Fifteen-year trend in the treatment and outcome of acute myocardial infarction in Japan

To assess the changes in treatment and outcome of acute myocardial infarction (AMI) over a 15-year period, the medical records of 1,437 patients with AMI who underwent emergency coronary angiography within 24 h of the onset of chest pain at Hiroshima City Hospital from 1985 to 1999 were reviewed. The patients were divided into 3 groups in chronological order: group 1 (1985-89, n=439), group 2 (1990-94, n=453) and group 3 (1995-99, n=545). Conventional balloon angioplasty and thrombolysis were frequently performed in group 1 (56% and 29%, respectively) and group 2 (71% and 13%, respectively), whereas coronary stenting and conventional balloon angioplasty were more often performed in group 3 (57% and 23%, respectively). The achievement of TIMI grade 3 flow improved in the chronological order (62%, 80% and 85%, respectively; p<0.001). The incidence of reinfarction was lower in group 3 (4.2%) than groups 1 and 2 (8.0% and 7.5%, respectively; p=0.007), and in-hospital mortality decreased from group 1 to group 3 (11.8%, 8.2% and 5.5%, respectively; p=0.002). Stenting is now the most frequently chosen treatment for AMI and sustained TIMI grade 3 flow is obtained in most of the cases, with the result that mortality has reduced by 50% in the past decade.