In Japanese ISCAD patients with AMI, aspirin and β-blocker use were associated with lower in-hospital mortality, while primary PCI did not reduce mortality.
Does the use of aspirin, beta-blockers, or primary PCI improve in-hospital mortality in Japanese patients with AMI attributable to ISCAD?
In Japanese patients with AMI due to ISCAD, in-hospital mortality is similar to non-ISCAD AMI, and medical therapy with aspirin and beta-blockers is associated with lower mortality.
Absolute Event Rate: 0% vs 0%
Abstract Background Idiopathic spontaneous coronary artery dissection (ISCAD) is a non-atherosclerotic, non-traumatic, and non-iatrogenic cause of acute myocardial infarction. Due to limited understanding and data about ISCAD, clinical characteristics and cardiovascular outcomes of patients with ISCAD remain to be fully determined. In addition, appropriate therapeutic management has not yet been fully established. The Japanese Registry of All Cardiac and Vascular Diseases (JROAD)–DPC database is a nationwide database that collects DPC data in Japanese patients with cardiovascular disease. This database provided an important opportunity to characterize Japanese patients with ISCAD. Purpose To elucidate clinical characteristics, mortality and effective management in Japanese patients with ISCAD. Methods The current study selected ISCAD patients aged ≦60 years who were hospitalized due to AMI by using the JROAD-DPC database (April 1, 2012 – March 31, 2022). We identified potential candidates for ISCAD according to ICD-10 code=I24.8. Then, those having a keyword (=dissection) in any diagnosis fields of "main diagnosis", "admission-precipitating diagnosis", and/or "coexisting comorbidities on admission" were selected. Of these, ISCAD patients who were admitted urgently and received coronary angiography were analyzed and compared with those without ISCAD. Clinical demographics and in-hospital all-cause mortality were compared between those with and without ISCAD. Results Of 96,304 AMI patients in the JROAD-DPC database, 0.34% of them were identified as ISCAD. Patients with ISCAD were more likely to be younger (mean 47.6 years vs. 51.5 years, p0.001) and female (82.7 % vs. 10.0 %, p0.001) with a lower frequency of atherogenic risk factors (hypertension: 58.5 %, vs. 67.3 %, p0.001, type 2 diabetes mellitus: 5.5 % vs. 30.4 %, p0.001, Dyslipidemia: 51.5 % vs. 73.4 %, p0.001). Furthermore, the guideline-recommended therapies were less frequently used in ISCAD patients (Table). Under these in-hospital management, age, sex matched analysis as well as propensity-matching analysis demonstrated that in-hospital mortality did not differ between the two groups (Figure 1). Further analysis was conducted to evaluate the efficacy of medical therapies and primary PCI on all-cause death in patients with ISCAD. As shown in Figure 2, after adjusting clinical characteristics, the use of aspirin (0 % vs. 3.8 %, p=0.002) and β-blocker (0 % vs. 2.4 %, p=0.026) were associated with lower all-cause mortality, whereas primary PCI did not necessarily lower mortality (Figure 2). Conclusion Despite the less atherogenic features of ISCAD, their in-hospital mortality did not differ from AMI patients with atherosclerotic causes. A lower all-cause mortality was observed in ISCAD patients who received aspirin and β-blocker, respectively. These observations support the clinical importance of selecting appropriate medical therapies for improving the cardiovascular outcomes of ISCAD.
Wayama et al. (Sat,) reported a other. In Japanese ISCAD patients with AMI, aspirin and β-blocker use were associated with lower in-hospital mortality, while primary PCI did not reduce mortality.