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Masami Kosuge,
Keiji Uchida,
Kiyotaka Imoto,
Naoki Hashiyama,
Toshiaki Ebina,
Kiyoshi Hibi, Kengo Tsukahara,
Nobuhiko Maejima,
Munetaka Masuda,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: Although patients with Stanford type A acute aortic dissection often show ST-T abnormalities at presentation, the frequency and implication of such findings remain unclear. To clarify these points, admission electrocardiograms from 233 patients admitted ≤6 hours after symptom onset who underwent emergency surgery for type A acute aortic dissection were studied. The prevalence of electrocardiographic (ECG) patterns was 51% for ST-T abnormalities (4% for ST-segment elevation and 47% for ST-segment depression and/or negative T waves), 30% for normal ECG findings or no significant ST-T changes, and 19% for ECG confounders such as bundle branch block or left ventricular hypertrophy. Patients with ST-T abnormalities had higher prevalence of pericardial effusion (48% vs 9% and 38%), cardiac tamponade (28% vs 3% and 18%), moderate or severe aortic regurgitation (28% vs 7% and 18%), shock on admission (34% vs 3% and 13%), coronary ostial involvement (14% vs 1% and 2%), concomitant coronary artery bypass surgery (9% vs 1% and 0%), and in-hospital mortality (11% vs 1% and 4%) compared with patients with normal ECG findings or no significant ST-T changes and those who had ECG confounders (p <0.05 for all). On multivariate analysis, ST-T abnormalities were the only independent predictor of in-hospital mortality (odds ratio 3.87, 95% confidence interval 1.02 to 14.7, p = 0.035). In conclusion, about 50% of patients who underwent emergency surgery for type A acute aortic dissection had ST-T abnormalities, characterized predominantly by ST-segment depression or negative T waves, in the acute phase. ST-T abnormalities were associated with more complicated features and independently predicted in-hospital death.
The American journal of cardiology 05/2013; · 3.58 Impact Factor
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Yasushi Matsuzawa,
Masaaki Konishi,
Eiichi Akiyama,
Hiroyuki Suzuki,
Naoki Nakayama,
Masayoshi Kiyokuni,
Shinichi Sumita,
Toshiaki Ebina,
Masami Kosuge,
Kiyoshi Hibi, [......],
Kenichiro Saka,
Katsutaka Hashiba,
Kozo Okada,
Masataka Taguri,
Satoshi Morita,
Seigo Sugiyama,
Hisao Ogawa,
Hironobu Sashika,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: OBJECTIVES: This study was designed to determine the additional clinical value of gait speed to Framingham risk score (FRS), cardiac function and comorbid conditions in predicting cardiovascular events in patients with ST-segment-elevation myocardial infarction (STEMI). BACKGROUND: There is growing evidence that gait speed is inversely associated with all-causes mortality, particularly cardiovascular mortality, among the elderly. METHODS: We undertook a single-center prospective observational study of gait speed in 472 patients with STEMI in Japan, between 2001 and 2008. Gait speeds were measured using 200-meter course before discharge in all patients and we followed cardiovascular events which consist of cardiovascular deaths, non-fatal myocardial infarctions, and non-fatal ischemic strokes. RESULTS: During the 2596 person-years of follow-up, 83 patients (17.6%) experienced cardiovascular events. Cardiovascular events increased across decreasing tertiles of gait speed (fastest tertile: n=5; 3.2%, middle tertile: n=20; 12.6%, slowest tertile: n=58; 36.7%). By multiple adjusted Cox proportional hazards analysis, gait speed was a significant and independent predictor of cardiovascular events (hazard ratio for increasing 0.1m/s of gait speed: 0.71, 95% confidence interval [CI]: 0.63 - 0.81, P<0.001). The addition of gait speed to the model incorporating FRS, B-type natriuretic peptide levels and comorbidity index improved reclassification (Net reclassification index: 32.8%, 95% CI: 17.4 - 48.3, P<0.001) and the C-statistics with a reasonable global fit and calibration (C-statistics [95% CI]: from 0.703 [0.636 - 0.763] to 0.786 [0.738 - 0.829]). CONCLUSION: Among patients with STEMI, slow gait speed was significantly associated with an increased risk of cardiovascular events.
