430 results on '"Takeshi Morimoto"'
Search Results
2. P-wave terminal force in lead V1 and outcomes in patients with persistent atrial fibrillation undergoing catheter ablation
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Yuya Sudo, Takeshi Morimoto, Ryu Tsushima, Masahiro Sogo, Masatomo Ozaki, Masahiko Takahashi, and Keisuke Okawa
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Cardiology and Cardiovascular Medicine - Published
- 2023
3. Rationale and study design of the GOREISAN for heart failure (GOREISAN-HF) trial: A randomized clinical trial
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Hidenori Yaku, Takao Kato, Takeshi Morimoto, Kazuhisa Kaneda, Ryusuke Nishikawa, Takeshi Kitai, Yasutaka Inuzuka, Yodo Tamaki, Taketoshi Yamazaki, Jun Kitamura, Hirotaka Ezaki, Kazuya Nagao, Hiromi Yamamoto, Akihiro Isotani, Arita Takeshi, Chisato Izumi, Yukihito Sato, Yoshihisa Nakagawa, Satoaki Matoba, Yasushi Sakata, Koichiro Kuwahara, and Takeshi Kimura
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Cardiology and Cardiovascular Medicine - Published
- 2023
4. Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention inPatients With Multivessel Disease
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Ko Yamamoto, Hiroki Shiomi, Takeshi Morimoto, Hiroki Watanabe, Akiyoshi Miyazawa, Kyohei Yamaji, Masanobu Ohya, Sunao Nakamura, Satoru Mitomo, Satoru Suwa, Takenori Domei, Shojiro Tatsushima, Koh Ono, Hiroki Sakamoto, Kiyotaka Shimamura, Masataka Shigetoshi, Ryoji Taniguchi, Yuji Nishimoto, Hideki Okayama, Kensho Matsuda, Takafumi Yokomatsu, Masahiro Muto, Ren Kawaguchi, Koichi Kishi, Mitsuyoshi Hadase, Tsutomu Fujita, Yasunori Nishida, Masami Nishino, Hiromasa Otake, Kengo Tanabe, Mitsuru Abe, Kiyoshi Hibi, Kazushige Kadota, Kenji Ando, and Takeshi Kimura
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coronary stent ,percutaneous coronary intervention ,Cardiology and Cardiovascular Medicine ,intravascular ultrasound - Abstract
BACKGROUND: Intravascular ultrasound (IVUS) was only rarely used in landmark trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel disease. OBJECTIVES: The authors aimed to evaluate clinical outcomes after optimal IVUS-guided PCI in patients undergoing multivessel PCI. METHODS: The OPTIVUS (OPTimal IntraVascular UltraSound)-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1, 021 patients undergoing multivessel PCI, including left anterior descending coronary artery using IVUS, aiming to meet the prespecified criteria (OPTIVUS criteria: minimum stent area > distal reference lumen area [stent length≥28mm], and minimum stent area >0.8× average reference lumen area [stent length
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- 2023
5. Clopidogrel Monotherapy After 1-Month DAPT in Patients With High Bleeding Risk or Complex PCI
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Ko Yamamoto, Hirotoshi Watanabe, Takeshi Morimoto, Yuki Obayashi, Masahiro Natsuaki, Takenori Domei, Kyohei Yamaji, Satoru Suwa, Tsuyoshi Isawa, Hiroki Watanabe, Ruka Yoshida, Hiroki Sakamoto, Masaharu Akao, Yoshiki Hata, Itsuro Morishima, Hideo Tokuyama, Masahiro Yagi, Hiroshi Suzuki, Kohei Wakabayashi, Nobuhiro Suematsu, Tsukasa Inada, Toshihiro Tamura, Hideki Okayama, Mitsuru Abe, Kazuya Kawai, Koichi Nakao, Kenji Ando, Kengo Tanabe, Yuji Ikari, Yoshihiro Morino, Kazushige Kadota, Yutaka Furukawa, Yoshihisa Nakagawa, and Takeshi Kimura
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coronary stent ,percutaneous coronary intervention ,high bleeding risk ,Cardiology and Cardiovascular Medicine ,complexity ,antiplatelet therapy - Abstract
BACKGROUND: High bleeding risk (HBR) and complex percutaneous coronary intervention (PCI) are major determinants for dual antiplatelet therapy (DAPT) duration. OBJECTIVES: The aim of this study was to evaluate the effects of HBR and complex PCI on short vs standard DAPT. METHODS: Subgroup analyses were conducted on the basis of Academic Research Consortium-defined HBR and complex PCI in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Verulam's-Eluting Cobalt-Chromium Stent-2) Total Cohort, which randomly compared clopidogrel monotherapy after 1-month DAPT with 12-month DAPT with aspirin and clopidogrel after PCI. The primary endpoint was the composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) or bleeding (Thrombolysis In Myocardial Infarction [TIMI] major or minor) endpoints at 1 year. RESULTS: Regardless of HBR (n=1, 893 [31.6%]) and complex PCI (n=999 [16.7%]), the risk of 1-month DAPT relative to 12-month DAPT was not significant for the primary endpoint (HBR, 5.01% vs 5.14%; non-HBR, 1.90% vs 2.02%; P interaction=0.95) (complex PCI, 3.15% vs 4.07%; noncomplex PCI, 2.78% vs 2.82%; P interaction=0.48) and for the cardiovascular endpoint (HBR, 4.35% vs 3.52%; and non-HBR, 1.56% vs 1.22%; P interaction=0.90) (complex PCI, 2.53% vs 2.52%; noncomplex PCI, 2.38% vs 1.86%; P interaction=0.53), while it was lower for the bleeding endpoint (HBR, 0.66% vs 2.27%; non-HBR, 0.43% vs 0.85%; P interaction=0.36) (complex PCI, 0.63% vs 1.75%; noncomplex PCI, 0.48% vs 1.22%; P interaction=0.90). The absolute difference in the bleeding between 1- and 12-month DAPT was numerically greater in patients with HBR than in those without HBR (-1.61% vs-0.42%). CONCLUSIONS: The effects of 1-month DAPT relative to 12-month DAPT were consistent regardless of HBR and complex PCI. The absolute benefit of 1-month DAPT over 12-month DAPT in reducing major bleeding was numerically greater in patients with HBR than in those without HBR. Complex PCI might not be an appropriate determinant for DAPT durations after PCI. (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 [STOPDAPT-2], NCT02619760; Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 for the Patients With ACS [STOPDAPT-2 ACS], NCT03462498).
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- 2023
6. Atrial Fibrillation Ablation Outcomes and Heart Failure (from the Kansai Plus Atrial Fibrillation Registry)
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Nobuaki Tanaka, Koichi Inoue, Atsushi Kobori, Kazuaki Kaitani, Takeshi Morimoto, Toshiya Kurotobi, Itsuro Morishima, Hirosuke Yamaji, Yumie Matsui, Yuko Nakazawa, Kengo Kusano, Koji Tanaka, Yuko Hirao, Masato Okada, Yasushi Koyama, Atsunori Okamura, Katsuomi Iwakura, Kenshi Fujii, Takeshi Kimura, and Satoshi Shizuta
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Cardiology and Cardiovascular Medicine - Abstract
The impact of rhythm outcomes on heart failure (HF) hospitalizations remains unknown after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). We sought to elucidate whether AF recurrence was associated with HF hospitalizations after AF RFCA. We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry), enrolling 5,010 consecutive patients (age 64 ± 10 years, 27.3% female, and 35.7% nonparoxysmal AF) who underwent an initial AF RFCA at 26 centers. The median follow-up duration was 2.9 years. The cumulative 3-year incidence of HF hospitalizations after the initial RFCA was 1.84% (0.69%/year). Hospitalized patients with HF were older with a higher prevalence of nonparoxysmal AF, renal dysfunction, diabetes, and underlying heart disease pre-RFCA. HF hospitalizations occurred more often in patients with than without recurrences (3.27 vs 0.84%, log-rank p0.0001). After adjusting for confounders using a Cox model, AF recurrence remained an independent predictor of HF hospitalizations (hazard ratio [HR] 2.84, 95% confidence interval [CI] 1.80 to 4.47, p0.0001). AF recurrence was a distinct HF hospitalization risk in patients with a left ventricular ejection fraction ≥50% (HR 4.54, 95% CI 2.38 to 8.65, p0.0001) but not50% (HR 1.31, 95% CI 0.65 to 2.62, p = 0.45), with significant interactions. Furthermore, patients with AF recurrences within 1 year had a greater HF hospitalization risk after 1 year (1.61% vs 0.79%, log-rank p = 0.019). In conclusion, AF recurrence after RFCA was independently associated with HF hospitalizations.
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- 2023
7. Catheter Ablation for Paroxysmal Atrial Fibrillation With Sick Sinus Syndrome: Insights From the Kansai Plus Atrial Fibrillation Registry
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Itsuro Morishima, Yasunori Kanzaki, Yasuhiro Morita, Koichi Inoue, Atsushi Kobori, Kazuaki Kaitani, Toshiya Kurotobi, Hirosuke Yamaji, Yumie Matsui, Yuko Nakazawa, Kengo Kusano, Toshiro Tomomatsu, Yoshihiro Ikai, Koichi Furui, Ryota Yamauchi, Hiroyuki Miyazawa, Nobuaki Tanaka, Takeshi Morimoto, Takeshi Kimura, and Satoshi Shizuta
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Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Coexisting sick sinus syndrome (SSS) is associated with both electrical and structural atrial remodelling in patients with atrial fibrillation (AF). Limited data are available concerning catheter ablation (CA) for AF in this condition. This study investigated the efficacy of CA as a curative therapy for AF and SSS in a large-scale prospective multicentre registry.The Kansai Plus Atrial Fibrillation registry enrolled 5,010 consecutive patients who underwent CA for AF; this included 3,133 patients with paroxysmal AF (mean age, 66 years; male, 69.3%; mean CHA2DS2-VASc score, 2.05±1.50; SSS, n=315 [tachy-brady syndrome, n=285]). The endpoints included the recurrence of AF with a blanking period of 90 days after CA, and de novo pacemaker implantation during the follow-up period (median duration, 2.93 years).The AF-free survival did not significantly differ between patients with and those without SSS (n=2,818) after the initial (log-rank p=0.864) and final sessions (log-rank p=0.268). Pacemakers were implanted in 48 patients with SSS, and implantation in this group was significantly associated with AF recurrence, including early recurrence (adjusted odds ratio, 3.57; 95% confidence interval, 1.67-7.64; p=0.002). The remaining 85.3% of patients with SSS did not require pacemaker implantation at 3 years after CA.Coexisting SSS did not adversely affect recurrence-free survival after CA for paroxysmal AF. Pacemaker implantation was not required in most patients with SSS, with AF recurrence serving as a strong predictor for this.
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- 2023
8. Atrial fibrillation in patients with severe aortic stenosis
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Shintaro, Matsuda, Takao, Kato, Takeshi, Morimoto, Tomohiko, Taniguchi, Eri, Minamino-Muta, Mitsuo, Matsuda, Hiroki, Shiomi, Kenji, Ando, Shinichi, Shirai, Norio, Kanamori, Koichiro, Murata, Takeshi, Kitai, Yuichi, Kawase, Chisato, Izumi, Makoto, Miyake, Hirokazu, Mitsuoka, Masashi, Kato, Yutaka, Hirano, Kazuya, Nagao, Tsukasa, Inada, Hiroshi, Mabuchi, Yasuyo, Takeuchi, Keiichiro, Yamane, Mamoru, Toyofuku, Mitsuru, Ishii, Moriaki, Inoko, Tomoyuki, Ikeda, Akihiro, Komasa, Katsuhisa, Ishii, Kozo, Hotta, Nobuya, Higashitani, Toshikazu, Jinnai, Yoshihiro, Kato, Yasutaka, Inuzuka, Yuko, Morikami, Naritatsu, Saito, Kenji, Minatoya, and Takeshi, Kimura
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Cardiology and Cardiovascular Medicine - Abstract
There has been no previous report evaluating the long impact of atrial fibrillation (AF) on the clinical outcomes stratified by the initial management [conservative or aortic valve replacement (AVR)] strategies of severe aortic stenosis (AS).We analyzed 3815 patients with severe AS enrolled in the CURRENT AS registry. Patients with AF were defined as those having a history of AF when severe AS was found on the index echocardiography. The primary outcome measure was a composite of aortic valve-related death or hospitalization for heart failure.The cumulative 5-year incidence of the primary outcome measure was significantly higher in patients with AF than in those without AF (44.2 % versus 33.2 %, HR 1.54, 95 % CI 1.35-1.76). After adjusting for confounders, the risk of AF relative to no AF remained significant (HR 1.34, 95 % CI 1.16-1.56). The magnitude of excess adjusted risk of AF for the primary outcome measure was greater in the initial AVR stratum (N = 1197, HR 1.95, 95 % CI 1.36-2.78) than in the conservative stratum (N = 2618, HR 1.26, 95 % CI 1.08-1.47) with a significant interaction (p = 0.04). In patients with AF, there was a significant excess adjusted risk of paroxysmal AF (N = 254) relative to chronic AF (N = 528) for the primary outcome measure (HR 1.34, 95 % CI 1.01-1.78).In patients with severe AS, concomitant AF was independently associated with worse clinical outcomes regardless of the initial management strategies. In those patients with conservative strategy, paroxysmal AF is stronger risk factor than chronic AF.
