論文 - 海北 幸一
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Clinical Outcomes of Rivaroxaban Monotherapy in Heart Failure Patients With Atrial Fibrillation and Stable Coronary Disease: Insights From the AFIRE Trial. 査読あり
Yazaki Y, Nakamura M, Iijima R, Yasuda S, Kaikita K, Akao M, Ako J, Matoba T, Miyauchi K, Hagiwara N, Kimura K, Hirayama A, Matsui K, Ogawa H, AFIRE Investigators.
Circulation 144 ( 17 ) 1449 - 1451 2021年10月
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Ishii M., Seki T., Kaikita K., Sakamoto K., Nakai M., Sumita Y., Nishimura K., Miyamoto Y., Noguchi T., Yasuda S., Kanaoka K., Terasaki S., Saito Y., Tsutsui H., Komuro I., Ogawa H., Tsujita K., Kawakami K.
European Journal of Preventive Cardiology 28 ( 13 ) 1435 - 1444 2021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：European Journal of Preventive Cardiology
Background: Air pollution including particulate matter with an aerodynamic diameter ≤2.5 µm (PM ) increases the risk of acute myocardial infarction. However, whether short-term exposure to PM triggers the onset of myocardial infarction with nonobstructive coronary arteries, compared with myocardial infarction with coronary artery disease, has not been elucidated. This study aimed to estimate the association between short-term exposure to PM and admission for acute myocardial infarction, myocardial infarction with coronary artery disease, and myocardial infarction with nonobstructive coronary arteries. Design: This was a time-stratified case-crossover study and multicenter validation study. Methods: This study used a nationwide administrative database in Japan between April 2012–March 2016. Of 137,678 acute myocardial infarction cases, 123,633 myocardial infarction with coronary artery disease and 14,045 myocardial infarction with nonobstructive coronary arteries were identified by a validated algorithm combined with International Classification of Disease (10th revision), diagnostic, and procedure codes. Air pollutants and meteorological data were obtained from the monitoring station nearest to the admitting hospital. Results: In spring (March–May), the short-term increase of 10 µg/m in PM 2 days before admission was significantly associated with admission for acute myocardial infarction, myocardial infarction with nonobstructive coronary arteries, and myocardial infarction with coronary artery disease after adjustment for meteorological variables (odds ratio 1.060, 95% confidence interval 1.038–1.082; odds ratio 1.151, 1.079–1.227; odds ratio 1.049, 1.026–1.073, respectively), while the association was not significant in other variables. These associations were also observed after adjustment for other co-pollutants. The risk for myocardial infarction with nonobstructive coronary arteries (vs myocardial infarction with coronary artery disease) was associated with an even lower concentration of PM under the current environmental standards. Conclusions: This study showed the seasonal difference of acute myocardial infarction risk attributable to PM and the difference in the threshold of triggering the onset of acute myocardial infarction subtype. 2.5 2.5 2.5 2.5 2.5 2.5 3
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Antithrombotic Therapy for Atrial Fibrillation and Coronary Artery Disease in Patients With Prior Atherothrombotic Disease: A Post Hoc Analysis of the AFIRE Trial. 査読あり
Matsuzawa Y, Kimura K, Yasuda S, Kaikita K, Akao M, Ako J, Matoba T, Nakamura M, Miyauchi K, Hagiwara N, Hirayama A, Matsui K, Ogawa H, AFIRE Investigators.
Journal of the American Heart Association e020907 2021年10月
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Hanatani S., Izumiya Y., Yamamoto M., Araki S., Fujisue K., Arima Y., Takashio S., Yamamoto E., Kaikita K., Matsushita K., Tsujita K.
