研究者詳細 - 田中　哲人

論文 - 田中　哲人

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Bedside cannulation for veno-venous extracorporeal membrane oxygenation using portable X-ray system in a coronavirus disease patient 査読有り

Kondo T., Kuwayama T., Hiraiwa H., Kasugai D., Goto Y., Numaguchi A., Katsu T., Matsui T., Hashimoto N., Tanaka A., Morimoto R., Okumura T., Murohara T.

Journal of Cardiology Cases 25 巻 ( 3 ) 頁： 185 - 187 2022年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology Cases

Transportation of patients with coronavirus disease (COVID)-19 outside isolation rooms should be avoided to prevent further spread of the disease. Here, we report a safe and accurate bedside cannulation method for veno-venous extracorporeal membrane oxygenation (VV-ECMO) in a COVID-19 patient in the intensive care unit. A 71-year-old man was admitted to our hospital and diagnosed as having COVID-19 pneumonia. We decided to initiate VV-ECMO therapy because maintaining blood oxygen saturation was difficult despite the mechanical ventilation. We placed two flat-panel detectors behind the patient's chest and the right inguinal area. We repeatedly imaged and monitored insertion of wires and cannulas using a portable X-ray system. Cannulas were successfully inserted in the appropriate position, and VV-ECMO was initiated without any complications. <Learning objective: Transportation of patients with coronavirus disease outside isolation rooms carries the risk of further spread of the disease. By repeatedly acquiring images using a portable X-ray system, safe and accurate cannulation for veno-venous extracorporeal membrane oxygenation cannulation can be performed at the bedside in the intensive care unit.>

DOI： 10.1016/j.jccase.2021.09.008

Albuminuria Predicts Short-Term Worsening Renal Function After Transcatheter Aortic Valve Replacement 査読有り国際誌

Tobe A., Tanaka A., Tokuda Y., Shirai Y., Otsuka S., Yamamoto T., Tokoro M., Furusawa K., Ishii H., Usui A., Murohara T.

Cardiovascular Revascularization Medicine 42 巻頁： 178 - 181 2022年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Cardiovascular Revascularization Medicine

Albuminuria is a major risk factor of cardiovascular events, however, the impact of albuminuria on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) has not been fully investigated. This retrospective study included 206 patients who underwent TAVR for severe aortic stenosis. Patients were divided into two groups according to the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR ≥ 30 mg/g) and low (ACR < 30 mg/g). The incidence of 1-month worsening renal function (WRF), defined as a decrease in estimated glomerular filtration rate (eGFR) ≥10% from baseline after TAVR, was investigated. Patients with high ACR had acute kidney injury (8.5% vs. 1.0%, p = 0.01) and 1-month WRF (29.2% vs. 12.0%, p = 0.002) more frequently than those with low ACR. High ACR was independently associated with 1-month WRF (odds ratio, 3.72; 95% confidence interval, 1.72–8.08; p < 0.001). Albuminuria can be a useful predictor of deterioration of renal function at various time points after TAVR.

DOI： 10.1016/j.carrev.2022.03.014

Assessment of appropriate body mass index cut-off points for long-term mortality among ST-elevation myocardial infarction survivors in Asian population using machine learning algorithm 査読有り国際誌

Yoshioka Naoki, Takagi Kensuke, Tanaka Akihito, Morita Yasuhiro, Yoshida Ruka, Nagai Hiroaki, Kanzaki Yasunori, Watanabe Naoki, Yamauchi Ryota, Komeyama Shotaro, Sugiyama Hiroki, Shimojo Kazuki, Imaoka Takuro, Sakamoto Gaku, Ohi Takuma, Goto Hiroki, Ishii Hideki, Morishima Itsuro, Murohara Toyoaki

HEART AND VESSELS 37 巻 ( 2 ) 頁： 219 - 228 2022年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Heart and Vessels

