Sen Yachi

Incidence and clinical impact of coronary stent fracture after sirolimus-eluting stent implantation

Background: Stent fracture is one of the possible causes of restenosis after sirolimus‐eluting stents (SES) implantation. The aim of our study was to evaluate the prevalence and clinical impact of coronary stent fracture after SES implantation. Methods: From our prospective institutional database, 280 patients were treated solely with SES from August 2004 to June 2005. Among the 280 patients, 256 patients with a total of 307 lesions underwent follow‐up angiography on an average of 240 days after the procedure. Results: Stent fractures were observed in eight (2.6%) lesions. Of the eight lesions with stent fracture, five were located in the right coronary artery (RCA), two in the saphenous vein (SV) graft, and one in the left anterior descending coronary artery. The stent fractures were all in the locations that served as hinges during vessel movement in the cardiac contraction cycle. Seven of the eight stent fractures were adjacent to the edge of previously implanted or overlapped stent. Significant multivariate predictors of stent fracture were SV graft location (Odds ratio 35.88; 95% confidence interval 2.73–471.6, P = 0.006), implanted stent length (Odds ratio 1.04; 95% confidence interval 1.01–1.07, P = 0.02), and RCA location (Odds ratio 10.00; 95% confidence interval 1.11–89.67, P = 0.04). In‐stent binary restenosis rate was 37.5% and target lesion repeat revascularization rate was 50.0% in patients with stent fracture. Conclusions: Stent fracture was likely to be affected by mechanical stress provoked by rigid structures and hinge points. Stent fracture might be associated with the high incidence of target lesion revascularization.

Prevalence of Carotid Artery Stenosis in Patients With Coronary Artery Disease in Japanese Population

Background and Purpose— Prevalence of carotid artery stenosis in patients with coronary artery disease (CAD) is unknown in Japanese population. Methods— The study populations consisted of 632 consecutive patients who underwent coronary angiography because of suspicion of CAD. All patients underwent carotid ultrasonography to screen carotid artery stenosis before coronary angiography. We defined echographic carotid stenosis as area stenosis of >50% or peak systolic velocity of >200 cm/s. Results— Echographic carotid stenosis was observed in 124 patients (19.6%). Coronary angiography revealed 433 patients had CAD. Prevalence of echographic carotid artery stenosis was 14 of 199 (7.0%), 18 of 124 (14.5%), 28 of 131 (21.4%), and 64 of 178 (36.0%) in patients with 0-, 1-, 2-, and 3-vessel CAD, respectively (P<0.0001). The prevalence rate with carotid stenosis and CAD was 25.4%. Multivariate stepwise logistic regression analysis showed that age and the extent of CAD were independently related to the presence of carotid stenosis (P=0.0002 and <0.0001, respectively). Conclusions— Prevalence of carotid stenosis in patients with CAD is high in Japan as well as in Western countries. Screening of carotid artery stenosis is recommended especially in older patients with multivessel CAD.

Impact of renal insufficiency on clinical and angiographic outcomes following percutaneous coronary intervention with sirolimus-eluting stents

Background: Sirolimus‐eluting stents (SES) have been demonstrated to reduce restenosis. However, there have been few studies evaluating the impact of renal insufficiency on the angiographic as well as clinical outcomes after SES implantation. Methods: This study was composed of 304 consecutive patients having 361 lesions who underwent percutaneous coronary intervention with SES. The patients were divided into 3 groups according to renal function (group 1 [n = 204]; creatinine clearance (Ccr) ≥≥60ml/min, group 2 [n = 69]; Ccr <60 ml/min, group 3 [n = 31]; hemodialysis). Clinical and angiographic follow‐up were evaluated at 8 months. Results: Clinical follow‐up was obtained in all patients and angiographic follow‐up was obtained in 283 patients (93.1%). Patients in group 3 showed a higher incidence of previous coronary artery bypass graft surgery, and there were more female gender, hypertensive, and less hyperlipidemia in this group. Late lumen loss at 8 months was significantly different among the 3 groups (group 1; 0.16 ± 0.46 mm, group 2; 0.44 ± 0.62 mm, group 3; 0.81 ± 0.88 mm, P < 0.0001). Major adverse cardiac events (MACE) were documented in 22 patients (10.8%) in group 1, 13patients (18.8%) in group 2, and 12 patients (38.7%) in group 3, respectively (P = 0.0002). Conclusion: Neointimal growth following SES implantation is more pronounced in patients with renal insufficiency, especially those undergoing dialysis, compared with patients with normal renal function. Regardless of the beneficial effect of SES, the increased risk of MACE mainly due to high incidence of target vessel revascularization in the subgroup of patients with renal insufficiency should be taken into account.

