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Gohbara M, Hibi K, Morimoto T, Kirigaya H, Yamamoto K, Ono K, Shiomi H, Ohya M, Yamaji K, Watanabe H, Amano T, Morino Y, Takagi K, Honye J, Matsuo H, Abe M, Kadota K, Ando K, Nakao K, Sonoda S, Suwa S, Kawai K, Kozuma K, Nakagawa Y, Ikari Y, Nanasato M, Hanaoka K, Tanabe K, Hata Y, Akasaka T, Kimura T. SYNTAX Score and 1-Year Outcomes in the OPTIVUS-Complex PCI Study Multivessel Cohort. Am J Cardiol 2023; 205:431-441. [PMID: 37660669 DOI: 10.1016/j.amjcard.2023.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The optimal revascularization strategy in patients with multivessel disease and intermediate SYNTAX score (SS) has not been fully elucidated. This study aimed to investigate the clinical outcomes of optimal intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) stratified by SS. METHODS This was a substudy of the OPTIVUS-Complex PCI study Multivessel Cohort, which aimed to meet the prespecified criteria for optimal stent expansion after IVUS-guided PCI. A total of 1,005 patients were divided into 3 groups according to SS: low, ≤22; intermediate, 23 to 32; and high, ≥33. The primary end points were major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of death, myocardial infarction, stroke, or coronary revascularization. RESULTS The cumulative 1-year incidence of the primary end point was significantly higher in patients with high SS than in those with intermediate or low SS (25.0%, 10.9%, and 9.5%, respectively; p = 0.003). This difference was mainly caused by the incidence of coronary revascularization. In the multivariable Cox proportional hazards models, the excess risk of patients with high versus low SS remained significant for the primary end point (hazard ratio 3.19, 95% confidence interval 1.65 to 6.16, p <0.001), whereas the excess risk of patients with intermediate versus low SS was no longer significant (hazard ratio 1.20, 95% confidence interval 0.72 to 2.01, p = 0.46). CONCLUSIONS After IVUS-guided multivessel PCI, patients with intermediate SS had a similar 1-year risk of MACCE to that of patients with low SS, whereas patients with high SS had a higher 1-year risk of MACCE than those with low SS.
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Affiliation(s)
- Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hidekuni Kirigaya
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Ko Yamamoto
- 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
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Japan
| | - Junko Honye
- Department of Cardiovascular Medicine, Kikuna Memorial Hospital, Yokohama, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kouichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University Hospital, Isehara, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Keiichi Hanaoka
- Hanaoka Seishu Memorial Cardiovascular Clinic, Hokkaido, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshiki Hata
- Department of Cardiology, Minamino Cardiovascular Hospital, Hachioji, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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2
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Obayashi Y, Shiomi H, Morimoto T, Miyake M, Inoko M, Nishikawa R, Kaneda K, Yamamoto K, Takeji Y, Tada T, Nagao K, Uegaito T, Ehara N, Sakai H, Suwa S, Tamura T, Sakamoto H, Inada T, Matsuda M, Sato Y, Furukawa Y, Ando K, Kadota K, Nakagawa Y, Kimura T. The Impact of Mitral Regurgitation on Long-Term Outcomes in Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2023; 203:384-393. [PMID: 37517134 DOI: 10.1016/j.amjcard.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/01/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Abstract
It is important to clarify the precise impact of mitral regurgitation (MR) on long-term outcomes in acute myocardial infarction (AMI) patients who underwent percutaneous coronary intervention (PCI). In the Coronary Revascularization Demonstrating Outcome study in Kyoto Acute Myocardial Infarction (CREDO-Kyoto AMI) Registry Wave-2, the study population consisted of 5,266 patients with AMI who underwent PCI. The clinical outcomes of all-cause death, cardiovascular death, and hospitalization for heart failure (HF) were compared according to the severity of MR. Mild and moderate/severe MR were identified in 2,112 (40%) and 531 patients (10%), respectively. Patients with greater severity of MR were more likely to be old, had more co-morbidities, and more often presented with large myocardial infarction with HF. During median follow-up duration of 5.6 (interquartile range: 4.2 to 6.6) years, as the MR severity increased from no, mild, to moderate/severe MR, the cumulative 5-year incidences of all-cause death, cardiovascular death and hospitalization for HF incrementally increased ([15.3%, 19.6%, 33.3%], [8.9%, 11.7%, 21.0%] and [5.9%, 12.4%, 23.9%], respectively, P for all<0.001). After adjusting for confounders, however, mild and moderate/severe MR were not independently associated with the higher risks for all-cause death (hazard ratio [95% confidence interval]:1.05 [0.92 to 1.19], p = 0.51, and 1.10 [0.92 to 1.32], p = 0.28) and cardiovascular death (1.01 [0.85 to 1.21], p = 0.89, and 0.93 [0.73 to 1.18], p = 0.54) as compared with no MR. Both mild and moderate/severe MR were independently associated with the higher risks for hospitalization for HF (1.73 [1.42 to 2.11], p <0.001, and 2.23 [1.73 to 2.87], p <0.001). In a large population of patients with AMI who underwent PCI, MR was not independently associated with higher long-term mortality risk but was independently associated with higher risk for hospitalization for HF.
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Affiliation(s)
- Yuki Obayashi
- 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
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Ryusuke Nishikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuhisa Kaneda
- 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
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuya Nagao
- Division of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, Japan
| | - Takashi Uegaito
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Sakai
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | | | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tsukasa Inada
- Division of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, Japan
| | - Mitsuo Matsuda
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
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3
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Akashi N, Matoba T, Kohro T, Oba Y, Kabutoya T, Imai Y, Kario K, Kiyosue A, Mizuno Y, Nochioka K, Nakayama M, Iwai T, Miyamoto Y, Ishii M, Nakamura T, Tsujita K, Sato H, Fujita H, Nagai R. Sex Differences in Long-Term Outcomes in Patients With Chronic Coronary Syndrome After Percutaneous Coronary Intervention - Insights From a Japanese Real-World Database Using a Storage System. Circ J 2023; 87:775-782. [PMID: 36709982 DOI: 10.1253/circj.cj-22-0653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several studies have reported some sex differences in patients with coronary artery diseases. However, the results regarding long-term outcomes in patients with chronic coronary syndrome (CCS) are inconsistent. Therefore, the present study investigated sex differences in long-term outcomes in patients with CCS after percutaneous coronary intervention (PCI).Methods and Results: This was a retrospective, multicenter cohort study. We enrolled patients with CCS who underwent PCI between April 2013 and March 2019 using the Clinical Deep Data Accumulation System (CLIDAS) database. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, or hospitalization for heart failure. In all, 5,555 patients with CCS after PCI were included in the analysis (4,354 (78.4%) men, 1,201 (21.6%) women). The median follow-up duration was 917 days (interquartile range 312-1,508 days). The incidence of MACE was not significantly different between the 2 groups (hazard ratio [HR] 1.20; 95% confidential interval [CI] 0.97-1.47; log-rank P=0.087). After performing multivariable Cox regression analyses on 4 different models, there were still no differences in the incidence of MACE between women and men. CONCLUSIONS There were no significant sex differences in MACE in patients with CCS who underwent PCI and underwent multidisciplinary treatments.
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Affiliation(s)
- Naoyuki Akashi
- Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takahide Kohro
- Department of Clinical Informatics, Jichi Medical University School of Medicine
| | - Yusuke Oba
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Yasushi Imai
- Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Arihiro Kiyosue
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo Hospital.,Development Bank of Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation, and Education Center, Tohoku University Hospital
| | - Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Taishi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Hideo Fujita
- Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center
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4
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Takeji Y, Morimoto T, Shiomi H, Kato ET, Imada K, Yoshikawa Y, Matsumura-Nakano Y, Yamamoto K, Yamaji K, Toyota T, Tada T, Tazaki J, Yamamoto E, Nakatsuma K, Suwa S, Ehara N, Taniguchi R, Tamura T, Watanabe H, Toyofuku M, Yamamoto T, Shinoda E, Mabuchi H, Inoko M, Onodera T, Sakamoto H, Inada T, Ando K, Furukawa Y, Sato Y, Kadota K, Nakagawa Y, Kimura T. Sex Differences in Clinical Outcomes After Percutaneous Coronary Intervention. Circ J 2023; 87:277-286. [PMID: 36351607 DOI: 10.1253/circj.cj-22-0517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a scarcity of studies comparing the clinical outcomes after percutaneous coronary intervention (PCI) for women and men stratified by the presentation of acute coronary syndromes (ACS) or stable coronary artery disease (CAD).Methods and Results: The study population included 26,316 patients who underwent PCI (ACS: n=11,119, stable CAD: n=15,197) from the CREDO-Kyoto PCI/CABG registry Cohort-2 and Cohort-3. The primary outcome was all-cause death. Among patients with ACS, women as compared with men were much older. Among patients with stable CAD, women were also older than men, but with smaller difference. The cumulative 5-year incidence of all-cause death was significantly higher in women than in men in the ACS group (26.2% and 17.9%, log rank P<0.001). In contrast, it was significantly lower in women than in men in the stable CAD group (14.2% and 15.8%, log rank P=0.005). After adjusting confounders, women as compared with men were associated with significantly lower long-term mortality risk with stable CAD but not with ACS (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.69-0.82, P<0.001, and HR: 0.92, 95% CI: 0.84-1.01, P=0.07, respectively). There was a significant interaction between the clinical presentation and the mortality risk of women relative to men (interaction P=0.002). CONCLUSIONS Compared with men, women had significantly lower adjusted mortality risk after PCI among patients with stable CAD, but not among those with ACS.
