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Takeji Y, Taniguchi T, Morimoto T, Shirai S, Kitai T, Tabata H, Kitano K, Ohno N, Murai R, Osakada K, Murata K, Nakai M, Tsuneyoshi H, Tada T, Amano M, Watanabe S, Shiomi H, Watanabe H, Yoshikawa Y, Nishikawa R, Yamamoto K, Obayashi Y, Toyofuku M, Tatsushima S, Kanamori N, Miyake M, Nakayama H, Nagao K, Izuhara M, Nakatsuma K, Inoko M, Fujita T, Kimura M, Ishii M, Usami S, Sawada K, Nakazeki F, Okabayashi M, Shirotani M, Inuzuka Y, Ando K, Komiya T, Minatoya K, Kimura T. In-hospital outcomes after SAVR or TAVI in patients with severe aortic stenosis. Cardiovasc Interv Ther 2024; 39:65-73. [PMID: 37349628 PMCID: PMC10764526 DOI: 10.1007/s12928-023-00942-x] [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: 02/08/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
There were no data comparing the in-hospital outcomes after transcatheter aortic valve implantation (TAVI) with those after surgical aortic valve replacement (SAVR) in Japan. Among consecutive patients with severe AS between April 2018 and December 2020 in the CURRENT AS Registry-2, we identified 1714 patients who underwent aortic valve replacement (TAVI group: 1134 patients, and SAVR group: 580 patients). Patients in the TAVI group were much older (84.4 versus 73.6 years, P < 0.001) and more often had comorbidities than those in the SAVR group. In-hospital death rate was numerically lower in the TAVI group than in the SAVR group (0.6% versus 2.2%). After excluding patients with dialysis, in-hospital death rate was very low and comparable in the TAVI and SAVR groups (0.6% versus 0.8%). The rates of major bleeding and new-onset atrial fibrillation during index hospitalization were higher after SAVR than after TAVI (72% versus 20%, and 26% versus 4.6%, respectively), while the rate of pacemaker implantation was higher after TAVI than after SAVR (8.1% versus 2.4%). Regarding the echocardiographic data at discharge, the prevalence of patient-prosthesis mismatch was lower in the TAVI group than in the SAVR group (moderate: 9.0% versus 26%, and severe: 2.6% versus 4.8%). In this real-world data in Japan, TAVI compared with SAVR was chosen in much older patients with more comorbidities with severe AS. In-hospital death rate was numerically lower in the TAVI group than in the SAVR group.
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Affiliation(s)
- Yasuaki Takeji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Shirai
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Tabata
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazuki Kitano
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobuhisa Ohno
- Division of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kohei Osakada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Masanao Nakai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryusuke Nishikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Obayashi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shojiro Tatsushima
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Norio Kanamori
- Division of Cardiology, Shimada General Medical Center, Shimada, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Hiroyuki Nakayama
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Masayasu Izuhara
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takanari Fujita
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masahiro Kimura
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunsuke Usami
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Fumiko Nakazeki
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Marie Okabayashi
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Manabu Shirotani
- Division of Cardiology, Faculty of Medicine, Nara Hospital, Kinki University, Ikoma, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga General Hospital, Moriyama, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
- Department of Cardiology, Hirakata Kohsai Hospital, 1-2-1 Fujisaka Higashi-machi, Hirakata, 573-0153, Japan.
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2
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Taniguchi T, Morimoto T, Yamaji K, Shirai S, Ando K, Shiomi H, Takeji Y, Ohno N, Kanamori N, Yamazaki F, Koyama T, Kim K, Ehara N, Furukawa Y, Komiya T, Iwakura A, Shirotani M, Esaki J, Sakaguchi G, Fujii K, Nakayama S, Mabuchi H, Tsuneyoshi H, Eizawa H, Shiraga K, Hanyu M, Nakano A, Ishii K, Tamura N, Higashitani N, Kouchi I, Yamada T, Nishizawa J, Jinnai T, Morikami Y, Minatoya K, Kimura T. Life Expectancy of Patients With Severe Aortic Stenosis in Relation to Age and Surgical Risk Score. Ann Thorac Surg 2023; 116:1195-1203. [PMID: 36739072 DOI: 10.1016/j.athoracsur.2023.01.028] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/28/2022] [Accepted: 01/14/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is a paucity of data regarding shorter life expectancy after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). METHODS Among 3815 patients with severe AS enrolled in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry, there were 1469 patients (initial AVR: n = 647; conservative strategy: n = 822) with low surgical risk, 1642 patients (initial AVR: n = 433; conservative strategy: n = 1209) with intermediate surgical risk, and 704 patients (initial AVR: n = 117; conservative strategy: n = 587) with high surgical risk. Among 1163 patients who actually underwent surgical AVR as the initial strategy, patients were divided into 4 groups according to age <65 years (n = 185), 65 to 74 (n = 394), 75 to 80 (n = 345), and >80 (n = 239). The expected survival of the general Japanese population was obtained from the Statistics Bureau of Japan. The surgical risk was estimated using The Society of Thoracic Surgery (STS) score. RESULTS The median follow-up was 3.7 years. The cumulative incidences of all-cause death were significantly lower in the initial AVR strategy than in the initial conservative strategy across the 3 STS groups. Shorter life expectancy after surgical AVR was seen especially in younger patients. The observed mortality in low-risk patients was comparable to the expected mortality across all the age-groups, while intermediate-risk patients aged <75 years, and high-risk patients across all age-groups had higher mortality compared with the expected mortality. CONCLUSIONS The risk stratification according to age and STS score might be useful to estimate shorter life expectancy after AVR, and these findings have implications for decision making in the choice of surgical or transcatheter AVR.
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Affiliation(s)
- Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinichi Shirai
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Norio Kanamori
- Department of Cardiovascular Medicine, Shimada General Medical Center, Shimada, Japan
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri City, Japan
| | - Manabu Shirotani
- Department of Cardiovascular Medicine, Kindai University Nara Hospital, Nara, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, West Kyoto, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Hospital, Osaka Sayama City, Japan
| | - Kosuke Fujii
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiovascular Medicine, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroshi Eizawa
- Department of Cardiovascular Medicine, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Kotaro Shiraga
- Department of Cardiovascular Surgery, Kyoto Medical Center, Kyoto Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kitano Hospital, Osaka, Japan
| | - Akira Nakano
- Department of Cardiovascular Medicine, Hikone Municipal Hospital, Hikone, Japan
| | - Katsuhisa Ishii
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital, Fukushima, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Nobuya Higashitani
- Department of Cardiovascular Medicine, Otsu Red Cross Hospital, Otsu, Japan
| | - Ichiro Kouchi
- Department of Cardiovascular Medicine, Saiseikai Noe Hospital, Osaka, Japan
| | - Tomoyuki Yamada
- Department of Cardiovascular Surgery, Shiga General Hospital, Shiga, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu City, Japan
| | - Toshikazu Jinnai
- Department of Cardiovascular Medicine, Otsu Red Cross Hospital, Otsu, Japan
| | - Yuko Morikami
- Department of Cardiovascular Medicine, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Yamamoto K, Morimoto T, Natsuaki M, Shiomi H, Ozasa N, Sakamoto H, Takeji Y, Domei T, Tada T, Taniguchi R, Uegaito T, Yamada M, Takeda T, Eizawa H, Suwa S, Shirotani M, Tamura T, Inoko M, Sakai H, Ishii K, Toyofuku M, Miki S, Onodera T, Furukawa Y, Inada T, Ando K, Kadota K, Nakagawa Y, Kimura T. Polypharmacy and Bleeding Outcomes After Percutaneous Coronary Intervention. Circ J 2023:CJ-23-0558. [PMID: 37722886 DOI: 10.1253/circj.cj-23-0558] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Polypharmacy was reported to be associated with major bleeding in various populations. However, there are no data on polypharmacy and its association with bleeding in patients undergoing percutaneous coronary intervention (PCI).Methods and Results: Among 12,291 patients in the CREDO-Kyoto PCI Registry Cohort-3, we evaluated the number of medications at discharge and compared major bleeding, defined as Bleeding Academic Research Consortium Type 3 or 5 bleeding, across tertiles (T1-3) of the number of medications. The median number of medications was 6, and 88.0% of patients were on ≥5 medications. The cumulative 5-year incidence of major bleeding increased incrementally with increasing number of medications (T1 [≤5 medications] 12.5%, T2 [6-7] 16.5%, and T3 [≥8] 20.4%; log-rank P<0.001). After adjusting for confounders, the risks for major bleeding of T2 (hazard ratio [HR] 1.21; 95% confidence interval [CI] 1.08-1.36; P=0.001) and T3 (HR 1.27; 95% CI 1.12-1.45; P<0.001) relative to T1 remained significant. The adjusted risks of T2 and T3 relative to T1 were not significant for a composite of myocardial infarction or ischemic stroke (HR 0.95 [95% CI 0.83-1.09; P=0.47] and HR 1.06 [95% CI 0.91-1.23; P=0.48], respectively). CONCLUSIONS In a real-world population of patients undergoing PCI, approximately 90% were on ≥5 medications. Increasing number of medications was associated with a higher adjusted risk for major bleeding, but not ischemic events.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiology, Kokura Memorial Hospital
| | | | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | | | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital
| | | | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | | | | | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Hiroshi Sakai
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | | | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | | | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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4
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Takeji Y, Taniguchi T, Morimoto T, Shirai S, Kitai T, Tabata H, Kitano K, Ono N, Murai R, Osakada K, Murata K, Nakai M, Tsuneyoshi H, Tada T, Amano M, Shiomi H, Watanabe H, Yoshikawa Y, Yamamoto K, Toyofuku M, Tatsushima S, Kanamori N, Miyake M, Nakayama H, Nagao K, Izuhara M, Nakatsuma K, Inoko M, Fujita T, Kimura M, Ishii M, Usami S, Sawada K, Nakazeki F, Okabayashi M, Shirotani M, Inuzuka Y, Komiya T, Minatoya K, Kimura T. CORRIGENDUM: Rationale, Design, and Baseline Characteristics of the CURRENT AS Registry-2. Circ J 2023; 87:1146-1149. [PMID: 37495511 DOI: 10.1253/circj.cj-66-0215] [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: 07/28/2023]
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5
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Watanabe H, Yamamoto K, Shiomi H, Morimoto T, Kato E, Matsumura Y, Nakatsuma K, Takeji Y, Yaku H, Yamamoto E, Yamashita Y, Yoshikawa Y, Fuki M, Yamaji K, Ehara N, Sakamoto H, Imada K, Tada T, Taniguchi R, Nishikawa R, Tada T, Uegaito T, Ogawa T, Yamada M, Takeda T, Eizawa H, Tamura N, Tambara K, Suwa S, Shirotani M, Tamura T, Inoko M, Nishizawa J, Natsuaki M, Sakai H, Yamamoto T, Kanemitsu N, Ohno N, Ishii K, Marui A, Tsuneyoshi H, Terai Y, Nakayama S, Yamazaki K, Takahashi M, Tamura T, Esaki J, Miki S, Onodera T, Mabuchi H, Furukawa Y, Tanaka M, Komiya T, Soga Y, Hanyu M, Ando K, Kadota K, Minatoya K, Nakagawa Y, Kimura T. Percutaneous coronary intervention using new-generation drug-eluting stents versus coronary arterial bypass grafting in stable patients with multi-vessel coronary artery disease: From the CREDO-Kyoto PCI/CABG registry Cohort-3. PLoS One 2022; 17:e0267906. [PMID: 36174029 PMCID: PMC9521921 DOI: 10.1371/journal.pone.0267906] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Aims There is a scarcity of studies comparing percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) with coronary artery bypass grafting (CABG) in patients with multi-vessel coronary artery disease. Methods and results The CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who underwent first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. The current study population consisted of 2464 patients who underwent multi-vessel coronary revascularization including revascularization of left anterior descending coronary artery (LAD) either with PCI using new-generation DES (N = 1565), or with CABG (N = 899). Patients in the PCI group were older and more often had severe frailty, but had less complex coronary anatomy, and less complete revascularization than those in the CABG group. Cumulative 5-year incidence of a composite of all-cause death, myocardial infarction or stroke was not significantly different between the 2 groups (25.0% versus 21.5%, P = 0.15). However, after adjusting confounders, the excess risk of PCI relative to CABG turned to be significant for the composite endpoint (HR 1.27, 95%CI 1.04–1.55, P = 0.02). PCI as compared with CABG was associated with comparable adjusted risk for all-cause death (HR 1.22, 95%CI 0.96–1.55, P = 0.11), and stroke (HR 1.17, 95%CI 0.79–1.73, P = 0.44), but with excess adjusted risk for myocardial infarction (HR 1.58, 95%CI 1.05–2.39, P = 0.03), and any coronary revascularization (HR 2.66, 95%CI 2.06–3.43, P<0.0001). Conclusions In this observational study, PCI with new-generation DES as compared with CABG was associated with excess long-term risk for major cardiovascular events in patients who underwent multi-vessel coronary revascularization including LAD.
