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Wada N, Mizunaga M, Abe N, Miyauchi K, Kobayashi S, Ohtani M, Tsunekawa R, Nagabuchi M, Morishita S, Ohyama T, Yamaguchi S, Iuchi H, Noda T, Saga Y, Motoya T, Kawakami N, Nishihara M, Numata A, Kakizaki H. Comparison of mirabegron and vibegron for clinical efficacy and safety in female patients with overactive bladder: a multicenter prospective randomized crossover trial. World J Urol 2024; 42:113. [PMID: 38431689 DOI: 10.1007/s00345-024-04799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of mirabegron and vibegron in female OAB patients. METHODS We conducted a multicenter, prospective, randomized crossover study of female patients with OAB. The patients were assigned to Group MV (mirabegron for 8 weeks, followed by vibegron for 8 weeks) or group VM (vibegron for 8 weeks, followed by mirabegron for 8 weeks). The primary endpoint was the change in OABSS from baseline, and the secondary endpoint was the change in FVC parameters. After completion of the study, each patient was asked which drug was preferable. RESULTS A total of 83 patients were enrolled (40 and 43 in groups MV and VM, respectively). At 8th and 16th week, 33 and 29 in Group MV and 34 and 27 in Group VM continued to receive the treatment. The change in PVR was not significantly different between treatment with mirabegron and vibegron. The changes in OABSS, nighttime frequency, mean, and maximum voided volume were similar between mirabegron and vibegron. The mean change in the daytime frequency was greater in the vibegron than in the mirabegron. Of the 56 patients, 15 (27%) and 30 (53%) preferred mirabegron and vibegron, respectively. The remaining 11 patients (20%) showed no preference. The change in the urgency incontinence score during vibegron was better in patients who preferred vibegron to mirabegron. CONCLUSION The efficacies of mirabegron and vibegron in female patients was similar. The patients' preference for vibegron could depend on the efficacy of vibegron for urgency incontinence.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | | | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shin Kobayashi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Miyu Ohtani
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Ryoken Tsunekawa
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Masaya Nagabuchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shun Morishita
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Teppei Ohyama
- Department of Urology, Kitasaito Hospital, Asahikawa, Japan
| | | | - Hiromichi Iuchi
- Department of Urology, Hokushinkai Megumino Hospital, Eniwa, Japan
| | - Tsuyoshi Noda
- Department of Urology, Fukagawa City Hospital, Fukagawa, Japan
| | - Yuji Saga
- Department of Urology, Fukagawa City Hospital, Fukagawa, Japan
| | - Tadasu Motoya
- Department of Urology, Asahikawa Rehabilitation Hospital, Asahikawa, Japan
| | - Norihiro Kawakami
- Department of Urology, Asahikawa Rehabilitation Hospital, Asahikawa, Japan
| | | | - Atsushi Numata
- Department of Urology, Furano Kyokai Hospital, Furano, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
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Wada N, Abe N, Miyauchi K, Makino S, Kakizaki H. High-Fat and High-Sucrose Diet Leads to Skeletal Muscle Loss and Bladder Dysfunction in Rat. Res Rep Urol 2023; 15:305-313. [PMID: 37425652 PMCID: PMC10327923 DOI: 10.2147/rru.s406808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/29/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose In this study, we investigated skeletal muscle loss and bladder dysfunction caused by high-fat/high-sucrose (HFS) diet. Methods Twelve-week-old Sprague-Dawley (SD) female rats were fed on normal (Group N) or HFS (Group HFS) diet for 12 weeks. We conducted urodynamic investigation and pharmacologic in vitro. In addition, we measured gastrocnemius and tibialis muscle weight and protein concentration. The hypoxia-inducible factor (HIF)-1α and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in the bladder were assayed. Results The urodynamic investigations revealed the significantly shorter intercontraction intervals and lower maximal voiding pressure in Group HFS than in Group N. Furthermore, the absolute and relative weights of the gastrocnemius muscle were found to be significantly lower in Group HFS than in Group N. The protein concentration of the gastrocnemius muscle was also significantly lower in Group HFS than in Group N. The absolute and relative weights of the bladder were also significantly lower in Group HFS than in Group N. The contractile responses of the bladder strips to electrical field stimulation and carbachol were significantly lower in Group HFS than in Group N. The HIF1α and 8OHdG in the bladder muscle were significantly higher in Group HFS than in Group N. The HFS diet reduced bladder capacity and contractility along with the loss of the gastrocnemius muscle. Conclusion HFS diet promotes bladder dysfunction similar to detrusor hyperreflexia with impaired contractility.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shogo Makino
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
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Aoki T, Wada N, Tamaki G, Abe N, Kobayashi S, Miyauchi K, Ishikawa M, Makino S, Nagabuchi M, Kakizaki H. [Pre-Operative Factors Affecting Trifecta Achievement in the Initial Series of Robot-Assisted Partial Nephrectomy]. Hinyokika Kiyo 2023; 69:73-77. [PMID: 37038346 DOI: 10.14989/actauroljap_69_3_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
We investigated pre-operative factors affecting trifecta achievement in robot-assisted partial nephrectomy (RAPN). We retrospectively analyzed 81 patients who underwent RAPN from December 2016 to September 2021 with final malignant pathologies. Trifecta was defined as negative resection margin (RM),warm ischemic time (WIT) less than 25 minutes, and no severe perioperative complications (Clavien-Dindo<III). Factors affecting trifecta achievement were analyzed using sex, age, body mass index, RENAL nephrometry score (low or moderate/high complexity), surgical approach (transabdominal or retroperitoneal), tumor diameter and surgical experiences of each surgeon. Negative RM, WIT less than 25 minutes, and no severe complications were obtained in 75 (93%), 65 (80%), and 79 patients (98%), respectively. The trifecta was achieved in 60 patients (74%). In multivariate regression analysis, surgical experience (OR:0.92, 95% CI : 0.86-0.99) was significantly associated with trifecta achievement. Receiver operating characteristic curve analysis identified 9 cases as the optimal cut-off values for the predication of trifecta achievement (AUC=0.69,p =0.11). The achievement of WIT less than 25 minutes (65 vs 90%, p<0.01) and trifecta (58 vs 84%,p <0.05) were significantly lower in surgical experiences less than 9 cases than in 9 or greater. We conclude that surgical experience in RAPN is an important factor affecting WIT and trifecta achievement in the initial series.
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Affiliation(s)
- Takahiro Aoki
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Naoki Wada
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Gaku Tamaki
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Noriyuki Abe
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Shin Kobayashi
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Kotona Miyauchi
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Mayumi Ishikawa
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Shogo Makino
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Masaya Nagabuchi
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Hidehiro Kakizaki
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
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Noda T, Nochioka K, Kaikita K, Akao M, Ako J, Matoba T, Nakamura M, Miyauchi K, Hagiwara N, Kimura K, Hirayama A, Matsui K, Ogawa H, Yasuda S. Antithrombotic monotherapy for stable coronary artery disease and atrial fibrillation patients with and without prior coronary artery revascularization: Insights from the AFIRE trial. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Japan Cardiovascular Research Foundation under a contract with Bayer Yakuhin
Background
The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial demonstrated that rivaroxaban monotherapy was noninferior to combination therapy with rivaroxaban plus a single antiplatelet therapy regarding efficacy and superior for safety endpoints in patients with atrial fibrillation and stable coronary artery disease including patients not requiring revascularization [prior percutaneous coronary intervention (PCI) or bypass grafting (CABG)].
Purpose
The aim of this post-hoc subgroup analysis was to investigate the efficacy and safety of rivaroxaban monotherapy compared to combination therapy in patients with and without prior revascularization.
Methods
Among 2,215 patients included in the modified intention-to-treat analysis in the AFIRE trial, 1445 patients (65.2%) had undergone previous PCI alone, and 252 (11.4%) had undergone previous CABG. The remaining 518 patients (23.4%) was categorized as a group without prior revascularization and then compared with a group with prior revascularization (PCI or CABG). The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause. The primary safety end point was major bleeding, according to the criteria of the International Society on Thrombosis and Hemostasis.
Results
In 1697 patients with prior revascularization, efficacy and safety endpoints of rivaroxaban monotherapy were superior to combination therapy (efficacy: HR 0.62, 95%CI 0.45-0.85, p=0.003; safety: HR 0.62, 95%CI 0.39-0.98, p=0.040), whereas there were no significant differences in efficacy and safety endpoints among 518 patients without prior revascularization (efficacy: HR 1.19, 95%CI 0.67-2.11, p=0.553; safety: HR 0.47, 95%CI 0.18-1.26, p=0.125). There was a borderline interaction of efficacy endpoint (P for interaction=0.055) by randomized treatment assignment (Figure 1 and Figure 2). Compared with combination therapy, the safety benefit of rivaroxaban monotherapy on any bleeding was significant in patients without prior revascularization (HR 0.59, 95%CI 0.38-0.93, p=0.022).
Conclusions
In patients with prior PCI or CABG, rivaroxaban monotherapy resulted in more favorable safety and efficacy outcomes than combination therapy. There was a borderline interaction for primary efficacy outcome between prior revascularization and anti-thrombotic therapy.
