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Hidehiro Kaneko,
Shinya Suzuki,
Junji Yajima,
Yuji Oikawa,
Koichi Sagara,
Takayuki Otsuka, Shunsuke Matsuno,
Hiroto Kano,
Tokuhisa Uejima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Clinical data on the mortality and morbidity of unselected Japanese patients with heart failure (HF) are limited. In this study, we aimed to determine the clinical characteristics, long-term outcomes, and prognostic factors of Japanese HF patients with preserved or reduced left ventricular ejection fraction (LVEF). METHODS AND RESULTS: We used a single hospital-based cohort from the Shinken Database 2004-2011 that comprised all new patients (n=17,517) visiting the Cardiovascular Institute Hospital. A total of 1525 patients diagnosed with symptomatic HF at the initial visit were included in the analysis. Of these, 1121 patients (74%) exhibited a preserved LVEF (>50%) and 404 patients (26%) had a reduced LVEF (≤50%). HF patients with preserved LVEF (HFpEF) were older and more often female than patients with reduced LVEF (HFrEF). Kaplan-Meier curves and log-rank test results showed that HFpEF patients had a better prognosis than HFrEF patients. However, there were no significant differences in clinical outcomes between HFpEF and HFrEF patients when the analysis was limited to inpatients. Cox regression analysis showed that HFpEF patients had a significantly lower risk of all-cause death (p=0.027; hazard ratio, 0.547, 95% confidence interval, 0.321-0.933). Multivariate analyses performed separately showed that the independent predictors of all-cause death in HFrEF were advanced age, lower body mass index, diabetes mellitus, and the absence of statin treatment, whereas those for HFpEF were advanced age, absence of dyslipidemia, anemia, and left ventricular hypertrophy. CONCLUSIONS: This prospective cohort study identified the clinical characteristics, long-term outcomes, and prognostic factors of Japanese HF patients with reduced and preserved ejection fractions in a real-world clinical setting.
Journal of Cardiology 05/2013; · 1.28 Impact Factor
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Hidehiro Kaneko,
Junji Yajima,
Yuji Oikawa,
Shingo Tanaka,
Daisuke Fukamachi,
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka, Shunsuke Matsuno,
Ryuichi Funada,
Hiroto Kano,
Tokuhisa Uejima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: The impact of obesity on Japanese patients who undergo primary percutaneous coronary intervention (PCI) remains unclear. METHODS AND RESULTS: Within a single hospital-based cohort in the Shinken Database 2004-2010, which comprised all new patients (n=15227) who visited the Cardiovascular Institute, we followed patients who underwent PCI. Major adverse cardiac events (MACE)-death, myocardial infarction, or target lesion revascularization (TLR)-were defined as the composite endpoint. A total of 1205 patients were included in this study (median follow-up of 1037±703 days): 92 lean [body-mass-index (BMI)<20]; 640 normal-weight (BMI=20-24.9); 417 overweight (BMI=25-29.9); and 56 obese (BMI≥30). Mean age decreased and male gender increased with increasing BMI. Classic coronary risk factors were more common in overweight and obese patients than in normal-weight and lean patients. Chronic kidney disease (CKD) was more common in lean patients than in overweight and obese patients. Patients taking dual antiplatelet therapy, statins, beta-blockers, and renin-angiotensin-system inhibitors increased in a BMI-dependent manner. Obese patients had a significantly lower frequency of MACE, all-cause death, cardiac death, and hospital admission for heart failure than lean patients. Multivariate analysis showed that BMI category was independently associated with all-cause death after PCI. CONCLUSION: Over-weight and obese patients were independently associated with favorable long-term clinical outcomes after PCI, suggesting that obesity paradox was applicable to Japanese patients after PCI in real-world clinical setting.
Journal of Cardiology 05/2013; · 1.28 Impact Factor
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Hidehiro Kaneko,
Junji Yajima,
Yuji Oikawa,
Shingo Tanaka,
Daisuke Fukamachi,
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka, Shunsuke Matsuno,
Ryuichi Funada,
Hiroto Kano,
Tokuhisa Uejima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
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.
