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ABSTRACT: OBJECTIVES: Higher rates of incomplete revascularization (IR) and reduced patency are possible drawbacks of off-pump coronary artery bypass grafting (OPCAB); both may adversely affect outcome after surgery. This study was conducted to shed light on the relationships among IR, angiographic patency, and midterm results after OPCAB surgery. METHODS: A total of 1604 consecutive patients underwent OPCAB during a 6-year period; 1581 patients (95%) underwent systematic postoperative angiography. Complete follow-up was achieved in 99.5% (median, 3.2 years; up to 6.5 years). A total of 216 patients had IR (13%), and 225 had at least 1 graft failure (FitzGibbon B or O). RESULTS: All the event-free survival rates for all-cause mortality (P < .001), cardiac death (P = .020), and major adverse cardiac and cerebrovascular events (P < .001) were lower in the IR group. By using the Cox proportional hazards model, IR was an independent risk factor for all-cause mortality (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.15-2.81). Of those who underwent postoperative angiography, the patients with graft failure experienced reintervention more frequently than those with all grafts patent (HR, 5.49; 95% CI, 3.43-8.77). Even with excluding patients who had undergone reintervention immediately after angiography, graft failure was still an independent risk factor for reintervention afterwards (HR, 2.41; 95% CI, 1.30-4.47). CONCLUSIONS: Incomplete revascularization was relevant to higher midterm mortality after OPCAB, whereas the risk of reintervention was higher for patients with occluded grafts. Complete revascularization, coupled with achievement of a higher patency rate, could be expected to improve follow-up outcomes after OPCAB surgery.
The Journal of thoracic and cardiovascular surgery 04/2013; · 3.41 Impact Factor
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ABSTRACT: BACKGROUND: Postoperative retrosternal adhesion increases the risk of cardiac injury during cardiac reoperation. We created a novel biodegradable glue called "Lydex" that is derived from food additives. The purpose of this study is to evaluate this new biomaterial's biocompatibility and its preventive effect on retrosternal adhesion. METHODS: We performed a median sternotomy and anterior pericardiectomy on Japanese white rabbits, and then closed the chest (control, group 1; n = 12), implanted an expanded polytetrafluoroethylene membrane (group 2; n = 12), or applied Lydex (group 3; n = 12) before closure. After 4 weeks, we evaluated macroscopic adhesion (each group; n = 6) and microscopic findings for fibrosis and macrophage infiltration (each group; n = 6). RESULTS: In group 3, the retrosternal adhesion score was significantly lower than in group 1 (P = .0022). There was no significant difference between groups 2 and 3. The fibrotic area ratio was significantly lower in group 3 than in groups 1 and 2 (P < .001 vs group 1; P < .001 vs group 2). In group 3, the macrophage count was significantly lower than in group 2 (P < .001) and almost equal to that in group 1. CONCLUSIONS: Our findings indicate that Lydex reduces retrosternal adhesion and attenuates the progression of fibrosis with excellent biocompatibility. Lydex is a next-generation substance for safer cardiac reoperation, with excellent capability for preventing adhesion, biocompatible and biodegradable properties, and lower potential for viral infections related to human plasma or other animal-derived products.