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Affiliation(s)
- T Noda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine , Sendai , Japan
| | - K Nochioka
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine , Sendai , Japan
| | - K Kaikita
- University of Miyazaki, Faculty of Medicine, Division of Cardiovascular Medicine and Nephrology, Department of Internal Medi , Miyazaki , Japan
| | - M Akao
- National Hospital Organization Kyoto Medical Center, Department of Cardiology , Kyoto , Japan
| | - J Ako
- Kitasato University School of Medicine, Department of Cardiovascular Medicine , Sagamihara , Japan
| | - T Matoba
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine , Fukuoka , Japan
| | - M Nakamura
- Toho University Ohashi Medical Center, Division of Cardiovascular Medicine , Tokyo , Japan
| | - K Miyauchi
- Juntendo Tokyo Koto Geriatric Medical Center, Department of Cardiovascular Medicine , Tokyo , Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Department of Cardiology , Tokyo , Japan
| | - K Kimura
- Yokohama City University Medical Center, Cardiovascular Center , Yokohama , Japan
| | - A Hirayama
- Osaka Police Hospital, Department of Cardiology , Osaka , Japan
| | - K Matsui
- Kumamoto University, Department of General Medicine and Primary Care , Kumamoto , Japan
| | - H Ogawa
- Kumamoto University , Kumamoto , Japan
| | - S Yasuda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine , Sendai , Japan
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Ishii K, Matsue Y, Miyauchi K, Miyazaki S, Hidemori H, Nishizaki Y, Nojiri S, Saito Y, Nagashima K, Okumura Y, Daida H, Minamino T. Predicting new-onset heart failure hospitalization of patients with atrial fibrillation: development and external validations of a risk score. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a well-known risk factor for heart failure (HF), and HF development as a complication of AF is associated with a decline in the quality of life and poor prognosis. However, unlike thrombotic events, incidence of HF in patients with AF has not changed for decades, and a preventive strategy has yet to be developed.
Purpose
We sought to develop a risk model for new-onset HF admission in patients with AF and without a history of HF. Additionally, we attempted to externally validate the developed risk model.
Methods
We utilized two multicenter, prospective, observational registries of AF and analyzed the patients without a history of AF. One of which is defined as a derivation cohort, which included 2,857 patients, and the other is defined as a validation cohort, which included 2,516 patients. We developed a risk model by selecting variables with regularized regression and weighing coefficients by Cox regression analysis with the derivation cohort. The external validity was tested in the validation cohort.
Results
During the follow-up period, 148 patients (5.2%) in the derivation cohort and 104 patients (4.1%) in the validation cohort developed HF during the median follow-up period of 1,396 (interquartile range [IQR]: 1,078–1,820) days and 1,168 (IQR: 844–1,309) days, respectively. In the derivation cohort, four predictors (age, hemoglobin, serum creatinine, and log-transformed brain natriuretic peptide) were identified as potential risk factors for HF development. The developed risk model showed good discrimination and calibration in both the derivation (area under the curve [AUC], 0.77 [95% confidence interval (CI) 0.73–0.81]; Hosmer-Lemeshow test, P=0.257) and validation cohorts (AUC: 0.76 [95% CI 0.72–0.81]; Hosmer-Lemeshow test, P=0.475). Considering death not due to HF as a competing risk, the cumulative incidence curves for HF admission stratified by the risk score were generated, which showed higher HF hospitalization rate for the higher risk score categories.
Conclusion
The newly developed risk model with four readily available clinical characteristics and biomarkers performed well in the prediction of new-onset HF admission of patients with AF in both derivation and validation cohort.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Ishii
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - Y Matsue
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - K Miyauchi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - S Miyazaki
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - H Hidemori
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - Y Nishizaki
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - S Nojiri
- Juntendo University School of Medicine, Medical Technology Innovation Center , Tokyo , Japan
| | - Y Saito
- Nihon University School of Medicine, Division of Cardiology, Department of Medicine , Tokyo , Japan
| | - K Nagashima
- Nihon University School of Medicine, Division of Cardiology, Department of Medicine , Tokyo , Japan
| | - Y Okumura
- Nihon University School of Medicine, Division of Cardiology, Department of Medicine , Tokyo , Japan
| | - H Daida
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - T Minamino
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
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Ishii M, Kaikita K, Yasuda S, Akao M, Ako J, Matoba T, Nakamura M, Miyauchi K, Hagiwara N, Kimura K, Hirayama A, Matsui K, Ogawa H, Tsujita K. Effect of rivaroxaban monotherapy vs. combination with anti-platelet therapy in patients with atrial fibrillation and stable coronary artery disease across different body mass index categories. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial showed both noninferiority for efficacy and superiority for safety endpoints of rivaroxaban monotherapy compared to rivaroxaban plus antiplatelet therapy (combination therapy) in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD). However, no accumulating evidence regarding efficacy and safety of these fixed-dose direct oral anticoagulant therapy was available in underweight and obese patients.
Purpose
The aim of this post-hoc analysis of the AFIRE trial was to evaluate outcomes of rivaroxaban monotherapy (vs. combination therapy) in patients with AF and stable CAD across body mass index (BMI) categories.
Methods
Patients were categorized into groups 1 (underweight: BMI of <18.5 kg/m2), 2 (normal: BMI of 18.5 to <25 kg/m2), 3 (overweight: BMI of 25 to <30 kg/m2), and 4 (obesity: BMI of ≥30 kg/m2). Efficacy (a composite of all-cause death, myocardial infarction, unstable angina requiring revascularization, stroke, or systemic embolism) and safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria) were compared between rivaroxaban monotherapy and combination therapy across BMI categories.
Results
We analyzed 2,054 patients with a median age of 75.0 (interquartile range [IQR], 69 to 80)) years old and CHA2DS2-VASc of 4 (IQR, 3 to 5). Group 1 through 4 included 72 (3.5%), 1,158 (56.4%), 680 (33.1%), 144 (7.0%) patients and 62.3%, 52.3%, 36.2%, and 30.3% were received reduced dose of rivaroxaban, respectively. Although the sample sizes for group 1 and 4 were limited, monotherapy was superior to combination therapy for efficacy in group 2 (hazard ratio [HR], 0.64; 95% CI, 0.44 to 0.95) and safety in group 3 (HR, 0.25; 95% CI, 0.10 to 0.62), whereas a significant difference in the endpoints was not observed in the other BMI categories. Impact of monotherapy on endpoints did not have a significant interaction in BMI.
Conclusions
Rivaroxaban monotherapy had similar effect on prognosis across all BMI categories in patients with AF and stable CAD.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Japan Cardiovascular Research Foundation based on a contract with Bayer Yakuhin, Ltd
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Affiliation(s)
- M Ishii
- Kumamoto University Hospital , Kumamoto , Japan
| | - K Kaikita
- University of Miyazaki , Miyazaki , Japan
| | - S Yasuda
- Tohoku University , Sendai , Japan
| | - M Akao
- Kyoto Medical Centre , Kyoto , Japan
| | - J Ako
- Kitasato University School of Medicine , Sagamihara , Japan
| | - T Matoba
- Kyushu University , Fukuoka , Japan
| | - M Nakamura
- Toho University Ohashi Medical Center , Tokyo , Japan
| | - K Miyauchi
- Juntendo University School of Medicine , Tokyo , Japan
| | - N Hagiwara
- Tokyo Women's Medical University , Tokyo , Japan
| | - K Kimura
- Yokohama City University Medical Center , Yokohama , Japan
| | | | - K Matsui
- Kumamoto University Hospital , Kumamoto , Japan
| | - H Ogawa
- Kumamoto University , Kumamoto , Japan
| | - K Tsujita
- Kumamoto University Hospital , Kumamoto , Japan
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Yachimoto K, Wada N, Tamaki G, Ishikawa M, Nagabuchi M, Makino S, Abe N, Miyauchi K, Kobayashi S, Hori JI, Kakizaki H. [Comparison of Perioperative Outcomes between Open and Robot-Assisted Laparoscopic Radical Cystectomy]. Hinyokika Kiyo 2022; 68:317-322. [PMID: 36329379 DOI: 10.14989/actauroljap_68_10_317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We compared the perioperative outcomes of open (ORC) and robot-assisted laparoscopic radical cystectomy (RARC) for patients with bladder cancer. We retrospectively investigated the intraoperative and 90-day postoperative complications of ORC and RARC performed from March 2014 to September 2021 based on the medical records. Perioperative complications were categorized according to the Clavien- Dindo classification. We used the propensity score matching to adjust for the inherent bias of the different patient characteristics at baseline including gender, age, preoperative chemotherapy, and pathological T classification. Surgery time of RARC was significantly shorter than that of ORC, and blood transfusion was significantly less frequent in RARC than in ORC (3% vs 81%, p<0.01). The rate of overall complications of Grade III/IV was lower in RARC (8%) than in ORC (25%) (P=0.09). The prevalence of perioperative urinary tract infection, ileus, and abscess/infectious cyst was similar in ORC and RARC. In patients who underwent RARC, the complication rate was similar in extracorporeal and intracorporeal urinary diversion. Compared to ORC, RARC is more beneficial to reduce blood loss and severe complications.
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Affiliation(s)
- Kouta Yachimoto
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Naoki Wada
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Gaku Tamaki
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Mayumi Ishikawa
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Masaya Nagabuchi
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Shogo Makino
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Noriyuki Abe
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Kotona Miyauchi
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Shin Kobayashi
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Jun-Ichi Hori
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Hidehiro Kakizaki
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
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Wada N, Ishikawa M, Nagabuchi M, Makino S, Miyauchi K, Abe N, Kakizaki H. Deterioration of bladder compliance after botulinum toxin A injection and discontinuation of medication for overactive bladder. IJU Case Rep 2022; 5:384-388. [PMID: 36090943 PMCID: PMC9436694 DOI: 10.1002/iju5.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction We report a case of deterioration of bladder compliance after botulinum toxin type A injection and discontinuation of medication for overactive bladder. Case presentation A female patient with overactive bladder in her sixties had been visiting our outpatient clinic regularly for 4 years. She had received posterolateral spondylus fusion twice, which resulted in a compression fracture. She had been receiving a combination therapy of anticholinergics and β3‐adrenoceptor agonist for the management of overactive bladder. She received botulinum toxin type A injection for refractory overactive bladder and discontinued medical treatment for overactive bladder. Three months after botulinum toxin type A injection, cystometry revealed the deterioration of bladder compliance. Renal dysfunction, hydronephrosis, and vesicoureteral reflux were shown. Renal function and hydronephrosis were improved after restarting anticholinergics and β3‐adrenoceptor agonist therapy and inserting a temporary transurethral catheter. Conclusion Deterioration of bladder compliance may occur after botulinum toxin type A injection and discontinuation of overactive bladder medication in some patients with underlying neurological disease.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Mayumi Ishikawa
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Masaya Nagabuchi
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Shogo Makino
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Noriyuki Abe
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
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Abe N, Wada N, Tamaki G, Nagabuchi M, Ishikawa M, Makino S, Miyauchi K, Kobayashi S, Hori J, Kakizaki H. [Clinical Significance of Preoperative Image Classification Systems in Robot-Assisted Laparoscopic Partial Nephrectomy]. Hinyokika Kiyo 2022; 68:133-138. [PMID: 35748230 DOI: 10.14989/actauroljap_68_5_133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Robot-assisted laparoscopic partial nephrectomy (RAPN) is being used in Japan as a less invasive procedure. RENAL nephrometry (RN) score, Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) Classification and Simplified PADUA Renal (SPARE) nephrometry system are tumor-specific morphometry scoring systems used for predicting the difficulty of partial nephrectomy. Adherent perinephric fat (APF) is one of the patient-specific factors related to the difficulty of partial nephrectomy. Mayo Adhesive Probability (MAP) score measures the difficulty of partial nephrectomy due to APF. Whether these scoring systems were associated with perioperative outcome of RAPN was retrospectively analyzed in 57 patients who underwent RAPN by two experienced surgeons at our hospital from December 2016 to March 2020. Forty-five patients were male and 12 were female. The right side was resected in 25 and the left side in 32 patients. The approach was transperitoneal in 42 and retroperitoneal in 15 patients. There were significant correlations among RN, PADUA and SPARE scores, while MAP score was independent from the other scores. Warm ischemic time was significantly correlated with RN (r=0.46, p<0.001), PADUA (r=0.45, p<0.001) and SPARE scores (r=0.44, p<0.001). Time for console was significantly correlated with MAP score (r=0.28, p=0.035). In conclusion, RN and MAP scores might be useful parameters to predict warm ischemic time and time for console during RAPN, respectively.