Journal of the American College of Cardiology 03/2013; · 14.16 Impact Factor
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ABSTRACT: Early transmitral flow velocity (E) divided by early diastolic velocity of the mitral valve annulus (e') is referred to as the E/e' ratio, a variable that strongly correlates with mean left ventricular filling pressure. E/e' obtained at acute phase has been reported as useful in predicting prognosis in patients with acute myocardial infarctions. The aim of this study was to evaluate the clinical utility of echocardiographic indices obtained 2 weeks after the onset of a first ST-segment elevation myocardial infarction as predictors of outcomes.
Echocardiography was performed and blood samples were obtained from 301 consecutive patients 2 weeks after the onset of a first ST-segment elevation myocardial infarction. All patients underwent primary percutaneous coronary intervention <12 hours after symptom onset and were followed for 51.7 ± 19.0 months. The primary end point was cardiac death or readmission for heart failure.
During follow-up, cardiac death occurred in 10 patients, and heart failure developed in 35. On univariate analysis, age > 75 years, plasma brain natriuretic peptide > 180 pg/mL, early diastolic/late diastolic wave velocity of mitral inflow > 1.0, mitral inflow deceleration time < 140 msec, and E/e' > 15 were associated with the primary end points. Multivariate analysis showed that E/e' > 15 was the strongest predictor (hazard ratio, 3.702; 95% confidence interval, 1.895-7.391; P = .0001), followed by early diastolic/late diastolic wave velocity of mitral inflow > 1.0 (hazard ratio, 3.053; 95% confidence interval, 1.584-6.125; P = .008). Predictive accuracy was further enhanced by combing E/e' > 15 and early diastolic/late diastolic wave velocity of mitral inflow > 1.0 (hazard ratio, 7.373; 95% confidence interval, 3.529-16.528; P < .0001).
E/e' > 15 obtained 2 weeks after onset is the strongest predictor of cardiac death and readmission for heart failure after a reperfused first ST-segment elevation myocardial infarction. The predictive value of E/e' at 2 weeks is further enhanced by combining this variable with mitral inflow filling pattern.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2012; 25(12):1290-8. · 2.98 Impact Factor
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ABSTRACT: Background: It remains unclear whether concomitant use of omeprazole attenuates platelet function as compared with that of famotidine in patients with acute coronary syndromes (ACS) who receive clopidogrel. Methods and Results: In this prospective study, 130 ACS patients treated with aspirin and clopidogrel who underwent stent implantation were randomly assigned to receive a Japanese standard dose of omeprazole 10mg daily or famotidine 20mg daily for at least 4 weeks. Between 14 and 28 days after enrollment, there was no significant difference in the platelet reactivity index (PRI) measured with vasodilator-stimulated phosphoprotein phosphorylation assay between the omeprazole group (n=65) and famotidine group (n=65) (55±17% vs. 51±19%; P=0.26). The cumulative rate of adverse cardiovascular events at 12 months was similar in the groups (13% vs. 17%; P=0.81). The PRI was similar (54.9±17.9% vs. 54.0±17.8%; P=0.83) in the omeprazole group (n=33) and the famotidine group (n=39) among patients with ST-elevation myocardial infarction (STEMI). However, there was a trend toward a higher PRI (55.2±15.9% vs. 46.4±19.4%; P=0.06) in the omeprazole group (n=32) as compared with the famotidine group (n=26) among patients without persistent ST-segment elevation ACS. Conclusions: As compared with famotidine, concomitant use of low-dose omeprazole does not significantly attenuate the antiplatelet effects of clopidogrel in patients with ACS, especially in those with STEMI. (Circ J 2012; 76: 2673-2680).
Circulation Journal 07/2012; 76(11):2673-80. · 3.77 Impact Factor
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Hideto Yano,
Kiyoshi Hibi,
Naoki Nozawa,
Hiroyuki Ozaki,
Ikuyoshi Kusama,
Toshiaki Ebina,
Masami Kosuge, Kengo Tsukahara,
Jun Okuda,
Satoshi Morita,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: The aim of the present study was to assess the effects of angiotensin II receptor blocker (ARB) on coronary plaque progression in patients with acute myocardial infarction (AMI) who received an angiotensin-converting enzyme inhibitor (ACEI).