The Journal of thoracic and cardiovascular surgery 04/2013; · 3.41 Impact Factor
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Toshiaki Toyota,
Yutaka Furukawa,
Natsuhiko Ehara,
Shunsuke Funakoshi,
Takeshi Morimoto,
Shuichiro Kaji,
Yoshihisa Nakagawa,
Kazushige Kadota,
Masashi Iwabuchi,
Hiroki Shiomi,
Atsushi Yamamuro,
Makoto Kinoshita,
Takeshi Kitai,
Kitae Kim,
Tomoko Tani,
Atsushi Kobori,
Toru Kita, Ryuzo Sakata,
Takeshi Kimura
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ABSTRACT: Background: Limited data are available for sex-based differences in Japanese patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Methods and Results: The study patients comprised 1,197 women and 3,182 men who underwent primary PCI for AMI in 2005-2007. Compared with the men, the women were significantly older, and had significantly longer onset-to-balloon time and lower rate of follow-up coronary angiography. In-hospital mortality was higher among women than men (8.7% vs. 4.9%, P<0.001). Although the cumulative incidence of all-cause death at 3 years was also higher for women (17.7% vs. 10.7%, P<0.001), the adjusted risk for all-cause death was comparable [hazard ratio (HR, women vs. men)=0.94, 95% confidence interval (CI): 0.71-1.24, P=0.66]. The incidence (12.1% vs. 12.4%, P=0.77) and the adjusted risk (HR=0.99, 95% CI 0.78-1.24, P=0.92) for any clinically-driven coronary revascularization were both comparable. However, regarding any non-clinically-driven coronary revascularization, the incidence (19.6% vs. 27.8%, P<0.001) and the adjusted risk (HR=0.79, 95% CI 0.65-0.95, P=0.012) were both lower in women relative to men. Conclusions: In current Japanese clinical practice for AMI, onset-to-balloon time was significantly longer in women than in men. Female sex was associated with lower follow-up coronary angiography rate and lower incidence of any non-clinically-driven coronary revascularization, whereas the incidence of any clinically-driven coronary revascularization was comparable between the sexes.
Circulation Journal 03/2013; · 3.77 Impact Factor
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Tomohiro Nishino,
Yutaka Furukawa,
Shuichiro Kaji,
Natsuhiko Ehara,
Hiroki Shiomi,
Kitae Kim,
Takeshi Kitai,
Makoto Kinoshita,
Takeshi Morimoto, Ryuzo Sakata,
Takeshi Kimura
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ABSTRACT: Background: It is controversial whether angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) provide significant survival benefits in patients with coronary artery disease (CAD) but without myocardial infarction (MI). This study investigated whether the association of ACEI/ARB therapy with clinical outcome in patients undergoing percutaneous coronary intervention (PCI) was affected by history of MI. Methods and Results: A total of 11,590 patients undergoing first PCI were divided into 2 groups: those with MI and those without MI. All-cause and cardiovascular mortality were compared between the patients with and without ACEI/ARB at discharge in each group. In patients with MI, significantly lower 3-year all-cause/cardiovascular mortality for patients with ACEI/ARB relative to those without ACEI/ARB was noted in the total patients (all-cause: 6.6% vs. 11.7%, P<0.0001; cardiovascular: 3.8% vs. 6.9%, P<0.0001) and in the 1,007 propensity score-matched pairs (all-cause: 8.2% vs. 11.3%, P=0.018; cardiovascular: 3.7% vs. 5.7%, P=0.014). In patients without MI, however, all-cause (5.2% vs. 5.6%, P=0.56) and cardiovascular (3.2% vs. 3.0%, P=0.23) mortality were similar regardless of whether ACEI/ARB were used or not; and similarly in the 2,061 propensity score-matched pairs (all-cause: 4.1% vs. 5.4%, P=0.33; cardiovascular: 1.4% vs. 2.1%, P=0.30). Conclusions: Use of ACEI/ARB at hospital discharge was associated with lower all-cause/cardiovascular mortality in revascularized CAD patients with MI, but not in those without MI.
Circulation Journal 12/2012; · 3.77 Impact Factor
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ABSTRACT: The stroke rate after coronary artery bypass grafting (CABG) compared to percutaneous coronary intervention (PCI) is generally considered high because cardiopulmonary bypass and aortic manipulations are often associated with cerebrovascular complications. However, an increasing number of CABGs performed without cardiopulmonary bypass (OPCAB) may improve those outcomes. Of 6,323 patients with multivessel and/or left main coronary artery disease, 3,877 patients underwent PCI, 1,381 conventional on-pump CABG, and 1,065 OPCAB. Median follow-up was 3.4 years. Stroke types were classified as early (onset of stroke within 24 hours after revascularization), delayed (within 30 days), and late (after 30 days). Propensity score analysis showed that the incidences of early, delayed, and late stroke did not differ between PCI and OPCAB (0.65, 95% confidence interval 0.08 to 5.45, p = 1.00; 0.36, 0.10 to 1.29, p = 0.23; 0.81, 0.52 to 1.27, p = 0.72, respectively). In contrast, incidence of early stroke after on-pump CABG was higher than after OPCAB (7.22, 1.67 to 31.3, p = 0.01), but incidences of delayed and late stroke were not different (1.66, 0.70 to 3.91, p = 0.50; 1.18, 0.83 to 1.69, p = 0.73). In conclusion, occurrence of stroke was not found to differ in patients after PCI versus OPCAB regardless of onset of stroke. Occurrence of early stroke after OPCAB was lower than that after on-pump CABG, yet occurrences of delayed and late strokes were similar for the 3 revascularization strategies.
