Raisuke Iijima

Toho University, Edo, Tōkyō, Japan

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Publications (74)394.32 Total impact

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    ABSTRACT: Hemodialysis (HD) patients with critical limb ischemia (CLI) suffer chronic inflammation and repeated infection, require intervention, and may have a protracted hospital stay. Therefore, early prediction is particularly important for management of CLI in patients with suspected peripheral artery disease. The purpose of this study is to develop a simple score for predicting the incidence of CLI in HD patients with suspected peripheral artery disease. The subjects were 139 asymptomatic patients receiving maintenance HD and with ABI <1.0. Multivariate logistic regression analysis was used to identify factors associated with development of CLI. These factors were subsequently weighted and integrated into a scoring system for the prediction of onset of CLI. Twenty-five patients had onset of CLI. Five factors selected from the multivariate model were weighted proportionally using their respective odds ratio (OR) for incidence of CLI (history of cerebral vascular disease, OR 6.42 [3 points]; diabetes, OR 3.92 [2 points]; hypoesthesia, OR 4.21 [2 points]; left ventricular ejection fraction <50%, OR 3.89 [2 points]; serum albumin <3.5 g/dL, OR 4.39 [2 points]). Three strata of risk were defined (low risk, 0 to 3 points; intermediate risk, 4 to 6 points; and high risk 7 to 11 points) with excellent prognostic accuracy for progression to CLI using the Kaplan-Meier method. Five factors were identified that increased the risk of progression to CLI in HD patients with suspected peripheral artery disease. A combination of those factors permitted establishment of three risk strata for accurate prediction of onset of CLI. © 2015 The Authors. Therapeutic Apheresis and Dialysis © 2015 International Society for Apheresis.
    Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 03/2015; DOI:10.1111/1744-9987.12287 · 1.53 Impact Factor
  • Circulation Journal 01/2015; DOI:10.1253/circj.CJ-14-0940 · 3.69 Impact Factor
  • Journal of Cardiac Failure 10/2014; 20(10):S168. DOI:10.1016/j.cardfail.2014.07.211 · 3.07 Impact Factor
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    ABSTRACT: Introduction and objectives Previous studies have reported that coronary intervention for complex lesions is independently correlated with major bleeding. The SYNTAX score is an angiographic tool used to grade the complexity of coronary artery diseases. The aim of this study was to assess the ability of the SYNTAX score to predict major bleeding following drug-eluting stent implantation. Methods We analyzed 722 patients who underwent drug-eluting stent implantation in an all-comers population between January 2007 and April 2010. The incidence of major bleeding and stent thrombosis was investigated during a 2-year period. Major bleeding was evaluated using the CRUSADE score and Bleeding Academic Research Consortium criteria. Patients were stratified into the following groups according to the SYNTAX trial: low (≤ 22; n = 484), intermediate (23–32; n = 128), and high (≥ 33; n = 110). Results Major bleeding was observed in 47 patients (6.5%) during the 2-year period, and there were 12 incidents of stent thrombosis (1.7%). Major bleeding rates for patients in the low, intermediate, and high SYNTAX score tertiles were 2.9%, 7.8%, and 20.9%, respectively (P < .0001). The SYNTAX score had an adjusted hazard ratio of 1.81 (95% confidence interval, 1.27-2.57) for 2-year major bleeding. The predictive value of the adjusted area under the receiver operating characteristic curve for major bleeding significantly improved after inclusion of the CRUSADE score (C statistic, 0.890 vs 0.812). Conclusions Although the SYNTAX score can predict major bleeding risk, the predictive value of the CRUSADE score was higher. These scores may be useful in clinical decision-making on revascularization strategies and on the optimal duration of dual antiplatelet therapy following drug-eluting stent implantation. Full English text available from:www.revespcardiol.org/en
    Revista Espa de Cardiologia 08/2014; DOI:10.1016/j.recesp.2014.02.030 · 3.34 Impact Factor