Heart and Vessels 04/2013; · 2.05 Impact Factor
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Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka,
Hiroto Kano, Shunsuke Matsuno,
Hideaki Takai,
Tokuhisa Uejima,
Yuji Oikawa,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Junji Yajima,
Hiroaki Tanabe,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: Frequent supraventricular extrasystoles (SVEs) are associated with the subsequent first-time appearance of atrial fibrillation (AF) and ischemic stroke. The aim of this study was to investigate the combined role of SVEs and an AF-related risk score for ischemic stroke, the CHADS2 score, on the occurrence of new AF in patients in sinus rhythm. The Shinken Database 2004-2010 lists 3,263 patients who underwent 24-hour Holter monitoring. A total of 2,589 patients were analyzed, after excluding 674 patients previously diagnosed with AF. Frequent SVEs were defined as ≥102 beats/day (the top quartile) and the presence of a clinical background for a CHADS2 score ≥2 points as a high CHADS2 score. During the mean follow-up period of 571.4 ± 606.4 days, new AF occurred in 38 patients (9.4 per 1,000 patient-years). The incidence of new AF was 2.7 and 37.7 per 1,000 patient-years for patients with nonfrequent SVEs (<102 beats/day) and low CHADS2 scores and those with frequent SVEs and high CHADS2 scores, respectively. Multivariate Cox regression analysis showed that the hazard ratio for frequent SVEs and a high CHADS2 score compared with nonfrequent SVEs and a low CHADS2 score was 9.49 (95% confidence interval 3.20 to 28.15, p <0.001), even after adjustment for gender, age, medications, and echocardiographic parameters. In conclusion, frequent SVEs and a high CHADS2 score independently and synergistically predict the first-time appearance of AF in patients in sinus rhythm, indicating an approximately 10-fold higher risk. Patients meeting these criteria should have more aggressive early intervention for preventing AF.
The American journal of cardiology 03/2013; · 3.58 Impact Factor
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Hidehiro Kaneko,
Junji Yajima,
Yuji Oikawa,
Shingo Tanaka,
Daisuke Fukamachi,
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka, Shunsuke Matsuno,
Ryuichi Funada,
Hiroto Kano,
Tokuhisa Uejima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: Statins reduce cardiovascular morbidity and mortality from coronary artery disease (CAD). However, the effects of statin therapy in patients with CAD and chronic kidney disease (CKD) remain unclear. Within a single hospital-based cohort in the Shinken Database 2004-2010 comprising all patients (n = 15,227) who visited the Cardiovascular Institute, we followed patients with CKD and CAD after percutaneous coronary intervention (PCI). A major adverse cardiovascular and cerebrovascular event (MACCE) was defined by composite end points, including death, myocardial infarction, cerebral infarction, cerebral hemorrhage, and target lesion revascularization. A total of 391 patients were included in this study (median follow-up time 905 ± 679 days). Of these, 209 patients used statins. Patients with statin therapy were younger than those without. Obesity and dyslipidemia were more common, and the glomerular filtration rate (GFR) was significantly higher, in patients undergoing statin treatment. MACCE and cardiac death tended to be less common, and all-cause death was significantly less common, in patients taking statins. Multivariate analysis showed that low estimated GFR, poor left ventricular ejection fraction, and the absence of statin therapy were independent predictors for all-cause death of CKD patients after PCI. Statin therapy was associated with reduced all-cause mortality in patients with CKD and CAD after PCI.
Heart and Vessels 02/2013; · 2.05 Impact Factor
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Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka,
Hiroto Kanou, Shunsuke Matsuno,
Tokuhisa Uejima,
Yuji Oikawa,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Junji Yajima,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Several reports have identified that decline in renal function and presence of proteinuria are closely associated with incidence of atrial fibrillation (AF). However, it is still unclear whether these kidney-related markers are associated with the progression of AF from paroxysmal to persistent form. METHODS AND RESULTS: Among the new patients who visited the Cardiovascular Institute Hospital between 2004 and 2010 (Shinken Database 2004-2010, n=15,227), both estimated glomerular filtration rate (eGFR) and proteinuria were measured in 1074 AF patients (paroxysmal/persistent 579/495, respectively), who were divided into tertiles of eGFR (the borderlines were 60.07 and 73.67ml[min(-1)]1.73[m(-2)], respectively), and then further divided into the two categories with/without proteinuria. The average value of eGFR was lower (63.1ml[min(-1)]1.73[m(-2)] vs. 68.8ml[min(-1)]1.73[m(-2)], p<0.001) and the detection rate of proteinuria was higher (13.7% vs. 8.5%, p=0.006) in patients with persistent AF than in those with paroxysmal AF, respectively. In the multivariate analysis without parameters of echocardiography [left ventricular ejection fraction (LVEF) and left atrial dimension (LAD)], both eGFR and proteinuria were independently associated with persistent AF, but the association was abolished when the model included LAD and LVEF. CONCLUSIONS: In the present analysis with cross-sectional design, both eGFR and proteinuria were apparently linked to the persistent form of AF, but their role in the pathogenesis does not seem to exceed the atrial stretch and remodeling, represented by LAD and LVEF.
