Kazuteru Fujimoto

National Hospital Organization Kumamoto Medical Center, Kumamoto, Kumamoto, Japan

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Publications (24)65.32 Total impact

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    ABSTRACT: New criteria for diagnosis of acute myocardial infarction (AMI) were proposed in 2000 as a universal definition, in which cardiac troponin (cTn) was the preferred biomarker. A large number of patients formerly classified by creatine kinase (CK) as unstable angina are now ruled-in by cTn as non-ST-elevation myocardial infarction (NSTEMI).Methods and Results:The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry conducted in 28 institutions. We enrolled 3,283 consecutive patients with AMI diagnosed by cTn-based criteria who were admitted to participating institutions within 48 h of symptom onset. There were 2,262 patients (68.9%) with STEMI and 1,021 (31.1%) with NSTEMI. CK was not elevated more than twice the upper limit of normal in 458 patients (44.9%) with NSTEMI (NSTEMI-CK). Although there was no significant difference in the in-hospital mortality of STEMI and NSTEMI with CK elevation (NSTEMI+CK) patients (7.1% vs. 7.8%, P=0.57), it was significantly lower in patients with NSTEMI-CK than in those with STEMI or NSTEMI+CK (1.7%, P<0.001 for each). J-MINUET revealed the clinical presentation, management and outcomes of Japanese patients with AMI in the current cTn era. We should be aware of the difference between AMI diagnosed by CK-based criteria and AMI diagnosed by cTn-based criteria when using universal definitions for the diagnosis of AMI.
    Circulation Journal 04/2015; 79(6). DOI:10.1253/circj.CJ-15-0217
  • Tsuyoshi Honda, Kazuteru Fujimoto, Yuji Miyao
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    ABSTRACT: This study was conducted to clarify the influence of weather conditions on the onset of acute myocardial infarction (AMI) in Kumamoto. We studied 642 consecutive patients (males 433, females 209; 71±13 years) who were admitted with AMI. Days of frequent onset (F-days) were defined as days on which ≥2 patients had been admitted for AMI, whereas days of non-frequent onset (N-days) indicated those with fewer than 2 admissions for AMI. Meteorological factors, including the mean atmospheric pressure and rainfall, the mean, maximum, and minimum temperature, intra-day temperature difference, humidity, wind speed, and the number of sunlight hours, were analyzed. All variables were measured on the day of onset of AMI and on each of the 2 days immediately prior to the day of onset. There were 86 F-days and 1740 N-days. F-days were significantly associated with lower air temperature (mean, maximum, and minimum), higher intra-day temperature difference, lower humidity, and longer daily duration of sunlight compared with N-days. In addition, meteorological factors for frequent onset of AMI affected older subjects to a greater extent than either young or female subjects. Multiple logistic regression analysis showed that minimum temperature two days before onset was associated with the frequent onset of AMI (odds ratio, 0.805; p<0.05). Lower minimum temperature on the 2nd day preceding the onset is an independent risk factor for the frequent onset of AMI. The association between low ambient temperature and frequent onset of AMI was stronger in elderly and female subjects. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
    Journal of Cardiology 04/2015; DOI:10.1016/j.jjcc.2015.02.013
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    ABSTRACT: Background:The aim of this study was to examine the effects of different statins on the clinical outcomes of Japanese patients with coronary stent implants.Methods and Results:This study included 5,801 consecutive patients (males, 4,160; age, 69.7±11.1 years, mean±SD) who underwent stent implantation between April 2008 and March 2011. They were treated with a strong statin (n=3,042, 52%, atorvastatin, pitavastatin, or rosuvastatin), a regular statin (n=1,082, 19%, pravastatin, simvastatin, or fluvastatin) or no statin (n=1,677, 29%). The patients with chronic kidney disease (CKD) were divided into mild-to-moderate CKD (30≤eGFR<60, n=1,956) and severe CKD (eGFR <30, n=559). Primary endpoints included cardiovascular death and nonfatal myocardial infarction, including stent thrombosis and ischemic stroke. The clinical outcome for the primary endpoint in mild-to-moderate CKD patients treated with a strong statin (hazard ratio 0.50, 95% confidence interval 0.31-0.81; P=0.005) was significantly lower than in those on no statins, but that in the patients treated with a regular statin was not (P=0.160). The clinical outcome for the primary endpoint in severe CKD patients treated with a strong or regular statin was no different than not being on statin therapy (P=0.446, P=0.194, respectively).Conclusions:In patients with mild-to-moderate CKD, only strong statins were associated with lower risk compared with no statin, but regular statins were not. It is possible that taking a strong statin from the early stage of CKD is useful for suppression of cardiovascular events.
