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Featured researches published by Satoru Suwa.


Circulation-cardiovascular Interventions | 2014

Late Adverse Events After Implantation of Sirolimus-Eluting Stent and Bare-Metal Stent Long-Term (5–7 Years) Follow-Up of the Coronary Revascularization Demonstrating Outcome Study-Kyoto Registry Cohort-2

Masahiro Natsuaki; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Kyohei Yamaji; Kenji Ando; Satoshi Shizuta; Hiroki Shiomi; Tomohisa Tada; Junichi Tazaki; Yoshihiro Kato; Mamoru Hayano; Mitsuru Abe; Takashi Tamura; Manabu Shirotani; Shinji Miki; Mitsuo Matsuda; Mamoru Takahashi; Katsuhisa Ishii; Masaru Tanaka; Takeshi Aoyama; Osamu Doi; Ryuichi Hattori; Masayuki Kato; Satoru Suwa; Akinori Takizawa; Yoshiki Takatsu; Eiji Shinoda; Hiroshi Eizawa

Background—Late adverse events such as very late stent thrombosis (VLST) or late target-lesion revascularization (TLR) after first-generation sirolimus-eluting stents (SES) implantation have not been yet fully characterized at long term in comparison with those after bare-metal stent (BMS) implantation. Methods and Results—Among 13 058 consecutive patients undergoing first percutaneous coronary intervention in the Coronary REvascularization Demonstrating Outcome study-Kyoto registry Cohort-2, 5078 patients were treated with SES only, and 5392 patients were treated with BMS only. During 7-year follow-up, VLST and late TLR beyond 1 year after SES implantation occurred constantly and without attenuation at 0.24% per year and at 2.0% per year, respectively. Cumulative 7-year incidence of VLST was significantly higher in the SES group than that in the BMS group (1.43% versus 0.68%, P<0.0001). However, there was no excess of all-cause death beyond 1 year in the SES group as compared with that in the BMS group (20.8% versus 19.6%, P=0.91). Cumulative incidences of late TLR (both overall and clinically driven) were also significantly higher in the SES group than in the BMS group (12.0% versus 4.1%, P<0.0001 and 8.5% versus 2.6%, P<0.0001, respectively), leading to late catch-up of the SES group to the BMS group regarding TLR through the entire 7-year follow-up (18.8% versus 25.2%, and 10.6% versus 10.2%, respectively). Clinical presentation as acute coronary syndrome was more common at the time of late SES TLR compared with early SES TLR (21.2% and 10.0%). Conclusions—Late catch-up phenomenon regarding stent thrombosis and TLR was significantly more pronounced with SES than that with BMS. This limitation should remain the target for improvements of DES technology.


Catheterization and Cardiovascular Interventions | 2007

Comparison of myocardial perfusion by distal protection before and after primary stenting for acute myocardial infarction: angiographic and clinical results of a randomized controlled trial.

Toshiya Muramatsu; Ken Kozuma; Reiko Tsukahara; Yoshiaki Ito; Naoya Fujita; Satoru Suwa; Shiho Koyama; Masahiko Saitoh; Haruo Kamiya; Masato Nakamura

To assess the myocardium‐reperfusing effect of a distal protection device, GuardWire Plus™ (GuardWire Plus), in patients with acute myocardial infarction (AMI).


Heart and Vessels | 2003

Cardiac hemangioma: a report of two cases and review of the literature

Satoshi Kojima; Masataka Sumiyoshi; Satoru Suwa; Hiroshi Tamura; Akitoshi Sasaki; Takahiko Kojima; Yoriaki Mineda; Hiroshi Ohta; Michio Matsumoto; Yasuro Nakata

Cardiac hemangioma is extremely rare. We encountered two patients with cardiac hemangioma detected by thoracic echocardiography during a medical checkup. In the first case, transthoracic echocardiography revealed a pedunculated tumor in the left ventricle. Selective left coronary angiography demonstrated that the main feeding artery of the tumor arose from the third diagonal branch of the left anterior descending coronary artery. In the second case, thoracic and transesophageal echocardiography showed an oval tumor arising from the right atrium. Both tumors were successfully resected. Histopathological examination revealed that one of the tumors was a capillary hemangioma and the other was a mixed capillary and cavernous hemangioma. After operation, both patients had an uneventful recovery without any complications.