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Affiliation(s)
- Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Eri Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukiko Matsumura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenori Yaku
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Fuki
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuaki Imada
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takashi Uegaito
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Keiichi Tambara
- Department of Cardiovascular Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
| | | | - Moriaki Inoko
- Department of Cardiology, Kitano Hospital, Osaka, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | | | - Hiroshi Sakai
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takashi Yamamoto
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Denryoku Hospital, Osaka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuhiko Terai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaru Tanaka
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kitano Hospital, Osaka, Japan
| | - Kenji Ando
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
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6
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Yamaji K, Shiomi H, Morimoto T, Matsumura-Nakano Y, Ehara N, Sakamoto H, Takeji Y, Yoshikawa Y, Yamamoto K, Kato ET, Imada K, Tada T, Taniguchi R, Nishikawa R, Tada T, Uegaito T, Ogawa T, Yamada M, Takeda T, Eizawa H, Tamura N, Tambara K, Suwa S, Shirotani M, Tamura T, Inoko M, Nishizawa J, Natsuaki M, Sakai H, Yamamoto T, Kanemitsu N, Ohno N, Ishii K, Marui A, Tsuneyoshi H, Terai Y, Nakayama S, Yamazaki K, Takahashi M, Tamura T, Esaki J, Miki S, Onodera T, Mabuchi H, Furukawa Y, Tanaka M, Komiya T, Soga Y, Hanyu M, Domei T, Ando K, Kadota K, Minatoya K, Nakagawa Y, Kimura T. Modifiers of the Risk of Diabetes for Long-Term Outcomes After Coronary Revascularization: CREDO-Kyoto PCI/CABG Registry. JACC Asia 2022; 2:294-308. [PMID: 36411876 PMCID: PMC9675601 DOI: 10.1016/j.jacasi.2021.12.012] [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] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization. OBJECTIVES This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions. METHODS The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry. The primary outcome measure was major adverse cardiovascular and cerebral endpoints (MACCE), which was defined as a composite of all-cause death, myocardial infarction, and stroke. RESULTS With median follow-up of 5.6 years, diabetes was associated with significantly higher adjusted risks for MACCE. The excess adjusted risks of diabetes relative to nondiabetes for MACCE increased with younger age (≤64 years: adjusted HR: 1.30; 95% CI: 1.19-1.41; P < 0.001; 64-73 years: adjusted HR: 1.24; 95% CI: 1.16-1.33; P < 0.001; >73 years: adjusted HR: 1.17; 95% CI: 1.10-1.23; P < 0.001; P interaction < 0.001), mainly driven by greater excess adjusted mortality risk of diabetes relative to nondiabetes in younger tertile. No significant interaction was observed between adjusted risk of diabetes relative to nondiabetes for MACCE and other subgroups such as sex, mode of revascularization, and clinical presentation of acute myocardial infarction. CONCLUSIONS The excess risk of diabetes relative to nondiabetes for MACCE was profound in the younger population. This observation suggests more aggressive interventions for secondary prevention in patients with diabetes might be particularly relevant in younger patients.
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Affiliation(s)
- Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukiko Matsumura-Nakano
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eri T. Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuaki Imada
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takashi Uegaito
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Keiichi Tambara
- Department of Cardiovascular Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
| | | | - Moriaki Inoko
- Department of Cardiology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | | | - Hiroshi Sakai
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takashi Yamamoto
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Denryoku Hospital, Osaka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuhiko Terai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaru Tanaka
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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7
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Takeji Y, Taniguchi T, Morimoto T, Shirai S, Kitai T, Tabata H, Kitano K, Ono N, Murai R, Osakada K, Murata K, Nakai M, Tsuneyoshi H, Tada T, Amano M, Shiomi H, Watanabe H, Yoshikawa Y, Yamamoto K, Toyofuku M, Tatsushima S, Kanamori N, Miyake M, Nakayama H, Nagao K, Izuhara M, Nakatsuma K, Inoko M, Fujita T, Kimura M, Ishii M, Usami S, Sawada K, Nakazeki F, Okabayashi M, Shirotani M, Inuzuka Y, Komiya T, Minatoya K, Kimura T. Rationale, Design, and Baseline Characteristics of the CURRENT AS Registry-2. Circ J 2022; 86:1769-1776. [PMID: 35444112 DOI: 10.1253/circj.cj-21-1062] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is scarce data evaluating the current practice pattern and clinical outcomes for patients with severe aortic stenosis (AS), including both those who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) and those who were managed conservatively in the TAVI era.Methods and Results: The Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis (CURRENT AS) Registry-2 is a prospective, physician-initiated, multicenter registry enrolling consecutive patients who were diagnosed with severe AS between April 2018 and December 2020 among 21 centers in Japan. The rationale for the prospective enrollment was to standardize the assessment of symptomatic status, echocardiographic evaluation, and other recommended diagnostic examinations such as computed tomography and measurement of B-type natriuretic peptide. Moreover, the schedule of clinical and echocardiographic follow up was prospectively defined and strongly recommended for patients who were managed conservatively. The entire study population consisted of 3,394 patients (mean age: 81.6 years and women: 60%). Etiology of AS was degenerative in 90% of patients. AS-related symptoms were present in 60% of patients; these were most often heart failure symptoms. The prevalence of high- and low-gradient AS was 58% and 42%, respectively, with classical and paradoxical low-flow low-gradient AS in 4.5% and 6.7%, respectively. CONCLUSIONS The CURRENT AS Registry-2 might be large and meticulous enough to determine the appropriate timing of intervention for patients with severe AS in contemporary clinical practice.
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Affiliation(s)
- Yasuaki Takeji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | | | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Nobuhisa Ono
- Division of Cardiovascular Surgery, Kokura Memorial Hospital
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Kohei Osakada
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Masanao Nakai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital
| | | | | | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | | | | | | | - Hiroyuki Nakayama
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital
| | | | | | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Takanari Fujita
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | | | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Shunsuke Usami
- Department of Cardiology, Kansai Electric Power Hospital
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Manabu Shirotani
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine
| | | | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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8
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Yamamoto K, Natsuaki M, Morimoto T, Shiomi H, Yoshikawa Y, Tazaki J, Tada T, Watanabe H, Kato E, Toyofuku M, Inada T, Kaneda K, Takeda T, Sakai H, Yamamoto T, Eizawa H, Yamada M, Shinoda E, Mabuchi H, Shirotani M, Matsuda M, Takahashi M, Ishii K, Onodera T, Sakamoto H, Aoyama T, Miki S, Ando K, Kimura T. Ischemic and Bleeding Events After First Major Bleeding Event in Patients Undergoing Coronary Stent Implantation. Am J Cardiol 2022; 162:13-23. [PMID: 34706818 DOI: 10.1016/j.amjcard.2021.09.017] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 01/28/2023]
Abstract
There is a scarcity of data on ischemic and bleeding events in patients who experienced major bleeding after percutaneous coronary intervention (PCI). Moreover, there also is a shortage of data on comparative outcomes between patients with and without interruption of an antithrombotic drug after major bleeding. We evaluated the incidence and prognostic impacts of ischemic (myocardial infarction or ischemic stroke) and bleeding (Bleeding Academic Research Consortium type 3 or 5) events after major bleeding in 12,691 consecutive patients who underwent first PCI in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI registry cohort-3. In the entire cohort, incidence of the first ischemic event and bleeding event was 2.3 per 100 person-years and 3.8 per 100 person-years, respectively. Major bleeding (Bleeding Academic Research Consortium type 3) occurred in 2,142 patients during a median follow-up of 5.7 years. In patients with major bleeding, cumulative 30-day, 1-year, and 5-year incidence of an ischemic event was 2.6%, 4.8%, and 13.2% (3.2 per 100 person-years), respectively, whereas that of a bleeding event was 6.3%, 16.1%, and 29.2% (8.5 per 100 person-years), respectively. Ischemic and bleeding events were independently associated with mortality (hazard ratio 2.36, 95% confidence interval 1.87 to 2.96, p <0.001, and hazard ratio 2.85, 95% confidence interval 2.42 to 3.37, p <0.001). The cumulative 180-day incidence of ischemic and bleeding events was not significantly different between patients with and without interruption of an antithrombotic drug in patients with major bleeding. In conclusion, the incidence of an ischemic event after the first major bleeding was approximately 1/3 of that of recurrent major bleeding, and the rates of ischemic and bleeding events after the first major bleeding were higher than the rates of first events in the general PCI population. Both ischemic events and bleeding events were strongly associated with subsequent mortality. The incidence of ischemic and recurrent bleeding events was not different between patients with and without interruption of an antithrombotic drug.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junichi Tazaki
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eri Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuhisa Kaneda
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Sakai
- Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takashi Yamamoto
- Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Eiji Shinoda
- Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
| | - Mitsuo Matsuda
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | | | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takeshi Aoyama
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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9
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Natsuaki M, Morimoto T, Shiomi H, Yamamoto K, Yamaji K, Watanabe H, Uegaito T, Matsuda M, Tamura T, Taniguchi R, Inoko M, Mabuchi H, Takeda T, Domei T, Shirotani M, Ehara N, Eizawa H, Ishii K, Tanaka M, Inada T, Onodera T, Nawada R, Shinoda E, Yamada M, Yamamoto T, Sakai H, Toyofuku M, Tamura T, Takahashi M, Tada T, Sakamoto H, Tada T, Kaneda K, Miki S, Aoyama T, Suwa S, Sato Y, Ando K, Furukawa Y, Nakagawa Y, Kadota K, Kimura T. Bleeding Outcomes After Percutaneous Coronary Intervention in the Past Two Decades in Japan - From the CREDO-Kyoto Registry Cohort-2 and Cohort-3. Circ J 2021; 86:748-759. [PMID: 34526432 DOI: 10.1253/circj.cj-21-0526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Optimal intensity is unclear for P2Y12receptor blocker therapy after percutaneous coronary intervention (PCI) in real-world clinical practice.Methods and Results:From the CREDO-Kyoto Registry, the current study population consisted of 25,419 patients (Cohort-2: n=12,161 and Cohort-3: n=13,258) who underwent their first PCI. P2Y12receptor blocker therapies were reduced dose of ticlopidine (200 mg/day), and global dose of clopidogrel (75 mg/day) in 87.7% and 94.8% of patients in Cohort-2 and Cohort-3, respectively. Cumulative 3-year incidence of GUSTO moderate/severe bleeding was significantly higher in Cohort-3 than in Cohort-2 (12.1% and 9.0%, P<0.0001). After adjusting 17 demographic factors and 9 management factors potentially related to the bleeding events other than the type of P2Y12receptor blocker, the higher bleeding risk in Cohort-3 relative to Cohort-2 remained significant (hazard ratio (HR): 1.52 95% confidence interval (CI) 1.37-1.68, P<0.0001). Cohort-3 compared with Cohort-2 was not associated with lower adjusted risk for myocardial infarction/ischemic stroke (HR: 0.96, 95% CI: 0.87-1.06, P=0.44). CONCLUSIONS In this historical comparative study, Cohort-3 compared with Cohort-2 was associated with excess bleeding risk, which might be at least partly explained by the difference in P2Y12receptor blockers.
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Affiliation(s)
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | | | | | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | | | | | | | | | | | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Hiroshi Eizawa
- Department of Cardiovascular Medicine, Kobe City Nishi-Kobe Medical Center
| | | | | | | | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital
| | - Ryuzo Nawada
- Department of Cardiology, Shizuoka City Shizuoka Hospital
| | - Eiji Shinoda
- Department of Cardiology, Hamamatsu Rosai Hospital
| | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital
| | - Takashi Yamamoto
- Department of Cardiology, Shiga University of Medical Science Hospital
| | - Hiroshi Sakai
- Department of Cardiology, Shiga University of Medical Science Hospital
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | | | | | | | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital
| | - Kazuhisa Kaneda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | | | - Satoru Suwa
- and Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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10
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Murai R, Kawase Y, Taniguchi T, Morimoto T, Kadota K, Ohya M, Shimada T, Maruo T, Fuku Y, Komiya T, Ando K, Hanyu M, Kanamori N, Aoyama T, Murata K, Onodera T, Yamazaki F, Kitai T, Furukawa Y, Koyama T, Miyake M, Izumi C, Nakagawa Y, Yamanaka K, Mitsuoka H, Shirotani M, Kato M, Miki S, Nakajima H, Hirano Y, Miyazaki S, Saga T, Sugioka S, Matsuda S, Matsuda M, Ogawa T, Nagao K, Inada T, Nakayama S, Mabuchi H, Takeuchi Y, Sakamoto H, Sakaguchi G, Yamane K, Eizawa H, Toyofuku M, Tamura T, Iwakura A, Ishii M, Akao M, Shiraga K, Minamino-Muta E, Kato T, Inoko M, Ueyama K, Ikeda T, Himura Y, Komasa A, Ishii K, Hotta K, Sato Y, Fujiwara K, Kato Y, Kouchi I, Inuzuka Y, Ikeguchi S, Miwa S, Maeda C, Shinoda E, Nishizawa J, Jinnai T, Higashitani N, Kitano M, Morikami Y, Kitaguchi S, Minatoya K, Kimura T. Concomitant Mitral Regurgitation in Severe Aortic Stenosis - A Report From the CURRENT AS Registry. Circ J 2021; 86:427-437. [PMID: 34275976 DOI: 10.1253/circj.cj-21-0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical significance of concomitant mitral regurgitation (MR) has not been well addressed in patients with severe aortic stenosis (AS).Methods and Results:We analyzed 3,815 patients from a retrospective multicenter registry of severe AS in Japan (CURRENT AS registry). We compared the clinical outcomes between patients with moderate/severe MR and with none/mild MR according to the initial treatment strategy (initial aortic valve replacement [AVR] or conservative strategy). The primary outcome measure was a composite of aortic valve-related death or heart failure hospitalization. At baseline, moderate/severe MR was present in 227/1,197 (19%) patients with initial AVR strategy and in 536/2,618 (20%) patients with a conservative strategy. The crude cumulative 5-year incidence of the primary outcome measure was significantly higher in patients with moderate/severe MR than in those with none/mild MR, regardless of the initial treatment strategy (25.2% vs. 14.4%, P<0.001 in the initial AVR strategy, and 63.3% vs. 40.7%, P<0.001 in the conservative strategy). After adjusting confounders, moderate/severe MR was not independently associated with higher risk for the primary outcome measure in the initial AVR strategy (hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.67-1.83, P=0.69), and in the conservative strategy (HR 1.13, 95% CI 0.93-1.37, P=0.22). CONCLUSIONS Concomitant moderate/severe MR was not independently associated with higher risk for the primary outcome measure regardless of the initial treatment strategy.
