著者

Ko Yamamoto Hiroki Shiomi Takeshi Morimoto Hiroki Watanabe Akiyoshi Miyazawa Kyohei Yamaji Masanobu Ohya Sunao Nakamura Satoru Mitomo Satoru Suwa Takenori Domei Shojiro Tatsushima Koh Ono Hiroki Sakamoto Kiyotaka Shimamura Masataka Shigetoshi Ryoji Taniguchi Yuji Nishimoto Hideki Okayama Kensho Matsuda Kenji Nakatsuma Yohei Takayama Jun Kuribara Hidekuni Kirigaya Kohei Yoneda Yuta Imai Umihiko Kaneko Hiroshi Ueda Kota Komiyama Naotaka Okamoto Satoru Sasaki Kengo Tanabe Mitsuru Abe Kiyoshi Hibi Kazushige Kadota Kenji Ando Takeshi Kimura on behalf of the OPTIVUS-Complex PCI Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0837, (Released:2023-03-11)

参考文献数

11

被引用文献数

5

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Background: There is a paucity of data on the effect of optimal intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with standard PCI or coronary artery bypass grafting (CABG) in patients with multivessel disease.Methods and Results: The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1,021 patients undergoing multivessel PCI including the left anterior descending coronary artery using IVUS aiming to meet the prespecified criteria for optimal stent expansion. We conducted propensity score matching analyses between the OPTIVUS group and historical PCI or CABG control groups from the CREDO-Kyoto registry cohort-3 (1,565 and 899 patients) fulfilling the inclusion criteria for this study. The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization. In the propensity score-matched cohort (OPTIVUS vs. historical PCI control: 926 patients in each group; OPTIVUS vs. historical CABG control: 436 patients in each group), the cumulative 1-year incidence of the primary endpoint was significantly lower in the OPTIVUS group than in the historical PCI control group (10.4% vs. 23.3%; log-rank P<0.001) or the historical CABG control group (11.8% vs. 16.5%; log-rank P=0.02).Conclusions: IVUS-guided PCI targeting the OPTIVUS criteria combined with contemporary clinical practice was associated with superior clinical outcomes at 1 year compared with not only the historical PCI control, but also the historical CABG control.

著者

Hirotoshi Watanabe Takeshi Morimoto Ko Yamamoto Yuki Obayashi Masahiro Natsuaki Kyohei Yamaji Manabu Ogita Satoru Suwa Tsuyoshi Isawa Takenori Domei Kenji Ando Shojiro Tatsushima Hiroki Watanabe Masanobu Oya Kazushige Kadota Hideo Tokuyama Tomohisa Tada Hiroki Sakamoto Hiroyoshi Mori Hiroshi Suzuki Tenjin Nishikura Kohei Wakabayashi Takeshi Kimura for the STOPDAPT-2 ACS Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.87, no.5, pp.657-668, 2023-04-25 (Released:2023-04-25)

参考文献数

28

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Background: The REAL-CAD trial, reported in 2017, demonstrated a significant reduction in cardiovascular events with high-intensity statins in patients with chronic coronary syndrome. However, data are scarce on the use of high-intensity statins in Japanese patients with acute coronary syndrome (ACS).Methods and Results: In STOPDAPT-2 ACS, which exclusively enrolled ACS patients between March 2018 and June 2020, 1,321 (44.2%) patients received high-intensity statins at discharge, whereas of the remaining 1,667 patients, 96.0% were treated with low-dose statins. High-intensity statins were defined as the maximum approved doses of strong statins in Japan. The incidence of the cardiovascular composite endpoint (cardiovascular death, myocardial infarction, definite stent thrombosis, stroke) was significantly lower in patients with than without high-intensity statins (1.44% vs. 2.69% [log-rank P=0.025]; adjusted hazard ratio [aHR] 0.48, 95% confidence interval [CI] 0.24–0.94, P=0.03) and the effect was evident beyond 60 days after the index percutaneous coronary intervention (log-rank P=0.01; aHR 0.38, 95% CI 0.17–0.86, P=0.02). As for the bleeding endpoint, there was no significant difference between the 2 groups (0.99% vs. 0.73% [log-rank P=0.43]; aHR 0.96, 95% CI 0.35–2.60, P=0.93).Conclusions: The prevalence of high-intensity statins has increased substantially in Japan. The use of the higher doses of statins in ACS patients recommended in the guidelines was associated with a significantly lower risk of the primary cardiovascular composite endpoint compared with lower-dose statins.

