Background:Acute coronary syndrome (ACS) hospital survivors experience a wide array of late adverse cardiac events, despite considerable advances in the quality of care. We investigated 30-day and ...1-year outcomes of ACS hospital survivors using a Japanese nationwide cohort.Methods and Results:We studied 20,042 ACS patients who underwent percutaneous coronary intervention (PCI) in 2017: 10,242 (51%) with ST-elevation myocardial infarction (STEMI), 3,027 (15%) with non-ST-elevation myocardial infarction (NSTEMI), and 6,773 (34%) with unstable angina (UA). The mean (±SD) age was 69.6±12.4 years, 77% of the patients were men, and 20% had a previous history of PCI. The overall 30-day all-cause, cardiac, and non-cardiac mortality rates were 3.0%, 2.4%, and 0.6%, respectively. The overall 1-year incidence of all-cause, cardiac, and non-cardiac death was 7.1%, 4.2%, and 2.8%, respectively. Compared with UA patients, STEMI patients had a higher risk of all fatal events, non-fatal ischemic stroke, and acute heart failure, and NSTEMI patients had a higher risk of heart failure.Conclusions:The results from our ACS hospital survivor PCI database suggest the need to improve care for the acute myocardial infarction population to lessen the burden of 30-day mortality due to ACS, heart failure, and sudden cardiac death, as well as 1-year ischemic stroke and heart failure events.
Background:With the rapid spread of COVID-19, hospitals providing percutaneous coronary intervention (PCI) were placed in unique and unfamiliar circumstances. This study evaluated variations in the ...treatment of coronary artery disease according to time course of the COVID-19 pandemic in Japan.Methods and Results:The Japanese Association of Cardiovascular Intervention and Therapeutics performed serial surveys during the pandemic (in mid-April, late-April and mid-May 2020) with queries regarding the implementation of PCI. Hospitals were asked about their treatment strategies for elective PCI and emergency PCI for ST-elevation myocardial infarction (STEMI) and high-risk acute coronary syndrome (ACS) patients. Most hospitals opted to perform primary PCI in the usual manner at the beginning of the pandemic. As the pandemic progressed, hospitals in the 7 populated areas downgraded the performance of PCI for chronic coronary syndrome and high-risk ACS, but not for STEMI patients. After the state of emergency was lifted in most prefectures in mid-May, the rate of PCI gradually normalized. Screening tests, such as polymerase chain reaction and chest computed tomography, in ACS were frequently used.Conclusions:The COVID-19 pandemic greatly affected PCI treatment in Japan. However, even in the most critical situations during the pandemic, most institutions continued to perform primary PCI normally for STEMI patients.
Adoption of the results of large-scale randomized controlled trials in percutaneous coronary intervention (PCI) may differ internationally, yet few studies have described the potential variations in ...PCI practice patterns.
Using representative national registries, we compared temporal trends in procedural volume, patient characteristics, pre-procedural testing, procedural characteristics, and quality metrics in the United States and Japan.
The National Cardiovascular Data Registry CathPCI was used to describe care in the United States, and the J-PCI was used to assess practice patterns in Japan (numbers of participating hospitals: 1,752 in the United States and 1,108 in Japan). Both registries were summarized between 2013 and 2017.
PCI volume increased by 15.8% in the United States from 550,872 in 2013 to 637,650 in 2017, primarily because of an increase in nonelective PCIs (p for trend <0.001). In Japan, the volume of PCIs increased by 36%, from 181,750 in 2013 to 247,274 in 2017, primarily because of an increase in elective PCIs (p for trend <0.001). The proportion of PCI cases for elective conditions was >2-fold greater in Japan (72.7%) than in the United States (33.8%; p < 0.001). Overall, the ratio of nonelective PCI (vs. elective PCI; 27.3% vs. 66.2%; p < 0.001) and the performance of noninvasive stress testing in patients with stable disease (15.2% vs. 55.3%; p < 0.001) was lower in Japan than in the United States. Computed tomography angiography was more commonly used in Japan (22.3% vs. 2.0%; p < 0.001).
Elective PCI is more than twice as common in Japan as in the United States in contemporary practice. Computed tomography angiography is much more frequently used pre-procedurally in Japan than in the United States.
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Cardiovascular interventions have achieved a level of excellence, with many outstanding advanced techniques and results. The mission of the Japanese Association of Cardiovascular Intervention and ...Therapeutics (CVIT) is to further our understanding of cardiovascular intervention and establish its procedural safety.