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Affiliation(s)
- Noriyuki Abe
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Naoki Wada
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Gaku Tamaki
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Masaya Nagabuchi
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Mayumi Ishikawa
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Shogo Makino
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Kotona Miyauchi
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Shin Kobayashi
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Junichi Hori
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Hidehiro Kakizaki
- The Department of Renal and Urologic Surgery, Asahikawa Medical University
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10
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Wada N, Abe N, Miyauchi K, Ishikawa M, Makino S, Kakizaki H. Dutasteride add-on treatment to tadalafil for patients with benign prostatic enlargement is similarly effective as dutasteride add-on treatment to alpha blocker: a propensity-score matching analysis. Int Urol Nephrol 2022; 54:1193-1198. [PMID: 35362820 DOI: 10.1007/s11255-022-03198-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the efficacy of dutasteride add-on treatment to tadalafil in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic enlargement (BPE). METHODS A prospective study was conducted in patients with BPE who had not been satisfied with tadalafil monotherapy for more than 3 months. Inclusion criteria were prostate volume (PV) ≥ 30 ml and IPSS ≥ 8 or QOL index ≥ 3 under administration of tadalafil without anticholinergic agent. Before and 24 weeks after dutasteride add-on treatment to tadalafil, we assessed IPSS, overactive bladder symptom score (OABSS), serum PSA and testosterone, and uroflowmetry (UFM) to compare these parameters before and after dutasteride add-on treatment. Using a propensity-score matching analysis, the efficacy of dutasteride add-on treatment to tadalafil was compared with the previous study of dutasteride add-on treatment to alpha blocker. RESULTS Of 52 patients who were enrolled in this study, 48 patients completed the study (mean age: 72 ± 5 years old). Dutasteride add-on treatment to tadalafil significantly improved IPSS (from 16.4 ± 5.2 to 13.3 ± 6.4) and IPSS-QOL (from 4.0 ± 1.2 to 3.3 ± 1.1), and reduced PV from 55 ± 26 to 39 ± 22 ml. Propensity-score matching identified 42 matched pairs of patients. The improvement rate of IPSS and reduction rate of PV were similar between patients treated with dutasteride add-on treatment to tadalafil and dutasteride add-on treatment to alpha blocker. The logistic regression analysis showed that PV at baseline and reduction rate of PV after treatment were associated with the effective symptomatic outcome. CONCLUSIONS The dutasteride add-on is a reasonable treatment option for male patients with LUTS who are not satisfied with tadalafil monotherapy.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Mayumi Ishikawa
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shogo Makino
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
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11
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Wada N, Abe N, Miyauchi K, Ishikawa M, Makino S, Kakizaki H. Risk factors for failure of long-term dutasteride add-on treatment to alpha-adrenergic antagonist for patients with lower urinary tract symptoms and benign prostatic enlargement. Int Urol Nephrol 2021; 54:31-36. [PMID: 34767140 DOI: 10.1007/s11255-021-03053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify the clinical factors resulting in the failure of dutasteride add-on treatment to alpha-adrenergic antagonist for patients with lower urinary tract symptoms and benign prostatic enlargement (BPE). METHODS We retrospectively surveyed the patient cohort who had been enrolled in the study of dutasteride add-on treatment to alpha-adrenergic antagonist from December 2009 to November 2011. Treatment failure was defined as receiving surgery for BPE or requiring intermittent catheterization or permanent bladder catheter for urinary retention or huge postvoid residual urine. Clinical parameters before dutasteride treatment were compared between the successful and failed group. RESULTS Of 92 patients, 23 (25%) were defined as treatment failure at 7-109 months (mean: 38 months) after dutasteride add-on treatment. In the failed group, the patient' age was younger (71.6 ± 6.8 vs 75.4 ± 8.4, p = 0.033), prostatic volume (PV) was larger (76 ± 41 vs 49 ± 26 ml, p = 0.005), voiding efficiency was lower (54 ± 27 vs 68 ± 24%, p = 0.045) and bladder outlet obstruction index was higher (73 ± 30 vs 48 ± 30, p = 0.015). The cox proportional-hazards model indicated that only intravesical prostatic protrusion (IPP) was associated with treatment failure. Non-failure rate at 3 years after dutasteride add-on treatment was 89% with patients of IPP < 13 mm versus 51% with those of IPP ≥ 13 mm (p < 0.001). CONCLUSION IPP ≥ 13 mm is the risk factor resulting in the failure of dutasteride add-on treatment to alpha-adrenergic antagonist. This kind of information should be provided to the patients early in the clinical practice so that they could consider the necessity of BPE surgery in the long run.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Mayumi Ishikawa
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shogo Makino
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
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12
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Takeuchi M, Dohi T, Takahashi N, Endo H, Wada H, Doi S, Kato Y, Ogita M, Okai I, Iwata H, Okazaki S, Isoda K, Suwa S, Miyauchi K, Minamino T. Comparison of clinical effect of living alone between urban area and rural area in patient with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and objective
Living alone is reported as an independent risk factor for worse clinical outcomes after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Manifestations of psychological stress such as depression and anxiety in patients living alone is thought to be associated with subsequent cardiovascular events. The impact of living alone on the psychological factors of patients may be differ depending on their living environment. However, comparison of the effects of living alone in different living environment on the prognosis of patients with ACS has not been reported.
Purpose
The aim of the present study was to compare the clinical effect of living alone on clinical outcomes in patients with ACS between urban area and rural area.
Methods
Data from a multi-center, observational study of consecutive patients who underwent emergency PCI for ACS between January 2012 and December 2016 were analyzed. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE). MACCE was defined as composite of cardiovascular death, ACS, and stroke.
Results
In this study, 1349 patients were enrolled and divided into two population according to their living environment: urban area population (n=417), and rural area population (n=932). In urban area population, 87 patients (20.9%) were living alone, and 330 (79.1%) were living together. In rural area population, 169 (18.1%) were living alone, and 763 (81.9%) were living together. There are no significant differences in baseline characteristics between the living alone group and the living together group in both urban area population and rural area population. During a median follow-up period of 2.1 years, Kaplan-Meier curves showed the living alone group had higher risk of MACCE than the living together group in urban area population (log-rank, p=0.01). On the other hands, there are no significant differences in the incidences of MACCE between two groups in rural area population (p=0.86). After adjustment for other covariates, the living alone was significantly associated with MACCE (hazard ratio [HR], 2.83; 95% confidential interval [CI], 1.16–6.91; p=0.02) compared with the living together group in urban area population. However, in rural area population, the living alone group was not significantly associated with MACCE (HR, 1.02; 95% CI, 0.66–1.57; p=0.92) compared with the living together group.
Conclusion
Living alone was significantly associated with worse clinical outcomes after emergency PCI of ACS in urban area but not in rural area.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- M Takeuchi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - T Dohi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - N Takahashi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - H Endo
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - H Wada
- Juntendo University Shizuoka Hospital, Department of Cardiovascular Medicine, Izunokuni, Japan
| | - S Doi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - Y Kato
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - M Ogita
- Juntendo University Shizuoka Hospital, Department of Cardiovascular Medicine, Izunokuni, Japan
| | - I Okai
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - H Iwata
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - S Okazaki
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - K Isoda
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Department of Cardiovascular Medicine, Izunokuni, Japan
| | - K Miyauchi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - T Minamino
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
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13
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Takeuchi M, Dohi T, Fukase T, Nishio R, Takahashi N, Endo H, Doi S, Kato Y, Okai I, Iwata H, Okazaki S, Isoda K, Miyauchi K, Minamino T. Comparison of clinical outcomes between percutaneous coronary intervention for the de novo lesion versus in-stent restenosis lesion. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and objective
Percutaneous coronary intervention (PCI) with metallic coronary stent (bare-metal stents [BMS] and drug-eluting stents [DES]) implantation is most frequently performed therapeutic procedures for coronary artery disease. In-stent restenosis (ISR) is a critical drawback of metallic coronary stents. Incidence of ISR has been reported in up to 30% after BMS implantation. The use of DES has greatly reduced the proportion of restenosis compared with the BMS. However, ISR still remains the primary concern after PCI even in the contemporary DES era, and thought to be associated with worse clinical outcomes. However, comparative data on ISR and de novo lesions are rare.
Purpose
The aim of the present study was to compare the clinical outcomes after PCI for the de novo lesion and the ISR lesion.
