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Matsumoto T, Saito Y, Sato T, Yamashita D, Suzuki S, Saito K, Wakabayashi S, Kitahara H, Sano K, Kobayashi Y. Diagnostic ability of Japanese version of high bleeding risk criteria for ischemic outcomes in patients with acute myocardial infarction. Heart Vessels 2024; 39:1-9. [PMID: 37598361 DOI: 10.1007/s00380-023-02303-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Abstract
The Japanese version of high bleeding risk (J-HBR) criteria was domestically proposed to identify patients at HBR after percutaneous coronary intervention (PCI). The applicability of J-HBR on bleeding events has been validated, while whether J-HBR predicts ischemic events is uncertain. This bi-center registry included 904 patients with acute myocardial infarction (MI) undergoing primary PCI. Patients were stratified by the J-HBR major (1 point) and minor (0.5 point) criteria. Patients with J-HBR ≥ 1 point were diagnosed as having HBR. The primary endpoint was major adverse cardiovascular events (MACE), a composite of cardiovascular death, recurrent MI, and ischemic stroke, after discharge. Of the 904 patients, 451 (49.9%) had the J-HBR. The primary endpoint more frequently occurred in patients with J-HBR than in those without (10.9% vs. 4.9%, p < 0.001) during the median follow-up period of 522 days. Probability of MACE was progressively increased with the increase in the number of J-HBR major and minor criteria, in which severe anemia, severe chronic kidney disease, prior heart failure, peripheral artery disease, and prior ischemic stroke were identified as significant factors associated with MACE. In patients with acute MI undergoing PCI, the J-HBR criteria were predictive for ischemic outcomes after discharge, suggesting that the J-HBR criteria may be useful to identify patients at high bleeding and ischemic risks.
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Affiliation(s)
- Tadahiro Matsumoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Takanori Sato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Daichi Yamashita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Sakuramaru Suzuki
- Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Kan Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Shinichi Wakabayashi
- Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Koichi Sano
- Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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Komaki S, Ishii M, Kaichi R, Takae M, Mori T, Toida R, Kurogi K, Matsuura Y, Yamamoto N, Tsujita K, Tsuruda T, Kaikita K. Relationship between coronary artery calcium score and bleeding events after percutaneous coronary intervention in chronic coronary syndrome. Heart Vessels 2023; 38:919-928. [PMID: 36847811 DOI: 10.1007/s00380-023-02248-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
The relationship between coronary artery calcium (CAC) and bleeding events after percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome (CCS) is not well established. This study aimed to examine the association between CAC scores and clinical outcomes after PCI in patients with CCS. This retrospective observational study included 295 consecutive patients who underwent multidetector computer tomography and were scheduled for their first elective PCI. Patients were categorized into two groups based on the CAC scores (low: ≤ 400 or high: > 400). The bleeding risk was evaluated using the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. The primary clinical outcome was a major bleeding event within 1 year after PCI, defined as Bleeding Academic Research Consortium (BARC) 3 or 5. The high CAC score group had a higher proportion of patients meeting the ARC-HBR criteria than the low CAC score group (52.7% vs. 31.3%, p < 0.001). Kaplan-Meier survival analysis showed that the incidence of major bleeding events was higher in the high CAC score group as compared to the low CAC score group (p < 0.001). Furthermore, multivariate Cox regression anal ysis revealed that a high CAC score was an independent determinant of major bleeding events during the first year after PCI. A high CAC score is significantly associated with the incidence of major bleeding events after PCI in CCS patients.
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Affiliation(s)
- Soichi Komaki
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkoji, Nobeoka, Miyazaki, 882-0835, Japan.,Cardiorenal Research Laboratory, Department of Hemo-Vascular Advanced Medicine Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-City, Miyazaki, 889-1692, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Ryota Kaichi
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkoji, Nobeoka, Miyazaki, 882-0835, Japan
| | - Masafumi Takae
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkoji, Nobeoka, Miyazaki, 882-0835, Japan
| | - Takayuki Mori
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkoji, Nobeoka, Miyazaki, 882-0835, Japan
| | - Reiko Toida
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkoji, Nobeoka, Miyazaki, 882-0835, Japan
| | - Kazumasa Kurogi
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkoji, Nobeoka, Miyazaki, 882-0835, Japan
| | - Yunosuke Matsuura
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-City, Miyazaki, 889-1692, Japan
| | - Nobuyasu Yamamoto
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkoji, Nobeoka, Miyazaki, 882-0835, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Toshihiro Tsuruda
- Cardiorenal Research Laboratory, Department of Hemo-Vascular Advanced Medicine Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-City, Miyazaki, 889-1692, Japan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-City, Miyazaki, 889-1692, Japan.
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Ishii M, Kawai T, Tsujita K, Igarashi A, Suzuki M, Deguchi H, Fernandez J. Cost-Effectiveness of Vonoprazan Compared With Proton Pump Inhibitors in Patients Taking Low-Dose Aspirin for Secondary Prevention of Cardiovascular Events in Japan. Circ J 2023; 87:348-359. [PMID: 36002313 DOI: 10.1253/circj.cj-22-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Low-dose aspirin (LDA) is used to prevent recurrent cardiovascular (CV) events, but is associated with upper gastrointestinal (GI) bleeding; concomitant use of a proton pump inhibitor (PPI) reduces this risk. This study aimed to assess the cost-effectiveness of vonoprazan compared with PPIs (lansoprazole and esomeprazole) in patients taking LDA for secondary prevention of CV events.Methods and Results: A Markov simulation model was developed to predict the number of GI bleeding and acute CV events using 3 strategies (vonoprazan+LDA, esomeprazole+LDA, and lansoprazole+LDA), which were translated into quality-adjusted life-years (QALYs) and costs. Transition probabilities and utilities were derived from the results of published literature, and medical costs were based on the Japanese National Health Insurance fee table and claims databases in 2020. Outcomes were projected over 30 years starting at age 65 years and discounted at 2% annually. Expected costs with esomeprazole 20 mg, lansoprazole 15 mg and vonoprazan 10 mg were JPY 1,225,657, JPY 943,930, and JPY 1,059,510, respectively. The QALY gain for vonoprazan vs. esomeprazole was 0.35, thus vonoprazan was dominant against esomeprazole. The QALY gain for vonoprazan vs. lansoprazole was 0.29 and the incremental cost-effectiveness ratio (ICER) was JPY 398,551, thus, vonoprazan was more cost-effective than lansoprazole. CONCLUSIONS Vonoprazan is dominant or cost-effective compared with esomeprazole and lansoprazole in patients taking LDA for secondary prevention of CV events.
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Affiliation(s)
- Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo
| | - Manabu Suzuki
- Japan Medical Office, Takeda Pharmaceutical Company Limited
| | - Hisato Deguchi
- Japan Medical Office, Takeda Pharmaceutical Company Limited
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Moribayashi K, Matsuura Y, Kaikita K. Stratifying Bleeding Risk and Beyond ― Predicting Where Bleeding Will Occur ―. Circ J 2022; 86:784-786. [DOI: 10.1253/circj.cj-22-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kohei Moribayashi
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
| | - Yunosuke Matsuura
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
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