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Purpose: Several studies have reported gender difference in presentation, management and outcome in patients with acute myocardial infarction (AMI). In this study, we focused the impact of age on gender difference in mortality after AMI. Methods: Between July 2012 and March 2014, 3283 patients were admitted to the 28 hospitals participating to the J-MINUET group within 48 hours after the onset of AMI. AMI was diagnosed by universal definition (type 1 or type 2). Patients were divided into 5 strata according to their age: those with age Results: There were 813 women (24.8%). Women were significantly older than men (74.5±11.8 years vs 66.6±12.3 years, P Conclusions: Women had higher in-hospital mortality than men after AMI even in the contemporary troponin era. However, their high mortality was mostly explained by their advanced age.

Background: Previous study showed that number of yellow plaque in a coronary artery was associated with future risk of acute coronary syndrome. However, impact of intrastent yellow plaque has not fully understood. Purpose: This study was investigated to assess the association of the grade of intrastent yellow plaque observed by coronary angioscopy at late phase after drug-eluting stents (DES) implantation and clinical outcome. Methods: This study consisted of 97 patients tread with DES implantation (39 patients with sirolimus-eluting stents ; 9 patients with paclitaxel-eluting stents; 24 patients with everolimus-eluting stents; 6 patients with zotalolimus-eluting stents; 19 patients with biolimus-eluting stents ). Coronary angioscopy was performed 8 months after DES implantation. The plaque color at stent segment was grade as 0 (white), 1 (light yellow), 2 (yellow), 3 (bright yellow). The maximum color grade of the plaques in stent segment was assessed. We divided these patients into 2 groups (53 patients with yellow plaque grade 2 or 3; 44 patients with yellow plaque grade 0 or 1). We evaluated the incidence of revascularization, such as percutaneous coronary intervention or coronary artery bypass graft. Results: Kaplan-Meier curves for 7-year Revascularization free rate are shown in Figure. Revascularization free rate was tend to be higher in patients with yellow grade 0/1 than those with yellow grade 2/3. Conclusion: The presence of intrastent yellow plaque at late phase after stent implantation might be associated with the future revascularization in coronary artery disease.

Several studies have shown that both chronic kidney disease (CKD) and diabetes mellitus are risk factors for mortality in patients with acute myocardial infarction (AMI). This study was undertaken to investigate influence of CKD on the prognostic significance of diabetes in patients with AMI. Between January 1996 and December 2005, 888 patients with AMI underwent coronary angiography within 24 hours after the onset of chest pain. CKD was difined estimated glomerular filtration rate (eGFR) of less than 60.0 ml/minute/1.73 m 2 of body-surface area (stage3–5). Kaplan-Meier method was used to compare 5-year survival of diabetic and non-diabetic patients, in the presence (n=337) or absence (n=551). Kaplan-Meier curves for 5-year survival rate are shown in Figure . In the absence of CKD, there was no significant difference in 5-year survival rate between patients with diabetes and those without (93 % v.s. 94 %, p=0.82). In patients with CKD, however, diabetes was associated with lower 5-year survival rate (65 % v.s. 87 %, p

Background: Sirolimus-Eluting Stent (SES) is effective in reducing restenosis. Although several studies have reported the usefulness of SES in patients with acute myocardial infarction (AMI), the current major concerns of the use of SES in AMI are over-suppression of neointimal formation and late thrombosis. Coronary angioscopic examination provides an opportunity to assess neointimal coverage over stent and adherent thrombus in patients. Method: This study consisted of 18 patients who underwent primary angioplasty with SES for AMI. A mean average of 7.6 ± 2.5 months after SES implantation, coronary angioscopic examination was performed. Neointimal coverage of the SES was assessed by the grading as: grade 0 = complete exposure of the stent struts, grade 1 = dull light reflex from stent struts, grade 2 = no light reflex, but slightly visible stent struts, and grade 3 = complete coverage. Because the grade of neointimal coverage may vary from struts to struts, both maximum and minimum grade of neointimal coverage were assessed. The presence of thrombus was also evaluated. Results: All but one patient had at least 2 different grades of neointimal coverage; one patient had only grade 0. When the maximum grade of neointimal coverage was assessed, grade 0 was observed in 1 patient, grade 1 in 4 patients, grade 2 in 8 patients, and grade 3 in 5 patients. As to minimum grade, grade 0 was observed in 11 patients and grade 1 in 7 patients, however, grade 2 and 3 was not observed. Thrombus adherent to uncovered stent struts (grade 0 or 1) was observed in 8 patients (44%). Conclusion: The process of neointimal coverage over SES was heterogeneous. Even 7 months after SES implantation for AMI, most of the stent struts were not covered by neointimal with high incidence of adherent thrombus. Long-term aggressive anti-platelet therapy should be advocated for patients with AMI who were treated with SES.