Clinical and Angiographic Outcomes Following Percutaneous Coronary Intervention With Sirolimus-Eluting Stents Versus Bare-Metal Stents in Hemodialysis Patients

BACKGROUND Percutaneous coronary intervention for hemodialysis patients has been hampered by the high rate of adverse cardiac events. Our aim was to investigate whether sirolimus-eluting stents (SESs) improve clinical outcomes of hemodialysis patients compared with bare-metal stents (BMSs). STUDY DESIGN Retrospective study. SETTING & PARTICIPANTS 123 consecutive patients on hemodialysis therapy treated with either an SES or BMS. There were 56 patients with 68 lesions treated with SESs between August 2004 and April 2006 (SES group) and 67 patients with 71 lesions treated with BMSs 4 years before approval of SESs in Japan (BMS group). PREDICTOR SES and BMS implantation for hemodialysis patients with coronary artery disease. OUTCOMES & MEASUREMENTS Follow-up angiography was performed at 6 to 8 months and clinical follow-up was obtained at 9 months after the procedure. Late lumen loss and major adverse cardiac events, including all-cause death, myocardial infarction, and target-lesion revascularization, were investigated. RESULTS Clinical follow-up was obtained in all patients. Angiographic follow-up was obtained in 50 patients (89.3%) in the SES group and 50 patients (74.6%) in the BMS group. The SES group had more complex lesions than the BMS group. Quantitative angiographic analysis showed a significant difference for in-stent late lumen loss (SES, 0.62 +/- 0.75 mm; BMS, 1.07 +/- 0.75 mm; P = 0.003). Of angiographic restenosis lesions analyzed, a focal restenotic pattern was observed more frequently in the SES group than the BMS group (SES, 87.5%; BMS, 23.8%; P < 0.001). The rate of major adverse cardiac events was significantly lower in the SES group (n = 14; 25.0%) than the BMS group (n = 26; 38.9%; log-rank P = 0.02). LIMITATIONS Retrospective study design, small sample size, and a single-center study. CONCLUSIONS Clinical and angiographic data in the present study suggest that SESs are more effective than BMSs in hemodialysis patients.

Impact of Coronary Calcium on Outcome Following Sirolimus-Eluting Stent Implantation

There remain a small but sizable number of patients who develop restenosis after sirolimus-eluting stent (SES) implantation. However, the cause of SES restenosis has not been fully elucidated. The study population consisted of 52 patients with 69 lesions who underwent noninvasive coronary imaging by 64-slice multidetector computed tomography before SES deployment. Agatston calcium scores in target lesions were measured. All patients underwent follow-up coronary angiography at 8 months. Three coronary segments (in stent, proximal edge, and distal edge) were analyzed by quantitative coronary angiography. Agatston calcium score in target lesions averaged 214.7. Late lumen losses in the proximal edge, stent, and distal edge were 0.16 ± 0.45, 0.47 ± 0.58, and 0.07 ± 0.29 mm, respectively. Lesions with restenosis at follow-up showed a trend to produce higher preprocedural calcium scores (629) compared to those without restenosis (153, p = 0.08). There was a significant positive correlation between lesion calcium score and in-stent late lumen loss (r = 0.47, p <0.01). In conclusion, assessment of coronary calcium by multidetector computed tomography might be useful to predict outcomes after SES implantation.

Difference of culprit plaque composition between patients with and without pre-infarction angina: an intravascular ultrasound radiofrequency analysis.

AIMS This study was performed to assess the differences in culprit plaque composition between patients with and without pre-infarction angina (PA) by using spectral analysis of intravascular ultrasound (IVUS) radiofrequency (RF) data. METHODS AND RESULTS Of 57 patients consecutively admitted to our institution with acute myocardial infarction, pre-intervention IVUS RF data of culprit plaques were obtained and analysed in 35 patients after percutaneous aspiration thrombectomy. Among the 35 patients, 21 patients had PA. Culprit plaques of patients without PA consisted of a higher percentage of the necrotic core component than those with PA (minimum lumen area [MLA]) site, 21.2+/-8.9% versus 9.9+/-9.8%, p=0.0015; entire culprit lesion, 18.9+/-6.3% versus 12.0+/-9.6%, p=0.023). In contrast, culprit plaques of patients with PA contained a higher percentage of the fibrofatty component than those without PA (MLA site, 21.0+/-12.0% versus 11.5+/-7.6%, p=0.013; entire culprit lesion, 16.8+/-7.9% versus 12.1+/-5.5%, p=0.062). There was no significant difference in quantitative parameters between the patients with and without PA. CONCLUSIONS Culprit plaques of patients with PA were different from those without PA. Plaque composition may play an important role in the occurrence of PA.