The American journal of cardiology 09/2012; · 3.58 Impact Factor
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ABSTRACT: Regenerative medicine is emerging as a new approach to the treatment of severe cardiovascular diseases that are resistant to conventional therapies. Although the type of cell transplanted (e.g., pluripotent stem cells, bone marrow-derived stem cells, skeletal myoblasts, or cardiac stem cells) influences the outcome of stem cell transplantation, the method of transplantation is also important, as the efficiency of engraftment after simple needle injection is poor. Scaffold-free cell sheet transplantation technology is one of the most promising methods in this regard. Although the results of clinical trials of stem cell therapy have been marginal to date, further elucidation of the actual mechanisms of cardiac repair following cell therapy would enhance the potential for full-scale implementation of stem cell therapy. In addition to stem cell therapy, the field of cardiovascular regenerative medicine includes interspecific chimera technology, drug delivery systems using biodegradable materials, and gene therapy. Integration of these new modalities with conventional therapies will be important to realize the goal of cardiovascular regenerative medicine tailored to the condition of each individual patient. Cardiovascular surgery would be an excellent means of carrying out this strategy and could potentially resolve the health problems of the increasing number of advanced cardiovascular patients. Herein, we review the recent basic and clinical research associated with the realization of regenerative medicine in the field of cardiovascular surgery.
General Thoracic and Cardiovascular Surgery 08/2012;
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ABSTRACT: Although statin therapy is essential for secondary cardiovascular prevention, the therapeutic effect of statins on cardiovascular outcomes in patients with advanced chronic kidney disease (CKD) after coronary revascularization has not been fully elucidated. In the CREDO-Kyoto Registry Cohort-2, 14,706 patients who underwent first coronary revascularization were divided into 4 strata based on estimated glomerular filtration rate (eGFR) or status of hemodialysis (HD). Patients in each stratum were further divided into 2 groups based on statin therapy at discharge: non-CKD stratum (eGFR ≥60 ml/min/1.73 m(2)), 8,959 patients (statin, n = 4,747; no statin, n = 4,212); mild CKD stratum (eGFR ≥30 to <60 ml/min/1.73 m(2)), 4,567 patients (statin, n = 2,135; no statin, n = 2,432); severe CKD stratum (eGFR <30 ml/min/1.73 m(2)), 608 patients (statin, n = 229; no statin, n = 379); and HD stratum, 572 patients (statin, n = 117; no statin, n = 455). Median follow-up duration was 956 days (interquartile range 699 to 1,245). Adjusted risk for major adverse cardiovascular events (MACEs; composite of cardiovascular death, myocardial infarction, or stoke) was significantly lower in the statin group than in the no-statin group in the non-CKD (hazard ratio 0.8, 95% confidence interval 0.68 to 0.95, p = 0.01) and mild CKD (hazard ratio 0.69, 95% confidence interval 0.56 to 0.84, p = 0.0002) strata. However, a significant association of statin therapy and lower risk for MACEs was not seen in the severe CKD (hazard ratio 0.91, 95% confidence interval 0.6 to 1.38, p = 0.65) and HD (hazard ratio 1.04, 95% confidence interval 0.64 to 1.69, p = 0.87) strata. In conclusion, statin therapy was associated with significantly lower risk for MACEs in patients with non-CKD and mild CKD undergoing coronary revascularization. However, therapeutic benefits of statins were not apparent in patients with severe CKD and HD.