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- 2023
9. Statins Reduce Bleeding Risk in Patients Taking Oral Anticoagulants for Nonvalvular Atrial Fibrillation: A Retrospective Registry Study
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Kazutaka Uchida, Shinichiro Ueda, Fumihiro Sakakibara, Norito Kinjo, Mari Nezu, Hideki Arai, and Takeshi Morimoto
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Pharmacology (medical) ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
The effects of statins in patients with non-valvular atrial fibrillation (NVAF) taking oral anticoagulants (OACs) are not well-studied. This study was a historical multicenter registry of patients with NVAF taking OACs in Japan.We excluded those patients with mechanical heart valves or a history of pulmonary or deep vein thrombosis. Overall, 7826 patients were registered on 26 February 2013 and followed until 25 February 2017. We compared those with versus without statin treatment (statin vs. no-statin groups) for the primary outcome of major bleeding and secondary outcomes of all-cause mortality, ischemic events, hemorrhagic stroke, and ischemic stroke.Statins were administered in 2599 (33%) patients. The statin group was more likely to have paroxysmal AF (37% vs. 33%; p = 0.0003), hypertension (84% vs. 76%; p 0.0001), diabetes mellitus (41% vs. 27%; p 0.0001), and dyslipidemia (91% vs. 30%; p 0.0001) than the no-statin group. The cumulative incidence of major bleeding was 6.9% and 8.1% (p = 0.06). The adjusted hazard ratio [HR] (95% confidence interval [CI]) of the statin group for major bleeding was 0.77 (0.63-0.94) compared with the no-statin group. The adjusted HR (95% CI) for all-cause mortality, ischemic events, hemorrhagic stroke, and ischemic stroke were 0.58 (0.47-0.71), 0.77 (0.59-0.999), 0.85 (0.48-1.50), and 0.79 (0.60-1.05), respectively.Statins significantly reduced the risk of major bleeding, all-cause mortality, and ischemic events in patients with NVAF taking OACs. Their additive benefits should be considered in routine practice and thus be further researched.
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- 2022
10. Association between body mass index and long-term clinical outcomes in patients with non-valvular atrial fibrillation taking oral anticoagulants
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Mari Nezu, Shinichiro Ueda, Kazutaka Uchida, Fumihiro Sakakibara, Norito Kinjo, Hideki Arai, and Takeshi Morimoto
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Cardiology and Cardiovascular Medicine - Abstract
The association between body mass index (BMI) and clinical outcomes of patients with non-valvular atrial fibrillation (NVAF) taking oral anticoagulants (OACs) are controversial, and we thus analyzed the large registry data to elucidate them.We conducted a historical cohort study at 71 centers in Japan and included outpatients with NVAF taking vitamin K antagonists (VKAs). Physicians in charge could change VKAs to direct OACs based on their judgement during follow-up period. We categorized patients into four BMI groups (kg/mAmong NVAF patients taking OACs, underweight patients had higher risks of all-cause death and ischemic events than other patients. Overweight patients had lower risk of all-cause death.
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- 2022
11. Drug-Related Pneumonitis Induced by Osimertinib as First-Line Treatment for Epidermal Growth Factor Receptor Mutation-Positive Non-Small Cell Lung Cancer
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Yuki Sato, Hiromitsu Sumikawa, Ryota Shibaki, Takeshi Morimoto, Yoshihiko Sakata, Yuko Oya, Motohiro Tamiya, Hidekazu Suzuki, Hirotaka Matsumoto, Takashi Yokoi, Kazuki Hashimoto, Hiroshi Kobe, Aoi Hino, Megumi Inaba, Yoko Tsukita, Hideki Ikeda, Daisuke Arai, Hirotaka Maruyama, Satoshi Hara, Shinsuke Tsumura, Shinya Sakata, and Daichi Fujimoto
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Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine - Published
- 2022
12. Safety of Apixaban Monotherapy for Non-Valvular Atrial Fibrillation-Related Acute Stroke with Intra-/Extracranial Artery Stenosis
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Masaomi, Koyanagi, Taketo, Hatano, Kazutaka, Uchida, Takenori, Ogura, Hiroshi, Yamagami, Masunari, Shibata, Yukiko, Enomoto, Norihito, Fukawa, Yasushi, Matsumoto, Nobuyuki, Sakai, Masataka, Takeuchi, Tadashi, Nonaka, Fuminori, Shimizu, Masayuki, Ezura, Takahiro, Ota, Hajime, Ohta, Masafumi, Morimoto, Takeshi, Morimoto, and Shinichi, Yoshimura
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Neurology ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: We investigated whether apixaban is safe for the prevention of further adverse events in non-valvular atrial fibrillation (NVAF) patients with intra-/extracranial artery stenosis (Stenosis group) compared with acute large vessel occlusion without intra-/extracranial artery stenosis (No stenosis group). We also examined whether combination therapy using apixaban and antiplatelet is safe. Methods: ALVO (Apixaban on clinical outcome of patients with Large Vessel Occlusion [LVO] or stenosis) was a historical and prospective multicenter registry at 38 centers in Japan. Patients with NVAF and acute LVO or stenosis who received apixaban within 14 days after onset were included. We conducted the post hoc analysis using the ALVO dataset. We compared patients with stenosis versus those without stenosis in terms of the primary outcome, which was defined as a composite of all-cause death, major bleeding events, and ischemic events 365 days after onset. Results: Of the 662 patients, 54 (8.2%) patients were classified into the Stenosis group, and 104 patients of the total (16%) reached the primary outcome. The cumulative incidence of primary outcome was not significantly different between the No stenosis and the Stenosis groups (hazard ratio [HR] 1.2, 95% confidence interval [CI]: 0.64–2.4; p = 0.52). Even after adjustment for predictive clinical variates, no significant difference in the primary endpoint between the No stenosis and the Stenosis groups was shown (adjusted HR 1.2, 95% CI: 0.59–2.5; p = 0.60). Fifty patients (7.6%) used an antiplatelet with apixaban. Among the Stenosis group patients, the cumulative incidence of the primary outcome was significantly higher among patients treated with an antiplatelet and apixaban (HR 3.5, 95% CI: 1.0–12; p = 0.048). Conclusion: Apixaban monotherapy appears safe for the prevention of further adverse events in the Stenosis group patients similar to the No stenosis group patients. Concomitant use of an antiplatelet might not be favorable in patients with stenosis.
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- 2022
13. Relationship Between Endothelial Dysfunction and the Outcomes After Atrial Fibrillation Ablation
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Keisuke Okawa, Masahiro Sogo, Takeshi Morimoto, Ryu Tsushima, Yuya Sudo, Eisuke Saito, Masatomo Ozaki, and Masahiko Takahashi
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Cardiology and Cardiovascular Medicine - Abstract
Background Endothelial dysfunction (ED) is associated with cardiovascular events in patients with atrial fibrillation (AF). However, the utility of ED as a prognostic marker after AF ablation supplementary to the CHA 2 DS 2 ‐VASc score is unclear. This study aimed to investigate the relationship between ED and 5‐year cardiovascular events in patients undergoing AF ablation. Methods and Results We conducted a prospective cohort study of patients who underwent a first‐time AF ablation and for whom the endothelial function was assessed by the peripheral vascular reactive hyperemia index (RHI) before ablation. We defined ED as an RHI of 2 DS 2 ‐VASc score ( P =0.004). The 5‐year incidence of cardiovascular events was higher among patients with ED than those without ED (98 [11.8%] versus 13 [6.2%]; log‐rank P =0.014). We found ED to be an independent predictor of cardiovascular events after AF ablation (hazard ratio [HR], 1.91 [95% CI, 1.04–3.50]; P =0.036) along with a CHA 2 DS 2 ‐VASc score of ≥2 (≥3 for women) (HR, 3.68 [95% CI, 1.89–7.15]; P Conclusions The prevalence of ED among patients with AF was high. Assessing the endothelial function could enable the risk stratification of cardiovascular events after AF ablation.
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- 2023
14. Age and long-term outcomes of patients with venous thromboembolism: From the COMMAND VTE Registry
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Kotaro Takahashi, Yugo Yamashita, Takeshi Morimoto, Tomohisa Tada, Hiroki Sakamoto, Toru Takase, Seiichi Hiramori, Kitae Kim, Maki Oi, Masaharu Akao, Yohei Kobayashi, Po-Min Chen, Koichiro Murata, Yoshiaki Tsuyuki, Yuji Nishimoto, Jiro Sakamoto, Kiyonori Togi, Hiroshi Mabuchi, Kensuke Takabayashi, Takao Kato, Koh Ono, and Takeshi Kimura
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Cardiology and Cardiovascular Medicine - Published
- 2023
15. Heterogeneity in Characteristics and Outcomes of Patients who met the Indications for Vericiguat Approved by the Japanese Agency: From the KCHF Registry
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MASAYUKI SHIBA, TAKAO KATO, TAKESHI MORIMOTO, HIDENORI YAKU, YASUTAKA INUZUKA, YODO TAMAKI, NEIKO OZASA, YUTA SEKO, ERIKA YAMAMOTO, YUSUKE YOSHIKAWA, TAKESHI KITAI, YUGO YAMASHITA, MORITAKE IGUCHI, KAZUYA NAGAO, YUICHI KAWASE, TAKASHI MORINAGA, MAMORU TOYOFUKU, YUTAKA FURUKAWA, KENJI ANDO, KAZUSHIGE KADOTA, YUKIHITO SATO, KOICHIRO KUWAHARA, and TAKESHI KIMURA
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Cardiology and Cardiovascular Medicine - Published
- 2023
16. Insomnia in patients with acute heart failure: from the KCHF registry
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Yuta, Seko, Erika, Yamamoto, Takao, Kato, Takeshi, Morimoto, Hidenori, Yaku, Yasutaka, Inuzuka, Yodo, Tamaki, Neiko, Ozasa, Masayuki, Shiba, Yusuke, Yoshikawa, Yugo, Yamashita, Takeshi, Kitai, Ryoji, Taniguchi, Moritake, Iguchi, Kazuya, Nagao, Takafumi, Kawai, Akihiro, Komasa, Ryusuke, Nishikawa, Yuichi, Kawase, Takashi, Morinaga, Mamoru, Toyofuku, Yutaka, Furukawa, Kenji, Ando, Kazushige, Kadota, Yukihito, Sato, Koichiro, Kuwahara, and Takeshi, Kimura
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Heart Failure ,Hospitalization ,Insomnia ,Acute heart failure ,Humans ,Registries ,Diuretics ,Cardiology and Cardiovascular Medicine ,Patient Discharge ,Outcome - Abstract
[Aims] Insomnia is a known risk factor for heart failure (HF) and a predictor of cardiac events in HF patients, but the clinical significance of insomnia in patients with acute HF (AHF) is not adequately evaluated. This study aimed to investigate the association between insomnia and subsequent clinical outcomes in patients with AHF. [Methods] From the Kyoto Congestive Heart Failure registry, consecutive 3414 patients hospitalized for HF who were discharged alive were divided into the 2 groups at discharge: insomnia group and non-insomnia group. We compared baseline characteristics and 1 year clinical outcomes according to the presence of insomnia. The primary outcome measure was all-cause death. [Results] There were 330 patients (9.7%) and 3084 patients (90.3%) with and without insomnia, respectively. In the multivariable logistic regression analysis, brain-type natriuretic peptide above median value at discharge (OR = 1.50, 95% CI = 1.08–2.10, P = 0.02) and the presence of oedema at discharge (OR = 4.23, 95% CI = 2.95–6.07, P < 0.001) were positively associated with insomnia at discharge, whereas diuretics at discharge (OR = 0.60, 95% CI = 0.39–0.90, P = 0.01) were negatively associated with insomnia at discharge. The cumulative 1 year incidence of all-cause death was significantly higher in the insomnia group than in the non-insomnia group (25.1% vs. 16.2%, P < 0.001). Even after adjusting the confounders, the higher mortality risk of patients with insomnia relative to those without insomnia remained significant (HR = 1.55, 95% CI = 1.24–1.94; P < 0.001). [Conclusions] Patients with insomnia at discharge were associated with a higher risk of mortality than those without insomnia at discharge.
