研究者詳細 - 田中　哲人

論文 - 田中　哲人

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Reduced exercise capacity and clinical outcomes following acute myocardial infarction 査読有り

Tashiro Hiroshi, Tanaka Akihito, Ishii Hideki, Motomura Nariko, Arai Kenji, Adachi Takeshi, Okajima Takashi, Iwakawa Naoki, Kojima Hiroki, Mitsuda Takayuki, Hirayama Kenshi, Hitora Yusuke, Hayashi Motoharu, Furusawa Kenji, Yoshida Ruka, Imai Hajime, Ogawa Yasuhiro, Kawaguchi Katsuhiro, Murohara Toyoaki

HEART AND VESSELS 35 巻 ( 8 ) 頁： 1044 - 1050 2020年8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：Heart and Vessels

Reduced exercise capacity is known to be an important predictor of poor prognosis and disability in patients with cardiovascular diseases and chronic heart failure, and even members of the general population. However, data about exercise capacity assessed by cardiopulmonary exercise testing (CPX) in acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) is scarce. Among 594 consecutive AMI patients who underwent primary PCI, we examined 136 patients (85.3% men, 64.9 ± 11.9 years) who underwent CPX during hospitalization for AMI. CPX was usually performed 5 days after the onset of AMI. Reduced exercise capacity was defined as peak VO2 ≤ 12. Clinical outcomes including all-cause death, myocardial infarction, and hospitalization due to heart failure were followed. Among 136 patients, reduced exercise capacity (peak VO2 ≤ 12) was seen in 38 patients (28%). Patients with reduced exercise capacity were older, more likely to have hypertension, and had lower renal function. In echocardiography, patients with reduced exercise capacity had higher E/e’ and larger left atrial dimension. Multivariate logistic analysis showed that E/e’ (OR 1.19, 95% CI 1.09–1.31, p < 0.001) was an independent predictor of reduced exercise capacity (peak VO2 ≤ 12). Median follow-up term was 12 months (IQR 9–22). The occurrence of composite endpoints of all-cause death, myocardial infarction, and hospitalization due to heart failure was significantly higher in patients with peak VO2 ≤ 12 than those with peak VO2 > 12 (p < 0.001). Reduced exercise capacity following primary PCI in AMI patients is associated with diastolic dysfunction and may lead to poorer clinical outcomes.

DOI： 10.1007/s00380-020-01576-2

Prognostic impact of recanalizing chronic total occlusion in non-infarct related arteries on long-term clinical outcomes in acute myocardial infarction patients undergoing primary percutaneous coronary intervention 査読有り

Yoshida Ruka, Ishii Hideki, Morishima Itsuro, Tanaka Akihito, Takagi Kensuke, Yoshioka Naoki, Kataoka Takashi, Tashiro Hiroshi, Hitora Yusuke, Niwa Kiyoshi, Furusawa Kenji, Morita Yasuhiro, Tsuboi Hideyuki, Murohara Toyoaki

CARDIOVASCULAR INTERVENTION AND THERAPEUTICS 35 巻 ( 3 ) 頁： 259 - 268 2020年7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 Intervention and Therapeutics

Although chronic total occlusion (CTO) in non-infarct-related arteries (non-IRAs) negatively affects long-term mortality in patients with acute myocardial infarction (AMI) who are undergoing primary percutaneous coronary intervention (PCI), the prognostic impact of successful CTO-PCI has not been completely addressed. Among 1855 consecutive patients with AMI who underwent primary PCI, those who were treated for CTO with either PCI or medical therapy were included. We evaluated the association between recanalization of CTO and long-term cardiac mortality. Of the 172 included patients, 88 underwent CTO-PCI, and the procedures were successful in 65 patients. Thus, the successfully recanalized CTO (SR-CTO) group included 65 patients; and the no recanalized CTO (NR-CTO) group, 107 patients. During the follow-up, 72 patients died, and of whom 56 (77.8%) died because of cardiac causes. The cumulative 10-year, 30-day, and 30-day to 10-year incidences of cardiac mortality were lower in the SR-CTO group than in the NR-CTO group (19.0% vs. 51.9% p = 0.004; 4.6% vs. 14.0%, p = 0.05; 15.0% vs. 44.1%, p = 0.003, respectively). After adjusting for confounding factors, the benefits of SR-CTO for the 10-year cardiac mortality remained significant compared with those of NR-CTO (hazard ratio 0.37; 95% confidence interval 0.17–0.75; p = 0.004). In conclusion, patients with SR-CTO in non-IRAs after AMI was associated with reduced long-term cardiac mortality compared with those with NR-CTO.

