41 results on '"Tomohiro Fujisaki"'
Search Results
2. Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis
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Yujiro Yokoyama, Toshiki Kuno, Nana Toyoda, Tomohiro Fujisaki, Hisato Takagi, Shinobu Itagaki, Michael Ibrahim, Maral Ouzounian, Ismail El‐Hamamsy, and Shinichi Fukuhara
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aortic valve substitute ,bioprosthetic aortic valve replacement ,mechanical aortic valve replacement ,Ross procedure ,surgical aortic valve replacement ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background The Ross operation appears to restore normal survival in young and middle‐aged adults with aortic valve disease. However, there are limited data comparing it with conventional aortic valve replacement. Herein, we compared outcomes of the Ross procedure with mechanical and bioprosthetic aortic valve replacement (M‐AVR and B‐AVR, respectively). Methods and Results MEDLINE and EMBASE were searched through March 2022 to identify randomized controlled trials and propensity score–matched studies that investigated outcomes of patients aged ≥16 years undergoing the Ross procedure, M‐AVR, or B‐AVR. The systematic literature search identified 2 randomized controlled trials and 8 propensity score–matched studies involving a total of 4812 patients (Ross: n=1991; M‐AVR: n=2019; and B‐AVR: n=802). All‐cause mortality was significantly lower in the Ross procedure group compared with M‐AVR (hazard ratio [HR] [95% CI], 0.58 [0.35–0.97]; P=0.035) and B‐AVR (HR [95% CI], 0.32 [0.18–0.59]; P
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- 2023
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3. Time-dependent change of relative apical longitudinal strain index in patients with wild-type transthyretin amyloid cardiomyopathy
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Hiroki Usuku, Eiichiro Yamamoto, Daisuke Sueta, Momoko Noguchi, Tomohiro Fujisaki, Koichi Egashira, Mami Morioka, Takashi Komorita, Fumi Oike, Koichiro Fujisue, Shinsuke Hanatani, Yuichiro Arima, Seiji Takashio, Seitaro Oda, Hiroaki Kawano, Kenichi Matsushita, Mitsuharu Ueda, Hirotaka Matsui, and Kenichi Tsujita
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Wild-type transthyretin amyloid cardiomyopathy ,Echocardiography ,Two-dimensional speckle tracking echocardiography ,Longitudinal strain ,Left ventricular apical sparing ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Aim: This study was conducted to investigate the meaning of left ventricular (LV) apical sparing in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). Methods and results: 165 patients who were diagnosed with ATTRwt-CM at Kumamoto University Hospital from January 2002 to December 2020 and had sufficient data for two-dimensional speckle tracking echocardiography were enrolled. Of these, 86 patients (52 %) had LV apical sparing (relative apical longitudinal strain index (RapLSI) > 1.0). Multivariable logistic regression analysis revealed the following variables were significantly associated with LV apical sparing: interventricular septal thickness in diastole (odds ratio (OR), 1.19; 95 % confidence interval (CI), 1.01–1.41; p
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- 2022
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4. The Use of Bumper Wire Technique and Intravascular Ultrasound for Precise Aorto-Ostial Stenting
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Pavan K. V. Reddy, Joseph Daibes, Michel Skaf, Roberto Ochoa, Tomohiro Fujisaki, Patricia Lin, Apurva Patel, and Tak Kwan
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aorto ostial ,intravascular ultrasound (IVUS) ,intervention ,Coronary Artery Disease ,stent ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundAorto-ostial interventions are challenging due to the limitations of contemporary equipment, imprecise ostial demarcation, and problematic ostial lesion characteristics. Suboptimal stent placement is common and portends worse clinical outcomes. Procedural and long-term outcomes of the bumper wire technique with intravascular ultrasound (IVUS) assessment have not been investigated.MethodsA single-center retrospective study was conducted. Patients who underwent ostial lesion percutaneous coronary intervention (PCI) with the bumper wire technique between January 2019 and September 2020 were identified. The primary endpoint was to determine the geographic miss rate defined by inadequate ostial coverage or excess stent protrusion of > 2 mm by IVUS or angiography. The secondary endpoint was target lesion failure (TLF) at 6 months after PCI, defined as the composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularization.ResultsIn total, 45 patients were identified. The average age was 71.7 years old, and 85.4% were men. Indication for PCI was acute coronary syndrome in about a third of patients. Twenty-six patients had left main ostial lesions and 19 patients had right coronary artery ostial lesions. Geographic miss was detected in two patients (4.4%): one patient (2.2%) had excess proximal stent protrusion and one patient (2.2%) had an ostial miss. Six patients were lost to follow-up. TLF, stroke, or major bleeding were not observed in any of the patients.ConclusionThe bumper wire technique is safe and efficient with low rates of geographic miss or adverse clinical outcomes. This is the first study to confirm precise aorto-ostial stent implantation with the bumper wire technique using IVUS confirmation.
