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Objective: Delirium is dangerous and a predictor of poor patient outcomes. We have previously reported the utility of the bispectral EEG (BSEEG) with a novel algorithm for the detection of delirium and prediction of patient outcomes including mortality. The present study employed a normalized BSEEG (nBSEEG) score to integrate the previous cohorts to combine their data to investigate the prediction of patient outcomes. We also aimed to test if the BSEEG method can be applicable regardless of age, and independent of delirium motor subtypes., Methods: We calculated nBSEEG score from raw BSEEG data in each cohort and classified patients into BSEEG-positive and BSEEG-negative groups. We used log-rank test and Cox proportional hazards models to predict 90-day and 1-year outcomes for the BSEEG-positive and -negative groups in all subjects and motor subgroups., Results: A total of 1,077 subjects, the BSEEG-positive group showed significantly higher 90-day (hazard ratio 1.33 [95% CI 1.16-1.52] and 1-year (hazard ratio 1.22 [95% CI 1.06-1.40] mortality rates than the negative group after adjustment for covariates such as age, sex, CCI, and delirium status. Among patients with different motor subtypes of delirium, the hypoactive group showed significantly higher 90-day (hazard ratio 1.41 [95% CI 1.12-1.76] and 1-year mortality rates (hazard ratio 1.32 [95% CI 1.05-1.67], which remained significant after adjustment for the same covariates., Conclusion: We found that the BSEEG method is capable of capturing patients at high mortality risk., (Copyright © 2023 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Hyperglycemia at admission and intramyocardial hemorrhage (IMH) are associated with poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Little is known about the relationship between glucose levels at admission and IMH. The association between matrix metalloproteinase-9 (MMP-9), which plays an important role in the development of IMH, and hyperglycemia is also unknown. This study aimed to investigate the relationship between hyperglycemia at admission and IMH in patients with STEMI., Methods: We enrolled 174 patients with first STEMI who underwent primary percutaneous coronary intervention (PCI) and cardiovascular magnetic resonance (CMR) imaging. T2-weighted imaging and late gadolinium enhancement (LGE)-CMR were performed to detect IMH and microvascular obstruction (MVO), respectively. Two patient groups were created: IMH group and non-IMH group. MMP-9 levels were measured in the culprit coronary arteries of 13 patients., Results: Glucose level at admission and the value of glycosylated hemoglobin were higher in the IMH group than in the non-IMH group [IMH group vs. non-IMH group; 208.5 (157.8-300.5) mg/dL vs. 157.0 (128.8-204.3) mg/dL, p < 0.001, and 6.2 (5.7-7.5) % vs. 5.8 (5.4-6.6) %, p = 0.030, respectively]. A multivariable logistic regression analysis revealed that only admission glucose level was an independent predictor of IMH (OR: 1.012; 95 % CI: 1.005-1.020, p = 0.001). The MMP-9 levels in patients with IMH were higher than those in patients without IMH [256.0 (161.0-396.0) ng/mL vs. 73.5 (49.5-131.0) ng/mL, p = 0.040]. There was a moderate positive correlation between glucose levels at admission and MMP-9 levels (r = 0.600, p = 0.030)., Conclusions: Hyperglycemia at admission is associated with the occurrence of IMH in patients with STEMI., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: It has been widely documented that circannual variation has an impact on the incidence and prognosis of cardiovascular diseases. It is unclear why cold ambient temperature increase the incidence of acute myocardial infarction (AMI). We investigated the relationship between the ambient temperature at the onset of AMI, the morphology of the culprit lesion in patients with AMI., Methods: We investigated 202 consecutive patients with AMI who underwent optical coherence tomography (OCT). The participants were divided into lower (n = 100) and higher (n = 102) temperature groups based on the ambient temperature. The culprit lesion morphology was compared between the two groups., Results: The median temperature at the onset of AMI was 16.6 °C. The prevalence of plaque ruptures was higher at lower temperatures (lower 66% vs. higher 45%, p = .003), whereas OCT-erosion was more frequent in the higher temperature group (lower 13% vs. higher 26%, p = .021). The lower temperature group showed more cholesterol crystals (lower 71% vs. higher 54%, p = .014)., Conclusion: The peak incidence of