Methods
We performed a retrospective analysis of patients who underwent PCI between 2013 and 2020. The incidences of major adverse cardiac and cerebrovascular events (MACCE) and all-cause death were evaluated. MACCE was defined as composite of cardiovascular death, non-fatal myocardial infarction, and stroke.
Results
In this study, 1538 patients were enrolled and divided into two groups: PCI for de novo lesion group (n=1258, 81.8%), and PCI for ISR lesion group (n=280, 18.2%). Patients in the ISR lesion group were significantly older and had higher prevalence of hypertension, diabetes mellitus, dyslipidemia and chronic kidney disease than patients in the de novo lesion group. During a median follow-up period of 1.9 years, Kaplan-Meier curves showed no significant differences in the incidences of MACCE (log-rank, p=0.86) and all-cause death (p=0.84) between two groups. After adjustment for other covariates, PCI for ISR lesion were not significantly associated with MACCE (hazard ratio [HR], 1.10; 95% confidential interval [CI], 0.61–1.97; p=0.76) and all-cause death (HR, 0.93; 95% CI, 0.56–1.56; p=0.79)
Conclusion
PCI for the ISR lesion was not associated with worse clinical outcomes compared with PCI for the de novo lesion.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Takeuchi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - T Dohi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - T Fukase
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - R Nishio
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - N Takahashi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - H Endo
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - S Doi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - Y Kato
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - I Okai
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - H Iwata
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - S Okazaki
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - K Isoda
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - K Miyauchi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
| | - T Minamino
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan
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14
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Fukaya H, Ako J, Yasuda S, Kaikita K, Akao M, Matoba T, Nakamura M, Miyauchi K, Hagiwara N, Kimura K, Hirayama A, Matsui K, Ogawa H. Aspirin vs. P2Y12 inhibitors with anticoagulation therapy for atrial fibrillation: insights from the AFIRE trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with coronary artery disease (CAD) and atrial fibrillation (AF) can be treated with multiple antithrombotic therapies including antiplatelets and oral anticoagulants; however, this has the potential to increase bleeding risk.
Purpose
This sub-analysis aimed to evaluate the efficacy and safety of P2Y12 inhibitors and aspirin in patients also receiving oral anticoagulant therapy.
Methods
We evaluated patients from the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial who received combination therapy (rivaroxaban plus a single antiplatelet agent). The choice of antiplatelets was left to the physician's discretion. The primary efficacy endpoint was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, and death from any cause. The primary safety endpoint was major bleeding according to the International Society on Thrombosis and Haemostasis criteria.
Results
A total of 1,075 patients were included (P2Y12 inhibitor group, n=297; aspirin group, n=778). Approximately 60% of patients were administered proton pump inhibitors (PPIs), and there was no significant difference in PPI use in the P2Y12 inhibitor and aspirin groups. Regarding the primary efficacy endpoint, there was no significant difference between the P2Y12 inhibitor and aspirin groups (hazard ratio, 1.31; 95% confidence interval, 0.88–1.94; p=0.178). Likewise, the primary safety endpoint was not different between the groups (hazard ratio, 0.79; 95% confidence interval, 0.43–1.47; p=0.456). In the detailed subgroup analysis, there were no differences in the efficacy and safety endpoints.
Conclusions
There were no significant differences between P2Y12 inhibitors and aspirin in cardiovascular events in patients with AF and stable CAD taking rivaroxaban in the chronic phase.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The Japan Cardiovascular Research Foundation based on a contract with Bayer Yakuhin, Ltd. Summary of this study
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Affiliation(s)
- H Fukaya
- Kitasato University School of Medicine, Cardiovascular Medicine, Sagamihara, Japan
| | - J Ako
- Kitasato University School of Medicine, Cardiovascular Medicine, Sagamihara, Japan
| | - S Yasuda
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - K Kaikita
- Kumamoto University, Cardiovascular Medicine, Kumamoto, Japan
| | - M Akao
- Kyoto Medical Centre, Cardiology, Kyoto, Japan
| | - T Matoba
- Kyushu University, Cardiovascular Medicine, Fukuoka, Japan
| | - M Nakamura
- Toho University Ohashi Medical Center, Cardiovascular Medicine, Tokyo, Japan
| | - K Miyauchi
- Juntendo University School of Medicine, Cardiology, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - K Kimura
- Yokohama City University Medical Center, Cardiovascular Center, Yokohama, Japan
| | - A Hirayama
- Osaka Police Hospital, Cardiovascular division, Osaka, Japan
| | - K Matsui
- Kumamoto University Hospital, General and Community Medicine, Kumamoto, Japan
| | - H Ogawa
- National Cerebral & Cardiovascular Center, Suita, Japan
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15
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Takahashi N, Dohi T, Endo H, Nishio R, Fukase T, Takeuchi M, Doi S, Kato Y, Okai I, Iwata H, Okazaki S, Isoda K, Miyauchi K, Daida H, Minamino T. The relationship among extent of lipid-rich plaque, factors associated with a reduction of lipid-rich plaque and late lumen loss: a near-infrared spectroscopy and intravascular ultrasound study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) are useful imaging modalities to identify lipid-rich plaque (LRP) which is associated with an increased risk of future cardiovascular events in individuals undergoing PCI. Pathological studies have raised concerns that treating LRP with stents may impair vascular healing. However, the impact of stent implantation to LRP lesions was less known. Moreover, little information is available about changes in the extent of LRP at before and after PCI.
Purpose
The aim of this study was to investigate changes in LRP by NIRS between pre- and post-stent implantation, and to evaluate an association among impact of LRP by NIRS at pre- and post-stenting and late lumen loss (LLL) by angiography.
Methods
We studied 175 lesions in 149 patients who underwent PCI under NIRS-IVUS guidance and follow-up angiography at 8-month later from 2017 to 2020. Plaque characteristics on IVUS, the extent of LRP [defined as a long segment with a 4-mm maximum lipid core burden index (maxLCBI4mm)] on NIRS, and quantitative coronary angiography measurements were analyzed. We evaluated a change of the extent of LRP between pre- and post-stenting at index PCI procedure, and association between the extent of LRP and a 8-month LLL at follow-up coronary angiography. A large LRP was defined as maxLCBI4mm>400 at pre-stenting.
Results
Mean age was 64.5 years old, and 123 (82%) patients were male. The prevalence of large LRP was 51% and median plaque burden at minimum lumen area was 81%. The extent of LRP at culprit lesion significantly decreased from pre- to post-stenting (median maxLCBI4mm [interquartile range (IQR)]: 407 [199, 580] to 133 [13, 319], p<0.001) (Figure 1). In multivariable liner regression analysis, independent predictors for the reduction of LRP were a pre-stenting LRP (β coefficient = −57.0, 95% confidence interval (CI) [−65.1 to −48.8], p<0.001) and plaque burden (β coefficient = −30.0, 95% CI [−56.6 to −3.4], p<0.001), respectively. On the other hands, patient comorbidities, lipid profile and inflammatory markers were not associated with the reduction of LRP (all p>0.05). Median LLL at follow-up angiogram was 0.17 [0.07–0.35] mm. Both the extent of pre- and post-stenting LRP were not associated with LLL (r=0.018, p=0.80 and r=0.022, p=0.76, respectively) (Figure 2). In addition, there was no significant difference in LLL between the post-stenting large and non-large LRP (median [IQR] 0.18 [0.08–0.35] vs. 0.17 [0.07–0.35]; P=0.95).
Conclusions
This study showed coronary stent implantation significantly reduced the NIRS-derived LRP in patients undergoing PCI. Although the extent of pre-stenting LRP and IVUS plaque burden predicted the reduction of LRP, the extent of pre- and post-stenting LRP were not associated with LLL. These findings suggest that stent implantation for LRP, even in a large LRP, is safe and does not affect LLL.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Scatter plotsFigure 2. CENTRAL Figure
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Affiliation(s)
- N Takahashi
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - T Dohi
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - H Endo
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - R Nishio
- Juntendo University Shizuoka Hospital, Cardiology, Izunokuni, Japan
| | - T Fukase
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - M Takeuchi
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - S Doi
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - Y Kato
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - I Okai
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - H Iwata
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - S Okazaki
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - K Isoda
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - K Miyauchi
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - H Daida
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
| | - T Minamino
- Juntendo University Graduate School of Medicine, Cardiovascular Biology and Medicine, Tokyo, Japan
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16
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Takahashi N, Dohi T, Endo H, Nishio R, Fukase T, Takeuchi M, Doi S, Kato Y, Okai I, Iwata H, Okazaki S, Isoda K, Miyauchi K, Daida H, Minamino T. Coronary lipid-rich plaque characteristics with acute coronary syndrome and chronic coronary syndrome: a near infrared spectroscopy and intravascular ultrasound study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Asians have a much lower incidence of adverse coronary events than Caucasians, and the characteristics of vulnerable plaque might be different among the ethnics.
Purpose
The aim of this study was to investigate the clinical characteristics of lipid-rich plaque (LRP) in the Asian population and we also aimed to distinguish the characteristics of an acute coronary syndrome (ACS) culprit lesion and a chronic coronary syndrome (CCS) culprit lesion. Furthermore, we evaluated the association between lipid core burden index (LCBI) and cardiovascular risk factors, lipid profiles, and inflammatory biomarkers, as determined in vivo by near infrared spectroscopy intravascular ultrasound (NIRS-IVUS) imaging in patients undergoing percutaneous coronary intervention (PCI).
Methods
We evaluated 207 patients (ACS, n=75; CCS, n=132) who underwent PCI under NIRS-IVUS. Plaque characteristics and the extent of LRP [defined as a long segment with a 4-mm maximum LCBI (maxLCBI4mm)] on NIRS in de-novo culprit and non-culprit segments were analyzed.