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Affiliation(s)
- Yasuaki Takeji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Eri Toda Kato
- 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
| | | | - Toshiaki Toyota
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki Hospital
| | | | - Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | - Takashi Yamamoto
- Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital
| | - Eiji Shinoda
- Department of Cardiovascular Medicine, Hamamatsu Rosai Hospital
| | | | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital
| | | | - Tsukasa Inada
- Department of Cardiovascular Medicine, Osaka Red Cross Hospital
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki Hospital
| | | | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.,Department of Cardiology, Hirakata Kohsai Hospital
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5
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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6
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Takeji Y, Shiomi H, Morimoto T, Yamamoto K, Matsumura-Nakano Y, Nagao K, Taniguchi R, Yamaji K, Tada T, Kato ET, Yoshikawa Y, Obayashi Y, Suwa S, Inoko M, Ehara N, Tamura T, Onodera T, Watanabe H, Toyofuku M, Nakatsuma K, Sakamoto H, Ando K, Furukawa Y, Sato Y, Nakagawa Y, Kadota K, Kimura T. Differences in mortality and causes of death between STEMI and NSTEMI in the early and late phases after acute myocardial infarction. PLoS One 2021; 16:e0259268. [PMID: 34788296 PMCID: PMC8598015 DOI: 10.1371/journal.pone.0259268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background The detailed causes of death in non–ST-segment–elevation myocardial infarction (NSTEMI) have not been adequately evaluated compared to those in ST-segment elevation myocardial infarction (STEMI). Methods The study population was 6,228 AMI patients who underwent percutaneous coronary intervention (STEMI: 4,625 patients and NSTEMI: 1,603 patients). The primary outcome was all-cause death. Results Within 6 months after AMI, the adjusted mortality risk was not significantly different between NSTEMI patients and STEMI patients (HR: 0.83, 95%CI: 0.67–1.03, P = 0.09). Regarding the causes of death within 6 months after AMI, mechanical complications more frequently occurred in STEMI patients than in NSTEMI patients, while proportions of post resuscitation status on arrival and heart failure were higher in in NSTEMI patients than in STEMI patients. Beyond 6 months after AMI, the adjusted mortality risk of NSTEMI relative to STEMI was not significantly different. (HR: 1.04, 95%CI: 0.90–1.20, P = 0.59). Regarding causes of death beyond 6 months after AMI, almost half of deaths were cardiovascular causes in both groups, and breakdown of causes of death was similar between NSTEMI and STEMI. Conclusion The mortality risk within and beyond 6 months after AMI were not significantly different between STEMI patients and NSTEMI patients after adjusting confounders. Deaths due to post resuscitation status and heart failure were more frequent in NSTEMI within 6 months after AMI.
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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
- * E-mail:
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukiko Matsumura-Nakano
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuya Nagao
- Department of Cardiovascular Medicine, Osaka Red Cross Hospital, Osaka, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Eri Toda Kato
- 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
| | - Yuki Obayashi
- 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
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Mamoru Toyofuku
- 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, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihito Sato
- Department 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
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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7
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Obayashi Y, Shiomi H, Morimoto T, Tamaki Y, Inoko M, Yamamoto K, Takeji Y, Tada T, Nagao K, Yamaji K, Kaneda K, Suwa S, Tamura T, Sakamoto H, Inada T, Matsuda M, Sato Y, Furukawa Y, Ando K, Kadota K, Nakagawa Y, Kimura T. Newly Diagnosed Atrial Fibrillation in Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e021417. [PMID: 34533047 PMCID: PMC8649521 DOI: 10.1161/jaha.121.021417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background It remains controversial whether long‐term clinical impact of newly diagnosed atrial fibrillation (AF) in the acute phase of acute myocardial infarction (AMI) is different from that of prior AF diagnosed before the onset of AMI. Methods and Results The current study population from the CREDO‐Kyoto AMI (Coronary Revascularization Demonstrating Outcome Study in Kyoto Acute Myocardial Infarction) Registry Wave‐2 consisted of 6228 patients with AMI who underwent percutaneous coronary intervention. The baseline characteristics and long‐term clinical outcomes were compared according to AF status (newly diagnosed AF: N=489 [7.9%], prior AF: N=589 [9.5%], and no AF: N=5150 [82.7%]). Median follow‐up duration was 5.5 years. Patients with newly diagnosed AF and prior AF had similar baseline characteristics with higher risk profile than those with no AF including older age and more comorbidities. The cumulative 5‐year incidence of all‐cause death was higher in newly diagnosed AF and prior AF than no AF (38.8%, 40.7%, and 18.7%, P<0.001). The adjusted hazard ratios (HRs) for mortality of newly diagnosed AF and prior AF relative to no AF remained significant with similar magnitude (HR, 1.31; 95% CI, 1.12–1.54; P<0.001, and HR, 1.32; 95% CI, 1.14–1.52; P<0.001, respectively). The cumulative 5‐year incidence of stroke decreased in the order of newly diagnosed AF, prior AF and no AF (15.5%, 12.9%, and 6.3%, respectively, P<0.001). The higher adjusted HRs of both newly diagnosed AF and prior AF relative to no AF were significant for stroke, with a greater risk of newly diagnosed AF than that of prior AF (HR, 2.05; 95% CI, 1.56–2.69; P<0.001, and HR, 1.33; 95% CI, 1.00–1.78; P=0.048, respectively). The higher stroke risk of newly diagnosed AF compared with prior AF was largely driven by the greater risk within 30 days. The higher adjusted HRs of newly diagnosed AF and prior AF relative to no AF were significant for heart failure hospitalization (HR, 1.73; 95% CI, 1.35–2.22; P<0.001, and HR, 2.23; 95% CI, 1.82–2.74; P<0.001, respectively) and major bleeding (HR, 1.46; 95% CI, 1.23–1.73; P<0.001, and HR, 1.36; 95% CI, 1.15–1.60; P<0.001, respectively). Conclusions Newly diagnosed AF in AMI had risks for mortality, heart failure hospitalization, and major bleeding higher than no AF, and comparable to prior AF. The risk of newly diagnosed AF for stroke might be higher than that of prior AF.
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Affiliation(s)
- Yuki Obayashi
- 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
| | - Yodo Tamaki
- Department of Cardiology Tenri Hospital Tenri Japan
| | - Moriaki Inoko
- Cardiovascular Center Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Ko Yamamoto
- 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
| | - Tomohisa Tada
- Department of Cardiology Shizuoka General Hospital Shizuoka Japan
| | - Kazuya Nagao
- Department of Cardiovascular Center Osaka Red Cross Hospital Osaka Japan
| | - Kyohei Yamaji
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Kazuhisa Kaneda
- Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
| | - Satoru Suwa
- Department of Cardiology Juntendo University Shizuoka Hospital Izunokuni Japan
| | | | - Hiroki Sakamoto
- Department of Cardiology Shizuoka General Hospital Shizuoka Japan
| | - Tsukasa Inada
- Department of Cardiovascular Center Osaka Red Cross Hospital Osaka Japan
| | - Mitsuo Matsuda
- Department of Cardiology Kishiwada City Hospital Kishiwada Japan
| | - Yukihito Sato
- Department of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine Kobe City Medical Center General Hospital Kobe Japan
| | - Kenji Ando
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Kazushige Kadota
- Department of Cardiology Kurashiki Central Hospital Kurashiki Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine Shiga University of Medical Science Shiga Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
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8
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Coronary Revascularization in the Past Two Decades in Japan (From the CREDO-Kyoto PCI/CABG Registries Cohort-1, -2, and -3). Am J Cardiol 2021; 153:20-29. [PMID: 34238444 DOI: 10.1016/j.amjcard.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 01/08/2023]
Abstract
The treatment of coronary artery disease has substantially changed over the past two decades. However, it is unknown whether and how much these changes have contributed to the improvement of long-term outcomes after coronary revascularization. We assessed trends in the demographics, practice patterns and long-term outcomes in 24,951 patients who underwent their first percutaneous coronary intervention (PCI) (n = 20,106), or isolated coronary artery bypass grafting (CABG) (n = 4,845) using the data in a series of the CREDO-Kyoto PCI/CABG Registries (Cohort-1 [2000 to 2002]: n = 7,435, Cohort-2 [2005 to 2007]: n = 8,435, and Cohort-3 [2011 to 2013]: n = 9,081). From Cohort-1 to Cohort-3, the patients got progressively older across subsequent cohorts (67.0 ± 10.0, 68.4 ± 9.9, and 69.8 ± 10.2 years, ptrend < 0.001). There was increased use of PCI over CABG (73.5%, 81.9%, and 85.2%, ptrend < 0.001) and increased prevalence of evidence-based medications use over time. The cumulative 3-year incidence of all-cause death was similar across the 3 cohorts (9.0%, 9.0%, and 9.3%, p = 0.74), while cardiovascular death decreased over time (5.7%, 5.1%, and 4.8%, p = 0.03). The adjusted risk for all-cause death and for cardiovascular death progressively decreased from Cohort-1 to Cohort-2 (HR:0.89, 95%CI:0.80 to 0.99, p = 0.03, and HR:0.80, 95%CI:0.70 to 0.92, p = 0.002, respectively), and from Cohort-2 to Cohort-3 (HR:0.86, 95%CI:0.78 to 0.95, p = 0.004, and HR:0.77, 95%CI:0.67-0.89, p < 0.001, respectively). The risks for stroke and repeated coronary revascularization also improved over time. In conclusions, we found a progressive and substantial reduction of adjusted risk for all-cause death, cardiovascular death, stroke, and repeated coronary revascularization over the past two decades in Japan.
