著者

Masato Nakamura Kazushige Kadota Koichi Nakao Yoshihisa Nakagawa Junya Shite Hiroyoshi Yokoi Ken Kozuma Kengo Tanabe Takashi Akasaka Toshiro Shinke Takafumi Ueno Atsushi Hirayama Shiro Uemura Atsushi Harada Takeshi Kuroda Atsushi Takita Raisuke Iijima Yoshitaka Murakami Shigeru Saito

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-1058, (Released:2021-02-11)

参考文献数

20

被引用文献数

9

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Background:Outcomes with prasugrel single antiplatelet therapy (SAPT) vs. dual antiplatelet therapy (DAPT) in Japanese percutaneous coronary intervention (PCI) patients with high bleeding risk (HBR) are currently unknown.Methods and Results:Data from 1,173 SAPT and 2,535 DAPT patients from the PENDULUM mono and PENDULUM registry studies (respective median DAPT durations: 108 vs. 312 days) were compared. The adjusted cumulative incidence of Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding from 1 to 12 months after PCI (primary endpoint) was 2.8% (95% confidence interval [CI], 1.9–4.2) and 4.1% (95% CI, 3.3–5.1), respectively (hazard ratio [HR], 0.69; 95% CI, 0.45–1.06; P=0.090). The adjusted cumulative incidences of BARC 2, 3, or 5 bleeding from 0 to 12 months after PCI (secondary endpoint) were 3.8% (95% CI, 2.7–5.3) and 5.6% (95% CI, 4.7–6.7), respectively (HR, 0.68; 95% CI, 0.47–0.98; P=0.039). There was no significant difference in major adverse cardiac and cerebrovascular events (MACCE) from 1 to 12 months after PCI (HR, 0.93; 95% CI, 0.63–1.37; P=0.696) and at 12 months after PCI (HR, 0.85; 95% CI, 0.61–1.19; P=0.348) between the groups.Conclusions:Prasugrel SAPT may reduce BARC 2, 3, or 5 bleeding, without increasing MACCE, in Japanese patients with HBR.

著者

Masato Nakamura Takanari Kitazono Ken Kozuma Toru Sekine Shinya Nakamura Kazuhito Shiosakai Ayumi Tanabe Tomoko Iizuka

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.84, no.11, pp.1981-1989, 2020-10-23 (Released:2020-10-23)

参考文献数

20

被引用文献数

4

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Background:PRASFIT-Practice II is a postmarketing observational study conducted in 4,155 Japanese patients with ischemic heart disease (IHD) who received long-term prasugrel. The data were used to assess the utility of Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria.Methods and Results:Patients in PRASFIT-practice II were clinically followed for 2 years. The primary endpoint was the cumulative incidence of major adverse cardiovascular events (MACE) and Thrombolysis in Myocardial Infarction (TIMI) major/minor bleeding. Patients were divided into 2 groups based on ARC-HBR criteria (HBR (40.1% of patients) and non-HBR (59.9%)) and the effect of HBR on the primary endpoint was assessed. The median duration of dual antiplatelet therapy with prasugrel was 391.0 days. At 2 years, the cumulative incidence of MACE was 3.3%, and of TIMI major/minor bleeding was 2.7%. At 1 year, MACE and TIMI major/minor bleeding in the HBR group (4.0% and 3.4%, respectively) were higher than that in the non-HBR group (1.3% for both). Landmark analysis at 3 months and 1 year showed that the higher risk of MACE or TIMI major/minor bleeding in the HBR group persisted through 2 years.Conclusions:The results of this study confirmed the safety and effectiveness of long-term treatment with prasugrel, and demonstrated that the ARC-HBR criteria for bleeding risk are applicable in Japanese IHD patients treated with prasugrel.