Journal of Cardiology 10/2012; · 1.28 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: In the era of drug-eluting stents, revascularization of an initially non-target site owing to its progression as a new culprit lesion has emerged as a new therapeutic target of coronary artery disease. We aimed to clarify the prognostic factors for the progression of a previously non-significant coronary portion after prior percutaneous coronary intervention (PCI). We examined 275 patients who underwent PCI between February 2010 and January 2011 and had follow-up coronary angiography (CAG) after 6-12 months. Patients with target lesion revascularization were excluded. Finally, a total of 236 patients were included in this study. Thirty-three patients (14 %) underwent additional clinically driven PCI to treat previously non-significant lesions. There was no difference in background clinical characteristics between patients with and without additional PCI. The prevalence of chronic kidney disease (CKD; 61 vs. 31 %, p = 0.001) and multivessel disease (MVD; 55 vs. 35 %, p = 0.027), and the brachial-ankle pulse wave velocity (baPWV; 1,838 ± 371 vs. 1,589 ± 313 cm/s, p < 0.001) were significantly higher in patients with additional PCI than in those without. A multivariate analysis showed that CKD, MVD, higher baPWV, and lower high-density lipoprotein cholesterol at the follow-up CAG were independent determinants of the progression of new culprit coronary lesions. In conclusion, higher baPWV, CKD, and MVD are independent predictors of later additional PCI, suggesting an important role for arterial stiffness and impaired renal function in the progression of new culprit coronary artery lesions after PCI.
Cardiovascular intervention and therapeutics. 09/2012;
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Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka, Shunsuke Matsuno,
Ryuichi Funada,
Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: Risk stratification for heart failure (HF) in patients with atrial fibrillation (AF) has not been well established. The aim of this study was to identify the predictors of HF events in patients with AF, consequently developing a new risk-scoring system that stratifies the risk for HF events. In this prospective, single hospital-based cohort, all patients who presented from July 2004 to March 2010 were registered (Shinken Database 2004-2009). Follow-up was maintained by being linked to the medical records or by sending study documents of prognosis. Of the 13,228 patients in the Shinken Database 2004-2009, 1,942 patients with AF were identified. Of the patients with AF, HF events (hospitalization or death from HF) occurred in 147 patients (7.6%) during a mean follow-up period of 776 ± 623 days. After identifying the parameters that were independently associated with the incidence of HF events (coexistence of organic heart diseases, anemia [hemoglobin level <11 g/dl], renal dysfunction [estimated glomerular filtration rate <60 ml/min/m(2)], diabetes mellitus, and the use of diuretics), a new scoring system was developed, the H(2)ARDD score (heart diseases = 2 points, anemia = 1 point, renal dysfunction = 1 point, diabetes = 1 point, and diuretic use = 1 point; range 0 to 6 points). This scoring system discriminated the low- and high-risk populations well (incidence in patients scoring 0 and 6 points of 0.2% and 40.8% per patient-year, respectively) and showed high predictive ability (area under the curve 0.840, 95% confidence interval 0.803 to 0.876). In conclusion, the new H(2)ARDD score may help identify the population of patients with AF at high risk for HF events.
The American journal of cardiology 05/2012; 110(5):678-82. · 3.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Although sirolimus-eluting stents (SESs) have shown to significantly reduce the incidence of restenosis, it remains unclear
when the follow-up angiography should be performed after SES implantation. A total of 868 patients with 1,574 lesions were
treated with SES. Of the 71 patients with 87 lesions were performed serial angiographic and intravascular ultrasound (IVUS)
analysis (pre, post, 1st and 2nd-follow-up). The first follow-up period was 7.9±3.5months and the second follow-up was
18.9±7.7months. Late restenosis (LR) was defined as diameter stenosis ≥50% at second follow-up, which was <50% at first
follow-up. A total of restenosis was documented in 69 patients with 89 lesions (5.7%) overall, 13 lesions (3.2%) led to LR.