DOI： 10.1007/s12928-019-00615-8

Optical Coherence Tomography-Guided Stent Implantation for Woven Coronary Artery Anomaly 査読有り

Uemura Yusuke, Tanaka Akihito, Takemoto Kenji, Ishii Hideki, Murohara Toyoaki, Watarai Masato

CIRCULATION JOURNAL 84 巻 ( 6 ) 頁： 1044 - 1044 2020年6月

Clinical comparison study between a newly developed optical-based fractional flow reserve device and the conventional fractional flow reserve device 査読有り

Saka Yuki, Tanaka Akihito, Ishii Hideki, Takashima Hiroaki, Suzuki Akihiro, Nakano Yusuke, Sakurai Shinichiro, Ando Hirohiko, Murohara Toyoaki, Amano Tetsuya

CORONARY ARTERY DISEASE 31 巻 ( 4 ) 頁： 342 - 347 2020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：Coronary Artery Disease

Background Fractional flow reserve (FFR) measurement is the gold standard for identifying the functional severity of coronary artery disease. Although we can use newly developed pressure wires with optical fibers are now available, their safety and accuracy for FFR measurement are not clear. Therefore, we planned a clinical comparison study between pressure wires with optical fibers and the conventional FFR device. Methods We prospectively enrolled 51 patients (51 lesions) with intermediate coronary artery stenosis. For these lesions, FFR measurements with pressure wires with optical fibers were compared with those obtained with a conventional wire. Results All procedures were successfully completed without any complications. The procedure time with pressure wires with optical fibers and a conventional wire was 6.8 ± 3.0 and 6.9 ± 2.6 minutes (P = 0.89), respectively. There was no significant difference in FFR values between pressure wires with optical fibers and a conventional wire (0.83 ± 0.10 vs. 0.83 ± 0.12, P = 0.66). An excellent correlation was observed between FFR obtained with pressure wires with optical fibers and FFR obtained with a conventional wire (r = 0.81, P < 0.001). The pressure drift before and after FFR measurements was not significantly different between pressure wires with optical fibers and a convention wire (-0.01 ± 0.02 vs. -0.02 ± 0.06, P = 0.42). There was no significant difference in pressure drift defined as >0.03 or <-0.03 between pressure wires with optical fibers and a convention wire (13.7 vs. 17.6%, P = 0.79). Conclusion Excellent correlations were observed between FFR values measured using pressure wires with optical fibers and a conventional wire. Furthermore, measurement of FFR with pressure wires with optical fibers was as well tolerated and reliable as that with a conventional wire.

DOI： 10.1097/MCA.0000000000000842

Lipid-rich large plaques in a non-culprit left main coronary artery and long-term clinical outcomes 査読有り

Tashiro Hiroshi, Tanaka Akihito, Ishii Hideki, Sakakibara Keisuke, Tobe Akihiro, Kataoka Takashi, Miki Yusuke, Hitora Yusuke, Niwa Kiyoshi, Furusawa Kenji, Murohara Toyoaki

INTERNATIONAL JOURNAL OF CARDIOLOGY 305 巻頁： 5 - 10 2020年4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：International Journal of Cardiology