Results
The mean age was 65 years old and 82% of patients were male. The ACS culprit lesions had a significantly higher maxLCBI4mm (median [interquartile range (IQR)]: 533 [385–745] vs. 361 [174–527], p<0.001) than the CCS culprit lesions. Whereas, no significant difference was seen in maxLCBI4mm between ACS and CCS non-culprit lesion segments (246 [53, 342] vs. 185 [37, 350], p=0.47) (Figure 1). Receiver-operating characteristic analysis showed that the NIRS maxLCBI4mm could distinguish the ACS culprit segment from the CCS culprit segment, with a sensitivity of 73% and a specificity of 69% (c-statistic = 0.69; p<0.001, cut-off value of max LCBI4mm = 408) (Figure 2). On multivariate logistic analysis, a large LRP (defined as maxLCBI4mm ≥400) was the strongest independent predictor of the ACS culprit segment (odds ratio, 3.87; 95% confidence interval, 1.95–8.02). In non-culprit segments, 19.8% of patients had at least one large LRP without a small lumen. No significant correlation was found between the extent of LRP and circulating lipid profiles and inflammatory makers biomarkers (hs-CRP, IL-6, TNF-α) in both the culprit and non-culprit lesion segments, whereas the extent of LRP was positively correlated with IVUS plaque burden (r=0.24, p<0.001).
Conclusions
We confirmed that NIRS-IVUS plaque assessment could be useful to differentiate ACS from CCS culprit lesions, and that a threshold maxLCBI4mm ≥400 was clinically suitable in Japanese patients. No systemic surrogate markers were found to be associated with the extent of LRP by NIRS in culprit and non-culprit segments. Consequently, we believe that direct intravascular evaluation of coronary plaque characteristics remains important for identification of high-risk LRP.
Funding Acknowledgement
Type of funding sources: None. Figure 1. The difference of maxLCBI4mmFigure 2. ROC curve
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Affiliation(s)
- N Takahashi
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - T Dohi
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - H Endo
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - R Nishio
- Juntendo University Shizuoka Hospital, Cardiology, Izunokuni, Japan
| | - T Fukase
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - M Takeuchi
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - S Doi
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Y Kato
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - I Okai
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - H Iwata
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - S Okazaki
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - K Isoda
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - K Miyauchi
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - H Daida
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - T Minamino
- Juntendo University Graduate School of Medicine, Tokyo, Japan
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17
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Wada N, Watanabe M, Ishikawa M, Takeuchi K, Miyauchi K, Abe N, Banjo H, Kita M, Kakizaki H. Uroflowmetry pattern in detrusor underactivity and bladder outlet obstruction in male patients with lower urinary tract symptoms. Low Urin Tract Symptoms 2021; 13:361-365. [PMID: 33648017 DOI: 10.1111/luts.12377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate if uroflowmetry (UFM) curve patterns could differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO). METHODS A hundred consecutive data sets of male patients who were evaluated using UFM and invasive urodynamics (pressure flow study) were retrospectively collected. DU and BOO were diagnosed according to the bladder contractility index and BOO index. The UFM curve with two or more notches was defined as sawtooth pattern, and the interrupted pattern was defined if several curves with interruptions reducing to zero were noted. We also compared other UFM parameters including maximum and average flow rates (Qmax and Qave), voiding time, time to Qmax, the slope to first peak flow, the number of notches on the curve (sawtooth pattern), the number of curves (interrupted pattern), and the maximum drop on the sawtooth pattern. RESULTS Twenty-five and forty-nine patients were categorized in the BOO group and the DU group, respectively. The incidence of sawtooth pattern was significantly higher in the DU group (57%) than in the BOO group (32%), while the incidence of interrupted pattern was not different between the two groups (36% in the BOO group and 49% in the DU group). There were significant differences in age (area under the curve = 0.75), prostatic volume (0.67), the slope to first peak flow (0.58), the number of notches on the curve (0.61), and the maximum drop (0.76) between the two groups. CONCLUSIONS The sawtooth UFM pattern is more common in patients with DU than in those with BOO. New parameters on UFM curve patterns could be helpful to evaluate DU and BOO without invasive urodynamics.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masaki Watanabe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Mayumi Ishikawa
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Keigo Takeuchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroko Banjo
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masafumi Kita
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
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18
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Nagayoshi Y, Chujo T, Hirata S, Nakatsuka H, Chen CW, Takakura M, Miyauchi K, Ikeuchi Y, Carlyle BC, Kitchen RR, Suzuki T, Katsuoka F, Yamamoto M, Goto Y, Tanaka M, Natsume K, Nairn AC, Suzuki T, Tomizawa K, Wei FY. Loss of Ftsj1 perturbs codon-specific translation efficiency in the brain and is associated with X-linked intellectual disability. Sci Adv 2021; 7:7/13/eabf3072. [PMID: 33771871 PMCID: PMC7997516 DOI: 10.1126/sciadv.abf3072] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/09/2021] [Indexed: 05/06/2023]
Abstract
FtsJ RNA 2'-O-methyltransferase 1 (FTSJ1) gene has been implicated in X-linked intellectual disability (XLID), but the molecular pathogenesis is unknown. We show that Ftsj1 is responsible for 2'-O-methylation of 11 species of cytosolic transfer RNAs (tRNAs) at the anticodon region, and these modifications are abolished in Ftsj1 knockout (KO) mice and XLID patient-derived cells. Loss of 2'-O-methylation in Ftsj1 KO mouse selectively reduced the steady-state level of tRNAPhe in the brain, resulting in a slow decoding at Phe codons. Ribosome profiling showed that translation efficiency is significantly reduced in a subset of genes that need to be efficiently translated to support synaptic organization and functions. Ftsj1 KO mice display immature synaptic morphology and aberrant synaptic plasticity, which are associated with anxiety-like and memory deficits. The data illuminate a fundamental role of tRNA modification in the brain through regulation of translation efficiency and provide mechanistic insights into FTSJ1-related XLID.
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Affiliation(s)
- Y Nagayoshi
- Department of Molecular Physiology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - T Chujo
- Department of Molecular Physiology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - S Hirata
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - H Nakatsuka
- Department of Human Intelligence Systems, Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu 808-0196, Japan
| | - C-W Chen
- Laboratory for Protein Conformation Diseases, RIKEN Brain Science Institute, Saitama 351-0198, Japan
| | - M Takakura
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - K Miyauchi
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Y Ikeuchi
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
- Institute of Industrial Science, The University of Tokyo, Tokyo 153-8505, Japan
| | - B C Carlyle
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
| | - R R Kitchen
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
| | - T Suzuki
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - F Katsuoka
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - M Yamamoto
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
- Department of Medical Biochemistry, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Y Goto
- Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, NCNP, Tokyo 187-8551, Japan
| | - M Tanaka
- Laboratory for Protein Conformation Diseases, RIKEN Brain Science Institute, Saitama 351-0198, Japan
| | - K Natsume
- Department of Human Intelligence Systems, Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu 808-0196, Japan
| | - A C Nairn
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
| | - T Suzuki
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - K Tomizawa
- Department of Molecular Physiology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan.
| | - F-Y Wei
- Department of Molecular Physiology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan.
- Department of Modomics Biology and Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan
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19
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Asano T, Mitsuhashi Y, Yamashita J, Ito R, Saji M, Wakabayashi K, Yahagi K, Shinke T, Mase T, Miyachi H, Higuchi S, Miyauchi K, Yamamoto T, Nagao K, Takayama M. Relationship between age and the impact of revascularization on mortality in patients with non-ST-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
It is known that the early coronary revascularization in patients with non-ST-elevation myocardial infarction (NSTEMI) was associated with favorable clinical outcomes. However, it is still unclear whether this efficacy is equivalent over all the ages of the patients.
Methods
Patients with NSTEMI were screened from the database of the Tokyo CCU network registry. Of those, the patients treated without revascularization (medical treatment) were matched with the patients receiving revascularization by propensity score matching. The probabilities of in-hospital death were calculated in the logistic regression model. In two subgroups stratified according to median of the age (elderly and non-elderly subgroups), the odds ratios of revascularization for in-hospital death were calculated.
Results
In the patients registered between 2013 and 2017, 4,851 patients with NSTEMI were identified. After the screening, 370 patients with medical treatment were matched with 370 patients treated with revascularization. The incidence of in-hospital death was significantly higher in the patients with medical treatment (20.3% vs 13.0%, P=0.01). The two probability curves of in-hospital death in patients with and without revascularization converged as age increased. In the elderly subgroup, the revascularization was not significantly associated with favorable outcome of mortality, whereas it had a significant impact on mortality in the non-elderly subgroup (odds ratio: 0.47 [95% CI 0.23–0.95]).
Conclusion
The impact of revascularization on short-term mortality in patients with NSTEMI tended to be reduced as age increased.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Asano
- Tokyo CCU Network, Tokyo, Japan
| | | | | | - R Ito
- Tokyo CCU Network, Tokyo, Japan
| | - M Saji
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | - T Mase
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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20
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Takahashi N, Dohi T, Funamizu T, Endo H, Wada H, Doi S, Kato Y, Ogita M, Okai I, Iwata H, Okazaki S, Isoda K, Miyauchi K, Shimada K. Combined impact of residual inflammatory risk and chronic kidney disease on long-term clinical outcomes in patients undergoing percutaneous coronary intervention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inflammatory status pre-percutaneous coronary intervention (PCI) and post-PCI has been reported not only associated with poor prognosis, but also to impair renal function. Statins reduce cardiovascular events by lowering lipids and have anti-inflammatory impacts, but residual inflammatory risk (RIR) exists. It remains unclear that the synergistic effect of RIR and chronic kidney disease (CKD) on long-term clinical outcome in stable coronary artery disease (CAD) patients undergoing PCI in statin era.
Aim
The aim of this study was to investigate the long-term combined impact of RIR evaluating hs-CRP at follow-up and CKD among stable CAD patients undergoing PCI in statin era.
Methods
This is a single-center, observational, retrospective cohort study assessing consecutive 2,984 stable CAD patients who underwent first PCI from 2000 to 2016. We analyzed 2,087 patients for whom hs-CRP at follow-up (6–9 months later) was available. High residual inflammatory risk was defined as hs-CRP >0.6 mg/L according to the median value at follow up. Patients were assigned to four groups as Group1 (high RIR and CKD), Group2 (low RIR and CKD), Group3 (high RIR and non-CKD) or Group4 (low RIR and non-CKD). We evaluated all-cause death and major adverse cardiac events (MACE), defined as a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and non-fatal stroke.