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The Japanese Percutaneous Coronary Intervention (J-PCI) registry was established and sponsored by CVIT, and aims to provide basic statistics on the performance of percutaneous coronary interventions (PCI) in Japan. Today, the database has grown to become one of the largest healthcare procedural database with more than 200,000 cases registered annually from approximately 900 institutions in Japan representing over 90% of all PCI hospitals in the nation. Importantly, case registrations in the J-PCI registry are essential for coronary interventionalist and educating hospital certification. The present manuscript aimed to summarize the history of the J-PCI registry and outline the definitions of various items.
BACKGROUND—The pathomechanisms underlying very late stent thrombosis (VLST) after implantation of drug-eluting stents (DES) are incompletely understood. Using optical coherence tomography, we ...investigated potential causes of this adverse event.
METHODS AND RESULTS—Between August 2010 and December 2014, 64 patients were investigated at the time point of VLST as part of an international optical coherence tomography registry. Optical coherence tomography pullbacks were performed after restoration of flow and analyzed at 0.4 mm. A total of 38 early- and 20 newer-generation drug-eluting stents were suitable for analysis. VLST occurred at a median of 4.7 years (interquartile range, 3.1–7.5 years). An underlying putative cause by optical coherence tomography was identified in 98% of cases. The most frequent findings were strut malapposition (34.5%), neoatherosclerosis (27.6%), uncovered struts (12.1%), and stent underexpansion (6.9%). Uncovered and malapposed struts were more frequent in thrombosed compared with nonthrombosed regions (ratio of percentages, 8.26; 95% confidence interval, 6.82–10.04; P<0.001 and 13.03; 95% confidence interval, 10.13–16.93; P<0.001, respectively). The maximal length of malapposed or uncovered struts (3.40 mm; 95% confidence interval, 2.55–4.25; versus 1.29 mm; 95% confidence interval, 0.81–1.77; P<0.001), but not the maximal or average axial malapposition distance, was greater in thrombosed compared with nonthrombosed segments. The associations of both uncovered and malapposed struts with thrombus were consistent among early- and newer-generation drug-eluting stents.
CONCLUSIONS—The leading associated findings in VLST patients in descending order were malapposition, neoatherosclerosis, uncovered struts, and stent underexpansion without differences between patients treated with early- and new-generation drug-eluting stents. The longitudinal extension of malapposed and uncovered stent was the most important correlate of thrombus formation in VLST.
BACKGROUND:Recently, the Academic Research Consortium for High Bleeding Risk (ARC-HBR) has been proposed to standardize the definition of HBR, which was arbitrarily defined as a Bleeding Academic ...Research Consortium 3 or 5 bleeding ≥4% at 1-year. However, the prevalence and the expected bleeding event rate of HBR patients defined by ARC-HBR criteria are currently unknown in the real-world percutaneous coronary intervention practice.
METHODS:We applied the ARC-HBR criteria in the CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort-2, a multicenter registry that enrolled 13 058 consecutive patients who underwent their first percutaneous coronary intervention. The primary bleeding end point was defined as the Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries moderate/severe bleeding. There were 5570 patients (43%) in the HBR group and 7488 patients in the no-HBR group.
RESULTS:Cumulative incidence of the primary bleeding end point was much higher in the HBR group than in the no-HBR group (10.4% versus 3.4% at 1-year, and 18.9% versus 6.6% at 5-year, P<0.0001). Presence of each ARC-HBR major or even minor criterion, in isolation, with the exception of liver cirrhosis and prior ischemic stroke, was also associated with major bleeding risk higher than 4% at 1-year. Cumulative 5-year incidence of the primary bleeding end point got incrementally higher as the number of the ARC-HBR major criteria increased (≥3 majors49.9%, 2 majors30.6%, 1 major18.5%, ≥2 minors14.7%, and no-HBR6.6%, P<0.0001).
CONCLUSIONS:ARC-HBR criteria successfully identified those patients with very HBR after percutaneous coronary intervention, who represented 43% of patients in this all-comers registry.
