Multicenter research of bleeding risk between prasugrel and clopidogrel in Japanese patients with coronary artery disease undergoing percutaneous coronary intervention.

Although it has been reported that prasugrel achieves stronger antiplatelet effect and fewer cardiovascular events compared to clopidogrel in Japanese patients, there are limited data comparing the safety between the 2 dose regimens. Data from 1031 consecutive patients with coronary artery disease undergoing PCI at 5 institutions from May 2014 to April 2016, who received aspirin plus either clopidogrel (619 patients) or prasugrel (412 patients), were retrospectively analyzed. The choice of clopidogrel or prasugrel was left to the operator's discretion. Adverse events were defined as a composite of bleeding, hepatopathy, leukopenia, thrombopenia, exanthema, and major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke. The average follow-up period was 143 days in the prasugrel group and 263 days in the clopidogrel group. Adverse events occurred in 34.5% of patients in the prasugrel group and in 28.6% in the clopidogrel group. Although the Kaplan-Meier curves showed lower survival rates from MACE, all-bleeding, major bleeding, minor bleeding, and adverse events, in the prasugrel group compared to the clopidogrel group (log rank test p = 0.009, p = 0.001, p = 0.012, p = 0.018, and p < 0.001, respectively), multivariate Cox-regression analyses determined prasugrel as a significant risk factor for all-bleeding, minor bleeding, and adverse events, but not for MACE and major bleeding events. Dual antiplatelet therapy with prasugrel was independently associated with minor bleeding events, but not with MACE and major bleeding events, compared to clopidogrel, after PCI in common clinical settings.

A Predictive Model for Cancer-Associated Thrombosis in Japanese Cancer Patients: Findings from the J-Khorana Registry.

Background Although the close relationship between cancer and venous thromboembolism (VTE) has been identified, risk stratification for VTE in Japanese patients with cancer remains unclear. Objectives This study aimed to validate the Khorana VTE risk assessment score (KRS) for VTE diagnosis and establish an optimal predictive model for VTE in Japanese patients with cancer. Methods A total of 7,955 Japanese patients with cancer were subdivided into low- (0), intermediate- (1-2), and high-score (3) groups according to the KRS. Using 37 explanatory variables, a total of 2,833 patients with cancer were divided into derivation and validation cohorts (5:5). A risk model for Japanese participants was developed using the derivation cohort data. Results The prevalence of VTE in low-, intermediate-, and high-score patients was 1.2, 2.5, and 4.3%, respectively. Logistic regression analysis demonstrated that cancer stage (III-IV) and KRS ≥ 2 were independent and significant predictors of VTE onset. The risk model for VTE assigned 1 point to body mass index ≥25 kg/m 2 and 2 points each to the prevalence of osteochondral cancer and D-dimer level ≥1.47 µg/mL. The areas under the curve of the risk model were 0.763 and 0.656 in the derivation and validation cohorts, respectively. Conclusion The KRS was useful in Japanese patients, and our new predictive model may be helpful for the diagnosis of VTE in Japanese patients with cancer.

Location of focal vasospasm provoked by ergonovine maleate within coronary arteries in patients with vasospastic angina pectoris.

This study examined whether coronary focal vasospasm occurs in a nonuniform distribution within the coronary tree and whether a longitudinal plaque distribution pattern is present in patients with vasospastic angina using 3-dimensional intravascular ultrasound analysis. Of 121 patients with clinically suspected angina without fixed stenosis in the coronary arteries, vasospasm was provoked in 82 patients with 92 lesions (42 focal, 50 diffuse) by intravenous ergonovine maleate injection. Most focal vasospasms occurred in the proximal third of the coronary arteries (proximal 28, mid 8, distal 6, p <0.01), corresponding to the historical high-risk zones for acute coronary occlusion. More plaque burden also existed in the proximal third of the coronary arteries in patients with focal vasospasm.

Plasma low-density lipoprotein reduction and structural effects on coronary atherosclerotic plaques by atorvastatin as clinically assessed with intravascular ultrasound radio-frequency signal analysis: a randomized prospective study.

BACKGROUND: Plaque stabilization by statins is important for reduction of cardiovascular events but has not been demonstrated enough in vivo. We examined whether statins clinically alter the structure of coronary atherosclerotic plaques using intravascular ultrasound (IVUS) radio-frequency (RF) signal analysis. METHODS: Fifty consecutive patients undergoing percutaneous coronary intervention were enrolled. Intravascular ultrasound radio-frequency signals were acquired from non-percutaneous coronary intervention-targeted echolucent plaques. The patients were randomly assigned into 2 groups: group S (n = 25) taking atorvastatin 10 mg/d and group C (n = 25) as control. After 6-month follow-up, IVUS-RF signals were sampled at the same plaque sites. Several regions of interest were placed on each plaque. Intravascular ultrasound radio-frequency parameters were blindly calculated in all regions of interests (group S, n = 148; group C, n = 191). Targeted plaque volumes were also measured. Those data were compared between baseline and follow-up. RESULTS: In group S after 6 months, plasma low-density lipoprotein level was significantly decreased (133 +/- 13 to 87 +/- 29 mg/dL, P < .0001), integrated backscatter of IVUS-RF signals was substantially increased (-53.8 +/- 4.5 to -51.2 +/- 4.9 dB, P < .0001), and plaque volume was significantly reduced, whereas no change was demonstrated in group C. CONCLUSIONS: These results suggest that statins alter properties as well as volumes of coronary plaques within 6 months, which may be related to plasma low-density lipoprotein reduction. Intravascular ultrasound radio-frequency signal analysis may be useful to evaluate the effects of drugs on stabilization of coronary atherosclerotic plaques.