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- 2022
17. Life Expectancy of Patients With Severe Aortic Stenosis in Relation to Age and Surgical Risk Score
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Tomohiko Taniguchi, Takeshi Morimoto, Kyohei Yamaji, Shinichi Shirai, Kenji Ando, Hiroki Shiomi, Yasuaki Takeji, Nobuhisa Ohno, Norio Kanamori, Fumio Yamazaki, Tadaaki Koyama, Kitae Kim, Natsuhiko Ehara, Yutaka Furukawa, Tatsuhiko Komiya, Atsushi Iwakura, Manabu Shirotani, Jiro Esaki, Genichi Sakaguchi, Kosuke Fujii, Shogo Nakayama, Hiroshi Mabuchi, Hiroshi Tsuneyoshi, Hiroshi Eizawa, Kotaro Shiraga, Michiya Hanyu, Akira Nakano, Katsuhisa Ishii, Nobushige Tamura, Nobuya Higashitani, Ichiro Kouchi, Tomoyuki Yamada, Junichiro Nishizawa, Toshikazu Jinnai, Yuko Morikami, Kenji Minatoya, and Takeshi Kimura
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
18. Abstract 1: The Very Core Limit Of Endovascular Therapy For Acute Stroke With A Large Ischemic Region
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Manabu Inoue, Takeshi Yoshimoto, Kazunori Toyoda, Nobuyuki Sakai, Hiroshi Yamagami, Yuji Matsumaru, Yasushi Matsumoto, Kazumi Kimura, Reiichi Ishikura, Kazutaka Uchida, Mikiya Beppu, Fumihiro Sakakibara, Takeshi Morimoto, and Shinichi Yoshimura
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Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background and Purpose: To assess the actual malignant core volume in endovascular therapy (EVT) eligible patients with large ischemic regions from the RESCUE-Japan LIMIT database. Methods: RESCUE-Japan LIMIT was a multicenter, open-label, randomized clinical trial in large vessel occlusion patients with large ischemic region indicated by an ASPECTS valued from 3 to 5. We assessed the volumetrically measured core volume which identifies an unfavorable outcome (modified Rankin Scale; mRS 4-6 at 90 days) by receiver operating characteristic (ROC) analysis in the endovascular therapy (EVT) group. Predictive marginal probabilities were also assessed to identify the unfavorable outcome. Symptomatic intracranial hemorrhages and death within 90 days in the EVT group and the medical management (MM) group were compared. Clinical characteristics and radiological values were also compared. Results: Of the 203 cases enrolled, 182 patients (92 in EVT group vs. 90 in MM group) had adequate core volume. The mean age was 75.6±10 years old and 46% of females in the EVT group and 77.0±10 years old and 42% of females in the MM group. Median core volume was 94 (IQR; 65.3-147.5) mL in EVT patients and 110 (IQR; 74.0-140.0) mL in those with MM group (P=0.84). ROC analysis identified a core volume of 120 mL as the unfavorable outcome (61/92) in the EVT group (51% sensitivity and 77% specificity, area under curve=0.65) and 99 mL in the MM group (77/91, 62% sensitivity and 54% specificity, area under curve=0.56). Predictive marginal probabilities indicated 132 mL as an overlay of the two groups for achieving the unfavorable functional outcome. Symptomatic intracranial hemorrhage was seen in 9.8% in the EVT group and 5.6% in the MM group (p=0.28), and death within 90 days was 17.4% in the EVT group and 23.3% in the MM group (p=0.32). Conclusions: The current analysis demonstrates that a core threshold of approximately 130 mL is the upper limit for identifying large ischemic region stroke patients treated with EVT who are unlikely to suffer from unfavorable outcomes. EVT-eligible patients under this threshold may benefit from EVT. Registration: URL: http://www.clinicaltrials.gov; Unique identifier: NCT03702413.
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- 2023
19. Prognostic Value of the Severity of Clinical Congestion in Patients Hospitalized for Decompensated Heart Failure: Findings From the Japanese KCHF Registry
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KENJI AIDA, KAZUYA NAGAO, TAKAO KATO, HIDENORI YAKU, TAKESHI MORIMOTO, YASUTAKA INUZUKA, YODO TAMAKI, ERIKA YAMAMOTO, YUSUKE YOSHIKAWA, TAKESHI KITAI, RYOJI TANIGUCHI, MORITAKE IGUCHI, MASASHI KATO, MAMORU TAKAHASHI, TOSHIKAZU JINNAI, TAKAFUMI KAWAI, AKIHIRO KOMASA, RYUSUKE NISHIKAWA, YUICHI KAWASE, TAKASHI MORINAGA, KANAE SU, MITSUNORI KAWATO, YUTA SEKO, TSUKASA INADA, MORIAKI INOKO, MAMORU TOYOFUKU, YUTAKA FURUKAWA, YOSHIHISA NAKAGAWA, KENJI ANDO, KAZUSHIGE KADOTA, SATOSHI SHIZUTA, KOH ONO, YUKIHITO SATO, KOICHIRO KUWAHARA, NEIKO OZASA, and TAKESHI KIMURA
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Cardiology and Cardiovascular Medicine - Published
- 2023
20. Association between dihydropyridine calcium channel blockers and ischemic strokes in patients with nonvalvular atrial fibrillation
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Fumihiro Sakakibara, Shinichiro Ueda, Kazutaka Uchida, Norito Kinjo, Hideki Arai, Mari Nezu, and Takeshi Morimoto
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Male ,Dihydropyridines ,Physiology ,Anticoagulants ,Hemorrhage ,Calcium Channel Blockers ,Cohort Studies ,Stroke ,Hemorrhagic Stroke ,Atrial Fibrillation ,Internal Medicine ,Humans ,Female ,Cardiology and Cardiovascular Medicine ,Aged ,Ischemic Stroke - Abstract
Outside of clinical trials, the prophylactic effect of dihydropyridine calcium channel blockers (CCBs) on ischemic events in patients with nonvalvular atrial fibrillation (NVAF) has not been confirmed. We compared the effect of dihydropyridine CCBs on ischemic events in anticoagulated NVAF patients. We conducted a multicenter historical cohort study at 71 centers in Japan. The inclusion criterion was taking vitamin K antagonists for NVAF. The exclusion criteria were mechanical heart valves and a history of pulmonary thrombosis or deep vein thrombosis. Consecutive patients (N = 7826) were registered in February 2013 and were followed until February 2017. The primary outcomes were ischemic events and ischemic strokes; the secondary outcomes were all-cause mortality, major bleeding, and hemorrhagic strokes. The mean patient age was 73 years old, and 67% of the patients were male. Seventy-eight percent of the patients had hypertension, and dihydropyridine CCBs were used by 2693 (34%) patients (CCB group). The cumulative incidences of ischemic events and ischemic strokes at 4 years in the CCB and No-CCB groups were 5.9% vs. 5.2% and 5.6% vs. 4.8%, respectively. The adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) of the CCB group for ischemic events and ischemic strokes were 1.22 (0.95-1.57) and 1.32 (1.02-1.71), respectively; the adjusted HRs (95% CIs) of the CCB group for all-cause mortality, major bleeding, and hemorrhagic strokes were 0.85 (0.69-1.04), 1.12 (0.92-1.35), and 1.08 (0.62-1.88), respectively. Dihydropyridine CCB use by anticoagulated NVAF patients significantly increased ischemic strokes in a real-world setting.
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- 2022
21. Matched comparison of catheter ablation versus conservative management for atrial fibrillation
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Tetsuma Kawaji, Satoshi Shizuta, Kyohei Yamaji, Munekazu Tanaka, Kazuki Kitano, Takanori Aizawa, Shintaro Yamagami, Akihiro Komasa, Takashi Yoshizawa, Masashi Kato, Takafumi Yokomatsu, Shinji Miki, Koh Ono, Takeshi Morimoto, and Takeshi Kimura
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Heart Failure ,Stroke ,Treatment Outcome ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Conservative Treatment ,Cardiology and Cardiovascular Medicine - Abstract
It is still controversial whether catheter ablation for atrial fibrillation (AF) could improve clinical outcomes in general AF population. Among 4398 patients with diagnosis of AF in the outpatient department of Kyoto University Hospital between January 2005 and March 2015, we identified 537 pairs of patients who received first-time catheter ablation (ablation group) or conservative management (conservative group), matched for age, gender, AF duration, AF type, AF symptoms, and previous heart failure (HF). The primary outcome measure was a composite of cardiovascular death, HF hospitalization, ischemic stroke, or major bleeding. Most baseline characteristics were well balanced between the 2 groups, except for the higher prevalence of low body weight, history of malignancy, and severe chronic kidney disease in the conservative group. Median follow-up duration was 5.3 years. The cumulative 5-year incidence of the primary outcome measure was significantly lower in the ablation group than in the conservative group (5.2% versus 15.6%, log-rank P 0.001). Even after adjusting for the imbalances in the baseline characteristics, the lower risk of the ablation group relative to the conservative group for the primary outcome measure remained highly significant (HR 0.32, 95% CI 0.21-0.47, P 0.001). Ablation compared with conservative management was also associated with significantly lower risks for the individual components of the primary outcome. In this matched analysis in AF patients, ablation as compared with conservative management was associated with better long-term clinical outcomes, although we could not deny the possibility of selection bias and unmeasured confounding.
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- 2022
22. Coronary Artery Disease Without Standard Cardiovascular Risk Factors
- Author
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CREDO-Kyoto Pci, Takeshi Kimura, Kenji Ando, Yusuke Yoshikawa, Hiroshi Eizawa, Toshihiro Tamura, Moriaki Inoko, Yukiko Matsumura-Nakano, Mitsuo Matsuda, Erika Yamamoto, Shinji Miki, Tomoya Onodera, Mamoru Takahashi, Manabu Shirotani, Masahiro Natsuaki, Hidenori Yaku, Ko Yamamoto, Masayuki Fuki, Tsukasa Inada, Kenji Nakatsuma, Eiji Shinoda, Takeshi Aoyama, Yasuaki Takeji, Satoru Suwa, Yukihito Sato, Takeshi Morimoto, Yutaka Furukawa, Hiroki Watanabe, Kyohei Yamaji, Hiroshi Mabuchi, Mamoru Toyofuku, Hiroki Sakamoto, Eri Kato, Kazushige Kadota, Katsuhisa Ishii, Cabg Registry Cohort Investigators, Yoshihisa Nakagawa, Hiroki Shiomi, Takashi Yamamoto, and Yugo Yamashita
- Subjects
Male ,Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,Body Mass Index ,Time-to-Treatment ,Coronary artery disease ,Sex Factors ,Cause of Death ,Neoplasms ,Internal medicine ,Atrial Fibrillation ,Diabetes Mellitus ,Myocardial Revascularization ,medicine ,Humans ,Myocardial infarction ,Acute Coronary Syndrome ,Mortality ,Risk factor ,Aged ,Dyslipidemias ,Proportional Hazards Models ,Aged, 80 and over ,business.industry ,Smoking ,Hazard ratio ,Age Factors ,Percutaneous coronary intervention ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Heart Disease Risk Factors ,Chronic Disease ,Hypertension ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Dyslipidemia - Abstract
Recently, one observational study showed that patients with ST-segment elevation myocardial infarction (STEMI) without standard cardiovascular risk factors were associated with increased mortality compared with patients with risk factors. This unexpected result should be evaluated in other populations including those with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and chronic coronary syndrome (CCS). Among 30,098 consecutive patients undergoing first coronary revascularization in the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) registry cohort-2 and 3, we compared clinical characteristics and outcomes between patients with and without risk factors stratified by their presentation (STEMI n = 8,312, NSTE-ACS n = 3,386, and CCS n = 18,400). Patients with risk factors were defined as having at least one of the following risk factors: hypertension, dyslipidemia, diabetes, and current smoking. The proportion of patients without risk factors was low (STEMI: 369 patients [4.4%], NSTE-ACS: 110 patients [3.2%], and CCS: 462 patients [2.5%]). Patients without risk factors compared with those with risk factors more often had advanced age, low body weight, and malignancy and less often had history of atherosclerotic disease and prescription of optimal medical therapy. In patients with STEMI, patients without risk factors compared with those with risk factors were more often women and more often had atrial fibrillation, long door-to-balloon time, and severe hemodynamic compromise. During a median of 5.6 years follow-up, patients without risk factors compared with those with risk factors had higher crude incidence of all-cause death. After adjusting confounders, the mortality risk was significant in patients with CCS (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.01 to 1.49, p = 0.04) but not in patients with STEMI (HR 1.06, 95% CI 0.89 to 1.27, p = 0.52) and NSTE-ACS (HR 1.07, 95% CI, 0.74 to 1.54, p = 0.73). In conclusion, among patients undergoing coronary revascularization, patients without standard cardiovascular risk factors had higher crude incidence of all-cause death compared with those with at least one risk factor. After adjusting confounders, the mortality risk was significant in patients with CCS but not in patients with STEMI and NSTE-ACS.