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- 2022
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5. Cardiovascular and renal outcomes with SGLT-2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes mellitus and chronic kidney disease: a systematic review and network meta-analysis
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Takayuki Yamada, Mako Wakabayashi, Abhinav Bhalla, Nitin Chopra, Hirotaka Miyashita, Takahisa Mikami, Hiroki Ueyama, Tomohiro Fujisaki, Yusuke Saigusa, Takahiro Yamaji, Kengo Azushima, Shingo Urate, Toru Suzuki, Eriko Abe, Hiromichi Wakui, and Kouichi Tamura
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SGLT2 inhibitors ,GLP-1 receptor agonist ,Meta-analysis ,Cardiovascular disease ,Renal outcomes ,Diabetes mellitus ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Emerging evidence suggests that sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with decreased risk of cardiovascular and renal events in type 2 diabetes mellitus (DM) patients. However, no study to date has compared the effect of SGLT-2 inhibitors with that of GLP-1 RAs in type 2 DM patients with chronic kidney disease (CKD). We herein investigated the benefits of SGLT-2 inhibitors and GLP-1 RAs in CKD patients. Methods We performed a systematic literature search through November 2020. We selected randomized control trials that compared the risk of major adverse cardiovascular events (MACE) and a composite of renal outcomes. We performed a network meta-analysis to compare SGLT-2 inhibitors with GLP-1 RAs indirectly. Risk ratios (RRs) with corresponding 95% confidence intervals (CI) were synthesized. Results Thirteen studies were selected with a total of 32,949 patients. SGLT-2 inhibitors led to a risk reduction in MACE and renal events (RR [95% CI]; 0.85 [0.75–0.96] and 0.68 [0.59–0.78], respectively). However, GLP-1 RAs did not reduce the risk of cardiovascular or renal adverse events (RR 0.91 [0.80–1.04] and 0.86 [0.72–1.03], respectively). Compared to GLP-1 RAs, SGLT-2 inhibitors did not demonstrate a significant difference in MACE (RR 0.94 [0.78–1.12]), while SGLT-2 inhibitors were associated with a lower risk of renal events compared to GLP-1 RAs (RR 0.79 [0.63–0.99]). A sensitivity analysis revealed that GLP-1 analogues significantly decreased MACE when compared to placebo treatment (RR 0.81 [0.69–0.95]), while exendin-4 analogues did not (RR 1.03 [0.88–1.20]). Conclusions In patients with type 2 DM and CKD, SGLT-2 inhibitors were associated with a decreased risk of cardiovascular and renal events, but GLP-1 RAs were not. SGLT-2 inhibitors significantly decreased the risk of renal events compared to GLP-1 RAs. Among GLP-1 RAs, GLP-1 analogues showed a positive impact on cardiovascular and renal outcomes, while exendin-4 analogues did not.
