論文 - 海北 幸一
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急性冠症候群における凝固・線溶異常と抗血栓療法
海北幸一, 石井正将, 小川久雄
ICUとCCU 集中治療医学 40 ( 3 ) 223 - 229 2016年3月
担当区分：筆頭著者 掲載種別：研究論文（学術雑誌）
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Kimura Y., Izumiya Y., Hanatani S., Yamamoto E., Kusaka H., Tokitsu T., Takashio S., Sakamoto K., Tsujita K., Tanaka T., Yamamuro M., Kojima S., Tayama S., Kaikita K., Hokimoto S., Ogawa H.
Heart and Vessels 31 ( 1 ) 52 - 59 2016年1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：Heart and Vessels
Thrombospondin-2 (TSP-2) is highly expressed in hypertensive heart. Interstitial fibrosis is frequently observed in hypertensive heart, and it is a characteristic feature of heart failure with preserved ejection fraction (HFpEF). We tested here the hypothesis that high TSP-2 serum levels reflect disease severity and can predict poor prognosis of patients with HFpEF. Serum TSP-2 levels were measured by ELISA in 150 patients with HFpEF. HFpEF was defined as left ventricular ejection fraction ≥50 %, B-type natriuretic peptide (BNP) ≥100 pg/ml or E/e′ ≥15. The endpoints were mortality rate, HF-related hospitalization, stroke and non-fatal myocardial infarction. The median serum TSP-2 level was 19.2 (14.4–26.0) ng/ml. Serum TSP-2 levels were associated with the New York Heart Association (NYHA) functional class. Circulating levels of BNP and high-sensitivity troponin T were positively correlated with serum TSP-2 levels. Kaplan–Meier survival curve showed high risk of adverse cardiovascular events in the high TSP-2 group (>median value), and that the combination of high TSP-2 and high BNP (≥100 pg/ml) was associated with the worst event-free survival rate. Multivariate Cox proportional hazard analysis identified TSP-2 as independent predictor of risk of death and cardiovascular events. Circulating TSP-2 correlates with disease severity in patients with HFpEF. TSP-2 is a potentially useful predictor of future adverse cardiovascular events in patients with HFpEF.
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Tabata N., Hokimoto S., Akasaka T., Arima Y., Sakamoto K., Yamamoto E., Tsujita K., Izumiya Y., Yamamuro M., Kojima S., Kaikita K., Kumagae N., Morita K., Oniki K., Nakagawa K., Matsui K., Ogawa H.
Journal of Cardiology 67 ( 1 ) 104 - 109 2016年1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: There is some controversy regarding the effect of CYP2C19 polymorphism on clinical outcome in patients receiving dual antiplatelet therapy (DAPT). Peripheral endothelial dysfunction has recently been reported to predict adverse cardiovascular events. We hypothesized that CYP2C19 loss-of-function (LOF) allele carriers with peripheral endothelial dysfunction had worse prognosis. The aim of this study was to evaluate an additive effect of peripheral endothelial dysfunction on clinical outcome following percutaneous coronary intervention (PCI) in patients with a CYP2C19 variant. Methods: We enrolled 434 patients on DAPT following PCI. CYP2C19 genotype was examined, and we divided patients into two groups: carriers, who had at least one CYP2C19 LOF allele, and non-carriers. Peripheral endothelial dysfunction was examined using reactive hyperemia-peripheral arterial tonometry index (RHI), and we divided patients into low and high RHI. Thus, subjects were divided into four groups, and clinical events were followed up. Results: A total of 55 patients had a cardiovascular event. Kaplan-Meier analysis demonstrated a significantly higher probability of cardiovascular events in carriers with low RHI (log-rank test: p = 0.007). Multivariate Cox proportional hazards analysis identified both CYP2C19 LOF allele possession (hazard ratio (HR): 1.94; 95% confidence interval (CI): 1.1-3.69; p = 0.045) and low RHI (HR: 2.15; 95% CI: 1.22-3.78; p = 0.008) as independent and significant predictors of future cardiovascular events. Conclusions: CYP2C19 LOF allele carriers with peripheral endothelial dysfunction were significantly correlated with cardiovascular events. The additional evaluation of peripheral endothelial function along with CYP2C19 polymorphism might improve risk stratification after coronary stent implantation.