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    ABSTRACT: Introducción y objetivos En estudios previos se ha descrito que la intervención coronaria aplicada a lesiones complejas presenta una correlación independiente con las hemorragias mayores. La puntuación SYNTAX es un instrumento angiográfico utilizado para evaluar el grado de complejidad de las enfermedades arteriales coronarias. El objetivo de este estudio es evaluar la capacidad de la puntuación SYNTAX para predecir hemorragias mayores tras el implante de stents liberadores de fármacos. Métodos Se analizó a un total de 722 pacientes sometidos a implante de stents liberadores de fármacos de una población de pacientes consecutivos incluidos en el estudio entre enero de 2007 y abril de 2010. Se investigó la incidencia de hemorragias mayores y trombosis del stent durante un periodo de 2 años. La hemorragia mayor se evaluó mediante la puntuación CRUSADE y los criterios del Bleeding Academic Research Consortium. Se estratificó a los pacientes en los siguientes grupos según los criterios del ensayo SYNTAX: baja (≤ 22; n = 484), intermedia (23-32; n = 128) y alta (≥ 33; n = 110). Resultados Se observaron hemorragias mayores en 47 pacientes (6,5%) en el periodo de estudio de 2 años, y hubo 12 episodios de trombosis del stent (1,7%). Las tasas de hemorragia mayor en los pacientes de los terciles bajo, intermedio y alto de la puntuación SYNTAX fueron del 2,9, el 7,8 y el 20,9% respectivamente (p < 0,0001). La puntuación SYNTAX mostró una hazard ratio ajustada de hemorragia mayor a los 2 años de 1,81 (intervalo de confianza del 95%, 1,27-2,57). El valor predictivo del área bajo la curva de características operativas del receptor ajustada por hemorragia mayor mejoró significativamente tras la inclusión de la puntuación CRUSADE (estadístico C, 0,890 frente a 0,812). Conclusiones Aunque la puntuación SYNTAX puede predecir el riesgo de hemorragias mayores, el valor predictivo de la puntuación CRUSADE fue superior. Estas puntuaciones pueden resultar de utilidad en la toma de decisiones clínicas respecto a las estrategias de revascularización y la duración óptima del tratamiento antiagregante plaquetario doble tras implante de stents liberadores de fármacos.
    Revista Espanola de Cardiologia 08/2014; DOI:10.1016/j.rec.2014.02.028
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    ABSTRACT: Preprocedural chronic kidney disease and contrast-induced acute kidney injury are predictors of in-hospital death and long-term mortality. However, neither the time course of kidney function after percutaneous coronary intervention (PCI) nor the relation between the time course of kidney function and prognosis has been adequately studied. We studied 531 patients who underwent PCI for acute coronary syndrome. The continuous deterioration of kidney function (CDKF) was defined as a >25% increase in serum creatinine level or serum creatinine >0.5 mg/dl above baseline at 6 to 8 months after PCI. CDKF was observed in 87 patients (16.4%). Independent risk factors for CDKF were contrast-induced acute kidney injury, preprocedural hemoglobin level, and proteinuria. Patients with CDKF exhibited significant higher 5-year mortality rate than patients without CDKF (25% vs 9.4%, log-rank p = 0.0006). Independent risk factors for 5-year mortality were age >75 year, anemia, New York Heart Association class III or IV, low ejection fraction, and CDKF. CDKF is associated with an increased risk of all-cause mortality of 5 years in patients with acute coronary syndrome undergoing PCI.
    The American journal of cardiology 03/2014; DOI:10.1016/j.amjcard.2014.02.019 · 3.43 Impact Factor
  • 01/2014; 15(7). DOI:10.1093/ehjci/jeu002
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    ABSTRACT: In the era of drug-eluting stents (DES), a long-term dual antiplatelet therapy is required to prevent late stent thrombosis. However, in patients with atrial fibrillation (AF), there is a concern that combining warfarin with dual antiplatelet therapy may increase the risk of bleeding. We analyzed 1274 consecutive patients with coronary artery disease who were treated with coronary intervention from January 2006 through January 2009. Of these, we enrolled 74 AF patients treated with DES and dual antiplatelet therapy as well as warfarin. The primary endpoint was the incidence of major bleeding within 3 years; the predictive factor of major bleeding was also analyzed. To evaluate the efficacy of anticoagulant therapy, time in therapeutic range (TTR) was also measured. The 3-year incidence of major bleeding was 12.2 % (nine of 74 patients). The average observation period was 25.7 ± 20.2 months. Mean TTR value was 44.6 ± 33.0 % and was maintained at a relatively low level. Multivariate analysis revealed that a higher CHADS2 score (2-point more) was an independent predictor of increased risk of major bleeding. Major bleeding in the patients with triple antithrombotic therapy including warfarin occurred at a relatively high rate. Although the higher CHADS2-score indicates a high risk of thrombotic events, it was strongly associated with bleeding complications.