AMI in the winter is formed by increased plaque rupture, suggesting environmental temperature has an influence on the pathogenesis of AMI., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction and Objectives: Transradial cardiac catheterization reduces access site complications and is more comfortable for patients than the transfemoral approach. However, failure of the transradial approach is more common than the transfemoral approach. This study aimed to investigate whether ultrasound-guided rescue could facilitate transradial cardiac catheterization., Methods: We retrospectively analyzed 592 consecutive patients who underwent coronary angiography and/or percutaneous coronary intervention. Patients were divided into 2 groups: the palpation technique (PT) (n = 280) and the ultrasound guidance (UG) available group (n = 312). The application and the timing of introduction of ultrasound guidance in the UG group were at the discretion of the individual operators., Results: Real-time ultrasound guidance was used in 98 patients (31.4%) in the UG group. No statistically significant intergroup differences were observed in the incidence of hematoma (6.8% vs. 5.8%, p = 0.62). Although the procedural time in the UG group was longer than that in the PT group (303 s vs. 357 s, p < 0.01), the success rate of sheath insertion was significantly higher in the UG group (97% vs. 92%, p < 0.01). Multivariate analysis revealed that the availability of UG was the only independent predictor of success of sheath insertion (odds ratio 2.79, 95% confidence interval 1.24-6.31, p = 0.01)., Conclusions: Although UG maneuvers require additional procedural time for setting up systems, UG rescue was effective for successful transradial cardiac catheterization., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Aims: The aim of this study was to assess agreement between optical coherence tomography (OCT) and histopathology for healed coronary plaques (HCPs) in human coronary arteries ex vivo, and to evaluate the prevalence and characteristics of HCPs in vivo., Methods: Ex vivo OCT images were co-registered with histopathology in 144 cross-sections with ≥50% stenosis. Of these, 30 randomly selected pairs were employed to define morphological features of OCT for HCPs (OCT-derived HCPs); the remaining 114 pairs were used to evaluate the accuracy of OCT in detecting histologically-defined HCPs. In a clinical study, 60 target lesions from 60 patients with stable ischemic heart disease were divided into 2 groups according to the presence or absence of OCT-derived HCPs. Plaque characteristics were compared between the two groups., Results: In the autopsy study, an OCT-derived HCP was defined as a plaque with heterogeneous signal-rich layers of different optical signal density. The sensitivity, specificity, positive predictive value, and negative predictive value of OCT-derived HCP to detect histologically-defined HCPs were 81%, 98%, 93%, and 93%, respectively. In the clinical study, 46 (77%) had OCT-derived HCPs. Both microvessels and macrophages were more frequently identified in OCT-derived HCPs compared to their counterparts (43% vs. 0%; p<0.01, 70% vs. 21%; p<0.01, respectively)., Conclusions: An ex vivo OCT image has a good agreement with histology for HCPs detection. HCPs were frequently identified by OCT in target lesions in stable ischemic heart disease patients. OCT may be a useful intracoronary imaging for HCPs detection in vivo., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: The aim of the present study was to assess the effect of early statin therapy on fibrous-cap thickness in coronary plaques of patients with acute coronary syndrome (ACS) by using optical coherence tomography., Background: Statins can contribute to the stabilization of coronary plaques., Methods: This is a prospective, randomized, active-controlled, single-center study. Patients with ACS and untreated dyslipidemia were enrolled and randomly allocated (ratio 1:1) to either the early statin group (received pitavastatin 4 mg/day from baseline) or the late statin group (received pitavastatin 4 mg/day from 3 weeks after the baseline). Optical coherence tomography was performed at baseline, 3-week, and 36-week follow-up to assess nonculprit coronary plaques in 53 patients., Results: Between baseline and 3-week follow-up, fibrous-cap thickness increased in the early statin group (140 μm [interquartile range (IQR):120 to 170 μm] to 160 μm [IQR: 130 to 190 μm]; p = 0.017), but decreased in the late statin group (135 μm [IQR: 110 to 183 μm] to 130 μm [IQR: 108 to 160 μm]; p = 