Low body mass index (BMI) is a predictor of adverse events in patients with ST-elevated myocardial infarction (STEMI) in Western countries. Because the average BMI of Asians is significantly lower than that of the Western population, the appropriate cut-off BMI value and its role in long-term mortality are unclear in Asian patients. Between January 2006 and December 2017, 1215 patients who underwent percutaneous coronary intervention (PCI) for acute STEMI and were alive at discharge (mean age, 67.7 years; male, 75.4%) were evaluated. The cut-off BMI value, which could predict all-cause mortality within 10 years, was detected using a survival classification and regression tree (CART) model. The causes of death according to the BMI value were evaluated in each group. Based on the CART model, the patients were divided into three groups (BMI < 18 kg/m2: 54 patients, 18 kg/m2 ≤ BMI ≤ 20 kg/m2: 109 patients, and BMI > 20 kg/m2: 1052 patients). The BMI decreased with age; with an increased BMI, patients with dyslipidemia, diabetes mellitus, and smoking habit increased. During the study period (median, 4.9 years), 194 patients (26.8%) died (cardiac death, 59 patients; non-cardiac death, 135 patients). All-cause mortality was more frequent as the BMI decreased (BMI < 18 kg/m2; 72.8%, 18 kg/m2 ≤ BMI ≤ 20 kg/m2; 40.5%, and BMI > 20 kg/m2; 22.8%; log-rank p < 0.001). Non-cardiac deaths were more frequent than cardiac deaths in all groups, and the dominance of non-cardiac death was highest in the lowest BMI group. Cut-off BMI values of 18 kg/m2 and 20 kg/m2 can predict long-term mortality after PCI in Asian STEMI survivors, whose cut-off value is lower than that in the Western populations. The main causes of death in this cohort differed according to the BMI values.

DOI： 10.1007/s00380-021-01916-w

その他リンク： https://link.springer.com/article/10.1007/s00380-021-01916-w/fulltext.html

Computed tomography imaging using split-bolus contrast injection with volume scan of aortic root and heart for preoperative evaluation of transcatheter aortic valve implantation 査読有り

Koyanagi Hitomi, Tsutsumi Yoshinori, Tokuda Yoshiyuki, Tanaka Akihito, Endo Maki, Furukawa Yasushi, Abe Shinji

HEART AND VESSELS 37 巻 ( 1 ) 頁： 132 - 141 2022年1月

記述言語：英語出版者・発行元：Heart and Vessels

The purpose of this study was to investigate using split-bolus contrast injection (SPBI) with volume scanning of the heart and aortic root with helical scanning of the access route, compared to single bolus contrast injection (SI) with variable helical pitch scanning (VHP) of the heart and aortic root and access route in a preoperative evaluation before transcatheter aortic valve implantation (TAVI). Thirty-five patients who underwent preoperative CT before TAVI using SPBI (contrast media: 24.5 mgI /kg/s, injected for 12 s for heart scan and then injected for 8 s for access route) were examined. Electrocardiogram (ECG) gated scans of the heart were performed by volume scan, after a period of time, non-gated helical scans of the aorto-iliac were performed (SPBI method). For comparison, 40 patients who had a single bolus injection (26.5 mg I/kg/s, injected for period of the scan time plus 3 s) and a VHP scan (SI method) before the SPBI method was performed were included in the study. The image qualities of the coronary arteries, aortic root, and access route (aorta-iliac), as well as radiation and iodine doses, were assessed. In visual assessment, image quality of coronary artery was significantly better with the SPBI method (grade; excellent: 57.1% in SPBI vs. 24.3% in SI, p = 0.03). There was no significant difference in image quality of the aortic root by visual assessment. The signal-to-noise (SNR) and contrast-to-noise ratio (CNR) of coronary and aortic root were not significantly different between the two methods. The access route showed significantly higher SNR (45.7 ± 11.5 vs. 34.3 ± 9.8, p < 0.001) and CNR (36.0 ± 9.7 vs. 28.0 ± 8.8, p < 0.001) for the SPBI method. The SPBI method compared to SI method reduced iodine dose by 10% and radiation dose by 45%. Preoperative CT imaging before TAVI using SPBI with volume scan is useful and can reduce iodine and radiation doses.