    12/2013; 29(3). DOI:10.1007/s12928-013-0234-4
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    ABSTRACT: Hypercholesterolemia coexisting with diabetes still requires clinical intervention to manage the high risk of cardiovascular disease it poses. No second-step strategy is established, however, for cases where strong statins fail to bring cholesterol down to target levels. In this study we seek to demonstrate the superior effect of ezetimibe in combination with strong statins to reduce LDL-C in Japanese patients suffering from both T2DM and hyper LDL-cholesterolemia. T2DM outpatients (109 patients from 16 institutes) who failed to achieve the target LDL-C value were recruited and randomly assigned to two groups, a double-dose-statin group and ezetimibe-plus-statin group. Follow-ups were scheduled at 0, 12, 26, and 52 weeks. The primary endpoint was the percentage change in the level of LDL-C from baseline to 12 weeks.Interim results: We could successfully create randomized (gender, age, LDL-C, HbA1c, etc.) two groups except for slight differences in apolipoprotein-B and sd-LDL. RESEARCH is the first prospective, parallel-group, multicenter study comparing a double dose of strong statin with ezetimibe plus strong statin for T2DM patients. The RESEARCH study will provide reliable evidence with which to establish a clinical strategy for diabetics who fail to achieve the target LDL-C value.
    Lipids in Health and Disease 10/2013; 12(1):142. DOI:10.1186/1476-511X-12-142 · 2.31 Impact Factor
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    ABSTRACT: BACKGROUND: Although clinical restenosis within 1year after percutaneous coronary intervention has been remarkably reduced with the advent of drug-eluting stents (DES), the late catch-up (LCU) phenomenon remains an issue despite medical advances. The aim of this study was to investigate the incidence and predictive factors of the LCU phenomenon in an unselected population treated with first-generation DES. METHODS: A total of 923 patients treated with DES between June 2004 and August 2008 were analyzed. The LCU phenomenon was defined as secondary revascularization 1year after index stenting. Retreatment for very late stent thrombosis was considered as part of the LCU phenomenon. RESULTS: Incidence of the LCU phenomenon was seen in 33 patients (3.6%). Very late stent thrombosis was observed in 5 patients (0.6%) and very late in-stent restenosis was observed in 28 patients (3.0%). At the 12-month landmark analysis, the cumulative rate of cardiac death was significantly higher in patients with the LCU phenomenon than in those without any target lesion revascularization (9.0% vs. 0.9%, p<0.001). In the multivariate analysis, hemodialysis [odds ratio (OR) 6.07, p=0.003], number of stents (OR 1.58, p=0.02), and coronary bifurcation lesions (OR 2.06, p=0.048) were identified as independent predictors of the LCU phenomenon. CONCLUSION: The LCU phenomenon is associated with serious consequences and adverse events and remains an important issue in modern practice, despite medical advances. DES should be deployed with a minimum number of stents, and special consideration must be given to patients on hemodialysis and those with coronary bifurcation lesions.
    International journal of cardiology 04/2013; 168(3). DOI:10.1016/j.ijcard.2013.03.046 · 6.18 Impact Factor
  • 01/2013; 5(1):44-48. DOI:10.15245/cvit.5.44
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    ABSTRACT: Background: Numerous reports have shown that both carotid artery ultrasound (carotid US) findings and ankle-brachial index (ABI) are associated with the prevalence of coronary artery disease. The relationship between carotid US findings and ABI and the complexity of coronary artery disease (as measured by SYNTAX [SX] score), was evaluated. Methods and Results: The subjects included 496 consecutive patients who underwent carotid US, ABI analysis and initial coronary angiography. The mean common carotid artery intima-media thickness (mean IMT) was evaluated on carotid US. Patients with mean IMT ≥0.9mm had significantly higher SX scores than patients without thickening (mean IMT <0.9mm; P<0.0001). Similarly, patients with low ABI (<0.9) had significantly higher SX scores than patients with ABI ≥0.9 (P<0.0001). When the patients were divided into 4 groups on the basis of mean IMT and ABI (group A, mean IMT <0.9mm, ABI ≥0.9; group B, mean IMT <0.9mm, low ABI; group C, mean IMT ≥0.9mm, ABI ≥0.9; group D, mean IMT ≥0.9mm, low ABI), the SX scores were significantly different. Among the patients in group D, 75% had coronary artery disease. Conclusions: Carotid US and ABI are associated with SX score. The combination of carotid US and ABI provides useful information for predicting the complexity and presence of coronary artery disease.
