Despite its recommendation by the current guidelines, the role of long-term oral beta-blocker therapy has never been evaluated by randomized trials in uncomplicated ST-segment elevation myocardial ...infarction (STEMI) patients without heart failure, left ventricular dysfunction or ventricular arrhythmia who underwent primary percutaneous coronary intervention (PCI).
In a multi-center, open-label, randomized controlled trial, STEMI patients with successful primary PCI within 24 hours from the onset and with left ventricular ejection fraction (LVEF) ≥40% were randomly assigned in a 1-to-1 fashion either to the carvedilol group or to the no beta-blocker group within 7 days after primary PCI. The primary endpoint is a composite of all-cause death, myocardial infarction, hospitalization for heart failure, and hospitalization for acute coronary syndrome. Between August 2010 and May 2014, 801 patients were randomly assigned to the carvedilol group (N = 399) or the no beta-blocker group (N = 402) at 67 centers in Japan. The carvedilol dose was up-titrated from 3.4±2.1 mg at baseline to 6.3±4.3 mg at 1-year. During median follow-up of 3.9 years with 96.4% follow-up, the cumulative 3-year incidences of both the primary endpoint and any coronary revascularization were not significantly different between the carvedilol and no beta-blocker groups (6.8% and 7.9%, P = 0.20, and 20.3% and 17.7%, P = 0.65, respectively). There also was no significant difference in LVEF at 1-year between the 2 groups (60.9±8.4% and 59.6±8.8%, P = 0.06).
Long-term carvedilol therapy added on the contemporary evidence-based medications did not seem beneficial in selected STEMI patients treated with primary PCI.
CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in Large-scale Randomized Controlled Trial) ClinicalTrials.gov.number, NCT 01155635.
Aim: Multiple risk factor syndrome is a target for the prevention of coronary artery disease (CAD). A cluster of multiple risk factors, such as hypertension, glucose intolerance, and/or dyslipidemia, ...is encountered in Japanese without and with excess visceral fat. The present study investigated the relationship between multiple risk factor accumulation and CAD in Japanese without and with visceral fat accumulation. Methods: The study subjects comprised 257 Japanese with suspected CAD (males/females= 153/ 104), who underwent 64-row multislice computed tomography (CT) coronary angiography and visceral fat area (VFA) measurement by CT. Based on the Japanese criteria for visceral fat accumulation, they were divided into those with VFA <100 and≥10cm2. Results: In subjects with VFA <100 cm2, the age- and sex-adjusted odds ratios (ORs) for 2 and 3 risk factors were 5.33 (95% confidence intervals; 1.04-27.38, p=0.0449) and 4.07 (0.72-23.15, p=0.1138), respectively, compared with VFA <100 cm2 and 0 risk factor set at 1.0 (p=0.0569 for trend). In contrast, the respective ORs for subjects with VFA ≥100 cm2 were much higher 6.46 (1.25-33.44, p=0.0261) and 20.42 (3.60-115.73, p=0.0007) (p<0.0001 for trend). The multivariate adjusted model demonstrated a significant relative excess CAD risk of 1.08 (p=0.0484) and 5.01 (p<0.0001) for the interactions of 2 risk factors and VFA ≥100cm2, and 3 risk factors and VFA ≥100 cm2, whereas multiple risk factor accumulation was not related with the increase of CAD risk in subjects with VFA <100cm2. Conclusions: Coexistence of visceral fat and risk factor accumulations is strongly associated with CAD in Japanese.
Fistulas between an aneurysm branching off the abdominal aorta and the thoracic duct are rare. We report a case of aneurysmal-thoracic duct fistula diagnosed by angiography when aneurysm ruptured, ...and we successfully treated by catheter embolization. A 42-year-old man was referred to our hospital with a chief complaint of sudden back and chest pain. Computed tomography showed both post-mediastinal and retroperitoneal hematomas, with the aneurysm from the aorta being connected to the thoracic duct. After confirming the aneurysmal-thoracic duct fistula by angiography, we performed embolization of the aneurysm. The patient has remained well for 3 postoperative months, to date.