Results
Of patients (83% men; mean age 67 years), there were 299 (14.3%) patients in group 1, 201 (9.6%) patients in group 2, 754 (36.1%) patients in group 3, and 833 (39.9%) patients in group 4. The median follow-up period was 5.2 years (IQR, 1.9–9.9 years). In total, 189 (frequency, 16.1%) cases of all-cause death and 128 (11.2%) MACE were identified during follow-up, including 53 (4.6%) CV deaths, 27 (2.4%) MIs and 52 (4.8%) strokes. The rate of all-cause death and MACE in group 1 was significantly higher than other groups (p<0.001, respectively). There was a stepwise increase in the incidence rates of all-cause death and MACE. After adjustment for important covariates, the presence of high RIR and/or CKD were independently associated with higher incidence of MACE and higher all-cause mortality. (shown on figure).
Conclusion
The presence of both high RIR and CKD conferred a synergistic adverse effect on the risk for long-term adverse cardiac events in patients undergoing PCI.
Kaplan-Meier curve
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Takahashi
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - T Dohi
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - T Funamizu
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - H Endo
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - H Wada
- Juntendo University Shizuoka Hospital, Cardiology, Izunokuni, Japan
| | - S Doi
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - Y Kato
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - M Ogita
- Juntendo University Shizuoka Hospital, Cardiology, Izunokuni, Japan
| | - I Okai
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - H Iwata
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - S Okazaki
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - K Isoda
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - K Miyauchi
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - K Shimada
- Juntendo University Graduate School of Medicine, Cardiovascular Medicine, Tokyo, Japan
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21
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Asano T, Mitsuhashi Y, Sachi M, Wakabayashi K, Yahagi K, Shinke T, Mase T, Miyachi H, Tujiguchi S, Yamashita J, Yamazaki M, Miyauchi K, Yamamoto T, Nagao K, Takayama M. The impact of low diastolic blood pressure on 30-day mortality of patients with acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
It is known that low diastolic blood pressure (DBP) is associated with long-term cardiovascular events after acute myocardial infarction (AMI). However, the impact of low diastolic blood pressure on short-term outcome has not yet been well investigated.
Methods and results
We included 15,208 patients who were hospitalized for AMI and registered in the Tokyo CCU network registry between 2013 and 2016. Thirty-day in-hospital mortality rate was 4.8% (728/15,208). To assess the relationship between DBP at the time of admission and 30-day mortality non-linearly, spline regression model was applied with the stratification of the cohort according to tercile of systolic blood pressure (SBP, low:≤122 mmHg, intermediate:123–148 mmHg, high:≥149 mmHg) and J-curve phenomenon was observed in the low and high SBP groups. In multivariate logistic regression analysis, adjusted odds ratio of the lowest quintile of DBP (≤64 mmHg) was 1.65 (95% CI:1.02–2.66) in low SBP group and 4.55 (95% CI:1.72–12.00) in high SBP group.
Conclusion
Low DBP was associated with increased 30-day in-hospital mortality rate after AMI even in patients with high SBP.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Asano
- Tokyo CCU Network, Tokyo, Japan
| | | | - M Sachi
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | - T Mase
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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22
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Toyota T, Morimoto T, Iimuro S, Iwata H, Miyauchi K, Inoue T, Nakagawa Y, Daida H, Ozaki Y, Sakuma I, Furukawa Y, Ohashi Y, Matsuzaki M, Nagai R, Kimura T. P832LDL-C levels on statins and cardiovascular event risk in stable coronary artery disease: An observation from the REAL-CAD study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The relation between very low on-treatment low-density lipoprotein cholesterol (LDL-C) level and the cardiovascular event risk is still unclear in patients receiving the same doses of statins.
Methods
From the REAL-CAD study comparing high-dose with low-dose pitavastatin therapy in Japanese patients with stable coronary artery disease, 11105 patients without reported non-adherence for the study drug were divided into 3 groups according to the on-treatment LDL-C level at 6-month (<70 mg/dL, 70–100 mg/dL, and ≥100 mg/dL; N=1016, N=3078, and N=1665 in the pitavastatin 1 mg/day stratum; N=2431, N=2524, and N=391 in the pitavastatin 4 mg/day stratum). Primary outcome measure was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission.
Results
In the pitavastatin 1 mg/day stratum, cumulative 4-year incidence of the primary outcome measure was not significantly different across the 3 groups (5.0%, 5.7%, and 5.2%, P=0.51), while in the 4 mg/day stratum, it was significantly higher in the LDL-C ≥100 mg/dL group than in other groups (4.5%, 3.4%, and 9.1%, P<0.001). The adjusted risks of the LDL-C <70 mg/dL group relative to the LDL-C 70–100 mg/dL group (reference) remained insignificant for the primary outcome measure in both 1 mg/day and 4 mg/day strata (HR 0.84, 95% CI 0.58–1.18, P=0.32, and HR 1.25, 95% CI 0.88–1.79, P=0.22). The adjusted risk of LDL-C ≥100 mg/dL group relative to the reference group was not significant for the primary outcome measure in the 1 mg/day stratum (HR 0.82, 95% CI 0.60–1.11, P=0.21), while it was highly significant in the 4 mg/day stratum (HR 3.32, 95% CI 2.08–5.17, P<0.001). In the on-treatment LDL-C ≥100 mg/dL group in the 4 mg/day stratum, LDL-C increased by 6.3 mg/dL from baseline to 6-month despite dose escalation of pitavastatin from 1 mg/day to 4 mg/day, suggesting the presence of unreported poor adherence in this small subgroup.
Adjusted Effects of On-treatment LDL-C
Conclusions
Very low on-treatment LDL-C level (<70 mg/dL) was not associated with lower cardiovascular event risk compared with moderately low on-treatment LDL-C level (70–100 mg/dL) in patients receiving the same doses of statins. Too much emphasis on the target LDL-C strategy might mislead the clinical practice.
Acknowledgement/Funding
The Comprehensive Support Project for Clinical Research of Lifestyle-Related Disease of the Public Health Research Foundation.
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Affiliation(s)
- T Toyota
- Kobe City Medical Center General Hospital, Department of Cardiovascular Medicine, Kobe, Japan
| | - T Morimoto
- Hyogo College of Medicine, Department of Clinical Epidemiology, Nishinomiya, Japan
| | - S Iimuro
- Teikyo University, Teikyo Academic Research Center, Tokyo, Japan
| | - H Iwata
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - K Miyauchi
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Inoue
- Dokkyo Medical University, Department of Cardiovascular Medicine, Mibu, Japan
| | - Y Nakagawa
- Shiga University of Medical Science, Department of Cardiovascular Medicine, Otsu, Japan
| | - H Daida
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - Y Ozaki
- Fujita Health University School of Medicine, Department of Cardiology, Toyoake, Japan
| | - I Sakuma
- Caress Sapporo Hokko Memorial Clinic, Sapporo, Japan
| | - Y Furukawa
- Kobe City Medical Center General Hospital, Department of Cardiovascular Medicine, Kobe, Japan
| | - Y Ohashi
- Chuo University, Department of Integrated Science and Technology for Sustainable Society, Tokyo, Japan
| | | | - R Nagai
- Jichi Medical University, Shimotsuke, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
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23
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Ito R, Takayama M, Yamashita J, Yahagi K, Shinke T, Mase T, Abe K, Miyaji H, Higuchi S, Tanaka H, Yamazaki M, Miyauchi K, Yamamoto T, Nagao K, Chikamori T. P850Clinical difference of recent myocardial infarction compared with acute myocardial infarction - Insights from Tokyo CCU network multicenter registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although the patient's characteristics and outcome of acute myocardial infarction (AMI) have been sufficiently investigated and primary percutaneous coronary intervention (PCI) has been recognized as established treatment strategy, those of recent myocardial infarction (RMI) have not been fully evaluated.
Purpose
The purpose of the present study was to clarify clinical characteristics and in-hospital outcomes of RMI patients from the database of the Tokyo CCU network multicenter registry.
Methods
In Tokyo CCU network multicenter registry database from 2013 to 2016, 15788 consecutive patients were registered as AMI (within 24 hours from onset) and RMI (within 2–30 days from onset). However 1246 patients were excluded because of inadequate data. And we excluded 66 cases because of out of onset period and 129 cases that strongly suspected of involvement of vasospastic events. Therefore, remaining 14347 patients were categorized to RMI group (n=1853) and AMI group (n=12494), and analyzed.
Results
Compared with AMI group, average age was older (70.4±12.9 vs 68.0±13.4 years, p<0.001), male was less (72.4 vs 76.4%, p<0.001), chest pain as chief complaint was less (75.2 vs 83.6%, p<0.001), prevalence of diabetes mellitus was higher (35.9 vs 31.0%, p<0.001), multi-vessel coronary disease was more (54.7 vs 44.6%, p<0.001), patients undergoing PCI was less (79.0 vs 91.2%, p<0.001), and the incidence of mechanical complication was more in RMI group (3.0 vs 1.5%, p<0.001). Although 30-day mortality was equivalent between 2 groups (5.3 vs 5.8%, p=0.360), the major cause of death in AMI group was cardiogenic shock, while in the RMI group it was a mechanical complication. On Kaplan-Meier analysis, the 2 groups had significantly different cumulative incidence of death due to cardiogenic shock (p=0.006, Log-rank test) and mechanical complication (p=0.021, Log-rank test). Furthermore death due to mechanical complication in AMI group was plateau after about 1 week from hospitalization, whereas in RMI group it continued to increase.
Kaplan-Meier analysis
Conclusions
RMI patients had distinctive clinical features in backgrounds and treatment strategies compared with AMI patients, and the major cause of death of RMI patients was different from that of AMI patients. Furthermore, even though treatment during hospitalization of RMI patients was well done, death due to mechanical complications continued to increase.