Angiographic pattern of LR was predominately focal pattern. In LR group, late lumen loss by angiography was increased between
1st-follow-up and 2nd-follow-up (0.69±0.41mm in first follow-up and 1.98±0.44mm in second follow-up, p<0.0001). Minimum lumen area (MLA) by IVUS had slightly decreased already in 1st-follow-up (6.07±2.31mm2 in post procedure and 4.71±2.05mm2 in 1st-follow-up, p=0.098) and significantly decreased in 2nd-follow-up (6.07±2.31mm2 in post procedure and 1.71±0.93mm2 in 2nd-follow-up, p<0.0001). However, in each period, there were no significant difference in both late lumen loss and MLA in non-LR group.
Neointima growth prolonged gradually over 1year in LR group. These findings suggest that if neointimal proliferation is recognized
in short-term-follow-up period, long-follow-up should be needed.
KeywordsLate restenosis–Sirolimus-eluting stent–Intravascular ultrasound–Late stent thrombosis
Cardiovascular Intervention and Therapeutics 04/2012; 26(1):26-32.
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Hidehiro Kaneko,
Akira Koike,
Keitaro Senoo,
Shingo Tanaka,
Shinya Suzuki,
Osamu Nagayama,
Koichi Sagara,
Takayuki Otsuka, Shunsuke Matsuno,
Ryuichi Funada,
Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: The presence of heart failure (HF) with preserved ejection fraction (HFPEF) is increasingly recognized. However, prognostic factors for HFPEF remain unclear.
The data were derived from Shinken Database 2004-2010, a prospective cohort study (n=15,227). We examined 301 consecutive HFPEF patients (New York Heart Association Class II or greater) and tracked them for an average 3.5 years. Cardiopulmonary exercise testing (CPX), blood exams, and ultrasound cardiogram (UCG) were performed at the first medical examination. Acute decompensated HF (ADHF) admission was observed in 19 patients (6.3%). CPX showed that the anaerobic threshold was lower (7.3±4.8mL/min/kg vs. 9.7±4.3mL/min/kg, p=0.02) and slope of the increase in ventilation to the increase in CO(2) output (VE-VCO(2) slope) was higher (40.6±8.5 vs. 34.6±7.9, p<0.01) in patients with ADHF admission than those without. Serum brain natriuretic peptide (BNP) tended to be higher and left atrial (LA) dimension was significantly greater (47.0±15.8mm vs. 41.0±9.9mm, p=0.01) in patients with ADHF admission than those without. Multivariate analysis showed that higher VE-VCO(2) slope and greater LA dimension were independent determinants of ADHF admission.
An aggravated CPX parameter and LA dilatation were associated with ADHF admission in patients with symptomatic HFPEF, suggesting the prognostic role of cardiopulmonary dysfunction during exercise and LA remodeling in the pathogenesis of decompensated HF development in HFPEF.
Journal of Cardiology 03/2012; 59(3):359-65. · 1.28 Impact Factor
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Shinya Suzuki,
Takayuki Otsuka,
Koichi Sagara, Shunsuke Matsuno,
Ryuichi Funada,
Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUNd: The distribution of activated partial thromboplastin time (APTT) in nonvalvular atrial fibrillation (NVAF) patients under dabigatran therapy remains to be clarified. METHODS AND RESULTS: The study population was 196 NVAF patients who were treated with dabigatran in 2011 (126 with 220 mg/day). The APTT values showed a wide distribution among the patients, especially in those with a reduced dose, who seemed to show a high value even in patients without contraindications. CONCLUSIONS: We found a wide distribution of APTT in NVAF patients under dabigatran treatment. High APTT might help screen for bleeding risks among patients under dabigatran, but requires future investigation.
Circulation Journal 02/2012; 76(3):755-7. · 3.77 Impact Factor
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Keitaro Senoo,
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka, Shunsuke Matsuno,
Ryuichi Funada,
Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: The characteristics and prognosis of patients with first-detected atrial fibrillation (AF) in Japan remain unclear.
First-detected AF patients without structural heart disease (n=289) were reviewed with regard to 2 symptom classifications (CCS-SAF and EHRA). In both classifications, asymptomatic patients comprised ≈40% of the patients, and patients in the most symptomatic class (≈6%) had peculiar characteristics and poor prognosis. In other symptomatic classes, symptoms affected the treatment strategy without a significant difference in the patients' backgrounds and prognosis.
This is the first report to describe the distribution, characteristics and outcomes of first-detected AF patients according to symptom classifications.