International Journal of Obesity 45 ( 10 ) 2214 - 2220 2021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 Obesity
Background: Although sarcopenic obesity is associated with a higher risk of cardiovascular events compared with obesity without sarcopenia, it is difficult to diagnose sarcopenia in daily clinical settings. Recently, a simple scoring system has been developed to identify sarcopenia patients based on three variables (age, hand grip strength, and calf circumference). However, the utility of this score for cardiovascular risk stratification in patients with abdominal obesity is unknown. Methods: We calculated the sarcopenia score in 262 patients with abdominal obesity, defined as a waist circumference ≥90 cm in women or ≥85 cm in men. The composite endpoint of this study was cardiovascular mortality, nonfatal myocardial infarction, stroke, unstable angina, and heart failure hospitalization. Results: Of the 262 patients, 108 had a high sarcopenia score based on previously established criteria (≥105 in men and ≥120 in women). The patients with a high sarcopenia score had a significantly higher plasma level of B-type natriuretic peptide compared with those with a low sarcopenia score (median 56.7, interquartile range [28.2–142.9] vs. 37.9 [13.8–76.1] pg/mL; p < 0.0001). Kaplan–Meier curves revealed a significantly lower event-free survival rate in those with a high compared with a low sarcopenia score (log-rank test p = 0.001), even after adjustment for confounding factors using propensity score matching (log-rank test p = 0.009). Multivariate Cox proportional hazard analysis identified a high sarcopenia score (hazard ratio: 2.46; 95% confidence interval: 1.31–4.64, p = 0.005) as an independent predictor of the primary endpoints. The combination of a high sarcopenia score and low body mass index (<25 kg/m2) predicted a significantly higher risk of future adverse events (p = 0.005). Furthermore, patients with a high sarcopenia score and high B-type natriuretic peptide level (≥200 pg/mL) had the poorest prognosis (p < 0.0001). Conclusions: This simple screening test for sarcopenia can predict future adverse cardiovascular events in patients with abdominal obesity.
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Takae M., Fujisue K., Yamamoto E., Egashira K., Komorita T., Oike F., Nishihara T., Yamamoto M., Hirakawa K., Tabata N., Tokitsu T., Yamanaga K., Sueta D., Hanatani S., Nakamura T., Usuku H., Araki S., Arima Y., Takashio S., Suzuki S., Kaikita K., Matsushita K., Tsujita K.
ESC Heart Failure 8 ( 5 ) 3809 - 3821 2021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：ESC Heart Failure
Background: Heart failure (HF)-related congestive hepatopathy is a well-recognized problem in management of HF. The fibrosis-4 (FIB4) index calculated by [age × aspartate aminotransferase (IU/L)/platelet count (109/L) × square root of alanine aminotransferase (IU/L)] is useful for evaluating liver stiffness. We aimed to investigate the impact of the FIB4 index on prognosis in patients with HF. Methods and results: Consecutive HF patients referred for hospitalization at Kumamoto University Hospital, Japan, were registered between 2006 and 2015. We observed cardiovascular outcomes in each type of HF [HF with reduced left ventricular ejection fraction (LVEF) (HFrEF), HF with mid-range LVEF (HFmrEF) and with preserved LVEF (HFpEF)] according to their FIB4 index; Group 1 (FIB4 index <1.3), Group 2 (FIB4 index: 1.3–2.67), and Group 3 (FIB4 index >2.67). This study enrolled 83 HFrEF patients, 117 HFmrEF patients, and 504 HFpEF patients. In HFpEF patients, the Kaplan–Meier curve revealed that Group 3 had a significantly higher rate of total cardiovascular events compared with the other two groups. By contrast, the occurrences of total cardiovascular events were not different among three groups in HFrEF and HFmrEF patients. Multivariate Cox proportional hazard analysis with significant factors in univariate analysis identified that the FIB4 index as an independent and significant predictor for future total cardiovascular events in HFpEF patients (hazard ratio: 1.09, 95% confidence interval: 1.03–1.15, P = 0.001). Conclusions: The FIB4 index was a significant predictor for total cardiovascular events in HFpEF.
DOI： 10.1002/ehf2.13351
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Bleeding and Subsequent Cardiovascular Events and Death in Atrial Fibrillation With Stable Coronary Artery Disease: Insights From the AFIRE Trial. 査読あり
Kaikita K, Yasuda S, Akao M, Ako J, Matoba T, Nakamura M, Miyauchi K, Hagiwara N, Kimura K, Hirayama A, Matsui K, Ogawa H, AFIRE Investigators.
Circulation. Cardiovascular interventions 14 ( 11 ) CIRCINTERVENTIONS120010476 2021年9月
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Atarashi H., Uchiyama S., Inoue H., Kitazono T., Yamashita T., Shimizu W., Ikeda T., Kamouchi M., Kaikita K., Fukuda K., Origasa H., Shimokawa H.
