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Background Cardiopulmonary arrest (CPA) is the most serious presentation of acute myocardial infarction (AMI). However, the frequency and prognostic impact of CPA in young patients with AMI have been still unclear. Objectives This study aimed to characterize AMI in young patients who underwent primary percutaneous coronary intervention using large-scale nationwide all-comer registry data in Japan (J-PCI registry). Methods Data on risk factor profiles, clinical features, post-procedural complications, and in-hospital outcomes were reviewed within the J-PCI registry between 2014 and 2018. Results Among 213,297 patients with AMI, 23,985 (11.2%) were young (age, 20–49 years). Compared with the older group (age, 50–79 years; n=189,312), the young group included a higher number of men, smokers, patients with dyslipidemia, and patients with single-vessel disease, and a lower number of patients with hypertension and diabetes. Despite favorable clinical profiles, younger age was associated with a higher rate of presentation with CPA (Figure 1). Further, concomitant CPA was strongly associated with in-hospital mortality in the young group (Table 1). Conclusions Young patients with AMI presented a higher risk of CPA than older patients, which was strongly associated with in-hospital mortality. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI

PurposePatients with acute coronary syndrome (ACS), frequently caused by plaque rupture (PR), often have vulnerable plaques in residual and culprit lesions. However, whether this occurs in patients with plaque erosion (PE) as well is unknown. Therefore, we compared the tissue characteristics of residual lesions in patients with PE and those with PR.MethodsThe data of 88 patients with ACS who underwent both optimal coherence tomography (OCT) and intravascular ultrasound (IVUS) were retrospectively analyzed. Based on plaque morphology of the culprit lesions identified using OCT, patients were classified into PE and PR groups. The tissue characteristics of residual lesions evaluated using integrated backscatter IVUS were compared between the two groups after percutaneous coronary intervention. ResultsPatients were classified into the PE group (n=23) and PR group (n=35). The PE group had a significantly lower percent lipid volume and a higher percent fibrous volume than those of the PR group (35.0±17.8% vs. 49.2±13.4%, p<0.001; 63.2±17.1% vs. 50.3±13.1%, p=0.002, respectively). Receiver operating characteristic curve analysis revealed that the percent lipid volume in the residual lesions was a significant discriminant factor in estimating the plaque morphology of the culprit lesion (optimal cut-off value, <43.5%; sensitivity and specificity values were 73.9% and 68.6%, respectively).ConclusionsPatients with PE had a significantly lower percent lipid volume and a significantly higher percent fibrous volume in the residual lesions than in those with PR, suggesting that the nature of coronary plaques in patients with PE is different from that in patients with PR.

Background: Physiological assessments using fractional flow reserve (FFR) and resting full-cycle ratio (RFR) have been recommended for revascularization decision making. Previous studies have shown a 20% rate of discordance between FFR and RFR. In this context, the correlation between RFR and FFR in patients with renal dysfunction remains unclear. This study examined correlations between RFR and FFR according to renal function. Methods and Results:In all, 263 consecutive patients with 370 intermediate lesions were enrolled in the study. Patients were classified into 3 groups according to renal function: Group 1, estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m 2 ; Group 2, 30 mL/min/1.73 m 2 ≤eGFR<60 mL/min/1.73 m 2 ; Group 3, eGFR <30 mL/min/1.73 m 2 . The discordance between FFR and RFR was assessed using known cut-off values for FFR (≤0.80) and RFR (≤0.89). Of the 370 lesions, functional significance with FFR was observed in 154 (41.6%). RFR was significantly correlated with FFR in all groups (Group 1, R 2 =0.62 [P<0.001]; Group 2, R 2 =0.67 [P<0.001]; Group 3, R 2 =0.46 [P<0.001]). The rate of discordance between RFR and FFR differed significantly among the 3 groups (Group 1, 18.8%; Group 2, 18.5%; Group 3, 42.9%; P=0.02). Conclusions:The diagnostic performance of RFR differed based on renal function. A better understanding of the clinical factors contributing to FFR/RFR discordance, such as renal function, may facilitate the use of these indices.

PurposePatients with acute coronary syndrome (ACS), frequently caused by plaque rupture (PR), often have vulnerable plaques in residual and culprit lesions. However, whether this occurs in patients with plaque erosion (PE) as well is unknown. Therefore, we compared the tissue characteristics of residual lesions in patients with PE and those with PR.MethodsThe data of 88 patients with ACS who underwent both optimal coherence tomography (OCT) and intravascular ultrasound (IVUS) were retrospectively analyzed. Based on plaque morphology of the culprit lesions identified using OCT, patients were classified into PE and PR groups. The tissue characteristics of residual lesions evaluated using integrated backscatter IVUS were compared between the two groups after percutaneous coronary intervention. ResultsPatients were classified into the PE group (n=23) and PR group (n=35). The PE group had a significantly lower percent lipid volume and a higher percent fibrous volume than those of the PR group (35.0±17.8% vs. 49.2±13.4%, p<0.001; 63.2±17.1% vs. 50.3±13.1%, p=0.002, respectively). Receiver operating characteristic curve analysis revealed that the percent lipid volume in the residual lesions was a significant discriminant factor in estimating the plaque morphology of the culprit lesion (optimal cut-off value, <43.5%; sensitivity and specificity values were 73.9% and 68.6%, respectively).ConclusionsPatients with PE had a significantly lower percent lipid volume and a significantly higher percent fibrous volume in the residual lesions than in those with PR, suggesting that the nature of coronary plaques in patients with PE is different from that in patients with PR.