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Reverse redistribution (RR) of technetium99m tetrofosmin (TF) in patients with acute myocardial infarction (AMI) has been considered a sign of salvaged myocardium. We examined the time evolution of the RR pattern during a 6-month period and the clinical implications of RR. TF myocardial SPET was performed in 22 patients 1 week, 1 month and 3-6 months after AMI. Myocardial images were obtained 30 min and 180 min after the injection of TF. Regional uptake of TF was rated using a four-point scoring system. RR was defined as an increase of more than 1 point in the regional score on images obtained at 180 min. Echocardiography was performed to assess regional wall motion at the same time as TF imaging. RR observed at 1 week tended to disappear after 1 month and 3-6 months. The incidence of regional wall motion abnormality was reduced in patients with RR compared with that in patients with fixed defects. Recovery of abnormal regional wall motion occurred earlier in segments with disappearance of RR than in those without disappearance of RR. It is concluded that RR may reflect salvaged myocardium and that disappearance of RR may indicate earlier recovery of salvaged myocardium. [ABSTRACT FROM AUTHOR]

Objective: The predictors of in-hospital outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated with heart failure or cardiogenic shock at presentation remain unclear., Methods: Using the AMI-Kyoto Multi-Center Risk Study database, the clinical background characteristics, angiographic findings, primary PCI results, and in-hospital prognoses were retrospectively compared between primary PCI-treated AMI patients with a Killip class status of ≥2 (Killip 2-4 patients, n=390) and those with a Killip class 1 status (Killip 1 patients, n=1,057)., Results: The Killip 2-4 patients were more likely to have a higher age and proportion of women and exhibited a higher prevalence of previous myocardial infarction, diabetes mellitus and chronic kidney disease or anemia on admission, lower systolic blood pressure (SBP) values on admission, a higher rate of multivessels or left main trunk as the culprit artery, a larger number of diseased vessels, a lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery (IRA) before/after primary PCI and a significantly higher in-hospital mortality rate than the Killip 1 patients. According to a multivariate analysis, age was found to be an independent positive predictor of in-hospital mortality, while admission SBP was an independent positive predictor of in-hospital survival in both groups. In contrast, anemia on admission was found to be an independent predictor of in-hospital death, while the TIMI 3 flow in the IRA after PCI was found to be an independent factor for survival in the Killip 2-4 patients, but not the Killip 1 patients., Conclusion: Anemia on admission and the final TIMI 3 flow in the IRA are critical determinants of in-hospital death in AMI patients with a Killip class status of ≥2 undergoing primary PCI.

Cardiorenal anemia syndrome has recently been receiving greater attention; however, data regarding the relationship between chronic kidney disease (CKD)/anemia on presentation and in-hospital outcome in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are still limited in Japan.A total of 1,447 primary PCI-treated AMI patients were classified into 4 groups according to the presence of CKD and/or anemia on hospital admission (with CKD/with anemia n = 222, with CKD/without anemia n = 299, without CKD/with anemia n = 151, without CKD/without anemia n = 775). Angiographic acute results of primary PCI were similar among the 4 groups. The patients with CKD had a significantly higher in-hospital overall mortality rate than the patients without CKD, and in the presence or absence of CKD, patients with anemia tended to have a higher in-hospital mortality rate than the patients without anemia. According to a multivariate analysis, anemia on admission was found to be an independent predictor of in-hospital mortality, whereas admission CKD and admission eGFR were statistically not independent predictors. Moreover, the multivariable adjusted odds ratio of in-hospital death in AMI patients with CKD alone was 1.855 (95% CI 0.929-3.706), and that in AMI patients with CKD/with anemia was 3.384 (95% CI 1.697-6.748).These results suggest that among real-world, unselected Japanese AMI patients undergoing primary PCI, the combination of CKD and anemia on admission confers significant adverse effects on in-hospital mortality.

Background: Downsized devices for less invasive endovascular treatment are gaining more attention., Case Report: An 82-year-old woman was admitted to our hospital with pain and swelling in left lower extremity. Ultrasonography showed much thrombus at the left common femoral, superficial femoral, and popliteal veins, confirming a diagnosis of acute deep vein thrombosis (DVT). For lack of therapeutic effect of systemically administered anticoagulative and thrombolytic agents, we performed catheter intervention against DVT. After insertion of a 4.5 French guiding sheath (Parent Plus, Medikit, Tokyo, Japan) into left popliteal vein, venography showed a total occlusion of the common femoral vein. Even after thrombectomy by aspiration catheter, balloon dilation, and catheter-induced thrombolysis, severe stenosis at the proximal site of the left common iliac vein remained. After confirming the presence of iliac vein compression syndrome (IVCS) by intravascular ultrasound imaging, we successfully implanted a Zilver ® stent (Cook Inc., Bloomington, IN, USA) in the common-external iliac vein through a 4.5 French guiding sheath, leading to an optimal venous-return flow., Conclusions: The present case suggests that in addition to thrombus aspiration, Zilver stent implantation using a 4.5 French guiding sheath has the potential to serve as a minimally invasive strategy for the treatment of IVCS complicated with iliofemoral DVT.< Learning objective: During the interventional treatment of deep vein thrombosis, we should pay attention to procedure-related venous valve dysfunction in addition to bleeding complications and pulmonary embolism. From the point of view, downsized catheter devices might have some advantage with lesser prevalence of those complications.>.