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9
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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] [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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10
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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] [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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11
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Yamamoto K, Natsuaki M, Morimoto T, Shiomi H, Matsumura-Nakano Y, Nakatsuma K, Watanabe H, Yamamoto E, Kato E, Fuki M, Yamaji K, Nishikawa R, Nagao K, Takeji Y, Watanabe H, Tazaki J, Watanabe S, Saito N, Yamazaki K, Soga Y, Komiya T, Ando K, Minatoya K, Furukawa Y, Nakagawa Y, Kadota K, Kimura T. Periprocedural Stroke After Coronary Revascularization (from the CREDO-Kyoto PCI/CABG Registry Cohort-3). Am J Cardiol 2021; 142:35-43. [PMID: 33279479 DOI: 10.1016/j.amjcard.2020.11.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022]
Abstract
There is a scarcity of data on incidence, risk factors, especially clinical severity, and long-term prognostic impact of periprocedural stroke after coronary revascularization in contemporary real-world practice. Among 14,867 consecutive patients undergoing first coronary revascularization between January 2011 and December 2013 (percutaneous coronary intervention [PCI]: N = 13258, and coronary artery bypass grafting [CABG]: N = 1609) in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG registry Cohort-3, we evaluated the details on periprocedural stroke. Periprocedural stroke was defined as stroke within 30 days after the index procedure. Incidence of periprocedural stroke was 0.96% after PCI and 2.13% after CABG (log-rank p <0.001). Proportions of major stroke defined by modified Rankin Scale ≥2 at hospital discharge were 68% after PCI, and 77% after CABG. Independent risk factors of periprocedural stroke were acute coronary syndrome (ACS), carotid artery disease, advanced age, heart failure, and end-stage renal disease after PCI, whereas they were ACS, carotid artery disease, atrial fibrillation, chronic obstructive pulmonary disease, malignancy, and frailty after CABG. There was excess long-term mortality risk of patients with periprocedural stroke relative to those without after both PCI and CABG (hazard ratio 1.71 [1.25 to 2.33], and hazard ratio 4.55 [2.79 to 7.43]). In conclusion, incidence of periprocedural stroke was not negligible not only after CABG, but also after PCI in contemporary real-world practice. Majority of patients with periprocedural stroke had at least mild disability at hospital discharge. ACS and carotid artery disease were independent strong risk factors of periprocedural stroke after both PCI and CABG. Periprocedural stroke was associated with significant long-term mortality risk after both PCI and CABG.
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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
| | - Yukiko Matsumura-Nakano
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Erika Yamamoto
- 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
| | - Masayuki Fuki
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naritatsu Saito
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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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] [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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Araki E, Tanaka A, Inagaki N, Ito H, Ueki K, Murohara T, Imai K, Sata M, Sugiyama T, Ishii H, Yamane S, Kadowaki T, Komuro I, Node K. Diagnosis, prevention, and treatment of cardiovascular diseases in people with type 2 diabetes and prediabetes: a consensus statement jointly from the Japanese Circulation Society and the Japan Diabetes Society. Diabetol Int 2021; 12:1-51. [PMID: 33479578 PMCID: PMC7790968 DOI: 10.1007/s13340-020-00471-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501 Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohjiro Ueki
- Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenjiro Imai
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Shunsuke Yamane
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501 Japan
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14
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Araki E, Tanaka A, Inagaki N, Ito H, Ueki K, Murohara T, Imai K, Sata M, Sugiyama T, Ishii H, Yamane S, Kadowaki T, Komuro I, Node K. Diagnosis, Prevention, and Treatment of Cardiovascular Diseases in People With Type 2 Diabetes and Prediabetes - A Consensus Statement Jointly From the Japanese Circulation Society and the Japan Diabetes Society. Circ J 2020; 85:82-125. [PMID: 33250455 DOI: 10.1253/circj.cj-20-0865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University
| | | | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kohjiro Ueki
- Diabetes Research Center, Research Institute, National Center for Global Health and Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenjiro Imai
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital
| | - Shunsuke Yamane
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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15
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Khosravi A, Vakhshoori M, Sharif V, Roghani-Dehkordi F, Najafian J, Mansouri A. Comparison of survival rate and complications of percutaneous coronary intervention, coronary artery bypass graft, and medical treatment in patients with left main and/or three vessel diseases. ARYA ATHEROSCLEROSIS 2020; 16:85-93. [PMID: 33133207 PMCID: PMC7578519 DOI: 10.22122/arya.v16i2.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The probable complications of 3 different cardiovascular diseases treatment options including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and medical therapy (MT), especially in individuals suffering from left main (LM) and/or three vessel diseases (3VDs), have received less attention. Thus, the aim of this study was to compare the complications of the aforementioned therapeutic strategies in patients admitted with LM coronary artery disease (CAD) and/or having 3VDs. METHODS From March 2018 to March 2019, a total number of 251 eligible individuals (87, 86, and 78 subjects treated with PCI, CABG, and MT, respectively) were recruited in this cohort study. After the initiation of treatment, all individuals were followed for 6 months. Occurrence of any complications including chest pain (CP), re-hospitalization due to cardiac problems, heart failure (HF), death, myocardial infarction (MI), and stroke as well as major adverse cardiac events (MACE) were assessed. RESULTS Significantly lower percentages of CP, readmission, and HF were observed in the CABG group compared to the PCI and MT groups (24.4% vs. 47.1% and 53.9%, P < 0.001; 3.5% vs. 13.8% and 5.1%, P = 0.020; 1.2% vs. 2.3% and 9%; P = 0.040, respectively). Further analysis revealed an increased likelihood of hospitalization in the PCI group (OR: 3.82, 95% CI: 1.01-14.41, P = 0.040), and a lower risk of CP and HF occurrence in the CABG group subjects compared to the MT group (OR: 0.28, 95% CI: 0.13-0.62, P = 0.002 and OR: 0.05, 95% CI: 0.004-0.71, P = 0.030, respectively). This pattern was also observed in the PCI group in terms of HF (OR: 0.12, 95% CI: 0.02-0.83, P = 0.030). CONCLUSION Patients suffering from LM and/or 3VDs would most likely benefit from CABG followed by PCI, rather than MT. Further large-scale studies are required to confirm these results.
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Affiliation(s)
- Alireza Khosravi
- Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrbod Vakhshoori
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Sharif
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farshad Roghani-Dehkordi
- Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Najafian
- Associate Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asieh Mansouri
- Assistant Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Low blood pressure and cardiovascular events in diabetic patients with coronary artery disease after revascularization: the CREDO-Kyoto registry cohort-1. Hypertens Res 2020; 43:715-723. [PMID: 32015482 DOI: 10.1038/s41440-020-0407-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/09/2020] [Accepted: 01/12/2020] [Indexed: 12/13/2022]
Abstract
The current American, European, and Japanese guidelines for hypertension treatment have lowered blood pressure (BP) targets to <130/80 mmHg in patients with diabetes mellitus (DM) and patients with coronary artery disease (CAD). However, there is concern that low BP may increase cardiovascular events in diabetic CAD patients. Currently, coronary revascularization has become widespread in diabetic CAD patients. Thus, whether low BP is an independent risk factor for cardiovascular events in diabetic CAD patients after revascularization was investigated. We examined 2718 stable CAD patients with DM in the CREDO-Kyoto cohort-1 registry enrolling 9877 patients who underwent their first percutaneous coronary intervention or coronary bypass grafting. There were no cutoff points for systolic BP (SBP) below which the age- and sex-adjusted hazard ratios for cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke increased. The cutoff diastolic BP (DBP) for increasing cardiovascular death was 70 mmHg (P = 0.014), whereas there was no cutoff DBP for increasing nonfatal MI and nonfatal stroke. However, on stepwise Cox hazard proportional regression analysis, the independent factors increasing cardiovascular death were hypertension, low creatinine clearance, wide pulse pressure, prior MI, and nonuse of statins, but DBP < 70 mmHg was not a significant factor. In conclusion, in diabetic CAD patients after coronary revascularization, low SBP and DBP were not significant factors that increased cardiovascular events. Careful attention should be paid to vascular lesions and organ damage that have already progressed.
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17
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Tarasov RS, Ivanov SV, Kazantsev AN, Volkov AN, Shabayev AR, Bakovskiy KV, Lider RY, Grachev KI. [Long-term outcomes of coronary artery bypass surgery in young patients]. Khirurgiia (Mosk) 2019:57-63. [PMID: 31714531 DOI: 10.17116/hirurgia201911157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze long-term outcomes of CABG in young patients, incidence and structure of adverse cardiovascular events depending on patients' age. MATERIAL AND METHODS There were 175 young patients (up to 44 years old in accordance with WHO classification) who underwent CABG for the period from 2006 to 2016. The control group included 175 patients aged 45 years and older who were randomly selected among patients operated in the same period. Overall long-term follow-up period was 81.9±15.75 months (≈ 6.8 years). Data on long-term survival and adverse cardiovascular events were available in 86.3% of patients in general sample and 72.6% of young patients. RESULTS Young patients undergoing CABG were usually characterized by the absence of severe concomitant diseases, moderate coronary atherosclerosis by SYNTAX Score scale, high percentage of left ventricular aneurysm and previous PCI. Incidence and structure of in-hospital and long-term adverse cardiovascular events in young and older patients confirmed satisfactory results of CABG regardless age.
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Affiliation(s)
- R S Tarasov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - S V Ivanov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - A N Kazantsev
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - A N Volkov
- Kemerovo Regional Clinical Cardiology Dispensary, Kemerovo, Russia
| | - A R Shabayev
- Kemerovo Regional Clinical Cardiology Dispensary, Kemerovo, Russia
| | - K V Bakovskiy
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - R Yu Lider
- Kemerovo State Medical University of the Ministry of Health of the Russia, Kemerovo, Russia
| | - K I Grachev
- Kemerovo State Medical University of the Ministry of Health of the Russia, Kemerovo, Russia
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18
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Imura H, Maruyama Y, Amitani R, Maeda M, Shirakawa M, Nitta T. Long-term impact of critical silent cerebrovascular disease in patients undergoing coronary artery bypass surgery: a propensity score and multivariate analyses. Perfusion 2018; 34:147-153. [PMID: 30444180 DOI: 10.1177/0267659118813042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cerebrovascular disease (CVD) with brain hypoperfusion is a strong risk factor for stroke. However, how this pathology influences long-term outcomes after coronary artery bypass graft (CABG) surgery is not known. METHODS Magnetic resonance imaging/angiography (MRI/A) of the neck and brain was performed in 318 out of 575 consecutive CABG patients between May 2005 and April 2018. Critical CVD with chronic hypoperfusion was defined as multiple severe stenoses (⩾70%) and/or occlusion in the carotid and/or vertebral systems associated with reduced collateral flow due to severe contralateral and/or circle of Willis lesion. Fifty patients were identified to have this pathology (early results were previously reported). The entire cohort was followed up for 83.6 ± 53.7 months. Carotid endarterectomy was considered for symptomatic patients. Propensity matching was performed to compare long-term outcomes between patients with and without critical CVD. RESULTS Patients with critical CVD at follow-up displayed significantly higher incidences of stroke than those without critical CVD (p=0.007), with an extremely high final incidence (approximately 40% at 8 years). However, survival (p=0.623) and incidences of major adverse cardiac events (MACE: myocardial infarction, coronary revascularization and all causes of death) (p=0.881) were similar. The Cox hazard model revealed that critical CVD was the strongest risk factor for stroke (p=0.000; hazard ratio 6.572; 95% confidence interval 2.657-16.258) while not affecting survival and MACE. CONCLUSION Critical CVD was the strongest risk factor for long-term stroke after CABG. However, survival and MACE-free rates were equivalent in patients with critical CVD and those without critical CVD.
