Comparison of haemodialysis patients and non-haemodialysis patients with respect to clinical characteristics and 3-year clinical outcomes after sirolimus-eluting stent implantation: Insights from the Japan multi-centre post-marketing surveillance registry
Otsuka Y.,Japan National Cardiovascular Center Research Institute |
Otsuka Y.,Fukuoka Wajiro Hospital |
Ishiwata S.,Toranomon Hospital |
Inada T.,Red Cross |
And 5 more authors.
European Heart Journal | Year: 2011
Aims Long-term outcomes after sirolimus-eluting stent (SES) implantation in haemodialysis (HD) patients have remained controversial. We investigated the impact of HD on outcomes after SES implantation. Methods and resultsWe analysed the data on 2050 patients who underwent SES implantation in a multi-centre prospective registry in Japan. Three-year clinical outcomes were compared between the HD group (n 106) and the non-haemodialysis (NH) group (n 1944). At the 3-year clinical follow-up, the rates of unadjusted cardiac mortality (HD: 16.3 vs. NH: 2.3) and target-lesion revascularization (TLR) (HD: 19.4 vs. NH: 6.6) were significantly higher in the HD group than the NH group (P < 0.001). Although HD group had a numerically higher stent thrombosis rate, the difference in stent thrombosis between the two groups (HD: 2.0 vs. NH: 0.7) did not reach statistical significance. Using Coxs proportional-hazard models with propensity score adjustment for baseline differences, the HD group had higher risks of TLR [HD: 16.3 vs. NH: 6.1; hazard ratio, 2.83; 95 confidence interval (CI): 1.624.93, P 0.0003] and cardiac death (HD: 12.3 vs. NH: 2.3; hazard ratio, 5.51; 95 CI: 2.5811.78, P < 0.0001). The consistent results of analyses, whether unadjusted or adjusted for other baseline clinical and procedural differences, identify HD as an independent risk factor for cardiac death and TLR. ConclusionsPercutaneous coronary intervention with SES in HD patients has a higher incidence of repeat revascularization and mortality compared with those in NH patients. Haemodialysis appears to be strongly associated with mortality and repeat revascularization even after SES implantation. © 2011 The Author.
Nagamine H.,Yokohama Sakae Kyosai Hospital |
Ueno Y.,Yokohama Sakae Kyosai Hospital |
Ueda H.,Yokohama Sakae Kyosai Hospital |
Saito D.,Yokohama Sakae Kyosai Hospital |
And 4 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2013
OBJECTIVES: We developed a new classification system for branch perfusion patterns in acute aortic dissection and used it to retrospectively evaluate the perfusion status of whole aortic branches and to examine the effects of central aortic repair. METHODS: Thirty-four consecutive patients with acute type A aortic dissection underwent emergent surgery at our institution between August 2008 and December 2011. A retrospective review of pre- and postoperative computed tomographic angiography was performed. Branch perfusion patterns were categorized into three classes: Class I, dissection involving but not extending into the branch; Class II, dissection extending into the branch and Class III, dissection causing ostial avulsion. RESULTS: In cervical branches (total 169 branches), 70 branches (41%) presented with Class I patterns, 58 (34%) with Class II and none with Class III. In abdominal branches (total 135 branches), 76 branches (56%) presented with Class I patterns, 12 (9%) with Class II and 18 (13%) with Class III. In common iliac arteries (total 68 arteries), 14 arteries (21%) presented with Class I patterns, 24 (35%) with Class II and none with Class III. After repair, among 21 high-risk cervical branches, 14 branches (67%) showed improvement, 3 (14%) preserved distal perfusion supplied through the patent branch false lumen and 4 (19%) showed no improvement in high-risk perfusion pattern or worsened. Among 22 high-risk abdominal branches, 18 branches (82%) showed improvement, 3 (14%) preserved distal perfusion supplied through the patent branch or aortic false lumen and 1 (5%) showed no improvement in high-risk perfusion pattern. CONCLUSIONS: To overcome malperfusion syndromes associated with acute aortic dissection, recognition of diverse branch perfusion patterns through a universal classification system is imperative. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
Nozue T.,Yokohama Sakae Kyosai Hospital |
Michishita I.,Yokohama Sakae Kyosai Hospital |
Mizuguchi I.,Yokohama Sakae Kyosai Hospital
Journal of Atherosclerosis and Thrombosis | Year: 2010