Background: An integrated backscatter (IB) intravascular ultrasound (IVUS) provides an information about tissue components and vulnerability of coronary plaques. The presence of vulnerable plaque in non-culprit lesion is associated with future clinical events. The purpose of this study was to assess the association between the characteristics of non-culprit left main coronary artery (LMCA) plaques evaluated by IB-IVUS and long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Methods: Among the patients who underwent non-LMCA PCI, we studied 366 patients with adequate LMCA IVUS images. Conventional and IB-IVUS analyses of the LMCA segment were performed. Lipid-rich large plaque was defined as the presence of both a lager plaque volume and a higher percentage of the lipid component than the obtained median values. Major adverse cardiovascular events (MACE) included cardiac death, myocardial infarction, and unplanned revascularization. Results: The mean age of the patients was 68.5 ± 10.2 years, 79.8% were men. Median follow-up period was 6.0 years (IQR: 4.2–8.1 years). The incidence of MACE was significantly higher in patients with lipid-rich large plaques (P = .006). The incidence rates of cardiac death, myocardial infarction, and unplanned revascularization were significantly higher in patients with lipid-rich large plaques (P = .02, 0.004, and 0.02, respectively). Multivariate Cox regression analysis showed that the presence of a lipid-rich large plaque was significantly associated with MACE (HR: 1.74; 95%CI: 1.17–2.58; P = .006). Conclusion: The presence of lipid-rich large plaques in a non-culprit LMCA can be associated with the long-term MACE in patients who have undergone PCI.

DOI： 10.1016/j.ijcard.2020.01.072

Clinical outcomes after percutaneous coronary intervention in non-dialysis patients with acute coronary syndrome and advanced renal dysfunction 査読有り

Uemura Yusuke, Ishikawa Shinji, Takemoto Kenji, Negishi Yosuke, Tanaka Akihito, Takagi Kensuke, Yoshioka Naoyuki, Umemoto Norio, Inoue Yosuke, Morishima Itsuro, Shibata Naoki, Asano Hiroshi, Ishii Hideki, Watarai Masato, Murohara Toyoaki

CLINICAL AND EXPERIMENTAL NEPHROLOGY 24 巻 ( 4 ) 頁： 339 - 348 2020年4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：Clinical and Experimental Nephrology

Background: Data about the clinical outcomes of ACS patients with advanced renal dysfunction (estimated glomerular filtration rate < 30 mL/min/1.73 m2) following percutaneous coronary intervention (PCI) are limited. Methods: We examined the data obtained from 194 ACS patients with non-dialysis advanced renal dysfunction who underwent PCI at five hospitals. The primary composite endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, and ischemic stroke). Results: Eighty patients (41.2%) were diagnosed with ST-elevation myocardial infarction (STEMI), and 117 patients (58.8%) with non-ST-elevation ACS (NSTE-ACS). Overall patients were followed for a median of 657.5 days. Cumulative incidence of MACCE at median follow-up was 32.3% (45.4% for STEMI and 23.4% for NSTE-ACS). Kaplan–Meier analysis demonstrated that patients in the STEMI group had significantly higher incidence of MACCE than those in the non-STEMI and unstable angina group (Log-rank p < 0.001). In-hospital MACCE rate was higher in the STEMI group than in the NSTE-ACS group, whereas post-discharge MACCE rate was comparable between the two groups. In the multivariate analysis, STEMI and Killip classification ≥ 2 were associated with in-hospital MACCE. On the other hand, body mass index and serum albumin at admission were independent predictors of post-discharge MACCE. Conclusions: Short- and long-term prognoses following PCI in non-dialysis patients with ACS and advanced renal dysfunction is still unfavorable. STEMI and Killip classification ≥ 2 were independent predictors for in-hospital MACCE, and body mass index and serum albumin were for post-discharge MACCE.

DOI： 10.1007/s10157-019-01839-x

Influence of Preadmission Frailty on Short- and Mid-Term Prognoses in Octogenarians With ST-Elevation Myocardial Infarction 査読有り

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

CIRCULATION JOURNAL 84 巻 ( 4 ) 頁： 683 - 683 2020年4月

Influence of Preadmission Frailty on Short- and Mid-Term Prognoses in Octogenarians With ST-Elevation Myocardial Infarction 査読有り

CIRCULATION JOURNAL 84 巻 ( 1 ) 頁： 109 - 118 2020年1月

Differences in primary indication for guide-extension catheter usage among the three target vessels 査読有り

Yoshida Ruka, Ishii Hideki, Tanaka Akihito, Inukai Iwana, Takagi Kensuke, Murohara Toyoaki