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Affiliation(s)
- Ryosuke Murai
- Department of Cardiology, Kurashiki Central Hospital
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital
| | | | | | | | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Takeshi Maruo
- Department of Cardiology, Kurashiki Central Hospital
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kokura Memorial Hospital
| | | | | | | | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | | | - Chisato Izumi
- Division of Heart Failure, National Cerebral and Cardiovascular Center
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | | | | | | | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | | | - Yutaka Hirano
- Department of Cardiology, Kindai University Hospital
| | | | - Toshihiko Saga
- Department of Cardiovascular Surgery, Kindai University Hospital
| | | | | | | | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital
| | | | | | | | | | | | | | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Kotaro Shiraga
- Department of Cardiovascular Surgery, National Hospital Organization Kyoto Medical Center
| | - Eri Minamino-Muta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Koji Ueyama
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Tomoyuki Ikeda
- Department of Cardiovascular Surgery, Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | | | - Akihiro Komasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Kozo Hotta
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Keiichi Fujiwara
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center
| | | | | | | | | | - Senri Miwa
- Department of Cardiovascular Surgery, Shiga General Hospital
| | - Chiyo Maeda
- Department of Cardiology, Hamamatsu Rosai Hospital
| | - Eiji Shinoda
- Department of Cardiology, Hamamatsu Rosai Hospital
| | | | | | | | - Mitsuru Kitano
- Department of Cardiovascular Surgery, Japanese Red Cross Otsu Hospital
| | | | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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11
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Matsumura-Nakano Y, Shiomi H, Morimoto T, Yamaji K, Ehara N, Sakamoto H, Takeji Y, Yoshikawa Y, Yamamoto K, Imada K, Tada T, Taniguchi R, Nishikawa R, Tada T, Uegaito T, Ogawa T, Yamada M, Takeda T, Eizawa H, Tamura N, Tambara K, Suwa S, Shirotani M, Tamura T, Inoko M, Nishizawa J, Natsuaki M, Sakai H, Yamamoto T, Kanemitsu N, Ohno N, Ishii K, Marui A, Tsuneyoshi H, Terai Y, Nakayama S, Yamazaki K, Takahashi M, Tamura T, Esaki J, Miki S, Onodera T, Mabuchi H, Furukawa Y, Tanaka M, Komiya T, Soga Y, Hanyu M, Ando K, Kadota K, Minatoya K, Nakagawa Y, Kimura T. Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3). Am J Cardiol 2021; 145:25-36. [PMID: 33454340 DOI: 10.1016/j.amjcard.2020.12.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 01/14/2023]
Abstract
There is a scarcity of data comparing long-term clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease (3VD) in the new-generation drug-eluting stents era. CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who had undergone first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. We identified 2525 patients with 3VD (PCI: n = 1747 [69%], and CABG: n = 778 [31%]). The primary outcome measure was all-cause death. Median follow-up duration was 5.7 (interquartile range: 4.4 to 6.6) years. The cumulative 5-year incidence of all-cause death was significantly higher in the PCI group than in the CABG group (19.8% vs 13.2%, log-rank p = 0.001). After adjusting confounders, the excess risk of PCI relative to CABG for all-cause death remained significant (HR, 1.45; 95% CI, 1.14 to 1.86; p = 0.003), which was mainly driven by the excess risk for non-cardiovascular death (HR, 1.88; 95% CI, 1.30 to 2.79; p = 0.001), while there was no excess risk for cardiovascular death between PCI and CABG (HR, 1.19; 95% CI, 0.87 to 1.64; p = 0.29). There was significant excess risk of PCI relative to CABG for myocardial infarction (HR, 1.77; 95% CI, 1.19 to 2.69; p = 0.006), whereas there was no excess risk of PCI relative to CABG for stroke (HR, 1.24; 95% CI, 0.83 to 1.88; p = 0.30). In conclusion, in the present study population reflecting real-world clinical practice in Japan, PCI compared with CABG was associated with significantly higher risk for all-cause death, while there was no excess risk for cardiovascular death between PCI and CABG.
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Affiliation(s)
- Yukiko Matsumura-Nakano
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuaki Imada
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takashi Uegaito
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital; Hamamatsu, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Keiichi Tambara
- Department of Cardiovascular Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
| | | | - Moriaki Inoko
- Department of Cardiology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital; Hamamatsu, Japan
| | | | - Hiroshi Sakai
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takashi Yamamoto
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Denryoku Hospital, Osaka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuhiko Terai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaru Tanaka
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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12
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Takeji Y, Shiomi H, Morimoto T, Yoshikawa Y, Taniguchi R, Mutsumura-Nakano Y, Yamamoto K, Yamaji K, Tazaki J, Kato ET, Watanabe H, Yamamoto E, Yamashita Y, Fuki M, Suwa S, Inoko M, Takeda T, Shirotani M, Ehara N, Ishii K, Inada T, Tamura T, Onodera T, Shinoda E, Yamamoto T, Watanabe H, Yaku H, Nakatsuma K, Sakamoto H, Ando K, Soga Y, Furukawa Y, Sato Y, Nakagawa Y, Kadota K, Komiya T, Minatoya K, Kimura T. Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort study. BMJ Open 2021; 11:e043683. [PMID: 33789850 PMCID: PMC8016093 DOI: 10.1136/bmjopen-2020-043683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate changes in demographics, clinical practices and long-term clinical outcomes of patients with ST segment-elevation myocardial infarction (STEMI) before and beyond 2010. DESIGN Multicentre retrospective cohort study. SETTING The Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) AMI Registries Wave-1 (2005-2007, 26 centres) and Wave-2 (2011-2013, 22 centres). PARTICIPANTS 9001 patients with STEMI who underwent coronary revascularisation (Wave-1: 4278 patients, Wave-2: 4723 patients). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was all-cause death at 3 years. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, target vessel revascularisation, ischaemia-driven target vessel revascularisation, any coronary revascularisation and any ischaemia-driven coronary revascularisation. RESULTS Patients in Wave-2 were older, more often had comorbidities and more often presented with cardiogenic shock than those in Wave-1. Patients in Wave-2 had shorter onset-to-balloon time and door-to-balloon time, were more frequently implanted drug-eluting stents, and received guideline-directed medication than those in Wave-1. The cumulative 3-year incidence of all-cause death was not significantly different between Wave-1 and Wave-2 (15.5% and 15.7%, p=0.77). The adjusted risk of all-cause death in Wave-2 relative to Wave-1 was not significant at 3 years (HR 0.92, 95% CI 0.83 to 1.03, p=0.14), but lower beyond 30 days (HR 0.86, 95% CI 0.75 to 0.98, p=0.03). The adjusted risks of Wave-2 relative to Wave-1 were significantly lower for definite stent thrombosis (HR 0.59, 95% CI 0.43 to 0.81, p=0.001) and for any coronary revascularisation (HR 0.75, 95% CI 0.69 to 0.81, p<0.001), but higher for major bleeding (HR 1.34, 95% CI 1.20 to 1.51, p=0.005). CONCLUSIONS We could not demonstrate improvement in 3-year mortality risk from Wave-1 to Wave-2, but we found reduction in mortality risk beyond 30 days. We also found risk reduction for definite stent thrombosis and any coronary revascularisation, but an increase in the risk of major bleeding from Wave-1 to Wave-2.
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Affiliation(s)
- Yasuaki Takeji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryoji Taniguchi
- Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Yukiko Mutsumura-Nakano
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eri Toda Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masayuki Fuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Manabu Shirotani
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Katsuhisa Ishii
- Department of Cardiovascular Medicine, Kansai Denryoku Hospital, Osaka, Japan
| | - Tsukasa Inada
- Department of Cardiovascular Medicine, Osaka Red Cross Hospital, Osaka, Japan
| | | | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Eiji Shinoda
- Department of Cardiovascular Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Takashi Yamamoto
- Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Hidenori Yaku
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshiharu Soga
- Division of Cardiovascular surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihito Sato
- Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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13
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Takeji Y, Shiomi H, Morimoto T, Yoshikawa Y, Taniguchi R, Mutsumura-Nakano Y, Yamamoto K, Yamaji K, Tazaki J, Suwa S, Inoko M, Takeda T, Shirotani M, Ehara N, Ishii K, Inada T, Onodera T, Shinoda E, Yamamoto T, Tamura T, Nakatsuma K, Sakamoto H, Ando K, Soga Y, Furukawa Y, Sato Y, Nakagawa Y, Kadota K, Komiya T, Minatoya K, Kimura T. Demographics, practice patterns and long-term outcomes of patients with non-ST-segment elevation acute coronary syndrome in the past two decades: the CREDO-Kyoto Cohort-2 and Cohort-3. BMJ Open 2021; 11:e044329. [PMID: 33619198 PMCID: PMC7903127 DOI: 10.1136/bmjopen-2020-044329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To evaluate patient characteristics and long-term outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) in the past two decades. DESIGN Multicenter retrospective study. SETTING The Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) Registry Cohort-2 (2005-2007) and Cohort-3 (2011-2013). PARTICIPANTS 3254 patients with NSTEACS who underwent first coronary revascularisation. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, any coronary revascularisation and target vessel revascularisation. RESULTS Patients in Cohort-3 were older and more often had heart failure at admission than those in Cohort-2. The prevalence of PCI, emergency procedure and guideline-directed medical therapy was higher in Cohort-3 than in Cohort-2. In patients who received PCI, the prevalence of transradial approach, drug-eluting stent use and intravascular ultrasound use was higher in Cohort-3 than in Cohort-2. There was no change in 3-year adjusted mortality risk from Cohort-2 to Cohort-3 (HR 1.00, 95% CI 0.83 to 1.22, p=0.97). Patients in Cohort-3 compared with those in Cohort-2 were associated with lower adjusted risks for stroke (HR 0.65, 95% CI 0.46 to 0.92, p=0.02) and any coronary revascularisation (HR 0.76, 95%CI 0.66 to 0.87, p<0.001), but with higher risk for major bleeding (HR 1.25, 95% CI 1.06 to 1.47, p=0.008). The unadjusted risk for definite stent thrombosis was lower in Cohort-3 than in Cohort 2 (HR 0.29, 95% CI 0.11 to 0.67, p=0.003). CONCLUSIONS In the past two decades, we did not find improvement for mortality in patients with NSTEACS. We observed a reduction in the risks for definite stent thrombosis, stroke and any coronary revascularisation, but an increase in the risk for major bleeding.