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Affiliation(s)
- Hajime Imura
- 1 Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Yuji Maruyama
- 1 Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Ryosuke Amitani
- 1 Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Motohiro Maeda
- 1 Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Makoto Shirakawa
- 1 Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
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Fink N, Nikolsky E, Assali A, Shapira O, Kassif Y, Barac YD, Finkelstein A, Eitan A, Danenberg H, Zahger D, Sahar G, Atar S, Raanani E, Bolotin G, Goldenberg I, Segev A. Revascularization Strategies and Survival in Patients With Multivessel Coronary Artery Disease. Ann Thorac Surg 2018; 107:106-111. [PMID: 30267693 DOI: 10.1016/j.athoracsur.2018.07.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/23/2018] [Accepted: 07/23/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND We sought to assess real-world implementation of the guidelines in patients with multivessel coronary artery disease (CAD) using a prospective national registry in Israel. METHODS All consecutive patients with left main or 2- to 3-vessel CAD involving the proximal or mid left anterior descending artery were enrolled in a dedicated multicenter registry. Patients were managed at the discretion of the treating team at each hospital and were followed for 30 months. RESULTS This registry included 1,064 patients, 55% treated with percutaneous coronary intervention (PCI) and 45% with coronary artery bypass surgery (CABG). Multivariate logistic regression analysis showed that chronic renal failure (odds ratio [OR], 2.43; p = 0.001) and prior myocardial infarction (OR, 1.7; p = 0.024) were associated with referral to PCI versus CABG, whereas male gender (OR, 2.27; p < 0.001), prior aspirin treatment (OR, 1.72; p = 0.005), diabetes mellitus (OR, 1.51; p = 0.007), 3-vessel CAD (OR, 3.45; p < 0.001) and SYNTAX score (SS) greater than 32 (OR, 10.0; p < 0.001) were associated with referral to CABG versus PCI. Each point increment in the SS was independently associated with a 9% greater likelihood of referral to CABG (p < 0.001). Survival analysis showed that mortality risk was lower among PCI patients less than 8 months after the procedure, and CABG was associated with a significant survival benefit thereafter. CONCLUSIONS We found good agreement with current guidelines regarding revascularization strategies in real-world patients with multivessel CAD. The SS was the main independent predictor associated with the choice of revascularization strategy. The time-dependent association between revascularization strategy and long-term survival should be incorporated in the risk assessment of this population.
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Affiliation(s)
- Noam Fink
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | | | - Abid Assali
- Division of Cardiology, Rabin Medical Center, Petach-Tikva, Israel
| | - Oz Shapira
- Department of Cardiac Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Yigal Kassif
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaron D Barac
- Department of Cardiac Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | | | - Amnon Eitan
- Division of Cardiology, Rambam Healthcare Center, Haifa, Israel
| | - Haim Danenberg
- Division of Cardiology, Hadassah Medical Center, Jerusalem, Israel
| | - Doron Zahger
- Division of Cardiology, Soroka Medical Center, Beer-Sheva, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gideon Sahar
- Department of Cardiac Surgery, Soroka Medical Center, Beer-Sheva, Israel
| | - Shaul Atar
- Division of Cardiology, Galilee Medical Center, Naharyiah, Faculty of Medicine in the Galilee, Bar Ilan University, Ramat Gan, Israel
| | - Ehud Raanani
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Gil Bolotin
- Department of Cardiovascular Surgery, Rambam Healthcare Center, Haifa, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Yamazaki S, Kato T, Ushimaru S, Yokoi H, Mani H. Exercise-induced Atrioventricular Block with Coronary Artery Stenosis that Appeared Five Years after Bypass Surgery. Intern Med 2018; 57:363-366. [PMID: 29093419 PMCID: PMC5827317 DOI: 10.2169/internalmedicine.9398-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 68-year-old man with a history of coronary artery bypass surgery was referred to our hospital because of pre-syncope on effort. During a treadmill exercise electrocardiogram test, the patient developed advanced atrioventricular block associated with dizziness. Coronary angiography revealed significant stenosis of the right coronary artery, which had not existed at the time of the bypass surgery. We implanted drug-eluting stents in the stenotic lesion, and an exercise test showed resolution of the atrioventricular block. Exercise-induced atrioventricular block is rare, and it is necessary to distinguish it from ischemic heart disease, especially in patients with a history of coronary artery disease.
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Affiliation(s)
| | - Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital, Japan
| | | | - Hirokazu Yokoi
- Department of Cardiology, Rakuwakai Otowa Hospital, Japan
| | - Hiroki Mani
- Department of Arrhythmia, Rakuwakai Otowa Hospital, Japan
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21
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Jahangiry L, Najafi M, Farhangi MA, Jafarabadi MA. Coronary Artery Bypass Graft Surgery Outcomes Following 6.5 Years: A Nested Case-control Study. Int J Prev Med 2017; 8:23. [PMID: 28479965 PMCID: PMC5404634 DOI: 10.4103/ijpvm.ijpvm_250_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 02/05/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Coronary artery disease (CAD) is the leading causes of mortality and morbidity in worldwide. This nested case–control study investigated the predictors of death in long-term follow-up after coronary artery bypass graft surgery (CABG). Methods: Cases were defined as CABG patients who died in the period of May 2006–March 2013. Controls were CABG patients who were alive in the same period. Cases and controls were derived from an existing cohort, Tehran Heart Center-Coronary Outcome Measurement. One hundred and fifty-nine patients in control group were randomly selected from 566 available patients in follow-up database. A series of simple and multiple logistic regressions was performed in the context of univariate and multivariate analyses, respectively, for computing unadjusted and adjusted odds ratios and their confidence intervals (CI). In the univariate analyses, demographic or cardiometabolic factors were entered separately, and for multivariate analysis, we got both significant risk factors from univariate analysis and the major risk factors. Results: The results of multivariate analyses showed that for age, the likelihood of mortality increases in CABG patients (95%CI: 1.1; 1.03–1.2; P < 0.005). Other significant independent risk factors were peripheral vascular disease (PVD) (95%CI: 2.7; 1.06–6.8; P = 0.036), diabetics (95%CI: 2.49; 0.9–6.3; P = 0.039), smoking (95%CI: 4.38; 1.45–13.7; P = 0.011), length of stay in hospital after CABG surgery (95%CI: 1.14; 1.0–1.24; P = 0.001), total cholesterol (95%CI: 1.12; 1–1.2; P = 0.001), and C-reactive protein (CRP) (95%CI: 1.12; 0.99–1.27; P = 0.049) (all P < 0.05). Conclusions: The study results indicated that age, diabetes, cigarette smoking, PVD, long length of stay in hospital, elevated triglycerides, total cholesterol, CRP, and high-density lipoprotein cholesterol were significant contributing to increased mortality after CABG. It seems that vulnerable older patients continue to be at high risk with poor outcomes.
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Affiliation(s)
- Leila Jahangiry
- Health Education and Health Promotion Department, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Najafi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Abbasalizad Farhangi
- Department of Community Nutrition, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Epidemiology and Biostatistics Department, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Tabata N, Sueta D, Yamashita T, Utsunomiya D, Arima Y, Yamamoto E, Tsujita K, Kojima S, Kaikita K, Hokimoto S. Relationship between asymptomatic intra-cranial lesions and brachial-ankle pulse wave velocity in coronary artery disease patients without stroke. Hypertens Res 2016; 40:392-398. [PMID: 27881850 DOI: 10.1038/hr.2016.159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 09/29/2016] [Accepted: 10/12/2016] [Indexed: 12/17/2022]
Abstract
Little is known about the significance of asymptomatic intra-cranial lesions (ICL) identified by brain MRI in coronary artery disease (CAD) patients. Silent cerebral lesions are suggested to be associated with arterial stiffness in healthy subjects. We investigated whether subclinical ICL are associated with arterial stiffness and the prognosis in CAD patients without medical history of cerebrovascular diseases. We recruited CAD patients who required percutaneous coronary intervention (PCI), did not meet exclusion criteria, and agreed with MRI before PCI. Subjects were divided into two groups according to the presence of ICL of cerebral microbleeds or lacunar infarction. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). Clinical outcome was defined as a composite of cardiovascular death, non-fatal myocardial infarction, stroke, unstable angina and heart failure. In total, 149 patients underwent brain MRI. Patients with ICL (n=55) had significantly higher baPWV than those without ICL (1591-2204 vs. 1450-1956 cm per sec; P=0.009). A multivariate analysis showed that male sex (odds ratio (OR), 3.15; 95% confidence interval (CI), 1.38-7.20; P=0.006) and baPWV (OR, 1.001; 95% CI, 1.000-1.002; P=0.023) were predictors of ICL. In total, 12 patients experienced a cardiovascular event. The Kaplan-Meier analysis indicated a significantly higher incidence of cardiovascular events in patients with ICL (log-rank test: P=0.018). Multivariate Cox proportional hazards analyses indicated that ICL finding was a significant predictor of clinical outcome (hazard ratio, 3.41; 95% CI, 1.02-11.5; P=0.047). Patients with subclinical ICL had a higher baPWV and worse prognoses than those without ICL.