    Circulation Journal 02/2015; 79(5). DOI:10.1253/circj.CJ-14-0789
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    ABSTRACT: Although the positive association between achieved low-density lipoprotein cholesterol (LDL-C) level and the risk of coronary artery disease (CAD) has been confirmed by randomized studies with statins, many patients remain at high residual risk of events suggesting the necessity of novel pharmacologic strategies. The combination of ezetimibe/statin produces greater reductions in LDL-C compared to statin monotherapy. The Plaque REgression with Cholesterol absorption Inhibitor or Synthesis inhibitor Evaluated by IntraVascular UltraSound (PRECISE-IVUS) trial was aimed at evaluating the effects of ezetimibe addition to atorvastatin, compared with atorvastatin monotherapy, on coronary plaque regression and change in lipid profile in patients with CAD. The study is a prospective, randomized, controlled, multicenter study. The eligible patients undergoing IVUS-guided percutaneous coronary intervention will be randomly assigned to receive either atorvastatin alone or atorvastatin plus ezetimibe (10mg) daily using a web-based randomization software. The dosage of atorvastatin will be increased by titration within the usual dose range with a treatment goal of lowering LDL-C below 70mg/dL based on consecutive measures of LDL-C at follow-up visits. IVUS will be performed at baseline and 9-12 months follow-up time point at participating cardiovascular centers. The primary endpoint will be the nominal change in percent coronary atheroma volume measured by volumetric IVUS analysis. PRECISE-IVUS will assess whether the efficacy of combination of ezetimibe/atorvastatin is noninferior to atorvastatin monotherapy for coronary plaque reduction, and will translate into increased clinical benefit of dual lipid-lowering strategy in a Japanese population. Copyright © 2015. Published by Elsevier Ltd.
    Journal of Cardiology 01/2015; DOI:10.1016/j.jjcc.2014.12.011
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    Tsuyoshi Honda, Kazuteru Fujimoto, Yuji Miyao
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    ABSTRACT: Recent studies have reported the efficacy of sheathless percutaneous coronary intervention (PCI) using hydrophilic-coated 5-Fr guiding catheters that are one to two Fr sizes smaller in diameter than the corresponding introducer sheath (virtual 3-Fr PCI). However, the limited number of shapes of hydrophilic-coated guiding catheters occasionally makes them difficult to engage and control. To evaluate the efficacy and feasibility of virtual 3-Fr PCI using standard guiding catheters of various shapes. We identified 35 consecutive patients with stable angina, who underwent virtual 3-Fr PCI using either hydrophilic-coated guiding catheters (Works™, Medikit, Japan) or standard guiding catheters (Heartrail™, Terumo, Japan). Thirty-five patients were identified (63% men; mean age 70 ±13 years). In 2 cases, hydrophilic-coated guiding catheters were exchanged to standard guiding catheters because of difficulty in engaging the target coronary arteries. Ultimately, standard guiding catheters were used in 20 patients (57%) and hydrophilic-coated catheters were used in 15 (43%). One of 20 patients treated with standard guiding catheters and 1 of 15 treated with hydrophilic-coated guiding catheters underwent the 4-in-3 "slender mother and child" PCI technique due to difficulty of stent deployment. There were no differences between the two groups in PCI procedural variables such as procedural time, fluoroscopy time, radiation dose, or contrast dye volume. There were no access site-related complications in this study. These findings indicate that virtual 3-Fr PCI using standard guiding catheters is as efficient and safe as virtual 3-Fr PCI using hydrophilic-coated guiding catheters.
    Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 12/2014; 10(4):231-237. DOI:10.5114/pwki.2014.46763
  • International Journal of Cardiology 08/2014; 176(3). DOI:10.1016/j.ijcard.2014.08.027
  • 02/2014; 3(1). DOI:10.5083/ejcm.20424884.107
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    ABSTRACT: Background. Acute myocardial infarction (AMI) is accompanied by excessive production of catecholamines, which is characterized by a hypokalemic dip. A polymorphism of the adrenergic receptor has also been reported to be associated with target lesion revascularization (TLR) after coronary intervention. Subjects and Methods. We enrolled 276 consecutive patients with AMI within 24 hours of symptom onset, who underwent emergency coronary intervention using bare metal stents and had examinations over a 5–10-month follow-up period. The patients were divided into tertiles based on their serum potassium level on admission (low K, <3.9; mid K, ≥3.9, <4.3; and high K, ≥4.3). Results. Sixty-four TLRs were observed in the study. Increased potassium concentration was associated significantly with TLR. Patients in the high K group were about two and a half times more likely to have a TLR after AMI compared to those in the low K group. Multiple logistic analysis showed that potassium level on admission was an independent risk factor for TLR (odds ratio 1.69; confidence interval 1.04 to 2.74; P = 0.036). Conclusions. These findings indicated that increased potassium levels on admission might predict TLRs in AMI patients treated with bare metal stents.
    The Scientific World Journal 01/2014; 2014:946803. DOI:10.1155/2014/946803
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    ABSTRACT: Acute myocardial infarction (AMI) is prevalent and has serious consequences including re-infarction and death. Cigarette smoking is a coronary risk factor for AMI, although a "smoker's paradox" for AMI has been reported in Western countries. On the other hand, some researchers have reported that smoking is associated with subacute stent thrombosis (SAST) after AMI. However, the occurrence of this condition is not well documented in Japan. The aim of this study was to clarify how prior smoking status may affect prognosis, including SAST, in Japanese patients with AMI. A total of 266 consecutive patients with AMI were enrolled retrospectively in the study if they had undergone emergency coronary intervention (bare metal stent) within 24h of symptom onset, and had a 5-10 month follow-up examination. The patients were divided into three groups based on their cigarette smoking status (non-smokers, past smokers, and current smokers). Current smokers were significantly younger than the other two groups, although their levels of low density lipoprotein-cholesterol and triglyceride were significantly higher. White blood cell count and hemoglobin level on admission were also significantly higher in current smokers compared with the other two groups. The incidence of SAST was significantly higher in current smokers than in the other groups, although the occurrence of heart failure after AMI was similar in the three groups. On the other hand, improvement in left ventricular ejection fraction was observed in non-smokers and past smokers, but not in current smokers. Multiple logistic analysis revealed that current smoking was an independent risk factor for SAST (odds ratio 5.4; p<0.05). Current smokers were about five times more likely to have a SAST compared with non-smokers. These findings indicate that current cigarette smoking predicts SAST after primary percutaneous coronary intervention for AMI in Japanese patients.
    Journal of Cardiology 11/2013; 63(5). DOI:10.1016/j.jjcc.2013.10.007
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    Tsuyoshi Honda, Kazuteru Fujimoto, Yuji Miyao
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    ABSTRACT: We report two cases of successful percutaneous coronary intervention (PCI) using a 4-in-3 "Slender Mother and Child" PCI technique. In both cases, coronary angiography revealed severe stenosis of the right coronary artery (RCA). In both cases, 5-Fr sheathless guiding catheters were inserted into the RCA (virtual 3-Fr PCI) but stents could not pass through because of stents previously implanted at the proximal site of the target lesions. After 4-Fr straight "child" guiding catheters were inserted into the 5-Fr sheathless "slender mother" guiding catheters, they were deployed successfully at the target lesions. This system might be useful to improve stent delivery in virtual 3-Fr PCI.
    Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 09/2013; 9(3):286-90. DOI:10.5114/pwki.2013.37511
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    ABSTRACT: Spontaneous coronary artery dissection is rare and usually affects younger women in the peripartum period. Here, we report an interesting case of a 34-year-old woman with spontaneous coronary artery dissection that occurred 1 month after childbirth. Emergency coronary angiography showed stenosis of the left anterior descending artery, but immediately afterwards, a new occlusion of the right coronary artery occurred. Intravascular ultrasound was used to image both right and left coronary arteries. The new occlusion of the right coronary artery was probably iatrogenic, but the left coronary artery occlusion was spontaneous. The patient underwent percutaneous coronary intervention in the right coronary artery because of her unstable hemodynamic condition. Revascularization of the left coronary artery was performed by bypass grafting. The patient was discharged on postoperative day 30. As the optimal treatment for spontaneous coronary artery dissection has not yet been established, treatments should be based on the patient's clinical presentation.