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- 2021
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6. Large bowel obstruction caused by urinary retention from benign prostate hyperplasia
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Tomohiro Fujisaki, MD, Yasuhiko Fujita, MD, Hiroyuki Mizuta, MD, Naohisa Niina, MD, Nodoka Miyazaki, MD, Atsushi Tashiro, MD, Takahiro Hayashi, MD, Naotsuna Tada, MD, and Norio Tomono, MD
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Although large bowel obstruction is a common surgical emergency, its occurrence due to bladder distension is rarely reported in the literature. We report a case of large bowel obstruction caused by bladder distention secondary to benign prostate hyperplasia in a 67-year-old man. This case demonstrates a grossly distended urinary bladder compressing the rectosigmoid colon against the sacrum, presenting as a complete large bowel obstruction. Management consisted of transurethral urinary catheter insertion, which resulted in complete resolution of the bowel obstruction with drainage of a large amount of urine. Early recognition of the underlying etiology resulted in the expeditious treatment of large bowel obstruction. Keywords: Large bowel obstruction, Urinary retention, Bladder distention, Benign prostate hyperplasia
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- 2019
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7. Selection of Vascular Closure Devices in Transcatheter Aortic Valve Replacement: Systematic Review and Network Meta-Analysis
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Tomoki Sakata, Toshiki Kuno, Tomohiro Fujisaki, Yujiro Yokoyama, Naoki Misumida, Tadahisa Sugiura, and Azeem Latib
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General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Various vascular closure devices (VCDs) are commonly used for percutaneous transcatheter aortic valve replacement (TAVR). However, superiority and safety profile among them remain unclear. We compared periprocedural complications among various VCDs in patients undergoing TAVR. PubMed and EMBASE were searched through January 2022 to identify clinical studies comparing any 2 VCDs of Prostar, Proglide and MANTA in patients who underwent TAVR. Studies using surgical cut-down or alternative access other than transfemoral approach were excluded. We analyzed the odds ratios (ORs) of vascular complications (VC), bleeding, acute kidney injury and all-cause mortality using a network meta-analysis. All outcomes were defined by Valve Academic Research Consortium 2 criteria. Two randomized controlled trials and 15 observational studies were identified, yielding a total of 11,344 patients including Prostar (n = 4499), Proglide (n = 5705), or MANTA group (n = 1140). The rates of major VC and life-threatening and major bleeding were significantly lower in Proglide compared to Prostar (OR [95 % CI] = 0.54 [0.32-0.89], 0.68 [0.52-0.90], and 0.49 [0.26-0.95], respectively). There was no significant difference in major VC and bleeding between Proglide and MANTA groups. Proglide was associated with a lower rate of acute kidney injury (0.56 [0.34-0.92]) and red blood cell transfusion (0.39 [0.16-0.98]) compared to Prostar. There was no significant difference in additional interventions and 30-day overall mortality among three groups. In this network meta-analysis of VCD in patients undergoing TAVR, MANTA and Proglide had comparable outcomes while Proglide appears superior to Prostar in terms of major VC and bleeding.
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- 2023
8. Systematic Review and Meta-Analysis of the Treatment Strategies for Coronary Artery Bypass Graft Patients with Concomitant Carotid Artery Atherosclerotic Disease
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Junji Tsukagoshi, Yujiro Yokoyama, Tomohiro Fujisaki, Hisato Takagi, Takuro Shirasu, and Toshiki Kuno
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
9. Short-Term DAPT and DAPT De-Escalation Strategies for Patients With Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis.
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Toshiki Kuno, Atsuyuki Watanabe, Satoshi Shoji, Tomohiro Fujisaki, Hiroki Ueyama, Hisato Takagi, Deharo, Pierre, Cuisset, Thomas, Bangalore, Sripal, Mehran, Roxana, Stone, Gregg W., Shun Kohsaka, and Bhatt, Deepak L.