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Affiliation(s)
- R Ito
- Tokyo Medical University, Department of Cardiology, Tokyo, Japan
| | | | | | | | | | - T Mase
- Tokyo CCU Network, Tokyo, Japan
| | - K Abe
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
| | - T Chikamori
- Tokyo Medical University, Department of Cardiology, Tokyo, Japan
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Iwata H, Iimuro S, Inoue A, Miyauchi K, Taguchi I, Hiro T, Nakagawa Y, Ozaki Y, Ohashi Y, Daida H, Shimokawa H, Kimura T, Nagai R. P5320Reduction in high-sensitivity C-reactive protein by pitavastatin was associated with improved outcomes in Japanese patients with stable coronary artery disease: results from REAL-CAD study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The effect of statins on lowering high sensitivity C-reactive protein (hs-CRP) as well as low density lipoprotein cholesterol (LDL-C) has been associated with reduced risk for cardiovascular events in patients with elevated hs-CRP. However, it remains unclear whether this statin effect applies to low-risk patients with stable coronary artery disease (CAD). In this pre-specified sub-study within the REAL-CAD trial, we explored the association between achieved LDL-C/hs-CRP levels and cardiovascular events in Japanese patients with stable CAD who were treated with pitavastatin 1 mg or 4 mg/day.
Methods
The REAL-CAD trial randomly allocated 13,054 patients with stable CAD to pitavastatin 1 mg or 4 mg/day. LDL-C and hs-CRP were measured at baseline and at 6 months after randomization. We excluded those patients without 6-month data and those with endpoint events before 6 months (N=1915). The primary endpoint of the study was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring emergency hospitalization. Outcomes were assessed by landmark analysis beyond 6 months among 4 groups that were configured based on LDL-C (median) and hs-CRP (median) targets: achieving neither target, achieving LDL-C target only, achieving hs-CRP target only, and achieving both targets. Data were adjusted for baseline characteristics including age, gender, diabetes and baseline values of LDL-C and hs-CRP.
Results
Median LDL-C and hs-CRP levels were 88 mg/dL and 0.52 mg/L at baseline and 80 mg/dL and 0.48 mg/L after 6 months, respectively. There was no correlation between the change in LDL-C and hs-CRP levels from baseline to 6 months (correlation coefficient: 0.009, P=0.331). Of the 11,677 patients included in the study, 25.1% (N=2799) achieved both LDL-C and hs-CRP targets, 25.3% (N=2282) met neither target, 24.8% (N=2765) met only the hs-CRP target, and 24.7% (N=2753) met only the LDL-C target. Risk of primary endpoint occurrence was significantly lower in those achieving either or both targets than in those meeting neither target (Figure A). In the subgroup analysis stratified by the randomized dose of pitavastatin, the risk for the primary endpoint was significantly lower in patients achieving both targets in both the 1mg and 4 mg arms, and in patients achieving only hs-CRP target in the 1 mg arm (Figure B, C).
Figure 1
Conclusions
In this subanalysis of the REAL-CAD trial, the hs-CRP lowering effect of pitavastatin was independent from LDL-C lowering. Lower achieved hs-CRP was associated with lower risk for cardiovascular events in Japanese patients with stable CAD.
Acknowledgement/Funding
Public Health Research Foundation, The company manufacturing the study drug (Kowa Pharmaceutical Co Ltd) was one of the entities providing financial s
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Affiliation(s)
- H Iwata
- Juntendo University School of Medicine, Tokyo, Japan
| | - S Iimuro
- Teikyo University, Teikyo Academic Research Center, Tokyo, Japan
| | - A Inoue
- Dokkyo Medical University, Mibu, Japan
| | - K Miyauchi
- Juntendo University School of Medicine, Tokyo, Japan
| | - I Taguchi
- Dokkyo Medical University Koshigya Hospital, Koshigaya City, Japan
| | - T Hiro
- Nihon University, Tokyo, Japan
| | - Y Nakagawa
- Shiga University of Medical Science, Otsu, Japan
| | - Y Ozaki
- Fujita Health University School of Medicine, Toyoake, Japan
| | - Y Ohashi
- Chuo University, Department of Integrated Science and Technology for Sustainable Society, Tokyo, Japan
| | - H Daida
- Juntendo University School of Medicine, Tokyo, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - R Nagai
- Jichi Medical University, Shimotsuke, Japan
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SATO K, Hirano I, Sekine H, Miyauchi K, Nakai T, Kato K, Ito S, Yamamoto M, Suzuki N. SAT-116 A CELL LINE DERIVED FROM RENAL ERYTHROPOIETIN-PRODUCING CELLS PROVES THEIR MYOFIBROBLAST-TRANSFORMATION PROPERTY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Fukamachi D, Hirayama A, Miyauchi K, Yasuda S, Ogawa H, Ito H, Daida H. Corrigendum to "Antithrombotic therapy trends in non-valvular atrial fibrillation patients undergoing percutaneous coronary stent implantation: Results from a survey among fellows at the Japanese College of Cardiology" [J. Cardiol. 72 (2) (2018) 113-119]. J Cardiol 2018; 72:444. [PMID: 30097217 DOI: 10.1016/j.jjcc.2018.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- D Fukamachi
- The Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - A Hirayama
- The Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - K Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - S Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan
| | - H Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan
| | - H Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - H Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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Endo H, Dohi T, Miyauchi K, Funamizu T, Shitara J, Wada H, Doi S, Iwata H, Kasai T, Okazaki S, Isoda K, Daida H. 6134Long-term predictive value of high sensitivity c-reactive protein for cancer mortality in patients undergoing percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Endo
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - T Dohi
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - K Miyauchi
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - T Funamizu
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - J Shitara
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - H Wada
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - S Doi
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - H Iwata
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - T Kasai
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - S Okazaki
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - K Isoda
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - H Daida
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
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Otsuki H, Jujo K, Tanaka K, Okai I, Dohi T, Okazaki S, Kawashima H, Nakashima M, Nara Y, Kyono H, Yamaguchi J, Miyauchi K, Daida H, Kozuma K, Hagiwara N. P3587Gender difference in long-term clinical outcomes after rotational atherectomy in severely calcified coronary stenoses - From J2T multicenter registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Otsuki
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Jujo
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Tanaka
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - I Okai
- Juntendo University, Cardiology, Tokyo, Japan
| | - T Dohi
- Juntendo University, Cardiology, Tokyo, Japan
| | - S Okazaki
- Juntendo University, Cardiology, Tokyo, Japan
| | | | | | - Y Nara
- Teikyo University, Cardiology, Tokyo, Japan
| | - H Kyono
- Teikyo University, Cardiology, Tokyo, Japan
| | - J Yamaguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Miyauchi
- Juntendo University, Cardiology, Tokyo, Japan
| | - H Daida
- Juntendo University, Cardiology, Tokyo, Japan
| | - K Kozuma
- Teikyo University, Cardiology, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
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Isogai H, Naito R, Kasai T, Miyazaki T, Yokoyama K, Tokano T, Miyauchi K, Nakazato Y, Daida H. P3474Temporal trends in clinical features and outcomes in the elderly following percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Isogai
- Juntendo Urayasu Hospital, Heart Center, Urayasu, Japan
| | - R Naito
- Juntendo Urayasu Hospital, Heart Center, Urayasu, Japan
| | - T Kasai
- Juntendo University, Department of Cardiovascular medicine, Tokyo, Japan
| | - T Miyazaki
- Juntendo Urayasu Hospital, Heart Center, Urayasu, Japan
| | - K Yokoyama
- Juntendo Urayasu Hospital, Heart Center, Urayasu, Japan
| | - T Tokano
- Juntendo Urayasu Hospital, Heart Center, Urayasu, Japan
| | - K Miyauchi
- Juntendo Tokyo Koto Geriatric Medical Center, Cardiology, Tokyo, Japan
| | - Y Nakazato
- Juntendo Urayasu Hospital, Heart Center, Urayasu, Japan
| | - H Daida
- Juntendo University, Department of Cardiovascular medicine, Tokyo, Japan
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Kishi M, Yamasaki M, Mase T, Abe K, Higuchi S, Yamashita J, Yoshikawa M, Suzuki M, Tanaka H, Miyauchi K, Nagao K, Takayama M. P811Impact of non-infarct-related artery occlusion on short-term mortality in STEMI patients: insight from Tokyo CCU network database. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Kishi
- Tokyo CCU Network, Tokyo, Japan
| | | | - T Mase
- Tokyo CCU Network, Tokyo, Japan
| | - K Abe
- Tokyo CCU Network, Tokyo, Japan
| | | | | | | | | | | | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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Yatsu S, Naito R, Kasai T, Matsumoto H, Shitara J, Shimizu M, Murata A, Kato T, Suda S, Hiki M, Sai E, Miyauchi K, Daida H. P6408Association between sleep disordered breathing assessed by pulse oximetry and long-term clinical outcomes in patients with coronary artery disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Yatsu
- Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - R Naito
- Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - T Kasai
- Juntendo University Graduate School of Medicine, Cardiovascular Respiratory Sleep Medicine, Tokyo, Japan
| | - H Matsumoto
- Juntendo University Graduate School of Medicine, Cardiovascular Respiratory Sleep Medicine, Tokyo, Japan
| | - J Shitara
- Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Shimizu
- Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - A Murata
- Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - T Kato
- Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - S Suda
- Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Hiki
- Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - E Sai
- Juntendo Tokyo Koto Geriatric Medical Center, Department of Cardiology, Tokyo, Japan
| | - K Miyauchi
- Juntendo Tokyo Koto Geriatric Medical Center, Department of Cardiology, Tokyo, Japan
| | - H Daida
- Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan
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Shitara J, Kasai T, Miyauchi K, Endo H, Wada H, Doi S, Naito R, Konishi H, Tsuboi S, Ogita M, Dohi T, Okazaki S, Isoda K, Daida H. P6535Differing efficacy of beta blockers on long-term clinical outcomes between ischemic heart failure patients with reduced and mid-range ejection fraction following percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Shitara
- Juntendo University, Circulation, Tokyo, Japan
| | - T Kasai
- Juntendo University, Circulation, Tokyo, Japan
| | - K Miyauchi
- Juntendo University, Circulation, Tokyo, Japan
| | - H Endo
- Juntendo University, Circulation, Tokyo, Japan
| | - H Wada
- Juntendo University, Circulation, Tokyo, Japan
| | - S Doi
- Juntendo University, Circulation, Tokyo, Japan
| | - R Naito
- Juntendo University, Circulation, Tokyo, Japan
| | - H Konishi
- Juntendo University Shizuoka Hospital, Circulation Department, Izunokuni, Japan
| | - S Tsuboi
- Juntendo University Shizuoka Hospital, Circulation Department, Izunokuni, Japan
| | - M Ogita
- Juntendo University Shizuoka Hospital, Circulation Department, Izunokuni, Japan
| | - T Dohi
- Juntendo University, Circulation, Tokyo, Japan
| | - S Okazaki
- Juntendo University, Circulation, Tokyo, Japan
| | - K Isoda
- Juntendo University, Circulation, Tokyo, Japan
| | - H Daida
- Juntendo University, Circulation, Tokyo, Japan
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Wada H, Dohi T, Miyauchi K, Shitara J, Endo H, Doi S, Konishi H, Naito R, Tsuboi S, Ogita M, Kasai T, Hassan A, Okazaki S, Isoda K, Suwa S, Daida H. Long-term clinical impact of serum albumin in coronary artery disease patients with preserved renal function. Nutr Metab Cardiovasc Dis 2018; 28:285-290. [PMID: 29289574 DOI: 10.1016/j.numecd.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Low serum albumin level is reportedly associated with worse clinical outcomes in patients with chronic kidney disease (CKD). However, associations between decreased serum albumin level and outcomes in non-CKD patients with coronary artery disease (CAD) remain unclear. Therefore, we aimed to evaluate the prognostic value of serum albumin concentrations in stable CAD patients with preserved renal function. METHODS AND RESULTS We studied 1316 patients with CAD and preserved renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m2) who underwent their first PCI between 2000 and 2011 and had data available for pre-procedural serum albumin. Patients were assigned to quartiles based on pre-procedural albumin concentrations. The incidence of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, was evaluated. Mean albumin concentration was 4.1 ± 0.4 g/dL. During the median follow-up of 7.5 years, 181 events occurred (13.8%). Kaplan-Meier curves revealed that patients with decreased serum albumin concentrations showed a higher event rate for MACE (log-rank, p < 0.0001). Using the highest tertiles (>4.3 g/dL) as reference, adjusted hazard ratios were 1.97 (95% CI, 1.12-3.55), 1.77 (95% CI, 0.99-3.25), and 1.19 (95% CI, 0.68-2.15) for serum albumin concentrations of <3.9, 3.9-4.0, and 4.1-4.3 g/dL, respectively. Decreased serum albumin concentration was associated with MACE even after adjusting for other independent variables (HR, 2.21 per 1-g/dL decrease; 95% CI, 1.37-3.56, p = 0.001). CONCLUSION Decreased serum albumin concentration independently predicted worse long-term prognosis in non-CKD patients after PCI. Pre-procedural serum albumin concentration could offer a useful predictor for patients with CAD and preserved renal function.