Heart and Vessels 36 ( 9 ) 1410 - 1420 2021年9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
The EXPAND Study demonstrated the effectiveness and safety of rivaroxaban in patients with non-valvular atrial fibrillation (NVAF) in routine clinical practice in Japan. This sub-analysis was conducted to reveal the effectiveness and safety of rivaroxaban in Japanese NVAF patients according to baseline creatinine clearance (CrCl) levels and rivaroxaban doses in the EXPAND Study. We examined 6806 patients whose baseline CrCl data were available and classified them into 2 groups: normal renal function group with CrCl ≥ 50 mL/min (n = 5326, 78%) and renal dysfunction group with CrCl < 50 mL/min (n = 1480, 22%). In the normal renal function group, 1609 (30%) received 10 mg/day (under-dose), while in the renal dysfunction group, 108 (7%) received 15 mg/day (over-dose). In the normal renal function group, under-dose of rivaroxaban was associated with higher all-cause mortality, while in the renal dysfunction group, over-dose was associated with higher incidence of major bleeding. In contrast, the incidence of stroke or systemic embolism was not different between the 2 groups regardless of the dose of rivaroxaban. In the propensity score matched analysis to adjust the difference in characteristics according to doses of rivaroxaban, the incidences of clinical outcomes were comparable between the 2 dose groups in both renal function groups. These results indicate that the dose of rivaroxaban should be reduced depending on the renal function, considering the balance between risks of bleeding and ischemia.
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Kanazawa H., Kaikita K., Ito M., Kawahara Y., Hoshiyama T., Kanemaru Y., Kiyama T., Iwashita S., Tabata N., Yamanaga K., Fujisue K., Sueta D., Takashio S., Arima Y., Araki S., Usuku H., Nakamura T., Izumiya Y., Sakamoto K., Suzuki S., Yamamoto E., Soejima H., Matsushita K., Tsujita K.
Journal of the American Heart Association 10 ( 17 ) e021551 2021年9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 the American Heart Association
BACKGROUND: The clinical implication of vascular endothelial dysfunction in patients with atrial fibrillation (AF) remains un-clear. This study aimed to elucidate the correlation between changes in vascular endothelial function assessed by reactive hyperemia-peripheral arterial tonometry and the effect of sinus rhythm restoration after catheter ablation (CA) for AF. METHODS AND RESULTS: Consecutive 214 patients who underwent CA for AF were included in this single center, retrospective study. The natural logarithmic transformed reactive hyperemia-peripheral arterial tonometry index (LnRHI) of all patients was measured before CA as well as 3 and 6 months after CA. LnRHI in sinus rhythm was significantly higher than that in AF before CA. Multivariate logistic regression analysis revealed that the presence of AF was an independent risk factor for lowering of LnRHI (odds ratio, 4.092; P=0.002) before CA. The LnRHI was significantly improved 3 and 6 months after CA in patients without AF recurrence. Multivariate Cox hazard analysis revealed that changes in LnRHI from before to 3 months after CA independently correlated with recurrence of AF (hazard ratio, 0.106; P=0.001). Receiver operating characteristic analysis showed the decrease in LnRHI levels from before to 3 months after CA as a significant marker that suspects AF recurrence (area under the curve, 0.792; log-rank test, P<0.001). CONCLUSIONS: The presence of AF was independently correlated with the impaired vascular endothelial function assessed by the reactive hyperemia-peripheral arterial tonometry. Long-term sinus rhythm restoration after CA for AF might contribute to the improvement of vascular endothelial function, which may reflect the nonrecurrence of AF.
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Validation of the Khorana Venous Thromboembolism Risk Score in Japanese Cancer Patients. 査読あり
Akasaka-Kihara F, Sueta D, Ishii M, Maki Y, Hirakawa K, Tabata N, Ito M, Yamanaga K, Fujisue K, Hoshiyama T, Hanatani S, Kanazawa H, Takashio S, Arima Y, Araki S, Usuku H, Nakamura T, Suzuki S, Yamamoto E, Soejima H, Kaikita K, Matsushita K, Matsuoka M, Usuku K, Tsujita K
JACC. Asia 1 ( 2 ) 259 - 270 2021年9月
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HE4 predicts progressive fibrosis and cardiovascular events in patients with dilated cardiomyopathy 査読あり
Yamamoto M., Hanatani S., Araki S., Izumiya Y., Yamada T., Nakanishi N., Ishida T., Yamamura S., Kimura Y., Arima Y., Nakamura T., Takashio S., Yamamoto E., Sakamoto K., Kaikita K., Matsushita K., Morimoto S., Ito T., Tsujita K.