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Affiliation(s)
- Yasuaki Takeji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan
| | - Yukiko Mutsumura-Nakano
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Shiga, Japan
| | - Manabu Shirotani
- Division of Cardiology, Kinki University School of Medicine Nara Hospital, Ikoma, Nara, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Katsuhisa Ishii
- Department of Cardiovascular Medicine, Kansai Denryoku Hospital, Osaka, Japan
| | - Tsukasa Inada
- Department of Cardiovascular Medicine, Osaka Red Cross Hospital, Osaka, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Eiji Shinoda
- Department of Cardiovascular Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Shizuoka, Japan
| | - Takashi Yamamoto
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Yoshiharu Soga
- Division of Cardiovascular surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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14
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Natsuaki M, Morimoto T, Shiomi H, Ehara N, Taniguchi R, Tamura T, Tada T, Suwa S, Kaneda K, Watanabe H, Tazaki J, Watanabe S, Yamamoto E, Saito N, Fuki M, Takeda T, Eizawa H, Shinoda E, Mabuchi H, Shirotani M, Uegaito T, Matsuda M, Takahashi M, Inoko M, Tamura T, Ishii K, Onodera T, Sakamoto H, Aoyama T, Sato Y, Ando K, Furukawa Y, Nakagawa Y, Kadota K, Kimura T. Application of the Modified High Bleeding Risk Criteria for Japanese Patients in an All-Comers Registry of Percutaneous Coronary Intervention - From the CREDO-Kyoto Registry Cohort-3. Circ J 2020; 85:769-781. [PMID: 33298644 DOI: 10.1253/circj.cj-20-0836] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prevalence of and expected bleeding event rate in patients with the Japanese version of high bleeding risk (J-HBR) criteria are currently unknown in real-world percutaneous coronary intervention (PCI) practice.Methods and Results:We applied the J-HBR criteria in the multicenter CREDO-Kyoto registry cohort-3 that enrolled 13,258 consecutive patients who underwent first PCI. The J-HBR criteria included Japanese-specific major criteria such as heart failure, low body weight, peripheral artery disease and frailty in addition to the Academic Research Consortium (ARC)-HBR criteria. There were 8,496 patients with J-HBR, and 4,762 patients without J-HBR. The J-HBR criteria identified a greater proportion of patients with HBR than did ARC-HBR (64% and 48%, respectively). Cumulative incidence of the Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding was significantly higher in the J-HBR group than in the no-HBR group (14.0% vs. 4.1% at 1 year; 23.1% vs. 8.4% at 5 years, P<0.0001). Cumulative 5-year incidence of BARC 3/5 bleeding was 25.1% in patients with ARC-HBR, and 23.1% in patients with J-HBR. Cumulative incidence of myocardial infarction or ischemic stroke was also significantly higher in the J-HBR group than in the no-HBR group (6.9% vs. 3.6% at 1 year; 13.2% vs. 7.1% at 5 years, P<0.0001). CONCLUSIONS The J-HBR criteria successfully identified those patients with very high bleeding risk after PCI, who represented 64% of patients in this all-comers registry.
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Affiliation(s)
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | | | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | | | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Naritatsu Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masayuki Fuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center
| | - Eiji Shinoda
- Department of Cardiology, Hamamatsu Rosai Hospital
| | | | | | | | | | | | - Moriaki Inoko
- Department of Cardiology, Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | | | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital
| | | | | | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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15
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Taniguchi T, Morimoto T, Shiomi H, Ando K, Kanamori N, Murata K, Kitai T, Kadota K, Izumi C, Nakatsuma K, Sasa T, Watanabe H, Kuwabara Y, Makiyama T, Ono K, Shizuta S, Kato T, Saito N, Minatoya K, Kimura T, Kimura T, Taniguchi T, Shiomi H, Saito N, Imai M, Tazaki J, Toyota T, Higami H, Kawaji T, Ando K, Shirai S, Kourai K, Arita T, Miura S, Yamaji K, Aoyama T, Kanamori N, Onodera T, Murata K, Furukawa Y, Kitai T, Kim K, Kadota K, Kawase Y, Iwasaki K, Miyawaki H, Misao A, Kuwayama A, Ohya M, Shimada T, Amano H, Nakagawa Y, Izumi C, Miyake M, Amano M, Takahashi Y, Yoshikawa Y, Nishimura S, Kuroda M, Shirotani M, Mitsuoka H, Miki S, Mizoguchi T, Kato M, Yokomatsu T, Kushiyama A, Yaku H, Watanabe T, Miyazaki S, Hirano Y, Matsuda M, Matsuda S, Sugioka S, Inada T, Nagao K, Takahashi N, Fukuchi K, Murakami T, Mabuchi H, Takeda T, Sakaguchi T, Maeda K, Yamaji M, Maenaka M, Tadano Y, Sakamoto H, Takeuchi Y, Motooka M, Nishikawa R, Eizawa H, Yamane K, Kawato M, Kinoshita M, Aida K, Tamura T, Toyofuku M, Takahashi K, Ko E, Akao M, Ishii M, Masunaga N, Ogawa H, Iguchi M, Unoki T, Takabayashi K, Hamatani Y, Yamashita Y, Inoko M, Minamino-Muta E, Kato T, Himura Y, Ikeda T, Ishii K, Komasa A, Sato Y, Hotta K, Tsuji S, Hiraoka Y, Higashitani N, Kouchi I, Kato Y, Ikeguchi S, Inuzuka Y, Nishio S, Seki J, Shinoda E, Yamada M, Kawamoto A, Maeda C, Konishi T, Jinnai T, Sogabe K, Tachiiri M, Matsumura Y, Ota C, Kitaguchi S, Morikami Y, Sakata R, Minakata K, Minatoya K, Hanyu M, Yamazaki F, Koyama T, Komiya T, Yamanaka K, Nishiwaki N, Nakajima H, Ohnaka M, Osada H, Meshii K, Saga T, Onoe M, Nakayama S, Sakaguchi G, Iwakura A, Shiraga K, Ueyama K, Fujiwara K, Fukumoto A, Park M, Nishizawa J, Kitano M. Prognostic Impact of Left Ventricular Ejection Fraction in Patients With Severe Aortic Stenosis. JACC Cardiovasc Interv 2018; 11:145-157. [DOI: 10.1016/j.jcin.2017.08.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 11/25/2022]
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16
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Shiomi H, Morimoto T, Kitaguchi S, Nakagawa Y, Ishii K, Haruna Y, Takamisawa I, Motooka M, Nakao K, Matsuda S, Mimoto S, Aoyama Y, Takeda T, Murata K, Akao M, Inada T, Eizawa H, Hyakuna E, Awano K, Shirotani M, Furukawa Y, Kadota K, Miyauchi K, Tanaka M, Noguchi Y, Nakamura S, Yasuda S, Miyazaki S, Daida H, Kimura K, Ikari Y, Hirayama H, Sumiyoshi T, Kimura T. The ReACT Trial: Randomized Evaluation of Routine Follow-up Coronary Angiography After Percutaneous Coronary Intervention Trial. JACC Cardiovasc Interv 2016; 10:109-117. [PMID: 28040445 DOI: 10.1016/j.jcin.2016.10.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 10/20/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate long-term clinical impact of routine follow-up coronary angiography (FUCAG) after percutaneous coronary intervention (PCI) in daily clinical practice in Japan. BACKGROUND The long-term clinical impact of routine FUCAG after PCI in real-world clinical practice has not been evaluated adequately. METHODS In this prospective, multicenter, open-label, randomized trial, patients who underwent successful PCI were randomly assigned to routine angiographic follow-up (AF) group, in which patients were to receive FUCAG at 8 to 12 months after PCI, or clinical follow-up alone (CF) group. The primary endpoint was defined as a composite of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndrome, or hospitalization for heart failure over a minimum of 1.5 years follow-up. RESULTS Between May 2010 and July 2014, 700 patients were enrolled in the trial among 22 participating centers and were randomly assigned to the AF group (n = 349) or the CF group (n = 351). During a median of 4.6 years of follow-up (interquartile range [IQR]: 3.1 to 5.2 years), the cumulative 5-year incidence of the primary endpoint was 22.4% in the AF group and 24.7% in the CF group (hazard ratio: 0.94; 95% confidence interval: 0.67 to 1.31; p = 0.70). Any coronary revascularization within the first year was more frequently performed in AF group than in CF group (12.8% vs. 3.8%; log-rank p < 0.001), although the difference between the 2 groups attenuated over time with a similar cumulative 5-year incidence (19.6% vs. 18.1%; log-rank p = 0.92). CONCLUSIONS No clinical benefits were observed for routine FUCAG after PCI and early coronary revascularization rates were increased within routine FUCAG strategy in the current trial. (Randomized Evaluation of Routine Follow-up Coronary Angiography After Percutaneous Coronary Intervention Trial [ReACT]; NCT01123291).
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Affiliation(s)
- Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Shoji Kitaguchi
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | | | - Katsuhisa Ishii
- Division of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Yoshisumi Haruna
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases, Tokyo, Japan
| | - Makoto Motooka
- Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Satoru Mimoto
- Department of Cardiology, New Tokyo Hospital, Tokyo, Japan
| | - Yutaka Aoyama
- Department of Cardiology, Nagoya Second Red Cross Hospital, Nagoya, Japan
| | - Teruki Takeda
- Division of Cardiology, Koto Memorial Hospital, Higashioumi, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tsukasa Inada
- Cardiovascular Center Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Eizawa
- Division of Cardiology, Nishikobe Medical Center, Kobe, Japan
| | - Eiji Hyakuna
- Department of Cardiology, Saiseikai Shimonoseki General Hospital, Yamaguchi, Japan
| | - Kojiro Awano
- Department of Cardiology, Kitaharima Medical Center, Hyogo, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Nara, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Masaru Tanaka
- Cardiovascular Center Osaka Red Cross Hospital, Osaka, Japan
| | - Yuichi Noguchi
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Tokyo, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University, Kanagawa, Japan
| | - Haruo Hirayama
- Department of Cardiology, Nagoya Second Red Cross Hospital, Nagoya, Japan
| | - Tetsuya Sumiyoshi
- Department of Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases, Tokyo, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan.
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17
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Natsuaki M, Morimoto T, Furukawa Y, Nakagawa Y, Kadota K, Ando K, Shiomi H, Toyota T, Watanabe H, Ono K, Shizuta S, Tamura T, Inoko M, Inada T, Shirotani M, Matsuda M, Aoyama T, Onodera T, Suwa S, Takeda T, Inoue K, Kimura T. Short versus prolonged dual antiplatelet therapy duration after bare-metal stent implantation: 2-month landmark analysis from the CREDO-Kyoto registry cohort-2. Cardiovasc Interv Ther 2016; 33:23-34. [PMID: 27646646 DOI: 10.1007/s12928-016-0429-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/01/2016] [Accepted: 09/03/2016] [Indexed: 10/21/2022]
Abstract
One-month duration of dual antiplatelet therapy (DAPT) has widely been adopted after bare-metal stent (BMS) implantation in the real clinical practice. However, it has not been adequately addressed yet whether DAPT for only 1-month could provide sufficient protection from ischemic events beyond 1-month after BMS implantation. We assessed the effects of short DAPT relative to prolonged DAPT on clinical outcomes with the landmark analysis at 2 month after BMS implantation. Among 13,058 consecutive patients enrolled in the CREDO-Kyoto registry cohort-2, this study population consisted of 4905 patients treated with BMS only in whom the information on the status of antiplatelet therapy was available at 2 month after stent implantation [single-antiplatelet therapy (SAPT) group: N = 2575 (acute myocardial infarction (AMI): N = 1257, and non-AMI: N = 1318), and DAPT group: N = 2330 (AMI: N = 1304, and non-AMI: N = 1026)]. Cumulative 3-year incidence of the primary outcome measure (a composite of cardiovascular death, myocardial infarction, stroke, definite stent thrombosis, and GUSTO moderate/severe bleeding) was not significantly different between the SAPT and DAPT groups (9.8 versus 10.6 %, P = 0.34). After adjusting confounders, the risk of SAPT relative to DAPT for the primary outcome measure remained insignificant in the entire cohort (HR 0.97, 95 % CI 0.79-1.19, P = 0.77), and in both AMI and non-AMI strata without any significant interaction between clinical presentation (AMI versus non-AMI) and the effect of SAPT relative to DAPT (P interaction = 0.56). In conclusion, short DAPT <2 month after BMS implantation was as safe as prolonged DAPT ≥2-month in both AMI and non-AMI patients.