    General Thoracic and Cardiovascular Surgery 06/2013; 62(12). DOI:10.1007/s11748-013-0274-9
  • Journal of Cardiology Cases 01/2013; 9(2). DOI:10.1016/j.jccase.2013.10.003
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    ABSTRACT: The aim of this study was to investigate the risk factors for access site-related complications after transradial coronary angiography (CAG) or percutaneous coronary intervention (PCI). Transradial PCI has been shown to reduce access site-related bleeding complications compared with procedures performed through a femoral approach. Although previous studies focused on risk factors for access site-related complications after a transfemoral approach or transfemoral and transradial approaches, it is uncertain which factors affect vascular complications after transradial catheterization. We enrolled 500 consecutive patients who underwent transradial CAG or PCI. We determined the incidence and risk factors for access site-related complications such as radial artery occlusion and bleeding complications. Age, sheath size, the dose of heparin and the frequency of PCI (vs. CAG) were significantly greater in patients with than without bleeding complications. However, body mass index (BMI) was significantly lower in patients with than without bleeding complications. Sheath size was significantly higher and the frequency of statin use was significantly lower in patients with than without radial artery occlusion. Multiple logistic analysis revealed that sheath size [odds ratio (OR) 5.5; P < 0.05] and BMI (OR 0.86; P < 0.01) were risk factors for bleeding complications; and sheath size (OR 5.2; P < 0.05) and the lack of statin pretreatment (OR 0.50; P < 0.05) were risk factors for occlusive complications. In conclusion, these findings indicate that down-sizing of the devices used in transradial procedures might attenuate access site-related complications after transradial CAG or PCI. Statin pretreatment might also be a strategy that could prevent radial artery occlusion after transradial procedures.
    06/2012; 27(3):174-80. DOI:10.1007/s12928-012-0108-1
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    ABSTRACT: Two male patients, one in his thirties and the other in his fifties, were admitted to different hospitals for congestive heart failure (CHF). In both patients, laboratory findings indicated high plasma B-type natriuretic peptide (BNP) levels (266.0 and 902.7pg/mL, respectively) and echocardiography showed large left ventricular diastolic dimensions (LVDd) (67 and 73mm, respectively) and low ejection fractions (EF) (26% and 18%, respectively). Coronary arteriography revealed no organic stenosis in either patient. Following treatment, plasma BNP levels decreased to below the limit of measurement (4pg/mL) in both patients and echocardiography revealed improved LVDd (61 and 52mm, respectively) and EF (41% and 45%, respectively). Because these patients are related, genetic factors might have affected low plasma BNP levels. Moreover, these results suggest that marked decrease in plasma BNP during follow up may be an indicator of preserved neurohormonal and organ systems.
    Journal of Cardiology Cases 02/2012; 5(1). DOI:10.1016/j.jccase.2011.10.006
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    ABSTRACT: The aim of this study was to examine the effect of proton-pump inhibitor (PPI) on clinical outcomes in Japanese patients who undergo coronary stent implantation. A total of 1,270 patients (males 915, 69 years) were enrolled and dual antiplatelet therapy of aspirin and a thienopyridine derivative was prescribed (clopidogrel 630, ticlopidine 640). Patients were divided into 2 groups treated with or without PPI. PPI was administered in 331 cases (26%), and non-PPI in 939 (74%). There were no significant differences in cardiovascular death (PPI vs. non-PPI: 5 vs. 11 cases), nonfatal myocardial infarction (3 vs. 5), and stroke (3 vs. 16) between PPI and non-PPI groups, but the ratio of gastrointestinal events had a higher tendency in non-PPI group compared with PPI group (1 vs. 17, P=0.08). In subgroup analysis of patients taking clopidogrel, or patients with acute coronary syndrome, there was no significant difference in the ratio of cardiovascular events (7 vs. 16, 6 vs. 17, NS). The non-PPI group had a tendency of an increased risk of gastrointestinal events compared with the PPI group (0 vs. 9, P=0.06; 1 vs. 7, P=0.14). In contrast to the negative drug interaction of PPI reported elsewhere, in the present study the intake of PPI was not associated with an increased risk for adverse clinical outcomes in patients treated with stents.