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Ito M., Kaikita K., Sueta D., Ishii M., Oimatsu Y., Arima Y., Iwashita S., Takahashi A., Hoshiyama T., Kanazawa H., Sakamoto K., Yamamoto E., Tsujita K., Yamamuro M., Kojima S., Hokimoto S., Yamabe H., Ogawa H.
Journal of the American Heart Association 5 ( 1 ) 2016年1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：Journal of the American Heart Association
Background-Non-vitamin K antagonist oral anticoagulants are used to prevent thromboembolism in patients with atrial fibrillation. The T-TAS "Total Thrombus-formation Analysis System" (Fujimori Kogyo Co Ltd) was developed for quantitative analysis of thrombus formation using microchips with thrombogenic surfaces (collagen, platelet chip [PL] ; collagen plus tissue factor, atheroma chip [AR]). We evaluated the utility of T-TAS in predicting periprocedural bleeding in atrial fibrillation patients undergoing catheter ablation (CA). Methods and Results-After exclusion of 20 from 148 consecutive patients undergoing CA, the remaining 128 patients were divided into 2 treatment groups: the warfarin group (n=30) and the non-vitamin K antagonist oral anticoagulants group (n=98). Blood samples obtained on the day of CA (anticoagulant-free point) and at 3 and 30 days after CA were used in T-TAS to compute the thrombus formation area under the curve (AUC; AUC for the first 10 minutes for PL tested at flow rate of 24 μL/min [PL - AUC ]; AUC for the first 30 minutes for AR tested at flow rate of 10 μL/min [AR -AUC ]). AR -AUC and PL -AUC levels were similar in the 2 groups on the day of CA. Levels of AR -AUC , but not PL -AUC , were significantly lower in the 2 groups at days 3 and 30 after CA. Multiple logistic regression analyses identified the AR -AUC level on the day of CA as a significant predictor of periprocedural bleeding events (odds ratio 5.7; 95% CI 1.54-21.1; P=0.009). Receiver operating characteristic analysis showed that the AR -AUC level on the day of CA significantly predicted periprocedural bleeding events (AUC 0.859, 95% CI 0.766-0.951; P < 0.001). The cutoff AR -AUC level was 1648 for identification of periprocedural bleeding events. Conclusions-These results suggested that the AR -AUC level determined by T-TAS is a potentially useful marker for prediction of bleeding events in atrial fibrillation patients undergoing CA. 24 10 10 30 10 30 24 10 10 30 24 10 10 30 10 30 10 30 10 30
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A destabilized case of stable effort angina pectoris induced by low-dose adenosine triphosphate 査読あり
Sueta D., Kojima S., Izumiya Y., Yamamuro M., Kaikita K., Hokimoto S., Ogawa H.
Internal Medicine 55 ( 22 ) 3291 - 3294 2016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：Internal Medicine
A 79-year-old man was diagnosed with sudden deafness. He had previously experienced a suspected episode of angina pectoris. At a local hospital, after 500 mg of hydrocortisone and 80 mg adenosine triphosphate (ATP) were administered, he became aware of chest discomfort. An electrocardiogram revealed serious ST-segment depressions. He was diagnosed with a non-ST elevated myocardial infarction (NSTEMI). Emergency coronary angiography revealed triple vessel disease, and the lesion was successfully stented. The mechanisms whereby the stable effort angina pectoris destabilized in this case were thought to include a reduction of the local blood flow because of an ATP product and probable thrombus formation in response to the administered steroids.
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Hokimoto S, Soejima H, Kojima S, Kaikita K, Yamamuro M, Izumiya Y, Tsujita K, Yamamoto E, Tanaka T, Sugamura K, Arima Y, Sakamoto K, Akasaka T, Tabata N, Sueta D, Miyoshi I, Usami M, Ogawa H
Annals of vascular diseases 9 ( 1 ) 22 - 29 2016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：Annals of Vascular Diseases 編集委員会
<b>Objective:</b> To describe the distribution of ankle-brachial index (ABI) among Japanese cardiovascular inpatients and to explore risk factors of peripheral arterial disease (PAD) associated with ABI ≤0.9.<b>Materials and Methods:</b> This study was a retrospective analysis using clinical record databases of patients with cardiovascular disease admitted to the Department of Cardiovascular Medicine, Kumamoto University Hospital between 2007 and 2014.<b>Results:</b> Of 3639 patients included in the analysis, male patients accounted for 62.1% and the mean age of patients was 66.1 years. Ischemic heart disease (IHD) was observed in 49.1%. ABI ≤0.9 was observed in 11.3% of all patients, 14.1% in the IHD group and 8.5% in the non-IHD group. Age of ≥65 years (odds ratio [OR]: 2.93, 95% confidence interval [CI]: 2.22–3.86), current smoking (OR: 2.28, 95%CI:1.71–3.04), diabetes (OR: 2.15, 95%CI:1.71–2.71), hypertension (OR: 1.42, 95%CI:1.12–1.81) and chronic kidney disease (OR: 2.52, 95%CI:1.82–3.48) were significantly associated factors with ABI ≤0.9.<b>Conclusions:</b> This study suggests that PAD is prevalent even in patients without IHD. Active management of risk factors, early detection of PAD based on ABI, and therapeutic intervention could be effective in preventing future cardiovascular events or death.