POSTEPY W KARDIOLOGII INTERWENCYJNEJ 16 巻 ( 2 ) 頁： 192 - + 2020年

Long-term renal outcomes after elective percutaneous coronary intervention in patients with advanced renal dysfunction 査読有り

Tashiro Hiroshi, Tanaka Akihito, Ishii Hideki, Takagi Kensuke, Uemura Yusuke, Inoue Yosuke, Umemoto Norio, Negishi Yosuke, Shibata Naoki, Yoshioka Naoki, Shimizu Kiyokazu, Morishima Itsuro, Watarai Masato, Asano Hiroshi, Murohara Toyoaki

HEART AND VESSELS 36 巻 ( 4 ) 頁： 452 - 460 2020年

担当区分：責任著者記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Heart and Vessels

The aim of the present study was to evaluate the renal outcomes, including the time course of renal function, after elective PCI in patients with advanced renal dysfunction and to assess the predictors of renal dysfunction progression. This is a subanalysis of a previous observational multicenter study that investigated long-term clinical outcomes in patients with advanced renal dysfunction (eGFR < 30 mL/min/1.73 m2), focusing on 151 patients who underwent elective PCI and their long-term renal outcomes. Renal dysfunction progression was defined as a 20% relative decrease in eGFR at 1 year from baseline or the initiation of permanent dialysis within 1 year. Progression of renal dysfunction at 1 year occurred in 42 patients (34.1%). Among patients with renal dysfunction progression, the decrease of renal function from baseline was not observed at 1 month but after 6 months of the index PCI. Baseline eGFR and serum albumin level were significant predictors of renal dysfunction progression at 1 year. Among 111 patients who had not been initiated on dialysis within 1 year, those with renal dysfunction progression had a significantly higher incidence of dialysis initiation more than 1 year after the index PCI than those with preserved renal function (p < 0.001). Among patients with advanced renal dysfunction who underwent elective PCI, 34.1% showed renal dysfunction progression at 1 year. The decrease in renal function was not observed at 1 month but after 6 months of the index PCI in patients with renal dysfunction progression. Furthermore, patients with renal dysfunction progression had poorer long-term renal outcomes.

DOI： 10.1007/s00380-020-01720-y

Improved Renal Function After Percutaneous Coronary Intervention in Non-Dialysis Patients With Acute Coronary Syndrome and Advanced Renal Dysfunction 査読有り

Uemura Yusuke, Ishikawa Shinji, Takemoto Kenji, Negishi Yosuke, Tanaka Akihito, Takagi Kensuke, Yoshioka Naoki, Tashiro Hiroshi, Umemoto Norio, Inoue Yosuke, Morishima Itsuro, Shimizu Kiyokazu, Shibata Naoki, Asano Hiroshi, Ishii Hideki, Watarai Masato, Murohara Toyoaki

CARDIOVASCULAR REVASCULARIZATION MEDICINE 24 巻頁： 26 - 30 2020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：Cardiovascular Revascularization Medicine

Background: The deterioration of renal function is a strong prognostic predictor in patients with coronary artery disease. Although percutaneous coronary intervention (PCI) has sometimes resulted in improved renal function (IRF) in acute coronary syndrome (ACS) patients, its clinical implications have not been fully elucidated. This study aimed to investigate the prevalence and predictors of IRF after PCI and its relationship with long-term renal outcomes. Methods: In this retrospective observational cohort study, we examined data from 177 ACS patients with non-dialysis advanced renal dysfunction (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2) who underwent PCI. Patients with and without IRF were compared in terms of baseline demographic, clinical, and procedural characteristics and renal outcomes. IRF was defined as a 20% increase in eGFR from baseline at 7 or 30 days after the index PCI. Results: IRF was observed in 66 (37.3%) patients. ST-elevation myocardial infarction and shock during PCI were independent predictors of IRF. Patients were followed up for a median of 695 days. Kaplan-Meier analyses demonstrated that patients with IRF had the lower incidence of initiation of permanent dialysis than those without IRF (Log-rank P = 0.015). Conclusions: IRF was relatively common in non-dialysis patients with ACS and advanced renal dysfunction who underwent PCI. ST-elevation myocardial infarction and shock, which may be indicative of hemodynamic instability during PCI, were independent predictors of IRF. Further, IRF was associated with favorable renal outcomes. Hemodynamic stabilization may be important for improving the short-term and long-term renal outcomes of high-risk patients.