    Circulation Journal 12/2011; 76(1):71-8. DOI:10.1253/circj.CJ-11-0699
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    ABSTRACT: A 45-year-old man presented with acute inferior myocardial infarction and underwent emergent coronary angiography (CAG). CAG revealed total occlusion of both the proximal right coronary artery (RCA) and distal left circumflex artery, and two bare-metal stents were deployed in the RCA. After the procedure, dual antiplatelet therapy (DAT) with 100 mg aspirin and 75 mg clopidogrel daily were given as usual, however, stent thrombosis occurred three times and he underwent repeat interventions. To investigate the cause of repeated stent thrombosis, the platelet function during DAT was measured. The result showed that he did not achieve an adequate antiplatelet effect. Clopidogrel is a prodrug that requires biotransformation by cytochrome P450 (CYP) enzyme in the liver. Recently, the carriers of CYP2C19*2 or *3 null-of-function allele, have been shown to demonstrate an increased risk of cardiovascular events, including stent thrombosis, compared with non-carriers. This patient carried the CYP2C19*3/*3 genotype. This is the first report of repetitive stent thrombosis in a poor metabolizer carrying two loss-of-function alleles (CYP2C19*3/*3).
    Journal of Cardiology Cases 08/2011; 4(1):e16–e19. DOI:10.1016/j.jccase.2011.05.010
  • Tsuyoshi Honda, Hisanori Kanazawa, Kazuteru Fujimoto
    Circulation Journal 07/2011; 75(11):2714-5. DOI:10.1253/circj.CJ-11-0479
  • Journal of the American College of Cardiology 04/2011; 57(14). DOI:10.1016/S0735-1097(11)61903-7
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    ABSTRACT: Increased resting heart rate (HR) due to sympathetic hyperactivity is associated with coronary risk factors and increased cardiovascular events. Acute myocardial infarction (AMI) is accompanied by autonomic imbalance, which is characterized by sympathetic activation and parasympathetic inactivation. Although an increased HR in patients with acute coronary syndrome has been reported to be associated with 30-day and 6-month mortality before the coronary intervention era, it is unclear if an increased HR on admission is associated with the prognosis of AMI in the coronary intervention era. We enrolled 200 consecutive patients with AMI within 24 h of symptom onset. All patients underwent coronary angiography. They were divided into quartiles based on resting HR on admission. There was no difference in coronary risk factors and previous medical treatment among the four groups. Anterior AMI was significantly lower in the lowest quartile compared with other quartiles. There was no difference in peak creatine kinase value among the four groups, however left ventricular ejection fraction (LVEF) before discharge evaluated by echocardiography in the highest quartile group was significantly reduced compared to other quartiles. An increased HR was significantly associated with in-hospital death. Patients in the highest quartile of HR were about nine times more likely to have a poor prognosis after AMI compared to those in the lowest quartile. Multiple logistic analysis revealed that HR ≥93 was an independent risk factor for in-hospital death. HR was significantly associated with Killip class and LVEF on admission. These findings indicate that increased HR on admission predicts for poor cardiac function and in-hospital death after AMI.
    Journal of Cardiology 09/2010; 56(2):197-203. DOI:10.1016/j.jjcc.2010.05.006
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    ABSTRACT: There is conflicting information about whether mortality after AMI is higher in women than men. We investigated the significance of plasma adiponectin concentrations on major adverse cardiac events (MACE) after acute myocardial infarction (AMI) to delineate any differences between men and women. The study patients consisted of 114 men and 42 women with AMI. The incidence of MACE was significantly higher in women than men during the entire follow-up period (p<0.05). Compared with men for post-AMI MACE, the hazard ratio for women was 5.6 after adjustment for prognostic factors. Killip class (p<0.001) and sex differences (p<0.05) were independent predictors of MACE at 1 year post-AMI. Plasma adiponectin levels in women were significantly higher than men on admission (8.66 microg/mL [range: 6.6-14.08] versus 4.71 microg/mL [range: 3.47-7.27], p<0.0001) and during the post-AMI course (all p<0.0001). Multivariate analysis identified plasma adiponectin level on admission as an independent predictor of MACE in men (p<0.001) and the difference between plasma adiponectin levels at discharge and on admission in women (p<0.05). Patterns of serial changes in plasma adiponectin concentrations are different between men and women and plasma adiponectin concentrations can be used to predict future adverse cardiac events in AMI patients.
    Atherosclerosis 10/2007; 194(1):204-13. DOI:10.1016/j.atherosclerosis.2006.07.028