著者

Yasuaki Takeji Tomohiko Taniguchi Takeshi Morimoto Shinichi Shirai Takeshi Kitai Hiroyuki Tabata Kazuki Kitano Nobuhisa Ono Ryosuke Murai Kohei Osakada Koichiro Murata Masanao Nakai Hiroshi Tsuneyoshi Tomohisa Tada Masashi Amano Hiroki Shiomi Hirotoshi Watanabe Yusuke Yoshikawa Ko Yamamoto Mamoru Toyofuku Shojiro Tatsushima Norino Kanamori Makoto Miyake Hiroyuki Nakayama Kazuya Nagao Masayasu Izuhara Kenji Nakatsuma Moriaki Inoko Takanari Fujita Masahiro Kimura Mitsuru Ishii Shunsuke Usami Kenichiro Sawada Fumiko Nakazeki Marie Okabayashi Manabu Shirotani Yasutaka Inuzuka Tatsuhiko Komiya Kenji Minatoya Takeshi Kimura on behalf of the CURRENT AS Registry-2 Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-21-1062, (Released:2022-04-19)

参考文献数

29

被引用文献数

2

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Background: There is scarce data evaluating the current practice pattern and clinical outcomes for patients with severe aortic stenosis (AS), including both those who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) and those who were managed conservatively in the TAVI era.Methods and Results: The Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis (CURRENT AS) Registry-2 is a prospective, physician-initiated, multicenter registry enrolling consecutive patients who were diagnosed with severe AS between April 2018 and December 2020 among 21 centers in Japan. The rationale for the prospective enrollment was to standardize the assessment of symptomatic status, echocardiographic evaluation, and other recommended diagnostic examinations such as computed tomography and measurement of B-type natriuretic peptide. Moreover, the schedule of clinical and echocardiographic follow up was prospectively defined and strongly recommended for patients who were managed conservatively. The entire study population consisted of 3,394 patients (mean age: 81.6 years and women: 60%). Etiology of AS was degenerative in 90% of patients. AS-related symptoms were present in 60% of patients; these were most often heart failure symptoms. The prevalence of high- and low-gradient AS was 58% and 42%, respectively, with classical and paradoxical low-flow low-gradient AS in 4.5% and 6.7%, respectively.Conclusions: The CURRENT AS Registry-2 might be large and meticulous enough to determine the appropriate timing of intervention for patients with severe AS in contemporary clinical practice.

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

3

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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.