DOI： 10.1016/j.carrev.2020.09.011

Prognostic impact of lipoprotein(a) levels during lipid management with statins after ST-elevation acute myocardial infarction 査読有り

Mitsuda Takayuki, Uemura Yusuke, Ishii Hideki, Tanaka Akihito, Takemoto Kenji, Koyasu Masayoshi, Ishikawa Shinji, Shibata Rei, Watarai Masato, Murohara Toyoaki

CORONARY ARTERY DISEASE 30 巻 ( 8 ) 頁： 600 - 607 2019年12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：Coronary Artery Disease

The causal relationship of lipoprotein(a) with cardiovascular disease has been established. However, clinical impacts of lipoprotein(a) levels on adverse vascular events in patients with established coronary artery disease who are undergoing statin treatment have not been fully elucidated. We measured lipoprotein(a) levels of 668 consecutive patients with ST-elevated myocardial infarction upon admission and reevaluated lipoprotein(a) of 189 of these patients during statin treatment at least 6 months later than the date of index ST-elevated myocardial infarction. Changes in lipoprotein(a) and associations between lipoprotein(a) levels and the incidence of major adverse cardiac and cerebrovascular event for 3 years were examined. Lipoprotein(a) at baseline was an independent predictor of 3-year major adverse cardiac and cerebrovascular event after ST-elevated myocardial infarction. Levels of lipoprotein(a) at follow-up were slightly but significantly elevated despite improvements in other lipid parameters due to statin treatment. Furthermore, higher levels of lipoprotein(a) achieved with statin treatment were also associated with the subsequent incidence of major adverse cardiac and cerebrovascular event over 3 years, regardless of whether or not the LDL-cholesterol levels were below 100 mg/dl. In conclusion, lipoprotein(a) levels during lipid management by statin are also predictive of adverse vascular events in Japanese patients with ST-elevated myocardial infarction.

DOI： 10.1097/MCA.0000000000000798

Late Stent Thrombosis Concurrent With Stent Fracture at Calcified Nodule Lesion in Saphenous Vein Graft 査読有り

Uemura Yusuke, Tanaka Akihito, Takemoto Kenji, Koyasu Masayoshi, Mitsuda Takayuki, Ishii Hideki, Murohara Toyoaki, Watarai Masato

JACC-CARDIOVASCULAR INTERVENTIONS 12 巻 ( 22 ) 頁： E199 - E200 2019年11月

What are the remaining lessons to be learnt from 1st-generation bioresorbable scaffolds? 招待有り査読有り国際共著

Tanaka Akihito, Jabbour Richard J, Colombo Antonio

INTERNATIONAL JOURNAL OF CARDIOLOGY 293 巻頁： 103 - 104 2019年10月

Impact of adjunctive use of guide extension catheter on midterm outcome of drug-coated balloon angioplasty 査読有り

Yoshida Ruka, Ishii Hideki, Morishima Itsuro, Tanaka Akihito, Takagi Kensuke, Iwakawa Naoki, Tashiro Hiroshi, Kojima Hiroki, Mitsuda Takayuki, Hirayama Kenshi, Hitora Yusuke, Furusawa Kenji, Murohara Toyoaki

EUROINTERVENTION 15 巻 ( 8 ) 頁： 688 - 691 2019年10月

Impact of Postdischarge Bleeding on Long-Term Mortality in Percutaneous Coronary Intervention Patients Taking Oral Anticoagulants 査読有り

Yoshida Ruka, Ishii Hideki, Morishima Itsuro, Tanaka Akihito, Morita Yasuhiro, Takagi Kensuke, Yoshioka Naoki, Hirayama Kenshi, Iwakawa Naoki, Tashiro Hiroshi, Kojima Hiroki, Mitsuda Takayuki, Hitora Yusuke, Furusawa Kenji, Tsuboi Hideyuki, Murohara Toyoaki

JOURNAL OF CARDIOVASCULAR PHARMACOLOGY 74 巻 ( 3 ) 頁： 210 - 217 2019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：Journal of Cardiovascular Pharmacology

