Eleven-year temporal trends of clinical characteristics and long-term outcomes in patients undergoing percutaneous coronary intervention for acute coronary syndrome in the Shinken database
Despite the increasing incidence of acute coronary syndrome (ACS) in Japan, its prognosis has improved. However, there is a paucity of longitudinal registry data providing trends of in-hospital care and prognosis of ACS in Japan. ACS patients undergoing percutaneous coronary intervention (PCI) included in the Shinken Database 2004–2014 were divided into two groups according to admission year (2004–2009, n = 390; 2010–2014, n = 328). Patient characteristics, lesion/procedure characteristics, medications at discharge, all-cause mortality, cardiovascular death, acute myocardial infarction (AMI), target lesion revascularization (TLR), re-PCI to new lesion, and coronary artery bypass graft (CABG) within 2 years after discharge were compared between the groups. Prevalence of hypertension, dyslipidemia, and dual antiplatelet/statin prescription increased significantly between periods. Usage of second-generation drug-eluting stents (DES) increased markedly between the two periods (2.6, 66.8%), while those of bare metal stents (64.4, 26.5%) and first-generation DES (25.6, 1.5%) decreased (all, p < 0.01). Two-year event-free survival rate increased for all-cause mortality (94.6–98.3%, p = 0.01), TLR (79.4–96.1%, p < 0.01), and re-PCI to new lesion (87.3–95.1%, p < 0.01). There were no significant differences in cardiovascular death, AMI, or CABG between the two periods. The event-free rates for TLR and re-PCI to new lesion in ACS patients have increased over the last decade in Japan. These observations should be confirmed in larger, longitudinal, multicenter registries.
KeywordsAcute coronary syndrome Percutaneous coronary intervention Time trend
We thank Shiro Ueda and Nobuko Ueda at Medical Edge Company, Ltd., for assembling the database by the Clinical Study Supporting System and Ineko Hayakawa, Hiroaki Arai, and Hirokazu Aoki for data management and system administration. Dr. Suzuki received research funding and remuneration from Nippon Boehringer Ingelheim. Dr. Yamashita has received research funding and/or lecture fees from Daiichi Sankyo, Bayer Yakuhin, Bristol-Myers Squibb, Pfizer, Nippon Boehringer Ingelheim, Eisai, Mitsubishi Tanabe Pharm, Ono Pharmaceutical, and Toa Eiyo.
This study was partially supported by the Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus from Japan Agency for Medical Research and Development, AMED (15656344).
Compliance with ethical standards
Conflict of interest
Dr. Suzuki and Dr. Takayuki Otsuka received research funding and remuneration from Nippon Boehringer Ingelheim. Dr. Yamashita received research funding from Nippon Boehringer Ingelheim and Daiichi-Sankyo, and remuneration from Nippon Boehringer Ingelheim, Daiichi-Sankyo, Bayer Healthcare, Pfizer, Bristol-Myers Squibb, Eisai, and Ono Pharmaceutical.
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