Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan

Home , Katsushika, Setagaya, Shibuya, Shinjuku, Suginami

Circ J 2018; 82: 1666 – 1674 Supplementary File doi: 10.1253/circj.CJ-17-1275

Jun Masuda, MD, PhD; Mikio Kishi, MD; Naoto Kumagai, MD, PhD; Toru Yamazaki, PhD; Kenji Sakata, MD, PhD; Takumi Higuma, MD, PhD; Akiyoshi Ogimoto, MD, PhD; Kaoru Dohi, MD, PhD; Takashi Tanigawa, MD, PhD; Hiroyuki Hanada, MD, PhD; Mashio Nakamura, MD, PhD; Shigeru Sokejima, MD, PhD; Morimasa Takayama, MD, PhD; Jitsuo Higaki, MD, PhD; Masakazu Yamagishi, MD, PhD; Ken Okumura, MD, PhD; Masaaki Ito, MD, PhD

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Appendix S1. Participating Enrolling Facilities by Prefecture Memorial Hospital, Sumida; Fuchu Keijinkai Hospital, Fuchu; Included are all facilities participating in this study from 5 prefectures. Hakujikai Memorial Hospital, Adachi; Higashiyamato Hospital, Prefectures and facilities are listed alphabetically. Higashiyamato; Ikegami General Hospital, Ota; IMS Katsushika Heart Center, Katsushika; Japanese Red Cross Medical Center, Aomori Prefecture Shibuya; Japanese Red Cross Musashino Hospital, Musashino; Aomori City Hospital, Aomori; Aomori Kyoritsu Hospital, Aomori; JCHO Tokyo Shinjuku Medical Center, Shinjuku; JCHO Tokyo Aomori Prefectural Central Hospital, Aomori; Hachinohe City Yamate Medical Center, Shinjuku; Jikei University Daisan Hospital, Hospital, Hachinohe; Hachinohe Japanese Red Cross Hospital, Komae; Jikei University Hospital, Minato; Jikei University Hospital Hachinohe; Hirosaki University Graduate School of Medicine, Katsushika Medical Center, Katsushika; Juntendo University Hirosaki; Mutsu General Hospital, Mutsu; Seihoku Chuoh Hospital, Nerima Hospital, Nerima; Kanto Central Hospital, Setagaya; Kasai Goshogawara; Towada City Hospital, Towada. Shoikai Hospital, Edogawa; Kawakita General Hospital, Suginami; Keio University Hospital, Shinjuku; Kosei Hospital, Suginami; Kyorin Ehime Prefecture University Hospital, Mitaka; Meirikai Chuo General Hospital, Kita; Ehime Prefectural Central Hospital, Matsuyama; Ehime Prefectural Mishuku Hospital, Meguro; Mitsui Memorial Hospital, Chiyoda; Imabari Hospital, Imabari; Ehime Prefectural Niihama Hospital, National Center for Global Health and Medicine, Shinjuku; National Niihama; Ehime University Graduate School of Medicine, Toon; Hospital Organization Disaster Medical Center, Tachikawa; National Kitaishikai Hospital, Ozu; Matsuyama Red Cross Hospital, Hospital Organization Tokyo Medical Center, Meguro; Nihon Matsuyama; Saijo Central Hospital, Saijo; Uwajima City Hospital, Medical School Hospital, Bunkyo; Nihon University Hospital, Uwajima; Yawatahama City General Hospital, Yawatahama. Chiyoda; Nihon University Itabashi Hospital, Itabashi; Nishiarai Heart Center Hospital, Adachi; Nishitokyo Central General Hospital, Ishikawa Prefecture Nishitokyo; NTT Medical Center Tokyo, Shinagawa; Ogikubo Kanazawa Medical University Hospital, Kahoku; National Hospital Hospital, Suginami; Ome Municipal General Hospital, Ome; Omori Organization Kanazawa Medical Center, Kanazawa; Kanazawa Red Cross Hospital, Ota; Sakakibara Heart Institute, Fuchu; Showa University Graduate School of Medicine, Kanazawa; Keiju Medical University Hospital, Shinagawa; St. Luke’s International Hospital, Center, Nanao; Public Central Hospital of Matto Ishikawa, Hakusan; Chuo; Tama-Hokubu Medical Center, Higashimurayama; The Komatsu Municipal Hospital, Komatsu; Kanazawa Cardiovascular Cardiovascular Institute, Minato; Tobu Chiiki Hospital, Katsushika; Hospital, Kanazawa; Ishikawa Prefectural Central Hospital, Toho University Omori Medical Center, Ota; Toho University, Kanazawa. Ohashi Medical Center, Meguro; Tokai University Hachioji Hospital, Hachioji; Tokyo Heart Center, Shinagawa; Tokyo Medical And Dental Mie Prefecture University Medical Hospital, Bunkyo; Tokyo Medical University Japanese Red Cross Ise Hospital, Ise; Kuwana City Medical Center, Hachioji Medical Center, Hachioji; Tokyo Medical University Kuwana; Matsusaka Chuo General Hospital, Matsusaka; Mie Chuo Hospital, Shinjuku; Tokyo Metropolitan Bokutoh Hospital, Sumida; Medical Center, Tsu; Mie Heart Center, Taki; Mie Prefectural Tokyo Metropolitan Geriatric Hospital, Itabashi; Tokyo Metropolitan General Medical Center, Yokkaichi; Mie University Graduate School Health and Medical Corporation Toshima Hospital, Itabashi; Tokyo of Medicine, Tsu; Nabari City Hospital, Nabari; Nagai Hospital, Tsu; Metropolitan Hiroo Hospital, Shibuya; Tokyo Metropolitan Tama Saiseikai Matsusaka General Hospital, Matsusaka; Suzuka General Medical Center, Fuchu; Tokyo Nishi Tokushukai Hospital, Akishima; Hospital, Suzuka; Suzuka Kaisei Hospital, Suzuka; Okanami General Tokyo Rinkai Hospital, Edogawa; Tokyo Saiseikai Central Hospital, Hospital, Iga; Owase General Hospital, Owase. Minato; Tokyo Women’s Medical University Hospital, Shinjuku; Tokyo-Kita Medical Center, Kita. Tokyo Metropolitan Ayase Heart Hospital, Adachi; Edogawa Hospital, Edogawa; Fraternity