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- 2022
23. Venous thromboembolism: Recent advancement and future perspective
- Author
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Takeshi Morimoto, Yugo Yamashita, and Takeshi Kimura
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medicine.medical_specialty ,Vena Cava Filters ,medicine.drug_class ,Deep vein ,medicine.medical_treatment ,Lower risk ,Inferior vena cava ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Intensive care medicine ,Venous Thrombosis ,business.industry ,Anticoagulants ,Venous Thromboembolism ,Thrombolysis ,Vitamin K antagonist ,equipment and supplies ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Clinical trial ,medicine.anatomical_structure ,medicine.vein ,Cardiology ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business - Abstract
Clinicians have been more and more often encountering patients with venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, leading to the increased importance of VTE in daily clinical practice. VTE is becoming a common issue in Asian countries including Japan. The management strategies of VTE have changed dramatically in the past decade including the introduction of direct oral anticoagulants (DOACs). In addition, there have been several landmark clinical trials assessing acute treatment strategies including thrombolysis and inferior vena cava (IVC) filter. The current VTE guidelines do not recommend the routine use of thrombolysis or IVC filters based on recent evidence; Nevertheless, the prevalence of thrombolysis and IVC filter use in Japan was strikingly high. The novel profiles of DOACs with rapid onset of action and potential benefit of a lower risk for bleeding compared with vitamin K antagonist could make home treatment feasible and is safer even with extended anticoagulation therapy. One of the most clinically relevant issues for VTE treatment is optimal duration of anticoagulation for the secondary prevention of VTE. Considering recent evidence, optimal duration of anticoagulation should be determined based on the risk for recurrence as well as the risk for bleeding in an individual patient. Despite the recent advances for VTE management, there are still a number of uncertain issues that challenge clinicians in daily clinical practice, such as cancer-associated VTE and minor VTE including subsegmental pulmonary embolism and distal deep vein thrombosis, warranting future research. Several clinical trials are now ongoing for these issues, globally as well as in Japan. The current review is aimed to overview the recent advances in VTE management, describe the current status including some domestic issues in Japan, and discuss the future perspective of VTE.
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- 2022
24. Coronary angiography in patients with acute heart failure: from the KCHF registry
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Takeshi Morimoto, Takashi Morinaga, Kchf Study Investigators, Yasutaka Inuzuka, Kenji Ando, Koichiro Kuwahara, Erika Yamamoto, Takeshi Kimura, Yuichi Kawase, Neiko Ozasa, Yugo Yamashita, Takafumi Kawai, Ryusuke Nishikawa, Mamoru Toyofuku, Moritake Iguchi, Takeshi Kitai, Yodo Tamaki, Ryoji Taniguchi, Akihiro Komasa, Yuta Seko, Masayuki Shiba, Takefumi Kishimori, Hidenori Yaku, Kazushige Kadota, Yusuke Yoshikawa, Kazuya Nagao, Yukihito Sato, Yutaka Furukawa, and Takao Kato
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Coronary angiography ,Lower risk ,Ventricular Dysfunction, Left ,Internal medicine ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Registries ,Outcome ,Aged, 80 and over ,Heart Failure ,Ejection fraction ,business.industry ,Hazard ratio ,Acute heart failure ,Atrial fibrillation ,Odds ratio ,Original Articles ,medicine.disease ,Confidence interval ,Hospitalization ,RC666-701 ,Heart failure ,Cardiology ,Original Article ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Little is known about the characteristics and outcomes of patients who undergo coronary angiography during heart failure (HF) hospitalization, as well as those with coronary stenosis, and those who underwent coronary revascularization. Methods and results We analysed 2163 patients who were hospitalized for HF without acute coronary syndrome or prior HF hospitalization. We compared patient characteristics and 1 year clinical outcomes according to (i) patients with versus without coronary angiography, (ii) patients with versus without coronary stenosis, and (iii) patients with versus without coronary revascularization. The primary outcome measure was the composite of all‐cause death or HF hospitalization. Coronary angiography was performed in 37.0% of patients. In the multivariable logistic regression analysis, factors independently associated with coronary angiography were age
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- 2021
25. Characteristics of Elderly Patients with Heart Failure and Impact on Activities of Daily Living: A Registry Report from Super-Aged Society
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Tohru Izumi, Shinichi Noto, Mitsuaki Isobe, Keisuke Suzuki, Hiroaki Obata, Wataru Mitsuma, Takeshi Morimoto, and Masashi Yamashita
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Male ,medicine.medical_specialty ,Octogenarians ,Activities of daily living ,medicine.medical_treatment ,Aftercare ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Activities of Daily Living ,Health care ,Registry report ,Humans ,Medicine ,Registries ,030212 general & internal medicine ,Disease management (health) ,Aged ,Aged, 80 and over ,Heart Failure ,Rehabilitation ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Patient Discharge ,Heart failure ,Cohort ,Emergency medicine ,Female ,Cardiology and Cardiovascular Medicine ,business ,human activities - Abstract
Background To assess the health care burden of elderly patients with heart failure (HF) in an aging Japanese community-based hospital, we investigated the outcomes of cardiac rehabilitation. Methods and Results We enrolled all patients with HF aged ≥65 years admitted to 3 hospitals in the Niigata Prefecture. We prospectively collected data on their hospital stays and for 2 years postdischarge. The cohort comprised 617 patients (46.5% men; mean age 84.7 years), 76.2% of whom were aged ≥80 years. Among these patients, 15.6% were nursing home residents, 57.7% required long-term care insurance, only 37.6% could walk unaided at the time of admission, and 70.5% required cardiac rehabilitation; age had no significant rehabilitative effect on the degree of improvement in activities of daily living (ADLs). Two years postdischarge, all-cause mortality, and HF rehospitalization were 41.1% and 38.6%, respectively. The ADL score at discharge was an independent prognostic factor for mortality. The incidence of mortality and rehospitalization was lower in elderly patients with preserved ADLs at discharge. Conclusions Elderly patients with HF in our super-aged society were mainly octogenarians who required disease management and personalized care support. Although their ADL scores increased with comprehensive cardiac rehabilitation, improved scores at discharge were closely associated with prognosis.
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- 2021
26. Severity of pulmonary embolism at initial diagnosis and long-term clinical outcomes: From the COMMAND VTE Registry
- Author
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Kensuke Takabayashi, Takeshi Morimoto, Koh Ono, Seiichi Hiramori, Hiroshi Mabuchi, Toru Takase, Masaharu Akao, Kitae Kim, Yohei Kobayashi, Maki Oi, Mamoru Toyofuku, Kiyonori Togi, Takao Kato, Tomohisa Tada, Command Vte Registry Investigators, Kazushige Kadota, Yugo Yamashita, Toshiaki Izumi, Minako Kinoshita, Tomoki Sasa, Jiro Sakamoto, Takeshi Kimura, Koichiro Murata, Moriaki Inoko, Po-Min Chen, Yoshiaki Tsuyuki, and Yuji Nishimoto
- Subjects
Venous Thrombosis ,medicine.medical_specialty ,business.industry ,Confounding ,Hazard ratio ,Anticoagulants ,Venous Thromboembolism ,medicine.disease ,Confidence interval ,Pulmonary embolism ,Recurrence ,Risk Factors ,Interquartile range ,Internal medicine ,Landmark analysis ,medicine ,Humans ,Population study ,Registries ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Venous thromboembolism - Abstract
Background There is a paucity of data on the long-term clinical outcomes according to the severity of pulmonary embolism (PE) at initial diagnosis. Methods The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic venous thromboembolism (VTE). After excluding 1312 patients without PE, the current study population consisted of 1715 patients with PE, who were divided into 3 groups according to the clinical severity; massive PE, sub-massive PE and low-risk PE. Results There were 179 patients (10%) with massive PE, 742 patients (43%) with sub-massive PE, and 794 patients (46%) with low-risk PE. By the landmark analysis at 3 months, the cumulative incidences of recurrent VTE were similar among the 3 groups both within and beyond 3 months (Massive PE: 2.9%, Sub-massive PE: 4.2%, and Low-risk PE: 3.3%, P = 0.61, and 4.3%, 8.8%, and 7.8% at 5 years, P = 0.47, respectively). After adjusting confounders, the risk of massive PE relative to low-risk PE for recurrent VTE beyond 3 months remained insignificant (adjusted HR 0.54, 95% CI: 0.13–1.51, P = 0.27). Patients with massive PE at initial diagnosis more often presented as severe recurrent PE events than those with sub-massive and low-risk PE. Conclusions In the current real-world large registry, the long-term risk of overall recurrent VTE in patients with massive PE at initial diagnosis did not significantly differ from those with sub-massive and low-risk PE beyond 3 months, although patients with massive PE at initial diagnosis more frequently developed recurrent VTE as PE with severe clinical presentation.
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- 2021
27. Five-year outcomes after coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with complex coronary artery disease
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Hiroki Watanabe, Shingo Hirao, Tatsuhiko Komiya, Naoki Kanemitsu, Jiro Esaki, Kenji Minatoya, Hiroyuki Hara, Takeshi Morimoto, Yuki Hori, and Takeshi Kimura
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Octogenarians ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,Lower risk ,Coronary artery disease ,Percutaneous Coronary Intervention ,Interquartile range ,Internal medicine ,Humans ,Medicine ,cardiovascular diseases ,Coronary Artery Bypass ,Aged ,Aged, 80 and over ,business.industry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,General Medicine ,medicine.disease ,Cardiac surgery ,Death ,Stroke ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Cardiothoracic surgery ,Conventional PCI ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
We assessed the clinical effectiveness of coronary artery bypass grafting (CABG) in comparison with that of percutaneous coronary intervention (PCI) in octogenarians with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease. From the CREDO-Kyoto registry cohort-2, 527 patients, who were ≥ 80 years of age and underwent the first coronary revascularization for TVD or LMCA disease, were divided into the CABG group (N = 151) and the PCI group (N = 376). The median and interquartile range of patient’s age was 82 (81–84) in the CABG group and 83 (81–85) in the PCI group (P = 0.10). Patients > = 85 years of age accounted for 19% and 31% in the CABG and PCI groups, respectively (P = 0.01). The cumulative 5-year incidence of all-cause death was similar between CABG and PCI groups (35.8% vs. 42.9%, log-rank P = 0.18), while CABG showed a lower rate of the composite of cardiac death/MI than PCI (21.7% vs. 33.9%, log-rank P = 0.005). After adjusting for confounders, the lower risk of CABG relative to PCI was significant for all-cause death (HR 0.61, 95% CI 0.43–0.86, P = 0.005), any coronary revascularization (HR 0.25, 95% CI 0.14–0.43, P
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- 2021
28. Sex Differences in Clinical Outcomes After Percutaneous Coronary Intervention
- Author
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Yasuaki Takeji, Takeshi Morimoto, Hiroki Shiomi, Eri Toda Kato, Kazuaki Imada, Yusuke Yoshikawa, Yukiko Matsumura-Nakano, Ko Yamamoto, Kyohei Yamaji, Toshiaki Toyota, Tomohisa Tada, Junichi Tazaki, Erika Yamamoto, Kenji Nakatsuma, Satoru Suwa, Natsuhiko Ehara, Ryoji Taniguchi, Toshihiro Tamura, Hiroki Watanabe, Mamoru Toyofuku, Takashi Yamamoto, Eiji Shinoda, Hiroshi Mabuchi, Moriaki Inoko, Tomoya Onodera, Hiroki Sakamoto, Tsukasa Inada, Kenji Ando, Yutaka Furukawa, Yukihito Sato, Kazushige Kadota, Yoshihisa Nakagawa, and Takeshi Kimura
- Subjects
General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
There is a scarcity of studies comparing the clinical outcomes after percutaneous coronary intervention (PCI) for women and men stratified by the presentation of acute coronary syndromes (ACS) or stable coronary artery disease (CAD).Methods and Results: The study population included 26,316 patients who underwent PCI (ACS: n=11,119, stable CAD: n=15,197) from the CREDO-Kyoto PCI/CABG registry Cohort-2 and Cohort-3. The primary outcome was all-cause death. Among patients with ACS, women as compared with men were much older. Among patients with stable CAD, women were also older than men, but with smaller difference. The cumulative 5-year incidence of all-cause death was significantly higher in women than in men in the ACS group (26.2% and 17.9%, log rank P0.001). In contrast, it was significantly lower in women than in men in the stable CAD group (14.2% and 15.8%, log rank P=0.005). After adjusting confounders, women as compared with men were associated with significantly lower long-term mortality risk with stable CAD but not with ACS (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.69-0.82, P0.001, and HR: 0.92, 95% CI: 0.84-1.01, P=0.07, respectively). There was a significant interaction between the clinical presentation and the mortality risk of women relative to men (interaction P=0.002).Compared with men, women had significantly lower adjusted mortality risk after PCI among patients with stable CAD, but not among those with ACS.