0.020). The percentage of increase in fibrous-cap thickness between baseline and 3-week follow-up was significantly greater in the early statin group compared with the late statin group (8.3% [IQR: 0.0% to 21.4%] vs. -5.8% [IQR: -16.0% to 0.0%]; p < 0.001). Between baseline and 36-week follow-up, fibrous-cap thickness increased comparably in the 2 groups., Conclusions: Early therapy with pitavastatin 4 mg/day for patients with ACS provided an increase in fibrous-cap thickness in coronary plaques during the first 3 weeks of follow-up and a further increase during 36 weeks of follow-up. The study was registered with UMIN Clinical Trial Registry (Effect of PitavaStatin on Coronary Fibrous-cap Thickness-Assessment by Fourier-Domain Optical CoheRence Tomography [ESCORT]; UMIN000002678)., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Although about half of patients with spontaneous coronary artery dissection (SCAD) face ongoing necrosis, conservative therapy is recommended due to a high complication rate in angiography-guided percutaneous coronary intervention (PCI). The aim of this study was to investigate clinical outcomes of SCAD treated by optical coherence tomography (OCT)-guided PCI., Methods: This study consisted of consecutive 306 patients with acute coronary syndrome (ACS) who underwent OCT-guided PCI. Based on the culprit lesion morphology by OCT, patients were assigned to four groups: a SCAD group, a plaque rupture (PR) group, a calcified nodule (CN) group, and an undetermined etiology (UE) group. Successful PCI was defined as thrombolysis in myocardial infarction flow grade 3 in final angiography without any complications. Primary endpoint was defined as occurrence rate of major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and unstable angina pectoris., Results: OCT revealed 12 SCADs, 149 PRs, 16 CNs, and 129 UEs, respectively. No significant difference was observed in the success rate of PCI (SCAD 91.7%, PR 85.2%, CN 81.2%, UE 86.8%, p=0.88), while wire repositioning was needed in 2 SCAD cases (p<0.01). The mean follow-up periods were 17.1±13.3 months. No significant difference was observed in MACE among the groups (p=0.56)., Conclusions: The clinical outcomes of OCT-guided PCI for SCAD were favorable, as well as those for other ACS etiologies. OCT-guided PCI could become a therapeutic option for SCAD compromised with ongoing necrosis., (Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Objectives: The aim of the present study was to investigate the association between plaque rupture (PR) assessed by optical coherence tomography (OCT), and the transmural extent of infarction (TEI) assessed by contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI)., Background: PR is associated with larger infarct size as assessed by cardiac enzymes in STEMI patients. CE-CMR is a favorable method to assess TEI, which can predict the prognosis of STEMI patients., Methods: First, STEMI patients with primary PCI within 12 h after onset were enrolled and divided into 2 groups according to presence (n = 71) or absence (n = 32) of PR at the culprit lesion as assessed by pre-intervention OCT. CE-CMR was performed at 1 week after primary PCI., Results: The frequency of no-reflow phenomenon (37% vs. 16%; p = 0.032) and distal embolization (24% vs. 6%; p = 0.032) was significantly higher in the rupture group compared with the non-rupture group. TEI grade was significantly greater in the rupture group (28% vs. 15% in grade 3 and 45% vs. 13% in grade 4; p < 0.001). Microvascular obstruction was more frequently seen in the rupture group (39% vs. 19%; p = 0.039). Multivariate analysis identified PR (odds ratio: 6.60, 95% confidence interval: 2.19 to 21.69; p < 0.001) and no statin use before admission (odds ratio: 3.37, 95% confidence interval: 1.06 to 11.19; p = 0.039) as independent predictors of TEI grade 3 or 4., Conclusions: PR as assessed by OCT is associated with greater TEI as assessed by CE-CMR in STEMI patients after primary PCI., (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Prasugrel is a new-generation thienopyridine antiplatelet agent that provides more consistent and prompt platelet inhibition than clopidogrel. The aim of this study was to compare in-stent thrombus inhibition effect of pretreatment with prasugrel and clopidogrel by using optical coherence tomography (OCT) immediately after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS)., Methods: We performed OCT immediately after PCI in 108 ACS patients pretreated with either prasugrel (n=51) or clopidogrel (n=57). OCT detected thrombus/plaque