Circulation-cardiovascular Interventions | 2012

Duration of Dual Antiplatelet Therapy and Long-Term Clinical Outcome After Coronary Drug-Eluting Stent Implantation Landmark Analyses From the CREDO-Kyoto PCI/CABG Registry Cohort-2

Tomohisa Tada; Masahiro Natsuaki; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Robert A. Byrne; Adnan Kastrati; Kazushige Kadota; Masashi Iwabuchi; Satoshi Shizuta; Junichi Tazaki; Hiroki Shiomi; Mitsuru Abe; Natsuhiko Ehara; Tetsu Mizoguchi; Hirokazu Mitsuoka; Tsukasa Inada; Makoto Araki; Satoshi Kaburagi; Ryoji Taniguchi; Hiroshi Eizawa; Akira Nakano; Satoru Suwa; Akinori Takizawa; Ryuji Nohara; Hisayoshi Fujiwara; Kazuaki Mitsudo; Masakiyo Nobuyoshi; Toru Kita; Takeshi Kimura

Background— Optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been yet fully elucidated. Methods and Results— We assessed the influence of prolonged thienopyridine therapy on clinical outcomes with landmark analysis at 4 and 13 months after DES implantation. Among 6802 patients with at least 1 DES implantation in the CREDO-Kyoto Registry Cohort-2, 6309 patients (on thienopyridine, 5438 patients; off thienopyridine, 871 patients) and 5901 patients (on thienopyridine, 4098 patients; off thienopyridine, 1803 patients) were eligible for the 4- and 13-month landmark analyses, respectively. The majority of patients had stable coronary artery disease (73%) and received sirolimus-eluting stents (93%), and approximately 90% of thienopyridine was ticlopidine. Patients taking thienopyridine had more complex comorbidities and more complex lesion and procedural characteristics as compared with patients not taking thienopyridine. After adjusting for confounders, thienopyridine use was not associated with decreased risk for death/myocardial infarction/stroke (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.89–1.43, P=0.32 in the 4-month landmark analysis; HR, 1.14; 95% CI, 0.90–1.45, P=0.29 in the 13-month landmark analysis, respectively), whereas the risk for GUSTO moderate/severe bleeding tended to be higher in patients taking thienopyridine (HR, 1.51; 95% CI, 1.00–2.23, P=0.049 in the 4-month landmark analysis; HR, 1.44; 95% CI, 0.99–2.09, P=0.057 in the 13-month landmark analysis, respectively). Conclusions— Prolonged thienopyridine therapy beyond 4 and 13 months appeared not to be associated with reduction in ischemic events but to be associated with a trend toward increased bleeding. Optimal duration of DAPT after DES implantation might be shorter than the currently recommended 1-year interval.


Circulation | 2015

Clinical Presentation, Management and Outcome of Japanese Patients With Acute Myocardial Infarction in the Troponin Era – Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) –

Masaharu Ishihara; Masashi Fujino; Hisao Ogawa; Satoshi Yasuda; Teruo Noguchi; Koichi Nakao; Yukio Ozaki; Kazuo Kimura; Satoru Suwa; Kazuteru Fujimoto; Yasuharu Nakama; Takashi Morita; Wataru Shimizu; Yoshihiko Saito; Kennichi Tsujita; Kunihiko Nishimura; Yoshihiro Miyamoto