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BACKGROUND: Short-term (≤6 months) dual antiplatelet therapy (DAPT) and DAPT de-escalation become attractive for patients with acute coronary syndrome. METHODS: A systemic search identified randomized controlled trials that included patients with acute coronary syndrome treated using (1) standard DAPT (12 months) with clopidogrel, prasugrel (standard/low dose), or ticagrelor; (2) extended DAPT (≥18 months); (3) short-term DAPT (≤6 months) followed by P2Y
12 inhibitor or aspirin; (4) 12-month DAPT with unguided deescalation from potent P2Y12 inhibitors to low-dose potent P2Y12 inhibitor or clopidogrel at 1 month; and (5) guided selection DAPT with genotype or platelet function tests. The primary efficacy outcome (major adverse cardiovascular events) was a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety outcome was major or minor bleeding. RESULTS: This meta-analysis included 32 randomized controlled trials with 103 497 patients. While there were no differences in efficacy between short, unguided de-escalation and guided selection strategies, unguided de-escalation was associated with reduced risk of major adverse cardiovascular events compared with standard DAPT with clopidogrel or ticagrelor (hazard ratio [95% CI], 0.67 [0.49--0.93] and 0.68 [0.50--0.93]). Both short DAPT followed by P2Y12 inhibitor and unguided de-escalation were associated with reduced risks in safety compared with other strategies, including guided selection (hazard ratio [95% CI], 0.66 [0.47--0.93] and 0.48 [0.33--0.71]). Short DAPT followed by a P2Y12 inhibitor was associated with reduced risk of major bleeding and all-cause death compared with standard, extended DAPT (eg, versus DAPT with clopidogrel; hazard ratio [95% CI], 0.64 [0.42--0.97] and 0.60 [0.44-0.82]). By rankogram, unguided de-escalation strategy was the safest and most effective strategy in reducing major adverse cardiovascular events and major or minor bleeding while short DAPT followed by P2Y12 inhibitor was ranked the best for major bleeding and all-cause death. CONCLUSIONS: In patients with acute coronary syndrome, unguided de-escalation was associated with the lowest risk of major adverse cardiovascular events and major or minor bleeding outcomes, while short DAPT followed by P2Y12 inhibitor was associated with the lowest risk of major bleeding and all-cause death. GRAPHIC ABSTRACT: A graphic abstract is available for this article. [ABSTRACT FROM AUTHOR]- Published
- 2023
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10. Revascularization strategies in patients with diabetes and stable ischemic heart disease: a systematic review and meta-analysis of randomized trials
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Hiroki Ueyama, Tomohiro Fujisaki, Hisato Takagi, Toshiki Kuno, and Masahiko Noguchi
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medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Ischemia ,Coronary Artery Disease ,Disease ,Revascularization ,law.invention ,Percutaneous Coronary Intervention ,Randomized controlled trial ,law ,Internal medicine ,Diabetes mellitus ,Diabetes Mellitus ,Humans ,Medicine ,In patient ,Coronary Artery Bypass ,Randomized Controlled Trials as Topic ,business.industry ,General Medicine ,medicine.disease ,Treatment Outcome ,Meta-analysis ,Cardiology and Cardiovascular Medicine ,business ,Ischemic heart - Abstract
The optimal treatment strategy comparing invasive revascularization versus optimal medical therapy (OMT) in patients with diabetes mellitus (DM) and stable ischemic heart disease (SIHD) still remains unclear. We aimed to investigate clinical outcomes of invasive revascularization (percutaneous coronary intervention, coronary artery bypass grafting or both) versus OMT in patients with DM and SIHD from updated published randomised-controlled trials (RCTs).We conducted a comprehensive literature search through PubMed and EMBASE to investigate the effect of revascularization versus OMT for patients with DM and SIHD. The studies were limited to RCTs or their subgroup data for a meta-analysis. The outcomes of interest were major adverse cardiovascular events (MACE) in patients with DM and SIHD.Our search identified subgroup data with DM of four RCTs including a total of 5742 patients with SIHD. Our results showed that invasive revascularization was not associated with a decreased risk of MACE when compared to OMT [hazard ratio (95% confidence interval): 0.95 (0.85-1.05), P = 0.31; I2 = 0%].Invasive revascularization was not associated with a decreased risk of MACE when compared with OMT.