DOI： 10.1007/s00380-021-01899-8

Clinical Significance of the Left Atrial Appendage Orifice Area 査読有り

Miki Yusuke, Uchida Yasuhiro, Tanaka Akihito, Tobe Akihiro, Sakakibara Keisuke, Kataoka Takashi, Niwa Kiyoshi, Furusawa Kenji, Ichimiya Hitoshi, Watanabe Junji, Kanashiro Masaaki, Ishii Hideki, Ichimiya Satoshi, Murohara Toyoaki

Japanese Journal of Medicine 61 巻 ( 12 ) 頁： 1801 - 1807 2022年

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人日本内科学会

Objective The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. Three-dimensional transesophageal echocardiography (TEE) made it possible to perform a detailed evaluation of the LAA morphologies. This study aimed to evaluate the clinical implications of the LAA orifice area. Methods A total of 149 patients who underwent TEE without significant valvular disease were studied. The LAA orifice area was measured using three-dimensional TEE. The patients were divided into two groups according to the LAA orifice area (large LAA orifice group, !median value, and small LAA orifice group). The clinical characteristics and echocardiographic findings were evaluated. Results The median LAA orifice area among all patients was 4.09 cm2 (interquartile range 2.92-5.40). The large LAA orifice group were older (67.2±10.4 vs. 62.4±15.3 years, p=0.02), more often had hypertension (66.7% vs. 44.6%, p=0.007), and atrial fibrillation (70.7% vs. 39.2%, p<0.001) than the small LAA orifice group. Regarding the TEE findings, the LAA flow velocity was significantly lower (33.7±20.0 vs. 50.2±24.3, p<0.001) and spontaneous echo contrast was more often observed (21.3% vs. 8.1%, p=0.02) in the large LAA orifice group. Multivariate models demonstrated that atrial fibrillation was an independent predictor of the LAA orifice area. In the analysis of atrial fibrillation duration, the LAA orifice area tended to be larger as patients had a longer duration of atrial fibrillation. Conclusion Our findings indicated that a larger LAA orifice area was associated with the presence of atrial fibrillation and high thromboembolic risk based on TEE findings. A continuation of the atrial fibrillation rhythm might lead to the gradual expansion of the LAA orifice.

DOI： 10.2169/internalmedicine.8301-21

Spontaneous dissection of left internal mammary artery graft: A case report and literature review 査読有り

Riku S., Suzuki S., Tanaka A., Murohara T.

Cardiovascular Revascularization Medicine 2022年

担当区分：責任著者記述言語：英語出版者・発行元：Cardiovascular Revascularization Medicine

Spontaneous left internal mammary artery (LIMA) graft dissection is a rare condition, and clinical findings remain to be elucidated. We report a case of LIMA graft dissection diagnosed by a coronary computed tomography and intravascular ultrasound. The patient was successfully treated with percutaneous intervention. We also conducted a literature review of published cases and summarized the clinical presentation, pathophysiology, diagnosis, and treatment.

DOI： 10.1016/j.carrev.2022.04.007

Transcatheter aortic valve replacement for bicuspid aortic stenosis with a severely calcified raphe using an under-sized SAPIEN 3 valve: Sizing by the circle method and deployment by the pressure-regulated method 査読有り

Tobe A., Tanaka A., Tokuda Y., Shirai Y., Miyazaki T., Yuhara S., Akita S., Furusawa K., Ishii H., Mutsuga M., Murohara T.

Cardiovascular Revascularization Medicine 2022年

記述言語：英語出版者・発行元：Cardiovascular Revascularization Medicine

Transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve stenosis is challenging, and the absence of established methods for sizing the bicuspid aortic valve (BAV) complicates TAVR. We report a case of successful TAVR for bicuspid aortic stenosis with a severely calcified raphe. We used an undersized SAPIEN 3 valve, with three safety measures based on assessment of structural characteristics, sizing by the circle method, and deployment of the valve by the pressure-regulated method.