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Misumi I., Honda T., Usuku H., Togashi A., Kiyama T., Tsunoda R., Obayashi H., Yasuda H., Kaikita K., Hokimoto S., Ogawa H.
Internal Medicine 55 ( 13 ) 1747 - 1750 2016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：Internal Medicine
A 63-year-old woman with atrial fibrillation visited our hospital due to decompensated heart failure. Because atrial fibrillation was considered a remarkable precipitating factor for heart failure, cardioversion was performed. After cardioversion, refractory hypotension and cardiopulmonary arrest occurred. An arterial blood gas analysis showed marked lactic acidosis. Chronic kidney disease, heart failure, sedatives, and hypoventilation might have contributed to refractory hypotension due to severe acidosis in this case.
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冠攣縮性狭心症の発症機序
海北幸一、小川久雄
日本臨牀 74 ( 増刊号6 ) 39 - 42 2016年
担当区分：筆頭著者 掲載種別：研究論文（学術雑誌）
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冠攣縮性狭心症の診断と治療に関するガイドライン（2013年改訂版）
海北幸一、小川久雄
日本臨牀 74 ( 増刊号6 ) 54 - 57 2016年
担当区分：筆頭著者 掲載種別：研究論文（学術雑誌）
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冠攣縮性狭心症の危険因子・臨床的特徴・予後
石井正将、海北幸一、小川久雄
日本臨牀 74 ( 増刊号6 ) 48 - 53 2016年
掲載種別：研究論文（学術雑誌）
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Yamamoto M., Yamamoto E., Yasuda O., Yasuda H., Sakamoto K., Tsujita K., Izumiya Y., Kaikita K., Hokimoto S., Ogawa H.
Journal of Cardiology Cases 12 ( 6 ) 195 - 198 2015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：Journal of Cardiology Cases
We herein report a case of Werner's syndrome (WS) with cardiac syndrome X (CSX) and heart failure with preserved ejection fraction (HFpEF), receiving nicorandil treatment. A 58-year-old woman with chest discomfort on exercise was suspected of having effort-angina pectoris because of broad ST-depression in electrocardiogram of exercise test and reversible defect in the posterior-wall portion of left ventricle in exercise thallium myocardial scintigraphy. This patient also exhibited HFpEF, diagnosed by increased ratio of early-transmitral-flow-velocity to tissue-Doppler early-diastolic mitral annular velocity (E/e') in echocardiography and plasma B-type natriuretic peptide (BNP) levels. However, coronary angiography revealed no organic stenosis in epicardial coronary arteries, and coronary physiological measurements by PressureWire™ (St. Jude Medical, St Paul, MN, USA) demonstrated that coronary flow reserve (CFR) was greatly decreased. Because impaired CFR represents coronary microvascular dysfunction in the absence of obstructive coronary narrowing, we diagnosed CSX, and initiated the administration of nicorandil to improve coronary microcirculation. After three-month-treatment of nicorandil, the patient's symptoms were diminished, and reversible defect in exercise myocardial scintigraphy was improved. Furthermore, both E/e' and BNP were decreased, indicating the improvement of HFpEF via the restoration of microvascular dysfunction.Thus, nicorandil administration could bring beneficial effects in WS with CSX and HFpEF, accompanied by coronary microcirculation dysfunction. <. Learning objective: Contrary to previous case reports regarding Werner's syndrome (WS) with obstructive coronary artery disease (CAD), we herein report a case of WS with cardiac syndrome X (CSX) without obstructive CAD, complicated with heart failure with preserved ejection fraction (HFpEF). Because impaired coronary microcirculation is known to be associated with left ventricular hypertrophy and HFpEF, nicorandil could improve not only CSX but HFpEF via the restoration of coronary microvascular dysfunction.>. 201
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Kaikita K., Ishii M., Sato K., Nakayama M., Arima Y., Tanaka T., Sugamura K., Sakamoto K., Izumiya Y., Yamamoto E., Tsujita K., Yamamuro M., Kojima S., Soejima H., Hokimoto S., Matsui K., Ogawa H.
