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Morino Y.,Tokai University | Abe M.,Kyoto Medical Center | Morimoto T.,Kyoto University | Kimura T.,Kyoto University | And 12 more authors.
JACC: Cardiovascular Interventions | Year: 2011

Objectives This study sought to establish a model for grading lesion difficulty in interventional chronic total occlusion (CTO) treatment. Background Owing to uncertainty of success of the procedure and difficulties in selecting suitable cases for treatment, performance of interventional CTO remains infrequent. Methods Data from 494 native CTO lesions were analyzed. To eliminate operator bias, the objective parameter of successful guidewire crossing within 30 min was set as an end point, instead of actual procedural success. All observations were randomly assigned to a derivation set and a validation set at a 2:1 ratio. The J-CTO (Multicenter CTO Registry of Japan) score was determined by assigning 1 point for each independent predictor of this end point and summing all points accrued. This value was then used to develop a model stratifying all lesions into 4 difficulty groups: easy (J-CTO score of 0), intermediate (score of 1), difficult (score of 2), and very difficult (score of <3). Results The set end point was achieved in 48.2% of lesions. Independent predictors included calcification, bending, blunt stump, occlusion length >20 mm, and previously failed lesion. Easy, intermediate, difficult, and very difficult groups, stratified by J-CTO score, demonstrated stepwise, proportioned, and highly reproducible differences in probability of successful guidewire crossing within 30 min (87.7%, 67.1%, 42.4%, and 10.0% in the derivation set and 92.3%, 58.3%, 34.8%, and 22.2% in the validation set, respectively). Areas under receiver-operator characteristic curves were comparable (derivation: 0.82 vs. validation: 0.76). Conclusions This model predicted the probability of successful guidewire crossing within 30 min very well and can be applied for difficulty grading. © 2011 American College of Cardiology Foundation. Source

Kizawa Y.,University of Tsukuba | Tsuneto S.,Osaka University | Nagaoka H.,University of Tsukuba | Maeno T.,University of Tsukuba | Shima Y.,Tsukuba Medical Center Hospital
American Journal of Hospice and Palliative Medicine | Year: 2013

Objective: To examine the current status of advance directives (ADs) and do-not-resuscitate (DNR) orders among patients with terminal cancer in palliative care units (PCUs) in Japan. Methods: We conducted a retrospective chart review of the last 3 consecutive patients who died in 203 PCUs before November 30, 2010. Results: The percentages of patients who had ADs during the final hospitalization for cardiopulmonary resuscitation, mechanical ventilation, intravenous fluid administration, tube feeding, antibiotic administration, and who had appointed a health care proxy were 47%, 46%, 42%, 19%, 18%, and 48%, respectively. Seventy-six percent of the patients had a DNR order. Of the patients with decision-making capacity, 68% were involved in the DNR decision. Conclusions: These findings may reflect positive changes in patients' attitudes toward ADs, in Japan. © The Author(s) 2012. Source

Naruse Y.,University of Tsukuba | Sato A.,University of Tsukuba | Hoshi T.,University of Tsukuba | Takeyasu N.,Ibaraki Prefectural Central Hospital | And 5 more authors.
Circulation: Cardiovascular Interventions | Year: 2013

Background-Triple antithrombotic therapy increases the risk of bleeding events in patients undergoing percutaneous coronary intervention. However, it remains unclear whether good control of percent time in therapeutic range is associated with reduced occurrence of bleeding complications in patients undergoing triple antithrombotic therapy. Methods and Results-This study included 2648 patients (70±11 years; 2037 men) who underwent percutaneous coronary intervention with stent in the Ibaraki Cardiovascular Assessment Study registry and received dual antiplatelet therapy with or without warfarin. Clinical end points were defined as the occurrence of major bleeding complications (MBC), major adverse cardiac and cerebrovascular event, and all-cause death. Among these 2648 patients, 182 (7%) patients received warfarin. After a median follow-up period of 25 months (interquartile range, 15-35 months), MBC had occurred in 48 (2%) patients, major adverse cardiac and cerebrovascular event in 484 (18%) patients, and all-cause death in 206 (8%) patients. Multivariable Cox regression analysis revealed that triple antithrombotic therapy was the independent predictor for the occurrence of MBC (hazard ratio, 7.25; 95% confidence interval, 3.05-17.21; P<0.001). The time in therapeutic range value did not differ between the patients with and without MBC occurrence (83% [interquartile range, 50%-90%] versus 75% [interquartile range, 58%-87%]; P=0.7). However, the mean international normalized ratio of prothrombin time at the time of MBC occurrence was 3.3±2.1. Triple antithrombotic therapy did not have a predictive value for the occurrence of all-cause death (P=0.1) and stroke (P=0.2). Conclusions-Triple antithrombotic therapy predisposes patients to an increased risk of MBC regardless of the time in therapeutic range. © 2013 American Heart Association, Inc. Source

Ito S.,Tsukuba Medical Center Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2011

Tachyarrhythmia, especially atrial fibrillation, remains as a common complication after open heart surgery and sometimes leads to fatal condition. Many reports showed that landiolol (ultra short-acting beta one blocker) and amiodarone were effective against postoperative atrial fibrillation (POAF). However, there were few comparative studies between these 2 drugs as prophylactic agents, and no report mentioned the therapeutic efficacy. Our study suggests that landiolol be the 1st choice for rate control of tachyarrhythmia because of easy dose adjustment and mild side effects. Amiodarone may be useful for the patients whose left ventricular function is poor. Source

Hamano J.,Yamato Clinic | Maeno T.,University of Tsukuba | Kizawa Y.,University of Tsukuba | Shima Y.,Tsukuba Medical Center Hospital
American Journal of Hospice and Palliative Medicine | Year: 2013

Aims: This study aimed to clarify the accuracy of the Palliative Prognostic Index (PPI) for advanced cancer patients in home care settings. Method: The study included 65 advanced cancer patients who received home visiting services between April 2007 and June 2009, and who died at home or in the hospital. Using the medical records from initial home visits, we retrospectively calculated PPI scores along with sensitivity and specificity. Results: For 3- and 6-week survival, prognostic prediction demonstrated respective sensitivities of 55% and 63%, and specificities of 79% and 77%. Conclusion: The sensitivity of the PPI for advanced cancer patients in home care settings was lower than reported for those in palliative care units. Development of prognostic tools suitable for home care settings is needed. © The Author(s) 2012. Source

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