著者

Hirotoshi Watanabe Takeshi Morimoto Ko Yamamoto Yuki Obayashi Masahiro Natsuaki Kyohei Yamaji Manabu Ogita Satoru Suwa Tsuyoshi Isawa Takenori Domei Kenji Ando Shojiro Tatsushima Hiroki Watanabe Masanobu Oya Kazushige Kadota Hideo Tokuyama Tomohisa Tada Hiroki Sakamoto Hiroyoshi Mori Hiroshi Suzuki Tenjin Nishikura Kohei Wakabayashi Takeshi Kimura for the STOPDAPT-2 ACS Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0650, (Released:2022-12-08)

参考文献数

28

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Background: The REAL-CAD trial, reported in 2017, demonstrated a significant reduction in cardiovascular events with high-intensity statins in patients with chronic coronary syndrome. However, data are scarce on the use of high-intensity statins in Japanese patients with acute coronary syndrome (ACS).Methods and Results: In STOPDAPT-2 ACS, which exclusively enrolled ACS patients between March 2018 and June 2020, 1,321 (44.2%) patients received high-intensity statins at discharge, whereas of the remaining 1,667 patients, 96.0% were treated with low-dose statins. High-intensity statins were defined as the maximum approved doses of strong statins in Japan. The incidence of the cardiovascular composite endpoint (cardiovascular death, myocardial infarction, definite stent thrombosis, stroke) was significantly lower in patients with than without high-intensity statins (1.44% vs. 2.69% [log-rank P=0.025]; adjusted hazard ratio [aHR] 0.48, 95% confidence interval [CI] 0.24–0.94, P=0.03) and the effect was evident beyond 60 days after the index percutaneous coronary intervention (log-rank P=0.01; aHR 0.38, 95% CI 0.17–0.86, P=0.02). As for the bleeding endpoint, there was no significant difference between the 2 groups (0.99% vs. 0.73% [log-rank P=0.43]; aHR 0.96, 95% CI 0.35–2.60, P=0.93).Conclusions: The prevalence of high-intensity statins has increased substantially in Japan. The use of the higher doses of statins in ACS patients recommended in the guidelines was associated with a significantly lower risk of the primary cardiovascular composite endpoint compared with lower-dose statins.

著者

Ryosuke Murai Yuichi Kawase Tomohiko Taniguchi Takeshi Morimoto Kazushige Kadota Masanobu Ohya Takenobu Shimada Takeshi Maruo Yasushi Fuku Tatsuhiko Komiya Kenji Ando Michiya Hanyu Norio Kanamori Takeshi Aoyama Koichiro Murata Tomoya Onodera Fumio Yamazaki Takeshi Kitai Yutaka Furukawa Tadaaki Koyama Makoto Miyake Chisato Izumi Yoshihisa Nakagawa Kazuo Yamanaka Hirokazu Mitsuoka Manabu Shirotani Masashi Kato Shinji Miki Hiroyuki Nakajima Yutaka Hirano Shunichi Miyazaki Toshihiko Saga Sachiko Sugioka Shintaro Matsuda Mitsuo Matsuda Tatsuya Ogawa Kazuya Nagao Tsukasa Inada Shogo Nakayama Hiroshi Mabuchi Yasuyo Takeuchi Hiroki Sakamoto Genichi Sakaguchi Keiichiro Yamane Hiroshi Eizawa Mamoru Toyofuku Takashi Tamura Atsushi Iwakura Mitsuru Ishii Masaharu Akao Kotaro Shiraga Eri Minamino-Muta Takao Kato Moriaki Inoko Koji Ueyama Tomoyuki Ikeda Yoshihiro Himura Akihiro Komasa Katsuhisa Ishii Kozo Hotta Yukihito Sato Keiichi Fujiwara Yoshihiro Kato Ichiro Kouchi Yasutaka Inuzuka Shigeru Ikeguchi Senri Miwa Chiyo Maeda Eiji Shinoda Junichiro Nishizawa Toshikazu Jinnai Nobuya Higashitani Mitsuru Kitano Yuko Morikami Shouji Kitaguchi Kenji Minatoya Takeshi Kimura on behalf of the CURRENT AS Registry Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.86, no.3, pp.427-437, 2022-02-25 (Released:2022-02-25)