Although postdischarge bleeding (PDB) is known to negatively affect long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy (APT), the prognostic importance of PDB in patients who require both oral anticoagulants (OACs) and APT has not been fully elucidated. Among 3718 consecutive patients who underwent PCI, 302 patients were treated with both OACs and APT. We evaluated the association between PDB and 3-year all-cause mortality, as estimated by a time-updated Cox proportional hazard regression model. We performed nearest-neighbor matching on the propensity score to adjust the differences in baseline characteristics. Among 302 patients treated with OACs and APT, PDB was observed in 98 patients at a median time of 239 days. Patients experienced PDB had significantly higher incidence of 3-year all-cause mortality in the overall cohort and 94 propensity-score-matched pairs (hazard ratio 6.21, 95% confidence interval 3.29-11.72, P < 0.0001; and hazard ratio 6.13, 95% confidence interval 2.68-14.02, P < 0.0001, respectively). The risk of subsequent mortality was the highest within 180 days after PDB (58.3% within 180 days and 75.0% within 1 year). In conclusion, PDB was significantly associated with long-term mortality in patients taking both OACs and APT after PCI.

DOI： 10.1097/FJC.0000000000000702

Temporary immobile leaflet following transcatheter aortic valve replacement of a SAPIEN-XT valve 査読有り

Aoki Toshijiro, Tanaka Akihito, Tokuda Yoshiyuki, Oshima Hideki, Suzuki Susumu, Ishii Hideki

CARDIOVASCULAR INTERVENTION AND THERAPEUTICS 34 巻 ( 3 ) 頁： 277 - 278 2019年7月

Performance of HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS risk score for predicting long-term bleeding events in patients taking an oral anticoagulant undergoing percutaneous coronary intervention 査読有り

JOURNAL OF CARDIOLOGY 73 巻 ( 6 ) 頁： 479 - 487 2019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：Journal of Cardiology

Background: No standardized tool exists for weighting bleeding risk before selecting an antithrombotic regimen in patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet agents. Methods: We performed PCI in 3718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OAC and antiplatelet agents. We retrospectively evaluated the predictive performance of four major bleeding risk scores (HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS score). Patients were followed for up to 3 years for bleeding events, defined as a composite of major and minor bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) criteria and the Bleeding Academic Research Consortium (BARC) criteria. Results: TIMI significant bleedings (major, minor, and requiring medical attention) were seen in 90 patients (29.8%); whereas the BARC class ≥3 bleedings were seen in 53 patients (17.5%). Regarding TIMI significant bleedings, HAS-BLED, ORBIT, and PRECISE-DAPT scores equally categorized high-risk patients, but the PARIS score could not [high-risk versus non-high-risk: hazard ratio (HR), 1.74; 95% confidence interval (CI), 1.15–2.64; p = 0.01; HR, 1.63; 95% CI, 1.08–2.48; p = 0.02; HR, 1.62; 95% CI, 1.06–2.51; p = 0.03; HR, 1.05; 95% CI, 0.70–1.63; p = 0.79, respectively); regarding BARC class ≥3 bleeding, all four scores could stratify high-risk patients (high-risk versus non-high-risk: HR, 2.23; 95% CI, 1.30–3.88; p = 0.004; HR, 2.25; 95% CI, 1.31–3.96; p = 0.003; HR, 3.87; 95% CI, 2.06–7.91; p < 0.0001; HR, 1.85; 95% CI, 1.04–3.47; p = 0.04, respectively). Conclusions: In patients taking an OAC undergoing PCI, HAS-BLED, ORBIT, and PRECISE-DAPT scores predicted TIMI significant bleeding events better than the PARIS score; whereas all four scores could predict BARC class ≥3 bleeding events.