DOI： 10.1016/j.carrev.2022.08.025

Heterogeneous Carotid Plaque Predicts Cardiovascular Events after Percutaneous Coronary Intervention 査読有り

Tobe Akihiro, Tanaka Akihito, Furusawa Kenji, Shirai Yoshinori, Funakubo Hiroshi, Otsuka Satoshi, Kubota Yoshiaki, Kunieda Takeshige, Yoshioka Naoki, Sato Sara, Kudo Nobutaka, Ishii Hideki, Murohara Toyoaki

Ｊｏｕｒｎａｌ　ｏｆ　Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ　ａｎｄ　Ｔｈｒｏｍｂｏｓｉｓ advpub 巻 ( 0 ) 2022年

Impact of Handgrip Strength on Clinical Outcomes after Percutaneous Coronary Intervention 査読有り

Tobe Akihiro, Tanaka Akihito, Shirai Yoshinori, Kubota Yoshiaki, Kunieda Takeshige, Sato Sara, Furusawa Kenji, Ishii Hideki, Murohara Toyoaki

Ｊｏｕｒｎａｌ　ｏｆ　Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ　ａｎｄ　Ｔｈｒｏｍｂｏｓｉｓ advpub 巻 ( 0 ) 2022年

Prevalence of acute coronary syndrome during the pandemic of COVID-19 in the Tokai Region of Japan 査読有り

Kudo Nobutaka, Tanaka Akihito, Ishii Hideki, Uemura Yusuke, Takagi Kensuke, Iwama Makoto, Yoshida Ruka, Ohashi Taiki, Kawai Hideki, Negishi Yosuke, Umemoto Norio, Tanaka Miho, Watarai Masato, Yoshioka Naoki, Morishima Itsuro, Noda Toshiyuki, Yoshida Yukihiko, Tatami Yosuke, Muramatsu Takashi, Tanaka Toshikazu, Tashiro Hiroshi, Takada Yasunobu, Izawa Hideo, Watanabe Eiichi, Murohara Toyoaki

NAGOYA JOURNAL OF MEDICAL SCIENCE 83 巻 ( 4 ) 頁： 697 - 703 2021年11月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

The outbreak of coronavirus disease 19 (COVID-19) has had a great impact on medical care. During the COVID-19 pandemic, the rate of hospital admissions has been lower and the rate of in-hospital mortality has been higher in patients with acute coronary syndrome (ACS) in Western countries. However, in Japan, it is unknown whether the COVID-19 pandemic has affected the incidence of ACS. In the study, eleven hospitals in the Tokai region participated. Among enrolled hospital, we compared the incidence of ACS during the COVID-19 pandemic (April and May, 2020) with that in equivalent months in the preceding year as the control. During the study period; April and May 2020, 248 patients with ACS were admitted. Compared to April and May 2019, a decline of 8.1% [95% confidence interval (CI) 5.2–12.1; P = 0.33] in admissions for ACS was observed between April and May 2020. There was no significant difference in the strategy for revascularization and in-hospital deaths between 2019 and 2020. In conclusion, the rate of admission for ACS slightly decreased during the COVID-19 pandemic, compared to the same months in the preceding year. Moreover, degeneration of therapeutic procedures for ACS did not occur.

DOI： 10.18999/nagjms.83.4.697

Clinical Outcomes Following Emergent Percutaneous Coronary Intervention for Acute Total/Subtotal Occlusion of the Left Main Coronary Artery 査読有り

Shibata Naoki, Umemoto Norio, Tanaka Akihito, Takagi Kensuke, Iwama Makoto, Uemura Yusuke, Inoue Yosuke, Negishi Yosuke, Ohashi Taiki, Tanaka Miho, Yoshida Ruka, Shimizu Kiyokazu, Tashiro Hiroshi, Yoshioka Naoki, Morishima Itsuro, Noda Toshiyuki, Watarai Masato, Asano Hiroshi, Tanaka Toshikazu, Tatami Yosuke, Takada Yasunobu, Ishii Hideki, Murohara Toyoaki

日本循環器學誌 85 巻 ( 10 ) 頁： 1789 - 1796 2021年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人日本循環器学会