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Affiliation(s)
- Masahiro Natsuaki
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toshiaki Toyota
- Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koh Ono
- Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Tamura
- Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Moriaki Inoko
- Cardiovascular Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tsukasa Inada
- Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Manabu Shirotani
- Division of Cardiology, Nara Hospital, Kindai University Faculty of Medicine, Nara, Japan
| | - Mitsuo Matsuda
- Division of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Takeshi Aoyama
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Tomoya Onodera
- Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Satoru Suwa
- Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Teruki Takeda
- Division of Cardiology, Koto Memorial Hospital, Higashioumi, Japan
| | - Katsumi Inoue
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular of Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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18
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Watanabe H, Shiomi H, Nakatsuma K, Morimoto T, Taniguchi T, Furukawa Y, Nakagawa Y, Horie M, Kimura T, Kimura T, Sakata R, Marui A, Matsuda M, Mitsuoka H, Onoe M, Nakagawa Y, Yamanaka K, Fujiwara H, Takatsu Y, Ohno N, Nohara R, Murakami T, Takeda T, Nobuyoshi M, Iwabuchi M, Hanyu M, Tatami R, Matsushita T, Shirotani M, Nishiwaki N, Kita T, Furukawa Y, Okada Y, Kato H, Eizawa H, Is K, Tanaka M, Nakayama S, Lee JD, Nakano A, Koshiji T, Morioka K, Takizawa A, Shimamoto M, Yamazaki F, Takahashi M, Nishizawa J, Horie M, Takashima H, Tamura T, Aota M, Takahashi M, Tabata T, Tei C, Hamasaki S, Imoto Y, Yamamoto H, Kambara H, Doi O, Matsuda K, Nara M, Mitsudo K, Kadota K, Komiya T, Miki S, Mizoguchi T, Nakajima H, Ogawa H, Sugiyama S, Kawasuji M, Moriyama S, Hattori R, Aoyama T, Araki M, Suwa S, Tanbara K, Kitagawa K, Yamauchi M, Okamoto N, Fujino Y, Tezuka S, Saeki A, Hanazawa M, Sato Y, Hibi C, Sasae H, Takinami E, Uchida Y, Yamamoto Y, Nishida S, Yoshimoto M, Maeda S, Miki I, Minematsu S, Abe M, Shiomi H, Tada T, Tazaki J, Kato Y, Hayano M, Tokushige A, Natsuaki M, Nakajima T. Clinical efficacy of thrombus aspiration on 5-year clinical outcomes in patients with ST-segment elevation acute myocardial infarction undergoing percutaneous coronary intervention. J Am Heart Assoc 2015; 4:e001962. [PMID: 26077588 PMCID: PMC4599536 DOI: 10.1161/jaha.115.001962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) was reported to promote better coronary and myocardial reperfusion. However, long-term mortality benefit of TA remains controversial. The objective of this study is to investigate the clinical impact of TA on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. Methods and Results The CREDO-Kyoto AMI Registry is a large-scale cohort study of acute myocardial infarction patients undergoing coronary revascularization in 2005–2007 at 26 hospitals in Japan. Among 5429 patients enrolled in the registry, the current study population consisted of 3536 patients who arrived at the hospital within 12 hours after the symptom onset and underwent primary PCI. Clinical outcomes were compared between the 2 patient groups with or without TA. During primary PCI procedures, 2239 out of 3536 (63%) patients underwent TA (TA group). The cumulative 5-year incidence of all-cause death was significantly lower in the TA group than in the non-TA group (18.5% versus 23.9%, log-rank P<0.001). After adjusting for confounders, however, the risk for all-cause death in the TA group was not significantly lower than that in the non-TA group (hazard ratio: 0.90, 95% CI: 0.76 to 1.06, P=0.21). The adjusted risks for cardiac death, myocardial infarction, stroke, and target-lesion revascularization were also not significantly different between the 2 groups. Conclusions Adjunctive TA during primary PCI was not associated with better 5-year mortality in STEMI patients.
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Affiliation(s)
- Hiroki Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.)
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.)
| | - Kenji Nakatsuma
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.)
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.)
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.)
| | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.)
| | | | - Minoru Horie
- Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.)
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Ryuzo Sakata
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Akira Marui
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Mitsuo Matsuda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hirokazu Mitsuoka
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Masahiko Onoe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Kazuo Yamanaka
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hisayoshi Fujiwara
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yoshiki Takatsu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Nobuhisa Ohno
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Ryuji Nohara
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Tomoyuki Murakami
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Teruki Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Masakiyo Nobuyoshi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Masashi Iwabuchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Michiya Hanyu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Ryozo Tatami
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Tsutomu Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Manabu Shirotani
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Noboru Nishiwaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Toru Kita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yukikatsu Okada
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hiroshi Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hiroshi Eizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Katsuhisa Is
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Masaru Tanaka
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Shogo Nakayama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Jong-Dae Lee
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Akira Nakano
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Takaaki Koshiji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Koichi Morioka
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Akinori Takizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Mitsuomi Shimamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Fumio Yamazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Masaaki Takahashi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Junichiro Nishizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Minoru Horie
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hiroyuki Takashima
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Takashi Tamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Masaki Aota
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Mamoru Takahashi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Takafumi Tabata
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Chuwa Tei
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Shuichi Hamasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yutaka Imoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hirofumi Kambara
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Osamu Doi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Katsuhiko Matsuda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Masafumi Nara
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Kazuaki Mitsudo
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Tatsuhiko Komiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Shinji Miki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Tetsu Mizoguchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hiroyuki Nakajima
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Seigo Sugiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Michio Kawasuji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Syuji Moriyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Ryuichi Hattori
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Takeshi Aoyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Makoto Araki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Keiichi Tanbara
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Kumiko Kitagawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Misato Yamauchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Naoko Okamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yumika Fujino
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Saori Tezuka
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Asuka Saeki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Miya Hanazawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yuki Sato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Chikako Hibi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hitomi Sasae
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Emi Takinami
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yuriko Uchida
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yuko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Satoko Nishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Mai Yoshimoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Sachiko Maeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Izumi Miki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Saeko Minematsu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Mitsuru Abe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Tomohisa Tada
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Yoshihiro Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Mamoru Hayano
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Akihiro Tokushige
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Masahiro Natsuaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
| | - Tetsu Nakajima
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.W., H.S., K.N., T.T., T.K.) Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan (T.M.) Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.) Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.) Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan (M.H.)
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Watanabe H, Morimoto T, Natsuaki M, Furukawa Y, Nakagawa Y, Kadota K, Yamaji K, Ando K, Shizuta S, Shiomi H, Tada T, Tazaki J, Kato Y, Hayano M, Abe M, Tamura T, Shirotani M, Miki S, Matsuda M, Takahashi M, Ishii K, Tanaka M, Aoyama T, Doi O, Hattori R, Kato M, Suwa S, Takizawa A, Takatsu Y, Shinoda E, Eizawa H, Takeda T, Lee JD, Inoko M, Ogawa H, Hamasaki S, Horie M, Nohara R, Kambara H, Fujiwara H, Mitsudo K, Nobuyoshi M, Kita T, Kastrati A, Kimura T. Antiplatelet therapy discontinuation and the risk of serious cardiovascular events after coronary stenting: observations from the CREDO-Kyoto Registry Cohort-2. PLoS One 2015; 10:e0124314. [PMID: 25853836 PMCID: PMC4390156 DOI: 10.1371/journal.pone.0124314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/27/2015] [Indexed: 02/02/2023] Open
Abstract
Relation of antiplatelet therapy (APT) discontinuation with the risk of serious cardiovascular events has not been fully addressed yet. This study is aimed to evaluate the risk of ischemic event after APT discontinuation based on long-term APT status of large cohort. In the CREDO-Kyoto Registry Cohort-2 enrolling 15939 consecutive patients undergoing first coronary revascularization, 10470 patients underwent percutaneous coronary intervention either with bare-metal stents (BMS) only (N=5392) or sirolimus-eluting stents (SES) only (N=5078). Proportions of patients taking dual-APT were 67.3% versus 33.4% at 1-year, and 48.7% versus 24.3% at 5-year in the SES and BMS strata, respectively. We evaluated daily APT status (dual-, single- and no-APT) and linked the adverse events to the APT status just 1-day before the events. No-APT as compared with dual- or single-APT was associated with significantly higher risk for stent thrombosis (ST) beyond 1-month after SES implantation (cumulative incidence rates beyond 1-month: 1.23 versus 0.15/0.29, P<0.001/P<0.001), while higher risk of no-APT for ST was evident only until 6-month after BMS implantation (incidence rates between 1- and 6-month: 8.43 versus 0.71/1.20, P<0.001/P<0.001, and cumulative incidence rates beyond 6-month: 0.31 versus 0.11/0.08, P=0.16/P=0.08). No-APT as compared with dual- or single-APT was also associated with significantly higher risk for spontaneous myocardial infarction (MI) and stroke regardless of the types of stents implanted. Single-APT as compared with dual-APT was not associated with higher risk for serious adverse events, except for the marginally higher risk for ST in the SES stratum. In conclusion, discontinuation of both aspirin and thienopyridines was associated with increased risk for serious cardiovascular events including ST, spontaneous MI and stroke beyond 1-month after coronary stenting.
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Affiliation(s)
- Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Division of Genera Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masahiro Natsuaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohisa Tada
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihiro Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mamoru Hayano
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuru Abe
- Division of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Tamura
- Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Manabu Shirotani
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan
| | - Shinji Miki
- Division of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Mitsuo Matsuda
- Division of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | | | - Katsuhisa Ishii
- Division of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Masaru Tanaka
- Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takeshi Aoyama
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Osamu Doi
- Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryuichi Hattori
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Masayuki Kato
- Division of Cardiology, Maizuru Kyosai Hospital, Maizuru, Japan
| | - Satoru Suwa
- Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Akinori Takizawa
- Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiki Takatsu
- Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Eiji Shinoda
- Division of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Hiroshi Eizawa
- Division of Cardiology, Nishi-Kobe Medical Center, Kobe, Japan
| | - Teruki Takeda
- Division of Cardiology, Koto Memorial Hospital, Higashioumi, Japan
| | - Jong-Dae Lee
- Division of Cardiology, University of Fukui Hospital, Fukui, Japan
| | - Moriaki Inoko
- Cardiovascular Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shuichi Hamasaki
- Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory, Shiga University of Medical Science, Otsu, Japan
| | - Ryuji Nohara
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Hirofumi Kambara
- Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Hisayoshi Fujiwara
- Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Kazuaki Mitsudo
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Toru Kita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
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Goto K, Nakai K, Shizuta S, Morimoto T, Shiomi H, Natsuaki M, Yahata M, Ota C, Ono K, Makiyama T, Nakagawa Y, Furukawa Y, Kadota K, Takatsu Y, Tamura T, Takizawa A, Inada T, Doi O, Nohara R, Matsuda M, Takeda T, Kato M, Shirotani M, Eizawa H, Ishii K, Lee JD, Takahashi M, Horie M, Takahashi M, Miki S, Aoyama T, Suwa S, Hamasaki S, Ogawa H, Mitsudo K, Nobuyoshi M, Kita T, Kimura T. Anticoagulant and antiplatelet therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention. Am J Cardiol 2014; 114:70-8. [PMID: 24925801 DOI: 10.1016/j.amjcard.2014.03.060] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022]
Abstract
The prevalence, intensity, safety, and efficacy of oral anticoagulation (OAC) in addition to dual antiplatelet therapy (DAPT) in "real-world" patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not yet been fully evaluated. In the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry cohort-2, a total of 1,057 patients with AF (8.3%) were identified among 12,716 patients undergoing first PCI. Cumulative 5-year incidence of stroke was higher in patients with AF than in no-AF patients (12.8% vs 5.8%, p <0.0001). Although most patients with AF had CHADS2 score ≥2 (75.2%), only 506 patients (47.9%) received OAC with warfarin at hospital discharge. Cumulative 5-year incidence of stroke in the OAC group was not different from that in the no-OAC group (13.8% vs 11.8%, p = 0.49). Time in therapeutic range (TTR) was only 52.6% with an international normalized ratio of 1.6 to 2.6, and only 154 of 409 patients (37.7%) with international normalized ratio data had TTR ≥65%. Cumulative 5-year incidence of stroke in patients with TTR ≥65% was markedly lower than that in patients with TTR <65% (6.9% vs 15.1%, p = 0.01). In a 4-month landmark analysis in the OAC group, there was a trend for higher cumulative incidences of stroke and major bleeding in the on-DAPT (n = 286) than in the off-DAPT (n = 173) groups (15.1% vs 6.7%, p = 0.052 and 14.7% vs 8.7%, p = 0.10, respectively). In conclusion, OAC was underused and its intensity was mostly suboptimal in real-world patients with AF undergoing PCI, which lead to inadequate stroke prevention. Long-term DAPT in patients receiving OAC did not reduce stroke incidence.
