- 著者
- Hiroki Shiomi Takeshi Morimoto Yutaka Furukawa Yoshihisa Nakagawa Ryuzo Sakata Hitoshi Okabayashi Michiya Hanyu Mitsuomi Shimamoto Noboru Nishiwaki Tatsuhiko Komiya Takeshi Kimura on behalf of the CREDO-Kyoto PCI/CABG registry cohort-2 investigators
- 出版者
- 日本循環器学会
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- pp.CJ-15-0034, (Released:2015-03-30)
- 参考文献数
- 23
- 被引用文献数
- 9 36
Background:Studies evaluating long-term (≥5 years) outcome of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD) are still limited, despite concerns for late adverse events after drug-eluting stents implantation.Methods and Results:We identified 1,004 patients with ULMCAD (PCI: n=364, CABG: n=640) among 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG registry cohort-2. The primary outcome measure in the current analysis was a composite of death, myocardial infarction, and stroke (death/MI/stroke). The cumulative 5-year incidence of and the adjusted risk for death/MI/stroke were significantly higher in the PCI group than in the CABG group (34.5% vs. 24.1%, log-rank P<0.001, adjusted hazard ratio (HR): 1.48 [95% confidence interval (CI): 1.07–2.05, P=0.02]). The adjusted risks for all-cause death was not significantly different between the 2 groups. Regarding the stratified analysis by the SYNTAX score, the adjusted risk for death/MI/stroke was not significantly different between the 2 groups in patients with low (<23) or intermediate (23–33) SYNTAX score, whereas it was significantly higher in the PCI group than in the CABG group in patients with high (≤33) SYNTAX score.Conclusions:CABG as compared with PCI was associated with better long-term outcome in patients with ULMCAD, especially those with high anatomical complexity.
- 著者
- Kenji Nakai Junichi Tsuboi Hitoshi Okabayashi Akimune Fukushima Manabu Itoh Hiroshi Kawata Fumihiko Miyake Hiroshi Kasanuki
- 出版者
- International Heart Journal Association
- 雑誌
- International Heart Journal (ISSN:13492365)
- 巻号頁・発行日
- vol.48, no.6, pp.701-713, 2007 (Released:2007-12-27)
- 参考文献数
- 23
- 被引用文献数
- 15 18 13
Noninvasive risk stratification is important for screening for lethal arrhythmia. We developed a 187-channel signal-averaged vector-projected high-resolution electrocardiograph (187-ch SAVP-ECG) for detecting abnormalities in the spatial location of ventricular high-frequency late potentials (HFLPs) and ventricular repolarization. The subjects consisted of 30 normal controls (CONTROL) and 13 patients with HFLPs (6 with myocardial infarction [MI], 6 with cardiomyopathy, and 1 with Brugada syndrome). The modified X, Y, Z-lead ECG and the synthesized signals from vector-projected 187-channel ECGs were amplified and passed through a digital filter. We calculated the integration of the HFLPs area between QRSend and 30 ms before QRSend. The integrated HFLPs map was superimposed on the corrected recovery time (RTc) and Tpeak-end dispersion maps composed by 187-ch SAVP-ECG. All patients received an examination by 64-channel magnetocardiography (64-ch MCG) on the same day. The spatial distribution of HFLPs by the 187-ch SAVP-ECG map was in agreement with the location of increased RT dispersion in MI. The spatial distribution of HFLPs in DCM demonstrated a wide variety of patterns. Interestingly, the spatial distribution of HFLPs in cases with ARVC was located at around a right ventricular outflow region. The spatial distribution of HFLPs by 187-ch SAVP-ECG was in agreement with those determined by 64-ch MCG. The 187-ch SAVP-ECG might be useful for evaluating the spatial distribution of nonuniform conduction and ventricular repolarization heterogeneity.
- 著者
- Kenji Nakai Fumihiko Miyake Hiroshi Kasanuki Morio Shoda Keisuke Futagawa Atsushi Takahashi Yuko Matsuyama Takashi Nirei Junichi Tsuboi Hitoshi Okabayashi Manabu Itoh Hiroshi Kawata
- 出版者
- International Heart Journal Association
- 雑誌
- International Heart Journal (ISSN:13492365)
- 巻号頁・発行日
- vol.49, no.2, pp.153-164, 2008 (Released:2008-05-13)
- 参考文献数
- 24
- 被引用文献数
- 14 16
The purpose of this study was to verify the spatial distribution of myocardial repolarization heterogeneity using a newly developed 187-channel signal-averaged vector-projected ECG (187-ch SAVP-ECG). We constructed corrected recovery time (RTc) and Tpeak-end (corrected Tp-e) dispersion maps using a 187-ch SAVP-ECG based on vector-projection theory using a Mason-Likar lead system. We compared the spatial distribution and quantitative values of dispersion maps by 187-ch SAVP-ECG with those by 64-ch magnetocardiography (MCG) in 27 normal controls (control) and 16 patients (12 myocardial infarction (MI), and 4 dilated cardiomyopathy (DCM)). The wave pattern of the 187-ch SAVP-ECG in the representative cases was similar to those in 64-ch MCG. Spatial distribution increased RTc and corrected Tp-e dispersion maps defined by 187-ch SAVP-ECG were in agreement with those by 64-ch MCG. The value of RTc dispersion in MI was higher than that in control (41 ± 21 ms in MI versus 30 ± 12 ms in control, P < 0.05). The value of corrected Tp-e dispersion in DCM was higher than that in control (58 ± 12 ms in DCM versus 30 ± 13 ms in control, P < 0.001). There was a good correlation between RTc and corrected Tp-e dispersion values determined by 187-ch SAVP-ECG and 64-ch MCG modalities (y = 0.46x + 18, r = 0.62, P = 0.02 for RTc dispersion; y = 0.52x + 15, r = 0.63, P = 0.01 for corrected Tp-e dispersion). RTc and corrected Tp-e dispersion maps by 187-ch SAVP-ECG based on vector-projection theory can evaluate the spatial distribution of myocardial repolarization heterogeneity.