IMPACT OF?3/6 POLYUNSATURATED FATTY ACIDS RATIO ON THE PREVALENCE OF CORONARY ARTERY DISEASE ASSESSED BY 320-ROW CT CORONARY ANGIOGRAPHY

Previous studies have shown that eicosapentaenoic acid (EPA)/ arachidonic acid (AA) may be a marker of coronary artery disease (CAD). However, there have been few studies to assess the association of plasma EPA/AA ratio on the prevalence of CAD by using a computed tomography coronary angiography (

Mid-term results of a closed biatrial procedure using bipolar radiofrequency ablation concomitantly performed with non-mitral cardiac operations

The long-term success rate of the Cox maze III procedure is excellent, although it has not been widely adopted because of the need for extensive incisions of the atria. In this study, we report our experience with a closed biatrial procedure using bipolar radiofrequency (RF) ablation for treating atrial fibrillation (AF) during non-mitral cardiac operations. Beginning in December 2004, a total of 19 patients underwent a closed biatrial procedure with bipolar RF energy. All the patients had a maze procedure plus a concomitant non-mitral operation. Except for several stabs to introduce the bipolar device, no incisions were made in either atrium. The first six patients were investigated with 64-slice multidetector computed tomography (MDCT), six months after the operation. Patients were followed-up monthly with a clinical examination and electrocardiography. There were no operative deaths. MDCT showed no evidence of coronary sinus stenosis. At one year of follow-up, 93% of the patients (14/15) were in sinus rhythm. The closed biatrial procedure using bipolar RF ablation is safe and effective in treating AF during open-heart surgery. This could be particularly beneficial for patients with AF who are undergoing a cardiac surgical procedure without opening the left atrium.

Aortic regurgitation due to back-and-forth intimal flap movement detected by both multidetector computed tomography and transesophageal echocardiography

A 46-year-old man with a history of hypertension, chronic kidney disease, and chronic aortic dissection classified as DeBakey type IIIB was referred to our hospital with chest and back pain. The patient underwent 64-row multidetector computed tomography (MDCT), which revealed new-onset DeBakey type II aortic dissection. The intimal flap prolapsed into left ventricle in the diastolic phase of cardiac cycle and stuck to the right coronary cusp (RCC) of the aortic valve. He also underwent transesophageal echocardiography (TEE) to assess the relationship between the intimal flap and aortic valve in detail. The intimal flap overlaid the RCC and prolapsed into the left ventricle outflow tract in the diastolic phase. These images suggested that the circumferential intimal flap stuck to the aortic valve, resulting in severe aortic regurgitation. One day after the admission, the patient underwent replacement of ascending aorta with a prosthetic graft. Intraoperative observation exhibited the intimal flap inverted to the left ventricle. MDCT could detect the flat movement, as well as TEE, in addition to the extent of aortic dissection. <Learning objective: Acute aortic regurgitation is one of the complications in aortic dissection involving the ascending aorta. The mechanisms are aortic root dilatation, asymmetry of the aortic root, and diastolic prolapse of the intimal flap into the left ventricle. Evaluation of the mechanism is beneficial for surgical procedure and TEE is a useful tool. With the advancement of MDCT, MDCT could also detect the flap movement and become a useful tool for evaluating mechanism, in addition to the extent of aortic dissection.>.

P-200 Prevalence of Polyvascular Disease in Patients with Coronary Artery Disease in Japanese Population

The mean of carotid IMT was 0.948±0.28mm in men and 0.881±0.22mm in women (p < 0.001). The prevalence of the MS was 31.6% in men and 45.2% in women. Mean carotid IMT increased with an increasing number of risk factors (p for trend <0.001) and carotid IMT values were 0.815mm, 0.848mm, 0.869mm, 0.889mm and 0.940mm for 0, 1, 2, 3, 4, and 5 risk factors, respectively. After adjustment, those with more components of MS had higher odds ratios for highest quartile carotid IMT compared with those without components. Carotid IMT was increased with the increasing number of components of MS. There is a strong relationship between carotid IMT and the MS. Current findings indicate the need for prevention and control of metabolic syndrome in a population of middle-aged Koreans.