After local ethics committee approval and obtaining of informed consent, 116 patients with AMI were randomly assigned to receive a combination of valsartan and captopril or captopril alone. Non-culprit intermediate coronary atherosclerosis was assessed on intravascular ultrasound. The primary and secondary endpoints were the nominal change in percent atheroma volume (PAV) and percent change in lumen volume (%ΔLV), respectively. The combination group had a significantly lower systolic blood pressure (117 vs. 125 mmHg; P=0.02) and a lower plasma aldosterone level (56 vs. 75 pg/ml; P=0.02) at follow-up. The nominal change in PAV was slightly lower in the combination group than in the ACEI group (-1.9 vs. -0.68%, P=0.06). %ΔLV was -0.3% in the ACEI group and was 4.3% in the combination group (P=0.03). Logistic regression analysis showed that additional ARB therapy was independently associated with LV enlargement (odds ratio, 2.144; 95% confidence interval: 1.818-5.618; P=0.03).
In this study of patients with AMI, additional ARB therapy had minimal impact on the progression of coronary atherosclerosis as compared with an ACEI alone. The combination of these 2 drugs, however, induces coronary artery enlargement.
Circulation Journal 04/2012; 76(6):1442-51. · 3.77 Impact Factor
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Masami Kosuge,
Toshiaki Ebina,
Kiyoshi Hibi,
Noriaki Iwahashi, Kengo Tsukahara,
Mitsuaki Endo,
Nobuhiko Maejima,
Zenko Nagashima,
Hiroyuki Suzuki,
Satoshi Morita,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: In both takotsubo cardiomyopathy (TC) and reperfused anterior acute myocardial infarction (AMI), negative T waves commonly appear on the ECG in the subacute phase. This study aimed to clarify the ECG differences between these diseases.
We compared the ECGs with the greatest amplitude of negative T wave from 34 patients with TC and 237 patients with a first reperfused anterior AMI who were admitted within 6 h of symptom onset and who had no abnormal Q-waves on discharge ECG. Time from symptom onset to recording the ECG did not differ between TC and anterior AMI (2.4 ± 1.5 vs. 2.1 ± 2.0 days, P = 0.48). TC was associated with a greater maximal amplitude of negative T wave (1.00 ± 0.44 vs. 0.79 ± 0.46 mV, P = 0.044), and a greater number of leads with negative T waves (9.5 ± 1.0 vs. 6.0 ± 2.1, P<0.001). Negative T waves were consistently observed in leads -aV(R) and V(4-6), whereas negative T waves were rare in lead V(1) in TC. Negative T waves in lead -aV(R) (ie, positive T waves in lead aV(R)) and no negative T waves in lead V(1) identified TC with 94% sensitivity and 95% specificity, representing the highest diagnostic accuracy.
During the subacute phase, deeper negative T waves were more frequently and broadly distributed, particularly around leads facing the apical region, in TC than in reperfused anterior AMI.
Circulation Journal 12/2011; 76(2):462-8. · 3.77 Impact Factor
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Katsutaka Hashiba,
Jun Okuda,
Nobuhiko Maejima,
Noriaki Iwahashi, Kengo Tsukahara,
Yoshio Tahara,
Kiyoshi Hibi,
Masami Kosuge,
Toshiaki Ebina,
Tsutomu Endo,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: To assess the role of percutaneous cardiopulmonary support (PCPS) for the resuscitation of patients with massive pulmonary embolism (PE) with circulatory collapse. We also compared outcomes for PCPS between patients with massive PE with circulatory collapse and patients with AMI with cardiogenic shock.
The effectiveness of PCPS for acute myocardial infarction (AMI) complicated with cardiogenic shock has been reported, but there are few reports on the use of PCPS for massive PE with circulatory collapse.
We studied 12 consecutive patients with massive PE and 16 patients with AMI, who required PCPS for resuscitation either during cardiopulmonary resuscitation (CPR) or after successful CPR.
Twelve patients with PE and 16 patients with AMI were identified. There were no differences in age, the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) score at admission, rate of cardiac arrest on arrival, and time from first circulatory collapse to PCPS between the two groups. However, the proportion of men with PE (33%) was smaller than those with AMI (87%, p<0.05). The duration of PCPS was shorter in PE (38 h) compared with AMI (83 h, p=0.051) patients. The proportion of patients successfully weaned from PCPS (100% vs. 37.5%, p<0.01), survival rate at discharge (83.3% vs. 12.5%, p<0.001) and good neurological outcome (58.3% vs. 6.3%, p=0.004) was significantly higher for PE compared to AMI patients.
In our small case series, percutaneous cardiopulmonary support (PCPS) had a life saving role in patients with massive PE and cardiac arrest. PCPS was also more effective in patients with massive PE with cardiac arrest than in patients with AMI and cardiac arrest.