The American journal of cardiology 08/2012; · 3.58 Impact Factor
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ABSTRACT: To elucidate the relationship between hospital volume and cardiothoracic surgical outcomes in Japan using the annual survey data, obtained between 2005 and 2009, collected by the Committee for Scientific Affairs of the Japanese Association for Thoracic Surgery.
The relationship between hospital volume and 30-day mortality was analyzed using a logistic regression model. The empirical Bayes (EB) method was also used to stabilize any large variation resulting from a small sample size. Hospitals, whose lower limit of the EB mortality 95 % confidence interval was above the mean EB mortality of all hospitals, were defined as those with "inferior outcomes". The surgical procedures analyzed were coronary artery bypass grafting (CABG: elective + emergency), elective CABG, emergency CABG, single-valve surgery, surgery for acute type A dissection, open heart surgery for newborns, open heart surgery for infants, surgery for lung cancer, and surgery for esophageal cancer.
There were large variations in 30-day mortality for all procedures, particularly in the lower-volume hospitals. There was a significant but weak inverse correlation between the hospital volume and the 30-day mortality rate for elective CABG, emergency CABG, single valve surgery, surgery for acute type A dissection, and lung cancer surgery. There was no correlation between hospital volume and the 30-day morality for open heart surgery for newborns and infants, and esophageal cancer surgery. After EB method adjustment, there was no hospital with inferior outcomes for conventional operations such as elective CABG, single-valve surgery and lung cancer surgery. The ratio of hospitals with inferior outcomes in more complex procedures was 1.8 % for open heart surgery for newborns, 0.8 % for open heart surgery for infants, and 0.2 % for esophageal cancer surgery.
There is a weak or no inverse correlation between the hospital volume and the mortality in cardiothoracic surgery in Japan. Most of the low-volume hospitals are not associated with inferior outcomes. The performance of the lower-volume hospitals should be carefully scrutinized using risk adjustment.
General Thoracic and Cardiovascular Surgery 08/2012; 60(10):625-38.
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ABSTRACT: Pulmonary dysfunction is one of the major factors for postoperative pulmonary complication. Preoperative pulmonary function test reveals possible operative risk. Particularly, in the patient with stage Ⅲ and Ⅳ chronic obstructive pulmonary disease (COPD), open heart surgery with cardiopulmonary bypass is at higher risk of complication. In these patients, safe and reliable surgical procedures are required. Preoperatively, quitting smoking and incentive spirometry can reduce the risk of pulmonary complications. Furthermore, noninvasive positive pressure ventilation (NPPV) on the appropriate indication can help to improve the outcome in the patients with pulmonary dysfunction.
Kyobu geka. The Japanese journal of thoracic surgery 08/2012; 65(8):621-4.
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Hiroki Shiomi,
Takeshi Morimoto,
Mamoru Hayano,
Yutaka Furukawa,
Yoshihisa Nakagawa,
Junichi Tazaki,
Masao Imai,
Kyohei Yamaji,
Tomohisa Tada,
Masahiro Natsuaki, [......],
Mitsuomi Shimamoto,
Noboru Nishiwaki,
Yutaka Imoto,
Tatsuhiko Komiya,
Minoru Horie,
Hisayoshi Fujiwara,
Kazuaki Mitsudo,
Masakiyo Nobuyoshi,
Toru Kita,
Takeshi Kimura
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ABSTRACT: The long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the CABG group (22.7% vs 14.8%, p = 0.0006, log-rank test). However, the adjusted outcome was not different between the PCI and CABG groups (hazard ratio [HR] 1.30, 95% confidence interval [CI] 0.79 to 2.15, p = 0.30). Stratified analysis using the SYNTAX score demonstrated that risk for a composite of death/MI/stroke was not different between the 2 treatment groups in patients with low (<23) and intermediate (23 to 33) SYNTAX scores (adjusted HR 1.70, 95% CI 0.77 to 3.76, p = 0.19; adjusted HR 0.86, 95% CI 0.37 to 1.99, p = 0.72, respectively), whereas in patients with a high SYNTAX score (≥33), it was significantly higher after PCI than after CABG (adjusted HR 2.61, 95% CI 1.32 to 5.16, p = 0.006). In conclusion, risk of PCI for serious adverse events seemed to be comparable to that after CABG in patients with ULMCAD with a low or intermediate SYNTAX score, whereas PCI compared with CABG was associated with a higher risk for serious adverse events in patients with a high SYNTAX score.
