Population aging has rapidly progressed in Japan. However, few data exist regarding the characteristics of extremely elderly patients with out-of-hospitalcardiacarrest (OHCA). We aimed to determine the prehospitalpredictors of one-month survival with favorable neurologicaloutcomes (Cerebral Performance Category scale, category 1 or 2; CPC 1-2) in this population.
We investigated 23,520 OHCA patientsaged ≥95years from a prospectively recorded, nationwide, Utstein-style Japanese database between 2008 and 2012. The primary study endpoint was one-month CPC 1-2 after OHCA.
The one-month CPC 1-2 rate was 0.27% (63/23,520). Only two variables were significantly associated with one-month CPC 1-2 in a multivariate logistic regression model: prehospital return of spontaneous circulation (ROSC) [adjusted odds ratio (aOR), 94.4; 95% confidential interval (CI), 50.1-191.7] and emergency medical service (EMS)-witnessed arrest (aOR, 5.1; 95% CI, 2.6-10.2). When stratified by these two predictors, the one-month CPC 1-2 rates were 20.2% (18/89) for patients who had both prehospital ROSC and EMS-witnessed arrest, 4.2% (33/783) for those who had prehospital ROSC without EMS-witnessed arrest, 0.28% (3/1065) for those who had EMS-witnessed arrest without prehospital ROSC, and 0.04% (9/21,583) for those who had neither predictor, respectively.
The crucial prehospitalpredictors for one-month CPC 1-2 in elderly OHCA patientsaged ≥95years in Japan were prehospital ROSC and EMS-witnessed arrest and the former was the predominant predictor.
Impact of combined lipid lowering and blood pressure control on coronary plaque: myocardial ischemia treated by percutaneous coronary intervention and plaque regression by lipid lowering and blood pressure controlling assessed by intravascular ultrasonography (MILLION) study
Kawashiri MA, Sakata K, Hayashi K, Gamou T, Kanaya H, Miwa K, Ueda K, Higashikata T, Mizuno S, Michishita I, Namura M, Nitta Y, Katsuda S, Okeie K, Hirase H, Tada H, Uchiyama K, Konno T, Ino H, Nagase K, Yamagishi M; Behalf of the MILLION Study Group.
The aim of the study was to elucidate the aggressive reduction of both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) reduced coronary atherosclerotic plaque volume compared with a standard treatment of LDL-C and BP in Japanese patients with coronary artery disease (CAD). This study is a prospective, randomized, and open-labelled with a blind-endpoint evaluation study. A total of 97 patients (81 men, mean age 62.0 ± 9.6) with CAD undergoing intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention (PCI) were randomized, and 68 patients had IVUS examinations at baseline and at 18-24 months follow-up. Patients were randomly assigned to standard or aggressive strategies targeting LDL-C and a BP of 100 mg/dL and 140/90 mmHg vs. 70 mg/dL and 120/70 mmHg, respectively. The primary endpoint was the percent change in coronary plaque volume. Both standard and aggressive strategies succeeded to achieve target levels of LDL-C and BP; 74.9 ± 14.7 vs. 63.7 ± 11.9 mg/dL (NS) and 124.1 ± 9.4/75.8 ± 7.7 vs. 113.6 ± 9.6/65.8 ± 9.4 mmHg (systolic BP; NS, diastolic BP; p < 0.05), respectively. Both groups showed a significant reduction in the coronary plaque volume of -9.4 ± 10.7% and -8.7 ± 8.6% (NS) in standard and aggressive therapies, respectively. Both standard and aggressive intervention significantly regressed coronary plaque volume by the same degree, suggesting the importance of simultaneous reductions of LDL-C and BP for prevention of CAD.