Background: Data regarding the clinical features, outcomes and prognostic factors in patients presenting with acute total/subtotal occlusion of the unprotected left main coronary artery (LMCA) remain limited. Methods and Results: From a multi-center registry, 134 patients due to acute total/subtotal occlusion of the unprotected LMCA were reviewed. Emergency room (ER) status classification was defined according to the presence of cardiogenic shock and cardiopulmonary arrest (CPA) in the ER (class 1=no cardiogenic shock; class 2= cardiogenic shock but not CPA; and class 3=CPA). In-hospital mortality and cerebral performance category (CPC) as the endpoints were evaluated. One-half (67/134) of the enrolled patients presented with total occlusion of the unprotected LMCA. Regarding ER status classification, class 1, 2, and 3 were observed in 30.6%, 45.5%, and 23.9% of the patients, respectively. In-hospital mortality occurred in 73 (54.5%) patients; of the remaining patients, 52 (85.3%) could be discharged with a CPC 1 or 2. ER status classification (odds ratio 4.4 [95% confidence interval: 2.33–10.67]; P<0.001) and total occlusion of the unprotected LMCA (odds ratio 8.29 [95% confidence interval 2.93–23.46]; P<0.001) were strong predictors of in-hospital mortality. Conclusions: Acute total/subtotal occlusion involving the unprotected LMCA appeared to be associated with high in-hospital mortality. ER status classification and initial flow in the unprotected LMCA were significant predictive factors of in-hospital mortality.

DOI： 10.1253/circj.cj-20-0545

In-hospital mortality among consecutive patients with ST-Elevation myocardial infarction in modern primary percutaneous intervention era similar to Insights from 15-year data of single-center hospital-based registry similar to 査読有り国際誌

Takagi Kensuke, Tanaka Akihito, Yoshioka Naoki, Morita Yasuhiro, Yoshida Ruka, Kanzaki Yasunori, Watanabe Naoki, Yamauchi Ryota, Komeyama Shotaro, Sugiyama Hiroki, Shimojo Kazuki, Imaoka Takuro, Sakamoto Gaku, Ohi Takuma, Goto Hiroki, Ishii Hideki, Morishima Itsuro, Murohara Toyoaki

PLOS ONE 16 巻 ( 6 ) 頁： e0252503 - e0252503 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：PLoS ONE

Objective To clarify the association of detailed angiographic findings with in-hospital outcome after primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) in Japan. Background Data regarding the association of detailed angiographic findings with in-hospital outcome after STEMI are limited in the p-PCI era. Methods Between January-2004 and December-2018, 1735 patients with STEMI (mean age, 68.5 years; female, 24.6%) who presented to the hospital in the 24-hours after symptom onset and underwent p-PCI were evaluated using the disease registries. The registry is an ongoing, retrospective, single-center hospital-based registry. Results The 30-day mortality rate and in-hospital mortality rate were 7.7% and 9.2%, respectively. Independent predictors of in-hospital mortality were ejection fraction (EF) < 40% [adjusted Odds Ratio (aOR), 4.446, p < 0.001], culprit lesions in the left coronary artery (LCA) (aOR, 2.940, p < 0.001) compared with those in the right coronary artery, Killip class > II (aOR, 7.438; p < 0.001), chronic kidney disease (CKD) (aOR, 4.056; p < 0.001), final thrombolysis in myocardial infarction (TIMI) grades 0/1/2 (aOR, 1.809; p = 0.03), absence of robust collaterals (aOR, 17.309; p = 0.01) and hypertension (aOR, 0.449; p = 0.01). Conclusions Among the consecutive patients with STEMI, the in-hospital mortality rate after p-PCI significantly improved in the second half. Not only CKD, Killip class > II, and EF < 40%, but also the angiographic findings such as culprit lesions in the LCA, absence of very robust collaterals, and final TIMI grades <3 were associated with an increased risk of in-hospital mortality.