The American journal of cardiology 06/2012; 110(7):924-32. · 3.58 Impact Factor
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General Thoracic and Cardiovascular Surgery 05/2012; 58(9):493-493.
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ABSTRACT: We report the case of a 68-year-old man with progressive heart failure due to effusive-constrictive pericarditis. During approximately 1 month, echocardiography revealed rapid progression from pericarditis with effusion without tamponade to pericardial thickening and diastolic dysfunction. Cardiac catheterization revealed that the pressure in the right heart chambers remained high after pericardiocentesis. The patient was rescued by aggressive pericardiectomy and sharp dissection of the epicardium into small fragments. This on-pump beating-heart surgery is known as the waffle procedure.
General Thoracic and Cardiovascular Surgery 05/2012; 60(5):297-301.
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General Thoracic and Cardiovascular Surgery 04/2012; 59(9):636-667.
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General Thoracic and Cardiovascular Surgery 04/2012; 58(7):356-383.
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ABSTRACT: Objective(s): To analyze early results and characteristic problems that develop after cardiac surgery on dialysis patients.Methods: One hundred fourteen patients on maintenance dialysis underwent cardiac surgery. Their mean age was 63.5±9.7 years, and
87 (76%) were male. The causes of chronic renal failur were diabetes mellitus in 41 (36%) and chronic glomerulonephritis in
40 (35%). Patients had previously been on dialysis for a mean duration of 7.8±5.6 years (range; 0.25–24 years).Results: Fourteen (12%) were emergent cases. Eighty six patients (75%) received isolated coronary artery bypass grafting (CABG),
and 10 patients underwent operations in which CABG was combined with other cardiac procedures. Twelve patients (14%) of the
isolated CABG patient group (86 patients) were restricted to non-clamping bypass procedure due to severe calcification of
the ascending aorta. Calcification score, which was represented by the sum of all involved coronary artery segments, was also
significantly higher in dialysis patients than in the control group (4.5±2.4 segments vs. 1.5±2.1 segments, p<0.05). Hospital
mortality was 8.8% (10/114) overall, and 7% (6/86) in isolated CABG patients. The causes of deaths were as follows: intestinal
necrosis in 3, arrhythmia in 2, cerebral infarction in 1, low output syndrome in 1, and sepsis in 3 (mediastinitis, pneumonia,
and prosthetic valve infection).Conclusions: Long-term dialysis is a major risk factor in cardiac surgery. However, because the surgical results proved to be acceptable,
long-term dialysis patients should not be denied cardiac surgery.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 49(7):420-423.
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ABSTRACT: Objective: The treatment of thoracic aortic aneurysm accompanied by ischemic heart disease presents a surgical challenge and has up
to now shown a high hospital mortality rate. This report discusses the factors contributing to improved results in these cases.Methods: We conducted a retrospective analysis of the records of 24 consecutive patients who had undergone replacement of thoracic
aorta with combined coronary artery bypass grafting (CABG) between May 1991 and October 1998. Fifteen patients received total
arch replacement (Arch-with-CABG Group), and the other 9 patients received the Bentall operation (Bentall-with-CABG Group).
These results were compared with those patients who had undergone replacement of the thoracic aorta without CABG (Without-CABG
Group).Results: In the combined CABG groups, the overall operative mortality rate was 16.7%. In comparison with the Arch-without-CABG Group,
there was a significantly longer cardiopulmonary bypass time and longer selective cerebral perfusion time in the Arch-with-CABG
Group. However, no significant difference was observed in postoperative complications between the two groups. In addition,
there was no significant difference in either actuarial survival or the cardiac-event-free rate at 5 years between the replacement
of thoracic aorta with-and without-CABG Groups (83.1% vs. 90.4%, and 78.5% vs. 77.7%, respectively). No reoperation and no
late death were observed during the follow-up period (mean 21.3 months).Conclusions: We concluded that replacement of the thoracic aorta combined with CABG can be carried out safely, and that revascularization
for coronary artery disease is useful for preventing any occurrence of cardiac event.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 49(4):236-243.
