Primary percutaneous coronary interventions (PCI) have been developed to improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). In primary PCI, the door-to-balloon time (DTBT) is closely associated with mortality and morbidity. The purpose of this study was to find determinants of short and long DTBT. From our hospital record, we included 214 STEMI patients, and divided into the short DTBT group (DTBT < 60 min, n = 60), the intermediate DTBT group (60 min ≤ DTBT ≤ 120 min, n = 121) and the long DTBT group (DTBT > 120 min, n = 33). In-hospital mortality was highest in the long DTBT group (24.2%), followed by the intermediate DTBT group (5.8%), and lowest in the short DTBT group (0%) (< 0.001). Transfers from local clinics or hospitals (OR 3.43, 95% CI 1.72-6.83, P < 0.001) were significantly associated with short DTBT, whereas Killip class 3 or 4 (vs. Killip class 1 or 2: OR 0.20, 95% CI 0.06-0.64, P = 0.007) was inversely associated with short DTBT in multivariate analysis. In conclusion, transfer from local clinics/hospitals was associated with short DTBT. Our results may suggest the current limitation of ambulance system, which does not include pre-hospital ECG system, in Japan. The development of pre-hospital ECG system would be needed for better management in STEMI.

Postprandial hyperglycemia is a risk factor for cardiovascular disease and mortality. Serum 1,5-anhydroglucitol (1,5-AG) level is an useful clinical marker of glucose metabolism which reflects postprandial hyperglycemia more robustly compared to hemoglobin A1c (HbA1c). Relationship between serum 1,5-AG level and cardiovascular disease has been reported; however, comparison between HbA1c and 1,5-AG as markers of cardiovascular disease was not performed. We included 227 consecutive patients who underwent coronary angiography meeting the following inclusion criteria: (1) patients who had no history of coronary artery disease (CAD); (2) patients without acute coronary syndrome; (3) patients without poorly controlled diabetes mellitus; (4) patients without anemia, liver dysfunction, acute, and chronic renal failure and malnutrition; and (5) patients without adhibition of acarbose or Chinese herbal medicine. We measured HbA1c, glycoalbumin, and 1,5-AG. Serum 1,5-AG was significantly lower in patients with CAD (16.6 ± 8.50 vs. 21.1 ± 7.97 μg/ml, P < 0.001). Multivariable logistic regression analysis showed decrease in serum 1,5-AG was independently associated with the presence of denovo CAD (0.93, 95% CI 0.88-0.98, P = 0.006). Serum 1,5-AG was also independently associated with the presence of denovo CAD in patients without diabetes mellitus (0.94, 95% CI 0.88-0.99, P = 0.046). In conclusion, lower serum 1,5-AG was associated with the presence of denovo CAD. Serum 1,5-AG may identify high cardiovascular risk patients for denovo CAD in both diabetic and non-diabetic patients.

Background Although several groups reported the risk factors for slow flow during rotational atherectomy (RA), they did not clearly distinguish modifiable factors, such as burr-to-artery ratio from unmodifiable ones, such as lesion length. The aim of this retrospective study was to investigate the modifiable and unmodifiable factors that were associated with slow flow. Methods We included 513 lesions treated with RA, which were classified into a slow flow group (n = 97) and a non-slow flow group (n = 416) according to the presence or absence of slow flow just after RA. The multivariate logistic regression analysis was performed to find factors associated with slow flow. Results Slow flow was inversely associated with reference diameter [Odds ratio (OR) 0.351, 95% confidence interval (CI) 0.205–0.600, p<0.001], primary RA strategy (OR 0.224, 95% CI 0.097–0.513, p<0.001), short single run (≤15 seconds) (OR 0.458, 95% CI 0.271–0.776, p = 0.004), and systolic blood pressure (BP) ≥ 140 mmHg (OR 0.501, 95% CI 0.297–0.843, p = 0.009). Lesion length (every 5 mm increase: OR 1.193, 95% CI 1.093–1.301, p<0.001), angulation (OR 2.054, 95% CI 1.171–3.601, p = 0.012), halfway RA (OR 2.027, 95% CI 1.130–3.635, p = 0.018), initial burr-to-artery ratio (OR 1.451, 95% CI 1.212–1.737, p<0.001), and use of beta blockers (OR 1.894, 95% CI 1.004–3.573, p = 0.049) were significantly associated with slow flow. Conclusions Slow flow was positively associated with several unmodifiable factors including lesion length and angulation, and inversely associated with reference diameter. In addition, slow flow was positively associated with several modifiable factors including initial burr-to-artery ratio and use of beta blockers, and inversely associated with primary RA strategy, short single run, and systolic blood pressure just before RA. Application of this information could help to improve RA procedures.

Since the number of elderly patients suffering from acute myocardial infarction (AMI) has been increasing in developed countries, primary percutaneous coronary intervention (PCI) for the very elderly aged " 80 years old is already common. The study aimed to examine the determinants of in-hospital death among the very elderly with AMI in current PCI era. We included 412 consecutive AMI patients aged "80 years old who received PCI to the culprit lesion; however, 42 patients (10.2%) died during the index hospitalization. Thus, univariate and multivariate logistic regression analyses were performed to identify the determinants of in-hospital death. Of note, the modified KATZ index, which is a seven-point scale ranging from 0 to 6 (0 point indicating no dependence and six points indicating full dependence), was calculated to evaluate pre-admission activity of daily living (ADL). In multivariate analysis, cardiac arrest (

Objectives This study aimed to compare the mid-term clinical outcomes of intravascular ultrasound (IVUS)-calcified nodules between percutaneous coronary intervention (PCI) with and without rotational atherectomy (RA). Background There has been a debate whether to use RA for the revascularization of calcified nodule. Although RA can ablate the calcified structure within calcified nodule and may facilitate adequate stent expansion, RA may provoke severe coronary perforation, because calcified nodule typically shows eccentric calcification. Methods We included 204 lesions with IVUS-calcified nodule, and divided into 73 lesions treated with RA (RA group) and 131 lesions without RA (non-RA group). After propensity-score matching, 42 lesions with RA (matched RA group) and 42 lesions without RA (matched non-RA group) were selected. We compared the clinical characteristics and outcomes between the 2 groups before and after propensity-score matching. The primary endpoint was ischemia-driven target vessel revascularization (TVR) within 1 year. Results Acute lumen area gain on IVUS was comparable between the matched RA group and matched non-RA group (3.9 ± 2.1 mm2 vs. 3.4 ± 1.6 mm2, p = 0.18). The stent malapposition at calcified nodules was frequently observed in both groups. The ischemia-driven TVR was not different between the 2 groups before (p = 0.82) and after propensity score-matching (p = 0.87). Conclusions The use of RA could not reduce the incidence of ischemia-driven TVR in lesions with IVUS-calcified nodule. Our results do not support the routine use of RA for lesions with IVUS-calcified nodule.