Circulation Journal 01/2012; 76(4):1020-3. · 3.77 Impact Factor
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Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka, Shunsuke Matsuno,
Ryuichi Funada,
Tokuhisa Uejima,
Yuji Oikawa,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Junji Yajima,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: Although various kinds of cardiovascular risk factors have been reported to be associated with atrial fibrillation (AF), the relationship between serum uric acid level and AF has not been fully examined.
Data were collected from a single hospital-based cohort in the Shinken Database 2004-2008 (n=11,123), and consisted of serum uric acid level for 7,155 patients. The association between serum uric acid level and AF prevalence was evaluated on logistic regression. Uric acid significantly increased the crude AF prevalence in both men and women (both, P<0.001). The odds ratio (OR) and 95% confidence interval (95%CI) in the highest tertile compared with the lowest one were 3.368 (2.478-4.578) and 1.408 (1.169-1.695) in women and men, respectively. Uric acid was also significantly associated with other various cardiovascular risk factors for AF. Even after the multivariate model was adjusted using these variables, the effect of uric acid on AF was independent in women (OR, 1.888; 95%CI: 1.278-2.790), but not in men.
Reflecting the composite of various cardiovascular risk factors, serum uric acid level was apparently associated with AF prevalence. The independent association in women might imply some sex-specific mechanisms. The results should be confirmed in prospective studies.
Circulation Journal 12/2011; 76(3):607-11. · 3.77 Impact Factor
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Michinari Nakamura,
Takeshi Yamashita,
Junji Yajima,
Yuji Oikawa,
Ken Ogasawara,
Koichi Sagara,
Akira Koike,
Hajime Kirigaya,
Kazuyuki Nagashima,
Takayuki Otsuka,
Tokuhisa Uejima,
Ryuichi Funada, Shunsuke Matsuno,
Shinya Suzuki,
Hitoshi Sawada,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: The effect of early statin initiation on secondary prevention remains uncertain in unselected Japanese populations with coronary artery disease (CAD).
We investigated the mortality and morbidity in CAD patients according to presence or absence of statins within 3 months after the diagnosis of CAD in the Shinken Database cohort study. The primary endpoint was all-cause mortality.
Data were available on 789 Japanese patients with CAD (male 78.8%). Among those, 351 patients (44.5%) received a statin. The mean (SD) baseline low-density lipoprotein (LDL)-cholesterol levels were 113.6 (35.7) mg/dL in the statin group and 113.6 (26.4) mg/dL in the non-statin group (p=0.992). Unadjusted 2-year survival in patients with or without statins was 98.4% and 92.1%, respectively (p<0.001). Among a prespecified subgroup of patients undergoing percutaneous coronary intervention (PCI) (n=238 with statins and n=183 without statins), a consistent effect of statins on 2-year survival was observed (98.5% and 90.9%, respectively, p<0.001). However, there was no significant difference in 2-year target lesion revascularization-free survival (77.9% in statins versus 73.7% in non-statins, respectively, p=0.298). The age- and gender-adjusted survival in the PCI subgroup was significantly higher in the statin group [hazard ratio (HR) 0.29, 95% confidence interval (CI) 0.095-0.913] compared to non-statin. Multivariate analysis showed statins significantly reduced mortality (HR 0.27, 95%CI 0.078-0.944), but not revascularization (HR 0.91, 95%CI 0.589-1.406).
This study suggested that statin therapy initiated early after the diagnosis of CAD can decrease the risk of fatal events in Japanese CAD patients.
Journal of Cardiology 12/2010; 57(2):172-80. · 1.28 Impact Factor
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Yuji Oikawa,
Junji Yajima,
Marco A Costa, Shunsuke Matsuno,
Masafumi Akabane,
Ryuichi Funada,
Toshiro Inaba,
Yuya Nakagawa,
Michinari Nakamura,
Kazuyuki Nagashima,
Hajime Kirigaya,
Ken Ogasawara,
Hitoshi Sawada,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: Histopathology of DES restenosis remains unclear. The purpose is to examine restenotic tissue characteristics after sirolimus-eluting stent (SES) and comparing with that after bare-metal stent (BMS).