DOI： 10.1371/journal.pone.0252503

Clinical characteristics and treatment of Spontaneous Coronary Artery Dissection in Young Women Undergoing Percutaneous Coronary Intervention 査読有り

Inoue Yosuke, Tanaka Akihito, Asano Hiroshi, Uemura Yusuke, Takagi Kensuke, Ohashi Taiki, Tanaka Miho, Umemoto Norio, Ajioka Masayoshi, Tashiro Hiroshi, Watarai Masato, Morishima Itsuro, Tatami Yosuke, Takada Yasunobu, Shimizu Kiyokazu, Ishii Hideki, Murohara Toyoaki

JOURNAL OF CARDIOVASCULAR MEDICINE 22 巻 ( 1 ) 頁： 14 - 19 2021年1月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of cardiovascular medicine (Hagerstown, Md.)

BACKGROUND: Spontaneous coronary artery dissection (SCAD) has recently been recognized as a cause of acute coronary syndrome (ACS), especially in young women. However, the characteristics, optimal treatment, and prognosis of patients who experience SCAD have not been fully described. METHODS: Data were retrospectively collected from a multicenter registry. Among 187 young women less than 60 years of age who underwent percutaneous coronary intervention, 19 (10.2%) with SCAD were identified through coronary angiography. Clinical characteristics and outcomes were investigated. RESULTS: Those with SCAD less frequently exhibited coronary risk factors, such as diabetes, dyslipidemia, and smoking, than those without SCAD. Intense emotional and/or physical stress was more frequently observed as a prominent precipitating factor in cases of SCAD. All 19 SCAD patients presented with ACS, 7 of whom were treated using stents, and the other 12 treated without stents. During a median follow-up of 960 days (interquartile range, 686-1504 days), two recurrent coronary artery dissections occurred within 7 days, both of which occurred in a vessel other than that in which primary dissection occurred. There were no deaths or recurrent dissection after 1 week. CONCLUSION: SCAD was not uncommon among young Japanese women requiring percutaneous coronary intervention. Patients with SCAD exhibited fewer coronary risk factors and more precipitating factors than those without SCAD, and long-term clinical outcomes after an early period appeared to be favorable.

DOI： 10.2459/jcm.0000000000001067

Association between discharge destination and mid-term mortality in octogenarian patients with ST-elevation myocardial infarction 査読有り国際誌

Yoshioka Naoki, Takagi Kensuke, Morishima Itsuro, Morita Yasuhiro, Uemura Yusuke, Inoue Yosuke, Umemoto Norio, Shibata Naoki, Negishi Yosuke, Yoshida Ruka, Tanaka Akihito, Asano Hiroshi, Watarai Masato, Ishii Hideki, Murohara Toyoaki

JOURNAL OF CARDIOLOGY 77 巻 ( 2 ) 頁： 116 - 123 2021年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background: Owing to an increasing aging population, the number of elderly patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is escalating. The onset of STEMI in elderly patients may lead to increased frailty, resulting in failure of discharge to home despite survival. However, the association of discharge destination with prognosis has not been fully evaluated in this population. Methods: Between January 2014 and December 2016, a total of 245 octogenarian STEMI survivors who underwent PCI (mean age, 84.4 years; male, 46.5%) were evaluated from a multicenter registry. The 2-year mortalities of the home discharge and non-home discharge groups were compared and analyzed using a Cox regression model. Results: Non-home discharge, which was defined as transfer to another hospital or nursing home after STEMI, was seen in 36 patients. During the 2 years, 37 patients died (home discharge, 27 patients; non-home discharge, 10 patients). The most frequent cause of death was due to infection (21.6%), followed by sudden death (18.9%) and heart failure (16.2%). The cumulative all-cause mortality was significantly higher in the non-home discharge group than in the home discharge group [36.4% vs. 14.8%; hazard ratio (HR), 2.95; 95% confidence interval (CI), 1.43−6.10; p = 0.003]. After multivariate analysis, non-home discharge (adjusted HR, 2.62; 95% CI, 1.20−5.75; p = 0.016) together with left ventricular ejection fraction <40% (adjusted HR, 3.15; 95% CI, 1.57−6.31; p = 0.001), prior heart failure (adjusted HR, 4.88; 95% CI, 1.82−13.13; p = 0.002), target lesion in the left anterior descending artery (adjusted HR, 2.20; 95% CI, 1.12−4.32; p = 0.022), and serum albumin level <3.5 g/dL (adjusted HR, 2.13; 95% CI, 1.06−4.27; p = 0.034) remained significant predictors of all-cause mortality. Conclusion: Non-home discharge was associated with an increased risk of mid-term mortality in octogenarian STEMI survivors.

