Nationwide real-world database of 20,462 patients enrolled in the Japanese Acute Myocardial Infarction Registry (JAMIR): Impact of emergency coronary intervention in a super-aging population

Abstract

BackgroundCardiovascular diseases, including acute myocardial infarction (AMI), are leading causes of death among the Japanese, who have the longest life expectancy in the world. Over the past 50 years in Japan, the percentage of elderly individuals has increased 4-fold, from 5.7% in 1960 to 23.1% in 2010. To explore medical practices and emergency care for AMI in this aging society, the Japan Acute Myocardial Infarction Registry (JAMIR) was established as a nationwide real-world database.MethodsJAMIR conducted retrospective analysis of 20,462 AMI patients (mean age, 68.8 ± 13.3 years; 15,281 men [74.7%]) hospitalized between January 2011 and December 2013.ResultsThe rates of ambulance use and emergency PCI were 78.9% and 87.9%, respectively. The median door-to-balloon time was 80 min (interquartile range, 53–143 min). Overall in-hospital mortality was 8.3%, including 6.6% due to cardiac death. JAMIR included 4837 patients aged ≥80 years (23.6%). In this age group, patients who underwent PCI (79.9%) had significantly lower in-hospital mortality than those who did not (11.1% vs. 36.9%, P < 0.001).ConclusionsThe large JAMIR database, with 24% of AMI patients aged ≥80 years, could provide useful information about medical care in an aging society. The reasonable in-hospital outcomes observed may justify consideration of PCI for patients with AMI aged ≥80 years.

Comparison of Real-Life Systems of Care for ST-Segment Elevation Myocardial Infarction

“…The percentage of patients who admitted to the hospitals by self-transportation was 18.3%. The overall in-hospital mortality was 8.3% [ 51 ].…”

Building a Longitudinal National Integrated Cardiovascular Database ― Lessons Learnt From SingCLOUD ―

“…In Asia, the Korean Acute Myocardial Infarction Registry (KAMIR) and the Japanese Acute Myocardial Infarction Registry (JAMIR) and JROAD registry are MI and cardiovascular registries, but they capture data only from contributing centers and do not track outpatient data in a systematic manner. [11][12][13] In contrast, SingCLOUD extracts data from all public hospitals and from MOH, tracks outcomes across all public primary care sites clinics, and includes clinical, laboratory, prescription, administrative and financial data over time. Even data from private hospitals are captured if claims to the Ministry are submitted.…”

Clinical Characteristics and In-Hospital Mortality According to Left Main and Non-Left Main Culprit Lesions ― Report From the Japan Acute Myocardial Infarction Registry (JAMIR) ―

“…The aims and protocols of this registry have been published elsewhere. 6 Initially, 20,596 consecutive patients with type 1 myocardial infarction (MI) who were hospitalized ≤24 h after MI onset between January 2011 and December 2013 were enrolled. ACS was diagnosed according to the universal definition of MI proposed by the Joint European Society of Cardiology/American Heart Association/World Heart Federation Task Force.…”

“…Therefore, to better understand the current status of revascularization strategies, we analyzed the clinical characteristics, in-hospital outcomes, and impact of primary PCI on in-hospital mortality in patients with ACS due to an unprotected LMCA lesion in the Japan Acute Myocardial Infarction Registry (JAMIR), a nationwide, real-world database of patients with ACS in Japan. 6 A cute coronary syndrome (ACS) involving occlusion of the unprotected left main coronary artery (LMCA) is a critical condition, often leading to abrupt and severe circulatory failure, lethal arrhythmia, and sudden cardiac death. [1][2][3] Percutaneous coronary intervention (PCI) is advantageous in that it achieves rapid reperfusion in critically ill patients.…”

“…6 Clinical characteristics in the JAMIR study were similar to those in a Japanese nationwide claim-based database, suggesting that the JAMIR data closely reflect the status of current ACS patients in Japan. 6,9 This large-scale registry enables the assessment of real-world medical practices and emergency care in patients with LMCA ACS. ACS due to an unprotected LMCA lesion is a critical condition characterized by a high risk of cardiogenic shock mortality was significantly higher in patients with LMCA ACS than in those with non-LMCA ACS; (3) primary PCI for an unprotected LMCA culprit lesion was more frequently performed in high-risk populations (e.g., elderly, STEMI, or patients with Killip class 4) but was not closely related to better in-hospital outcome; and (4) Killip class 4 and final TIMI grade <3 were independent predictors of in-hospital mortality in patients with LMCA ACS after primary PCI.…”