Aim: Ezetimibe is a novel cholesterol absorption inhibitor that reduces the level of low-density lipoprotein (LDL)-cholesterol (C). The effects of ezetimibe on remnant-like particle (RLP)-C, lipoprotein (a) [Lp(a)], and oxidized LDL (Ox-LDL) levels have not been examined. Methods: Fifty patients with dyslipidemia were treated with 10 mg/day of ezetimibe. At baseline and 12 weeks after treatment with ezetimibe, we measured the levels of RLP-C, Lp(a), Ox-LDL, and high-sensitivity C-reactive protein (hs-CRP). Results: The mean levels of total cholesterol (TC), LDL-C, triglycerides (TG), and apolipoprotein (apo) B, respectively, showed a significant decrease from 229±39 to 191±37 mg/dL (-16%, p< 0.0001), from 151±34 to 118±33 mg/dL (-22%, p<0.0001), from 162±82 to 135±55 mg/dL (-7%, p<0.01), and from 116±22 to 94±21 mg/dL (-18%, p<0.0001) after 12 weeks of treatment with ezetimibe. The mean level of RLP-C and median level of hs-CRP also decreased significantly from 6.8±4.0 to 4.8±2.5 mg/dL (-21%, p<0.0001) and from 0.6 to 0.4 mg/L (-33%, p<0.05). The median level of Lp(a) decreased significantly from 14 to 10 mg/dL (-29%, p<0.05) in patients treated with ezetimibe monotherapy. Conclusions: Ezetimibe was effective for reducing the levels of TC, LDL-C, TG, and RLP-C. Ezetimibe could be a potential therapeutic option for decreasing the Lp(a) level.
Effects of liraglutide, a glucagon-like peptide-1 analog, on left ventricular remodeling assessed by cardiac magnetic resonance imaging in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention
Nozue T.,The Mutual |
Yamada M.,Yokohama Sakae Kyosai Hospital |
Tsunoda T.,Yokohama Sakae Kyosai Hospital |
Katoh H.,The Mutual |
And 3 more authors.
Heart and Vessels | Year: 2015
The clinical efficacy of glucagon-like peptide-1 (GLP-1) analogs in patients with acute myocardial infarction (AMI) is uncertain. The purpose of the present study was to evaluate the effects of the GLP-1 analog liraglutide on left ventricular (LV) remodeling in patients with AMI. We retrospectively evaluated the effects of liraglutide on LV remodeling assessed by cardiac magnetic resonance imaging (CMRI) in 15 patients with type 2 diabetes who were successfully treated with primary percutaneous coronary intervention (PCI) for AMI. Patients were divided into two groups based on their hypoglycemic medication: liraglutide use (group L; n = 6) or standard therapy (group S; n = 9). The CMRI findings in the early phase and at the 6-month follow-up were compared. At the 6-month follow-up, group S showed increases in LV end-diastolic (from 64 to 74 mL/m2, p = 0.08) and end-systolic (from 38 to 45 mL/m2, p = 0.13) volume indexes, whereas no such increase was observed in group L. The LV mass index (LVMI) was significantly smaller in group L than in group S at baseline (64 vs. 75 g/m2, p = 0.05) and at follow-up (56 vs. 78 g/m2, p = 0.009). Multivariate regression analysis showed that liraglutide use was an independent negative predictor of LVMI (β = −0.720, p = 0.003). In conclusion, liraglutide may be able to prevent the progression of LV remodeling and is associated with a lower LV mass in diabetic patients with AMI undergoing primary PCI. © 2015 Springer Japan
Nozue T.,Yokohama Sakae Kyosai Hospital |
Michishita I.,Yokohama Sakae Kyosai Hospital
Lipids in Health and Disease | Year: 2015
Background: The effects of statins on serum n-3 to n-6 polyunsaturated fatty acids (PUFAs) levels have not been fully evaluated. We examined the effects of two types of statins (rosuvastatin and pitavastatin) on serum PUFAs levels and their ratios in patients with dyslipidemia. Findings: A total of 46 patients who were not receiving lipid-lowering therapy were randomly assigned to receive either 2.5 mg/day of rosuvastatin or 2 mg/day of pitavastatin. Serum PUFAs levels were measured at baseline, at 4 weeks, and at 12 weeks. Rosuvastatin was used to treat 23 patients, and the remaining 23 patients were treated using pitavastatin. Serum docosahexaenoic acid (DHA) levels decreased significantly at 12 weeks in both groups (rosuvastatin: from 169.6 to 136.3 μg/mL, p = 0.006; pitavastatin: from 188.6 to 153.9 μg/mL, p = 0.03). However, serum levels of eicosapentaenoic acid (EPA) and arachidonic acid (AA) did not change. In addition, the EPA/AA ratio did not change, whereas the DHA/AA ratio decreased significantly at 12 weeks in both groups (rosuvastatin: from 0.99 to 0.80, p = 0.01; pitavastatin: from 1.14 to 0.91, p = 0.003). No adverse events were observed during the study period. Conclusions: In this small, open-label, pilot study, rosuvastatin and pitavastatin decreased serum DHA levels and the DHA/AA ratio in patients with dyslipidemia. © 2015 Nozue and Michishita.