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- 2022
29. Periprocedural management and clinical outcomes of invasive procedures after venous thromboembolism: from the COMMAND VTE registry
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Kazuki Matsushita, Kiyonori Togi, Tomohisa Tada, Yugo Yamashita, Seiichi Hiramori, Kazushige Kadota, Takeshi Morimoto, Yoshiaki Tsuyuki, Hidewo Amano, Mamoru Toyofuku, Yuta Tsujisaka, Syunsuke Saga, Hiroshi Mabuchi, Command Vte Registry Investigators, Yuji Nishimoto, Tomoki Sasa, Arata Sano, Masaharu Akao, Kosuke Doi, Minako Kinoshita, Kensuke Takabayashi, Fumiya Yoneda, Ryosuke Murai, Takeshi Kimura, Jiro Sakamoto, Maki Oi, Toshiaki Izumi, Kohei Osakada, Takao Kato, Kitae Kim, Yuta Seko, Toru Takase, Reo Hata, Yohei Kobayashi, Koh Ono, Po-Min Chen, and Koichiro Murata
- Subjects
medicine.medical_specialty ,Hematology ,business.industry ,Heparin ,Surgery ,Internal medicine ,Medicine ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Venous thromboembolism ,Invasive Procedure ,Major bleeding ,medicine.drug - Abstract
Anticoagulation therapy is prescribed for the prevention of recurrence in patients with venous thromboembolism, which could be temporarily interrupted during invasive procedures. The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic VTE in Japan between January 2010 and August 2014. We identified patients who underwent invasive procedures during the entire follow-up period and evaluated periprocedural managements and clinical outcomes at 30 days after invasive procedures. During a median follow-up period of 1213 (IQR: 847–1764) days, 518 patients underwent invasive procedures with the cumulative incidences of 5.8% at 3 months, 11.1% at 1 year, and 24.0% at 5 years. Among 382 patients in high bleeding-risk category of invasive procedures, anticoagulation therapy had been discontinued already in 62 patients (16%) and interrupted temporarily in 288 patients (75%) during the invasive procedures with bridging anticoagulation therapy with heparin in 214 patients (56%). Among 80 patients in low bleeding-risk category, anticoagulation therapy had been already discontinued in 15 patients (19%) and interrupted temporarily in 31 patients (39%) during invasive procedure with bridging anticoagulation therapy with heparin in 17 patients (21%). At 30 days after the invasive procedures, 14 patients (2.7%) experienced recurrent VTE, while 28 patients (5.4%) had major bleeding. This study elucidated the real-world features of peri-procedural management and prognosis in patients with VTE who underwent invasive procedures during follow-up in the large multicenter VTE registry. The 30-day incidence rates of recurrent VTE and major bleeding events were 2.7% and 5.4%.
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- 2021
30. Development of Machine Learning Models to Predict Probabilities and Types of Stroke at Prehospital Stage: the Japan Urgent Stroke Triage Score Using Machine Learning (JUST-ML)
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Shinichi Yoshimura, Takeshi Morimoto, Fumihiro Sakakibara, Norito Kinjo, Kazutaka Uchida, Hayato Araki, and Junichi Kouno
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Emergency Medical Services ,Machine learning ,computer.software_genre ,Logistic regression ,Brain Ischemia ,Machine Learning ,Japan ,Humans ,Medicine ,Prospective Studies ,cardiovascular diseases ,Prospective cohort study ,Stroke ,Probability ,Retrospective Studies ,Receiver operating characteristic ,business.industry ,Cerebral infarction ,General Neuroscience ,medicine.disease ,Triage ,Cohort ,Neurology (clinical) ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,computer ,Predictive modelling - Abstract
In conjunction with recent advancements in machine learning (ML), such technologies have been applied in various fields owing to their high predictive performance. We tried to develop prehospital stroke scale with ML. We conducted multi-center retrospective and prospective cohort study. The training cohort had eight centers in Japan from June 2015 to March 2018, and the test cohort had 13 centers from April 2019 to March 2020. We use the three different ML algorithms (logistic regression, random forests, XGBoost) to develop models. Main outcomes were large vessel occlusion (LVO), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral infarction (CI) other than LVO. The predictive abilities were validated in the test cohort with accuracy, positive predictive value, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and F score. The training cohort included 3178 patients with 337 LVO, 487 ICH, 131 SAH, and 676 CI cases, and the test cohort included 3127 patients with 183 LVO, 372 ICH, 90 SAH, and 577 CI cases. The overall accuracies were 0.65, and the positive predictive values, sensitivities, specificities, AUCs, and F scores were stable in the test cohort. The classification abilities were also fair for all ML models. The AUCs for LVO of logistic regression, random forests, and XGBoost were 0.89, 0.89, and 0.88, respectively, in the test cohort, and these values were higher than the previously reported prediction models for LVO. The ML models developed to predict the probability and types of stroke at the prehospital stage had superior predictive abilities.
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- 2021
31. Coronary Revascularization in the Past Two Decades in Japan (From the CREDO-Kyoto PCI/CABG Registries Cohort-1, -2, and -3)
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Hiroshi Sakai, Hiroshi Eizawa, Atsushi Iwakura, Masaru Tanaka, Mamoru Toyofuku, Kazushige Kadota, Teruki Takeda, Hiroshi Mabuchi, Junichi Tazaki, Nobushige Tamura, Michiya Hanyu, Keiichi Tambara, Tatsuhiko Komiya, Tomoya Onodera, Junichiro Nishizawa, Takashi Uegaito, Kazuhisa Ishii, Toshihiro Tamura, Takeshi Kimura, Hiroki Shiomi, Mitsuo Matsuda, Takeshi Tada, Shinji Miki, Tadaaki Koyama, Kazuhisa Kaneda, Yoshihisa Nakagawa, Yukihito Sato, Yoshiharu Soga, Tomohisa Tada, Takeshi Aoyama, Yutaka Furukawa, Fumio Yamazaki, Satoru Suwa, Ryuzo Nawada, Hirotoshi Watanabe, Kenji Ando, Kyohei Yamaji, Yusuke Yoshikawa, Mamoru Takahashi, Tatsuya Ogawa, Jiro Esaki, Miho Yamada, Natsuhiko Ehara, Takeshi Morimoto, Moriaki Inoko, Takashi Yamamoto, Hiroki Sakamoto, Ryoji Taniguchi, Takashi Tamura, Shogo Nakayama, Manabu Shirotani, Hiroshi Tsuneyoshi, Eiji Shinoda, Nobuhisa Ohno, Naoki Kanemitsu, Kenji Minatoya, and Tsukasa Inada
- Subjects
Male ,Bypass grafting ,medicine.medical_treatment ,Myocardial Infarction ,Comorbidity ,Coronary Artery Disease ,Cohort Studies ,Coronary artery disease ,Postoperative Complications ,Japan ,Cause of Death ,Myocardial Revascularization ,Registries ,Coronary Artery Bypass ,Aged, 80 and over ,Evidence-Based Medicine ,Dual Anti-Platelet Therapy ,Smoking ,Age Factors ,Middle Aged ,Stroke ,Cardiovascular Diseases ,Hypertension ,Cohort ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,Reoperation ,medicine.medical_specialty ,Demographics ,Hemorrhage ,Postoperative Hemorrhage ,Percutaneous Coronary Intervention ,Renal Dialysis ,Internal medicine ,Diabetes Mellitus ,medicine ,Humans ,Mortality ,Aged ,Heart Failure ,Duration of Therapy ,Practice patterns ,business.industry ,Percutaneous coronary intervention ,Thrombosis ,medicine.disease ,Coronary revascularization ,Conventional PCI ,Kidney Failure, Chronic ,business - Abstract
The treatment of coronary artery disease has substantially changed over the past two decades. However, it is unknown whether and how much these changes have contributed to the improvement of long-term outcomes after coronary revascularization. We assessed trends in the demographics, practice patterns and long-term outcomes in 24,951 patients who underwent their first percutaneous coronary intervention (PCI) (n = 20,106), or isolated coronary artery bypass grafting (CABG) (n = 4,845) using the data in a series of the CREDO-Kyoto PCI/CABG Registries (Cohort-1 [2000 to 2002]: n = 7,435, Cohort-2 [2005 to 2007]: n = 8,435, and Cohort-3 [2011 to 2013]: n = 9,081). From Cohort-1 to Cohort-3, the patients got progressively older across subsequent cohorts (67.0 ± 10.0, 68.4 ± 9.9, and 69.8 ± 10.2 years, ptrend
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- 2021
32. Risk factors of thrombotic recurrence and major bleeding in patients with intermediate-risk for recurrence of venous thromboembolism
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Yugo Yamashita, Kensuke Takabayashi, Kazushige Kadota, Takeshi Morimoto, Masaharu Akao, Yoshiaki Tsuyuki, Koh Ono, Mamoru Toyofuku, Seiichi Hiramori, Hidewo Amano, Takao Kato, Yuji Nishimoto, Moriaki Inoko, Koichiro Murata, Po-Min Chen, Maki Oi, Kohei Osakada, Kazuki Matsushita, Kiyonori Togi, Tomohisa Tada, Yohei Kobayashi, Reo Hata, Tomoki Sasa, Arata Sano, Toru Takase, Command Vte Registry Investigators, Kitae Kim, Minako Kinoshita, Jiro Sakamoto, Hiroshi Mabuchi, and Takeshi Kimura
- Subjects
medicine.medical_specialty ,Hematology ,Proportional hazards model ,business.industry ,equipment and supplies ,Thrombophilia ,medicine.disease ,Discontinuation ,Internal medicine ,medicine ,Population study ,cardiovascular diseases ,Risk factor ,Cardiology and Cardiovascular Medicine ,business ,Venous thromboembolism ,Major bleeding - Abstract
Prolonged anticoagulation therapy is recommended for patients with intermediate-risk for recurrence of venous thromboembolism (VTE). The current study aimed to identify risk factors of VTE recurrence and major bleeding in intermediate-risk patients. The COMMAND VTE Registry is a multicenter registry enrolled consecutive 3027 patients with acute symptomatic VTE among 29 centers in Japan. The current study population consisted of 1703 patients with intermediate-risk for recurrence. The primary outcome measure was recurrent VTE during the entire follow-up period, and the secondary outcome measures were recurrent VTE and major bleeding during anticoagulation therapy. In the multivariable Cox regression model for recurrent VTE incorporating the status of anticoagulation therapy as a time-updated covariate, off-anticoagulation therapy was strongly associated with an increased risk for recurrent VTE (HR 9.42, 95% CI 5.97–14.86). During anticoagulation therapy, the independent risk factor for recurrent VTE was thrombophilia (HR 3.58, 95% CI 1.56–7.50), while the independent risk factors for major bleeding were age ≥ 75 years (HR 2.04, 95% CI 1.36–3.07), men (HR 1.52, 95% CI 1.02–2.27), history of major bleeding (HR 3.48, 95% CI 1.82–6.14) and thrombocytopenia (HR 3.73, 95% CI 2.04–6.37). Among VTE patients with intermediate-risk for recurrence, discontinuation of anticoagulation therapy was a very strong independent risk factor of recurrence during the entire follow-up period. The independent risk factors of recurrent VTE and those of major bleeding during anticoagulation therapy were different: thrombophilia for recurrent VTE, and advanced age, men, history of major bleeding, and thrombocytopenia for major bleeding. Unique identifier: UMIN000021132. COMMAND VTE Registry: http://www.umin.ac.jp/ctr/index.htm .
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- 2021
33. Refinement of a modified simplified Pulmonary Embolism Severity Index for elderly patients with acute pulmonary embolism
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Manuel Monreal, Yugo Yamashita, G. Vidal, David Jiménez, Andrés Tenes, Takeshi Morimoto, Behnood Bikdeli, Olivier Espitia, Carmen Rodriguez, Takeshi Kimura, Nuria Ruiz-Giménez, Raquel Morillo, and Riete Investigators
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medicine.medical_specialty ,Deep vein ,Plasma creatinine ,030204 cardiovascular system & hematology ,Logistic regression ,Risk Assessment ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Aged ,Aged, 80 and over ,Framingham Risk Score ,business.industry ,Prognosis ,medicine.disease ,Thrombosis ,Pulmonary embolism ,medicine.anatomical_structure ,Acute Disease ,Risk of death ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective To evaluate the utility of a modified (i.e., without the variable “Age >80 years”) simplified Pulmonary Embolism Severity Index (sPESI) in elderly patients with acute symptomatic pulmonary embolism (PE), and to derive and validate a refined version of the sPESI for identification of elderly patients at low risk of adverse events. Methods The study included normotensive patients aged >80 years with acute PE enrolled in the RIETE registry. We used multivariable logistic regression analysis to create a new risk score to predict 30-day all-cause mortality. We externally validated the new risk score in elderly patients from the COMMAND VTE registry. Results Multivariable logistic regression identified four predictors for mortality: high-risk sPESI, immobilization, coexisting deep vein thrombosis (DVT), and plasma creatinine >2 mg/dL. In the RIETE derivation cohort, the new model classified fewer patients as low risk (4.0% [401/10,106]) compared to the modified sPESI (35% [3522/10,106]). Low-risk patients based on the new model had a lower 30-day mortality than those based on the modified sPESI (1.2% [95% CI, 0.4–2.9%] versus 4.7% [95% CI, 4.0–5.4%]). In the COMMAND VTE validation cohort, 1.5% (3/206) of patients were classified as having low risk of death according to the new model, and the overall 30-day mortality of this group was 0% (95% CI, 0–71%), compared to 5.9% (95% CI, 3.1–10.1%) in the high-risk group. Conclusions For predicting short-term mortality among elderly patients with acute PE, this study suggests that the new model has a substantially higher sensitivity than the modified sPESI. A minority of these patients might benefit from safe outpatient therapy of their disease.