Background: Predictors of in-hospital outcome after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) requiring mechanical support devices such as intra-aortic balloon pumping (IABP) and/or percutaneous cardiopulmonary support (PCPS) remain unclear., Methods and Results: Using the AMI-Kyoto Multi-Center Risk Study database, clinical background, angiographic findings, results of primary PCI, and in-hospital prognosis were retrospectively compared between primary PCI-treated AMI patients requiring mechanical assist devices (with-IABP/PCPS patients, n=275) and those without (without-IABP/PCPS patients, n=1,510). The with-IABP/PCPS patients were more likely to have a larger number of diseased vessels, lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery (IRA) before/after primary PCI, and a significantly higher in-hospital mortality rate than the without-IABP/PCPS patients. On multivariate analysis, the number of diseased vessels > or =2 or diseased left main trunk (LMT) at initial coronary angiography (CAG) was the independent positive predictor of the in-hospital mortality in the with-IABP/PCPS patients, not in the without-IABP/PCPS patients, whereas acquisition of TIMI 3 flow in the IRA immediately after primary PCI was the negative predictor in the without-IABP/PCPS patients, not in the with-IABP/PCPS patients., Conclusions: The number of diseased vessels > or =2 or diseased LMT at initial CAG is an independent risk factor of in-hospital death in primary PCI-treated AMI patients requiring mechanical support devices.

Background: Recurrent acute myocardial infarction (AMI) is a deteriorated condition with high in-hospital morbidity and mortality, but the predictors of in-hospital outcome after primary percutaneous coronary intervention (PCI) for repeat AMI remain unclear., Methods and Results: Using the AMI-Kyoto Multi-Center Risk Study database, clinical background, angiographic findings, results of primary PCI, and in-hospital prognosis were retrospectively compared between primary PCI-treated AMI patients with previous myocardial infarction (MI) (repeat-MI patients, n=235) and those without previous MI (first-MI patients, n=1,550). The repeat-MI patients had higher prevalence of Killip class>or=3 at admission, larger number of diseased vessels, and a significantly higher in-hospital mortality rate than the first-MI patients. On multivariate analysis, number of diseased vessels>or=2 or diseased left main trunk (LMT) on initial coronary angiography was the independent positive predictor of in-hospital mortality in the repeat-MI patients, not in the first-MI patients, whereas acquisition of Thrombolysis In Myocardial Infarction 3 flow in the infarct-related artery immediately after primary PCI and elapsed time<24 h were the negative predictors in the first-MI patients, not in the repeat-MI patients., Conclusions: Number of diseased vessels>or=2 or diseased LMT on initial coronary angiography is an independent risk factor of in-hospital death in recurrent-AMI patients undergoing primary PCI.

Background: Several clinical studies have demonstrated an inverse relationship between hospital volume of primary percutaneous coronary interventions (PCI) and in-hospital mortality. However, the relationships among hospital primary PCI volume, angiographic results, and in-hospital prognosis in patients with acute myocardial infarction (AMI) have not been fully investigated in Japan., Methods and Results: Using the AMI-Kyoto Multi-Center Risk Study database between January 2000 and December 2005, hospitals were classified into quintiles based on their annual volume of primary PCI. The fifth quintile of hospitals was labeled as high-volume, and the other quintiles were combined and defined as low-volume. Although patients undergoing primary PCI in high-volume hospitals (high-volume group, n=764) had a larger number of diseased vessels at initial coronary angiography and lower Thrombolysis In Myocardial Infarction (TIMI) flow grade in the infarct-related artery before PCI, compared with those in low-volume hospitals (low-volume group, n=1,021), the rates of achieving TIMI flow grade 3 just after PCI in the high-volume group was significantly higher than that in the low-volume group. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class >or=3 at admission, multivessel disease or left main trunk (LMT) as culprit lesion, number of diseased vessels >or=2 or diseased LMT, and age were the independent positive predictors of in-hospital mortality, whereas the TIMI flow grade 3 after primary PCI and elapsed time <24 h were the negative ones, but not low-volume hospital., Conclusions: Angiographic results of primary PCI in high-volume hospitals were superior to those in low-volume hospitals, but there was no significant difference in the in-hospital mortality between AMI patients in high-volume hospitals and those in low-volume hospitals.