BACKGROUND New criteria for diagnosis of acute myocardial infarction (AMI) were proposed in 2000 as a universal definition, in which cardiac troponin (cTn) was the preferred biomarker. A large number of patients formerly classified by creatine kinase (CK) as unstable angina are now ruled-in by cTn as non-ST-elevation myocardial infarction (NSTEMI). METHODS AND RESULTS The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry conducted in 28 institutions. We enrolled 3,283 consecutive patients with AMI diagnosed by cTn-based criteria who were admitted to participating institutions within 48 h of symptom onset. There were 2,262 patients (68.9%) with STEMI and 1,021 (31.1%) with NSTEMI. CK was not elevated more than twice the upper limit of normal in 458 patients (44.9%) with NSTEMI (NSTEMI-CK). Although there was no significant difference in the in-hospital mortality of STEMI and NSTEMI with CK elevation (NSTEMI+CK) patients (7.1% vs. 7.8%, P=0.57), it was significantly lower in patients with NSTEMI-CK than in those with STEMI or NSTEMI+CK (1.7%, P<0.001 for each). CONCLUSIONS J-MINUET revealed the clinical presentation, management and outcomes of Japanese patients with AMI in the current cTn era. We should be aware of the difference between AMI diagnosed by CK-based criteria and AMI diagnosed by cTn-based criteria when using universal definitions for the diagnosis of AMI.


Circulation-cardiovascular Interventions | 2014

Long-Term Clinical Outcomes After Everolimus- and Sirolimus-Eluting Coronary Stent Implantation Final 3-Year Follow-Up of the Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial

Hiroki Shiomi; Ken Kozuma; Takeshi Morimoto; Keiichi Igarashi; Kazushige Kadota; Kengo Tanabe; Yoshihiro Morino; Takashi Akasaka; Mitsuru Abe; Satoru Suwa; Toshiya Muramatsu; Masakazu Kobayashi; Kazuoki Dai; Koichi Nakao; Masaaki Uematsu; Yasuhiro Tarutani; Kenshi Fujii; Charles A. Simonton; Takeshi Kimura

Background—Long-term clinical outcomes of everolimus-eluting stent (EES) compared with sirolimus-eluting stent (SES) have not been evaluated fully yet, especially whether EES implantation could positively affect late adverse events reported after SES implantation occurring >1 year. Methods and Results—In this all-comer prospective multicenter randomized open-label trial, 3196 patients were assigned randomly to implant either EES (n=1596) or SES (n=1600). At 3 years, EES was noninferior to SES on the primary safety end point (all-cause death or myocardial infarction; 10.1% versus 11.5%; noninferiority P <0.001; and superiority P=0.19). Cumulative incidence of definite stent thrombosis was low and was not significantly different between the 2 groups (0.5% versus 0.6%; P=0.81). There was no significant difference in the efficacy end point of target-lesion revascularization between the EES and SES groups (6.6% versus 7.9%; P=0.16). However, the cumulative incidence of target-lesion failure (cardiac death/target-vessel myocardial infarction/ischemia-driven target-lesion revascularization) was significantly lower in the EES group than in the SES group (8.8% versus 11.4%; P=0.01). By a landmark analysis at 1 year, the cumulative incidence of very late stent thrombosis and late target-lesion revascularization was not significantly different between the 2 groups (0.2% versus 0.2%; P=0.99 and 2.2% versus 2.9%; P=0.21, respectively). Conclusions—The efficacy and safety outcomes for this trial after EES implantation remained comparable with those after SES implantation through 3-year follow-up. However, improvement of clinical outcome after EES implantation compared with SES implantation was suggested by the significantly lower cumulative incidences of target-lesion failure, which has been the most widely used primary end point in the stent-versus-stent trials. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035450.


Circulation-cardiovascular Interventions | 2012

Incidence and Outcome of Surgical Procedures After Coronary Bare-Metal and Drug-Eluting Stent Implantation A Report From the CREDO-Kyoto PCI/CABG Registry Cohort-2

Akihiro Tokushige; Hiroki Shiomi; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Masashi Iwabuchi; Satoshi Shizuta; Tomohisa Tada; Junichi Tazaki; Yoshihiro Kato; Mamoru Hayano; Mitsuru Abe; Natsuhiko Ehara; Tsukasa Inada; Satoshi Kaburagi; Shuichi Hamasaki; Chuwa Tei; Hitoshi Nakashima; Hisao Ogawa; Ryozo Tatami; Satoru Suwa; Akinori Takizawa; Ryuji Nohara; Hisayoshi Fujiwara; Kazuaki Mitsudo; Masakiyo Nobuyoshi; Toru Kita; Takeshi Kimura