Takihata M.,Yokohama City University |
Nakamura A.,Yokohama City University |
Tajima K.,Yokohama City University |
Inazumi T.,Yokohama City University |
And 7 more authors.
Diabetes, Obesity and Metabolism | Year: 2013
Aims: To compare the efficacy and safety of these two agents and the impact on surrogate markers related to diabetic complications in Japanese type 2 diabetic patients. Methods: In a multicenter, open-label trial, 130 patients whose diabetes had been inadequately controlled (HbA1c, 6.9-9.5%) with metformin and/or sulphonylurea were randomly assigned to a sitagliptin group (50mg/day) or a pioglitazone group (15mg/day) and were followed up for 24weeks. At 16weeks, if the patient's HbA1c level was ≥6.5%, the dose of sitagliptin or pioglitazone was increased up to 100 or 30mg/day, respectively. Main outcome measure was the difference in the mean changes in the HbA1c level from baseline at 24weeks between these two groups. Results: Of the 130 patients who were enrolled, 115 subjects (sitagliptin group: 58 patients, pioglitazone group: 57 patients) completed this trial. At 0weeks, the mean HbA1c level was 7.47±0.66% in the sitagliptin group and 7.40±0.61% in the pioglitazone group. At 24weeks, the mean changes in the HbA1c level from baseline were -0.86±0.63% versus -0.58±0.68% (p=0.024). Hypoglycaemia (2 patients, 3.4% vs. 2 patients, 3.5%), gastrointestinal symptoms (3 patients, 5.2% vs. 1 patient, 1.8%) and pretibial oedema (0 patients, 0% vs. 39 patients, 68.4%, p<0.001) were observed for 24weeks. Conclusions: Sitagliptin was not only more tolerable, but also more effective than pioglitazone in Japanese type 2 diabetic patients who had been treated with metformin and/or sulphonylurea. © 2012 Blackwell Publishing Ltd.
Vallejo-Vaz A.J.,St George's, University of London |
Kondapally Seshasai S.R.,St George's, University of London |
Kurogi K.,Miyazaki Prefectural Nobeoka Hospital |
Michishita I.,Yokohama Sakae Kyosai Hospital |
And 5 more authors.
Atherosclerosis | Year: 2015
Aims: Whether adverse effect of statins on glycaemic indices is common to all statins remains controversial and as yet data for pitavastatin are limited. We sought to assess the effects of pitavastatin on glycaemia and new-onset diabetes (NOD) in non-diabetic individuals using data from RCT pooled together by means of a meta-analysis. Materials and methods: We searched Medline, Cochrane, Embase and clinical trials registries websites until November-2014 for ≥12-week follow-up placebo or statin-controlled RCT of pitavastatin that included participants without diabetes and reported on fasting blood glucose (FBG), HbA1c or NOD. We additionally sought studies by consulting with Kowa Ph. Ltd. The association of pitavastatin with the outcomes were estimated by random-effects meta-analyses. Heterogeneity was assessed by the I2 statistic and sensitivity and subgroup analyses, and publication bias with funnel plots and Egger and Harbord Tests. Results: 15 studies (approx. 1600 person-years) were included. No significant differences associated with pitavastatin (vs. control) were observed for FBG (MD -0.01 mg/dL [95%CI -0.77, 0.74], I2 = 0%), HbA1c (MD -0.03% [95%CI -0.11, 0.05], I2 = 43%) or NOD (RR 0.70 [95%CI 0.30, 1.61]; RD 0.0 [95%CI -0.004, 0.003]; I2 = 0%). Sensitivity and subgroup analyses (including type of control [placebo or other statin], pitavastatin dose or follow-up] did not yield significant results. Potential publication bias may occur for NOD. Conclusions: In the present meta-analysis pitavastatin did not adversely affect glucose metabolism or diabetes development compared with placebo or other statins. © 2015 Elsevier Ireland Ltd.
