Document Detail


Current antiplatelet therapy for Japanese patients with ST elevation acute myocardial infarction: J-AMI registry.
MedLine Citation:
PMID:  23233418     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Antiplatelet therapy could prevent stent thrombosis, but may be associated with an increased risk of bleeding. Recent studies have revealed that bleeding complications are relatively frequent in patients with acute coronary syndromes. Our aim was to describe the current status of antiplatelet therapy for Japanese patients with acute myocardial infarction (AMI). The Japan AMI (J-AMI) registry is a prospective observational study that has enrolled 2,030 consecutive patients with stent thrombosis elevation myocardial infarction (STEMI) admitted to 213 participating Japanese institutions. Current antiplatelet therapy for STEMI was assessed, and the occurrence of bleeding complications (based on GUSTO bleeding criteria) and stent thrombosis was also evaluated. Additionally, the clinical course after bleeding episodes was investigated. Percutaneous coronary intervention (PCI) was done in 97.2% of the patients, using a drug-eluting stent in 30% and a bare metal stent in 63% of PCI cases. A 300-mg loading dose of clopidogrel followed by its administration at 75 mg/day with aspirin was the current standard treatment for Japanese STEMI patients. In-hospital bleeding complications occurred in 1.9%, especially in patients with severe clinical features or a history of cerebrovascular disease. Moderate to severe bleeding complications were associated with 10 deaths. The in-hospital stent thrombosis (ST) rate was 1.47 %, and loading with clopidogrel prior to PCI was significantly less frequent in patients who developed ST (P < 0.001). In conclusion, the J-AMI registry revealed that severe symptoms of STEMI increased the risk of bleeding, while delay of clopidogrel loading was associated with ST. These findings suggest the need for treatment based on risk stratification to improve the balance between the beneficial and adverse effects of antiplatelet therapy in Japanese STEMI patients.
Authors:
Masato Nakamura; Masakazu Yamagishi; Takafumi Ueno; Kazuhiro Hara; Sugao Ishiwata; Tomonori Itoh; Ichiro Hamanaka; Tetsuzo Wakatsuki; Tetuszo Wakatsuki; Teruyasu Sugano; Kazuya Kawai; Takeshi Kimura
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2012-12-13
Journal Detail:
Title:  Cardiovascular intervention and therapeutics     Volume:  28     ISSN:  1868-4297     ISO Abbreviation:  Cardiovasc Interv Ther     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-08     Completed Date:  2013-11-14     Revised Date:  2013-11-15    
Medline Journal Info:
Nlm Unique ID:  101522043     Medline TA:  Cardiovasc Interv Ther     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  162-9     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Medicine, Toho University School of Medicine, Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan. masato@oha.toho-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aspirin / therapeutic use
Coronary Thrombosis / drug therapy,  epidemiology
Drug Therapy, Combination
Female
Humans
Incidence
Japan / epidemiology
Male
Middle Aged
Myocardial Infarction / drug therapy*,  mortality
Percutaneous Coronary Intervention*
Platelet Aggregation Inhibitors / therapeutic use*
Postoperative Hemorrhage / drug therapy*,  epidemiology
Preoperative Care
Prospective Studies
Registries
Risk Factors
Stents
Ticlopidine / analogs & derivatives*,  therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; A74586SNO7/clopidogrel
Comments/Corrections
Erratum In:
Cardiovasc Interv Ther. 2013 Oct;28(4):426
Note: Wakatsuki, Tetuszo [corrected to Wakatsuki, Tetsuzo]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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