Unstable Angina and Non-ST Elevation Acute Coronary Syndrome: Epidemiology and Current Management in Japan (Japan Multicenter Investigation for Cardiovascular Disease-D (JMIC-D) Committee)

• Published in: Circulation Journal 2007, Vol.71(9), pp.1335-1347
• Main Authors: Yui, Yoshiki, Hirayama, Atsushi, Nonogi, Hiroshi, Kimura, Kazuo, Kodama, Kazuhisa, Hosoda, Saichi, Kawai, Chuichi
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - physiopathology; Acute Coronary Syndrome - therapy; Acute coronary syndromes; Angina, Unstable - mortality; Angina, Unstable - physiopathology; Angina, Unstable - therapy; Calcium Channel Blockers - therapeutic use; Epidemiology; Female; Humans; Incidence; Japan - epidemiology; Male; Myocardial Revascularization; Non-ST elevation; Surveys and Questionnaires; Time Factors; Treatment Outcome; Unstable angina
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.71.1335

Background A multicenter study was conducted to assess the current medical management of unstable angina (UA) and non-ST-elevation acute coronary syndrome in Japan. Methods and Results This study presents the results of a nationwide questionnaire survey of 770 sites and a case report investigation performed at 20 sites. The questionnaire survey revealed that the number of acute myocardial infarction (AMI) patients treated annually was 1.56-fold greater than the number of UA patients. Non-ST-elevation AMI accounted for 17% of all patients with AMI. Analysis of case reports for 885 UA patients showed extensive use of invasive treatment. In the UA patients, the cumulative incidence of a composite endpoint (all-cause mortality, AMI, and urgent coronary revascularization) was 2% at 1 month and 9% at 6 months. Stratified analysis with respect to the composite endpoint through 6 months showed a significantly lower incidence in patients treated with a calcium-channel blocker than in patients not treated with a calcium-channel blocker. Conclusions In Japan, fewer patients are hospitalized annually for treatment of UA than for AMI. The largest percentage of UA patients had Braunwald class III disease. Non-ST-elevation AMI is managed in Japan according to the principle of early invasive treatment, resembling the treatment for ST-elevation AMI. The outcome of treatment is better for Japanese UA patients than for Japanese AMI patients. (Circ J 2007; 71: 1335 - 1347)