Journal of the American Heart Association 10 ( 15 ) e021069 2021年8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 the American Heart Association
BACKGROUND: Cardiac fibrosis plays a crucial role in the pathogenesis of dilated cardiomyopathy (DCM). HE4 (human epididymis protein 4) is a secretory protein expressed in activated fibroblasts that exacerbates tissue fibrosis. In the present study, we investigated the clinical utility of HE4 measurement in patients with DCM and its pathophysiological role in preclinical experi-ments in vivo and in vitro. METHODS AND RESULTS: We measured serum HE4 levels of 87 patients with DCM. Endomyocardial biopsy expressed severe fibrosis only in the high HE4 group (P<0.0001). Echocardiography showed that left ventricular end-diastolic diameter tends to decrease over time (58±7.3 to 51±6.6 mm; P<0.0001) in the low HE4 group (<59.65 pmol/L [median value]). HE4 was significantly associated with risk reduction of mortality and cardiovascular hospitalization in multivariate Cox model. In vivo, HE4 was highly expressed in kidney and lung tissue of mouse, and scarcely expressed in heart. In genetically induced DCM mouse model, HE4 expression increased in kidney but not in heart and lung. In vitro, supernatant from HE4-transfected human em-bryonic kidney 293T cells enhanced transdifferentiation of rat neonatal fibroblasts and increased expression of fibrosis-related genes, and this was accompanied by the activation of extracellular signal-regulated kinase signaling in cardiac fibroblasts. Treatment with an inhibitor of upstream signal of extracellular signal-regulated kinase or a neutralizing HE4 antibody canceled the profibrotic properties of HE4. CONCLUSIONS: HE4 functions as a secretory factor, activating cardiac fibroblasts, thereby inducing cardiac interstitial fibrosis. HE4 could be a promising biomarker for assessing ongoing fibrosis and a novel therapeutic target in DCM. REGISTRATION: URL: https://upload.umin.ac.jp/cgi-open-bin/ctr; Unique identifier: UMIN000043062.
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East Asian variant aldehyde dehydrogenase type 2 genotype exacerbates ischemia/reperfusion injury with ST-elevation myocardial infarction in men: possible sex differences. 査読あり
Ishida T, Arima Y, Mizuno Y, Harada E, Yamashita T, Sueta D, Sakamoto K, Suzuki S, Kaikita K, Yamada Y, Shimomura H, Oniki K, Saruwatari J, Hokimoto S, Yasue H, Tsujita K
Heart and vessels 37 ( 2 ) 184 - 193 2021年7月
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Kumamoto Intervention Conference Study (KICS) Investigators. Imaging‑guided PCI for event suppression in Japanese acute coronary syndrome patients: community‑based observational cohort registry 査読あり
Yamashita T, Sakamoto K, Tabata N, Ishii M, Sato R, Nagamatsu S, Motozato K, Yamanaga K, Sueta D, Araki S, Arima Y, Yamamoto E, Takashio S, Fujisue K, Fujimoto K, Shimomura H, Tsunoda R, Maruyama H, Nakamura N, Sakaino N, Nakamura S, Yamamoto N, Matsumura T, Kajiwara I, Tayama S, Sakamoto T, Nakao K, Oshima S, Kaikita K, Hokimoto S, Tsujita K
Cardiovascular Intervention and Therapeutics 36 ( 1 ) 81 - 90 2021年7月
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Akao M., Yasuda S., Kaikita K., Ako J., Matoba T., Nakamura M., Miyauchi K., Hagiwara N., Kimura K., Hirayama A., Matsui K., Ogawa H.