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- 2021
34. WBC count predicts heart failure in diabetes and coronary artery disease patients: a retrospective cohort study
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Atsuhiko Kawabe, Takanori Yasu, Takeshi Morimoto, Akihiro Tokushige, Shin‐ichi Momomura, Kenichi Sakakura, Koichi Node, Taku Inoue, Shinichiro Ueda, and The CHD Collaborative Investigators
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Male ,medicine.medical_specialty ,Major adverse cardiovascular event ,White blood cell count ,Coronary Artery Disease ,Coronary artery disease ,Cohort Studies ,Diabetes mellitus ,Interquartile range ,Internal medicine ,Original Research Articles ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Myocardial infarction ,cardiovascular diseases ,Original Research Article ,Stroke ,Aged ,Retrospective Studies ,Heart Failure ,Proportional hazards model ,business.industry ,Hazard ratio ,Middle Aged ,medicine.disease ,Coronary heart disease ,Quartile ,Diabetes Mellitus, Type 2 ,RC666-701 ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Aims White blood cell (WBC) count in healthy people is associated with the risk of coronary artery disease (CAD) and mortality. This study aimed to determine whether WBC count predicts heart failure (HF) requiring hospitalization as well as all‐cause death, acute myocardial infarction (AMI) and stroke in patients with Type 2 diabetes mellitus and established CAD. Methods We conducted this retrospective registry study that enrolled consecutive patients with Type 2 diabetes mellitus and CAD based on coronary arteriography records and medical charts at 70 teaching hospitals in Japan from 2005 to 2015. A total of 7608 participants (28.2% women, mean age 68 ± 10 years) were eligible. In the cohort, the median (interquartile range) and mean follow‐up durations were 39 (16.5–66.1 months) and 44.3 ± 32.7 months, respectively. The primary outcome was HF requiring hospitalization. The secondary outcomes were AMI, stroke, all‐cause death, 3‐point major adverse cardiovascular events (MACE) (AMI/stroke/death) and 4‐point MACE (AMI/stroke/death/HF requiring hospitalization). Outcomes were reported as cumulative incidences (proportion of patients experiencing an event) and incidence rates (events/100 person‐years). The primary and secondary outcomes were assessed using the Kaplan–Meier method and were compared using the log‐rank test stratified by the baseline WBC count. The association between the WBC count at baseline and each MACE was assessed using the Cox proportional hazard model and expressed as the hazard ratio (HR) and 95% confidence interval (CI) after adjusting for other well‐known risk factors for MACE. Results During the follow‐up, 880 patients were hospitalized owing to HF. The WBC Quartile 4 (≥7700 cells/μL) had significantly lower HF event‐free survival rate (log‐rank test, P
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- 2021
35. Low-Density Lipoprotein Cholesterol Levels on Statins and Cardiovascular Event Risk in Stable Coronary Artery Disease - An Observation From the REAL-CAD Study
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Toshiaki Toyota, Takeshi Morimoto, Satoshi Iimuro, Retsu Fujita, Hiroshi Iwata, Katsumi Miyauchi, Teruo Inoue, Yoshihisa Nakagawa, Yosuke Nishihata, Hiroyuki Daida, Yukio Ozaki, Satoru Suwa, Ichiro Sakuma, Yutaka Furukawa, Hiroki Shiomi, Hirotoshi Watanabe, Kyohei Yamaji, Naritatsu Saito, Masahiro Natsuaki, Yasuo Ohashi, Masunori Matsuzaki, Ryozo Nagai, and Takeshi Kimura
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Statin ,General Medicine ,Cardiology and Cardiovascular Medicine ,Coronary artery disease ,Lipids - Abstract
BACKGROUND: The relationship between very low on-treatment low-density lipoprotein cholesterol (LDL-C) level and cardiovascular event risk is still unclear in patients receiving the same doses of statins.Methods and Results: From the REAL-CAD study comparing high-dose (4 mg/day) with low-dose (1 mg/day) pitavastatin therapy in patients with stable coronary artery disease, 11, 105 patients with acceptable statin adherence were divided into 3 groups according to the on-treatment LDL-C level at 6 months (
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- 2022
36. Association of intravenous heparin administration with in-hospital clinical outcomes among hospitalized patients with acute heart failure
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Yasuhiro Hamatani, Takao Kato, Takeshi Morimoto, Moritake Iguchi, Hidenori Yaku, Yasutaka Inuzuka, Takeshi Kitai, Kazuya Nagao, Yodo Tamaki, Erika Yamamoto, Neiko Ozasa, Yugo Yamashita, Mitsuru Abe, Yukihito Sato, Koichiro Kuwahara, Masaharu Akao, and Takeshi Kimura
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Aged, 80 and over ,Heart Failure ,Heparin ,Humans ,Anticoagulants ,Hemorrhage ,Cardiology and Cardiovascular Medicine ,Hospitals ,Aged ,Ischemic Stroke - Abstract
Patients with acute heart failure (AHF) possess a high risk for thromboembolism, and thromboembolism prophylaxis using heparin has been recommended by the guidelines.Among 4056 patients enrolled in the KCHF Registry, the current study population consisted of 2525 patients after excluding patients with acute coronary syndrome and oral anticoagulants on admission and those with mechanical circulatory supports. There were 789 patients (31%) with heparin administration within 24 h after admission, and 1736 patients (69%) without.The baseline characteristics included mean age: 78 ± 13 years, New York Heart Association class IV: 51%, ischemic etiology: 30%, atrial fibrillation: 31% and mean left ventricular ejection fraction: 45%. During median hospitalization length of 16 days, 161 patients had all-cause death, 34 patients developed ischemic stroke, and 48 patients developed major bleeding. Multivariable logistic regression analyses demonstrated that heparin administration compared with no heparin administration was not associated with a lower risk for all-cause death (OR: 1.39, 95%CI: 0.90-2.15; P = 0.14), nor for ischemic stroke (OR: 1.14, 95%CI: 0.53-2.43; P = 0.74), but was associated with a higher risk for major bleeding (OR: 2.88, 95%CI: 1.54-5.41; P 0.001).In patients with AHF, heparin administration within 24 h after admission was not associated with a lower risk of all-cause death and ischemic stroke, but was associated with a higher risk of major bleeding during hospitalization. Our study raises questions about the routine use of heparin for thromboembolism prophylaxis in hospitalized patients with AHF. Further studies are warranted to address the utility of anticoagulant therapy in these patients.
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- 2022
37. A comparison between hospital follow-up and collaborative follow-up in patients with acute heart failure
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Koichi Washida, Takao Kato, Neiko Ozasa, Takeshi Morimoto, Hidenori Yaku, Yasutaka Inuzuka, Yodo Tamaki, Yuta Seko, Erika Yamamoto, Yusuke Yoshikawa, Masayuki Shiba, Takeshi Kitai, Yugo Yamashita, Ryoji Taniguchi, Moritake Iguchi, Kazuya Nagao, Yuichi Kawase, Yuji Nishimoto, Takashi Kuragaichi, Kozo Hotta, Takashi Morinaga, Mamoru Toyofuku, Yutaka Furukawa, Kenji Ando, Kazushige Kadota, Yukihito Sato, Koichiro Kuwahara, and Takeshi Kimura
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Clinical outcome ,Transitional care ,Heart failure ,Post discharge follow-up ,Cardiology and Cardiovascular Medicine ,Collaborative follow-up - Abstract
AIMS: There are no previous studies focusing on collaborative follow-ups between hospitals and clinics for patients discharged after acute heart failure (AHF) in Japan. The purpose of this study was to determine the status of collaboration between hospitals and clinics for patients with AHF in Japan and to compare patient characteristics and clinical outcomes using a large Japanese observational database. METHODS AND RESULTS: Of 4056 consecutive patients hospitalized for AHF in the Kyoto Congestive Heart Failure registry, we analysed 2862 patients discharged to go home, who were divided into 1674 patients (58.5%) followed up at hospitals with index hospitalization (hospital follow-up group) and 1188 (41.5%) followed up in a collaborative fashion with clinics or other general hospitals (collaborative follow-up group). The primary outcome was a composite of all-cause death or heart failure (HF) hospitalization within 1year after discharge. Previous hospitalization for HF and length of hospital stay longer than 15days were associated with hospital follow-up. Conversely, ≥80years of age, hypertension, and cognitive dysfunction were associated with collaborative follow-up. The cumulative 1-year incidence of the primary outcome, all cause death, and cardiovascular death were similar between the hospital and collaborative follow-up groups (31.6% vs. 29.6%, P=0.51, 13.1% vs, 13.9%, P=0.35, 8.4% vs. 8.2%, P=0.96). Even after adjusting for confounders, the difference in risk for patients in the hospital follow-up group relative to those in the collaborative follow-up group remained insignificant for the primary outcome, all-cause death, and cardiovascular death (HR: 1.11, 95% CI: 0.97-1.27, P=0.14, HR: 1.10, 95% CI: 0.91-1.33, P=0.33, HR: 0.96, 95% CI: 0.87-1.05, P=0.33). The cumulative 1-year incidence of HF hospitalization was higher in the hospital follow-up group than in the collaborative follow-up group (25.5% vs. 21.3%, P=0.02). The risk of HF hospitalization was higher in the hospital follow-up group than in the collaborative follow-up group (HR: 1.19, 95% CI: 1.01-1.39, P=0.04). CONCLUSIONS: In patients hospitalized for AHF, 41.5% received collaborative follow-up after discharge. The risk of HF hospitalization was higher in the hospital follow-up group than in the collaborative follow-up, although risk of the primary outcome, all-cause death, and cardiovascular death were similar between groups.
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- 2022
38. Identifying large vessel occlusion using the hyperdense artery sign in patients treated with mechanical thrombectomy
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Takuya Saito, Ryo Itabashi, Kazutaka Uchida, Yuichi Kawabata, Shota Igasaki, Kazuhiko Sato, Tomohiro Chiba, Takeshi Morimoto, and Yukako Yazawa
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Rehabilitation ,Surgery ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
The hyperdense artery sign on non-contrast computed tomography-reconstructed images is useful for identifying large vessel occlusion in acute ischemic stroke. This study aimed to assess its efficacy in patients with large vessel occlusion treated with mechanical thrombectomy.This retrospective and prospective single-centered study from June 2019 to May 2021 evaluated the use of non-contrast computed tomography-reconstructed images for detecting hyperdense artery sign to identify large vessel occlusion from June 2020 to May 2021. We registered consecutive potential candidates for mechanical thrombectomy due to suspected stroke and assessed the accuracy of hyperdense artery sign on non-contrast computed tomography-reconstructed images for large vessel occlusion in the hyperacute setting. Non-contrast computed tomography images were reconstructed into maximum intensity projection images with iterative reconstruction algorithms to detect hyperdense artery signs. We compared the door-to-puncture time and functional outcome at 90 days before and after employing non-contrast computed tomography-reconstructed images in patients with large vessel occlusion treated with mechanical thrombectomy.The cohort included 82 patients, wherein 47 were treated with mechanical thrombectomy. The sensitivity (96%) and specificity (94%) of hyperdense artery sign on non-contrast computed tomography-reconstructed images for large vessel occlusion were performed. The door-to-puncture time was significantly shortened after using non-contrast computed tomography-reconstructed images (49 versus 28 min, p = 0.001), but the functional outcome at 90 days remained unchanged.Non-contrast computed tomography-reconstructed images, as a vascular imaging tool for mechanical thrombectomy, can reduce workflow time in hospitals by identifying large vessel occlusion with high sensitivity and specificity.
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- 2022
39. Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation
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Shushi Nishiwaki, Shin Watanabe, Fumiya Yoneda, Munekazu Tanaka, Takanori Aizawa, Shintaro Yamagami, Akihiro Komasa, Tetsuma Kawaji, Takashi Yoshizawa, Hirohiko Kohjitani, Takeshi Morimoto, Takeshi Kimura, and Satoshi Shizuta
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Atrial fibrillation (AF) plays the main role in atrial functional tricuspid regurgitation (TR). However, the effectiveness of catheter ablation (CA) for atrial functional TR together with the mechanisms of improvement of atrial functional TR have not been fully evaluated.We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Kyoto University Hospital, Kyoto, Japan. The current study population consisted of 2331 patients with available transthoracic echocardiographic (TTE) data before CA (2110 patients without significant TR and 221 patients with significant TR). Among the 221 patients with significant TR, there were 64 patients with functional TR and follow-up TTE at 6-18 months after CA for AF, in whom we compared echocardiographic parameters from baseline to follow-up.Patients with significant TR were older, and more often women, and had more persistent AF than those without significant TR. Among the 64 patients with functional TR, TR severity and TR jet area significantly improved at follow-up (TR jet area: 5.8 [4.0-7.6] cmTR severity and jet area improved after CA in patients with AF and significant TR. The improvement of TR might be associated with reverse remodeling of the right heart.
