Search

Background First-generation drug-eluting stents (DES) have reduced short-term stent failure as compared to bare-metal stents due to the inhibition of neointima hyperplasia, but instead increased the risk of very-late stent failure. Although better outcomes have been reported for second-generation DES than for first-generation DES, the difference in the angioscopic findings at 1-year follow-up has not been adequately elucidated among second-generation DES. Methods Consecutive 161 patients who received angioscopic examination at 1 year after implantation of second-generation DES, i.e. Nobori biolimus-eluting stents (Terumo, Tokyo, Japan) (N-BES, n = 25), Xience everolimus-eluting stents (Abbot Vascular, Santa Clara, CA, USA; X-EES, n = 95), or Resolute zotarolimus-eluting stents (Resolute Integrity; Medtronic, Minneapolis, MN, USA; R-ZES, n = 41), in de novo native coronary lesions were analyzed. Results Maximum neointima coverage grade (N-BES, 0.9 ± 0.3; X-EES, 1.2 ± 0.4; R-ZES, 1.5 ± 0.5; p

Background Although extensive substrate modification in addition to pulmonary vein isolation (PVI) has been recommended in catheter ablation for persistent atrial fibrillation (AF), recent randomized controlled trials have not demonstrated efficacy of such additional ablations. Methods and study design The Osaka Cardiovascular Conference will conduct a multicenter, randomized, open-label trial aiming to examine whether PVI alone is non-inferior to PVI plus additional ablation such as linear ablation and/or complex fractionated atrial electrogram ablation in patients with persistent AF. The primary outcome is recurrence of AF documented by scheduled or symptom-driven electrocardiogram tests during a 1-year follow-up period after the index ablation. The key secondary endpoints include all-cause death, occurrence of symptomatic stroke, complications related to the procedure, and quality of life assessment using the 36-item Short-Form Health Survey. The clinical impact of the presence or absence of AF trigger foci, and their origins in cases with them, on the results of catheter ablation will also be investigated as an exploratory endpoint. A total of 512 patients will be enrolled and followed up to 1 year. Conclusions The EARNEST-PVI trial is a randomized controlled trial designed to assess whether PVI alone is non-inferior to extended substrate ablation for patients with persistent AF undergoing a first catheter ablation.

Background Dissociated pulmonary vein activity (DPVA), defined as isolated intrinsic ectopic beats observed after successful pulmonary vein (PV) isolation, indicates the presence of remnant foci of trigger ectopy but has yet to be extensively studied. We investigated the correlation between DPVA and the PV triggers of atrial fibrillation (AF). Method and results Consecutive 110 patients undergoing AF ablation were enrolled. We defined trigger ectopy as documented ectopic foci observed to spontaneously initiate AF. Trigger ectopy was detected in 62 (56%) patients. DPVA in at least one PV was detected in 95 (86%) patients. Of the 440 isolated PVs, we recognized trigger ectopy in 73 (16%) PVs (culprit PVs) and DPVA in 184 (42%) PVs. DPVA was more frequently observed in culprit PVs than in non-culprit PVs [59% vs. 39%; odds ratio (OR) = 2.3; p = 0.001]. The concordance ratio of culprit PV was 67% (8/12) in PV with fibrillatory DPVA, 20% (35/172) in PV with non-fibrillatory DPVA, and 12% (30/256) in PV without DPVA. Fibrillatory DPVA was more frequently observed in culprit PVs than non-fibrillatory DPVA (OR = 7.8; p = 0.001). Non-PV foci were observed in 10 (11%) of the 95 patients with DPVA and 5 (33%) of the 15 patients without DPVA (OR = 4.3; p = 0.02). No significant difference in the frequency of AF recurrence was observed between them. Conclusions Fibrillatory DPVA was found to be strongly associated with trigger ectopy of AF. Non-fibrillatory DPVA might merely indicate the existence of bystander ectopic foci located inside PVs. Non-PV ectopic foci were frequently observed in patients without DPVA.

SummaryBackgroundDisruption of vulnerable plaques causes acute coronary syndrome and stenosis progression. Yellow plaques are regarded as vulnerable and the number of yellow plaques per vessel (NYP) has been reported as a marker of vulnerable patients. Therefore, we examined if patients with more yellow plaques would have higher risk of stenosis progression.Methods and resultsA series of patients (n=70) who received percutaneous coronary intervention (PCI) and angioscopy was included. Patients were divided into 2 groups according to NYP: group 1 (NYP

Background Although extremely high blood thrombogenicity has been reported in patients with acute myocardial infarction, it has not been clarified if the increased blood thrombogenicity is a cause of acute myocardial infarction or a mere result induced by thrombus formation at the disrupted plaque. Therefore, we examined if blood thrombogenicity is extremely increased as in acute myocardial infarction patients when disrupted plaque is present in patients with stable coronary artery disease. Methods and results Consecutive patients ( n = 38) with stable coronary artery disease who received angioscopic examination were included. Patients were divided into two groups according to presence or absence of disrupted plaque that accompanied thrombus. Blood thrombogenicity was evaluated by blood vulnerability index and compared between the patients with and without disrupted plaque. Among 38 study patients, 16 had disrupted plaque and 22 did not. Blood vulnerability index was not different between the patients with and without disrupted plaque (2395 ± 612 vs. 3013 ± 1476, p = 0.12). Multivariate analysis revealed no significant association between blood vulnerability index and the presence of disrupted plaque. Conclusion The presence of disrupted plaque, in comparison with its absence, was not associated with higher blood thrombogenicity evaluated by blood vulnerability index.