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Affiliation(s)
- Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takayoshi Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sunao Kojima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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23
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Shiomi H, Yamaji K, Morimoto T, Shizuta S, Nakatsuma K, Higami H, Furukawa Y, Nakagawa Y, Kadota K, Ando K, Sakata R, Okabayashi H, Hanyu M, Shimamoto M, Nishiwaki N, Komiya T, Kimura T. Very Long-Term (10 to 14 Year) Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease in the Bare-Metal Stent Era. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.115.003365. [PMID: 27512087 DOI: 10.1161/circinterventions.115.003365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many of the previous randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease reported equivalent or better survival with CABG as compared with PCI at 5-year follow-up. However, 5-year follow-up might be too short to evaluate the true differences in long-term clinical outcomes between PCI and CABG. METHODS AND RESULTS Among 8934 patients enrolled in the extended 10- to 14-year follow-up study of the CREDO-Kyoto registry cohort-1 (Coronary Revascularization Demonstrating Outcome study in Kyoto) conducted in the bare-metal stent era, 5152 (PCI: n=3490 and CABG: n=1662) patients had multivessel coronary artery disease without left main disease. Median follow-up duration was 11.2 (interquartile range: 10.2-12.2) years. The cumulative 10-year incidence of all-cause death was not significantly different between PCI and CABG (32.2% versus 31.7%; log-rank P=0.93). After adjusting for confounders, however, the mortality risk of PCI was significantly higher than that of CABG (hazard ratio, 1.19 [95% confidence interval, 1.02-1.39]; P=0.03). Within 5 years after the index procedure, the risk for all-cause death was significantly higher after PCI than after CABG (hazard ratio, 1.41; 95% CI, 1.12-1.79; P=0.004). By a landmark analysis at 5 years, however, the cumulative 10-year incidence of and adjusted risk for all-cause death beyond 5 years were not significantly different between PCI and CABG (19.3% versus 20.0%; log-rank P=0.22 and hazard ratio, 1.02, 95% confidence interval, 0.83-1.26; P=0.82). CONCLUSIONS CABG as compared with PCI was associated with better 10-year survival in patients with multivessel coronary artery disease. However, the benefit of CABG compared with PCI on late mortality beyond 5 years was not observed in this study.
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Affiliation(s)
- Hiroki Shiomi
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Kyohei Yamaji
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Takeshi Morimoto
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Satoshi Shizuta
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Kenji Nakatsuma
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Hirooki Higami
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Yutaka Furukawa
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Yoshihisa Nakagawa
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Kazushige Kadota
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Kenji Ando
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Ryuzo Sakata
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Hitoshi Okabayashi
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Michiya Hanyu
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Mitsuomi Shimamoto
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Noboru Nishiwaki
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Tatsuhiko Komiya
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.)
| | - Takeshi Kimura
- From the Department of Cardiovascular Medicine (H.S., S.S., K.N., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Japan; Division of Cardiology (K.Y., K.A.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Japan (T.M.); Division of Cardiology, Otsu Redcross Hospital, Japan (H.H.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Department of Cardiovascular Surgery, Iwate Medical University, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Japan (M.S.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Japan (N.N.).
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24
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Yamaji K, Shiomi H, Morimoto T, Nakatsuma K, Toyota T, Ono K, Furukawa Y, Nakagawa Y, Kadota K, Ando K, Shirai S, Onodera T, Watanabe H, Natsuaki M, Sakata R, Hanyu M, Nishiwaki N, Komiya T, Kimura T. Effects of Age and Sex on Clinical Outcomes After Percutaneous Coronary Intervention Relative to Coronary Artery Bypass Grafting in Patients With Triple-Vessel Coronary Artery Disease. Circulation 2016; 133:1878-91. [PMID: 27009629 DOI: 10.1161/circulationaha.115.020955] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Age and sex are important considerations in the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in daily clinical practice. METHODS AND RESULTS Of 25 816 patients enrolled in the multicenter Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto; Cohort-1, n=9877; Cohort-2, n=15 939), the present study population consisted of 5651 patients (men, n=3998; women, n=1653) with triple-vessel coronary artery disease who were considered to be pertinent in comparisons of PCI with CABG (PCI, n=3165; CABG, n=2486). Patients were divided into 3 groups according to the tertiles of age: ≤65 years (n=1972), 66 to 73 years (n=1820), and ≥74 years (n=1859). The excess adjusted mortality risk of PCI relative to CABG was significant in patients ≥74 years of age (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.10-1.79; P=0.006), whereas the risks were neutral in patients ≤65 years of age (HR, 1.05; 95% CI, 0.73-1.53; P=0.78) and in patients 66 to 73 years of age (HR, 1.03; 95% CI, 0.78-1.36; P=0.85; interaction P=0.003). The excess mortality risk of PCI relative to CABG was significant in men (HR, 1.24; 95% CI, 1.03-1.50; P=0.02) and trended to be significant in women (HR, 1.34; 95% CI, 0.98-1.84; P=0.07) without significant interaction between sex and the mortality risk of PCI relative to CABG (interaction P=0.40). CONCLUSIONS There was a significant association between age and the mortality risk of PCI relative to CABG with excess risk in patients ≥74 years of age and neutral risk in younger patients. There was no significant sex-related difference in the mortality risk of PCI relative to CABG.
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Affiliation(s)
- Kyohei Yamaji
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Hiroki Shiomi
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Takeshi Morimoto
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Kenji Nakatsuma
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Toshiaki Toyota
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Koh Ono
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Yutaka Furukawa
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Yoshihisa Nakagawa
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Kazushige Kadota
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Kenji Ando
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Shinichi Shirai
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Tomoya Onodera
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Hirotoshi Watanabe
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Masahiro Natsuaki
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Ryuzo Sakata
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Michiya Hanyu
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Noboru Nishiwaki
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Tatsuhiko Komiya
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.)
| | - Takeshi Kimura
- From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.).
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Stella SF, Gehling Bertoldi E, Polanczyk CA. Contemporary Context of Drug-Eluting Stents in Brazil: A Cost Utility Study. Med Decis Making 2016; 36:1034-42. [PMID: 26964876 DOI: 10.1177/0272989x16636054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/18/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although drug-eluting stents (DES) have been widely incorporated into clinical practice in developed countries, several countries restrict their use mainly because of their high cost and unfavorable incremental cost-effectiveness ratios (ICER). OBJECTIVE To evaluate the cost-effectiveness of DES in comparison with bare-metal stents (BMS) for treatment of coronary artery disease (CAD). DESIGN Markov model. DATA SOURCES Published literature, government database, and CAD patient cohort. TARGET POPULATION Single-vessel CAD patients. TIME HORIZON One year and lifetime. PERSPECTIVE Brazilian Public Health System (SUS). INTERVENTION Six strategies composed of percutaneous intervention with a BMS or 1 of 5 DES (paclitaxel, sirolimus, everolimus, zotarolimus, and zotarolimus resolute). OUTCOME MEASURES Cost for target vessel revascularization avoided and cost for quality-adjusted life year gained. BASE CASE ANALYSIS In the short-term analysis, sirolimus was the most effective and least costly among DES (ICER of I$20,642 per target vessel revascularization avoided), with all others DES dominated by sirolimus. Lifetime cumulative costs ranged from I$18,765 to I$21,400. In the base case analysis, zotarolimus resolute had the most favorable ICER among the DES (ICER I$62,761), with sirolimus, paclitaxel, and zotarolimus being absolute dominated and everolimus extended dominated by zotarolimus resolute, although all the results were above the willingness-to-pay threshold of 3 times the gross domestic product per capita (I$35,307). SENSITIVITY ANALYSIS In deterministic sensitivity analysis, results were sensitive to cost of DES, number of stents used per patient, baseline probability, and duration of stent thrombosis risk. The probabilistic sensitivity analysis demonstrated a probability of 81% for BMS being the strategy of choice, with 9% for everolimus and 9% zotarolimus resolute, at the willingness-to-pay threshold. CONCLUSION DES is not a good value for money in SUS perspective, despite its benefit in reducing target vessel revascularization. Since the cost-effectiveness of DES is mainly driven by the stents' cost difference, they should cost less than twice the BMS price to become a cost-effective alternative.
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Affiliation(s)
- Steffan Frosi Stella
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (SFS, EGB, CAP),National Institute of Science and Technology for Health Technology Assessment (IATS), CNPq, Brazil (SFS, EGB, CAP)
| | - Eduardo Gehling Bertoldi
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (SFS, EGB, CAP),National Institute of Science and Technology for Health Technology Assessment (IATS), CNPq, Brazil (SFS, EGB, CAP),Department of Internal Medicine, School of Medicine, Universidade Federal de Pelotas, Pelotas, Brazil (EGB)
| | - Carísi Anne Polanczyk
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (SFS, EGB, CAP),National Institute of Science and Technology for Health Technology Assessment (IATS), CNPq, Brazil (SFS, EGB, CAP),Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (CAP),Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (CAP)
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Kai H, Kimura T, Fukuda K, Fukumoto Y, Kakuma T, Furukawa Y. Impact of Low Diastolic Blood Pressure on Risk of Cardiovascular Death in Elderly Patients With Coronary Artery Disease After Revascularization – The CREDO-Kyoto Registry Cohort-1 –. Circ J 2016; 80:1232-41. [DOI: 10.1253/circj.cj-15-1151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hisashi Kai
- Department of Cardiology, Kurume University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kenji Fukuda
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine
- Department of Cerebrovascular Medicine, St. Mary’s Hospital
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine
| | | | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital
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Influence of Sex on Long-Term Outcomes After Implantation of Bare-Metal Stent. Circulation 2015; 132:2323-33. [DOI: 10.1161/circulationaha.115.017168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/02/2015] [Indexed: 11/16/2022]
Abstract
Background—
Female sex was reported to be associated with lower risk for midterm restenosis and repeat revascularization after bare-metal stent implantation. However, the influence of sex on very long-term outcomes after bare-metal stent implantation has not been yet reported.