This unusual case of Takayasu arteritis presenting as acute myocardial infarction could be defined by ultrasonography and 18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) coregistered with computed tomography (CT). A 55-year-old male was admitted to our hospital with continuous chest pain and left-side neck pain. After primary percutaneous coronary intervention, elevation of inflammatory markers persisted and dull pain in the left side of the neck continued. Ultrasonography revealed characteristic wall thickening of the left common carotid artery and subsequent 18F-FDG PET with CT depicted positive uptake in the left common carotid artery and the vessel wall of the ascending aorta, confirming the diagnosis of Takayasu arteritis. Three months after angioplasty, follow-up cardiac catheterization was performed. Coronary angiography showed no restenosis. During the catheterization, angiography confirmed the mild stenosis in the long segment of the left common carotid artery and the left subclavian artery as well as the focal narrowing and the dilation of the abdominal aorta. This case shows that ultrasonography in the cervical region and combined 18F-FDG PET with CT may be useful in the diagnosis and evaluation of Takayasu arteritis. In addition, we should pay attention to underlying disease even in middle-aged or older male patients with acute myocardial infarction.

Background: Obesity is an established risk factor for coronary heart disease. However, data on the relationship between obesity and prognosis following acute myocardial infarction (AMI) are still lacking in Japan., Methods and Results: In the present study, 1,458 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2003. Among survivors of hospitalized AMI, clinical characteristics and medium-term prognosis were retrospectively compared between 240 normal weight male patients [body mass index (BMI) 18.5-25.0 kg/m2, normal weight group], and 116 obese male patients (BMI > or = 25.0 kg/m2, obese group), who could be followed up after hospital discharge. The obese group were younger and had higher prevalence of smoking and hypercholesterolemia than the normal weight group. The two groups had similar angiographic findings and outcomes of primary percutaneous coronary intervention. During the follow-up period (mean 2.18 years for normal weight, 2.15 years for obese), overall mortality rate as well as event-free survival rate did not differ significantly between the two groups. Multivariate analysis showed the presence of previous myocardial infarction, diabetes mellitus, and age were predictors of medium-term mortality, but BMI was not., Conclusions: These results suggest that obesity is not associated with increased medium-term mortality and cardiac morbidity in Japanese male survivors hospitalized for AMI.

Background: Primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is performed in hospitals without on-site coronary artery bypass graft surgery in the ;real world'. However, data on the in-hospital outcomes of primary PCI performed at hospitals with and without on-site cardiac surgery are still lacking in Japan., Methods and Results: In the present study, 2,230 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2005. Of these, 1,817 patients underwent primary PCI. Excluding patients without adequate data, we retrospectively compared clinical background, coronary risk factors, angiographic findings, acute results of primary PCI and in-hospital prognosis between patients undergoing primary PCI in hospitals without on-site cardiac surgery (without surgery group, n=792) and those in hospitals with (with surgery group, n=993). The without surgery group had higher prevalence of previous myocardial infarction, Killip class>or=3 at admission and multivessels as a culprit lesion than the with surgery group. The without surgery group was more likely to have lower frequency of stent usage and lower thrombolysis in myocardial infarction flow grade just after PCI, whereas it was more likely to have intra-aortic balloon pumping and temporary pacing during procedures. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class>or=3 at admission, multivessels or left main trunk (LMT) as culprit lesions, number of diseased vessels>or=2 or diseased LMT, and age were the independent predictors of the in-hospital mortality, but the presence of on-site cardiac surgery was not., Conclusions: These results suggest that in-hospital outcomes in AMI patients undergoing primary PCI at hospitals without on-site cardiac surgery are comparable to those at hospitals with on-site cardiac surgery in Japan.

Objectives: Obesity may be linked with coronary atherosclerosis in young males. This study investigated the etiology of acute myocardial infarction (AMI) in young Japanese male patients with or without obesity., Methods and Results: This retrospective study included 2,230 AMI patients enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2005. Clinical background, risk factors, angiographic findings, acute results of primary percutaneous coronary intervention (PCI), and in-hospital outcome were evaluated in 33 young male patients < 40 years old. The study group was divided into the obese group [body mass index (BMI) > or =25, n=21] and non-obese group (BMI < 25, n=12). Four of the 12 non-obese patients had underlying disease (Kawasaki disease 2, Buerger's disease 1, drug abuse 1). The non-obese group had a higher prevalence of underlying disease than the obese group. The non-obese group had a higher incidence of left anterior descending coronary artery as culprit lesion and higher Thrombolysis in Myocardial Infarction (TIMI) grade flow in the infarct-related artery before primary PCI. The acquisition rates of TIMI 3 flow after primary PCI and in-hospital outcome did not differ between the two groups., Conclusions: Non-obese young AMI male patients have a higher frequency of underlying disease. Most young male AMI patients were obese, suggesting that obesity may be important in the pathogenesis of AMI in young male adults.