Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation　― The J-MINUET Study ―

Ishihara, Masaharu; Nakao, Kōichi; Kimura, Kazuo; Ako, Junya; Noguchi, Teruo; Fujino, Masashi; Yasuda, Satoshi; Suwa, Satoru; Fujimoto, Kazuteru; Nakama, Yasuharu; Morita, Takashi; Shimizu, Wataru; Saito, Yoshihiko; Hirohata, Atsushi; Morita, Yasuhiro; Inoue, Teruo; Okamura, Atsunori; Uematsu, Masaaki; Hirata, Kazuhito; Tanabe, Kengo; Shibata, Yoshisato; Owa, Mafumi; Tsujita, Kenichi; Funayama, Hiroshi; Kokubu, Nobuaki; Kozuma, Ken; Tobaru, Tetsuya; Nakai, Michikazu; Nishimura, Kunihiro; Miyamoto, Yoshihiro; Ogawa, Hisao

doi:10.1253/circj.cj-17-0033

Cited by 44 publications

(60 citation statements)

References 23 publications

(13 reference statements)

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“…2 We consider that the model used in the present study, which is based on meta-analysis and the J-MINUET study (Japan's largest registry), is the optimal model. 2, 15 We performed several scenario analyses to compensate for model assumptions. In the scenario analyses, even if the effect of PCI, the observation period, and patient age was changed, PCI remained cost-effective over medical therapy.…”

Section: Discussionmentioning

confidence: 99%

“…For the STEMI model, cardiovascular event rates in the PCI group and medical treatment group were estimated based on the Japan registry of acute Myocardial Infarction diagnosed by Universal dEfiniTion (J-MINUET) study and a meta-analysis. 2, 15 The J-MINUET study is a large-registry study of acute MI (AMI) in Japan. 15 For the AP model, cardiovascular event rates in the PCI…”

Section: Methodsmentioning

confidence: 99%

“…2, 15 The J-MINUET study is a large-registry study of acute MI (AMI) in Japan. 15 For the AP model, cardiovascular event rates in the PCI…”

Section: Methodsmentioning

confidence: 99%

“…The average age of the target patients was 68 years; 77% of patients were men; diabetes mellitus was present in 35% of patients; and single-vessel disease was present in 58% of patients (Table 1). 15 The percentage of patients admitted ≤12 h after onset was 89%. In the PCI group, the door-to-balloon time was ≤90 min.…”

Section: Time Horizonmentioning

confidence: 97%

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Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in Japan

Kodera

Morita

Kiyosue

et al. 2019

Circ J

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Evaluation 2 (FAME 2) trial, a large randomized controlled trial evaluating patients with AP, cardiovascular events were significantly reduced in the fractional flow reserve (FFR)-guided PCI group. 3,4 The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, however, a large randomized controlled trial evaluating patients with AP, showed no difference in cardiovascular events between PCI and medical therapy. 5 The initial PCI method for STEMI differs to that for AP. That is, primary PCI is performed for STEMI patients while FFR-guided PCI is performed for AP patients. Consequently, the cost-effectiveness of PCI should be evaluated separately for STEMI and AP. Variable results have been reported for the cost-effectiveness of PCI over medical treatment for STEMI and AP. 6-14 Many studies showed that PCI in STEMI was cost-effective compared with medical therapy, 6-9 and some studies reported that PCI for AP was cost-effective compared with medical therapy, whereas others reported PCI for AP was not cost-effective. Background:The cost-effectiveness of percutaneous coronary intervention (PCI) for ischemic heart disease is undetermined in Japan. The aim of this study was to analyze the cost-effectiveness of PCI compared with medical therapy for ST-elevation myocardial infarction (STEMI) and angina pectoris (AP) in Japan. Methods and Results:We used Markov models for STEMI and AP to assess the costs and benefits associated with PCI or medical therapy from a health system perspective. We estimated the incremental cost-effectiveness ratio (ICER), expressed as qualityadjusted life-years (QALY), and ICER <¥5 m per QALY gained was judged to be cost-effective. The impact of PCI on cardiovascular events was based on previous publications. In STEMI patients, the ICER of PCI over medical treatment was ¥0.97 m per QALY gained. The cost-effectiveness probability of PCI was 99.9%. In AP patients, the ICER of fractional flow reserve (FFR)-guided PCI over medical treatment was ¥4.63 m per QALY gained. The cost-effectiveness probability of PCI was 50.4%. The ICER of FFR-guided PCI for asymptomatic patients was ¥23 m per QALY gained. Conclusions:In STEMI patients, PCI was cost-effective compared with medical therapy. In AP patients, FFR-guided PCI for symptomatic patients could be cost-effective compared with medical therapy. FFR-guided PCI for asymptomatic patients with myocardial ischemia was not cost-effective.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…2, 15 The J-MINUET study is a large-registry study of acute MI (AMI) in Japan. 15 For the AP model, cardiovascular event rates in the PCI…”