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Affiliation(s)
- Koji Goto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kentaro Nakai
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeshi Morimoto
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Natsuaki
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsuhiko Yahata
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Chihiro Ota
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiki Takatsu
- Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Takashi Tamura
- Division of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Akinori Takizawa
- Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tsukasa Inada
- Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Osamu Doi
- Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryuji Nohara
- Division of Cardiology, Cardiovascular Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Mitsuo Matsuda
- Division of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Teruki Takeda
- Division of Cardiology, Koto Memorial Hospital, Higashioumi, Japan
| | - Masayuki Kato
- Division of Cardiology, Maizuru Kyosai Hospital, Maizuru, Japan
| | - Manabu Shirotani
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan
| | - Hiroshi Eizawa
- Division of Cardiology, Nishi-Kobe Medical Center, Kobe, Japan
| | - Katsuhisa Ishii
- Division of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Jong-Dae Lee
- Division of Cardiology, University of Fukui Hospital, Fukui, Japan
| | | | - Minoru Horie
- Department of Cardiovascular and Respiratory, Shiga University of Medical Science, Otsu, Japan
| | | | - Shinji Miki
- Division of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Takeshi Aoyama
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Satoru Suwa
- Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka Japan
| | - Shuichi Hamasaki
- Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuaki Mitsudo
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Toru Kita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kimura T, Morimoto T, Furukawa Y, Nakagawa Y, Kadota K, Iwabuchi M, Shizuta S, Shiomi H, Tada T, Tazaki J, Kato Y, Hayano M, Abe M, Tamura T, Shirotani M, Miki S, Matsuda M, Takahashi M, Ishii K, Tanaka M, Aoyama T, Doi O, Hattori R, Tatami R, Suwa S, Takizawa A, Takatsu Y, Takahashi M, Kato H, Takeda T, Lee JD, Nohara R, Ogawa H, Tei C, Horie M, Kambara H, Fujiwara H, Mitsudo K, Nobuyoshi M, Kita T. Long-term safety and efficacy of sirolimus-eluting stents versus bare-metal stents in real world clinical practice in Japan. Cardiovasc Interv Ther 2011; 26:234-45. [DOI: 10.1007/s12928-011-0065-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 04/05/2011] [Indexed: 11/29/2022]
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22
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Shirotani M, Yokota R, Kouchi I, Hirai T, Uemori N, Haba K, Hattori R. Influence of atenolol on coronary artery spasm after acute myocardial infarction in a Japanese population. Int J Cardiol 2010; 139:181-6. [DOI: 10.1016/j.ijcard.2008.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 08/13/2008] [Accepted: 10/12/2008] [Indexed: 11/15/2022]
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Shirotani M, Yui Y, Kawai C. Restenosis after Coronary Angioplasty: Pathogenesis of Neointimal Thickening Initiated by Endothelial Loss. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/10623329309100951] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Abstract
We describe a rare case of Becker's muscular dystrophy (BMD) in a 28-year-old man complicated by rapidly progressing heart failure without apparent clinical signs of neuromuscular disease. He showed rhabdomyolysis, which repeatedly occurred causing acute renal failure as heart failure worsened. His serum creatine kinase (CK) level was generally below 300 IU/l. However, it exceeded more than 10,000 IU/l at the time of myoglobinuria. This suggests that the worsening of heart failure could induce rhabdomyolysis in a BMD patient. Gene analysis for BMD should be considered when the elevation of serum CK is noted in heart failure.
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Affiliation(s)
- Ryoji Yokota
- Department of Cardiology, Nara Hospital, Kinki University School of Medicine, Ikoma
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25
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Misago N, Mochizuki Y, Sekiyama-Kodera H, Shirotani M, Suzuki K, Inokuchi A, Narisawa Y. Cutaneous polyarteritis nodosa: therapy and clinical course in four cases. J Dermatol 2001; 28:719-27. [PMID: 11804068] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Cutaneous polyarteritis nodosa (PN) has a benign and chronic course; relapses are frequently associated with steroid dependence. We have observed four cases of cutaneous PN in the past 15 years and followed up two of the four cases long-term for 13 and 10 years after diagnosis. There has been a marked contrast in the clinical courses of these two cases: one case has shown a complete remission for 12.5 years without treatment during the most recent 11 years; the other case had four relapses and has never experienced cessation of treatment. The only difference between the two cases was careful therapy with adequate prednisolone in the long-term remission case. The other two cases clinically showed erythema nodosum-like features, and they had antecedent sore throats and embedded chronic tonsillitis; one was associated with presumed streptococcal infection. These two cases may simply be an accelerated process of post-streptococcal erythema nodosum rather than typical cutaneous PN. We performed tonsillectomies as adjuvant therapy in these two cases. No relapse of the disease has been observed in these two cases, and the tonsillectomy allowed us to taper the dose of steroids, resulting in discontinuation of the treatment in one of the two cases. The duration of the remission as well as the adjuvant therapy was variable in each of our cutaneous PN cases. Tonsillectomy can be recommended as an adjuvant to steroids for PN cases with chronic tonsillitis and/or streptococcal infection.
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Affiliation(s)
- N Misago
- Division of Dermatology, Department of Internal Medicine, Saga Medical School, Nabeshima, Japan
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26
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Sakata K, Nakamura T, Tamekiyo H, Obayashi K, Ishikawa J, Nawada R, Yoshida H, Shirotani M. Pseudoxanthoma elasticum with dipyridamole-induced coronary artery spasm: a case report. Jpn Circ J 1999; 63:806-8. [PMID: 10553925 DOI: 10.1253/jcj.63.806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In patients with pseudoxanthoma elasticum, severe organic coronary artery stenosis often occurs without coronary risk factors. However, this report presents the case of a 49-year-old woman with pseudoxanthoma elasticum who had coronary artery spasm with an angiographically normal coronary artery. In addition, coronary artery spasm was provoked with dipyridamole thallium-201 cardiac imaging.
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Affiliation(s)
- K Sakata
- The Department of Cardiology, Shizuoka General Hospital, Japan
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27
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Sakata K, Shirotani M, Yoshida H, Nawada R, Obayashi K, Togi K, Miho N. Effects of amlodipine and cilnidipine on cardiac sympathetic nervous system and neurohormonal status in essential hypertension. Hypertension 1999; 33:1447-52. [PMID: 10373231 DOI: 10.1161/01.hyp.33.6.1447] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
N-Type calcium channel antagonists may suppress sympathetic activity. The purpose of this study was to assess the effects of amlodipine and cilnidipine on the cardiac sympathetic nervous system and the neurohormonal status of essential hypertension. 123I-metaiodobenzylguanidine (MIBG) cardiac imaging was performed and blood samples were taken to determine plasma renin activity and plasma norepinephrine concentration before and 3 months after drug administration in 47 patients with mild essential hypertension. Twenty-four of the patients were treated with 5 to 10 mg/d of amlodipine; the other 23 were treated with 10 to 20 mg/d of cilnidipine. For comparison, 12 normotensive subjects were also studied. No significant differences were found in the basal characteristics between the 2 hypertensive groups. In both hypertensive groups, both the systolic and diastolic blood pressures were significantly reduced to similar levels 3 months after drug treatment. Before the drug treatment, the 2 hypertensive groups had a significantly higher washout rate and lower heart-to-mediastinum (H/M) ratio compared with the normotensive subjects. The H/M ratio significantly increased (P<0.05) in combination with a decreased washout rate (P<0.02) after drug treatment in the cilnidipine group. In the amlodipine group, a significant decrease in washout rate (P<0. 04) was noted, without an increase in the H/M ratio. However, no significant changes were found in plasma renin activity and plasma norepinephrine concentration in either group. Thus, in patients with essential hypertension, cilnidipine suppressed cardiac sympathetic overactivity and amlodipine had a little suppressive effect. Cilnidipine may provide a new strategy for treatment of cardiovascular diseases with sympathetic overactivity.
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Affiliation(s)
- K Sakata
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
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Abstract
BACKGROUND Impaired fibrinolysis is associated with thromboembolic complications in hypertensive patients. It has been reported that cardiovascular morbidity and mortality rates are high even after lowering the elevated blood pressure with antihypertensive drugs. The aim of this study was to assess the effect of clinically used dosages of enalapril and nitrendipine on the fibrinolytic system. METHODS Tissue plasminogen activator antigen (tPA) and tissue plasminogen activator inhibitor-1 (PAI-1) activity were measured in 20 normotensive male subjects and 46 male patients with mild essential hypertension divided into 2 groups (22 patients treated with 5 to 10 mg enalapril once a day and 24 treated with 5 to 10 mg nitrendipine once a day) before and 3 months after drug administration. Plasma renin activity and norepinephrine concentration were also measured. RESULTS There were no significant differences in basal characteristics between the 2 hypertensive groups. In both hypertensive groups, blood pressure was significantly reduced to a similar level after drug treatment. In the 2 hypertensive groups, plasma renin activity significantly increased after drug treatment; however, there were no significant changes in norepinephrine concentration. Before drug treatment, the 2 hypertensive groups had significantly higher tPA and higher PAI-1 activity than the normotensive subjects. In the enalapril group, there was no significant change in tPA although PAI-1 activity significantly decreased after drug treatment. In the nitrendipine group, there was no significant change in tPA although PAI-1 activity significantly increased after drug treatment. CONCLUSION Thus enalapril improved impaired fibrinolysis but nitrendipine further aggravated fibrinolysis in essential hypertension. Considering the effect of antihypertensive drugs on the fibrinolytic system, more effective and beneficial treatment of hypertensives, especially at a high risk for thrombus formation might be selected.
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Affiliation(s)
- K Sakata
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
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Sakata K, Shirotani M, Yoshida H, Kurata C. Cardiac sympathetic nervous system in early essential hypertension assessed by 123I-MIBG. J Nucl Med 1999; 40:6-11. [PMID: 9935049] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
UNLABELLED Sympathetic overactivity has been noted in various clinical stages of essential hypertension. The purpose of this study is to investigate 123I-metaiodobenzylguanidine (MIBG) uptake and washout in patients with borderline and mild hypertension. METHODS To assess cardiac sympathetic function in essential hypertension, we performed 123I-MIBG cardiac imaging and echocardiography in 25 normotensive, 25 borderline hypertensive and 24 mildly hypertensive men. Age and body mass index were similar in the three groups. RESULTS Regarding the echocardiographic variables, the left ventricular mass index (LVMI) was significantly higher in the mildly hypertensive group (125.6+/-28.6 g/m2) than in the normotensive (99.9+/-20.7 g/m2) and the borderline hypertensive (110.0+/-24.4 g/m2) groups (P < 0.001 and P < 0.05, respectively). Regarding the scintigraphic variables, the heart-to-mediastinum (H/M) ratio was significantly lower in the mildly hypertensive group (1.8+/-0.3) than in the normotensive (2.1+/-0.3) and the borderline hypertensive (2.1+/-0.2) groups. In contrast, the washout rate was significantly higher in the mildly hypertensive group (17.6%+/-10.8%) than in the normotensive (7.0%+/-4.9%) and the borderline (11.9%+/-8.9%) hypertensive groups (P< 0.001 and P< 0.02, respectively). In addition, the borderline hypertensive group had a significantly higher washout rate than the normotensive group (P < 0.05). MIBG washout rate had a strong positive correlation with LVMI (r = 0.77, P < 0.0001). In contrast, the H/M ratio had a weak negative correlation with LVMI (r = -0.40, P < 0.0006). CONCLUSION During the course of establishment of essential hypertension, the washout rate becomes higher with the advance of hypertension and with the development of left ventricular hypertrophy. Thus, we suggest a strong relationship between cardiac sympathetic activity and the advance of hypertension at its early stages.
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Affiliation(s)
- K Sakata
- Department of Cardiology, Shizuoka General Hospital, Japan
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Yoshida H, Shirotani M, Mochizuki M, Sakata K. Assessment of myocardial fatty acid metabolism in atrioventricular synchronous pacing: analysis of iodine 123-labeled beta-methyl iodophenyl pentadecanoic acid SPECT. J Nucl Cardiol 1999; 6:33-40. [PMID: 10070839 DOI: 10.1016/s1071-3581(99)90063-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We used beta-methyl iodophenyl pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT) to evaluate fatty acid metabolism in patients who were candidates for permanent pacemaker implantation and in patients with atrioventricular (AV) synchronous pacing. METHODS AND RESULTS We performed BMIPP SPECT studies in 66 patients with bradyarrhythmia, of whom 11 patients were candidates for permanent pacemaker implantation, 27 patients had atrial pacing (atrial sensing, inhibited mode, simple programmable [AAI]), and 28 patients had atrial synchronous ventricular inhibited pacing (ventricular pacing, 2-chamber sensing, atrial-triggered and ventricular-inhibited, multiprogrammable [VDD]) or atrial and ventricular pacing in sequence (atrial and ventricular sensing, atrial-inhibited and atrial-triggered, ventricular-inhibited, multiprogrammable [DDD]). A qualitative assessment revealed that the BMIPP uptake at the septal, inferior, and apical regions was significantly decreased in the patients with VDD/DDD compared with both the candidates for permanent pacemaker implantation and the patients with AAI. The total extent score (ES) and severity score (SS) were significantly higher in the patients with VDD/DDD than in the other 2 groups. Significant regional differences of both ES and SS values were observed at the septal and inferior regions in the patients with VDD/DDD compared with the other groups. No differences were found between the qualitative and quantitative measures of BMIPP uptake in the candidates for permanent pacemaker implantation and those in the patients with AAI. CONCLUSION Our study suggests that AV synchronous right ventricular pacing resulting in the delayed conduction and depolarization of myocardial cells may directly interfere with regional cellular free fatty acid uptake and metabolism.