Journal of the American Heart Association 4 ( 12 ) 2015年12月
担当区分：筆頭著者, 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：Journal of the American Heart Association
Background-Myocardial lactate production in the coronary circulation during acetylcholine (ACh)-provocation test (abbreviated as lactate production) provides supporting evidence for coronary spasm-induced myocardial ischemia. The purpose of this study was to examine the clinical features, predictive factors, and prognosis of patients with coronary vasospastic angina (VSA) and lactate production. Methods and Results-We examined all 712 patients who underwent both myocardial lactate measurement during AChprovocation test in the left coronary artery and genetic screening test of a -786T/C polymorphism in the 50-flanking region of the endothelial nitric oxide synthase (eNOS) gene between January 1991 and December 2010. Lactate production was observed in 252 of the 712 patients and in 219 of 356 VSA patients diagnosed by ACh-provocation test. Compared with lactate production- negative VSA patients, the lactate production-positive counterparts were more likely to be nonsmoker female diabetics with - 786T/C eNOS polymorphism (61% vs 31%, P < 0.001, 62% vs 34%, P < 0.001, 24% vs 14%, P=0.016, and 25% vs 15%, P=0.018, respectively). Multivariable logistic regression analysis identified female sex, diabetes mellitus, and -786T/C eNOS polymorphism to correlate with lactate production (odds ratio 3.51, 95% CI 2.16 to 5.70, P < 0.001; odds ratio 2.53, 95% CI 1.38 to 4.65, P=0.003; and odds ratio 1.85, 95% CI 1.02 to 3.35, P=0.044, respectively). Kaplan-Meier survival curve showed no difference in 5-year survival rate free from major adverse cardiac events between lactate production-positive and -negative VSA patients (P=0.319). Conclusions-The results indicated that female sex, diabetes, and mutation in -786T/C eNOS gene correlate with ACh-provoked myocardial ischemia in patients with coronary spasm.
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Usefulness of excimer laser atherectomy for balloon uncrossable lesion in chronic total occlusion 査読あり
Sueta D, Hokimoto S＊, Miyazaki T, Sakamoto K, Tsujita K, Yamamoto E, Tabata N, Kojima S, Kaikita K, Ogawa H
IJC Heart &Vasculature 9 70 - 72 2015年12月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Nocturia in patients with sleep-disordered breathing and cardiovascular disease 査読あり
Miyazaki T., Kojima S., Yamamuro M., Sakamoto K., Izumiya Y., Tsujita K., Yamamoto E., Tanaka T., Kaikita K., Hokimoto S., Ogawa H.
Circulation Journal 79 ( 12 ) 2632 - 2640 2015年11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：Circulation Journal
Background:Sleep apnea is a common condition and a cardiovascular risk factor. Continuous positive airway pressure (CPAP) reduces cardiovascular events and sleep apnea-related symptoms, especially in patients with obstructive sleep apnea (OSA), who occasionally experience nocturia, a common problem in individuals of advanced age.Methods and Results:The present study was a prospective, observational study including 1,429 consecutive patients with cardiovascular disease (CVD). A questionnaire on nocturia was administered and nocturnal pulse oximetry was performed. Patients with moderate-to-severe sleep-disordered breathing (SDB) underwent polysomnography, and patients with OSA received CPAP therapy. Nocturia was observed in 561 of 666 patients included in the analysis. A multiple logistic regression analysis revealed that nocturia was associated with oxygen desaturation defined as a 3% decrease (P=0.0335) independent of age (P<0.0001), male sex (P=0.0078), hypertension (P=0.0139), and B-type natriuretic peptide (BNP) level (P=0.0185). Nocturia was reduced in patients who continued CPAP treatment and they also showed a decrease in the apnea-hypopnea index (45.3±13.6 vs. 2.5±3.7 events/h, P<0.0001), systolic blood pressure (121.6±11.9 vs. 113.4±8.8 mmHg, P=0.0002), and BNP level (57.7 [15.0–144.4] vs. 27.4 [8.5–111.7] pg/ml, P=0.0006).Conclusions:CPAP has the potential to reduce nocturia and risk factors for SDB such as increased blood pressure and BNP level, which may be beneficial in older men with CVD and OSA.