Intravascular ultrasound (IVUS), coronary angioscopy (CAS), and directional coronary atherectomy were performed simultaneously in 21 patients who presented restenosis after SES (n=13) and BMS (n=8). Mean time of restenosis was 10.8 months in the SES versus 7.5 months in the BMS. Typical "black hole'', echolucent appearance by IVUS was observed in one SES case, and corresponded to a fibrin rich tissue by histology which appeared translucent tissue by CAS. CAS did not reveal red thrombus, but showed white thrombus in six SES versus two BMS (46.2% vs. 25.0%, p=0.597). Histology demonstrated various patterns after SES including thrombus, fibrin, inflammatory infiltrate, and collagen-matrix rich tissue, while thrombus component was not detected in BMS. Thrombus and fibrin deposition detected by either CAS or histopathology were observed more frequently in SES than in BMS group (92.3% vs. 25.0%, p=0.007).
Restenosis after SES and BMS have different clinical and histological patterns. SES restenosis may be frequently associated with thrombus component.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 08/2010; 6(3):380-7. · 3.29 Impact Factor
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Yuya Nakagawa,
Junji Yajima,
Yuji Oikawa,
Ken Ogasawara,
Hajime Kirigaya,
Kazuyuki Nagashima,
Ryuichi Funada, Shunsuke Matsuno,
Toshiro Inaba,
Michinari Nakamura,
Hitoshi Sawada,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: It has been reported that nitinol stents provide higher patency in chronic phase than stainless steel stents after intervention to superficial femoral artery (SFA). However, there are few reports about stent patency for chronic total occlusion of SFA (SFA CTO).
To compare clinical outcomes of self-expanding nitinol stents and stainless steel stents after percutaneous peripheral intervention (PPI) for SFA CTO.
Between April 2004 and August 2007, a total of 25 SFA CTO lesions (nitinol stent group, 13; stainless steel stent group, 12) in 21 patients were treated with PPI, all patients were followed clinically, and 21 lesions (nitinol, 9; stainless steel, 12) received follow-up angiography. There was no significant difference in baseline characteristics, mean stent diameter (7.3+/-0.7 mm vs. 6.9+/-1.2 mm, p=0.32), pre-ankle-brachial index (ABI), and Fontaine stage between groups. Mean occlusion length and stent length were significantly longer (129.5+/-54.9 mm vs. 39.0+/-20.6 mm, 250.8+/-90.0 mm vs. 145.2+/-64.6 mm, respectively, p<0.01) and number of stents was significantly larger (2.8+/-0.9 vs. 1.6+/-0.5, p<0.01) in the nitinol stent group. At follow-up, ABI was significantly lower (0.73+/-0.20 vs. 0.95+/-0.13, p=0.04), restenosis rate and target lesion revascularization was significantly higher (58.3% vs. 15.4%, p=0.03; 50.0% vs. 7.7%, p=0.02, respectively) in the stainless steel stent group.
Our study demonstrates the superiority of nitinol stent implantation compared with stainless steel stent implantation for SFA CTO.
Journal of Cardiology 06/2009; 53(3):417-21. · 1.28 Impact Factor
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Ryuichi Funada,
Yuji Oikawa,
Junji Yajima,
Hajime Kirigaya,
Kazuyuki Nagashima,
Ken Ogasawara, Shunsuke Matsuno,
Toshiro Inaba,
Yuya Nakagawa,
Michinari Nakamura,
Masahiko Kurabayashi,
Tadanori Aizawa
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ABSTRACT: The aim is to compare virtual histology which uses spectral analysis of backscattered intravascular ultrasound (VH-IVUS) and multidetector-row computed tomography (MDCT) for the characterization of coronary atherosclerotic plaques obtained by directional coronary atherectomy (DCA). We performed DCA in 15 de novo native coronary stenotic lesions (15 patients) and selected one or two segments within the plaque from each patient (total 29 segments). Then, we evaluated the accuracy of the VH-IVUS findings in 50 sites among the 29 segments compared with the histopathology findings. MDCT was performed in all patients before percutaneous coronary intervention (PCI), and CT density values were measured. VH-IVUS data analysis correlated well with histopathological examination (predictive accuracy: 66.7% for fibrous, 100% for fibro-fatty, 100% for necrotic core, and 100% for dense calcium regions, respectively). In addition, CT density values between fibrous and fibro-fatty plaques classified by histopathology were 100.0 +/- 26.0 HU versus 110.4 +/- 67.9 HU, there were no difference among them (P = 0.594). These findings indicated that the validation of plaque characteristics using VH-IVUS correlates well with histopathology. While tissue characterization using CT density could be difficult to distinguish between fibro-fatty and fibrous tissue.
