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Cardiovascular Intervention and Therapeutics

, Volume 34, Issue 1, pp 47–58 | Cite as

Mortality impact of post-discharge myocardial infarction size after percutaneous coronary intervention: a patient-level pooled analysis from the 4 large-scale Japanese studies

  • Hirotoshi Watanabe
  • Takeshi Morimoto
  • Hiroki Shiomi
  • Yusuke Yoshikawa
  • Takao Kato
  • Naritatsu Saito
  • Satoshi Shizuta
  • Koh Ono
  • Kyohei Yamaji
  • Kenji Ando
  • Shuichiro Kaji
  • Yutaka Furukawa
  • Masaharu Akao
  • Tetsuya Ishikawa
  • Takashi Tamura
  • Yoshito Yamamoto
  • Toshiya Muramatsu
  • Satoru Suwa
  • Yoshihisa Nakagawa
  • Kazushige Kadota
  • Yoshiki Takatsu
  • Hideo Nishikawa
  • Yoshikazu Hiasa
  • Yasuhiko Hayashi
  • Shunichi Miyazaki
  • Takeshi Kimura
Original Article

Abstract

It is unknown whether there is a threshold of creatine kinase (CK) or CK-MB affecting the subsequent mortality for post-discharge myocardial infarction (PDMI) after percutaneous coronary intervention. Current study sought to evaluate the impact of PDMI. The study population included 30,051 patients with successful coronary stenting and discharged alive in the pooled patient-level database of 4 Japanese studies (j-Cypher registry, CREDO-Kyoto PCI/CABG registry cohort-2, RESET, and NEXT). During 4.4 ± 1.4 year follow-up, 915 patients experienced PDMI (cumulative 5-year incidence of 3.6%). Among 466 patients with available peak CK ratio (peak CK/upper limit of normal), peak CK ratio (< 3) was present in 21% of patients, while peak CK ratios (≥ 3 and < 5), (≥ 5 and < 10), (≥ 10 and < 30), and (≥ 30) were present in 17, 25, 30, and 7.3% of patients, respectively. The excess mortality risk of patients with relative to those without PDMI for subsequent mortality was significant (adjusted HR 5.12, 95% CI 4.52–5.80, P < 0.001) by the Cox model with PDMI incorporated as the time-updated covariate. However, the mortality risk of patients in the smallest peak CK ratio category (< 3) was insignificant (HR 0.85, 95% CI 0.43–1.71, P = 0.65). In conclusion, despite significant overall mortality risk of PDMI, the mortality risk of small PDMI was similar to that of no PDMI, suggesting the presence of some threshold about infarct size influencing mortality.

Trial registrations The Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial (RESET); NCT01035450 and NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial (NEXT); NCT01303640. J-Cypher and CREDO-Kyoto PCI/CABG registry cohort 2 were not registered into clinical trial database.

Keywords

Percutaneous coronary intervention Myocardial infarction Mortality Prognosis 

Notes

Acknowledgements

We appreciate the members of Research Institute for Production Development handling a series of large clinical trials hosted by Kyoto University and the co-investigators actively enrolling patients, collecting follow-up data, or adjudicating clinical event.

Funding

This report is derived from pooled database including following 4 studies, j-Cypher registry funded by Johnson & Johnson K.K.; CREDO-Kyoto PCI/CABG Registry Cohort 2 by Pharmaceuticals and Medical Devices Agency (PMDA) in Japan; RESET by Abbott Vascular Japan, Co., Ltd.; and NEXT by Terumo Japan, Co., Ltd.

Compliance with ethical standards

Conflict of interest

T. Kimura reports position as an advisory board member of Terumo Japan and Abbott Vascular. The other authors report no disclosures with regard to the content of this manuscript.

Supplementary material

12928_2018_517_MOESM1_ESM.doc (932 kb)
Supplementary material 1 (DOC 931 kb)

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Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2018

Authors and Affiliations

  • Hirotoshi Watanabe
    • 1
  • Takeshi Morimoto
    • 2
  • Hiroki Shiomi
    • 1
  • Yusuke Yoshikawa
    • 1
  • Takao Kato
    • 1
  • Naritatsu Saito
    • 1
  • Satoshi Shizuta
    • 1
  • Koh Ono
    • 1
  • Kyohei Yamaji
    • 3
  • Kenji Ando
    • 3
  • Shuichiro Kaji
    • 4
  • Yutaka Furukawa
    • 4
  • Masaharu Akao
    • 5
  • Tetsuya Ishikawa
    • 6
  • Takashi Tamura
    • 7
  • Yoshito Yamamoto
    • 8
  • Toshiya Muramatsu
    • 9
  • Satoru Suwa
    • 10
  • Yoshihisa Nakagawa
    • 11
  • Kazushige Kadota
    • 12
  • Yoshiki Takatsu
    • 13
  • Hideo Nishikawa
    • 14
  • Yoshikazu Hiasa
    • 15
  • Yasuhiko Hayashi
    • 16
  • Shunichi Miyazaki
    • 17
  • Takeshi Kimura
    • 1
  1. 1.Department of Cardiovascular Medicine, Graduate School of MedicineKyoto UniversityKyotoJapan
  2. 2.Department of Clinical EpidemiologyHyogo College of MedicineNishinomiyaJapan
  3. 3.Division of CardiologyKokura Memorial HospitalKitakyushuJapan
  4. 4.Department of Cardiovascular MedicineKobe City Medical Centre General HospitalKobeJapan
  5. 5.Division of CardiologyNational Hospital Organization Kyoto Medical CentreKyotoJapan
  6. 6.Division of CardiologyThe Jikei University Kashiwa HospitalKashiwaJapan
  7. 7.Division of CardiologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
  8. 8.Division of CardiologyIwaki Kyoritsu HospitalIwakiJapan
  9. 9.Division of CardiologyTokyo General HospitalTokyoJapan
  10. 10.Division of CardiologyJuntendo University Shizuoka HospitalIzunokuniJapan
  11. 11.Division of CardiologyTenri HospitalTenriJapan
  12. 12.Division of CardiologyKurashiki Central HospitalKurashikiJapan
  13. 13.Division of CardiologyHyogo Prefectural Amagasaki General Medical CentreAmagasakiJapan
  14. 14.Division of CardiologyMie Heart CentreMieJapan
  15. 15.Division of CardiologyTokushima Red Cross HospitalTokushimaJapan
  16. 16.Division of CardiologyTsuchiya General HospitalHiroshimaJapan
  17. 17.Division of Cardiology, Department of Medicine, Faculty of MedicineKindai UniversityOsakasayamaJapan

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