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Fujisue K., Sugiyama S., Matsuzawa Y., Akiyama E., Sugamura K., Matsubara J., Kurokawa H., Maeda H., Hirata Y., Kusaka H., Yamamoto E., Iwashita S., Sumida H., Sakamoto K., Tsujita K., Kaikita K., Hokimoto S., Matsui K., Ogawa H.
Circulation Journal 79 ( 12 ) 2623 - 2631 2015年11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：Circulation Journal
Background:Endothelial dysfunction plays a crucial role in heart failure (HF), but the association between peripheral microvascular endothelial function assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT) and prognosis remains unknown in HF with reduced left ventricular (LV) ejection fraction (HFREF). We prospectively investigated the association between peripheral microvascular endothelial function and HF-related near-future cardiovascular outcomes in HFREF patients.Methods and Results:The 362 HFREF patients (LVEF <50%) were followed for HF-related events (composite of cardiovascular death and HF hospitalization) up to 3 years. A natural logarithmic-scaled RH-PAT index (Ln-RHI) was obtained for each patient. A total of 82 HF-related events were recorded. The lower-RHI group (Ln-RHI ≤0.49, median) experienced a higher rate of HF-related events compared with the higher-RHI group by Kaplan-Meier analysis (30.9% vs. 14.4%, log-rank test: P<0.001). Multivariable Cox hazard analysis identified Ln-RHI as an independent predictor for HF-related events (per 0.1, hazard ratio: 0.84, 95% confidence interval: 0.75–0.95, P=0.005). Adding Ln-RHI to the Meta-analysis Global Group in Chronic HF risk score (MAGGICs) and Seattle Heart Failure Model (SHFM), powerful prognostic predictors of HF, significantly improved the net reclassification index (MAGGICs: 20.11%, P=0.02, SHFM: 24.88%, P<0.001), and increased the C-statistics for prediction of HF-related events (MAGGICs+Ln-RHI: from 0.612 to 0.670, SHFM+Ln-RHI: from 0.662 to 0.695).Conclusions:Peripheral microvascular endothelial dysfunction assessed by RH-PAT was associated with future HF-related events in HFREF.
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Clinical significance of plasma galectin-3 in patients with coronary artery disease 査読あり
Kusaka H., Yamamoto E., Hirata Y., Fujisue K., Tokitsu T., Sugamura K., Sakamoto K., Tsujita K., Kaikita K., Hokimoto S., Sugiyama S., Ogawa H.
International Journal of Cardiology 201 532 - 534 2015年10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：International Journal of Cardiology
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Yamanaga K., Tsujita K., Komura N., Kaikita K., Sakamoto K., Miyazaki T., Saito M., Ishii M., Tabata N., Akasaka T., Arima Y., Yamamoto E., Yamamuro M., Izumiya Y., Kojima S., Tayama S., Nakamura S., Hokimoto S., Ogawa H.
International Journal of Cardiology 201 535 - 537 2015年10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：International Journal of Cardiology
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Tsujita K., Sugiyama S., Sumida H., Shimomura H., Yamashita T., Yamanaga K., Komura N., Sakamoto K., Ono T., Oka H., Nakao K., Nakamura S., Ishihara M., Matsui K., Sakaino N., Nakamura N., Yamamoto N., Koide S., Matsumura T., Fujimoto K., Tsunoda R., Morikami Y., Matsuyama K., Oshima S., Kaikita K., Hokimoto S., Ogawa H.
