Hiroyuki Sugimura

Eicosapantaenoic acid treatment based on the EPA/AA ratio in patients with coronary artery disease: follow-up data from the Tochigi Ryomo EPA/AA Trial in Coronary Artery Disease (TREAT-CAD) study

Eicosapentaenoic acid (EPA) administration has been reported to decrease the incidence of cardiovascular events, and the serum EPA/arachidonic acid (AA) ratio has been identified as a potential new risk marker for coronary artery disease (CAD). The present study aimed to investigate the value of EPA treatment based on the EPA/AA ratio at baseline. We retrospectively analyzed clinical outcome data from 149 CAD patients with a baseline EPA/AA ratio ≤ 0.4 who had received purified EPA (EPA group) or not (no EPA group) and CAD patients with an EPA/AA ratio > 0.4 who had not received EPA (control group). The baseline EPA/AA ratios were similar in the EPA and no EPA groups and were significantly lower than those in the control group (P < 0.0001). The EPA/AA ratio significantly increased in the EPA group (P < 0.0001) and the no EPA group (P < 0.001) but not in the control group. The cumulative incidence of cardiovascular death tended to be lower in the EPA group (log-rank test: P = 0.07). Receiver operating characteristic curve analysis demonstrated that the cut-off value of the target EPA/AA ratio after EPA treatment for all-cause death was 1.23 (AUC = 0.85, P = 0.016). These results suggest that EPA treatment may improve the long-term prognosis in CAD patients with an EPA/AA ratio ≤ 0.4 and that an EPA/AA ratio > 1.2 may be an appropriate EPA treatment target value to reduce mortality.

Feasibility of using an automatic blood return system compared with the manual method during a power interruption

キーワード:自動,返血,透析,停電 〈要旨〉 【目的】バックアップオンライン返血機能を搭載したニプロ社製透析用患者監視装置 NCV‒3の利便性を通常の手動 での生理食塩水を用いた返血と比較検討した.【方法】試験デザインはクロスオーバー法を採用した.NCV‒3のオ ンライン返血と生理食塩水を用いた手動返血を,透析部臨床工学技士スタッフ 4名がそれぞれ 8回ずつ独力でシ ミュレーションし,返血開始から終了までの時間を計測した.【結果】バックアップオンライン自動返血の所要時間 は個人差がなく,初回 222.0±5.0秒であり,手動返血にかかる時間(344.0±14.1秒,p=0.0005)と比較して有意 に短かった.手動返血では実施回数を重ねるにつれ全員の所要時間は徐々に短縮し 8回目の所要時間は 236.5±9.6 秒となり,自動返血とほぼ互角となった.【結論】バックアップオンライン自動返血は,人手をかけず緊急時の返血 業務を素早く行うことができる.

Out-of-hospital cardiac arrest related to coronary arterial spasm in three elderly patients with no obstructive coronary artery disease

Coronary spastic angina (CSA) is relatively more common in young people than in elderly people. Here, we present three cases of elderly male patients who experienced out-of-hospital cardiac arrest (OHCA) likely due to coronary spasm-induced ventricular fibrillation (Vf) from 2013 to 2016. After defibrillation, emergency coronary arteriography demonstrated severe coronary vasospasm that resolved following intracoronary infusion of nitroglycerin in the right coronary arteries in all three patients, with no organic obstructive lesion in the coronary arteries after nitroglycerin infusion. Case 1 was a 74-year-old patient with a past history of unstable angina and no organic obstructive lesion on coronary arteriography. He was administered oral amlodipine, isosorbide mononitrate, and nicorandil. He survived an OHCA and underwent implantable cardioverter defibrillator (ICD) implantation on day 57. Case 2 was a 71-year-old patient without prior CSA, who suddenly lost consciousness during a break after tennis. Vf was reversed to sinus rhythm by defibrillation in the ambulance. He died of multi-organ failure on day 7. Case 3 was a 66-year-old patient diagnosed with multi-vessel CSA by coronary arteriography with acetylcholine provocation test. He survived an OHCA associated with inferior acute myocardial infarction, rejected ICD implantation, and has not had a chest pain attack or syncope since discharge. <Learning objective: This article reports a case series of out-of-hospital cardiac arrest (OHCA) likely due to coronary spastic angina (CSA) in the presence of non-obstructive coronary artery disease in elderly patients. Although CSA is associated with an increased risk of OHCA, little is known regarding clinical risk factors, the effectiveness of implanted defibrillators for the secondary prevention of cardiac arrest, or the long-term prognosis of elderly CSA patients who survive OHCA.>.