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- 2022
40. Long-Term Impact of Diabetes Mellitus on Initially Conservatively Managed Patients With Severe Aortic Stenosis
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Hiroki Shiomi, Mamoru Toyofuku, Yuichi Kawase, Koichiro Murata, Yasutaka Inuzuka, Toshikazu Jinnai, Kenji Ando, Chisato Izumi, Masashi Kato, Shintaro Matsuda, Yuko Morikami, Takeshi Kitai, Eri Minamino-Muta, Moriaki Inoko, Nobuya Higashitani, Takeshi Morimoto, Mitsuru Ishii, Yoshihiro Kato, Naritatsu Saito, Xiaoyang Song, Chiyo Maeda, Tomoyuki Ikeda, Katsuhisa Ishii, Norio Kanamori, Tsukasa Inada, Tomohiko Taniguchi, Hirokazu Mitsuoka, Makoto Miyake, Yutaka Hirano, Keiichiro Yamane, Kenji Minatoya, Yusuke Yoshikawa, Kazuya Nagao, Tomoyuki Murakami, Takao Kato, Takeshi Kimura, Kozo Hotta, and Yasuyo Takeuchi
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Aortic valve ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Insulins ,030204 cardiovascular system & hematology ,Sudden death ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Survival analysis ,business.industry ,Aortic stenosis ,Hazard ratio ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Comorbidity ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Diabetes Mellitus, Type 2 ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND: Although diabetes mellitus (DM) is a common comorbidity of aortic stenosis (AS), clinical evidence about the long-term effect of DM on patients with AS is insufficient.Methods and Results:Data were acquired from CURRENT AS, a large Japanese multicenter registry that enrolled 3, 815 patients with severe AS. Patients without initial valve replacement were defined as the conservative group; among them, 621 (23.4%) had DM, whereas 1997 did not. The DM group was further divided into 2 groups according to insulin treatment (insulin-treated DM, n=130; non-insulin treated DM, n=491). The primary outcome was a composite of aortic valve (AV)-related death and heart failure (HF) hospitalization. Secondary outcomes were AV-related death, HF hospitalization, all-cause death, cardiovascular death, sudden death, and surgical or transcatheter AV replacement during follow up. As a result, DM was associated with higher risk for the primary outcome (52.8% vs. 42.9%, P
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- 2021
41. CORRIGENDUM: Acute Coronary Syndrome With Unprotected Left Main Coronary Artery Culprit ― An Observation From the AOI-LMCA Registry ―
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Hirooki Higami, Takeshi Kimura, Hiromi Muranishi, Koji Nishida, Masanobu Ohya, Kenji Ando, Kazuya Kawai, Takashi Tamura, Yuhei Yamaji, Yasushi Fuku, Daisuke Furukawa, Takeshi Morimoto, Hiroki Sakamoto, Kazushige Kadota, Kyohei Yamaji, Tomohisa Tada, Mamoru Toyofuku, and Euihong Ko
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medicine.medical_specialty ,Acute coronary syndrome ,business.industry ,medicine.medical_treatment ,Cardiogenic shock ,Percutaneous coronary intervention ,Hemodynamics ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Culprit ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Shock (circulatory) ,Conventional PCI ,medicine ,Cardiology ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,TIMI - Abstract
BACKGROUND Data on the clinical outcomes of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) in patients with acute coronary syndrome (ACS) are limited. Therefore, this study aimed to assess the clinical outcome of patients with ACS who underwent PCI for LMCA culprit lesion.Methods and Results:Of 1,809 patients enrolled in the Assessing Optimal Percutaneous Coronary Intervention for the LMCA (AOI-LMCA) registry (a retrospective 6-center registry of consecutive patients undergoing LMCA stenting in Japan), the current study population consisited of 1,500 patients with unprotected LMCA stenting for LMCA ACS (ACS with shock: 115 patients, ACS without shock: 281 patients) and stable CAD (1,104 patients). The cumulative 180-day incidence of death was markedly higher in the ACS with shock group than in the other groups (49.5%, 8.6%, and 3.3%, respectively; P
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- 2021
42. Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3)
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Kazuaki Imada, Teruki Takeda, Nobuhisa Ohno, Hiroshi Mabuchi, Hiroshi Eizawa, Kenji Minatoya, Yusuke Yoshikawa, Katsuhisa Ishii, Manabu Shirotani, Hiroshi Tsuneyoshi, Yasuaki Takeji, Kenji Ando, Takeshi Tada, Miho Yamada, Ko Yamamoto, Ryusuke Nishikawa, Takeshi Kimura, Tatsuya Ogawa, Satoru Suwa, Jiro Esaki, Naoki Kanemitsu, Yutaka Furukawa, Shinji Miki, Takashi Tamura, Yoshiharu Soga, Shogo Nakayama, Takashi Yamamoto, Kyohei Yamaji, Natsuhiko Ehara, Moriaki Inoko, Mamoru Takahashi, Keiichi Tambara, Toshihiro Tamura, Nobushige Tamura, Ryoji Taniguchi, Tomohisa Tada, Kazushige Kadota, Tatsuhiko Komiya, Takashi Uegaito, Hiroshi Sakai, Takeshi Morimoto, Kazuhiro Yamazaki, Hiroki Shiomi, Yoshihisa Nakagawa, Cabg Registry Cohort Investigators, Yasuhiko Terai, Yukiko Matsumura-Nakano, Masahiro Natsuaki, Michiya Hanyu, Tomoya Onodera, Junichiro Nishizawa, Masaru Tanaka, Hiroki Sakamoto, and Akira Marui
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Cohort Studies ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Japan ,Interquartile range ,Cause of Death ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Coronary Artery Bypass ,Mortality ,Stroke ,Aged ,Proportional Hazards Models ,Cause of death ,Aged, 80 and over ,business.industry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,surgical procedures, operative ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
There is a scarcity of data comparing long-term clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease (3VD) in the new-generation drug-eluting stents era. CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who had undergone first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. We identified 2525 patients with 3VD (PCI: n = 1747 [69%], and CABG: n = 778 [31%]). The primary outcome measure was all-cause death. Median follow-up duration was 5.7 (interquartile range: 4.4 to 6.6) years. The cumulative 5-year incidence of all-cause death was significantly higher in the PCI group than in the CABG group (19.8% vs 13.2%, log-rank p = 0.001). After adjusting confounders, the excess risk of PCI relative to CABG for all-cause death remained significant (HR, 1.45; 95% CI, 1.14 to 1.86; p = 0.003), which was mainly driven by the excess risk for non-cardiovascular death (HR, 1.88; 95% CI, 1.30 to 2.79; p = 0.001), while there was no excess risk for cardiovascular death between PCI and CABG (HR, 1.19; 95% CI, 0.87 to 1.64; p = 0.29). There was significant excess risk of PCI relative to CABG for myocardial infarction (HR, 1.77; 95% CI, 1.19 to 2.69; p = 0.006), whereas there was no excess risk of PCI relative to CABG for stroke (HR, 1.24; 95% CI, 0.83 to 1.88; p = 0.30). In conclusion, in the present study population reflecting real-world clinical practice in Japan, PCI compared with CABG was associated with significantly higher risk for all-cause death, while there was no excess risk for cardiovascular death between PCI and CABG.
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- 2021
43. Impact of no, distal, and proximal deep vein thrombosis on clinical outcomes in patients with acute pulmonary embolism: From the COMMAND VTE registry
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Hidewo Amano, Yohei Kobayashi, Shushi Nishiwaki, Yoshiaki Tsuyuki, Koh Ono, Maki Oi, Toru Takase, Takeru Makiyama, Syunsuke Saga, Po-Min Chen, Command Vte Registry Investigators, Yusuke Morita, Takao Kato, Minako Kinoshita, Moriaki Inoko, Mamoru Toyofuku, Hiroki Shiomi, Koichiro Murata, Hiroshi Mabuchi, Tomoki Sasa, Jiro Sakamoto, Toshiaki Izumi, Takeshi Morimoto, Masaharu Akao, Kiyonori Togi, Tomohisa Tada, Seiichi Hiramori, Kitae Kim, Takeshi Kimura, Kensuke Takabayashi, and Yugo Yamashita
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medicine.medical_specialty ,Deep vein ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Internal medicine ,medicine ,Humans ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Thrombus ,Cause of death ,Venous Thrombosis ,business.industry ,Incidence (epidemiology) ,Anticoagulants ,Venous Thromboembolism ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Venous thrombosis ,medicine.anatomical_structure ,Concomitant ,Cardiology ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The majority of acute pulmonary embolism (PE) is caused by thrombus developed from leg veins. However, impact of concomitant deep venous thrombosis (DVT) on clinical outcomes has not been fully evaluated in patients with acute PE. Methods The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic venous thromboembolism (VTE) in Japan. The current study population consisted of 655 acute PE patients who underwent lower extremities ultrasound examination at diagnosis for the assessment of concomitant DVT status. Results There were 424 patients with proximal DVT (64.7%), 162 patients with distal DVT (24.7%), and 69 patients with no DVT (10.5%). The cumulative 90-day incidence of all-cause death was higher in proximal DVT patients than in distal DVT and no DVT patients (7.9%, 2.5%, and 1.4%, p = 0.01). Regarding the causes of death, the cumulative 90-day incidence of PE-related death was low, and not significantly different across the 3 groups (1.4%, 0.6%, and 1.7%, p = 0.62). The most frequent cause of death was cancer in proximal and distal DVT patients. There were no significant differences in 90-day rates of recurrent VTE and major bleeding, regardless of the status of concomitant DVT (2.9%, 3.2%, and 2.2%, p = 0.79, and 1.5%, 4.4%, and 4.9%, p = 0.46, respectively). Conclusions Acute PE with proximal DVT at diagnosis was associated with a higher risk for short-term mortality than in patients without DVT, while the risk for short-term mortality was not significantly different between distal DVT patients and patients without DVT.
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- 2021
44. Clopidogrel Monotherapy After 1-Month Dual Antiplatelet Therapy in Patients With Diabetes Undergoing Percutaneous Coronary Intervention
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Ko Yamamoto, Hirotoshi Watanabe, Takeshi Morimoto, Yuki Obayashi, Masahiro Natsuaki, Kyohei Yamaji, Takenori Domei, Manabu Ogita, Masanobu Ohya, Shojiro Tatsushima, Hirohiko Suzuki, Tomohisa Tada, Mitsuru Ishii, Akira Nikaido, Naoki Watanabe, Shinya Fujii, Hiroyoshi Mori, Tenjin Nishikura, Nobuhiro Suematsu, Fujio Hayashi, Kota Komiyama, Tatsuya Shigematsu, Tsuyoshi Isawa, Satoru Suwa, Kenji Ando, and Takeshi Kimura
- Subjects
Cardiology and Cardiovascular Medicine - Abstract
Diabetes was reported to be associated with an impaired response to clopidogrel.The aim of this study was to evaluate the safety and efficacy of clopidogrel monotherapy after very short dual antiplatelet therapy (DAPT) in patients with diabetes undergoing percutaneous coronary intervention (PCI).A subgroup analysis was conducted on the basis of diabetes in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2) Total Cohort (N = 5,997) (STOPDAPT-2, n = 3,009; STOPDAPT-2 ACS [Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 for the Patients With ACS], n = 2,988), which randomly compared 1-month DAPT followed by clopidogrel monotherapy with 12-month DAPT with aspirin and clopidogrel after cobalt-chromium everolimus-eluting stent implantation. The primary endpoint was a composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) or bleeding (TIMI [Thrombolysis In Myocardial Infarction] major or minor) endpoints at 1 year.There were 2,030 patients with diabetes (33.8%) and 3967 patients without diabetes (66.2%). Regardless of diabetes, the risk of 1-month DAPT relative to 12-month DAPT was not significant for the primary endpoint (diabetes, 3.58% vs 4.12% [HR: 0.87; 95% CI: 0.56-1.37; P = 0.55]; nondiabetes, 2.46% vs 2.49% [HR: 0.99; 95% CI: 0.67-1.48; P = 0.97]; PClopidogrel monotherapy after 1-month DAPT compared with 12-month DAPT reduced major bleeding events without an increase in cardiovascular events regardless of diabetes, although the findings should be considered as hypothesis generating, especially in patients with acute coronary syndrome, because of the inconclusive result in the STOPDAPT-2 ACS trial. (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 [STOPDAPT-2], NCT02619760; Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 for the Patients With ACS [STOPDAPT-2 ACS], NCT03462498).