Resuscitation 11/2011; 83(2):183-7. · 3.60 Impact Factor
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ABSTRACT: The aim of this study was to assess the association between the spatial location of plaque rupture and remodeling pattern of culprit lesions in acute anterior myocardial infarction (MI). Positive remodeling suggests a potential surrogate marker of plaque vulnerability, whereas plaque rupture causes thrombus formation followed by coronary occlusion and MI. Intravascular ultrasound (IVUS) can determine the precise spatial orientation of coronary plaque formation. We studied 52 consecutive patients with acute anterior MI caused by plaque rupture of the culprit lesion as assessed by preintervention IVUS. The plaques were divided into those with and without positive remodeling. We divided the plaques into three categories according to the spatial orientation of plaque rupture site: myocardial (inner curve), epicardial (outer curve), and lateral quadrants (2 intermediate quadrants). Among 52 plaque ruptures in 52 lesions, 27 ruptures were oriented toward the epicardial side (52%), 18 toward the myocardial side (35%), and 7 in the 2 lateral quadrants (13%). Among 35 plaques with positive remodeling, plaque rupture was observed in 21 (52%) on the epicardial side, 12 (34%) on the myocardial side, and 2 (6%) on the lateral side. However, among 17 plaques without positive remodeling, plaque rupture was observed in 6 (35%), 6 (35%), and 5 (30%), respectively (p = 0.047). Atherosclerotic plaques with positive remodeling showed more frequent plaque rupture on the epicardial side of the coronary vessel wall in anterior MI than those without positive remodeling.
Heart and Vessels 09/2011; · 2.05 Impact Factor
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Takayuki Mitsuhashi,
Kiyoshi Hibi,
Masami Kosuge,
Satoshi Morita,
Naohiro Komura,
Ikuyoshi Kusama,
Fumiyuki Otsuka,
Mitsuaki Endo,
Noriaki Iwahashi,
Jun Okuda, Kengo Tsukahara,
Toshiaki Ebina,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: We sought to assess whether hyperinsulinemia is associated with percentage lipid and coronary plaque burden in nondiabetic patients with acute coronary syndromes (ACS).
Hyperinsulinemia carries an increased risk of cardiovascular disease even in pre-diabetic patients, but the precise mechanisms of its effects remain unclear.
Nonculprit coronary lesions associated with mild-to-moderate stenosis in 82 nondiabetic patients with ACS were examined by integrated backscatter intravascular ultrasound (IB-IVUS), using a 40-MHz intravascular catheter. Conventional IVUS and IB-IVUS measurements from the worst 10-mm segment (1-mm intervals) were calculated. All patients underwent a 75-g oral glucose tolerance test (OGTT) to calculate the area under the insulin concentration-time curve (AUC insulin) from 0 to 120 min.
Patients in the high tertile of AUC insulin had a significantly greater percentage lipid area and absolute lipid volume than did patients in the intermediate and low tertiles (tertile 3 vs. tertile 2 vs. tertile 1; 37.6 ± 16.6% vs. 25.8 ± 11.9% vs. 27.5 ± 14.7%, p < 0.01 by analysis of variance [ANOVA], and 29.9 ± 22.6 mm(3) vs. 15.3 ± 12.6 mm(3) vs. 17.7 ± 12.7 mm(3), p < 0.01 by ANOVA, respectively) and a smaller percentage fibrosis area (55.0 ± 11.5% vs. 61.7 ± 9.4% vs. 60.7 ± 9.4%, p = 0.03 by ANOVA). Multiple regression analysis showed that the high tertile of AUC insulin was independently associated with an increased percentage lipid area (p < 0.05). On conventional IVUS analysis, external elastic membrane cross-sectional area was significantly increased with greater plaque volume in patients in the high tertile of AUC insulin (both p < 0.05 by ANOVA).
Hyperinsulinemia is associated with an increased lipid content and a greater plaque volume of nonculprit intermediate lesions in nondiabetic patients with ACS, suggesting that plaque vulnerability is increased in this subgroup of patients.