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Affiliation(s)
- H Wada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - T Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - K Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - J Shitara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - H Endo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - S Doi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - H Konishi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - R Naito
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - S Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - M Ogita
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - T Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - A Hassan
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Cardiology, Suez Canal University, Ismailia, Egypt
| | - S Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - K Isoda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - S Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - H Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Jujo K, Tanaka K, Otsuki H, Okai I, Nakashima M, Dohi T, Okazaki S, Kawashima H, Nara Y, Kyono H, Yamaguchi J, Miyauchi K, Daida H, Kozuma K, Hagiwara N. P501Prediction of 3-year mortality after rotational atherectomy in severely calcified coronary artery. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Endo H, Iwata H, Naito R, Wada H, Doi S, Konishi H, Tsuboi S, Ogita M, Dohi T, Kasai T, Okazaki S, Isoda K, Miyauchi K, Daida H. P5336Persistent higher high sensitivity C-reactive protein after percutaneous coronary intervention (PCI) predicts higher mortality in patients undergoing PCI with stable coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kishi M, Yamasaki M, Horiuchi Y, Saji M, Iwata H, Higuchi S, Yamashita J, Suzuki M, Yoshikawa M, Tanaka H, Miyauchi K, Takayama M. P3705Pre-hospital routine oxygen supplement may do harm: insight from Tokyo CCU network database. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jujo K, Otsuki H, Tanaka K, Okai I, Nakashima M, Dohi T, Okazaki S, Kawashima H, Nara Y, Kyono H, Yamaguchi J, Miyauchi K, Daida H, Kozuma K, Hagiwara N. P6452Predictors for long-term cardiovascular death after rotational atherectomy in patients with regular hemodialysis - from J2T multicenter registry -. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K. Jujo
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H. Otsuki
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K. Tanaka
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - I. Okai
- Juntendo University, Department of Cardiology, Tokyo, Japan
| | - M. Nakashima
- Teikyo University, Department of Cardiology, Tokyo, Japan
| | - T. Dohi
- Juntendo University, Department of Cardiology, Tokyo, Japan
| | - S. Okazaki
- Juntendo University, Department of Cardiology, Tokyo, Japan
| | - H. Kawashima
- Teikyo University, Department of Cardiology, Tokyo, Japan
| | - Y. Nara
- Teikyo University, Department of Cardiology, Tokyo, Japan
| | - H. Kyono
- Teikyo University, Department of Cardiology, Tokyo, Japan
| | - J. Yamaguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K. Miyauchi
- Juntendo University, Department of Cardiology, Tokyo, Japan
| | - H. Daida
- Juntendo University, Department of Cardiology, Tokyo, Japan
| | - K. Kozuma
- Teikyo University, Department of Cardiology, Tokyo, Japan
| | - N. Hagiwara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
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Kishi M, Yamasaki M, Horiuchi Y, Saji M, Iwata H, Higuchi S, Yamashita J, Suzuki M, Yoshikawa M, Tanaka H, Miyauchi K, Takayama M. P3643Cardiac rupture in current primary PCI era: a multicenter cohort study of Tokyo CCU network database. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Takahashi N, Ogita M, Miyauchi K, Wada H, Naito R, Konishi H, Tsuboi S, Dohi T, Kasai T, Okazaki S, Isoda K, Suwa S, Bujo H, Daida H. P4941Impact of LR11 as residual risk on long term clinical outcomes in patients with coronary artery disease treated with statin after first percutaneous coronary intervention. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Miyauchi K, Tamura H, Okazaki S, Daida H. Efficacy of chronic high-dose statin therapy in procedural myocardial injury and long-term outcomes in patients undergoing rotablational atherectomy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Miura M, Yamasaki M, Takagi A, Miyauchi K, Tanaka H, Yoshikawa M, Miyachi H, Yamamoto T, Nagao K, Takayama M. Impact of statin administration on mortality in patients with acute myocardial infarction; multicenter registry from Tokyo CCU network database. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Shimizu T, Miyauchi K, Shirasuna K, Bollwein H, Magata F, Murayama C, Miyamoto A. Effects of lipopolysaccharide (LPS) and peptidoglycan (PGN) on estradiol production in bovine granulosa cells from small and large follicles. Toxicol In Vitro 2012; 26:1134-42. [DOI: 10.1016/j.tiv.2012.06.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 05/15/2012] [Accepted: 06/25/2012] [Indexed: 11/29/2022]
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43
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Doihara H, Mitsuyama S, Sato S, Komaki K, Ikeda T, Miyauchi K, Yanagita Y, Shien T, Anan K, Kusama M. P287 The effects of toremifene (TOR) and letrozole (LET) on serum lipids and bone metabolism in postmenopausal patients with estrogen receptor (ER) positive breast cancer – MULTI03 study interim report. Breast 2011. [DOI: 10.1016/s0960-9776(11)70229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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44
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Dohi T, Miyauchi K, Okazaki S, Yokoyama T, Tamura H, Kojima T, Yokoyama K, Kurata T, Daida H. Long-term impact of mild chronic kidney disease in patients with acute coronary syndrome undergoing percutaneous coronary interventions. Nephrol Dial Transplant 2011; 26:2906-11. [DOI: 10.1093/ndt/gfq820] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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45
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Miyauchi K, Fujita M, Oikawa K, Ohtomo Y, Endo G, Fukuda M. Characterization of arsenic resistance genes in Rhodococcus jostii RHA1. J Biotechnol 2010. [DOI: 10.1016/j.jbiotec.2010.09.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Shimodaira J, Miyauchi K, Takeda H, Kasai D, Masai E, Fukuda M. Regulatory mechanism of biphenyl/PCB-degradation gene transcription in Rhodococcus jostii RHA1. J Biotechnol 2010. [DOI: 10.1016/j.jbiotec.2010.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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47
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Nguyen T, Sato Y, Miyauchi K, Kasai D, Masai E, Fukuda M. 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (DDE) degradation enzyme system in Janibacter sp. TYM3221. J Biotechnol 2010. [DOI: 10.1016/j.jbiotec.2010.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Ohira T, Miyauchi K, Sakaguchi Y, Suzuki T, Suzuki T. Precise analysis of modification status at various stage of tRNA maturation in Saccharomyces cerevisiae. ACTA ACUST UNITED AC 2009:301-2. [DOI: 10.1093/nass/nrp151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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49
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Kiyanagi T, Miyauchi K, Shimada K, Hiki M, Kume A, Miyazaki T, Sumiyoshi K, Daida H. Abstract: P392 DIFFERENCES IN VASCULAR RESPONSE AND RENAL FUNCTION FOLLOWING MODERATE OR AGGRESSIVE LIPID LOWERING THERAPY IN HYPERCHOLESTEROLEMIC PATIENTS WITH CARDIOVASCULAR DISEASES. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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Hidaka K, Yasutake D, Ito E, Imai S, Kitano M, Miyauchi K. INNOVATIVE CULTIVATION OF VEGETABLES ON VERTICALLY MOVING BEDS CONTROLLED BY DOUBLE SEESAW MECHANICS. ACTA ACUST UNITED AC 2008. [DOI: 10.17660/actahortic.2008.801.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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