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Affiliation(s)
- H Yoshida
- Department of Cardiology, Shizuoka General Hospital, Shizuoka Prefecture, Japan
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Sakata K, Shirotani M, Yoshida H, Kurata C. Physiological fluctuation of the human left ventricle sympathetic nervous system assessed by iodine-123-MIBG. J Nucl Med 1998; 39:1667-71. [PMID: 9776265] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
UNLABELLED It has been proposed that sympathetic nervous system pathophysiology is involved in the development of cardiovascular disorders. Since cardiac adrenergic activity has been difficult to assess in humans, physiological changes in the sympathetic nervous system in the human left ventricle remain unclear. METHODS To determine if age and gender influence the sympathetic nervous function of the left ventricle, 300 angiographically normal subjects (170 men, 130 women; age range 40-79 yr) had 123I-metaiodobenzylguanidine (MIBG) cardiac imaging. Regional quantitative analysis of MIBG uptake and washout rate was performed. RESULTS Men and women had prominent age-related decreases in MIBG uptake in the inferior and lateral walls (r2 = 0.34, p <0.0001 for both). Both genders had a significant positive correlation between regional washout rate and age in each region. In contrast to men, women had strong positive correlations in all regions (r2 = 0.54, p <0.0001 in the anterior wall, r2 = 0.56, p <0.0001 in the lateral wall and r2 = 0.44, p <0.0001 in the inferior wall). According to the decade-by-decade analysis of washout rate, women had a significantly lower washout than men under 50 yr in every region and a significantly higher washout in the lateral wall than men over 70 yr. CONCLUSION The sympathetic nervous system in the human left ventricle showed age- and gender-related regional changes. The findings suggested that men have high sympathetic nerve activity from a younger age, and women have a progressive increase in sympathetic nerve activity with aging. These changes may contribute to the age and gender differences in the incidence and development of cardiac disorders.
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Affiliation(s)
- K Sakata
- Department of Cardiology, Shizuoka General Hospital, Japan
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Abstract
OBJECTIVES The purpose of this study was to assess the effects of enalapril and nitrendipine on the cardiac sympathetic nervous system. BACKGROUND Angiotensin-converting enzyme inhibitors and long-acting calcium channel blockers have been widely used in the treatment of cardiovascular diseases, in some of which sympathetic overactivity plays a major role in the pathophysiology and prognosis. However, little information is available on the effects of these drugs on the cardiac sympathetic nervous system. METHODS 123I-metaiodobenzylguanidine (MIBG) cardiac imaging was performed before and 3 months after drug administration in 46 patients with mild essential hypertension. Twenty-two patients were treated with 5 to 10 mg of enalapril once a day, and the other 24 with 5 to 10 mg of nitrendipine once a day. For comparison, 20 normotensive subjects were also studied. RESULTS There were no significant differences between the basal characteristics in the 2 hypertensive groups. In both hypertensive groups, both systolic and diastolic blood pressures were significantly reduced to similar levels after the 3-month drug treatment. Before the drug treatment, the 2 hypertensive groups had a significantly higher washout rate and lower MIBG uptake than the normotensive subjects. The heart-to-mediastinum ratio significantly increased (p < 0.0001), with decreased (p < 0.002) washout rate after drug treatment in the enalapril group, but with no significant changes in the nitrendipine group. CONCLUSION Enalapril could suppress cardiac sympathetic activity and nitrendipine had no effect on it. The knowledge of antihypertensive drugs on the cardiac sympathetic nervous system appears to be helpful in selecting appropriate treatment in cardiovascular diseases.
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Affiliation(s)
- K Sakata
- The Department of Cardiology, Shizuoka General Hospital, Japan
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Sakata K, Miho N, Ohtani S, Shirotani M, Yoshida H, Takada A. Remnant-like particle cholesterol in coronary artery disease: correlation with plasminogen activator inhibitor-1 activity. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0268-9499(98)80293-2] [Citation(s) in RCA: 6] [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: 11/30/2022]
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Yoshida H, Sakata K, Mochiduki M, Shirotani M. Comparison of filled-in myocardial segments after early and late reinjection of thallium-201--influence of the timing of reinjection on fill-in. Jpn Circ J 1998; 62:178-82. [PMID: 9583443 DOI: 10.1253/jcj.62.178] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Thallium-201 (201Tl) late reinjection after stress-redistribution imaging improves the detection of viable myocardium. Recently, early reinjection of 201Tl immediately after stress imaging was proposed as a new method for distinguishing ischemic myocardium, hibernating myocardium, and myocardial scar. However, there are no data on the influence of the timing of reinjection on "fill-in." This study was designed to assess whether the reinjection time influences "fill-in" in chronic coronary artery disease. Thirty-three patients with chronic coronary artery disease were studied. All patients underwent exercise 201Tl tomography. Immediately after stress imaging, 37 MBq of thallium was reinjected earlier than usual and early reinjection delayed image (ERDI) was acquired 3 h later. With the same protocol, all patients also underwent a second study involving late reinjection of 201Tl within 1 week. An additional 37 MBq of thallium was reinjected 3 h after stress imaging, and late reinjection delayed image (LRDI) was obtained 10 min later. All images were analyzed qualitatively using a 4-point grading uptake score. Of the 72 hypoperfused segments on stress images, 66 segments showed fill-in and 6 showed persistent defects on ERDI, and of the same 72 segments 55 segments displayed fill-in and the remaining 17 showed persistent defects on LRDI (p<0.05). The delta uptake score (the uptake score of the delayed image minus that of stress image) in early reinjection was 1.60+/-0.80, which was significantly higher than that in late reinjection (1.24+/-0.94, p<0.01). A small dose of thallium reinjected immediately after stress imaging with delayed images obtained 3 h later is convenient and might provide another technique for determining myocardial viability.
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Affiliation(s)
- H Yoshida
- Department of Cardiology, Shizuoka General Hospital, Japan
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Sakata K, Miho N, Shirotani M, Yoshida H, Takada Y, Takada A. Remnant-like particle cholesterol is a major risk factor for myocardial infarction in vasospastic angina with nearly normal coronary artery. Atherosclerosis 1998; 136:225-31. [PMID: 9543092 DOI: 10.1016/s0021-9150(97)00209-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We investigated the association of remnant-like particle cholesterol (RLP-C), with vasospastic angina (VSA). We selected 66 subjects with nearly normal coronary artery as a control group, and 74 VSA with nearly normal coronary artery, of whom 19 had prior myocardial infarction (MI). Coronary risk factors, triglyceride, lipoproteins and apolipoproteins were evaluated using stepwise discriminant analysis, smoking was the only discriminator of the control group from VSA and RLP-C was the only discriminator of VSA with MI from VSA without MI. In comparison between VSA with and without MI, using stepwise logistic regression analysis, the only significant variable was RLP-C, and odds ratio of RLP-C for MI was 1.59. Thus, RLP-C is a major discriminator of VSA with MI and appears to be a major risk factor for MI in VSA.
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Affiliation(s)
- K Sakata
- Department of Cardiology, Shizuoka General Hospital, Japan
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Kaneda T, Aoshima M, Ishigami N, Iemura J, Hoshino T, Shirotani M, Matsuda K. [A case of an expanding congenital left ventricular aneurysm]. Kyobu Geka 1998; 51:74-7. [PMID: 9455074] [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: 02/06/2023]
Abstract
Congenital ventricular aneurysm is rare. There have been only 17 case reports in Japan. Only 9 of them were treated surgically. In this paper, we report a case with a congenital left ventricular aneurysm successfully treated by surgery. A 42-year-old female was admitted to our hospital with chest pain and ECG abnormalities. Left ventriculography revealed aneurysmal formation of the left ventricle with normal coronary arteries. Surgical resection was performed because repeated echocardiography had showed its enlargement. Surgical treatment for congenital ventricular aneurysm seems to be indicated to those with worsening symptoms, volume enlargement or thrombus formation.
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Affiliation(s)
- T Kaneda
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Japan
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Kato H, Shirotani M, Enoki M, Oogushi K, Emura S, Takashima T, Ohmori K. Parasite infection in an officer of an ocean liner. Postgrad Med J 1997; 73:749-51. [PMID: 9519198 PMCID: PMC2431576 DOI: 10.1136/pgmj.73.865.749] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- H Kato
- Department of Internal Medicine, Saga Medical School, Japan
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Sakata K, Shirotani M, Yoshida H, Kurata C. Iodine-123 metaiodobenzylguanidine cardiac imaging to identify and localize vasospastic angina without significant coronary artery narrowing. J Am Coll Cardiol 1997; 30:370-6. [PMID: 9247507 DOI: 10.1016/s0735-1097(97)00159-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We assessed the ability of iodine-123 metaiodobenzylguanidine (MIBG) imaging to identify and localize coronary spasm and determined the most useful method of MIBG analysis in vasospastic angina without significant coronary narrowing. BACKGROUND Various noninvasive methods have been used to detect vasospastic angina, but they are not very sensitive in patients with sporadic attacks. MIBG imaging has recently been proposed as a useful tool for detecting vasospastic angina. METHODS Normal limits of both visual and quantitative analysis of two-dimensional polar maps (bull's-eyes) for MIBG imaging were at first established in 59 normal subjects. For optimal criteria of visual analysis, we established regional differences in abnormal MIBG defect scores. An abnormal region of the bull's-eye was defined as an area > 2 SD below normal. An abnormal regional washout rate was defined as < 0%. Using these criteria, we prospectively evaluated 104 patients with suspected vasospastic angina. Visual, bull's-eye and regional washout rate analyses were compared for overall detection of the disease and for individual vessel involvement. RESULTS Overall sensitivity by these methods was 30%, 42% and 76%, respectively. Washout rate analysis showed a significantly higher sensitivity than the other two methods. Specificity was 78%, 72% and 87%, respectively. The sensitivity of detecting spasm-induced coronary artery with washout rate analysis was 82% for the left anterior descending (LAD), 76% for the right (RCA) and 69% for the circumflex (Cx) coronary arteries. The sensitivity of visual analysis was 29%, 15% and 35%, respectively; that for bull's-eye analysis was 34%, 54% and 41%, respectively. Washout rate analysis showed a significantly higher sensitivity for LAD spasm than for the other two methods and a higher sensitivity for RCA and Cx spasms than for visual analysis. CONCLUSIONS Regional washout rate analysis of MIBG imaging is a highly accurate technique for determining the presence and location of coronary artery spasm.
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Affiliation(s)
- K Sakata
- Department of Cardiology, Shizuoka General Hospital, Japan
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Sakata K, Miura F, Sugino H, Saegusa T, Shirotani M, Yoshida H, Hoshino T, Kurata C. Assessment of regional sympathetic nerve activity in vasospastic angina: analysis of iodine 123-labeled metaiodobenzylguanidine scintigraphy. Am Heart J 1997; 133:484-9. [PMID: 9124179 DOI: 10.1016/s0002-8703(97)70199-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
With the use of iodine 123-labeled metaiodobenzylguanidine (123I-MIBG) scintigraphy, this study evaluated regional sympathetic nerve activity in vasospastic angina. Twenty male patients with left anterior descending coronary artery spasm and 18 male patients with normal coronary arteries as a control group were studied. All patients underwent quantitative 123I-MIBG scintigraphy and atropine stress 123I-MIBG scintigraphy. Both groups showed a similar heterogeneous 123I-MIBG uptake in the left ventricle. However, the regional washout rate in patients with coronary artery spasm was significantly reduced in all three territories compared with that in the control group. In vasospastic angina, the regional washout rate in the left anterior descending coronary artery territory was significantly reduced as compared with the other two regions. After intravenous injection of 1 mg atropine, the regional washout rate in the three regions significantly increased in both groups, but the regional differences between the two groups disappeared. The current study demonstrated that cardiac sympathetic nerve activity in vasospastic angina was suppressed, especially in the territory of the spasm-induced coronary artery, probably because of the enhanced parasympathetic nerve activity.
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Affiliation(s)
- K Sakata
- Department of Cardiology, Shizuoka General Hospital, Japan
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Sakata K, Miura F, Sugino H, Shinobe M, Shirotani M, Yoshida H, Mori N, Hoshino T, Takada A. Impaired fibrinolysis early after percutaneous transluminal coronary angioplasty is associated with restenosis. Am Heart J 1996; 131:1-6. [PMID: 8553994 DOI: 10.1016/s0002-8703(96)90043-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study examined the role of fibrinolytic components in the process of restenosis after percutaneous transluminal coronary angioplasty (PTCA). Seventy-two patients with single-vessel disease who underwent successful PTCA were prospectively selected. Tissue plasminogen activator (TPA), free plasminogen activator inhibitor-1 (free PAI-1), TPA/PAI-1 complex, and total PAI-1 antigen levels were measured before, at 1 week after, and at 3 months after PTCA. Six months after PTCA, the study patients were divided into two groups: 41 patients without restenosis and 31 patients with restenosis. There were no significant differences with regard to sex, age, coronary risk factors, or morphologic changes in the target lesions between the two groups. There were no significant differences in plasma TPA, TPA/PAI-1 complex, or total PAI-1 levels at each sampling period, or in the time courses between the two groups, except for total PAI-1 levels at 1 week after PTCA. Although no significant differences in free PAI-1 levels before PTCA were observed, free PAI-1 levels after PTCA in the patients with restenosis were significantly higher than those in the patients without restenosis. In addition, each group had a significant change in the time course of free PAI-1 levels. The results suggest that impaired fibrinolysis early after PTCA might affect the repair process of vascular injury, which leads to restenosis, and also that serial determination of free PAI-1 levels could help predict restenosis.