JACC. Cardiovascular imaging 04/2011; 4(4):392-401. · 14.29 Impact Factor
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Kengo Tsukahara,
Kazuo Kimura,
Satoshi Morita,
Toshiaki Ebina,
Masami Kosuge,
Kiyoshi Hibi,
Noriaki Iwahashi,
Mitsuaki Endo,
Nobuhiko Maejima,
Teruyasu Sugano,
Satoshi Umemura
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ABSTRACT: Although there has been an intense debate whether concomitant use of proton-pump inhibitors (PPIs) attenuates the antiplatelet effects of thienopyridine derivatives, the drug-drug interaction remains unclear in Japanese patients with coronary artery disease.
Platelet function test was performed in 461 patients who were scheduled for or had undergone stent implantation, treated with 100mg/day of aspirin and a thienopyridine (200mg/day of ticlopidine or 75 mg/day of clopidogrel) for at least 14 days. Adenosine diphosphate-induced platelet aggregation was evaluated with screen filtration pressure method, and the upper quartile of high platelet reactivity was defined as high on-treatment platelet reactivity (HPR). PPI use was at physician's discretion. Patients taking a thienopyridine plus a PPI (n=166) were older and had a higher incidence of acute coronary syndromes on admission compared with patients taking a thienopyridine without a PPI (n=295). The rate of HPR was higher in patients taking a thienopyridine plus a PPI than in patients taking a thienopyridine without a PPI (31% vs 21%, p=0.01). On multivariate logistic regression analysis, independent predictors of HPR were concomitant PPI use [odds ratio (OR): 1.66, 95% confidence interval (CI): 1.03-2.68], diabetes mellitus (OR: 1.76, CI: 1.11-2.81), and calcium channel blockers use (OR: 1.93, CI: 1.18-3.18). However, there was no significant difference in the rate of extremely high platelet reactivity [58 patients (12.5%) with PATI<4.0 μM] between patients treated with a thienopyridine plus a PPI and those without a PPI (14% vs 11%, NS).
HPR was frequently observed in Japanese patients treated with thienopyridines plus PPIs compared to those without PPIs. Further prospective studies are needed to estimate the risk of adverse cardiovascular events associated with concomitant use of PPIs and thienopyridines.
Journal of Cardiology 03/2011; 57(3):275-82. · 1.28 Impact Factor
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Masami Kosuge,
Toshiaki Ebina,
Kiyoshi Hibi,
Noriaki Iwahashi, Kengo Tsukahara,
Mitsuaki Endo,
Nobuhiko Maejima,
Katsutaka Hashiba,
Hiroyuki Suzuki,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: In patients with acute myocardial infarction (AMI), QRS score at presentation electrocardiogram (ECG) may reflect the evolutionary stage of the infarction and allow one to predict the degree of myocardial reperfusion potentially achievable by reperfusion therapy.
The relationship between QRS score on admission ECG and myocardial blush grade, an angiographic marker of myocardial reperfusion, was examined in 416 patients with a first anterior AMI who received reperfusion therapy within 6h after symptom onset. Patients were classified into 3 groups according to QRS score: 0 or 1 (n=102), 2-4 (n=228), and ≥5 (n=86). Higher QRS scores were associated with a longer time to admission, a greater ST-segment elevation, a higher frequency of impaired initial and final culprit coronary vessel flow, a higher peak creatine kinase level, and a higher frequency of impaired myocardial reperfusion as defined by myocardial blush grade 0/1 on the final angiogram. Multivariate analysis showed that a high QRS score ≥5 was the strongest predictor of impaired myocardial reperfusion (odds ratio 20.3, P<0.001). These findings were similar when the data were stratified according to time to admission (≤2h, >2h).
In patients with a first anterior AMI treated by reperfusion therapy, admission high QRS score ≥5 strongly predicts impaired myocardial reperfusion, even when presentation is early (≤2h).
Circulation Journal 12/2010; 75(3):626-32. · 3.77 Impact Factor
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Fumiyuki Otsuka,
Kiyoshi Hibi,
Ikuyoshi Kusama,
Mitsuaki Endo,
Masami Kosuge,
Noriaki Iwahashi,
Jun Okuda, Kengo Tsukahara,
Toshiaki Ebina,
Sunao Kojima,
Seigo Sugiyama,
Hisao Ogawa,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: Several studies in experimental animals have shown that statins stabilize atheromatous plaques by increasing fibrous-cap thickness. However, direct evidence linking the use of statins to the incidence of plaque rupture in humans is lacking. We investigated whether statin treatment before the onset of ST-elevation myocardial infarction (STEMI) influences the incidence of plaque rupture detected by intravascular ultrasound (IVUS).