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- 2021
11. Systematic review and network meta-analysis of various nadir temperature strategies for hypothermic circulatory arrest for aortic arch surgery
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Junichi Shimamura, Yujiro Yokoyama, Toshiki Kuno, Tomohiro Fujisaki, Shinichi Fukuhara, Hiroo Takayama, Takeyoshi Ota, and Michael WA Chu
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Background The optimal nadir temperature for hypothermic circulatory arrest during aortic arch surgery remains unclear. We aimed to assess and compare clinical outcomes of all three temperature strategies (deep, moderate, and mild hypothermia) using a network meta-analysis. Methods After literature search with MEDLINE and EMBASE through December 2021, studies comparing clinical outcomes with deep (28°C) hypothermic circulatory arrest were included. The outcomes of interest were perioperative mortality, stroke, transient ischemia attack (TIA), acute kidney injury (AKI), postoperative bleeding, operative time, and length of hospital stay. Results Twenty-four comparative studies were identified, including 6018 patients undergoing aortic arch surgery using hypothermic circulatory arrest (deep: 2,978, moderate: 2,525, and mild: 515). Compared to deep hypothermia, mild and moderate hypothermia were associated with lower mortality (mild vs. deep: odds ratio [OR] 0.50; 95% confidence interval (CI) 0.29–0.87, moderate vs. deep: OR 0.68; 95% CI 0.54–0.86). In addition, mild hypothermia was associated with lower stroke (OR 0.50; 95% CI 0.28–0.89), AKI (OR 0.36; 95% CI 0.15–0.88) and postoperative bleeding (OR 0.55; 95% CI 0.31–0.97) compared to deep hypothermia. There was no significant difference between mild and moderate hypothermia in mortality, AKI or bleeding occurrence, while mild hypothermia was associated with shorter operative time and hospital stay. There was no significant difference in TIA rate among three groups. Conclusions Mild hypothermia was associated with overall more favorable clinical outcomes with comparable neurological complications compared to deep hypothermia. Furthermore, considering the shorter operative time and hospital stay compared with moderate hypothermia, mild hypothermia may be warranted when appropriate adjunctive cerebral perfusion is employed.
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- 2022
12. Cancer Development Associated with Cardiovascular Diseases
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Tomohiro, Fujisaki, Kenshi, Yamanaga, Eiichiro, Yamamoto, and Kenichi, Tsujita
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- 2022
13. Comparison of Unguided De-Escalation Versus Guided Selection of Dual Antiplatelet Therapy After Acute Coronary Syndrome: A Systematic Review and Network Meta-Analysis
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Toshiki Kuno, Tomohiro Fujisaki, Satoshi Shoji, Yuki Sahashi, Yusuke Tsugawa, Masao Iwagami, Hisato Takagi, Alexandros Briasoulis, Pierre Deharo, Thomas Cuisset, Azeem Latib, Shun Kohsaka, Deepak L. Bhatt, Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), and Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
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Dual Anti-Platelet Therapy ,genotype ,[SDV]Life Sciences [q-bio] ,Network Meta-Analysis ,percutaneous coronary intervention ,Myocardial Infarction ,Hemorrhage ,acute coronary syndrome ,Stroke ,Treatment Outcome ,stents ,Humans ,Cardiology and Cardiovascular Medicine ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,Randomized Controlled Trials as Topic - Abstract
Background: The benefit of dual antiplatelet therapy (DAPT) for reducing ischemic events is greatest in the early period of acute coronary syndrome, and recent randomized controlled trials have investigated the unguided de-escalation strategy of changing potent P2Y 12 inhibitors to less potent or reduced-dose P2Y 12 inhibitors 1 month after acute coronary syndrome. However, it remains unclear which strategy is more effective and safer: the uniform unguided de-escalation strategy versus the personalized guided selection of DAPT with genotype or platelet function tests. Methods: PubMed, EMBASE, and Cochrane Central were searched for articles published from database inception to September 10, 2021. Randomized controlled trials investigating DAPT using clopidogrel, low-dose prasugrel, standard-dose prasugrel, ticagrelor, unguided de-escalation strategy, and guided selection strategy for patients with acute coronary syndrome were included. Hazard ratios and relative risk