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Affiliation(s)
- K Sakata
- Department of Cardiology, Shizuoka General Hospital, Japan
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Shirotani M, Yui Y, Hattori R, Morishita H, Kawai C, Susawa T, Tamaki S, Takahashi M, Sakaguchi K. Emergency coronary angioplasty for acute myocardial infarction: predictors of early occlusion of the infarct-related artery after balloon inflation. Am Heart J 1993; 125:931-8. [PMID: 8465765 DOI: 10.1016/0002-8703(93)90099-u] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
THE FACTORS RESPONSIBLE FOR EARLY OCCLUSION OF THE INFARCT VESSEL AFTER emergency percutaneous transluminal coronary angioplasty (PTCA) were retrospectively examined in 191 patients with acute myocardial infarction. During the 24-hour period after the initial balloon inflation, 47 patients (25%) had occlusion of the vessel (occlusion group), whereas 144 did not (nonocclusion group). The former patients immediately underwent repeat PTCA, which was successful in 37. Univariate correlates of early occlusion were a shorter time interval between the onset of symptoms and PTCA (3.5 +/- 2.2 vs 4.5 +/- 2.9 hours, p = 0.025), right coronary artery involvement (53% vs 30%, p = 0.015), prior thrombolytic therapy (49% vs 32%, p = 0.035), and undersized inflation (43% vs 17%, p < 0.001). With multivariate analysis the three independent predictors were undersized inflation (p < 0.001), right coronary artery involvement (p = 0.004), and a shorter time interval until PTCA (p = 0.011). Thus patients undergoing early PTCA and having right coronary artery involvement appear to be at greater risk of having early occlusion. Thrombolytic agents and undersized inflation may also play an important role in its development.
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Affiliation(s)
- M Shirotani
- Department of Internal Medicine, Kyoto University Hospital, Japan
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42
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Shirotani M, Yui Y, Hattori R, Kawai C. [Early occlusion of the infarct-related artery after emergency PTCA for acute myocardial infarction]. Jpn Circ J 1993; 56 Suppl 5:1421-4. [PMID: 1291734 DOI: 10.1253/jcj.56.supplementv_1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- M Shirotani
- Department of Internal Medicine, Kyoto University
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Sase K, Yui Y, Hattori R, Shirotani M, Kawai C, Sasayama S. HA-1077 suppress both proliferation of vascular smooth muscle cells and c-fos mRNA induction. Jpn Circ J 1992; 56:1229-33. [PMID: 1479648 DOI: 10.1253/jcj.56.1229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
HA1077 is a newly synthesized vasodilator with unique intracellular calcium antagonistic action. In this study, its effect on the growth of vascular smooth muscle cells (VSMC) stimulated by fetal calf serum was examined. Both the proliferation and [3H]thymidine incorporation into DNA of the growth-arrested VSMC was dose-dependently inhibited by HA1077. The expression of a proto-oncogene, c-fos, which reached the maximum 30 min after addition of serum, was similarly inhibited by this agent in a dose-dependent manner. Thus, HA1077 is expected to be a useful vasodilator agent capable of suppressing the growth of VSMC which is thought to be an important underlying mechanism of atherosclerosis or restenosis after angioplasty.
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Affiliation(s)
- K Sase
- Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan
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44
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Shirotani M, Yui Y, Hattori R, Kawai C. A new type of vasodilator, HA1077, an isoquinoline derivative, inhibits proliferation of bovine vascular smooth muscle cells in culture. J Pharmacol Exp Ther 1991; 259:738-44. [PMID: 1941621] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The effects of a newly developed vasodilator agent, HA1077 [1-(5-isoquinolinesulfonyl)-homopiperazine hydrochloride], were investigated on the proliferation of cultured bovine aortic vascular smooth muscle cells (VSMC). HA1077 (10-100 microM) inhibited both fetal calf serum-induced proliferation and [3H]thymidine incorporation into DNA of the growth-arrested VSMC in a dose-dependent manner. When quiescent cells were stimulated with platelet-derived growth factor followed by insulin, HA1077 (1-30 microM), administered together with either stimulation, showed dose-dependent inhibition of [3H]thymidine incorporation. Further reduction of [3H]thymidine incorporation was observed when HA1077 was present at both stimulations, suggesting that HA1077 suppresses DNA synthesis acting in both competence and progression stages. After stimulation with fetal calf serum, quiescent VSMC started and ceased DNA synthesis in 15 to 18 hr and 24 hr, respectively. HA1077 inhibited [3H]thymidine incorporation when it was added either from 12 hr to 15 hr or from 21 hr to 24 hr after serum stimulation. In addition, when percent inhibition of [3H]thymidine incorporation by continuous exposure to HA1077 was examined as a function of the time it was added, reductions of the value were observed at 0 to 3 hr, 12 to 18 hr and 21 to 24 hr. Thus, we concluded that HA1077 suppresses DNA synthesis of bovine VSMC acting at the G0/G1 and the G1/S phase transitions and also in the S phase of the cell cycle. It is suggested that this agent may act as a potent inhibitor of VSMC proliferation as well as a vasodilator.
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Affiliation(s)
- M Shirotani
- Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan
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46
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Shirotani M, Yui Y, Hattori R, Kawai C. Serum from patients with restenosis after percutaneous transluminal coronary angioplasty stimulates proliferation of bovine vascular smooth muscle cells under low extracellular calcium condition. Jpn Circ J 1991; 55:634-42. [PMID: 1875531 DOI: 10.1253/jcj.55.634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We compared the effects on the proliferation of bovine vascular smooth muscle cells (VSMC) of serum from 36 patients without restenosis (group A), and 21 patients with restenosis (group B) after percutaneous transluminal coronary angioplasty (PTCA). Baseline characteristics were similar in both groups, except for the greater number of patients with unstable angina at the time of PTCA (52 vs 22%, p = 0.020) and the shorter interval between PTCA and repeat angiography in group B (106 +/- 30 vs 153 +/- 112 days, p = 0.022). Cultured bovine VSMC were stimulated with patient serum (5%) obtained at repeat angiography in either Ca(2+)-containing or Ca(2+)-free culture medium. DNA synthesis was assessed by [3H]thymidine incorporation. The following indices of VSMC proliferation were used: S(+) = [3H]thymidine uptake stimulated by 5% serum in Ca(2+)-containing medium/[3H]thymidine uptake stimulated by 5% fetal calf serum (FCS) in Ca(2+)-containing medium, S(-) = [3H]thymidine uptake stimulated by 5% serum in Ca(2+)-free medium/[3H]thymidine uptake stimulated by 5% FCS in Ca(2+)-free medium, and D = S(-)-S(+). D represented the preserved DNA synthesis in Ca(2+)-deprived medium. S(-) was lower than S(+) in group A (1.35 +/- 0.56 vs 1.57 +/- 0.58, p less than 0.0001), whereas it was higher than S(+) in group B (1.64 +/- 0.66 vs 1.50 +/- 0.58, p = 0.010). D was significantly higher in group B than in group A (0.14 +/- 0.23 vs -0.22 +/- 0.28, p less than 0.0001), and was not associated with any continuous variables including serum calcium level on univariate regression analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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MESH Headings
- Aged
- Angioplasty, Balloon, Coronary
- Animals
- Calcium/metabolism
- Cattle
- Cell Division
- Cells, Cultured
- Constriction, Pathologic/blood
- Constriction, Pathologic/pathology
- Constriction, Pathologic/therapy
- Coronary Disease/blood
- Coronary Disease/pathology
- Coronary Disease/therapy
- Extracellular Space/metabolism
- Female
- Humans
- Male
- Middle Aged
- Multivariate Analysis
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/metabolism
- Recurrence
- Regression Analysis
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Affiliation(s)
- M Shirotani
- Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan
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Shirotani M, Yui Y, Hattori R, Takahashi M, Aoyama T, Murohara Y, Morishita H, Kadota K, Kawai C. Serum from patients with restenosis after PTCA stimulates proliferation of bovine vascular smooth muscle cells under low extracellular calcium condition. J Am Coll Cardiol 1991. [DOI: 10.1016/0735-1097(91)90965-c] [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: 11/24/2022]
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Shirotani M, Yui Y, Hattori R, Kawai C. U-61,431F, a stable prostacyclin analogue, inhibits the proliferation of bovine vascular smooth muscle cells with little antiproliferative effect on endothelial cells. Prostaglandins 1991; 41:97-110. [PMID: 1708156 DOI: 10.1016/0090-6980(91)90023-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The effects of U-61,431F, ciprostene, a stable prostacyclin analogue, were examined on the proliferation of cultured quiescent bovine aortic endothelial cells (EC) and smooth muscle cells (SMC). After stimulation with 5% fetal calf serum, U-61,431F suppressed both the DNA synthesis and proliferation of SMC dose-dependently at the concentration of 3-100 microM, but had no effect on either of them in EC at a concentration of up to 30 microM. The inhibitory effect on DNA synthesis was greater in SMC than in EC at 3-50 microM. When SMC were stimulated with platelet-derived growth factor (PDGF) for 2 hrs followed by a 22-hr incubation with insulin, U-61,431F (1-50 microM) administered at the time of PDGF stimulation did not inhibit DNA synthesis. SMC initiated and terminated DNA synthesis at about 15-18 h and 24 h after stimulation with serum, respectively. Inhibition of DNA synthesis in serum-stimulated SMC as a function of the addition time of U-61,431F reduced at 3-12 h after the stimulation. U-61,431F raised the cyclic AMP (cAMP) content in SMC. Moreover, a phosphodiesterase inhibitor, 3-isobutyl-1-methylxanthine, and a more specific cAMP phosphodiesterase inhibitor, Ro 20-1724, augmented the inhibition of DNA synthesis in SMC concomitant with further elevation of cAMP level. These results suggest that U-61,431F inhibits DNA synthesis of SMC acting in the progression stage rather than in the competence stage, with little antiproliferative effect on EC. cAMP may play an important role in its antiproliferative action in SMC.
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MESH Headings
- 1-Methyl-3-isobutylxanthine/pharmacology
- 4-(3-Butoxy-4-methoxybenzyl)-2-imidazolidinone/pharmacology
- Animals
- Aorta/cytology
- Aorta/drug effects
- Aorta/metabolism
- Cattle
- Cell Division/drug effects
- Cells, Cultured
- Cyclic AMP/metabolism
- DNA Replication/drug effects
- Endothelium, Vascular/cytology
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Epoprostenol/analogs & derivatives
- Epoprostenol/pharmacology
- Kinetics
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Platelet-Derived Growth Factor/pharmacology
- Prostaglandins, Synthetic/pharmacology
- Thymidine/metabolism
- Tritium
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Affiliation(s)
- M Shirotani
- Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan
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49
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Aoyama T, Yui Y, Takatsu Y, Takahashi M, Murohara Y, Shirotani M, Yasumoto H, Morishita H, Kadota K, Sakaguchi K. The dynamic changes of plasma tissue-type plasminogen activator level and the activity of its inhibitor during coronary vasospasm. Jpn Circ J 1990; 54:1139-46. [PMID: 2125083 DOI: 10.1253/jcj.54.1139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study aimed to examine the dynamic changes of the fibrinolytic system during coronary vasospasm. Tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI) and fibrinopeptide A (FPA) levels were measured in the great cardiac venous and arterial blood of 9 patients with clinically and angiographically proven vasospastic angina and 11 controls. Before ergonovine provocation, although there was no difference between the above 2 groups in t-PA levels in the aorta or the great cardiac vein, the PAI level in patients with variant angina was lower than in the controls both in the aorta (4.2 +/- 3.5 IU/ml vs 10.9 +/- 5.2 IU/ml) and in the great cardiac vein (2.3 +/- 2.9 IU/ml vs. 11.9 +/- 4.9 IU/ml). During ergonovine-induced coronary vasospasm in patients with variant angina, the t-PA level in the great cardiac vein significantly increased from 3.4 +/- 0.7 ng/ml to 4.4 +/- 0.5 ng/ml (p less than 0.05), but it did not change in the aorta. The maximal dose of ergonovine (0.4 mg) induced mild diffuse coronary vasoconstriction in the controls, and this diffuse coronary vasoconstriction induced a reduction of PAI levels in the great cardiac vein from 11.9 +/- 4.9 IU/ml to 9.5 +/- 4.8 IU/ml (p less than 0.05). FPA levels in the great cardiac vein did not change during ergonovine-induced coronary vasospasm in either group. Thus, the coronary vasospasm induced the release of t-PA from endothelial cells of coronary vessels and resulted in the reduction in the PAI activity in the great cardiac vein.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T Aoyama
- Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan
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50
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Shirotani M, Yui Y, Hattori R, Takahashi M, Aoyama T, Murohara Y, Morishita H, Kadota K, Kawai C. Effects of U-61, 431F, a stable prostacyclin analogue, on the proliferation of bovine vascular edothelial and smooth muscle cells. J Am Coll Cardiol 1990. [DOI: 10.1016/0735-1097(90)92060-f] [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: 11/29/2022]
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