The study enrolled 458 patients with STEMI who were admitted within 6h from symptom onset. IVUS interrogation was performed before percutaneous coronary intervention.
Plaque ruptures were detected in 262 patients (57%). Patients with statin pretreatment (n=68) had a lower incidence of plaque rupture than those without (37% vs. 61%, p<0.001). Univariate analysis revealed that smoking (p=0.003), lower high-density lipoprotein cholesterol (p=0.001), and a lack of statin pretreatment (p<0.001) were associated with a higher incidence of plaque rupture. Multivariate logistic regression analysis identified statin pretreatment as a negative determinant of plaque rupture independent of age, gender, coronary risk factors, and all other medications (odds ratio 0.35; 95% CI 0.19-0.66, p=0.001). Positive remodeling was also associated with plaque rupture (p<0.001), and the relationship between statin pretreatment and a lower incidence of plaque rupture persisted after adjustment for positive remodeling (odds ratio 0.42; 95% CI 0.22-0.80, p=0.009).
Statin treatment before the onset of STEMI is associated with a lower incidence of plaque rupture, suggesting that the prevention of plaque rupture may be a crucial mechanism underlying clinical benefits associated with statins.
Atherosclerosis 09/2010; 213(2):505-11. · 3.79 Impact Factor
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Masami Kosuge,
Toshiaki Ebina,
Kiyoshi Hibi,
Satoshi Morita,
Jun Okuda,
Noriaki Iwahashi, Kengo Tsukahara,
Tatsuya Nakachi,
Masayoshi Kiyokuni,
Toshiyuki Ishikawa,
Satoshi Umemura,
Kazuo Kimura
Journal of the American College of Cardiology 06/2010; 55(22):2514-6. · 14.16 Impact Factor
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Mitsuaki Endo,
Kiyoshi Hibi,
Tomoaki Shimizu,
Naohiro Komura,
Ikuyoshi Kusama,
Fumiyuki Otsuka,
Takayuki Mitsuhashi,
Noriaki Iwahashi,
Jun Okuda, Kengo Tsukahara,
Masami Kosuge,
Toshiaki Ebina,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: The aim of this study was to assess whether ultrasound attenuation and plaque rupture as detected by intravascular ultrasound (IVUS) are associated with the incidence of no-reflow phenomenon after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
No-reflow phenomenon is associated with worse long-term outcomes after STEMI. Therefore, reliable and feasible intravascular imaging techniques are needed to identify patient subgroups that would be at high risk for no-reflow phenomenon.
One hundred seventy consecutive patients with STEMI who underwent PCI within 12 h after symptom onset were enrolled. The IVUS interrogation was performed before PCI.
No-reflow phenomenon occurred in 30 patients (18%), who had a higher incidence of no ST-segment resolution (50% vs. 9%; p < 0.001), a higher peak creatine kinase level (4,090 IU/l vs. 2,823 IU/l; p < 0.001), and a lower left ventricular ejection fraction in the chronic phase (51% vs. 59%; p < 0.01). Multivariate logistic regression analysis revealed that ultrasound attenuation with a longitudinal length of > or =5 mm, plaque rupture, and reperfusion time correlated with no-reflow phenomenon (all p < 0.05). In patients with both ultrasound attenuation > or =5 mm and plaque rupture, the incidence of no-reflow phenomenon was 88%, and the risk of decreased coronary reflow was higher than that predicted by either factor alone (p = 0.004 for interaction).
In patients with STEMI, a longer ultrasound attenuation and plaque rupture on IVUS are associated with an increased incidence of no-reflow phenomenon, suggesting that this subset of patients might be at high risk for distal embolism.
05/2010; 3(5):540-9. · 1.07 Impact Factor
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ABSTRACT: Monocytes and macrophages have been shown to play major roles in the progression of atherosclerosis. This study examined whether the circulating monocyte count can be used to predict coronary plaque progression of non-culprit intermediate lesions in acute myocardial infarction (AMI).
Intravascular ultrasound findings of non-culprit intermediate plaque in 90 patients were analyzed in the acute phase and at a 7-month follow up. A higher peak monocyte count after AMI was associated with a greater plaque volume change (r=0.32, P=0.002). Multivariate analysis showed that a peak monocyte count of > or =800 /mm(3) was an independent predictor of plaque progression (odds ratio 5.02, P=0.005). High monocyte (> or =800 /mm(3)) at baseline had a higher monocyte count at 7-month follow up than did those with a lower count (368+/-109 vs 263+/-64 /mm(3), P<0.0001). Moreover, the monocyte count at the 7-month follow up was also associated with plaque volume change (r=0.29, P=0.006).