    Circulation Journal 11/2012; 77(3). DOI:10.1253/circj.CJ-12-1087 · 3.69 Impact Factor
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    ABSTRACT: This report presents the case of a common hepatic artery (CHA) pseudoaneurysm secondary to postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD), which was successfully treated using a coronary covered stent. A 70-year-old female underwent subtotal stomach-preserving PD for middle cholangiocarcinoma. POPF was identified on postoperative day (POD) 7, and the patient suddenly lost 500 ml of blood via the abdominal drain on POD 19. Urgent celiac arteriography revealed a CHA pseudoaneurysm. A coronary covered stent was placed to prevent rupture of the pseudoaneurysm and to maintain hepatic arterial flow, instead of performing transarterial embolization. No vascular adverse events were encountered during or after the procedure. Computed tomography and angiography showed a patent stent graft and good hepatic arterial flow 9 months after placement of the stent. Endovascular stent-graft placement not only treated the pseudoaneurysm, but also preserved the arterial blood flow. This report describes the placement of a covered stent graft for delayed hemorrhage after PD.
    Surgery Today 08/2012; 44(1). DOI:10.1007/s00595-012-0314-6 · 1.21 Impact Factor
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    ABSTRACT: Aim: Glycated hemoglobin (HbA1c) is associated with an increased risk of cardiovascular disease and death from any cause. The aim of this study was to examine the relationship between HbA1c value and coronary artery lesion complexity.Methods: The subjects were 638 consecutive patients who underwent their first coronary angiography and had their HbA1c levels measured from December 2008 to August 2011. Sixty-one hemodialysis patients were excluded and 577 were analyzed. The complexity of the coronary artery lesions was evaluated using the SYNTAX score (SXscore). The subjects were divided into quartiles according to either the HbA1c or the fasting plasma glucose (FPG) values. Logistic regression analysis (with forced entry methods) was used to predict the prevalence of an intermediate or high SXscore.Results: Both the higher HbA1c quartiles (Q1 to Q4) and higher FPG quartiles were significantly associated with a higher SXscore (p for trend <0.0001 and 0.026, respectively). The association between higher HbA1c quartiles and a higher SXscore was even observed in non-diabetic subjects (n= 433, Q1: 3.0±6.8, Q2: 6.9±15.6, Q3: 7.6±11.8, Q4: 7.4±13.4 p for trend= 0.004). In addition, a higher HbA1c quartile independently predicted patients with intermediate or high SXscores (SXscore ≥23) after adjusting for age, sex, hypertension, dyslipidemia, creatinine and FPG values (Odds ratio: Q1: 1.00 reference, Q2: 3.24, Q3: 3.03, Q4: 8.04).Conclusion: HbA1c is significantly associated with the complexity of coronary lesions. This association is even observed in non-diabetic adults. A higher HbA1c value is an independent predictor of the prevalence of complex coronary lesions.
    Journal of atherosclerosis and thrombosis 08/2012; DOI:10.5551/jat.13722 · 2.77 Impact Factor
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    ABSTRACT: There are few reports demonstrating a relationship between carotid artery ultrasound (carotid-US) findings and the complexity of coronary artery disease. We aimed to examine the relationship between carotid-US findings and the severity of the SYNTAX score (SXscore). Subjects were 501 consecutive patients who underwent carotid-US and first coronary angiography from December 2008 to January 2011. Carotid-US was used to determine the mean common carotid artery intima-media thickness (meanIMT) and the plaque score (PS). The prevalences of low (0-22), intermediate (23-32), and high (≥33) SXscore patients were 84.8, 7.4, and 7.8%, respectively. The SXscore was correlated with the meanIMT (Spearman's rank correlation coefficient; ρ = 0.442, P< 0.0001) and the PS (ρ = 0.544; P< 0.0001). The odds ratios associated with the meanIMT and the PS for prediction of an intermediate or the high SXscore were 1.24 and 1.31, respectively. The areas under the receiver-operating characteristic curves for the meanIMT and the PS to predict the intermediate or the high SXscore were 0.791 and 0.846, respectively. When we set the cut-off value of a meanIMT of 0.9 mm, the sensitivity was 92.1% for intermediate or the high SXscore. Similarly, a cut-off level of a PS of 5 presented a sensitivity of 96.1%. A meanIMT ≥0.9 mm and a PS ≥ 5 had negative predictive values of 97.3 and 98.6%, respectively, for intermediate or high SXscore. Carotid-US parameters have predictive value for the SXscore. In addition, the PS and the meanIMT showed excellent negative predictive value for the presence of complex coronary artery lesions.