Abstract Effects of daily fluctuation of ambient temperature and concentrations of air pollutants on acute cardiovascular events have not been well studied. Between January 2011 and December 2012, a ...total of 56,863 consecutive ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention were registered from 929 institutes with median inter-institutional distance of 2.6 km. We constructed generalized linear mixed models in which presence or absence of STEMI patients per day per institute was included as a binomial response variable, with daily meteorological and environmental data obtained from their respective observatories nearest to the institutes (median distance of 9.7 km and 5.6 km) as the explanatory variables. Both lower mean temperature, and increase in maximum temperature from the previous day were independently associated with the STEMI occurrence throughout the year (OR 0.92595%CI 0.915-0.935, per10°C, P<0.001, and OR 1.01295%CI 1.009-1.015, per°C, P<0.001, respectively). Decrement in minimum temperature from -4 day to -3 day before the event date was marginally associated with the STEMI occurrence, only during the wintertime (OR 0.99195%CI 0.982-0.999, per°C, P=0.03). As for the air pollutants, nitrogen oxides and suspended particle matter were not correlated with the occurrence of STEMI after adjusting for the meteorological and livelihood variables. Both the absolute value and relative change in the ambient temperature were associated with the occurrence of STEMI; the associations with the air pollutant levels were less clear after adjustment for these meteorological variables in Japan.
Compared with bare metal stents, first-generation drug-eluting stents (DES) are associated with an increased risk of late restenosis and stent thrombosis (ST). Whether this risk continues or ...attenuates during long-term follow-up remains unknown.
We extended the follow-up of 1012 patients sirolimus-eluting stent (SES): N = 503 and paclitaxel-eluting stent (PES): N = 509 included in the all-comers, randomized Sirolimus-Eluting vs. Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX) trial to 10 years. Follow-up was complete in 895 patients (88.4%) at 10 years. At 1, 5, and 10 years of follow-up, rates of ischaemia-driven target lesion revascularization (ID-TLR) were 8.1%, 14.6% and 17.7%, respectively, and rates of ST were 1.9%, 4.5% and 5.6%, respectively. The annual risks of ID-TLR and definite ST were significantly higher between 1 and 5 years as compared with the 5- to 10-year period ID-TLR: 1.8% vs. 0.7%/year, hazard ratio (HR) 0.36, 95% confidence intervals (95% CI) 0.21-0.62, P < 0.001; definite ST: 0.67% vs. 0.23%/year, HR 0.31, 95% CI 0.13-0.75, P = 0.01. The attenuation of the risk of ID-TLR and ST beyond 5 years was independent of age. Major adverse events (cardiac death, myocardial infarction, and ID-TLR) occurred in 33.7% of SES- and 33.8% of PES-treated patients (P = 0.72).
During long-term follow-up through 10 years, the annual risks of ID-TLR and definite ST significantly decreased beyond 5 years after first-generation DES implantation. These findings may have important implications for secondary prevention after percutaneous coronary intervention with first-generation DES including long-term antiplatelet therapy.
http://www.clinicaltrials.gov. Unique identifier: NCT00297661.
Predictive ability of changes in the ankle–brachial index (ABI) after revascularization for long-term clinical outcomes remains unclear. Pre- and postprocedural ABI were recorded for 1307 consecutive ...patients who underwent their first successful EVT for symptomatic aortoiliac (
n
= 710) or femoropopliteal (
n
= 597) lesions. The patients were divided into two groups according to the increase in ABI: ∆ABI ≥ 0.15 (
n
= 980) and ∆ABI < 0.15 (
n
= 327). We investigated the association between ABI improvement after EVT and long-term clinical outcomes. The clinical outcome measures included all-cause mortality, myocardial infarction, stroke, target limb revascularization, EVT for target lesion revascularization, major amputation of the target limb, and a composite endpoint that included both target limb revascularization and major amputation. All-cause mortality was significantly lower in the ∆ABI ≥ 0.15 group than in the ∆ABI < 0.15 group crude hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.60–0.98,
P
= 0.03; however, this was no longer statistically significant after adjusting for baseline characteristics (adjusted HR 0.82, 95% CI 0.63–1.07,
P
= 0.14). A composite of target limb revascularization and major amputation was less often observed at 10 years in the ΔABI ≥ 0.15 group (258 patients, 38%) compared with the ΔABI < 0.15 group (112 patients, 59%; adjusted HR 0.54, 95% CI 0.42–0.68,
P
< 0.001), mainly because of a lower risk of target limb revascularization (adjusted HR 0.54, 95% CI 0.42–0.69,
P
< 0.001). No significant interactions were noted with regard to the locations of the treated lesions (
P
for the interaction, 0.13) or preprocedural ABI (
P
for the interaction, 0.40). An increase of ABI ≥ 0.15 after successful EVT was an independent predictor for freedom from a composite of target limb revascularization and major amputation, irrespective of the locations of the treated lesions and the preprocedural ABI.
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