DOI： 10.1016/j.jjcc.2020.06.011

Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement. 査読有り

Nishi T, Tokuda Y, Tanaka A, Furusawa K, Miki Y, Tobe A, Murohara T, Usui A

Circulation Reports 2 巻 ( 11 ) 頁： 701 - 702 2020年11月

Clinical outcomes following percutaneous coronary intervention for bifurcation lesions: kissing balloon inflation vs. sequential dilation 査読有り

Hitora Yusuke, Teraoka Tsubasa, Tanaka Akihito, Uemura Yusuke, Tobe Akihiro, Sakakibara Keisuke, Miki Yusuke, Kataoka Takashi, Niwa Kiyoshi, Tashiro Hiroshi, Furusawa Kenji, Takemoto Kenji, Watarai Masato, Kimura Akira, Ishii Hideki, Murohara Toyoaki

CARDIOVASCULAR INTERVENTION AND THERAPEUTICS 36 巻 ( 4 ) 頁： 436 - 443 2020年11月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Cardiovascular Intervention and Therapeutics

Percutaneous coronary intervention for bifurcation lesions remains challenging, with there being several debatable issues, including the requirement for kissing balloon inflation (KBI). The objective of this study was to assess the clinical outcomes following single crossover stent implantation with KBI or sequential dilation alone. Data were examined for 255 non-left main bifurcation lesions (246 patients) treated with single crossover stent implantation, followed by side branch (SB) strut dilation with KBI (n = 74 lesions) or sequential dilation (n = 181 lesions) in three hospitals. Target lesion revascularization (TLR) was the primary endpoint. There was no significant difference in the pre-procedural reference diameter of both the main vessel (MV) and SB between the KBI and sequential dilation groups. However, MV post-dilation balloon size was smaller with lower pressure and post-procedural minimal lumen diameter was significantly smaller in the KBI group. During the median follow-up period of approximately 3 years, TLR incidence was significantly higher in the KBI group than in the sequential dilation group; in particular, the TLR rate at the distal MV was higher in the former. For bifurcation lesions treated with single crossover stent implantation, the TLR rate was higher after KBI than after sequential dilation; this was mainly due to higher revascularization in the distal MV. For bifurcation lesions treated with KBI, MV post-dilation balloon diameter tended to be smaller with lower pressure, which might lead to poorer stent expansion and a higher TLR rate.

DOI： 10.1007/s12928-020-00728-5

Ablation effect of additional low-speed rotational atherectomy following high-speed rotational atherectomy: Low-speed RA following high-speed RA. 査読有り国際誌

Yoshida R, Ishii H, Morishima I, Tanaka A, Tsuda T, Takagi K, Morita Y, Kataoka T, Niwa K, Furusawa K, Yoshioka N, Tsuboi H, Murohara T

AsiaIntervention 6 巻 ( 1 ) 頁： 52 - 55 2020年7月

Coronary Drug-Eluting Stent Infection Complicated by Coronary Artery Aneurysm and Purulent Pericarditis: Complete Resolution Without Surgery 査読有り

Riku Shuro, Suzuki Susumu, Jinno Yasushi, Tanaka Akihito, Ishii Hideki, Murohara Toyoaki

CANADIAN JOURNAL OF CARDIOLOGY 36 巻 ( 6 ) 頁： 967.e1 - 967.e3 2020年6月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Canadian Journal of Cardiology

Coronary stent infection is considered to be a rare but catastrophic complication of percutaneous coronary intervention. In this report, we present a 72-year-old man who developed a coronary stent infection complicated by coronary aneurysm and purulent pericarditis. Coronary artery aneurysm resolved over a period of 8 months following the successful management of infection with intensive antibiotic therapy alone. This case suggests that conservative therapy can be a therapeutic option in patients with high operative risks.