protrusion in all stented segments., Results: Although stent volume (190.4±119.1mm 3 vs. 189.4±95.8mm 3 , p=0.961), mean stent area (6.9±2.9mm 2 vs. 7.1±2.0mm 2 , p=0.772), and minimum stent area (5.6±2.7mm 2 vs. 5.4±1.7mm 2 , p=0.554) were not different between the two groups, in-stent thrombus/plaque protrusion volume (1.8±2.9mm 3 vs. 4.5±5.3mm 3 , p=0.002), mean in-stent thrombus/plaque protrusion area (0.1±0.1mm 2 vs. 0.2±0.2mm 2 , p=0.005), and maximum in-stent thrombus/plaque protrusion area (0.5±0.7mm 2 vs. 0.8±0.6mm 2 , p=0.007) were significantly smaller in the prasugrel group compared with the clopidogrel group., Conclusions: Pretreatment with prasugrel was associated with significantly reduced in-stent thrombus/plaque protrusion immediately after PCI for ACS compared with that with clopidogrel., (Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Background: Previous animal studies have shown that a potassium channel opener, nicorandil, provokes vasodilation in renal microvasculature and increases renal blood flow. We conducted a clinical study that aimed to evaluate the effect of nicorandil on renal artery blood flow in comparison with nitroglycerin by using color Doppler ultrasound., Methods: The present study enrolled 40 patients with stable coronary artery disease who had no renal arterial stenosis and renal parenchymal disease. The patients received intravenous administration of nicorandil (n=20) or nitroglycerin (n=20). Before and after the administration, renal artery blood flow velocity was measured by color-guided pulsed-wave Doppler., Results: The peak-systolic, end-diastolic, and mean renal artery blood flow velocities before the administration were not different between the nicorandil group and the nitroglycerin group. The peak-systolic (79±15cm/s to 99±21cm/s, p<0.001; and 78±19cm/s to 85±19cm/s, p=0.004), end-diastolic (22±5cm/s to 28±8cm/s, p<0.001; and 24±6cm/s to 26±6cm/s, p=0.005) and mean (41±6cm/s to 49±9cm/s, p<0.001; and 43±9cm/s to 45±9cm/s, p=0.009) renal artery flow velocities increased significantly in either group. The nominal changes in the peak-systolic (20±10cm/s vs. 7±8cm/s, p<0.001), end-diastolic (5±4cm/s vs. 2±3cm/s, p=0.001), and mean (8±5cm/s vs. 2±2cm/s, p<0.001) renal artery blood flow velocities were significantly greater in the nicorandil group compared with the nitroglycerin group., Conclusion: Intravenous nicorandil increased renal artery blood flow velocity in comparison with nitroglycerin. Nicorandil has a significant effect on renal hemodynamics., (Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Background: Pressure guidewire pullback recording can differentiate between functional focal and diffuse disease types in coronary artery disease. The aim of this study was to compare the outcome of coronary artery bypass graft (CABG) patency between patients with functional focal versus diffuse disease types in recipient coronary arteries., Methods and Results: We investigated 89 patients who underwent pressure guidewire pullback in the left anterior descending (LAD) artery before CABG using internal mammary artery (IMA). Based on the pressure guidewire pullback data, the LAD lesions were classified into functional focal disease (abrupt pressure step-up; n=58) or functional diffuse disease (gradual pressure increase; n=31). Follow-up computed tomography (CT) angiography was conducted within 1year after CABG to assess the bypass graft patency. Pre CABG, LAD angiographic percent diameter stenosis (57±10% vs. 54±12%, p=0.228) and fractional flow reserve (FFR) (0.68±0.07 vs. 0.69±0.07, p=0.244) were not different between the functional focal and diffuse disease groups. The CABG procedure characteristics were similarly comparable between the two groups. In the follow-up CT angiography after CABG, occlusion or string sign of the IMA graft to LAD was more frequently observed in the functional diffuse disease group than in the functional focal disease group (26% vs. 7%, p=0.021)., Conclusion: In CABG, functional diffuse disease in the recipient coronary artery was associated with an increased risk of the graft failure in comparison with functional focal disease., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Autopsy studies have reported that rupture of a thin-cap fibroatheroma and subsequent thrombus formation is the major mechanism leading to acute coronary syndrome (ACS). However, it is not clear why only some plaque ruptures lead to ACS. Optical coherence tomography (OCT) is a high-resolution imaging modality which is capable of investigating detailed coronary plaque morphology