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There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI.Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed.Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMIAIS; for EMS use, AMIAIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI; additionally, age (65-74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI.Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

Introduction: Although a plaque damage such as rupture is quite commonly observed, catastrophic event with clinical symptoms is not common in real practice. Hypothesis: Hypercoagulability and impaired fibrinolysis can be associated with the risk of coronary thrombosis and long-term clinical prognosis in patients with coronary artery disease (CAD). Methods: CAD patients who underwent percutaneous coronary intervention (PCI) (n=2,705) were enrolled (presented with acute myocardial infarction [AMI], 47.8%). Global hemostatic properties were evaluated with thromboelastographic assay (TEG ® ) showing hypercoagulability (maximal amplitude [MA]: platelet-fibrin clot strength) and impaired fibrinolysis (LY 30 : percent lysis 30 minutes after maximal clot strength). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, myocardial infarction, or stroke. Results: Patients presented with AMI showed higher MA (66.5±7.8 vs. 65.3±7.2 mm, P30 levels (1.0±2.5% vs. 1.2±2.2%, P=0.009) compared with non-AMI patients. Combined criteria of ‘MA≥68 mm’ and ‘LY 30 30 30 30 ≥0.2%’ (adjusted HR 1.863, 95% CI 1.191-2.913, P=0.006) (Figure 1). Subgroup analysis showed that this trend was consistent irrespective of baseline demographics and lesional characteristics. Conclusions: Hypercoagulability and impaired fibrinolysis were more frequently observed in AMI patients. In addition, these properties were significantly associated with post-PCI clinical prognosis.