estimates were extracted from each study. The estimates were pooled using a random-effects network meta-analysis. The primary efficacy outcome was major adverse cardiovascular events, defined as a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety outcome was major or minor bleeding. Secondary outcomes were all-cause death, cardiovascular death, myocardial infarction, stroke, stent thrombosis, and major bleeding. Results: This study included 19 randomized controlled trials with 69 746 patients. Compared with guided selection of DAPT, unguided de-escalation of DAPT was associated with a decreased risk of the primary safety outcome (hazard ratio, 0.48 [95% CI, 0.33–0.72]) without increased risks of major adverse cardiovascular events (hazard ratio, 0.82 [95% CI, 0.53–1.28]) or any secondary outcomes. The results were similar when the guided selection strategy was divided into platelet function–guided and genotype-guided strategies. Conclusions: Compared with guided selection of DAPT, unguided de-escalation of DAPT decreased bleeding without increasing ischemic events in patients after acute coronary syndrome. If a strategy of de-escalation is chosen, these findings do not support the routine use of personalized guiding tests. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42021273082.
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- 2022
14. Distributing Address Selection Policy Using DHCPv6.
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Arifumi Matsumoto, Tomohiro Fujisaki, and Tim Chown
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- 2014
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15. Fieldcast2: Flexible P2P architecture for presence information sharing.
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Akira Kanamaru, Yoshitsugu Tsuchiya, Tomohiro Fujisaki, and Kenji Takahashi
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- 2004
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16. TREATMENT STRATEGIES FOR PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT WITH CONCOMITANT SEVERE CAROTID ARTERY OCCLUSIVE DISEASE: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
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Junji Tsukagoshi, Yujiro Yokoyama, Tomohiro Fujisaki, Hisato Takagi, Takuro Shirasu, and Toshiki Kuno
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Cardiology and Cardiovascular Medicine - Published
- 2023
17. Short- and Long-term Outcomes in Dialysis Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis
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Alexandros Briasoulis, Kentaro Hayashida, Yohei Numasawa, Hiroki Ueyama, Masaki Kodaira, Toshiki Kuno, Hisato Takagi, Tomohiro Fujisaki, and Tomo Ando
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medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,End stage renal disease ,law.invention ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Renal Dialysis ,law ,Humans ,Medicine ,030212 general & internal medicine ,Dialysis ,business.industry ,Hazard ratio ,Aortic Valve Stenosis ,Odds ratio ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Meta-analysis ,Kidney Failure, Chronic ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Transcatheter aortic valve implantation (TAVI) has become the main treatment for symptomatic severe aortic stenosis, but patients on dialysis have been excluded from major randomized controlled trials. Our aim was to compare mortality and procedure-related complications after TAVI in patients with end-stage renal disease (ESRD) on dialysis vs those without. Methods EMBASE and MEDLINE were searched through November 2019 to investigate the comparative outcomes between patients with ESRD on dialysis and those without who underwent TAVI. The main outcomes were short-term (30-day/in-hospital) mortality and procedural complications, and long-term (>6 months) all-cause mortality. Results Our search identified 10 observational studies enrolling 128,094 (5399 on dialysis) patients who underwent TAVI. Dialysis patients had a significantly higher rate of short-term and long-term mortality than nondialysis patients (odds ratio [95% confidential interval]: 2.18 [1.64-2.89], P Conclusion Dialysis patients had significantly higher rates of short- and long-term mortality, short-term life-threatening and/or major bleeding, permanent pacemaker implantation, and device failure compared with nondialysis patients. Careful selection of patients who would benefit from TAVI among patients with ESRD requiring dialysis is necessary to prevent high rates of postprocedural complications.