The results suggest that circulating monocytes play an important role in the progression of coronary plaque in AMI and that the peak monocyte count during hospitalization might be a predictor of plaque progression.
Circulation Journal 05/2010; 74(7):1384-91. · 3.77 Impact Factor
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Kengo Tsukahara,
Kazuo Kimura,
Satoshi Morita,
Toshiaki Ebina,
Masami Kosuge,
Kiyoshi Hibi,
Jun Okuda,
Noriaki Iwahashi,
Nobuhiko Maejima,
Tatsuya Nakachi,
Fumiyuki Ohtsuka,
Katsutaka Hashiba,
Yoshio Tahara,
Teruyasu Sugano,
Satoshi Umemura
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ABSTRACT: Few studies have examined whether high-responsiveness to antiplatelet therapy is associated with an increased risk of bleeding in patients receiving dual antiplatelet therapy.
Elective drug-eluting stent implantation was performed in 184 patients treated with aspirin and a thienopyridine (200 mg/day of ticlopidine or 75 mg/day of clopidogrel). The subjects were divided into 3 groups according to post-treatment platelet reactivity before stenting as measured by the response to adenosine diphosphate: the 1(st) quartile group was defined as high-responders, the 4(th) as low-responders, and the other 2 quartiles as middle-responders. Major bleeding occurred more frequently in high-responders than in middle- or low-responders during an average of 16 months' follow-up (15 vs 4, 2%, P=0.02). High-responsiveness was the independent predictor of major bleeding (odds ratio 4.26, P=0.03). Adverse cardiac events were less frequent in high- and middle-responders than in low-responders (24, 16 vs 37%, P=0.02). Middle-responders had better net clinical outcomes, defined as the sum of major bleeding and adverse cardiac events, than did high- or low-responders (21 vs 39, 39%, P=0.02).
In the present study high-responsiveness to antiplatelet therapy was associated with an increased risk of bleeding with no reduction in adverse cardiac events. Measuring platelet reactivity may be useful for risk stratification according to bleeding complications, as well as adverse cardiac events, in patients treated with drug-eluting stents.
Circulation Journal 02/2010; 74(4):679-85. · 3.77 Impact Factor
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Naohiro Komura,
Kiyoshi Hibi,
Ikuyoshi Kusama,
Fumiyuki Otsuka,
Takayuki Mitsuhashi,
Mitsuaki Endo,
Noriaki Iwahashi,
Jun Okuda, Kengo Tsukahara,
Masami Kosuge,
Toshiaki Ebina,
Satoshi Umemura,
Kazuo Kimura
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[hide abstract]
ABSTRACT: Ruptured plaque and culprit lesions associated with anterior acute myocardial infarction cluster mainly in the proximal segment of the left anterior descending coronary artery (LAD). This study investigated whether the tissue characteristics of plaque in the proximal LAD differs from that of plaque in the distal LAD as assessed by integrated backscatter (IB)-intravascular ultrasound (IVUS).
IVUS interrogation was used to study 107 non-culprit intermediate plaques in 68 patients with angina pectoris who underwent percutaneous coronary interventions. Proximal and distal segments were defined as <30 mm and > or =30 mm from the ostium, respectively. IB-IVUS images were recorded, and the average percentage values of each plaque component (lipid, fibrosis, dense fibrosis, and calcification) were compared between segments. Plaques in the proximal segment (n=51) had a higher %lipid content (36 vs 19%, P<0.01) and a lower %fibrosis content (57 vs 64%, P<0.01) than did plaques in the distal segment (n=56). Multiple linear regression analysis showed that proximal plaques had a higher %lipid content, independently of other coronary risk factors and plaque burden (P<0.01).
The %lipid and %fibrosis contents differ significantly between plaques in the proximal segment and those in the distal segment of the LAD. (Circ J 2010; 74: 142 - 147).