PubMed | Yokohama Sakae Kyosai Hospital and Kanto Rosai Hospital
Type: | Journal: The neuroradiology journal | Year: 2017
Background Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of pseudoaneurysms due to ruptured cerebral aneurysms in our case series and previously reported cases. Patients and methods Four additional and 20 reported patients presenting with subarachnoid hemorrhage (SAH) are included. Radiological findings and clinical features of these patients were reviewed. Results In our series, three-dimensional computed tomographic angiography (3D-CTA) and/or angiography showed an irregular- or snowman-shaped cavity extending from the parent artery. The radiological examination additionally revealed delayed filling and retention of contrast medium. These findings were the same as previously reported cases. One patient underwent direct clipping of the true aneurysm. For the other three patients with aneurysms at the basilar and anterior communicating arteries, the true portion of the aneurysm was embolized with platinum coils. During the procedures, care was taken not to insert the coils into the distal pseudoaneurysm portion to prevent rupture. The review of 24 cases revealed that the location of the aneurysms was most frequent in the anterior communicating artery (41.7%), and 86.7% of patients were in a severe stage of SAH (>Grade 3 in WFNS or Hunt & Kosnik grading) implying abundant SAH. Conclusions Pseudoaneurysm formation in SAH after non-traumatic aneurysm rupture is rare. However, in cases with an irregular-shaped aneurysm cavity, pseudoaneurysm formation should be taken into consideration.
PubMed | Yokohama Sakae Kyosai Hospital
Type: Journal Article | Journal: The neuroradiology journal | Year: 2016
Intracerebral hematoma usually resolves spontaneously. Chronic encapsulated intracerebral hematoma is rare and mimics a brain tumor.A 50-year-old man had developed intracerebral hematoma in the right temporal lobe. Computed tomography (CT) showed the gradually decreasing density of the hematoma. However, the hematoma did not decrease in size and it showed ring enhancement on contrast-enhanced CT for more than 1 year. Magnetic resonance imaging (MRI) revealed a lesion content showing a high intensity on both T1- and T2-weighted images with ring enhancement. The lesion was diagnosed as a chronic encapsulated intracerebral hematoma developing from an acute hematoma. Arterial spin labeling of MRI showed decreased blood perfusion even in the enhanced capsule, being different from findings of a cystic brain tumor.Arterial spin labeling might be a useful modality to distinguish a chronic encapsulated intracerebral hematoma from a cystic hypervascular brain tumor.
Sasame J.,Yokohama Sakae Kyosai Hospital |
Nomura M.,Yokohama Sakae Kyosai Hospital
Journal of Stroke and Cerebrovascular Diseases | Year: 2015
We report a patient with a probable dissecting aneurysm of the anterior inferior cerebellar artery (AICA) initially presenting with a nonhemorrhagic symptom, which resulted in subarachnoid hemorrhage. A 61-year-old woman suddenly experienced nausea. Computed tomography (CT) on admission showed a high-density mass with a double lumen in the right cerebellopontine angle without subarachnoid hemorrhage. Five days after the onset, she suddenly lost consciousness. CT demonstrated subarachnoid hemorrhage. Emergency angiography revealed a probable dissecting aneurysm at the lateral pontomedullary segment of the right AICA. Although the initial symptom is not hemorrhage, an unruptured dissecting aneurysm of the AICA may have a high risk of rupture. Immediate radical treatment to prevent subsequent rupture is necessary for even an unruptured dissecting aneurysm of the AICA. © 2015 National Stroke Association.