in vivo. The objective of this study was to determine whether ruptured plaque morphology assessed by OCT differs between asymptomatic coronary artery disease (CAD) and non-ST elevation acute coronary syndrome (NSTEACS)., Methods: We examined ruptured plaque morphology using OCT in 80 patients, 33 with asymptomatic CAD and 47 with NSTEACS., Results: The frequency of lipid-rich plaque and intracoronary thrombus was significantly lower in asymptomatic CAD than in NSTEACS (61% vs. 85%, p = 0.013 and 9% vs. 83%, p < 0.001, respectively). Although maximal ruptured cavity cross-sectional area (CSA) was similar in both groups, lumen area at the rupture site and minimal lumen area were significantly larger in asymptomatic CAD than in NSTEACS (3.78 ± 1.50 mm(2) vs. 2.70 ± 1.55 mm(2), p = 0.003 and 2.75 ± 0.99 mm(2) vs. 1.72 ± 0.90 mm(2), p < 0.001, respectively)., Conclusions: OCT revealed that the morphology of ruptured plaques differs between asymptomatic CAD and NSTEACS in terms of lumen area and the frequency of lipid-rich plaques and thrombi. These morphological features may be associated with the clinical presentation of CAD., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Although monocytes appear to be actively involved in the onset of acute coronary syndrome (ACS), they are heterogenous in human peripheral blood. How up-regulation of monocyte subsets leads to coronary plaque rupture followed by thrombus formation remains unclear. Recent studies have shown that P-selectin glycoprotein ligand-1 (PSGL-1) is involved in monocyte activation in patients with thrombus formation. We therefore investigated the relationship between the expression of PSGL-1 on monocyte subsets and thrombus formation using frequency-domain optical coherence tomography (FD-OCT) in patients with ACS., Methods: We enrolled a total of 100 individuals in this study: patients with acute myocardial infarction (AMI, n=25), unstable angina pectoris (UAP, n=20), or stable angina pectoris (n=35) who underwent coronary angiography, and control subjects (n=20). Three monocyte subsets (CD14++CD16-, CD14++CD16+, and CD14+CD16+) and the expression of PSGL-1 were measured by flow cytometry. In patients with AMI and UAP, FD-OCT was performed before percutaneous coronary intervention., Results: Circulating peripheral CD14++CD16+ monocytes expressed PSGL-1 more frequently than CD14++CD16- and CD14+CD16+ monocytes in patients with ACS. The expression of PSGL-1 on circulating peripheral CD14++CD16+ monocytes was significantly elevated in patients with AMI compared with the other 3 groups. Moreover, the expression levels of PSGL-1 on CD14++CD16+ monocytes were significantly higher in patients with plaque rupture or intracoronary thrombus assessed by FD-OCT., Conclusion: Up-regulation of PSGL-1 on CD14++CD16+ monocytes may be a crucial role in plaque rupture and thrombus formation., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). Plaques showing the napkin-ring sign in multidetector computed tomography (MDCT) have been reported as thin-cap fibroatheroma that is recognized as a precursor lesion for plaque rupture. The purpose of this study was to investigate distribution and frequency of napkin-ring sign and its relationship to features indicating coronary plaque vulnerability on MDCT in patients with coronary artery disease., Methods: We enrolled 273 patients with ACS (n=61) or stable angina pectoris (SAP, n=212) who were assessed by MDCT. The definition of the napkin-ring sign was the presence of a ring of high attenuation and the CT attenuation of a ring presenting higher than those of the adjacent plaque and no greater than 130HU., Results: The culprit plaques with the napkin-ring sign show higher remodeling index and lower CT attenuation (1.15±0.12 vs. 1.02±0.12, p<0.01 and 39.9±22.8 vs. 72.7±26.6, p<0.01, respectively). Napkin-ring sign at culprit lesions was more frequent in patients with ACS than those with SAP (49.0% vs. 11.2%, p<0.01). Moreover, napkin-ring sign at non-culprit lesions was more frequently observed in ACS patients compared with SAP patients (12.7% vs. 2.8%, p<0.01). The distribution of the napkin-ring sign in the right coronary arteries and left circumflex arteries of our population was relatively even, whereas the napkin-ring sign in the left anterior descending artery was common in the proximal sites (p<0.01)., Conclusions: The napkin-ring sign assessed by MDCT represents similar clinical features of fibroatheroma. MDCT could contribute to the search for fibroatheroma., (Copyright © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)