    European Heart Journal 01/2012; 33(1):113-9. DOI:10.1093/eurheartj/ehr399 · 14.72 Impact Factor
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    ABSTRACT: Spontaneous renal artery dissection is a rare condition that precedes renal infarction. We describe a 48-year-old, normotensive healthy woman presenting with left flank pain of sudden onset. Enhanced abdominal computed tomography demonstrated a dissecting intimal flap of the left renal artery complicating renal infarction. Doppler ultrasonography, selective angiography, and intravascular ultrasound revealed a dissecting intimal flap, with a large false lumen and narrow true lumen, of the renal artery bilaterally. Conservative management was undertaken with anticoagulant and analgesic therapy, and the patient was discharged after an uneventful clinical course.
    Journal of Cardiology Cases 10/2011; 4(2):e101-e105. DOI:10.1016/j.jccase.2011.06.002
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    ABSTRACT: Obesity is an important public health problem, especially among patients with cardiovascular disease. However, little is known about the impact of obesity on the long-term prognoses of patients with acute myocardial infarction (AMI). Major adverse cardiac and cerebrovascular events (MACCE) consist of all causes of death, stroke, target lesion revascularization, target vessel revascularization, non-fatal myocardial infarction, and hospitalization. From January 2001 to March 2005, we analyzed 121 patients who survived >30 days after suffering their first AMI of the left anterior descending artery for MACCE. The mean follow-up period for this study was 59 ± 26 months. Seventy-five patients presented with normal weight (BMI <25 kg/m(2)) and 46 were obese (BMI >25 kg/m(2)). During the follow-up period, 56 patients presented MACCE, including 18 deaths, 11 strokes, and seven non-fatal myocardial infarctions. Normal weight was significantly associated with the occurrence of MACCE (p = 0.012). Grouping of the patients by BMI and homeostasis model assessment ratio (HOMA-R) indicated that the combination of a higher BMI (>25) and lower insulin resistance (HOMA-R < 2.0) provided the best prognosis (p = 0.0006). Kaplan-Meier curves stratified to the four groups, sorted by diabetes mellitus and BMI at admission, showed that the normal weight patients with diabetes mellitus presented the highest risk of MACCE (p < 0.0001). Patients with higher BMI and no insulin resistance or diabetes mellitus present better long-term outcomes following anterior AMI.
    Heart and Vessels 09/2011; 26(5):495-501. DOI:10.1007/s00380-010-0083-3 · 2.11 Impact Factor
  • Journal of the American College of Cardiology 04/2011; 57(14). DOI:10.1016/S0735-1097(11)61961-X · 15.34 Impact Factor
  • Journal of the American College of Cardiology 04/2011; 57(14). DOI:10.1016/S0735-1097(11)61853-6 · 15.34 Impact Factor
  • Journal of the American College of Cardiology 04/2011; 57(14). DOI:10.1016/S0735-1097(11)61852-4 · 15.34 Impact Factor

Publication Stats

1k Citations
394.32 Total Impact Points

Institutions

  • 2001–2014
    • Toho University
      • • Department of Cardiovascular Medicine
      • • Department of Internal Medicine
      Edo, Tōkyō, Japan
  • 2006–2009
    • Technische Universität München
      • Medizinische Klinik und Poliklinik II
      München, Bavaria, Germany
  • 2008
    • Deutsches Herzzentrum München
      • Klinik für Herz- und Kreislauferkrankungen
      München, Bavaria, Germany
  • 2007
    • Minneapolis Heart Institute
      Minneapolis, Minnesota, United States
  • 2003–2006
    • Mitsui Memorial Hospital
      Edo, Tōkyō, Japan