Background— There still remain safety concerns on surgical procedures after coronary drug-eluting stents (DES) implantation, and optimal management of perioperative antiplatelet therapy (APT) has not been yet established. Methods and Results— During 3-year follow-up of 12 207 patients (DES=6802 patients and bare-metal stent [BMS] only=5405 patients) who underwent coronary stent implantation in the CREDO-Kyoto registry cohort-2, surgical procedures were performed in 2398 patients (DES=1295 patients and BMS=1103 patients). Surgical procedures (early surgery in particular) were more frequently performed in the BMS group than in the DES group (4.4% versus 1.9% at 42-day and 23% versus 21% at 3-year, log-rank P=0.0007). Cumulative incidences of death/myocardial infarction (MI)/stent thrombosis (ST) and bleeding at 30 days after surgery were low, without differences between BMS and DES (3.5% versus 2.9%, P=0.4 and 3.2% versus 2.1%, P=0.2, respectively). The adjusted risks of DES use relative to BMS use for death/MI/ST and bleeding were not significant (hazard ratio: 1.63, 95% confidence interval: 0.93 to 2.87, P=0.09 and hazard ratio: 0.6, 95% confidence interval: 0.34 to 1.06, P=0.08, respectively). The risks of perioperative single- and no-APT relative to dual-APT for both death/MI/ST and bleeding were not significant; single-APT as compared with dual-APT tended to be associated with lower risk for death/MI/ST (hazard ratio: 0.4, 95% confidence interval: 0.13 to 1.01, P=0.053). Conclusions— Surgical procedures were commonly performed after coronary stent implantation, and the risk of ischemic and bleeding complications in surgical procedures was low. In patients selected to receive DES or BMS, there were no differences in outcomes. Perioperative administration of dual-APT was not associated with lower risk for ischemic events.


American Journal of Cardiology | 2012

Impact of Statin Therapy on Late Target Lesion Revascularization After Sirolimus-Eluting Stent Implantation (from the CREDO-Kyoto Registry Cohort-2)

Masahiro Natsuaki; Yoshihisa Nakagawa; Takeshi Morimoto; Koh Ono; Satoshi Shizuta; Yutaka Furukawa; Kazushige Kadota; Masashi Iwabuchi; Yoshihiro Kato; Satoru Suwa; Tsukasa Inada; Osamu Doi; Akinori Takizawa; Masakiyo Nobuyoshi; Toru Kita; Takeshi Kimura

Therapeutic strategies preventing late target lesion revascularization (TLR) after drug-eluting stent implantation have not been yet adequately investigated. In 13,087 consecutive patients undergoing first percutaneous coronary intervention in the CREDO-Kyoto Registry Cohort-2, we identified 10,221 patients who were discharged alive after implantation of sirolimus-eluting stents (SESs) only (SES stratum 5,029) or bare-metal stents (BMSs) only (BMS stratum 5,192). Impact of statin therapy at time of discharge from the index hospitalization on early (within the first year) and late (1 year to 4 years) TLR, was assessed in the SES stratum (statin group 2,735; nonstatin group 2,294) and in the BMS stratum (statin group 2,576; nonstatin group 2,616). Despite a significantly lower incidence of early TLR (7.8% vs 22.2%, p <0.0001), SES use compared to BMS use was associated with a significantly higher incidence of late TLR (7.7% vs 3.0%, p <0.0001). In the SES and BMS strata, the incidence of early TLR was similar regardless of statin use. In the SES stratum, the incidence of late TLR was significantly lower in the statin group than in the nonstatin group (6.1% vs 9.6%, p = 0.002), whereas no significant difference was found in the BMS stratum (2.6% vs 3.3%, p = 0.38). After adjusting confounders, risk for late TLR significantly favored statin use in the SES stratum (hazard ratio 0.73, 95% confidence interval 0.54 to 0.98, p = 0.04), whereas the risk decrease was not significant in the BMS stratum (hazard ratio 0.74, 95% confidence interval 0.46 to 1.20, p = 0.23). In conclusion, statin therapy at hospital discharge was associated with a significantly lower risk for late TLR after SES implantation.


