Noriyuki Ohashi

Optical Coherence Tomography Findings in Lesions After Sirolimus-Eluting Stent Implantation With Peri-Stent Contrast Staining

Background—We have sometimes noted abnormal angiographic coronary dilatation, <50% of the reference vessel, at the site of sirolimus-eluting stent implantation, suggesting contrast staining outside the stent struts and named this finding peri-stent contrast staining (PSS). Little was known about optical coherence tomography findings of lesions with PSS. Methods and Results—Between May 2008 and March 2010, we performed optical coherence tomography for 90 in-stent restenosis lesions after sirolimus-eluting stent implantation. We found PSS in 20 of the 90 lesions by coronary angiography. The differences in optical coherence tomography findings, including incomplete stent apposition, multiple interstrut hollows (MIH), strut coverage, and thrombus, were compared between lesions with PSS and those without PSS. PSS is defined as contrast staining outside the stent contour extending to >20% of the stent diameter measured by quantitative coronary angiography. MIH is defined as multiple hollows (the maximum depth >0.5 mm) existing between and outside well-apposed stent struts. Both incomplete stent apposition (60.0% versus 10%; P<0.001) and MIH (85.0% versus 25.7%; P<0.001) were frequently observed in lesions with PSS than in lesions without PSS. Among the 20 lesions with PSS, there was only 1 lesion in which we found neither MIH nor incomplete stent apposition, but only minor dissection. Uncovered struts (11.6% versus 3.9%; P=0.001), malapposed struts (2.0% versus 0.0%; P<0.001), and red thrombus (35% versus 10%; P=0.012) were frequently observed in lesions with PSS than in lesions without PSS. Conclusions—PSS might be closely associated with 2 different optical coherence tomography findings, MIH and incomplete stent apposition, in lesions after sirolimus-eluting stent implantation.

DIRECT ORAL ANTICOAGULANTS VERSUS WARFARIN FOR ATRIAL FIBRILLATION IN FRAIL AND NON-FRAIL PATIENTS

Impact of direct oral anticoagulants (DOAC) on frail and non-frail patients with atrial fibrillation (AF), in comparison with that of warfarin is unknown. We enrolled 1209 consecutive AF patients between January 2013 and December 2015. Of whom, 486 elderly patients, including 436 patients receiving

Relationship between n-3 Polyunsaturated Fatty Acids and Extent of Vessel Disease in Patients with ST Elevation Myocardial Infarction

A relationship between serum polyunsaturated fatty acids (PUFAs) and cardiovascular disease has been reported; however, the existence of a relationship between serum PUFAs and extent of vessel disease (VD) in patients with ST elevation myocardial infarction (STEMI) remains unclear.Between July 2011 and June 2015, 866 consecutive STEMI patients underwent emergent percutaneous coronary intervention, 507 of whom were enrolled and classified into three groups according to the initial angiograms: 1VD, 294 patients; 2VD, 110 patients; and 3VD/left main trunk disease (LMTD), 103 patients. Serum levels of PUFAs, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid, and other laboratory data during hospitalization were evaluated.The serum EPA level in the 3VD/LMTD group was significantly lower than that in the 1VD group (55.5 ± 22.1 versus 66.2 ± 28.7, P = 0.002) and was slightly lower than that in the 2VD group (55.5 ± 22.1 versus 65.2 ± 28.9, P = 0.0167). Multivariate adjustment analysis revealed that age ≥ 70 years (odds ratio, 1.72; 95% confidence interval, 1.03-2.89; P = 0.038) and a low serum EPA level (odds ratio, 0.98; 95% confidence interval, 0.99-1.00; P = 0.023) were independent risk factors for 3VD/LMTD, while a low serum DHA level was not.A low serum EPA level may be more strongly related than a low serum DHA level to the extent of VD in STEMI patients. Age ≥ 70 years and a low serum EPA level may be independent risk factors for 3VD/LMTD.

DOES ANTIPLATELET THERAPY INCREASE THE BLEEDING EVENTS AMONG PATIENTS WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANT IN REAL WORLD?

Recently a considerable number of patients have Non-vitamin K antagonist oral anticoagulant (NOAC) for Atrial fibrillation (AF). Some AF patients have NOAC concurrent antiplatelet therapy for atherosclerosis. However there are few reports about bleeding events among NOAC patients with concurrent

RESTENOSIS PATTERN OF SECOND-GENERATION DRUG-ELUTING STENT

Differences in restenosis pattern and timing between bare-metal stent and first-generation drug-eluting stent (DES) have been reported. However, little is known about the effect of the type of second-generation DES on restenosis pattern and timing. From January 2012 to March 2014, 1835 consecutive