Damage to polymer of undelivered sirolimus-eluting stents.

BACKGROUND: Damage to the polymer coating on sirolimus-eluting stents (SES) may occur when it is delivered through complex lesions such as calcified lesions. The present study evaluated damage to the polymer of SES that could not be delivered into lesions. METHODS: SES that could not be delivered into lesions were prospectively collected and examined using a scanning electron microscope. RESULTS: There were 5 undelivered SES. In all cases, moderate or severe calcification with and without vessel tortuosity were reasons for unsuccessful delivery. Scanning electron microscopy demonstrated damage to the polymer of 4 out of the 5 undelivered SES. CONCLUSION: Damage to the polymer coating of SES may occur when delivered through a calcified coronary artery.

Large pseudoaneurysm after left main trunk stenting sealed by polytetrafluorethylene-covered stent.

Left main trunk (LMT) aneurysm is very rare and the management remains uncertain. We describe a patient who developed a pseudoaneurysm from coronary perforation during stent implantation in LMT and was then treated with polytetrafluorethylene (PTFE)-covered stent graft. PTFE-covered stent is considered to be a valid strategy for LMT aneurysms.

[Influence of diabetes mellitus on the initial and long-term outcome of patients treated with coronary stenting].

OBJECTIVES: The long-term outcome of patients with diabetes who underwent stent placement has not been assessed comprehensively. METHODS: Analysis of angioplasty procedures performed between January 1994 and December 1998 identified 140 diabetics (156 lesions) and 169 non-diabetics (187 lesions) who underwent successful stent placement. Follow-up was completed in 286 patients (93%) with a mean follow-up period of 2.8 +/- 1.3 years. Cardiac death, nonfatal myocardial infarction, coronary artery bypass grafting and repeat percutaneous transluminal coronary angioplasty were considered as adverse cardiac events. The primary clinical endpoint was event-free survival at 1 and 3 years. The primary angiographic endpoint was restenosis rate at follow-up angiography (follow-up rate 75% of 257 lesions). RESULTS: The diabetics were older (66 +/- 8 vs 62 +/- 11 years, p < 0.0005) with more risk factors such as hypertension (69% vs 57%, p < 0.05) and multivessel disease (69% vs 51%, p < 0.005). Final balloon size was smaller in diabetics than in non-diabetics (3.26 +/- 0.61 vs 3.39 +/- 0.53 mm, p < 0.05). Restenosis rate was significantly higher in diabetics than in non-diabetics (36% vs 24%, p < 0.05), but the target lesion revascularization in diabetics was not statistically different compared with non-diabetics (22% vs 16%). Long-term event-free survival was not significantly different between diabetics and non-diabetics (69.9% vs 74.8% at 1 year, 57.3% vs 66.0% at 3 years). CONCLUSIONS: Diabetics have an increased risk for angiographical restenosis after successful stent placement compared to non-diabetics. However, diabetics who underwent stent placement had a favorable clinical long-term outcome similar to non-diabetics.

Comparison between nicorandil and magnesium as an adjunct cardioprotective agent to percutaneous coronary intervention in acute anterior myocardial infarction.

BACKGROUND: It has been reported that both nicorandil and magnesium have a cardioprotective effect in experimental ischemia - reperfusion models. In the present study, the cardioprotective effects of nicorandil and magnesium as an adjunct to reperfusion therapy in patients with acute myocardial infarction (AMI) were compared. METHODS AND RESULTS: Forty consecutive patients with AMI caused by occlusion of anterior descending coronary artery were randomized into 3 groups: (1) Group N: nicorandil was given as 4 mg iv and 4 mg ic before reperfusion, followed by continuous infusion at 4 mg/h for 24 h; (2) Group M: magnesium was administered at 10 mmol iv before reperfusion, followed by continuous infusion at 0.4 mmol/h for 24 h; and (3) Group C: neither nicorandil nor magnesium was given. Left ventriculography was performed immediately after reperfusion and 3 months later. There was no significant change in regional wall motion (RWM) in either Group C or M, whereas that of group N improved significantly. The change in RWM in Group N was significantly greater than in Group C (Group N: 0.92+/-0.92, Group M: 0.44+/-0.80, Group C: -0.01+/-0.65, p<0.05). CONCLUSIONS: The early administration of nicorandil as an adjunct to reperfusion is useful for cardioprotection in AMI, but magnesium is not.

Usefulness of rapid quantitative measurement of myoglobin and troponin T in early diagnosis of acute myocardial infarction.

BACKGROUND: New equipment, the Cardiac Reader(TM), which can measure blood concentrations of troponin T (T) and myoglobin (M) in only 15 min at the bedside was evaluated for early diagnosis of acute myocardial infarction (AMI). METHODS AND RESULTS: A total of 34 consecutive patients with AMI who came to hospital within 24 h after onset were studied. Blood samples were collected from the patients at admission and 6, 12, 24, 48 h after onset to qualitatively and quantitatively measure T, M and creatine kinase-MB fraction. There were 20 patients with positive results by qualitative troponin T test and 29 with positive results by quantitative test. Of the patients who visited hospital within 3 h of onset, 17% were positive by the qualitative test and 67% cases had positive results in the quantitative test. The patients were divided into 2 groups according to the flow grade in the infarct-related coronary artery. In the TIMI 0-1 group (n=28), serum myoglobin concentrations were higher than in the TIMI 3-4 group (n=6) at admission and at their peak. CONCLUSION: The rapid quantitative test of T and M is useful for early diagnosis of AMI and as an indicator of its severity, which can be evaluated from the myoglobin concentration in the hyper-acute phase.