DOI： 10.1016/j.cjca.2020.01.007

Comparison of Anti-factor Xa Activity Among Three Different Factor Xa Inhibitors in Non-valvular Atrial Fibrillation Patients with Renal Impairment 査読有り

Tobe Akihiro, Osanai Hiroyuki, Tanaka Akihito, Sakaguchi Teruhiro, Kambara Takahiro, Nakashima Yoshihito, Asano Hiroshi, Ishii Hideki, Ajioka Masayoshi, Murohara Toyoaki

CLINICAL DRUG INVESTIGATION 40 巻 ( 6 ) 頁： 567 - 573 2020年6月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Clinical Drug Investigation

Background: Factor-Xa inhibitors (FXaIs) are widely used for the treatment of non-valvular atrial fibrillation (NVAF). Although we have previously reported the distribution of the anti-factor Xa activity (AXA) values of three different FXaIs in NVAF patients, the differences in the distribution of AXA values among the different FXaIs in patients with renal impairment (RI) have not been fully elucidated. Methods: Trough and peak AXA values were measured in 94 patients taking rivaroxaban, 124 patients taking apixaban, and 66 patients taking edoxaban. Of them, we identified 26 patients with moderate RI [creatinine clearance (CrCl) 30–49 mL/min] and 17 patients with severe RI (CrCl 15–29 mL/min) in the rivaroxaban cohort, 37 patients with moderate RI and 17 patients with severe RI in the apixaban cohort, and 21 patients with moderate RI and 9 patients with severe RI in the edoxaban cohort. AXA values were measured using chromogenic AXA assays. Both trough and peak AXA values were compared between patients with moderate RI and those with severe RI in each cohort, and differences in the peak-to-trough ratio among the different drugs were assessed. Results: In the rivaroxaban cohort, the peak AXA value was significantly higher in patients with severe RI than in those with moderate RI. In the apixaban cohort, neither the trough nor peak AXA values significantly differed between patients with moderate RI and those with severe RI. In the edoxaban cohort, the trough AXA value was significantly higher in patients with severe RI than in those with moderate RI, and peak AXA tended to be higher in patients with severe RI. The peak-to-trough ratio of AXA values was significantly lower in patients taking apixaban than in those taking rivaroxaban and edoxaban. Conclusion: Among Japanese NVAF patients with RI, the peak or trough AXA values were higher in patients with severe RI than in those with moderate RI when taking rivaroxaban and edoxaban, whereas both the peak and trough AXA values were similar between patients with severe RI and those with moderate RI when taking apixaban. The peak-to-trough ratio of AXA values was the lowest in patients taking apixaban.

DOI： 10.1007/s40261-020-00912-8

Heparin 'flush' induced thrombocytopenia triggered by total hip replacement: a case report

Yoshida Ruka, Tanaka Akihito, Yoshioka Naoki, Yokote Jun

EUROPEAN HEART JOURNAL-CASE REPORTS 4 巻 ( 2 ) 頁： 1 - 5 2020年6月

記述言語：日本語出版者・発行元：European Heart Journal - Case Reports

Background Heparin-induced thrombocytopenia (HIT) typically responds to heparin termination. Some types of HIT can persist after heparin discontinuation. Case summary A 95-year-old woman was referred to the cardiology from orthopaedics because of acute limb ischaemia (ALI) 1 day after surgery of a femoral neck fracture. Despite thrombectomy, ALI relapsed the next day. She had been treated with intravenous antibiotics with a diagnosis of aspiration pneumonia for 1 week until 3 days before surgery, together with heparin flush twice a day. Of note, no intra-/post-operative heparin was administered, no cell salvage device, central venous, nor arterial catheters were used before development of ALI. The patient and her family refused reattempting invasive therapies; consequently, the patient continued to worsen and died on post-operative day 3. Diagnosis of autoimmune HIT, which was prompted by surgery without re-exposure to heparin, was confirmed posthumously. Discussion This case emphasizes the significance of suspecting autoimmune HIT in any patient presenting with thrombosis, even if the heparin exposure dates back more than a few days or even without heparin exposure.

DOI： 10.1093/ehjcr/ytaa036

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