Rates of primary percutaneous coronary intervention worldwide.

BACKGROUND: Primary percutaneous coronary intervention (PCI) is at present the most effective procedure for reducing the mortality rate of patients with acute myocardial infarction (AMI). However, there is a great difference between Japan and other countries in the rate of primary PCI. METHODS AND RESULTS: Registration period, number of patients with AMI, rates of primary PCI or thrombolysis and in-hospital or 30-day mortality rates were analyzed in 3 Japanese, 4 European, 4 American and 2 world-wide databases of AMI. The primary PCI rate is higher (75-94%) in Japan than in the other countries (5.5-49.6%), particularly in low-volume hospitals, and the mortality rates at these centers were similar to those in high-volume hospitals (approximately 4-10%). The primary PCI rate has recently been rising (25-50%) worldwide and most PCI procedures are performed in large-volume centers, except in Japan. CONCLUSIONS: Comparison of the AMI databases suggest there is a relationship between the primary PCI rate and annual PCI caseload in each country. It is interesting that in Japan even low-volume PCI hospitals have comparable numbers of primary PCI cases.

Primary cardiac sarcoma mimicking benign myxoma: a case report.

A 53-year-old woman presented with a primary cardiac sarcoma mimicking benign myxoma manifesting as progressive heart failure. Transesophageal echocardiography disclosed two separate tumors in the left atrium which appeared just like myxoma, except for the origin and multiple growth profile. Three separate tumors were identified during the operation arising from the posterior wall of the left atrium, mitral valve orifice and left atrial free wall. The histological diagnosis was malignant undifferentiated sarcoma. Six months later, she noticed dyspnea and arm numbness due to local recurrence of cardiac tumor and brain metastasis. She died suddenly 6 months after the surgery during admission. The clinical and echocardiographic findings are crucial to discriminate malignant cardiac tumors from benign myxoma. Rapidly progressive clinical course, multiple tumor growth and non-septal attachment of the tumor all suggest a malignant profile of the primary cardiac tumors. Careful and precise preoperative evaluation, including echocardiographic survey of the tumor origin and multiple growth profile, are essential to identify malignant cardiac tumor.