In-Hospital Mortality in Acute Myocardial Infarction According to Population Density and Primary Angioplasty Procedures Volume

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  • Matsuzawa Yasushi
    Division of Cardiology, Yokohama City University Medical Center
  • Konishi Masaaki
    Division of Cardiology, Yokohama City University Medical Center
  • Nakai Michikazu
    Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
  • Saigusa Yusuke
    Department of Biostatistics, Yokohama City University
  • Taguri Masataka
    Department of Data Science, School of Data Science, Yokohama City University
  • Gohbara Masaomi
    Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
  • Ebina Toshiaki
    Division of Cardiology, Yokohama City University Medical Center
  • Kosuge Masami
    Division of Cardiology, Yokohama City University Medical Center
  • Hibi Kiyoshi
    Division of Cardiology, Yokohama City University Medical Center
  • Nishimura Kunihiro
    Preventive Medicine and Epidemiology Informatics, National Cerebral and Cardiovascular Center
  • Miyamoto Yoshihiro
    Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
  • Yasuda Satoshi
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Ogawa Hisao
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Saito Yoshihiko
    Department of Cardiovascular Medicine, Nara Medical University
  • Nakayama Naoki
    Department of Emergency Medicine, Yokohama City University Medical Center
  • Takeuchi Ichiro
    Department of Emergency Medicine, Yokohama City University Medical Center
  • Tamura Kouichi
    Department of Data Science, School of Data Science, Yokohama City University
  • Kimura Kazuo
    Division of Cardiology, Yokohama City University Medical Center

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<p>Background:Low population density may be associated with high mortality in acute myocardial infarction (AMI) patients. The purpose of this study was to investigate the effect of population density and hospital primary percutaneous coronary intervention (PCI) volume on AMI in-hospital mortality in Japan.</p><p>Methods and Results:This is a retrospective study of 64,414 AMI patients transported to hospital by ambulances. The main outcome measure was in-hospital mortality. The median population density was 1,147 (interquartile range, 342–5,210) persons/km2. There was a significant negative relationship between population density and in-hospital mortality (OR for a quartile down in population density 1.086, 95% CI 1.042–1.132, P<0.001). Patients in less densely populated areas were more often transported to hospitals with a lower primary PCI volume, and they had a longer distance to travel. By using multivariable analysis, primary PCI volume was found to be significantly associated with in-hospital mortality, but distance to hospital was not. When divided into the low- and high-volume hospitals, using the cut-off value of 115 annual primary PCI procedures, the increase in in-hospital mortality associated with low population density was observed only in patients hospitalized in the low-volume hospitals.</p><p>Conclusions:Increased in-hospital mortality related to low population density was observed only in AMI patients who were transported to the low primary PCI volume hospitals, but not in those who were transported to high-volume hospitals.</p>

収録刊行物

  • Circulation Journal

    Circulation Journal 84 (7), 1140-1146, 2020-06-25

    一般社団法人 日本循環器学会

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