Section: Methodsmentioning

confidence: 99%

Section: Time Horizonmentioning

confidence: 97%

See 2 more Smart Citations

Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in Japan

Kodera

Morita

Kiyosue

et al. 2019

Circ J

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“…In the clinic, MI diagnosis is based on elevated cardiac enzyme levels such as Creatine Phosphokinase and Troponin [2,3] and abnormal electrocardiogram (ECG) features such as ST segment elevation or depression and pathological Q waves [4]. Assessment of MI is commonly performed by single-photon emission computerized tomography, ultrasound imaging, nuclear imaging (radionuclide angiography, perfusion imaging, positron emission tomography), magnetic resonance imaging (MRI), or a combination thereof [5–8].…”

Section: Introductionmentioning

confidence: 99%

Electromechanical wave imaging and electromechanical wave velocity estimation in a large animal model of myocardial infarction

et al. 2017

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Background Echocardiography is often used in the clinic for detection and characterization of myocardial infarction. Electromechanical wave imaging (EWI) is a non-invasive ultrasound-based imaging technique based on time-domain incremental motion and strain estimation that can evaluate changes in contractility in the heart. In this study, electromechanical activation is assessed in infarcted heart to determine whether EWI is capable of detecting and monitoring infarct formation. Additionally, methods for estimating electromechanical wave (EW) velocity are presented, and changes in the EW propagation velocity after infarct formation are studied. Methods and Results Five (n=5) adult mongrels were used in this study. Successful infarct formation was achieved in three animals by ligation of the left anterior descending (LAD) coronary artery. Dogs were survived for a few days after LAD ligation and monitored daily with EWI. At the end of the survival period, dogs were sacrificed and TTC (Tetrazolium chloride) staining confirmed the formation and location of the infarct. In all three dogs, as soon as day 1 EWI was capable of detecting late-activated and non-activated regions, which grew over the next few days. On final day images, the extent of these regions corresponded to the location of infarct as confirmed by staining. EW velocities in border zones of infarct were significantly lower post-infarct formation when compared to baseline, whereas velocities in healthy tissues were not. Conclusions These results indicate that EWI and EW velocity might help with the detection of infarcts and their border zones, which may be useful for characterizing arrhythmogenic substrate.

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Validation study of the modified HEART and HEAR scores in patients with chest pain who visit the emergency department

Otsuka

Takeda

2020

Acute Medicine & Surgery

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Patients aged ≥20 years who presented with non-traumatic and undifferentiated chest pain were eligible for the study. On the basis of the total score, the patients were stratified as low risk (HEART and HEAR scores of 0-3), intermediate risk (HEART and HEAR scores of 4-6), and high risk (HEART score of 7-10 and HEAR score of 7-8). The major adverse cardiac events (MACEs) that occurred within 6 weeks were investigated, and the diagnostic value and efficiency of both scores were analyzed. Results: In total, 132 patients were included in the HEART score analysis and 220 patients in the HEAR score analysis. The incidence rates of MACEs in patients with low, intermediate, and high risks were 0%, 23.2%, and 63.6% in the HEART score analysis and 4.7%, 22.9%, and 62.5% in the HEAR score analysis (P < 0.001), respectively. The identification of MACEs in low-risk patients had a negative predictive value in the HEART score (1.00; 95% confidence interval, 0.90-1.00) and HEAR score (0.95; 95% confidence interval, 0.89-0.99) analyses. Conclusion: The modified HEART and HEAR scores were effective in identifying patients with chest pain who are at low risk of MACEs at an emergency department in Japan.

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Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation　― The J-MINUET Study ―

Cited by 44 publications

References 23 publications

Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in Japan

Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in Japan

Electromechanical wave imaging and electromechanical wave velocity estimation in a large animal model of myocardial infarction

Validation study of the modified HEART and HEAR scores in patients with chest pain who visit the emergency department

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Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation ― The J-MINUET Study ―

Cited by 44 publications

References 23 publications

Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in Japan

Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in Japan

Electromechanical wave imaging and electromechanical wave velocity estimation in a large animal model of myocardial infarction

Validation study of the modified HEART and HEAR scores in patients with chest pain who visit the emergency department

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Product

Resources

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Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation　― The J-MINUET Study ―