The international journal of cardiovascular imaging 04/2009; 25(5):471-8. · 2.15 Impact Factor
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ABSTRACT: Serum low-density lipoprotein (LDL), which includes apolipoprotein A-I (apoAI-LDL) may be generated by oxidization in the serum of patients with coronary artery disease (CAD). We determine the utility of the serum apoAI-LDL level as a novel coronary risk factor.
We measured serum apoAI-LDL in 473 consecutive patients who underwent diagnostic coronary angiography. Serum levels of apoAI-LDL were assayed by a newly developed ELISA.
The patients consisted of 84 with unstable angina (UA), 259 with stable CAD, and 130 without CAD (control). The serum level of apoAI-LDL was higher in CAD patients than in the control group (31.4 (22.1-41.4) microg/ml vs. 24.6 (18.4-29.2) microg/ml, respectively, p<0.001), as well as in patients with UA compared to those with stable CAD 44.5 (35.8-51.9) microg/ml vs. 27.1 (19.5-35.6) microg/ml, respectively, p<0.0001) (data are expressed as the median (25th-75th percentiles)). By logistic regression analysis, only apoAI-LDL was independent, being significantly able to predict CAD (odds ratio: 1.50, 95% CI: 1.23-1.82, p<0.001), and differentiate unstable angina (odds ratio: 1.80, 95% CI: 1.48-2.17, p<0.001) after controlling for classical risk factors.
The serum level of apoAI-LDL, a newly identified component of oxidized LDL, may be a more sensitive marker of CAD and acute coronary syndrome than CRP.
Clinica Chimica Acta 07/2008; 397(1-2):42-7. · 2.54 Impact Factor
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Yuji Oikawa,
Junji Yajima,
Dominick J Angiolillo,
Masafumi Akabane,
Ryuichi Funada, Shunsuke Matsuno,
Toshiro Inaba,
Yuya Nakagawa,
Michinari Nakamura,
Hitoshi Sawada,
Tadanori Aizawa
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ABSTRACT: Coronary artery aneurysm (CAA) often occurs after percutaneous coronary intervention, and it could be recognized more often in coronary intervention with directional coronary atherectomy (DCA). However, it has been uncertain and the natural history of CAA after DCA remains obscure. Thus, we examined the clinical course after DCA. This study included 792 lesions in which a follow-up angiogram was completed at mid- or long-term (3 months [mos.] or more than 1 year after DCA). The mean average of the angiographic follow-up period was 24.8 mos. (range 3-128 mos.), and clinical follow-up period was 45.6 mos. (range 3-144 mos.). CAA was defined as 1.5 > DCA site diameter/reference diameter by quantitative coronary angiography (QCA). CAAs were detected in 21 lesions (2.7%). There was no significant difference in the target lesion revascularization rate between CAA and non-CAA lesion (19.0% vs. 24.6%). More than twice as many follow-up coronary angiograms were performed in 15 lesions among 21 CAA lesions. The mean duration of the follow-up angiograms was 19.6 mos. There was no significant difference in lumen diameter between the value of QCA at first and final follow-up coronary angiography (3.9 +/- 0.9 vs. 4.0 +/- 0.8 mm). Acute coronary events or coronary perforations did not occur at all. This study showed the frequency of DCA-related CAA and revealed acceptable short- or long-term prognosis. DCA-related CAA had not been progressing during the follow-up period. We concluded that almost all CAAs should be managed conservatively.
The Journal of invasive cardiology 04/2008; 20(4):159-60. · 1.84 Impact Factor
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ABSTRACT: The purpose of this study is to evaluate the acute and chronic results of directional coronary atherectomy (DCA) using the Flexi-Cut atherectomy catheter to treat a left anterior descending artery (LAD) proximal lesion and the device's effect on the ostium of the left circumflex (LCx) immediately and during the postprocedure follow-up period.
From June 2001 to October 2004, 74 lesions were treated by DCA alone for LAD proximal lesions. Quantitative coronary angiography was performed pre-, post-DCA and during the follow-up period for the treated site and the LCx ostium.
The angiographic restenosis rate was 12.2%. The target lesion revascularization rate was 9.5%. After the procedure and during follow up, there was no evidence of LCx stenosis (% DS > 50%) caused by DCA.
This study suggests that DCA for LAD proximal lesions is a feasible strategy and does not affect the LCx ostium.
The Journal of invasive cardiology 02/2007; 19(1):10-1. · 1.84 Impact Factor
