Ryo Tsuruta

Effect of preoperative hemoglobin A1c levels on long-term outcomes for diabetic patients after off-pump coronary artery bypass grafting

BACKGROUND Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most convenient marker for monitoring glycemic control among diabetic patients. However, few studies have reported the impact of baseline HbA1c levels on outcomes for diabetic patients after CABG. This study therefore aimed to investigate whether preoperative HbA1c levels in diabetic patients are predictive of long-term outcomes after off-pump CABG (OPCAB). METHODS AND RESULTS Of 893 patients undergoing primary isolated OPCAB at Juntendo University Hospital from July 2002 to December 2007, subjects comprised 306 diabetic patients <80 years old. We divided these patients into 3 groups according to the preoperative HbA1c levels. No significant differences in baseline characteristics, angiographic findings, or operative parameters were apparent among the 3 groups. No operative or in-hospital mortality occurred. All-cause mortality and cardiac mortality rates were 6.2% (19 cases) and 1.3% (4 cases), respectively. Kaplan-Meiers survival showed no significant differences in all-cause or cardiac mortality (log-rank test, p=0.26, p=0.17, respectively). Multivariate analysis by Coxs proportional hazards model also demonstrated that no covariates predicted mortality except for age. CONCLUSIONS Preoperative HbA1c levels might not predict long-term outcomes for diabetic patients undergoing OPCAB. Careful evaluation for diabetes should be needed in preoperative management of CABG.

Prognostic significance of glomerular filtration rate estimated by the Japanese equation among patients who underwent complete coronary revascularization.

An equation that accurately estimates the glomerular filtration rate (GFR) in the Japanese population has been proposed; however, the prognostic significance of estimated GFR (eGFR) defined according to this equation has not been reported. In addition, the prognostic significance of eGFR during long-term follow-up after complete coronary revascularization remains unclear. We assessed the prognostic significance of eGFR values, estimated by the new Japanese equation, in a cohort of patients following complete coronary revascularization. We studied consecutive patients with complete revascularization from 1984 to 1992. Patients on dialysis were excluded. A novel Japanese equation was used to estimate the GFR: eGFR=194 × (serum creatinine)−1.094 × (age)−0.287 ( × 0.739 if female). Multivariate Cox proportional hazards regression analyses were performed to determine all-cause and cardiac mortality. We analyzed data of 1809 patients, of whom 571 (31.6%) had an eGFR of ⩾90 ml min−1 per 1.73 m2, 917 (50.7%) had an eGFR of 60–89 ml min−1 per 1.73 m2, 298 (16.5%) had an eGFR of 30–59 ml min−1 per 1.73 m2 and 23 (1.3%) had an eGFR of <30 ml min−1 per 1.73 m2. During follow-up (11.4±2.9 years), there were 397 (22.0%) all-cause and 123 (6.8%) cardiac deaths overall. Patients with an eGFR of 30–59 ml min−1 per 1.73 m2, and <30 ml min−1 per 1.73 m2 revealed significantly greater risk of all-cause mortality than those with eGFR of ⩾90 ml min−1 per 1.73 m2 (hazard ratio (HR) 1.91, P<0.001, HR 3.35, P<0.001, respectively). Furthermore, incidence of cardiac death was higher in patients with an eGFR of 30–59 ml min−1 per 1.73 m2 than those with an eGFR of ⩾90 ml min−1 per 1.73 m2 (HR 2.89, P<0.001). GFR as estimated using the new Japanese equation had a prognostic significance among patients with complete coronary revascularization.

Push-Up Technique and Anatomical Deployment With the Endurant Stent-Graft System for Severely Angulated Aneurysm Necks

Purpose: To describe a technique suitable for treating severely angulated (>75°) necks during endovascular aneurysm repair using the Endurant stent-graft. Technique: In the push-up technique, the suprarenal stent is released early to fix the proximal stent-graft in place so that each stent in the neck can be deployed individually without displacing the device upward. It is important to push the delivery system up after each stent deployment to allow the fabric between the stents to fold up circumferentially. By doing so, there is minimal upward force applied to the suprarenal stent. Because the stents expand along the angulated neck while catching blood flow, this anatomical deployment is feasible, with hardly any change to the proximal neck shape after stent-graft implantation. Conclusion: The push-up technique and anatomical deployment with the Endurant stent-graft system are effective and safe methods for treating aneurysms with severely angulated necks.

EFFECT OF CANDESARTAN WITH PIOGLITAZONE ON CORONARY ENDOTHELIAL FUNCTION AND VASCULAR INFLAMMATION IN PORCINE CORONARY ARTERIES IMPLANTED WITH SIROLIMUS-ELUTING STENTS

Methods and Results: Twenty-one pigs were randomized to control, candesartan (CAN) and candesartan plus pioglitazone (CAN+PIO) groups. Drugs were administered orally for 7 days before implantation until the time of euthanasia. Forty-two SES was deployed in porcine coronary arteries. The early inflammatory cell adhesion that was present on coronary was evaluated using scanning electron microscopy at 3 days and was found to be significantly suppressed in the CAN+PIO group than in the CAN group (p<0.05). Immunohistochemistry at 3 days showed that activated TNFexpression in the control SES edges was significantly less in the CAN and CAN+PIO groups whereas eNOS-positive areas recovered in the CAN and CAN+PIO groups (p<0.05, respectively). Bradykinin-induced endothelium-dependent relaxation at the distal edge of SES evaluated by organ chambers was reduced compared with intact sites in control coronaries at 28 days (p<0.05). Endothelial dysfunction was reversed by CAN and this beneficial effect was enhanced more obvious in the CAN+ PIO (p<0.05, respectively).