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ABSTRACT: Objective: To assess the efficacy and safety of cardiopulmonary bypass during coronary artery bypass grafting (CABG) in dialysis patients.Methods and results: Sixty four isolated CABG patients who underwent on cardiopulmonary bypass and whose intraoperative body weight gains were
accurately measured were studied retrospectively. The mean intraoperative body weight gain was 2.61±0.9 kg/m2 in the study group and 1.06±0.6 kg/m2 in controls, i.e) 100 patients selected at random from CABG patients during the same period using cardiopulmonary bypass
without chronic renal faulure, showing a statistically significant difference. Complete revascularization was successful in
98% of patients. Postoperative nonlethal complications involved brain infarction in 1 patient (1.7%), reintubation in 1 (1.7%),
and paralytic ileus in 2 (3.4%). All were successfully extubated within 24 hours of surgery, and no sternal wound complications
were found. Hospital mortality was 6.3% (4/64). Actuarial survival rates at 3, 5 and 8 years including all deaths were 90%,
70% and 56%, and estimated by cardiac deaths were 95%, 90%, and 90% respectively. Cardiac event free rates were 90%, 73% and
61% at 3, 5 and 8 years after CABG.Conclusions: In CABG for dialysis patients, the use of cardiopulmonary bypass demonstrates significant merits, and may expect long-term
survival with minimal postoperative complications.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 49(8):504-508.
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Hidetoshi Masumoto,
Takehiko Matsuo,
Kohei Yamamizu,
Hideki Uosaki,
Genta Narazaki,
Shiori Katayama,
Akira Marui,
Tatsuya Shimizu,
Tadashi Ikeda,
Teruo Okano, Ryuzo Sakata,
Jun K Yamashita
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ABSTRACT: Although stem cell therapy is a promising strategy for cardiac restoration, the heterogeneity of transplanted cells has been hampering the precise understanding of the cellular and molecular mechanisms. Previously, we established a cardiovascular cell differentiation system from mouse pluripotent stem cells, in which cardiomyocytes (CMs), endothelial cells (ECs), and mural cells (MCs) can be systematically induced and purified. Combining this with cell sheet technology, we generated cardiac tissue sheets reassembled with defined cardiovascular populations. Here, we show the potentials and mechanisms of cardiac tissue sheet transplantation in cardiac function after myocardial infarction (MI). Transplantation of the cardiac tissue sheet to a rat MI model showed significant and sustained improvement of systolic function accompanied by neovascularization. Reduction of the infarct wall thinning and fibrotic length indicated the attenuation of left ventricular remodeling. Cell tracing with species-specific fluorescent in situ hybridization after transplantation revealed a relatively early loss of transplanted cells and an increase in endogenous neovascularization in the proximity of the graft, suggesting an indirect angiogenic effect of cardiac tissue sheets rather than direct CM contributions. We prospectively dissected the functional mechanisms with cell type-controlled sheet analyses. Sheet CMs were the main source of vascular endothelial growth factor. Transplantation of sheets lacking CMs resulted in the disappearance of neovascularization and subsequent functional improvement, indicating that the beneficial effects of the sheet were achieved by sheet CMs. ECs and MCs enhanced the sheet functions and structural integration. Supplying CMs to ischemic regions with cellular interaction could be a strategic key in future cardiac cell therapy.
Stem Cells 03/2012; 30(6):1196-205. · 7.78 Impact Factor
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Masahiro Natsuaki,
Yutaka Furukawa,
Takeshi Morimoto,
Yoshihisa Nakagawa,
Koh Ono,
Satoshi Kaburagi,
Tsukasa Inada,
Hirokazu Mitsuoka,
Ryoji Taniguchi,
Akira Nakano,
Toru Kita, Ryuzo Sakata,
Takeshi Kimura
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ABSTRACT: Association of the type of statin and the achieved level of low-density lipoprotein cholesterol (LDL-C) with cardiovascular outcome has not been fully elucidated.