著者

Shiro Uemura Hiroshi Okamoto Michikazu Nakai Kunihiro Nishimura Yoshihiro Miyamoto Satoshi Yasuda Nobuhiro Tanaka Shun Kohsaka Kazushige Kadota Yoshihiko Saito Hiroyuki Tsutsui Issei Komuro Yuji Ikari Hisao Ogawa Masato Nakamura

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0004, (Released:2019-04-24)

参考文献数

33

被引用文献数

17

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Background:Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear.Methods and Results:The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6%), and received pPCI less frequently (62.2%) than younger patients (79.2%, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7%) than in younger patients (3.8%, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI.Conclusions:Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.

著者

Raisuke Iijima Rintaro Nakajima Kaoru Sugi Masato Nakamura

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.71, no.7, pp.1079-1085, 2007 (Released:2007-06-25)

参考文献数

34

被引用文献数

7 7

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Background Recent studies have shown that a global flow abnormality affects the entire coronary tree in patients with acute coronary syndrome (ACS), and that it is associated with adverse outcomes. Postprandial hyperglycemia is also thought to promote coronary endothelial dysfunction, as well as the release of inflammatory and vasoconstrictive factors. This study used the corrected Thrombolysis In Myocardial Infarction frame count (CTFC) to investigate whether optimal control of postprandial hyperglycemia improves pan-coronary flow. Methods and Results Eighty ACS patients with postprandial hyperglycemia who had successful coronary intervention and who had undergone a 75-g oral glucose tolerance test (OGTT) were included. A second OGTT and angiogram were performed 8 months after procedures. The patients were divided according to postprandial glycemia after the second 75-g OGTT; optimal postprandial hyperglycemia was defined as a 2-h blood glucose concentration <7.8 mmol/L. Changes in the CTFC of culprit/non-culprit arteries, glucose response, and other clinical variables were compared. Forty patients improved to an optimal control at 8 months. In the culprit artery, the 8-month angiogram revealed a significantly improved CTFC among those with optimal control compared with the initial angiogram (30±9 vs 24±12, p<0.05). In contrast, the CTFC was not evidently improved among patients with suboptimal control. The CTFC at 8 months had thus obviously improved more in patients with optimal, than with suboptimal control (24±12 vs 30±11, p<0.05). Conclusion Optimal control of postprandial hyperglycemia improves epicardial blood flow in both arteries and this beneficial effect might be from improved coronary endothelial function. (Circ J 2007; 71: 1079 - 1085)

著者

Nobuhiro Tanaka Masato Nakamura Takashi Akasaka Kazushige Kadota Shirou Uemura Tetsuya Amano Nobuo Shiode Yoshihiro Morino Kenshi Fujii Yutaka Hikichi for the CVIT-DEFER Registry 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-16-1213, (Released:2017-04-26)

参考文献数

14

被引用文献数

22

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Background:Clinical use of fractional flow reserve (FFR) has been rapidly increasing, but outcomes after FFR-based coronary intervention in Japanese daily clinical practice have not been well investigated.Methods and Results:The prospective multicenter cardiovascular intervention therapeutics registry (CVIT)-DEFER enrolled consecutive patients for whom FFR measurement was clinically indicated. This study comprised 3,857 vessels in 3,272 patients. Lesions were categorized into 4 groups according to FFR result and revascularization strategy: group 1: FFR >0.8, and deferral of PCI (n=1992); group 2: FFR >0.8, then PCI (n=230); group 3: FFR ≤0.8, and deferral of PCI (n=506); and group 4: FFR ≤0.8, then PCI (n=1,129). The event rate for deferred lesions was significantly low compared with that for PCI lesions (3.5% vs. 6.6%; P<0.05). Vessel-related events occurred in 62 (3.1%), 11 (4.8%), 25 (4.9%), and 79 (7.0%) patients in groups 1, 2, 3, and 4, respectively. PCI for lesions in which FFR was >0.8 (group 2) showed no improvement in the event rate compared with a defer-strategy. On the other hand, deferred lesions with lower FFR values had a higher risk of vessel-related events.Conclusions:A FFR-based revascularization strategy in daily clinical practice was safe with regard to vessel-related events.