Low Creatinine Clearance Is a Risk Factor for Severe Cardioembolic Stroke in Japanese Female Patients.

BACKGROUND/AIM: The relationship between renal function and severity of cardioembolic stroke (CES) stratified by sex remains poorly understood. PATIENTS AND METHODS: A total of 640 consecutive CES patients within 48 h after stroke onset and with a modified Rankin Scale (mRS) score of 0 or 1 before onset were studied. The patients were divided into three groups based on their CCr values: low creatinine clearance (CCr) (L-CCr) (n=71, <30 ml/min), middle CCr (M-CCr) (n=227, 30 to <50 ml/min), and high CCr (H-CCr) (n=342, ≥50 ml/min). We compared the severity and functional outcomes of stroke among the three groups according to sex. RESULTS: On admission, using the National Institutes of Health Stroke Scale, the L-CCr group had the most severe stroke, followed by the M-CCr and H-CCr groups (p<0.0001). Functional outcomes at discharge, assessed using the mRS, were the worst in the L-CCr group, followed by the M-CCr and H-CCr groups (p<0.0001). Multivariable analyses revealed that L-CCr was a significant determinant of severe stroke on admission and poor functional outcomes at discharge. According to sex, L-CCr was a significant determinant of severe stroke on admission and poor functional outcomes at discharge in female patients, but not in male patients. CONCLUSION: Low CCr is a risk factor for severe stroke on admission and unfavorable functional outcomes at discharge in Japanese CES patients, and particularly in female patients.

Characterization of the PRAETORIAN score in Japanese patients undergoing subcutaneous implantable cardioverter-defibrillator implantation.

BACKGROUND: The PRAETORIAN score was developed to evaluate the implant position and predict defibrillation success in patients implanted with a subcutaneous implantable cardioverter-defibrillator (S-ICD). However, usefulness of the PRAETORIAN score for Japanese patients is unknown. METHODS: We evaluated usefulness of this score, which was determined by width of sub-coil fat, sub-generator fat, and anterior positioning of the S-ICD generator by post-operative chest X-ray, in consecutive 100 Japanese S-ICD implanted patients [78 men, median age 59 (IQR 46.5-67.0) years, median body mass index (BMI) 24.2 (21.3-27.2) kg/m2]. RESULTS: The median PRAETORIAN score was 30 (30-45) and 93 patients were classified as a low risk of conversion failure. The remaining seven were at an intermediate risk. Almost all patients were classified as an optimal pulse-generator position in the second and third steps of the PRAETORIAN score. The only difference observed was in the width of sub-coil fat in the first step. To further evaluate its significance, patients were divided into the Thicker group (sub-coil fat >1 coil width, n = 19) and the Thinner group (sub-coil fat ≤1 coil width, n = 81). BMI and post-shock impedance were both higher in the Thicker group than in the Thinner group [27.1 (25.6-31.6) versus 23.1 (20.9-25.7) kg/m2, p < 0.001, and 75 (68-88) versus 63 (55-74) Ω, p = 0.003, respectively]. During the median follow-up periods of 888 (523-1418) days, 7 patients experienced appropriate shock therapy for spontaneous ventricular tachyarrhythmias, who were all at a low risk. No conversion failure was observed. Inappropriate shock (IAS) occurred in 11 patients, and there was no difference in IAS rate between the Thicker group (n = 2) and the Thinner group (n = 9) (p = 0.747 by log-rank test). CONCLUSIONS: Most Japanese patients were classified as at low risk of conversion failure. The PRAETORIAN score may be useful for the evaluation of conversion failure in Japanese S-ICD implanted patients.

Prognostic Impact of Diabetes Mellitus on Clinical Outcomes in Lean Patients With Acute Myocardial Infarction.

BACKGROUND/AIM: Little is known about the impact of diabetes mellitus (DM) on clinical outcomes in lean patients with acute myocardial infarction (AMI). We conducted this study to evaluate the impact of DM on clinical outcomes in AMI patients based on body mass index (BMI) level. PATIENTS AND METHODS: A total of 1,282 consecutive AMI patients who underwent emergent percutaneous coronary intervention within 24 hours from onset were retrospectively studied. The patients were divided into 2 groups based on BMI: Underweight group (BMI <18.5 kg/m2, n=61) and non-Underweight group (BMI ≥18.5 kg/m2, n=1,221). The primary endpoint was all-cause death, and the secondary endpoint was major adverse cardiovascular and cerebrovascular events. The median follow-up period was 3.8 (1.7-5.0) years. RESULTS: The Underweight patients were older and included more females than the non-Underweight patients, and had a lower prevalence of coronary risk factors including DM. The primary and secondary endpoints were significantly higher in the Underweight patients (both p<0.05 by the Log-rank test). When divided by the presence of DM, the secondary endpoint was significantly higher in the non-Underweight patients with DM than in those without DM (p<0.05). However, there was no significant difference between Underweight patients with DM and those without DM. Multivariate analyses showed that DM was an independent predictor for the primary and secondary endpoints in non-Underweight patients, but not in Underweight patients. CONCLUSION: DM was associated with worse clinical outcomes in normal-weight or obese AMI patients, but not in underweight AMI patients.