The study included 14,866 patients who underwent a first coronary revascularization in 2005-2007. We identified 7,299 patients with statin therapy at discharge (so-called strong statins [atorvastatin, rosuvastatin, and pitavastatin]: 4,742 patients; standard statins [pravastatin, simvastatin, and fluvastatin]: 2,557 patients). Unadjusted 3-year incidence of major adverse cardiovascular events (MACE: composite of cardiovascular death, myocardial infarction and stroke) was significantly lower (7.5% vs. 9.6%, P=0.0008) in the strong statin group, and there was a trend in adjusted risk of MACE favoring strong statins (hazard ratio [HR] 0.87, [95% confidence interval (CI) 0.73-1.04], P=0.13). Among 4,846 patients with follow-up LDL-C data available, outcomes were evaluated according to achieved LDL-C level (<80, 80-99 [reference], 100-119, ≥120 mg/dl). Compared with the reference group, the risk for MACE was significantly higher in the ≥120 mg/dl group (adjusted HR 1.74 [95%CI 1.11-2.71], P=0.01), although it was comparable in the 100-119 mg/dl group (adjusted HR 1.23 [95%CI 0.78-1.94], P=0.38) and in the <80 mg/dl group (adjusted HR 1.15 [95%CI 0.75-1.75], P=0.52).
Strong statin therapy was associated with a trend toward lower cardiovascular risk compared with standard statin therapy. When LDL-C <120 mg/dl was achieved, risks for cardiovascular events were comparable irrespective of achieved LDL-C level.
Circulation Journal 03/2012; 76(6):1369-79. · 3.77 Impact Factor
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Shun Kohsaka,
Masashi Goto,
Toshiyuki Nagai,
Vei-Vei Lee,
MacArthur Elayda,
Yutaka Furukawa,
Masanori Fukushima,
Masashi Komeda, Ryuzo Sakata,
Mitsuru Ohsugi,
Keiichi Fukuda,
James M Wilson,
Toru Kita,
Takeshi Kimura
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ABSTRACT: Approximately 25% of patients who undergo percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) have diabetes, and the diagnosis of diabetes roughly doubles the mortality risk associated with coronary artery disease. However, the impact of diabetes may differ according to ethnicity. Our objective was to examine the impact of diabetes on long-term survival among U.S. and Japanese patients who underwent PCI or CABG.
For the current analysis, we included 8,871 patients from a Japanese multicenter registry (Coronary Revascularization Demonstrating Outcome database in Kyoto; median follow-up 3.5 years; interquartile range [IQR] 2.6-4.3) and 7,229 patients from a U.S. multipractice registry (Texas Heart Institute Research Database; median follow-up 5.2 years; IQR 3.8-6.5).
Diabetes was more prevalent among Japanese than U.S. patients (39.2 vs. 31.0%; P < 0.001). However, after revascularization, long-term all-cause mortality was lower in diabetic Japanese patients than in diabetic U.S. patients (85.4 vs. 82.2%; log-rank test P = 0.009), whereas it was similar in nondiabetic Japanese and U.S. patients (89.1 vs. 89.5%; P = 0.50). The national difference in crude mortality was also significant among insulin-using patients with diabetes (80.8 vs. 74.9%; P = 0.023). When long-term mortality was adjusted for known predictors, U.S. location was associated with greater long-term mortality risk than Japanese location among nondiabetic patients (hazard ratio 1.58 [95% CI 1.32-1.88]; P < 0.001) and, especially, diabetic patients (1.88 [1.54-2.30]; P < 0.001).
Although diabetes was less prevalent in U.S. patients than in Japanese patients, U.S. patients had higher overall long-term mortality risk. This difference was more pronounced in diabetic patients.
Diabetes care 03/2012; 35(3):654-9. · 8.09 Impact Factor