Methods and Results—
Among the 9877 patients in the multicenter Coronary Revascularization Demonstrating Outcome study in Kyoto (CREDO-Kyoto) registry cohort-1, bare-metal stent implantation was performed in 5313 patients (men, n=3742 and women, n=1571). Follow-up was completed in 4515 patients (85.0%) at 10 years (duration, 10.3±3.1 [0.0–14.1] years). The cumulative incidence of target-lesion revascularization (TLR) was 27% at 1 year and 34% at 10 years (0.8%/y beyond 1 year). Non–target-lesion revascularization (non-TLR) was the dominant coronary revascularization beyond 1 year (13% at 1 year and 31% at 10 years [2.0%/y beyond 1 year]). Cumulative incidence of stent thrombosis was low (1.2% at 1 year and 1.9% at 10 years). Women were older and had greater prevalence of cardiovascular risk factors than men. The cumulative 10-year incidences of and adjusted risk for TLR were significantly higher in men than in women (36% versus 30%,
P
<0.001; adjusted hazard ratio, 1.29; 95% confidence interval, 1.15–1.46;
P
<0.001). The higher risk of men relative to women for TLR was consistent regardless of age (<75 years and ≥75 years). Men in comparison with women were also associated with significantly higher adjusted risks for all-cause death, myocardial infarction, stroke, coronary artery bypass grafting, TLR, and non-TLR.
Conclusions—
TLR and stent thrombosis continued to occur without attenuation up to 10 years after bare-metal stent implantation. Men in comparison with women were associated with higher adjusted 10-year risks for all-cause death, myocardial infarction, stroke, coronary artery bypass grafting, TLR, and non-TLR.
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Sudo M, Hiro T, Takayama T, Iida K, Nishida T, Fukamachi D, Kawano T, Higuchi Y, Hirayama A. Tissue characteristics of non-culprit plaque in patients with acute coronary syndrome vs. stable angina: a color-coded intravascular ultrasound study. Cardiovasc Interv Ther 2015; 31:42-50. [DOI: 10.1007/s12928-015-0345-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/04/2015] [Indexed: 10/23/2022]
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.09.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 64:e139-e228. [PMID: 25260718 DOI: 10.1016/j.jacc.2014.09.017] [Citation(s) in RCA: 2059] [Impact Index Per Article: 205.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:e344-426. [PMID: 25249585 DOI: 10.1161/cir.0000000000000134] [Citation(s) in RCA: 628] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2354-94. [PMID: 25249586 DOI: 10.1161/cir.0000000000000133] [Citation(s) in RCA: 736] [Impact Index Per Article: 73.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Uemura S. Comprehensive treatment of diabetic patients with second-generation drug-eluting stent implantation. Circ J 2014; 78:2149-50. [PMID: 25088143 DOI: 10.1253/circj.cj-14-0772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shiro Uemura
- First Department of Internal Medicine, Nara Medical University
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Relation of contrast-induced nephropathy to long-term mortality after percutaneous coronary intervention. Am J Cardiol 2014; 114:362-8. [PMID: 24927973 DOI: 10.1016/j.amjcard.2014.05.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/06/2014] [Accepted: 05/06/2014] [Indexed: 12/13/2022]
Abstract
There is little information on the effect of contrast-induced nephropathy (CIN) on long-term mortality after percutaneous coronary intervention in patients with or without chronic kidney disease (CKD). Of 4,371 patients who had paired serum creatinine (SCr) measurements before and after percutaneous coronary intervention and were discharged alive in the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry, the incidence of CIN (an increase in SCr of ≥0.5 mg/dl from the baseline) was 5% in our study cohort. The rate of CIN in patients with CKD was 11%, although it was 2% without CKD (p <0.0001). During a median follow-up of 42.3 months after discharge, 374 patients (8.6%) died. After adjustment for prespecified confounders, CIN was significantly correlated with long-term mortality in the entire cohort (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.62 to 2.29, p <0.0001) and in patients with CKD (HR 2.62, 95% CI 1.91 to 3.57, p <0.0001) but not in patients without CKD (HR 1.23, 95% CI 0.47 to 2.62, p = 0.6). Sensitivity analyses confirmed these results using the criteria defined as elevations of the SCr by ≥25% and 0.3 mg/dl from the baseline, respectively. In conclusion, CIN was significantly correlated with long-term mortality in patients with CKD but not in those without CKD.
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Natsuaki C, Inoguchi T, Maeda Y, Yamada T, Sasaki S, Sonoda N, Shimabukuro M, Nawata H, Takayanagi R. Association of borderline ankle-brachial index with mortality and the incidence of peripheral artery disease in diabetic patients. Atherosclerosis 2014; 234:360-5. [DOI: 10.1016/j.atherosclerosis.2014.03.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 11/17/2022]
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Shiomi H, Morimoto T, Makiyama T, Ono K, Furukawa Y, Nakagawa Y, Kadota K, Onodera T, Takatsu Y, Mitsudo K, Kita T, Sakata R, Okabayashi H, Hanyu M, Komiya T, Yamazaki F, Nishiwaki N, Kimura T. Evolution in practice patterns and long-term outcomes of coronary revascularization from bare-metal stent era to drug-eluting stent era in Japan. Am J Cardiol 2014; 113:1652-9. [PMID: 24792736 DOI: 10.1016/j.amjcard.2014.02.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/24/2014] [Accepted: 02/24/2014] [Indexed: 11/18/2022]
Abstract
Treatment of coronary artery disease has significantly changed over the past decade including an introduction of drug-eluting stents and a more stringent adherence to evidence-based medications. However, the impact of these advanced treatment methods on the practice patterns and long-term outcomes in patients undergoing coronary revascularization in the real world has not been yet fully evaluated. The present study population consisted of the 2 groups of patients who underwent their first coronary revascularization in the Coronary REvascularization Demonstrating Outcome Study in Kyoto Registry Cohort-1 (bare-metal stent era: January 2000 to December 2002, n = 8,986) and Cohort-2 (drug-eluting stent era: January 2005 to December 2007, n = 10,339). Compared with Cohort-1, the proportion of patients treated with percutaneous coronary intervention significantly increased in Cohort-2 (73% vs 81%, p <0.001), particularly for 3-vessel disease (50% vs 61%, p <0.001) and left main disease (18% vs 36%, p <0.001). Evidence-based medications were more frequently used in Cohort-2. The cumulative 2-year incidence of and the adjusted risk for all-cause death were not significantly different between Cohort-1 and Cohort-2 (6.2% vs 6.4%, p = 0.69, and hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.81 to 1.03, p = 0.15). Adjusted risks for both myocardial infarction and repeated coronary revascularization were significantly reduced in Cohort-2 compared with Cohort-1 (HR 0.80, 95% CI 0.67 to 0.96, p = 0.02, and HR 0.73, 95% CI 0.69 to 0.77, p <0.001, respectively). In conclusion, despite changes in treatment methods over time, the long-term mortality of patients undergoing coronary revascularization in the real-world clinical practice has not been changed, although there was a significant reduction of myocardial infarction and repeated coronary revascularization.
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Affiliation(s)
- Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tomoya Onodera
- Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiki Takatsu
- Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan
| | - Kazuaki Mitsudo
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toru Kita
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hitoshi Okabayashi
- Department of Cardiovascular Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Michiya Hanyu
- Division of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tatsuhiko Komiya
- Division of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Fumio Yamazaki
- Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Noboru Nishiwaki
- Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Marui A, Kimura T, Nishiwaki N, Komiya T, Hanyu M, Shiomi H, Tanaka S, Sakata R. Three-year outcomes after percutaneous coronary intervention and coronary artery bypass grafting in patients with heart failure: from the CREDO-Kyoto percutaneous coronary intervention/coronary artery bypass graft registry cohort-2†. Eur J Cardiothorac Surg 2014; 47:316-21; discussion 321. [PMID: 24662243 DOI: 10.1093/ejcts/ezu131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Ischaemic heart disease is a major risk factor for heart failure. However, long-term benefit of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in those patients has not been well elucidated. METHODS Of the 15 939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2, we identified 1064 patients with multivessel and/or left main disease with a history of heart failure (ACC/AHA Stage C or D). RESULTS There were 672 patients undergoing PCI and 392 CABG. Preprocedural left ventricular ejection fraction was not different between PCI and CABG (46.6 ± 15.1 vs 46.6 ± 14.6%, P = 0.89), but the CABG group included more patients with triple-vessel and left main disease (P < 0.01 each). Three-year outcomes revealed that the risk of hospital readmission for heart failure was higher after PCI than after CABG (hazard ratio [95% confidence interval]; 1.90 [1.18-3.05], P = 0.01). More importantly, adjusted mortality after PCI was significantly higher than after CABG (1.79 [1.13-2.82], P = 0.01). The risk of cardiac death after PCI was also higher than after CABG (1.98 [1.10-3.55], P = 0.02). Stratified analysis using the SYNTAX score demonstrated that risk of death was not different between PCI and CABG in patients with low (<23) and intermediate (23-32) SYNTAX scores (2.10 [0.57-7.68], P = 0.26 and 1.43 [0.63-3.21], P = 0.39, respectively), whereas those with a high (≥ 33) SYNTAX score, the risk of death was far higher after PCI than after CABG (4.83 [1.46-16.0], P = 0.01). CONCLUSIONS In patients with heart failure with advanced coronary artery disease, CABG was a better option than PCI because CABG was associated with better survival benefit, particularly in more complex coronary lesions stratified by the SYNTAX score.
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Affiliation(s)
- Akira Marui
- 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
| | - Noboru Nishiwaki
- Department of Cardiovascular Surgery, Nara Hospital Kinki University Faculty of Medicine, Ikoma, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Arakawa M, Yamaguchi A, Sakakura K, Okamura H, Ako J, Momomura SI, Adachi H. SYNTAX-justified trend toward restricting coronary artery bypass grafting to more serious cases. Gen Thorac Cardiovasc Surg 2013; 62:364-9. [PMID: 24338621 DOI: 10.1007/s11748-013-0360-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Since drug-eluting stents (DESs) appeared in Japan, coronary artery bypass grafting (CABG) has been indicated for more severe lesions. To understand the implications of this trend, we compared SYNTAX scores in two groups of patients treated with CABG before and after DESs approval. METHODS Consecutive CABG patients during January 2001-July 2003 (pre-DES era patients, n = 160) and January 2008-July 2010 (DES era patients, n = 103) were included. The SYNTAX scores of both groups were compared and a cardiologist retrospectively re-evaluated coronary angiograms to determine whether CABG or percutaneous coronary intervention (PCI) would be recommended under current standards. RESULTS SYNTAX scores were significantly higher in DES era group compared with pre-DES era group (33.3 ± 10.6 vs. 28.1 ± 10.6, p < 0.01). Percutaneous coronary intervention would be the preferred treatment option in 66 (41 %) of pre-DES patients, whose SYNTAX scores were significantly lower than those of patients who were considered good candidates for CABG (21.9 ± 9.3 vs. 32.5 ± 9.1, p < 0.01). CONCLUSIONS Although CABG is now being performed in intermediate-to-highly complex cases, DES era outcomes, including operative mortality and early graft failure, have not worsened in comparison to the pre-DES era.