Circulation | 2017

Preprocedural High-Sensitivity C-Reactive Protein Predicts Long-Term Outcome of Percutaneous Coronary Intervention

Hideki Wada; Tomotaka Dohi; Katsumi Miyauchi; Jun Shitara; Hirohisa Endo; Shinichiro Doi; Ryo Naito; Hirokazu Konishi; Shuta Tsuboi; Manabu Ogita; Takatoshi Kasai; Ahmed Hassan; Shinya Okazaki; Kikuo Isoda; Kazunori Shimada; Satoru Suwa; Hiroyuki Daida

BACKGROUND High-sensitivity C-reactive protein (hs-CRP) has been used to predict the risk of adverse cardiac events in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Less is known, however, about the association between hs-CRP and long-term outcome after PCI in the Japanese population.Methods and Results:We studied 3,039 all-comer patients with CAD who underwent their first PCI and had data available for preprocedural hs-CRP at Juntendo University between 2000 and 2011. Patients were assigned to tertiles based on preprocedural hs-CRP concentration. We evaluated the incidence of major adverse cardiac events (MACE) including all-cause death, acute coronary syndrome (ACS), and target vessel revascularization (TVR). Patients with higher hs-CRP had a higher prevalence of current smoking, chronic kidney disease and ACS, and a lower prevalence of statin use. During a median follow-up period of 6.5 years, ongoing divergence in MACE with hs-CRP tertile was noted on Kaplan-Meier curves (hs-CRP <0.08 mg/L, 26.4%; 0.08-0.25 mg/L, 38.2%; >0.25 mg/L, 45.6%; log-rank P<0.001). After adjustment for established cardiovascular risk factors, hs-CRP was associated with higher incidence of MACE (hazard ratio [HR], 1.10; 95% CI: 1.04-1.16, P<0.001) and higher all-cause mortality (HR, 1.14; 95% CI: 1.06-1.22, P<0.001). CONCLUSIONS Preprocedural hs-CRP measurement is clinically useful for long-term risk assessment in Japanese patients with established CAD and undergoing PCI.


Journal of the American Heart Association | 2015

Clinical Efficacy of Thrombus Aspiration on 5‐Year Clinical Outcomes in Patients With ST‐Segment Elevation Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Hiroki Watanabe; Hiroki Shiomi; Kenji Nakatsuma; Takeshi Morimoto; Tomohiko Taniguchi; Yutaka Furukawa; Yoshihisa Nakagawa; Minoru Horie; Takeshi Kimura; Ryuzo Sakata; Akira Marui; Mitsuo Matsuda; Hirokazu Mitsuoka; Masahiko Onoe; Kazuo Yamanaka; Hisayoshi Fujiwara; Yoshiki Takatsu; Nobuhisa Ohno; Ryuji Nohara; Tomoyuki Murakami; Teruki Takeda; Masakiyo Nobuyoshi; Masashi Iwabuchi; Michiya Hanyu; Ryozo Tatami; Tsutomu Matsushita; Manabu Shirotani; Noboru Nishiwaki; Toru Kita; Yukikatsu Okada

Background Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) was reported to promote better coronary and myocardial reperfusion. However, long-term mortality benefit of TA remains controversial. The objective of this study is to investigate the clinical impact of TA on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. Methods and Results The CREDO-Kyoto AMI Registry is a large-scale cohort study of acute myocardial infarction patients undergoing coronary revascularization in 2005–2007 at 26 hospitals in Japan. Among 5429 patients enrolled in the registry, the current study population consisted of 3536 patients who arrived at the hospital within 12 hours after the symptom onset and underwent primary PCI. Clinical outcomes were compared between the 2 patient groups with or without TA. During primary PCI procedures, 2239 out of 3536 (63%) patients underwent TA (TA group). The cumulative 5-year incidence of all-cause death was significantly lower in the TA group than in the non-TA group (18.5% versus 23.9%, log-rank P<0.001). After adjusting for confounders, however, the risk for all-cause death in the TA group was not significantly lower than that in the non-TA group (hazard ratio: 0.90, 95% CI: 0.76 to 1.06, P=0.21). The adjusted risks for cardiac death, myocardial infarction, stroke, and target-lesion revascularization were also not significantly different between the 2 groups. Conclusions Adjunctive TA during primary PCI was not associated with better 5-year mortality in STEMI patients.

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