Circulation Journal 12/2009; 74(1):142-7. · 3.77 Impact Factor
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Toshiaki Ebina,
Yoshihiro Ishikawa,
Keiji Uchida,
Shinichi Suzuki,
Kiyotaka Imoto,
Jun Okuda, Kengo Tsukahara,
Kiyoshi Hibi,
Masami Kosuge,
Shinichi Sumita,
Yasuyuki Mochida,
Toshiyuki Ishikawa,
Kazuaki Uchino,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: A 40-year-old man was referred to our hospital because of an abnormal shadow on the left cardiac border on the chest roentgenogram at the regular medical health examination without any symptoms. A giant coronary artery aneurysm of left anterior descending artery with a maximum diameter of approximately 50 mm was detected with computed tomography and coronary angiography. The patient was treated and followed up medically. Four years later, the size of the coronary artery aneurysm became larger. Then resection of the coronary artery aneurysm and coronary artery bypass grafting were successfully performed. Coronary artery aneurysms are rare in adults and are usually found in association with Kawasaki disease, coronary atherosclerosis, and so on. We also review the literature of giant coronary artery aneurysms exceeding 50 mm in diameter.
Journal of Cardiology 05/2009; 53(2):293-300. · 1.28 Impact Factor
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Masayoshi Kiyokuni,
Masami Kosuge,
Toshiaki Ebina,
Kiyoshi Hibi, Kengo Tsukahara,
Jun Okuda,
Noriaki Iwahashi,
Nobuhiko Maejima,
Ikuyoshi Kusama,
Naohiro Komura,
Naoki Nakayama,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: Experimental studies suggest that statins promote vascular fibrinolysis, so statin treatment before the onset of acute myocardial infarction (AMI) may result in a smaller infarct size.
The study group comprised 310 patients with AMI who received fibrinolysis within 12 h after symptom onset: 39 had received statin pretreatment (statin group) and 271 had not (non-statin group). Initial Thrombolysis In Myocardial Infarction (TIMI) flow grade did not differ between groups. Among 120 patients with initial TIMI flow grade 0/1, achievement of TIMI flow grade > or =2 after passing the guidewire through the culprit lesion was more frequent in the statin group (70% vs 35%, P=0.03). The final rate of TIMI flow grade 3 was higher in the statin group (95% vs 86%, P=0.11). Area under the curve (AUC) for creatine kinase (CK) was lower in the statin group (55,972+/-45,934 vs 84,195+/-84,276 IU . L(-1) . h(-1), P=0.04). Multivariate analysis revealed statin pretreatment as an independent negative predictor of larger infarct size as defined by the upper tertile of AUC for CK (odds ratio 0.25, 95% confidence interval 0.07-0.91, P=0.035).
Statin pretreatment may enhance fibrinolysis and reduce infarct size in patients with AMI.
Circulation Journal 01/2009; 73(2):330-5. · 3.77 Impact Factor
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Jun Okuda,
Masami Kosuge,
Toshiaki Ebina,
Kiyoshi Hibi, Kengo Tsukahara,
Noriaki Iwahashi,
Mitsuaki Endo,
Tatsuya Nakachi,
Takayuki Mitsuhashi,
Fumiyuki Otsuka,
Ikuyoshi Kusama,
Katsutaka Hashiba,
Naohiro Komura,
Satoshi Umemura,
Kazuo Kimura
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ABSTRACT: In patients with acute myocardial infarction (AMI), the relationship of serial changes in ST-segment elevation after reperfusion to left ventricular (LV) function remains unclear.
The study group comprised 164 patients with reperfused anterior AMI within 6 h of symptom onset. The sum of ST-segment deviation was calculated on admission (SigmaST-admission), and 1 h (SigmaST-1 h) and 24 h (SigmaST-24 h) after reperfusion. ST resolution was defined as a reduction in SigmaST-1 h of > or =50% as compared with SigmaST-admission. Patients were classified into 3 groups: group A, 82 patients with ST resolution in whom SigmaST-1 h > or = SigmaST-24 h; group B, 37 patients with ST resolution in whom SigmaST-1 h < SigmaST-24 h; group C, 45 patients without ST resolution. Peak creatine kinase were higher in groups B and C than in group A (4,578+/-2,176, 4,236+/-2,638, 2,222+/-1,926 mU/ml, p<0.01). At 6 months follow-up, the LV ejection fraction were lower in groups B and C than in group A (53+/-8, 54+/-12, 62+/-9%, p<0.01).
An increase in ST-segment elevation 1-24 h after reperfusion, despite ST resolution, is associated with a larger infarction and poorer LV function in patients with reperfused anterior AMI.
Circulation Journal 03/2008; 72(3):409-14. · 3.77 Impact Factor