American Heart Journal 236 59 - 68 2021年6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：American Heart Journal
Background: In the AFIRE trial, rivaroxaban monotherapy was noninferior to combination therapy with rivaroxaban and an antiplatelet agent for thromboembolic events or death, and superior for major bleeding in patients with atrial fibrillation (AF) and stable coronary artery disease. Little is known about impacts of stroke and bleeding risks on the efficacy and safety of rivaroxaban monotherapy. Methods: In this subanalysis of the AFIRE trial, we assessed the risk of stroke and bleeding by the CHADS2, CHA2DS2-VASc, and HAS-BLED scores. The primary efficacy end point was the composite of stroke, systemic embolism, myocardial infarction (MI), unstable angina requiring revascularization, or death from any cause. The primary safety end point was major bleeding defined by the International Society on Thrombosis and Haemostasis. Results: Rivaroxaban monotherapy significantly reduced the primary efficacy and safety end points with no evidence of differential effects by stroke risk (CHADS2, p for interaction = 0.727 for efficacy, 0.395 for safety; CHA2DS2-VASc, p for interaction = 0.740 for efficacy, 0.265 for safety) or bleeding risk (HAS-BLED, p for interaction = 0.581 for efficacy, 0.225 for safety). There was also no evidence of statistical heterogeneity across patient risk categories for other end points; stroke or systemic embolism, ischemic stroke, hemorrhagic stroke, MI, MI or unstable angina, death from any cause, any bleeding, or net adverse clinical events. Conclusions: The advantages of rivaroxaban monotherapy compared with those of combination therapy with respect to all prespecified end points, including thromboembolism, bleeding, and mortality were similar across patients with AF and stable coronary artery disease, irrespective of their risk for stroke and bleeding. Clinical Trial Registration: UMIN Clinical Trials Registry number, UMIN000016612, and ClinicalTrials.gov number, NCT02642419.
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Egashira K., Sueta D., Tomiguchi M., Kidoh M., Oda S., Usuku H., Hidaka K., Goto-Yamaguchi L., Sueta A., Komorita T., Takae M., Oike F., Fujisue K., Yamamoto E., Hanatani S., Takashio S., Arima Y., Araki S., Kaikita K., Matsushita K., Yamamoto Y., Hirai T., Tsujita K.
IJC Heart and Vasculature 34 100797 2021年6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：IJC Heart and Vasculature
Cardiotoxicity in the late phase after anthracycline drugs administration remains to be defined. Of the 44 patients who received anthracycline treatment, 7 were found to have cancer therapeutics–related cardiac dysfunction (CTRCD). The global longitudinal strain determined by echocardiography and myocardial extracellular volume fraction (ECV) determined by cardiac computed tomography (CCT) of the CTRCD(+) group were significantly higher than those of the control group and CTRCD(-) group, whereas there were no significant differences between the control and CTRCD(-) groups. Our findings indicated that CCT may be a tool comparable to echocardiography, indicating the effective evaluation of CTRCD by CCT.
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A Coronary Artery-Left Ventricular Fistula Through the Sinusoid. 査読あり
Sato K, Misumi I, Nagano M, Arima R, Ehara S, Sakamoto T, Usuku H, Kaikita K, Tsujita K
Internal medicine (Tokyo, Japan) 60 ( 23 ) 3755 - 3758 2021年5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：一般社団法人 日本内科学会
A 78-year-old woman was referred to our hospital because of repetitive suppurative arthritis at the artificial left knee joint. Her plasma brain natriuretic peptide level was 122 pg/mL. A 12-lead electrocardiogram showed a QS pattern in the inferior leads. A two-dimensional echocardiogram revealed hypokinesis at the inferior wall and hypertrophy at the apical lateral wall. Color flow imaging revealed this hypertrophic region to be a myocardial sinusoid, demonstrating diastolic coronary to left ventricular flow and early systolic flow vice versa. This was a very rare case of coronary to left ventricular fistula through a sinusoid without cyanotic congenital heart disease or severe coronary artery disease.
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Emoto T., Oda S., Kidoh M., Nakaura T., Nagayama Y., Sakabe D., Kakei K., Goto M., Funama Y., Hatemura M., Takashio S., Kaikita K., Tsujita K., Ikeda O.
