{\%}), and received pPCI less frequently (62.2{\%}) than younger patients (79.2{\%}, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7{\%}) than in younger patients (3.8{\%}, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI. Conclusions: Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.",
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T1 - Primary percutaneous coronary intervention in elderly patients with acute myocardial infarction — An analysis from a Japanese nationwide claim-based database

AU - Uemura, Shiro

AU - Okamoto, Hiroshi

AU - Nakai, Michikazu

AU - Nishimura, Kunihiro

AU - Miyamoto, Yoshihiro

AU - Yasuda, Satoshi

AU - Tanaka, Nobuhiro

AU - Kohsaka, Shun

AU - Kadota, Kazushige

AU - Saito, Yoshihiko

AU - Tsutsui, Hiroyuki

AU - Komuro, Issei

AU - Ikari, Yuji

AU - Ogawa, Hisao

AU - Nakamura, Masato

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear. Methods and Results: The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6%), and received pPCI less frequently (62.2%) than younger patients (79.2%, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7%) than in younger patients (3.8%, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI. Conclusions: Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.

AB - Background: Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear. Methods and Results: The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6%), and received pPCI less frequently (62.2%) than younger patients (79.2%, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7%) than in younger patients (3.8%, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI. Conclusions: Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.

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JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

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