Circulation Journal Vol.82, June 2018 Figure S1. Factors associated with attainment of final Thrombolysis in Myocardial Infarction (TIMI) flow grade 3. Adjusted odds ratio (OR) and 95% confidence interval (CI) indicate the likelihood of achieving final TIMI flow grade 3. OR >1 indicates increased odds of achieving final TIMI flow grade 3. *Reference category=Killip class 1. Covariates: age, sex, hypertension, diabetes mel- litus, dyslipidemia, current smoker, hemodialysis, previous PCI, previous myocardial infarction (MI), previous coronary artery bypass grafting (CABG), transport pathway, location of onset, Killip classification at presentation, ST elevation MI, left anterior descending artery lesion as culprit, multivessel disease, aspiration thrombectomy, stent implantation, and onset to balloon time ≤2 h.

Table S1. Factors Associated With In-Hospital Death Univariate Multivariate HR 95% CI P value HR 95% CI P value Age* 1.57 1.38–1.79 <0.01 1.37 1.20–1.57 <0.01 Sex, male 0.82 0.60–1.12 0.21 Hypertension 0.83 0.62–1.11 0.21 Diabetes 1.02 0.76–1.38 0.89 Current smoker 0.70 0.50–0.96 0.03 – – – Hemodialysis 1.88 0.83–4.24 0.13 PAD 2.57 1.26–5.22 <0.01 – – – Previous MI 1.05 0.69–1.60 0.81 Previous PCI 1.09 0.68–1.75 0.72 Previous CABG 3.86 1.71–8.72 <0.01 2.94 1.29–6.72 0.01 Previous stroke 1.19 0.69–2.06 0.53 Rural group 1.20 0.90–1.60 0.21 Onset at home 0.93 0.67–1.28 0.64 Direct ambulance transport 1.31 0.98–1.75 0.07 – – – Killip class at presentation 2.59 2.29–2.92 <0.01 2.38 2.09–2.71 <0.01 STEMI 0.59 0.42–0.83 <0.01 – – – LAD lesion as culprit 0.98 0.73–1.30 0.86 Multivessel disease 1.61 1.36–1.91 <0.01 1.30 1.02–1.66 0.04 Stent implantation 0.53 0.36–0.77 <0.01 – – – Initial TIMI flow grade 0 1.14 0.84–1.54 0.41 Final TIMI flow grade 3 0.31 0.22–0.43 <0.01 0.42 0.29–0.60 <0.01 Onset-to-balloon time ≤2 h 1.23 0.86–1.75 0.26 HRs and 95% CI were estimated by the Cox proportional hazard regression model. The following variables with a univariate P value <0.10 were selected for entry into the multivariate analysis using the Cox proportional hazard model: age, current smoker, PAD, previous CABG, direct ambulance transport, Killip class at presentation, STEMI, multivessel disease, stent implantation and final TIMI flow grade 3. *HRs and CI are reported for a 10-U incremental change. CABG, coronary artery bypass grafting; CI, confidence interval; HR, hazard ratio; LAD, left anterior descending artery; MI, myocardial infarction; PAD, peripheral artery disease; PCI, percutaneous coronary intervention; STEMI, ST elevation MI; TIMI, Thrombolysis in Myocardial Infarction.

Circulation Journal Vol.82, June 2018