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Background: The aim of this study was to examine the effect of proton-pump inhibitor (PPI) on clinical outcomes in Japanese patients who undergo coronary stent implantation., Methods and Results: A total of 1,270 patients (males 915, 69 years) were enrolled and dual antiplatelet therapy of aspirin and a thienopyridine derivative was prescribed (clopidogrel 630, ticlopidine 640). Patients were divided into 2 groups treated with or without PPI. PPI was administered in 331 cases (26%), and non-PPI in 939 (74%). There were no significant differences in cardiovascular death (PPI vs. non-PPI: 5 vs. 11 cases), nonfatal myocardial infarction (3 vs. 5), and stroke (3 vs. 16) between PPI and non-PPI groups, but the ratio of gastrointestinal events had a higher tendency in non-PPI group compared with PPI group (1 vs. 17, P=0.08). In subgroup analysis of patients taking clopidogrel, or patients with acute coronary syndrome, there was no significant difference in the ratio of cardiovascular events (7 vs. 16, 6 vs. 17, NS). The non-PPI group had a tendency of an increased risk of gastrointestinal events compared with the PPI group (0 vs. 9, P=0.06; 1 vs. 7, P=0.14)., Conclusions: In contrast to the negative drug interaction of PPI reported elsewhere, in the present study the intake of PPI was not associated with an increased risk for adverse clinical outcomes in patients treated with stents.

Background: Randomized trials have established statins as an agent for prevention of coronary heart disease (CHD). The purpose of this study was to assess the hypothesis that standard-dose statin therapy has a beneficial effect in normocholesterolemic diabetic patients with CHD., Methods and Results: A prospective, randomized, open, blinded-endpoint trial was conducted from 2002 to 2004 at 55 hospitals in Japan to evaluate the effect of statins on subsequent cardiovascular events. A total number of 1,016 CHD patients (301 patients with type 2 diabetes mellitus [DM] and 715 non-DM patients) with serum total cholesterol levels of 180-240 mg/dl were randomly divided into non-statin and statin treatments. Clinical parameters were comparable between DM and non-DM groups. Serum low-density lipoprotein (LDL)-cholesterol levels were equally decreased after statin treatment in the 2 groups. Statin treatment improved prognosis in both the DM and non-DM groups; however, the number needed to treat (NNT) and relative risk reduction (RRR) were remarkable especially in the DM group (NNT=8, RRR=67%) compared with the non-DM group (NNT=30, RRR=24%)., Conclusions: Standard-dose statin therapy provides incremental clinical benefits in DM patients with normal cholesterol levels compared with non-DM patients. The data suggest that DM patients may enjoy the pleiotropic effects of statins, independent of the LDL-cholesterol lowering effects of these agents.

Objectives: 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) enhances the inhibitory effects of angiotensin-receptor blocker (ARB) on vascular neointimal formation in mice. The present case-control study investigated the efficacy of combined treatment with statin and ARB for preventing restenosis in patients with coronary artery disease., Methods: We examined 210 patients with angina pectoris undergoing elective coronary stenting for de novo lesions of native coronary arteries. All enrolled patients received aspirin and ticlopidine. The subjects included patients who received no statin (control group, n = 137) or started statin treatment (statin group, n = 73) with or without ARB treatment after stenting., Results: The rate of restenosis at 6 months after stent implantation in the statin group (19%) was significantly lower than that in the control group (32%). The restenosis rate in self-expanding Radius stents. (23%) was significantly lower than that in balloon-expandable Velocity stents (42%) independent of statin treatment. Patients treated with statins and ARBs were least likely [odds ratio (95% confidence interval): 0.30 (0.12-0.74)] to develop coronary restenosis, as assessed by multiple logistic regression analysis., Conclusions: These findings indicate that combined treatment with statin and ARB after stenting is a useful strategy for the prevention of coronary restenosis.

Background: Previous studies suggested that hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) promotes collateral circulation in ischemic limbs of rabbits. The present study was designed to determine the association between treatment with pravastatin and the development of coronary collateral circulation as assessed by the Rentrop Score in patients with coronary artery disease (CAD) in a case-control study., Design: The study included patients who had one (1-V), two (2-V) or three (3-V) significantly stenosed vessels. Patients who did and did not receive pravastatin were defined as case participants (n = 42) and control participants (n = 100), respectively., Results: The case participants included a higher percentage of 3-V patients with a Rentrop Score 1 compared to the control participants but there was no difference among 1-V and 2-V patients, suggesting that pravastatin was associated with coronary collateral circulation independent of the number of stenosed vessels. Patients with 3-V disease who were treated with pravastatin were most likely [odds ratio (confidence interval), 17.4 (4.4-115)] to develop collateral circulation, as assessed by multiple logistic regression analysis., Conclusions: Treatment with pravastatin was associated with the development of collateral circulation in patients with CAD, suggesting that such action constitutes part of the pleiotropic effects of statin.