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Affiliation(s)
- Mamoru Arakawa
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan,
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Kawashiri MA, Sakata K, Uchiyama K, Konno T, Namura M, Mizuno S, Tatami R, Kanaya H, Nitta Y, Michishita I, Hirase H, Ueda K, Aoyama T, Okeie K, Haraki T, Mori K, Araki T, Minamoto M, Oiwake H, Ino H, Hayashi K, Yamagishi M. Impact of lesion morphology and associated procedures for left main coronary stenting on angiographic outcome after intervention: sub-analysis of Heart Research Group of Kanazawa, HERZ, Study. Cardiovasc Interv Ther 2013; 29:117-22. [DOI: 10.1007/s12928-013-0222-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 10/17/2013] [Indexed: 10/26/2022]
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Nanasato M, Nakajima K, Fujita H, Zen K, Kohsaka S, Hashimoto A, Moroi M, Fukuzawa S, Chikamori T, Nishimura S, Yamashina A, Kusuoka H, Hirayama A, Nishimura T. Rationale and design of J-ACCESS 4: prognostic impact of reducing myocardial ischemia identified using ECG-gated myocardial perfusion SPECT in Japanese patients with coronary artery disease. J Cardiol 2013; 63:159-64. [PMID: 24012330 DOI: 10.1016/j.jjcc.2013.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/25/2013] [Accepted: 07/23/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The findings of our recent study entitled, "Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS)" showed that myocardial perfusion single photon emission computed tomography (MPS) can detect coronary artery disease (CAD) and help to predict future cardiac events in patients with suspected or extant CAD. However, the extent of the benefit conferred by percutaneous coronary intervention (PCI) as an initial management strategy compared with optimal medical therapy remains controversial. Little evidence supports the notion that myocardial ischemia identified using MPS is an alternative target of coronary revascularization to reduce the likelihood of developing cardiac events. METHODS The multicenter, prospective cohort J-ACCESS 4 study aims to clarify the prognostic impact of reducing myocardial ischemia determined using electrocardiogram-gated MPS in Japanese patients with coronary artery disease. We started to register patients in J-ACCESS 4 at 74 facilities during June 2012 and will continue to do so until December 2013 or until the cohort comprises 500 patients who will participate in the study from one month before, until two months after stress/rest MPS assessment. Imaging data, the background of the patients including coronary risk factors and treatment before MPS assessments will be analyzed. The patients will undergo coronary revascularization within two months after MPS and/or receive appropriate medical therapy. The second stress/rest MPS will be performed from 4 to 10 months after coronary revascularization or registration. They will be followed up for over one year after the second MPS assessment. The primary endpoints will be cardiac death, sudden death of unknown cause, non-fatal myocardial infarction, and hospitalization for heart failure. The secondary endpoints will comprise death due to all causes including non-cardiac death and any cardiovascular events. This study will be completed in 2015. Here, we describe the design of the J-ACCESS 4 study.
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Affiliation(s)
- Mamoru Nanasato
- Cardiovascular Center, Nagoya Daini Red Cross Hospital, Aichi, Japan
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Ishikawa, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Kan Zen
- Division of Cardiology, Department of Medicine, Ohmihachiman Community Medical Center, Shiga, Japan
| | - Shun Kohsaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Akiyoshi Hashimoto
- Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shigeru Fukuzawa
- Division of Cardiology, Funabashi Municipal Medical Center, Chiba, Japan
| | | | | | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | | | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Tazaki J, Shiomi H, Morimoto T, Imai M, Yamaji K, Sakata R, Okabayashi H, Hanyu M, Shimamoto M, Nishiwaki N, Komiya T, Kimura T. Three-year outcome after percutaneous coronary intervention and coronary artery bypass grafting in patients with triple-vessel coronary artery disease: observations from the CREDO-Kyoto PCI/CABG registry cohort-2. EUROINTERVENTION 2013; 9:437-45. [DOI: 10.4244/eijv9i4a72] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Marui A, Okabayashi H, Komiya T, Tanaka S, Furukawa Y, Kita T, Kimura T, Sakata R. Impact of occult renal impairment on early and late outcomes following coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2013; 17:638-43. [PMID: 23793709 DOI: 10.1093/icvts/ivt254] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES High serum creatinine is considered an independent risk factor for poor outcomes following coronary artery bypass grafting (CABG). However, the impact of occult renal impairment (ORI), defined as an impaired glomerular filtration rate (GFR) with a normal serum creatinine (SCr) level, remains unclear. Thus, we sought to investigate the impact of ORI on outcomes after CABG. METHODS Among patients undergoing their first percutaneous coronary intervention (PCI) or CABG enrolled in the CREDO-Kyoto Registry (a registry of first-time PCI and CABG patients in Japan), 1842 patients with normal SCr levels undergoing CABG were enrolled in the study. Patients were divided into two groups based on preoperative estimated GFR calculated by the Cockcroft-Gault equation: 1339 patients with estimated GFR of ≥ 60 ml/min/1.73 m(2) (normal group) and 503 with estimated GFR of <60 ml/min/1.73 m(2) (ORI group). RESULTS Preoperative estimated GFR differed between the groups (51.3 ± 6.6 vs 85.8 ± 23.0 ml/min/1.73 m(2), P < 0.01). ORI was associated with high in-hospital mortality (3.2 vs 1.0%, P < 0.01) and need for dialysis (2.0 vs 0.2%, P < 0.01). In terms of long-term outcomes, ORI was associated with high mortality compared with the normal (hazard ratio [95% confidence interval]: 1.72 [1.16-2.54], P < 0.01) and high incidence of composite cardiovascular events (death, stroke or myocardial infarction: 1.53 [1.16-2.02], P < 0.01). CONCLUSIONS ORI was an independent risk factor for early and late death as well as cardiovascular events in patients undergoing CABG with normal SCr levels. A more accurate evaluation of renal function through a combination of SCr and estimated GFR is needed in patients with normal SCr levels.
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Affiliation(s)
- Akira Marui
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Impact of aging on the clinical outcomes of Japanese patients with coronary artery disease after percutaneous coronary intervention. Heart Vessels 2013; 29:156-64. [PMID: 23552901 PMCID: PMC3948512 DOI: 10.1007/s00380-013-0339-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 03/08/2013] [Indexed: 01/13/2023]
Abstract
Japan has become an aging society, resulting in an increased prevalence of coronary artery disease. However, clinical outcomes of elderly Japanese patients after percutaneous coronary intervention (PCI) remain unclear. Of the 15,227 patients in the Shinken Database, a single-hospital-based cohort of new patients, 1,214 patients who underwent PCI, was evaluated to determine the differences in clinical outcomes between the elderly (≥75 years) (n = 260) and the non-elderly (<75 years) (n = 954) patients. A major adverse cardiac event (MACE) was defined as a composite end point, including all-cause death, myocardial infarction (MI), and target lesion revascularization. Male gender and obesity were less common, and the estimated glomerular filtration rate (eGFR) was significantly lower in the elderly than in the non-elderly. Left ventricular ejection fraction (LVEF) was comparable between these groups. Left main trunk disease and multivessel disease were more common in the elderly than in the non-elderly group. Occurrence of MACE was frequent, and the incidences of all-cause death, cardiac death, and the admission rate for heart failure were significantly higher in the elderly patients. Multivariate analysis showed that prior MI, low eGFR, and poor LVEF were independent predictors for all-cause death in the elderly patients. Elderly patients had worse clinical outcomes than the non-elderly patients. Low eGFR and LVEF were independent predictors of all-cause death after PCI, suggesting that left ventricular dysfunction and renal dysfunction might synergistically contribute to the adverse clinical outcomes of the elderly patients undergoing PCI.
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Endo A, Kohsaka S, Miyata H, Kawamura A, Noma S, Suzuki M, Koyama T, Ishikawa S, Momiyama Y, Nakagawa S, Sueyoshi K, Takagi S, Takahashi T, Sato Y, Ogawa S, Fukuda K. Disparity in the application of guideline-based medical therapy after percutaneous coronary intervention: analysis from the Japanese prospective multicenter registry. Am J Cardiovasc Drugs 2013; 13:103-12. [PMID: 23585142 DOI: 10.1007/s40256-013-0021-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite the known benefits of evidence-based medical care in patients with coronary artery disease, disparities exist in the application of guideline-based medical therapy (GBMT) after percutaneous coronary intervention (PCI), particularly in patients who have undergone revascularization procedures. Underestimation of risk, overestimation of side effects, and preference of the treating physician to prioritize invasive procedures may all affect the prescription pattern. OBJECTIVE We sought to describe how GBMT is prescribed after PCI in Japan. METHODS From September 2008 to 2010, 1,612 patients underwent PCI with stenting at 14 Japanese hospitals participating in the Japanese Cardiovascular Database Registry. GBMT was defined as treatment including dual antiplatelet therapy, beta-adrenoceptor antagonists (beta-blockers) and/or calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and statins. RESULTS Overall, 749 patients (46.5%) were discharged on GBMT. Notably, the prescription rate of GBMT became lower with age (e.g. from 50.3% [age 50-59 years] to 35.9% [age over 80 years]). In addition, patients presenting with acute coronary syndrome (ACS) tended to receive GBMT more frequently (ST-segment elevation myocardial infarction [STEMI] 33.8 vs. 18.3%; p<0.001; non-ST-segment elevation myocardial infarction [NSTEMI] 8.5 vs. 5.9%; p=0.042), whereas patients presenting with cardiogenic shock (CS) had lower prescription rates of GBMT (2.1 vs. 4.1%; p=0.032). Overall age (odds ratio [OR] 0.647; p=0.020), as well as the acute and emergent presentation (OR 3.229; p<0.001 for STEMI; OR 2.122; p<0.001 for NSTEMI; OR 0.35; p=0.002 for CS) were also associated with prescription of GBMT. CONCLUSION Only about half of the post-PCI patients were discharged on ideal GBMT. Elderly patients and those presenting with non-ACS status or hemodynamic compromise tended not to receive GBMT, and required more attention for optimization of their care.