DOI： 10.1016/j.jjcc.2018.10.013

Contrast-Induced Nephropathy and Long-Term Clinical Outcomes Following Percutaneous Coronary Intervention in Patients With Advanced Renal Dysfunction (Estimated Glomerular Filtration Rate <30 ml/min/1.73 m(2)) 査読有り

Negishi Yosuke, Tanaka Akihito, Ishii Hideki, Takagi Kensuke, Inoue Yosuke, Uemura Yusuke, Umemoto Norio, Yoshioka Naoyuki, Morishima Itsuro, Asano Hiroshi, Watarai Masato, Shibata Naoki, Suzuki Susumu, Murohara Toyoaki

AMERICAN JOURNAL OF CARDIOLOGY 123 巻 ( 3 ) 頁： 361 - 367 2019年2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：American Journal of Cardiology

The incidence of contrast-induced nephropathy (CIN) increases with the progression of renal dysfunction. Recent reports have shown that percutaneous coronary intervention (PCI) can be safely performed even in patients with advanced renal dysfunction by appropriate CIN-prevention strategies. However, data are limited regarding the occurrence and prognostic influence of CIN in patients with advanced renal dysfunction. We examined the data obtained from 323 consecutive patients with advanced renal dysfunction (eGFR <30 ml/min/1.73 m 2 ) who underwent PCI at 5 hospitals. CIN was defined as a ≥25% increase in baseline serum creatinine levels and/or a ≥0.5 mg/dl increase in absolute serum creatinine levels within 72 hours after PCI. Incidence of all-cause death and the initiation of permanent dialysis were examined during follow-up. The prevalence of emergency/urgent PCI was 53.3%. Intravascular ultrasound was used in 266 patients (82.4%), and the volume of contrast used was 71.7 ± 57.2 ml. CIN was observed in 31 patients (9.7%). The median follow-up duration was 656 days (interquartile range 257–1143 days). The cumulative rates of all-cause death or the initiation of permanent dialysis, all-cause death, and the initiation of permanent dialysis were 38.1%, 25.9%, and 18.2%, respectively, at 2 years. A comparison between patients with and without CIN showed no significant intergroup differences in the occurrence of the aforementioned events. In conclusion, the incidence of CIN was not high in Japanese patients with advanced renal dysfunction in routine clinical practice. Whereas, the long-term prognosis following PCI is observed to be poor in this studied population, and CIN did not show a significant prognostic influence.

DOI： 10.1016/j.amjcard.2018.10.038

Influence of chronic kidney disease and worsening renal function on clinical outcomes in patients undergoing primary percutaneous coronary intervention 査読有り

Aoki Toshijiro, Ishii Hideki, Tanaka Akihito, Suzuki Susumu, Ichimiya Satoshi, Kanashiro Masaaki, Murohara Toyoaki

CLINICAL AND EXPERIMENTAL NEPHROLOGY 23 巻 ( 2 ) 頁： 182 - 188 2019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：Clinical and Experimental Nephrology

Background: The combined influence of CKD and worsening renal function (WRF) on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been fully understood. Methods: We analyzed 443 patients diagnosed with AMI who underwent primary PCI. Based on their estimated glomerular filtration rate (eGFR), they were classified into two groups: a high eGFR group (eGFR ≥ 45 mL/min/1.73 m 2 , n = 381) and a low eGFR group (eGFR < 45 mL/min/1.73 m 2 , n = 63). WRF was defined as an increase in serum creatinine levels ≥ 0.3 mg/dL above the admission value during the course of hospitalization. The primary end-point was set as all-cause mortality. Results: WRF was observed in 88 patients (19.8%). The median follow-up duration was 769 (interquartile range 397–1314) days. The all-cause mortality rate was significantly lower in the high eGFR than in the low eGFR group (5.5 vs. 28.6%, respectively, at 1500 days, P < 0.001). In patients with WRF, the all-cause and cardiac mortality rates were significantly higher than in patients without WRF, and these results were consistent between the high and low eGFR sub-groups. Multivariate Cox proportional hazards model analysis showed that low eGFR and WRF remained independent predictors of all-cause mortality [(hazard ratio 2.61, 95% confidence interval 1.27–5.36, P = 0.009) and (hazard ratio 2.59, 95% confidence interval 1.34–5.01, P = 0.005), respectively]. Conclusions: Both eGFR at baseline and WRF were observed to be important predictors of mortality in patients with AMI undergoing primary PCI. WRF showed a significant effect on mortality even in patients with high eGFR.

DOI： 10.1007/s10157-018-1622-y

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