Maximum allowable contrast dose (MACD) calculated as body weight × 5/serum creatinine has been a standard contrast dye volume (CV) used to decrease contrast-induced acute kidney injury. Recent ...advances in intravascular ultrasound-guided percutaneous coronary intervention (PCI) can dramatically minimize CV. The safe threshold when using an extremely low-dose CV is unknown. This study was designed as a multicenter, retrospective study of chronic kidney disease (CKD) patients with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m
2
undergoing elective PCI. We divided the patients into three groups according to following criteria: (1) low dose, CV/eGFR ratio <1.0; (2) medium dose, CV/eGFR ratio ≥1 and <MACD; and (3) high dose, CV ≥MACD. A total of 100 patients were enrolled. Average age was 74 ± 8 years, 64 % were male and 48 % were diabetic. Mean baseline eGFR was 22.8 ± 6.0 ml/min/1.73 m
2
. CV in the three groups was 15 ± 6 ml (
n
= 18), 69 ± 39 ml (
n
= 47) and 224 ± 99 ml (
n
= 35), respectively. The incidences of CI-AKI were 0, 11 and 23 %, respectively (
p
= 0.02). All-cause death or introduction of maintenance hemodialysis at 1 year was 0, 13.8 and 31 %, respectively (
p
= 0.01). Extreme reduction of CV to a CV/eGFR ratio <1.0 may reduce CI-AKI and achieve better clinical outcomes following PCI in patients with severe CKD.
Background The COMET study suggested the better effect of carvedilol to metoprolol in treating heart failure. However, its underlying mechanisms of action remain unclear. As a result, evaluation of ...the distinct effects of both drugs on the mitochondrial function and reactive oxygen species (ROS) production during Ca2+ overload was investigated. Methods and Results The mitochondrial oxygen consumption (mVO2) and the mitochondrial ROS production in isolated rat heart mitochondria was measured. Ca2+ overload from 10 to 100 μmol/L augmented mVO2 was from 527±139 to 671 ±138 nmol/mg (p<0.05), and this was then completely suppressed by carvedilol (1 μmol/L), but not by metoprolol (100 μmol/L). Ca2+ overload augmented the ROS production upon complex I injury (9.7±1.2 to 11.4±1.4 nmol/mg, p<0.05). Carvedilol dose-dependently suppressed this ROS production, whereas metoprolol did not. Conclusions Carvedilol, but not metoprolol, was thus found to inhibit the calcium-dependent augmentation of mVO2 and ROS production upon complex I injury. This new effect of carvedilol might partly explain the beneficial effect of carvedilol for the treatment of heart failure. (Circ J 2006; 70: 321 - 326)
Abstract
Background
Coronary artery perforation is a rare but life-threatening complication of percutaneous coronary intervention. We present a case of coronary artery perforation treated with a PK ...Papyrus covered stent. Neointimal coverage evaluation was performed using optical coherence tomography (OCT) and coronary angioscopy (CAS) at 3 and 9 months after stent implantation.
Case summary
A 63-year-old man was admitted to our hospital with worsening effort angina over 3 months. Coronary angiography revealed severe stenosis in the proximal segment of the left anterior descending artery. After stent implantation, coronary artery perforation occurred. We immediately sealed the perforation site using a PK Papyrus covered stent. The patient was discharged on postoperative day 4. OCT and CAS revealed incomplete neointimal coverage at the PK Papyrus covered stent strut 3 months after stent implantation. At 9 postoperative months, complete neointimal coverage was observed. We continued clopidogrel and edoxaban, but no clinical adverse events were encountered during the follow-up.
Discussion
To the best of our knowledge, this is the first report of a serial observation of PK Papyrus covered stent implantation for coronary artery perforation using OCT and CAS. In this case, OCT and CAS revealed complete neointimal coverage, without obvious thrombus, 9 months after PK Papyrus implantation. Based on the OCT and CAS findings, our report presents an appropriate follow-up strategy for the prevention of stent thrombosis when using a PK Papyrus covered stent, which will contribute to future research on the appropriate duration of dual antiplatelet therapy and evaluation of neointimal coverage.
The aim of this study was to investigate the spatiotemporal characteristics of rhythmic, stationary basketball bouncing in skilled and unskilled adult basketball players. Skilled (n = 12) and ...unskilled (n = 11) basketball players were asked to bounce a basketball every 700 msec, in as temporally stable and spatially accurate a manner as possible, while keeping their eyes fixed straight ahead. Spatial analyses revealed a lower variability of the ball bouncing point and less deviation from a target point in the performance of skilled players compared to unskilled players. Temporal analyses revealed no significant difference in variability of the interbounce interval in skilled versus unskilled players. However, skilled players had longer and more consistent contact time between hand and ball compared to the unskilled players. These results suggest that longer and more consistent hand contact with the ball play an important role in spatial control of basketball bouncing position.
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