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Clinical evidence versus patients' perception of coronary revascularization. Surg Today 2013; 43:347-52. [PMID: 23283351 DOI: 10.1007/s00595-012-0467-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/13/2012] [Indexed: 10/27/2022]
Abstract
Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have been developed as revascularization techniques for coronary artery disease. CABG offers a survival advantage over medical therapy, especially for high-risk coronary patients, whereas PCI is the most frequent initial procedure to treat multi-vessel coronary artery disease, because it is less invasive. However, PCI has been found to confer no additional benefit with respect to myocardial infarction (MI) or death. The SYNTAX trial compared the outcomes of patients with left main and/or three-vessel coronary artery disease treated with CABG versus PCI using drug-eluting stents. The 4-year results showed that all-cause mortality and cardiac death were both significantly higher in the PCI group than in the CABG group. Despite extensive evidence of the advantages of CABG over PCI with respect to death or MI, PCI is recommended more often and CABG less often than indicated in the guidelines. Patients with coronary artery disease should receive unbiased information about the risks and benefits of each procedure and the alternatives. A multidisciplinary approach, referred to as "the Heart Team", could help to improve the informed consent process when recommending revascularization treatment for coronary artery disease.
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Marui A, Kimura T, Tanaka S, Okabayashi H, Komiya T, Furukawa Y, Kita T, Sakata R. Comparison of frequency of postoperative stroke in off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting versus percutaneous coronary intervention. Am J Cardiol 2012; 110:1773-8. [PMID: 22981264 DOI: 10.1016/j.amjcard.2012.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 08/08/2012] [Accepted: 08/08/2012] [Indexed: 12/24/2022]
Abstract
The stroke rate after coronary artery bypass grafting (CABG) compared to percutaneous coronary intervention (PCI) is generally considered high because cardiopulmonary bypass and aortic manipulations are often associated with cerebrovascular complications. However, an increasing number of CABGs performed without cardiopulmonary bypass (OPCAB) may improve those outcomes. Of 6,323 patients with multivessel and/or left main coronary artery disease, 3,877 patients underwent PCI, 1,381 conventional on-pump CABG, and 1,065 OPCAB. Median follow-up was 3.4 years. Stroke types were classified as early (onset of stroke within 24 hours after revascularization), delayed (within 30 days), and late (after 30 days). Propensity score analysis showed that the incidences of early, delayed, and late stroke did not differ between PCI and OPCAB (0.65, 95% confidence interval 0.08 to 5.45, p = 1.00; 0.36, 0.10 to 1.29, p = 0.23; 0.81, 0.52 to 1.27, p = 0.72, respectively). In contrast, incidence of early stroke after on-pump CABG was higher than after OPCAB (7.22, 1.67 to 31.3, p = 0.01), but incidences of delayed and late stroke were not different (1.66, 0.70 to 3.91, p = 0.50; 1.18, 0.83 to 1.69, p = 0.73). In conclusion, occurrence of stroke was not found to differ in patients after PCI versus OPCAB regardless of onset of stroke. Occurrence of early stroke after OPCAB was lower than that after on-pump CABG, yet occurrences of delayed and late strokes were similar for the 3 revascularization strategies.
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Affiliation(s)
- Akira Marui
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Ochi M. Overview: Japanese guidelines for myocardial revascularization to treat stable ischemic heart disease 2012. Gen Thorac Cardiovasc Surg 2012; 61:246-53. [PMID: 23232903 DOI: 10.1007/s11748-012-0182-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Indexed: 11/25/2022]
Abstract
Since its introduction in the early 1970s, coronary artery bypass grafting (CABG) has become an established surgical treatment for coronary artery disease (CAD). Percutaneous coronary intervention (PCI), first clinically applied in 1977, was promoted as an alternative to CABG during the mid-1980s. Along with the nationwide expansion of PCI, the ratio of PCI to CABG has exceeded 6-7:1. The Japanese Circulation Society (JCS) published "Guidelines on elective coronary intervention, including coronary artery bypass grafting (CABG), for ischemic heart disease in 2000" and "Guidelines on the selection of bypass conduits and operative procedures in coronary artery bypass grafting for ischemic heart disease". The society intended to revise these guidelines in 2010 and to issue two new guidelines specific either to PCI or CABG. They also planned to issue joint guidelines for myocardial revascularization and PCI/CABG, which are primary indications for patients with stable CAD, especially with those with more complex left main trunk disease and/or multi-vessel disease. The scientific committee of JCS established the "Council for myocardial revascularization" that consisted of experts including interventional and non-interventional cardiologists, cardiac surgeons and physicians specialized in diabetes or nephrology selected by medical and surgical societies. After over 10 rounds of meetings, the Council prepared primary guidelines for myocardial revascularization to treat stable CAD, PCI/CABG. These guidelines consist of (1) Statements about myocardial revascularization, (2) Interpretation of the statements and (3) Indications for PCI/CABG including a table.
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Affiliation(s)
- Masami Ochi
- Department of Cardiovascular Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603, Japan.
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The Effect of Age on Outcomes of Coronary Artery Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease. J Am Coll Cardiol 2012; 60:2150-7. [DOI: 10.1016/j.jacc.2012.08.982] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/02/2012] [Accepted: 08/17/2012] [Indexed: 11/19/2022]
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Metabolic profiles predict adverse events after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2012; 143:873-8. [PMID: 22306227 DOI: 10.1016/j.jtcvs.2011.09.070] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/18/2011] [Accepted: 09/15/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Clinical models incompletely predict the outcomes after coronary artery bypass grafting. Novel molecular technologies can identify biomarkers to improve risk stratification. We examined whether metabolic profiles can predict adverse events in patients undergoing coronary artery bypass grafting. METHODS The study population comprised 478 subjects from the CATHGEN biorepository of patients referred for cardiac catheterization who underwent coronary artery bypass grafting after enrollment. Targeted mass spectrometry-based profiling of 69 metabolites was performed in frozen, fasting plasma samples collected before surgery. Principal components analysis and Cox proportional hazards regression modeling were used to assess the relation between the metabolite factor levels and a composite outcome of postcoronary artery bypass grafting myocardial infarction, the need for percutaneous coronary intervention, repeat coronary artery bypass grafting, and death. RESULTS During a mean follow-up period of 4.3 ± 2.4 years, 126 subjects (26.4%) experienced an adverse event. Three principal components analysis-derived factors were significantly associated with an adverse outcome on univariate analysis: short-chain dicarboxylacylcarnitines (factor 2, P = .001); ketone-related metabolites (factor 5, P = .02); and short-chain acylcarnitines (factor 6, P = .004). These 3 factors remained independently predictive of an adverse outcome after multivariate adjustment: factor 2 (adjusted hazard ratio, 1.23; 95% confidence interval, 1.10-1.38; P < .001), factor 5 (odds ratio, 1.17; 95% confidence interval, 1.01-1.37; P = .04), and factor 6 (odds ratio, 1.14; 95% confidence interval, 1.02-1.27; P = .03). CONCLUSIONS Metabolic profiles are independently associated with adverse outcomes after coronary artery bypass grafting. These profiles might represent novel biomarkers of risk that can augment existing tools for risk stratification of coronary artery bypass grafting patients and might elucidate novel biochemical pathways that mediate risk.
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Marui A, Kimura T, Tanaka S, Furukawa Y, Kita T, Sakata R. Significance of off-pump coronary artery bypass grafting compared with percutaneous coronary intervention: a propensity score analysis. Eur J Cardiothorac Surg 2012; 41:94-101. [PMID: 21676626 PMCID: PMC3241114 DOI: 10.1016/j.ejcts.2011.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/23/2011] [Accepted: 04/01/2011] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Although there have been several studies that compared the efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the impact of off-pump CABG (OPCAB) has not been well elucidated. The objective of the present study was to compare the outcomes after PCI, on-pump CABG (ONCAB), and OPCAB in patients with multivessel and/or left main disease. METHODS Among the 9877 patients undergoing first PCI using bare-metal stents or CABG who were enrolled in the CREDO-Kyoto Registry, 6327 patients with multivessel and/or left main disease were enrolled into the present study (67.9±9.8 years old). Among them, 3877 patients received PCI, 1388 ONCAB, and 1069 OPCAB. Median follow-up was 3.5 years. RESULTS Comparing PCI with all CABG (ONCAB and OPCAB), propensity-score-adjusted all-cause mortality after PCI was higher than that CABG (hazard ratio (95% confidence interval): 1.37 (1.15-1.63), p<0.01). The incidence of stroke was lower after PCI than that after CABG (0.75 (0.59-0.96), p=0.02). CABG was associated with better survival outcomes than PCI in the elderly (interaction p=0.04). Comparing OPCAB with PCI or ONCAB, propensity-score-adjusted all-cause mortality after PCI was higher than that after OPCAB (1.50 (1.20-1.86), p<0.01). Adjusted mortality was similar between ONCAB and OPCAB (1.18 (0.93-1.51), p=0.33). The incidence of stroke after OPCAB was similar to that after PCI (0.98 (0.71-1.34), p>0.99), but incidence of stroke after ONCAB was higher than that after OPCAB (1.59 (1.16-2.18), p<0.01). CONCLUSIONS In patients with multivessel and/or left main disease, CABG, particularly OPCAB, is associated with better survival outcomes than PCI using bare-metal stents. Survival outcomes are similar between ONCAB and OPCAB.
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Affiliation(s)
- Akira Marui
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, and Translational Research Center, Kyoto University Hospital, Kyoto, Japan.
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