参考文献数

26

被引用文献数

2

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Background:The clinical significance of concomitant mitral regurgitation (MR) has not been well addressed in patients with severe aortic stenosis (AS).Methods and Results:We analyzed 3,815 patients from a retrospective multicenter registry of severe AS in Japan (CURRENT AS registry). We compared the clinical outcomes between patients with moderate/severe MR and with none/mild MR according to the initial treatment strategy (initial aortic valve replacement [AVR] or conservative strategy). The primary outcome measure was a composite of aortic valve-related death or heart failure hospitalization. At baseline, moderate/severe MR was present in 227/1,197 (19%) patients with initial AVR strategy and in 536/2,618 (20%) patients with a conservative strategy. The crude cumulative 5-year incidence of the primary outcome measure was significantly higher in patients with moderate/severe MR than in those with none/mild MR, regardless of the initial treatment strategy (25.2% vs. 14.4%, P<0.001 in the initial AVR strategy, and 63.3% vs. 40.7%, P<0.001 in the conservative strategy). After adjusting confounders, moderate/severe MR was not independently associated with higher risk for the primary outcome measure in the initial AVR strategy (hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.67–1.83, P=0.69), and in the conservative strategy (HR 1.13, 95% CI 0.93–1.37, P=0.22).Conclusions:Concomitant moderate/severe MR was not independently associated with higher risk for the primary outcome measure regardless of the initial treatment strategy.

著者

Masahiro Natsuaki Takeshi Morimoto Hiroki Shiomi Ko Yamamoto Kyohei Yamaji Hirotoshi Watanabe Takashi Uegaito Mitsuo Matsuda Toshihiro Tamura Ryoji Taniguchi Moriaki Inoko Hiroshi Mabuchi Teruki Takeda Takenori Domei Manabu Shirotani Natsuhiko Ehara Hiroshi Eizawa Katsuhisa Ishii Masaru Tanaka Tsukasa Inada Tomoya Onodera Ryuzo Nawada Eiji Shinoda Miho Yamada Takashi Yamamoto Hiroshi Sakai Mamoru Toyofuku Takashi Tamura Mamoru Takahashi Tomohisa Tada Hiroki Sakamoto Takeshi Tada Kazuhisa Kaneda Shinji Miki Takeshi Aoyama Satoru Suwa Yukihito Sato Kenji Ando Yutaka Furukawa Yoshihisa Nakagawa Kazushige Kadota Takeshi Kimura on behalf of the CREDO-Kyoto PCI/CABG Registry Cohort-Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-21-0526, (Released:2021-09-16)

参考文献数

27

被引用文献数

1

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Background:Optimal intensity is unclear for P2Y12receptor blocker therapy after percutaneous coronary intervention (PCI) in real-world clinical practice.Methods and Results:From the CREDO-Kyoto Registry, the current study population consisted of 25,419 patients (Cohort-2: n=12,161 and Cohort-3: n=13,258) who underwent their first PCI. P2Y12receptor blocker therapies were reduced dose of ticlopidine (200 mg/day), and global dose of clopidogrel (75 mg/day) in 87.7% and 94.8% of patients in Cohort-2 and Cohort-3, respectively. Cumulative 3-year incidence of GUSTO moderate/severe bleeding was significantly higher in Cohort-3 than in Cohort-2 (12.1% and 9.0%, P<0.0001). After adjusting 17 demographic factors and 9 management factors potentially related to the bleeding events other than the type of P2Y12receptor blocker, the higher bleeding risk in Cohort-3 relative to Cohort-2 remained significant (hazard ratio (HR): 1.52 95% confidence interval (CI) 1.37–1.68, P<0.0001). Cohort-3 compared with Cohort-2 was not associated with lower adjusted risk for myocardial infarction/ischemic stroke (HR: 0.96, 95% CI: 0.87–1.06, P=0.44).Conclusions:In this historical comparative study, Cohort-3 compared with Cohort-2 was associated with excess bleeding risk, which might be at least partly explained by the difference in P2Y12receptor blockers.