- Published
- 2022
45. Prevention of Contrast-Induced Nephropathy After Cardiovascular Catheterization and Intervention With High-Dose Strong Statin Therapy in Japan - The PREVENT CINC-J Study
- Author
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Makoto, Watanabe, Kazutaka, Aonuma, Toyoaki, Murohara, Yasuo, Okumura, Takeshi, Morimoto, Sadanori, Okada, Sunao, Nakamura, Shiro, Uemura, Koichiro, Kuwahara, Tadateru, Takayama, Naofumi, Doi, Tamio, Nakajima, Manabu, Horii, Kenichi, Ishigami, Kazumiki, Nomoto, Daisuke, Abe, Koji, Oiwa, Kentaro, Tanaka, Terumasa, Koyama, Akira, Sato, Tomoya, Ueda, Tsunenari, Soeda, and Yoshihiko, Saito
- Subjects
Treatment Outcome ,Japan ,Creatinine ,Contrast Media ,Humans ,Kidney Diseases ,General Medicine ,Prospective Studies ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,Coronary Angiography ,Catheterization - Abstract
Previous studies have reported that high-dose strong statin therapy reduces the incidence of contrast-induced nephropathy (CIN) in statin naïve patients; however, the efficacy of high-dose strong statins for preventing CIN in real-world clinical practice remains unclear. The aim of this study was to evaluate the efficacy of strong statin therapy in addition to fluid hydration for preventing CIN after cardiovascular catheterization.Methods and Results: This prospective, multicenter, randomized controlled trial included 420 patients with chronic kidney disease who underwent cardiovascular catheterization. They were assigned to receive high-dose pitavastatin (4 mg/day × 4 days) on the day before and of the procedure and 2 days after the procedure (Statin group, n=213) or no pitavastatin (Control group, n=207). Isotonic saline hydration combined with a single bolus of sodium bicarbonate (20 mEq) was scheduled for administration to all patients. In the control group, statin therapy was continued at the same dose as that before randomization. CIN was defined as a ≥0.5 mg/dL increase in serum creatinine or ≥25% above baseline at 48 h after contrast exposure. Before randomization, 83% of study participants were receiving statin treatment. The statin group had a higher incidence of CIN than the control group (3.0% vs. 0%, P=0.01). The 12-month rate of major adverse cardiovascular events was similar between the 2 groups.High-dose pitavastatin increases the incidence of CIN in this study population.
- Published
- 2022
46. Periprocedural Stroke After Coronary Revascularization (from the CREDO-Kyoto PCI/CABG Registry Cohort-3)
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Kenji Nakatsuma, Yutaka Furukawa, Naritatsu Saito, Junichi Tazaki, Shin Watanabe, Yoshiharu Soga, Kazuhiro Yamazaki, Tatsuhiko Komiya, Takeshi Morimoto, Ko Yamamoto, Masayuki Fuki, Yasuaki Takeji, Hiroki Watanabe, Hirotoshi Watanabe, Ryusuke Nishikawa, Kenji Ando, Hiroki Shiomi, Yoshihisa Nakagawa, Kazushige Kadota, Takeshi Kimura, Kyohei Yamaji, Cabg Registry Cohort Investigators, Yukiko Matsumura-Nakano, Masahiro Natsuaki, Erika Yamamoto, CREDO-Kyoto Pci, Kenji Minatoya, Kazuya Nagao, and Eri Kato
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Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Bypass grafting ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Postoperative Complications ,0302 clinical medicine ,Japan ,Risk Factors ,Neoplasms ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Acute Coronary Syndrome ,Coronary Artery Bypass ,Stroke ,Aged ,Ischemic Stroke ,Heart Failure ,Frailty ,business.industry ,Incidence (epidemiology) ,Age Factors ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Coronary revascularization ,Hemorrhagic Stroke ,surgical procedures, operative ,medicine.anatomical_structure ,Cohort ,Conventional PCI ,Cardiology ,Kidney Failure, Chronic ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
There is a scarcity of data on incidence, risk factors, especially clinical severity, and long-term prognostic impact of periprocedural stroke after coronary revascularization in contemporary real-world practice. Among 14,867 consecutive patients undergoing first coronary revascularization between January 2011 and December 2013 (percutaneous coronary intervention [PCI]: N = 13258, and coronary artery bypass grafting [CABG]: N = 1609) in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG registry Cohort-3, we evaluated the details on periprocedural stroke. Periprocedural stroke was defined as stroke within 30 days after the index procedure. Incidence of periprocedural stroke was 0.96% after PCI and 2.13% after CABG (log-rank p0.001). Proportions of major stroke defined by modified Rankin Scale ≥2 at hospital discharge were 68% after PCI, and 77% after CABG. Independent risk factors of periprocedural stroke were acute coronary syndrome (ACS), carotid artery disease, advanced age, heart failure, and end-stage renal disease after PCI, whereas they were ACS, carotid artery disease, atrial fibrillation, chronic obstructive pulmonary disease, malignancy, and frailty after CABG. There was excess long-term mortality risk of patients with periprocedural stroke relative to those without after both PCI and CABG (hazard ratio 1.71 [1.25 to 2.33], and hazard ratio 4.55 [2.79 to 7.43]). In conclusion, incidence of periprocedural stroke was not negligible not only after CABG, but also after PCI in contemporary real-world practice. Majority of patients with periprocedural stroke had at least mild disability at hospital discharge. ACS and carotid artery disease were independent strong risk factors of periprocedural stroke after both PCI and CABG. Periprocedural stroke was associated with significant long-term mortality risk after both PCI and CABG.
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- 2021
47. Serum cholinesterase as a prognostic biomarker for acute heart failure
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Neiko Ozasa, Yasutaka Inuzuka, Kenji Ando, Yuichi Kawase, Takao Kato, Koichiro Kuwahara, Yukihito Sato, Yutaka Furukawa, Takashi Morinaga, Masayuki Shiba, Takeshi Kimura, Takeshi Kitai, Yusuke Yoshikawa, Yodo Tamaki, Kazuya Nagao, Takeshi Morimoto, Erika Yamamoto, Yugo Yamashita, Mamoru Toyofuku, Kazushige Kadota, Hidenori Yaku, Moritake Iguchi, and Yuta Seko
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medicine.medical_specialty ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Inferior vena cava ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Natriuretic Peptide, Brain ,Cholinesterases ,Humans ,Medicine ,030212 general & internal medicine ,Cholinesterase ,Heart Failure ,biology ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,General Medicine ,Prognosis ,Brain natriuretic peptide ,medicine.disease ,Patient Discharge ,Confidence interval ,Liver ,medicine.vein ,Heart failure ,Acute Disease ,biology.protein ,Cardiology ,Population study ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Aims The association between serum cholinesterase and prognosis in acute heart failure (AHF) remains to be elucidated. We investigated the serum cholinesterase level at discharge from hospitalization for AHF and its association with clinical outcomes in patients with AHF. Methods and results Among 4056 patients enrolled in the Kyoto Congestive Heart Failure multicentre registry, we analysed 2228 patients with available serum cholinesterase data. The study population was classified into three groups according to serum cholinesterase level at discharge: low tertile ( Conclusions Low serum cholinesterase levels are associated with congestive findings on echocardiography, higher BNP, and higher risks for a composite of all-cause death and HF hospitalization in patients with AHF.
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- 2021
48. Differences in Acute Ischemic Stroke Management and Prognosis between Multiple Large-Vessel Occlusion and Single Large-Vessel Occlusion: Subanalysis of the RESCUE-Japan Registry 2
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Kanta Tanaka, Hiroshi Yamagami, Hiroto Kageyama, Masataka Takeuchi, Nobuyuki Sakai, Nobuyuki Ohara, Shinichi Yoshimura, Kotaro Tatebayashi, Hirotoshi Imamura, Yasushi Matsumoto, Kazutaka Uchida, RESCUE-Japan Registry Investigators, and Takeshi Morimoto
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Male ,medicine.medical_specialty ,Mean arterial pressure ,Time Factors ,Risk Assessment ,Disability Evaluation ,Japan ,Risk Factors ,Modified Rankin Scale ,Internal medicine ,Occlusion ,Humans ,Medicine ,Registries ,Risk factor ,Aged ,Ischemic Stroke ,Thrombectomy ,Aged, 80 and over ,business.industry ,Mortality rate ,Endovascular Procedures ,Recovery of Function ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Functional Status ,Treatment Outcome ,Neurology ,Embolism ,Cardiology ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: The management and prognosis of acute ischemic stroke due to multiple large-vessel occlusion (LVO) (MLVO) are not well scrutinized. We therefore aimed to elucidate the differences in patient characteristics and prognosis of MLVO and single LVO (SLVO). Methods: The Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2 (RESCUE-Japan Registry 2) enrolled 2,420 consecutive patients with acute LVO who were admitted within 24 h of onset. We compared patient prognosis between MLVO and SLVO in the favorable outcome, defined as a modified Rankin Scale (mRS) score ≤2, and in mortality at 90 days by adjusting for confounders. Additionally, we stratified MLVO patients into tandem occlusion and different territories, according to the occlusion site information and also examined their characteristics. Results: Among the 2,399 patients registered, 124 (5.2%) had MLVO. Although there was no difference between the 2 groups in terms of hypertension as a risk factor, the mean arterial pressure on admission was significantly higher in MLVO (115 vs. 107 mm Hg, p = 0.004). MLVO in different territories was more likely to be cardioembolic (42.1 vs. 10.4%, p = 0.0002), while MLVO in tandem occlusion was more likely to be atherothrombotic (39.5 vs. 81.3%, p < 0.0001). Among MLVO, tandem occlusion had a significantly longer onset-to-door time than different territories (200 vs. 95 min, p = 0.02); accordingly, the tissue plasminogen activator administration was significantly less in tandem occlusion (22.4 vs. 47.9%, p = 0.003). However, interestingly, the endovascular thrombectomy (EVT) was performed significantly more in tandem occlusion (63.2 vs. 41.7%; adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1–5.0). The type of MLVO was the only and significant factor associated with EVT performance in multivariate analysis. The favorable outcomes were obtained less in MLVO than in SLVO (28.2 vs. 37.1%; aOR, 0.48; 95% CI, 0.30–0.76). The mortality rate was not significantly different between MLVO and SLVO (8.9 vs. 11.1%, p = 0.42). Discussion/Conclusion: The prognosis of MLVO was significantly worse than that of SLVO. In different territories, we might be able to consider more aggressive EVT interventions.
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- 2021
49. Impact of Procedure Time on Clinical Outcomes of Patients Who Underwent Endovascular Therapy for Acute Ischemic Stroke
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Kanta Tanaka, Yukiko Enomoto, Yasushi Matsumoto, Nobuyuki Sakai, Takeshi Morimoto, Hiroshi Yamagami, Nobuyuki Ohara, Kazutaka Uchida, Hirotoshi Imamura, Yusuke Egashira, and Shinichi Yoshimura
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Male ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,Risk Assessment ,Disability Evaluation ,Japan ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Registries ,Endovascular treatment ,Acute ischemic stroke ,Aged ,Ischemic Stroke ,Thrombectomy ,Procedure time ,Intracerebral hemorrhage ,business.industry ,Endovascular Procedures ,Odds ratio ,medicine.disease ,Confidence interval ,Treatment Outcome ,Neurology ,Cohort ,Cardiology ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose: The time from onset to reperfusion is associated with clinical outcomes in acute ischemic stroke due to large vessel occlusion (LVO); nevertheless, the time limit of the continuing procedure remains unclear. We analyzed the relationship between procedure time and clinical outcomes in patients with LVO who underwent endovascular treatment (EVT). Methods: We assessed 1,247 patients who underwent EVT for LVO. Data were obtained from our multicenter registry, and patients were included if data on procedure time were available. Multivariate analysis was performed to assess the impact of procedure time on clinical outcomes using the following parameters: favorable outcome (the modified Rankin score of 0–2 at 90 days), mortality within 90 days, symptomatic intracranial hemorrhage within 72 h after stroke onset, and procedure-related complications. Results: The rate of favorable outcomes linearly decreased with increasing procedure time, but there was no linear relationship between procedure time and other outcomes. The adjusted odds ratio for 30-minute delay in procedure time was 0.76 (95% confidence interval, 0.68–0.84) for favorable outcome, 1.15 (0.97–1.36) for mortality, 1.08 (0.87–1.33) for symptomatic intracranial hemorrhage, and 0.92 (0.75–1.16) for complications. Significant interactions in the effect of procedure time on favorable outcome were observed between the subgroups stratified by age (≥75 or Conclusions: Increasing procedure time was associated with less favorable outcomes, but not with the rate of mortality, symptomatic intracerebral hemorrhage, or complications in our cohort.
- Published
- 2021
50. A COMBINED APPROACH USING HIGH-SENSITIVE TROPONIN I AND N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE FOR RISK STRATIFICATION IN PATIENTS WITH CORONAVIRUS DISEASE 2019
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Madoka Sano, Toshiaki Toyota, Takeshi Morimoto, Ryosuke Murai, Taiji Okada, Tomohiko Taniguchi, Kitae Kim, Atsushi Kobori, Natsuhiko Ehara, Makoto Kinoshita, Asako Doi, Keisuke Tomii, Yasuki Kihara, and Yutaka Furukawa
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Cardiology and Cardiovascular Medicine - Published
- 2023
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