Potential risk polarization for acute myocardial infarction during the COVID-19 pandemic: Single-center experiences in Osaka, Japan

This study compared the time course and outcomes of acute myocardial infarction, including mechanical complications and hospital mortality, before and after the coronavirus disease 2019 (COVID-19) pandemic at a regional core hospital in South Osaka, Japan. Moreover, it identified predictors for hospital mortality and mechanical complications. In total, 503 patients who underwent emergency percutaneous coronary intervention between January 2011 and December 2021 at our institution were examined retrospectively. The time course of acute myocardial infarction, mechanical complications, and mortality rate before and after the COVID-19 emergency declaration were compared. Overall, 426 patients with ST-segment elevation myocardial infarction and 77 patients with non-ST-segment elevation myocardial infarction were identified. For patients with ST-segment elevation myocardial infarction, the onset-to-door time was longer (181 vs. 156 min, P = 0.001) and mechanical complications were worse (7.8% vs. 2.6%, P = 0.025) after the emergency declaration of COVID-19 than before the pandemic. Age, low ejection fraction, out-of-hospital cardiac arrest, and mechanical complications were identified as independent risk factors for hospital mortality among patients with ST-segment elevation myocardial infarction, using multivariable analysis. Post-declaration, age, walk-ins, referrals, and intra-aortic balloon pump use were independent predictors of mechanical complications among patients with ST-segment elevation myocardial infarction. Onset-to-door time and mechanical complication rate increased after the COVID-19 declaration among patients with ST-segment elevation myocardial infarction. Arrival by walk-in and a referral that caused treatment delay were identified as independent risk factors for mechanical complication, in addition to age, use of intra-aortic balloon pump, and post-declaration of COVID-19. Therefore, the risks posed by the COVID-19 pandemic might have a polarization tendency resulting from the relief or worsening of cardiac symptoms.

Estimation of seroprevalence of novel coronavirus disease (COVID-19) using preserved serum at an outpatient setting in Kobe, Japan: A cross-sectional study.

BackgroundCoronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has been affecting many people on earth and our society. Japan is known to have relatively less number of infections as well as deaths among developed nations. However, accurate prevalence of COVID-19 in Japan remains unknown. Therefore, we conducted a cross-sectional study to estimate seroprevalence of SARS-CoV-2 infection. MethodsWe conducted a cross-sectional serologic testing for SARS-CoV-2 antibody using 1,000 samples from patients at outpatient settings who visited the clinic from March 31 to April 7, 2020, stratified by the decade of age and sex. ResultsThere were 33 positive IgG among 1,000 serum samples (3.3%, 95%CI: 2.3-4.6%). By applying this figure to the census of Kobe City (population: 1,518,870), it is estimated that the number of people with positive IgG be 50,123 (95%CI: 34,934-69,868). Age and sex adjusted prevalence of positivity was calculated 2.7% (95%CI: 1.8-3.9%), and the estimated number of people with positive IgG was 40,999 (95%CI: 27,333-59,221). These numbers were 396 to 858 fold more than confirmed cases with PCR testing in Kobe City. ConclusionsOur cross-sectional serological study suggests that the number of people with seropositive for SARS-CoV-2 infection in Kobe, Japan is far more than the confirmed cases by PCR testing.

Restless Legs Syndrome with Severe Limb Pain during Pregnancy / General Medicine

Herein we report a case of restless legs syndrome (RLS) during pregnancy in a 32-year-old woman who began feeling pain in her feet at night at 30 weeks of gestation. She could relieve the pain by moving her legs, but her symptoms worsened, preventing sleep. She was diagnosed with pregnancy-related RLS. Neither carbamazepine nor gabapentin alleviated her symptoms effectively, but the discomfort spontaneously improved two months after delivery. RLS during pregnancy leads to sleep disorders, which are associated with adverse pregnancy outcomes. More attention should be given to RLS during pregnancy.

Surgical Management for Arteriosclerosis Obliterans Complicated with Ischemic Heart Disease / 日本心臓血管外科学会雑誌

We studied the incidence of associated ischemic heart disease (IHD) among 110 consecutive patients (males 99, females 11, mean age 66.0±8.8 years) operated upon for arteriosclerosis obliterans (ASO). The screening of IHD was routinely conducted by using dipyridamole thallium scintigraphy, and when results were positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged as positive for IHD. Forty-eight patients (44%) of ASO were simultaneously afflicted with IHD. Ten patients were operated on for ASO after coronary artery bypass grafting (CABG), five for ASO and IHD (CABG) simultaneously, eight for ASO after PTCA. Twenty-five patients underwent surgery for ASO only with infusion of nitroglycerin, with or without diltiazem. We also compared 15 patients with thrombotic obliteration at the end of the abdominal aorta o: Leriche's syndrome with the remaining 95 patients in this series. The patients with Leriche's syndrome were younger and had higher incidences of hyperlipidemia (<i>p</i>=0.0254) and IHD (<i>p</i>=0.0225) than those without Leriche's syndrome. In surgical treatment for ASO, particularly for Leriche's syndrome, meticulous attention to complications is needed due to the frequent association of IHD. When both ASO and IHD are severe enough to warrant surgical treatment at the earliest opportunity, we recommend concomitant operations for ASO and IHD (CABG).

Multivessel Coronary Artery Bypass Surgery with Internal Thoracic Artery Grafts: Early and Late Besults / 日本心臓血管外科学会雑誌

Multivessel coronary artery bypass grafting (CABG) utilizing ITA grafts was performed in 110 consecutive patients, ranging in age from 24 to 76 years with a mean of 54±9 years. A mean of 3.2±0.8 grafts per patient was placed with a hospital mortality of 0.9%. Bilateral ITAs (BITA) were used in 87 patients and sequential ITA grafting (SQ-ITA) was carried out in 31, and both BITA and SQ-ITA were used in 8 patients. Noncardiac late death occurred in 1 patient and a 5-year survival rate was 98%. During this follow-up term, 11 (10%) patients underwent low-risk PTCA for ITA anastomotic stenosis (4 lesions), SVG stenosis (5 lesions) and native coronary stenosis (4 lesions) with a success in all. No reoperation has been required so far in this series. Graft patency rates were 97% for BITA with no differences for the left and right ITAs, and 100% for SQ-ITA (both proximal and distal). No sternal infection was encountered in this series, on which we believe mediastinal, sternal and subcutaneous irrigation appeared most effective. In BITA grafting, right ITA was frequently anastomosed to the LAD, passing on the aorta, which will make reoperation through a median sternotomy dangerous to this graft. To improve safety for reoperation, we have covered the ITA graft with an 8mm EPTFE graft or membrane with no side effects on ITA grafts. However, true efficacy of this protective method remains unproved because no reoperations have been required in this series of patients.