This clinical pilot study was a randomized, controlled, open-label study in 80 patients with acute myocardial infarction and was designed to examine the effects of a novel free radical scavenger, edaravone. Administration of edaravone before myocardial reperfusion was associated with smaller enzymatic infarcts and better clinical outcome. [Copyright &y& Elsevier]

Background and aims Although dual low-density lipoprotein cholesterol (LDL-C)-lowering therapy (DLLT) with statin-ezetimibe combination showed clinical benefit in patients with acute coronary syndrome (ACS) confirming “the lower, the better,” the underlying mechanisms of DLLT are still unknown. Methods PRECISE-IVUS trial evaluated the effects of DLLT on IVUS-derived coronary atherosclerosis and lipid profile, compared with atorvastatin monotherapy, quantifying the coronary plaque response in 100 ACS patients. We explored the potential predictors of plaque regression. Results Lower total cholesterol, LDL-C, triglyceride, remnant-like particles cholesterol, and stronger reduction of small dense LDL-C and cholesterol absorption markers were observed in patients with plaque regression compared to those with progression. Multivariate analysis revealed that achieved LDL-C was the strongest predictor for coronary plaque regression (95% CI: 0.944–1.000, p = 0.05), followed by age (95% CI: 0.994–1.096, p = 0.09). Conclusions Incremental LDL-C lowering by DLLT was associated with stronger coronary plaque regression, reconfirming that lowering LDL-C to levels below previous targets provided additional clinical benefit. [ABSTRACT FROM AUTHOR]

We assessed serial changes in oxidative stress in patients with acute myocardial infarction by measuring urinary 8-hydroxy-2′-deoxyguanosine excretion. The urinary 8-hydroxy-2′-deoxyguanosine creatinine levels peaked at 4 hours after reperfusion therapy and the levels were higher in the cardiac event group than in the noncardiac event group before and after reperfusion. [Copyright &y& Elsevier]

Introduction: Under the awareness of appropriate use criteria, the significance of PCI for the patients with silent myocardial ischemia (SMI) decreases. On the other hand, the prognoses of SMI patients have been reported to be equivalent to those of symptomatic effort angina pectoris (EAP) patients. We aimed to clarify the prognosis of SMI after PCI and elucidate the factors influencing the mortality. Methods: The Kumamoto Intervention Conference Study is multicenter registry enrolling consecutive patients undergoing PCI in 16 centers in Japan. Overall, 11,093 consecutive patients were enrolled during April 2008 to March 2014. To compare the clinical events between SMI and EAP, 5,039 subjects, excluding acute coronary syndrome, post successful PCI were enrolled with 1-year follow-up data. Results: In this study, 1,124 patients were classified as SMI and 3,915 patients were EAP. Male, diabetes, smoking habits, prior myocardial infarction (MI), and composite of PAD were all significantly higher in the SMI group. Although nonfatal MI and stent thrombosis were comparable between the 2 groups, all cause mortality and cardiac death during 12-months were significantly higher in the SMI group than in the EAP group (3.7% vs 1.6%, 1.4% vs 0.4%, respectively). Kaplan-Meier analysis showed a significant difference between the groups (Figure). In addition to lower BMI, composite of PAD, and LMT lesion, SMI was an independent predictor for cardiac death. Even after adjustment by propensity-score matching, SMI showed a higher cardiac death rate compared with EAP (1.4% vs 0.2%, p=0.001), and it remained as a significant predictor. In the sub-analysis for SMI patients, multivariate analysis revealed lower BMI and LMT lesion as predictors for cardiac death. Conclusion: In this study, SMI itself was associated with higher mortality after PCI, especially in patients with lower BMI or LMT lesion. Strict follow-up and assessment of residual ischemia should be necessary for SMI patients. [ABSTRACT FROM AUTHOR]

Background: Sex differences in clinical characteristics of ischemic heart disease patients have been widely examined, differences in the type of coronary artery disease (CAD) and their impacts on prognosis have not been well elucidated in Japanese. Methods: The Kumamoto Intervention Conference Study (KICS) is a multicenter registry enrolling consecutive patients undergoing percutaneous coronary intervention (PCI) in 16 centers in Japan. Between August 2008 and March 2014, 11,095 consecutive patients were enrolled in this registry. To clarify the sex differences, depending on the type of coronary artery disease, 10,822 successful PCI subjects with 1-year follow-up were enrolled in this study. Results: In this patient population, 2,983 patients (28.3%) were female and the remaining 7,839 patients (71.7%) were male. Age and comorbidity of chronic kidney disease(CKD) were significantly higher in female, and other atherosclerotic factors were significantly higher in male. The 1-year MACE was significantly higher in female patients (2.6% vs. 2.0%, p=0.084). Sub-analysis in patients with stable coronary artery disease (sCAD) or unstable angina (UA), sex difference was not observed in any 1-year MACE, procedural factors, or medication treatments. Multivariate analysis revealed CKD and peripheral artery disease (PAD) in female, and PAD in males as independent predictors for 1-year MACE. As regards patients with acute myocardial infarction (AMI), 1-year MACE was significantly higher in female (2.5% vs. 1.5%, p=0.023). Proportion of Killip3/4 (11.5% vs. 9.2%, p=0.034) and slow flow/no reflow rate during PCI procedures (11.5% vs. 8.9%, p=0.015) were significantly higher in female than in male. Post dilatation after stent deployments was significantly fewer in female than in male (44.0% vs. 50.7%, p=0.001). Regarding with medication treatments, usage of beta-blocker was significantly lower in female than in male (48.6% vs. 53.4%, p=0.009). Predictive factors for 1-year MACE in AMI patients were high age and left main trunk (LMT) lesions in female, CKD and LMT lesion in male, respectively. Conclusion: Sex differences in the clinical events after PCI were observed only in AMI patients, furthermore, the predictors for the events, depending on the sex, were different among the different type of coronary artery disease. [ABSTRACT FROM AUTHOR]