Academic Radiology 28 ( 5 ) e119 - e126 2021年5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：Academic Radiology
Rationale and Objectives: To clarify the accuracy of two measurement methods for myocardial extracellular volume (ECV) quantification (ie, the standard subtraction method [ECV ] and the dual-energy iodine method [ECV ]) with the use of cardiac CT in comparison to cardiac magnetic resonance imaging (CMR) as a reference standard. Materials and Methods: Equilibrium phase cardiac images of 21 patients were acquired with a dual-layer spectral detector CT and CMR, and the images were retrospectively analyzed. CT-ECV was calculated using ECV and ECV . The correlation between the ECV values measured by each method was assessed. Bland-Altman analysis was used to identify systematic errors and to determine the limits of agreement between the CT-ECV and CMR-ECV values. Root mean squared errors and residual values for the ECV and ECV were also assessed. Results: The correlations between ECV and ECV for both septal and global measurement were r = 0.95 (p < 0.01) and 0.91 (p < 0.01), respectively, while those between the mean ECV and CMR-ECV were r = 0.90 (septal, p < 0.01) and 0.84 (global, p < 0.01), and those between ECV and CMR-ECV were r = 0.94 (septal, p < 0.01) and 0.95 (global, p < 0.01). Bland-Altman plots showed lower 95% limits of agreement between ECV and CMR-ECV compared with that between ECV and CMR-ECV in both septal and global measurement. The root mean squared error of ECV was higher than that of ECV . The mean residual value of ECV was significantly higher than that of ECV . Conclusion: ECV yielded more accurate myocardial ECV quantification than ECV , and provided a comparable ECV value to that obtained by CMR. sub iodine sub iodine sub iodine sub iodine sub iodine iodine sub sub iodine sub iodine iodine sub
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抗血栓療法時の検査法の意義 (特集 冠動脈疾患患者における抗血栓療法の現状と課題) 査読あり
海北 幸一, 辻田 賢一
ICUとCCU = Japanese journal of intensive care medicine : 集中治療医学 45 ( 5 ) 273 - 279 2021年5月
担当区分：筆頭著者 記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：医学図書出版
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抗血栓療法時の検査法の意義.
海北幸一, 辻田賢一.
ICUとCCU 集中治療医学 45 ( 5 ) 273 - 279 2021年5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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JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. 査読あり
Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H, Japanese Circulation Society Working Group.
Circulation journal : official journal of the Japanese Circulation Society 85 ( 4 ) 402 - 572 2021年3月
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Nakanishi N., Kaikita K., Ishii M., Kuyama N., Tabata N., Ito M., Yamanaga K., Fujisue K., Hoshiyama T., Kanazawa H., Hanatani S., Sueta D., Takashio S., Arima Y., Araki S., Usuku H., Nakamura T., Suzuki S., Yamamoto E., Soejima H., Matsushita K., Tsujita K.
International Journal of Cardiology 325 121 - 126 2021年2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：International Journal of Cardiology
Background: Antithrombotic therapy is established for the treatment of various cardiovascular events. However, it has been shown to increase the bleeding risk. Total Thrombus-formation Analysis System (T-TAS) is reported to be useful for evaluating thrombogenicity. Here, we estimated whether T-TAS is useful for predicting bleeding events risk in patients undergoing percutaneous coronary intervention (PCI). Methods: This was a retrospective, observational study at Kumamoto University Hospital between April 2017 and March 2019. Blood samples obtained on the day of PCI were used in T-TAS to compute the thrombus formation area under the curve (AUC) (AR -AUC , AUC for AR chip). We divided the study population into 2 groups according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) (182 patients in ARC-HBR positive, 118 in ARC-HBR negative). The primary endpoint was 1-year bleeding events that were defined by Bleeding Academic Research Consortium type2, 3, or 5. Results: The AR -AUC levels were significantly lower in the ARC-HBR positive group than in the ARC-HBR negative group (median [interquartile range] 1571.4 [1277.0–1745.3] vs. 1726.2 [1567.7–1799.6], p < 0.001). The combination of ARC-HBR and AR -AUC could discriminate the bleeding risk, and improved predictive capacity compared with ARC-HBR by c-statistics. Decision-curve analysis also revealed that combining AR -AUC with ARC-HBR ameliorated bleeding risk-prediction. In multivariate Cox hazards analyses, combining ARC-HBR with lower AR -AUC levels was significantly associated with 1-year bleeding events. Conclusions: The results highlight that AR -AUC evaluated by T-TAS could be a potentially useful marker for predicting high bleeding risk in patients undergoing PCI. 10 30 10 30 10 30 10 30 10 30 10 30