Journal of Cardiology 66 ( 4 ) 353 - 358 2015年10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: Although the positive association between achieved low-density lipoprotein cholesterol (LDL-C) level and the risk of coronary artery disease (CAD) has been confirmed by randomized studies with statins, many patients remain at high residual risk of events suggesting the necessity of novel pharmacologic strategies. The combination of ezetimibe/statin produces greater reductions in LDL-C compared to statin monotherapy. Purpose: The Plaque REgression with Cholesterol absorption Inhibitor or Synthesis inhibitor Evaluated by IntraVascular UltraSound (PRECISE-IVUS) trial was aimed at evaluating the effects of ezetimibe addition to atorvastatin, compared with atorvastatin monotherapy, on coronary plaque regression and change in lipid profile in patients with CAD. Methods: The study is a prospective, randomized, controlled, multicenter study. The eligible patients undergoing IVUS-guided percutaneous coronary intervention will be randomly assigned to receive either atorvastatin alone or atorvastatin plus ezetimibe (10. mg) daily using a web-based randomization software. The dosage of atorvastatin will be increased by titration within the usual dose range with a treatment goal of lowering LDL-C below 70. mg/dL based on consecutive measures of LDL-C at follow-up visits. IVUS will be performed at baseline and 9-12 months follow-up time point at participating cardiovascular centers. The primary endpoint will be the nominal change in percent coronary atheroma volume measured by volumetric IVUS analysis. Conclusion: PRECISE-IVUS will assess whether the efficacy of combination of ezetimibe/atorvastatin is noninferior to atorvastatin monotherapy for coronary plaque reduction, and will translate into increased clinical benefit of dual lipid-lowering strategy in a Japanese population.
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Nagano M., Hokimoto S., Nakao K., Kaikita K., Akasaka T., Ogawa H., Fujimoto K., Miyao Y., Shimomura H., Tsunoda R., Hirose T., Nakamura N., Sakaino N., Oka H., Yamamoto N., Morikami Y., Matsumura T., Kajiwara I., Koide S.
Journal of Cardiology 66 ( 4 ) 333 - 340 2015年10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: Stent thrombosis (ST) has emerged as a severe complication of percutaneous coronary intervention (PCI). Since the occurrence of ST is lower in Japan than Western countries, there are few data to predict ST after drug-eluting stent (DES) implantation in Japan. We examined the independent predictors of ST incidence after DES implantation in Japanese patients, including the use of calcium channel blockers (CCBs). Methods and results: We used data from the Kumamoto Intervention Conference Study registry. There were 6286 consecutive patients enrolled from June 2008 to March 2011. Among them, we analyzed 3493 patients who underwent DES implantation. The incidence of definite/probable ST throughout a median follow-up period of 364 days was 0.57% (20 patients). There were 8 patients with early ST (within 30 days), 8 patients with late ST (between 31 and 365 days), and 4 patients with very late ST (after 1 year). The frequency of CCB use was significantly lower in ST than non-ST patients (25.0% versus 51.4%, respectively, p = 0.016). Multiple regression analysis showed that longer stent length (p = 0.034), acute coronary syndrome (p = 0.039), and the absence of CCB use (p = 0.046) were significant and independent predictors of ST within 1 year. Conclusions: These results suggest that CCB use may be associated with a decreased risk of ST after DES implantation within 1 year in Japanese patients.
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Yoshimura H., Kaikita K., Ono T., Iwashita S., Nakayama N., Sato K., Horio E., Tsujita K., Kojima S., Tayama S., Hokimoto S., Ogawa H.
Heart and Vessels 30 ( 5 ) 572 - 579 2015年9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
Peri-procedural myocardial damage (MD) is associated with increased risk of major in-hospital complications and adverse clinical events. The aim of this study was to evaluate the effects of on-clopidogrel platelet aggregation and CYP2C19-reduced-function gene variants on elective percutaneous coronary intervention (PCI)-related MD. We measured changes in serum high-sensitive troponin T (hs-TnT) levels, CYP2C19 genotype, and on-clopidogrel platelet aggregation (PA) using VerifyNow P2Y12 system in 91 patients who received stent implantation (stent group). The control group comprised 30 patients who did not receive PCI. Blood samples were obtained before and 24 h after PCI or coronary angiography (CAG). Patients of the stent group were divided into high and low MD groups based on the median value of hs-TnT level at 24 h after PCI. Serum hs-TnT levels were significantly higher 24 h after PCI (86.8 ± 121.5 pg/ml) compared with before PCI (9.4 ± 5.3, p < 0.001), whereas the levels were identical before and 24 h after CAG in the control group. Simple logistic regression analysis demonstrated that MD correlated with age (p = 0.014), estimated GFR (p = 0.003), hemoglobin A1c (p = 0.015), baseline serum hs-TnT (p = 0.049), and stent length (p < 0.001). Multiple logistic regression analysis identified old age, high hemoglobin A1c level, and long stent, but not CYP2C19 reduced-function allele or high on-clopidogrel PA, as independent predictors of elective PCI-related MD. The present study demonstrated no significant relation between peri-procedural MD and high on-clopidgrel PA associated with CYP2C19 reduced-function allele in patients undergoing elective PCI. ®