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- 2020
18. Developing platform for cooperative Internet management.
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Masaki Hamada, T. Inuzuka, Tomohiro Fujisaki, and Katsuyoshi Kageyama
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- 2000
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19. A case report of Kounis syndrome presenting with a rash, very late stent thrombosis and coronary evaginations
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Yoichi Uechi, Naoya Maehira, Tomohiro Fujisaki, and Tomitaka Higa
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medicine.medical_specialty ,Platelet adhesion ,medicine.medical_treatment ,Kounis syndrome ,Case Reports ,Internal medicine ,Case report ,Hypersensitivity ,medicine ,In patient ,Coronary heart disease (incl. Cardiac Intervention) ,Stent thrombosis ,Evagination ,Very late stent thrombosis ,Sirolimus-eluting stent ,Optical coherence tomography ,business.industry ,Stent ,medicine.disease ,Rash ,Pathophysiology ,medicine.anatomical_structure ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background Very late stent thrombosis (ST) is a concern in the era of drug-eluting stents (DESs), and ST is associated with peri-DES coronary artery aneurysmal lesions or coronary evaginations. An increasing number of cases of concurrent systemic allergic reaction and ST have been reported as Kounis syndrome (KS) in the literature. The number of patients with very late ST caused by KS is small, and further investigation of the potential pathophysiology is required. Case summary We report a case of KS that manifested as systemic urticaria followed by very late ST 14 years after placement of two sirolimus-eluting stents (SESs). Three months after the event of ST, coronary evaginations at the stented segments were detected on intravascular optical coherence tomography. Discussion Coronary evaginations are associated with local hypersensitivity, stent malapposition, uncovered strut, and flow disturbance that may predispose to ST. Systemic allergic reactions are known to promote platelet adhesion and aggregation. This case of KS suggests a pathophysiology in which the synergic effects between the coronary evaginations and a systemic allergic reaction may contribute to very late ST. For patients with Type 3 KS, performing follow-up intracoronary imaging tests may be important to confirm potential coronary evaginations, especially in patients with SESs.
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- 2020
20. Problem Statement for Default Address Selection in Multi-Prefix Environments: Operational Issues of RFC 3484 Default Rules.
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Arifumi Matsumoto, Tomohiro Fujisaki, Ruri Hiromi, and Ken-ichi Kanayama
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- 2008
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21. Requirements for Address Selection Mechanisms.
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Arifumi Matsumoto, Tomohiro Fujisaki, Ruri Hiromi, and Ken-ichi Kanayama
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- 2008
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22. Association of Donor Brain Death Due to Stroke With Prognosis After Heart Transplantation
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Takahisa Mikami, Shinobu Itagaki, Tomohiro Fujisaki, Toshiki Kuno, David P. Lerner, Joseph D. Burns, and Anelechi C. Anyanwu
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Stroke ,Brain Death ,Graft Survival ,Age Factors ,Heart Transplantation ,Humans ,Cardiology and Cardiovascular Medicine ,Prognosis ,Tissue Donors ,United States ,Retrospective Studies - Abstract
The proximate cause of donor brain death is not considered a conventional risk factor in modern heart transplantation.This study aimed to investigate the effect of the cause of donor brain death on recipients.Using the United Network for Organ Sharing registry, long-term mortality and allograft failure were compared in recipients who underwent heart transplantation in the United States from 2005 through 2018 between allograft recipients from donors with stroke as the cause of brain death (n = 3,761) vs nonstroke causes (n = 14,677). Inverse probability weighting was used for risk adjustment. Interactions were investigated between the cause of brain death and other conventional donor risk factors for recipient mortality.There was an interaction between the cause of brain death and donor age (PAs the cause of donor brain death, stroke had a substantially different effect on recipient and allograft survival depending on donor age. In the case of younger donor ages, stroke was associated with higher recipient mortality and allograft failure than other causes of brain death. The strength of this association decreased with increasing donor age such that the increased hazard was no longer present in donors older than approximately 40 years.
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- 2021
23. A Scalable Fault-Tolerant Network Management System Built Using Distributed Object Technology.
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Tomohiro Fujisaki, Masaki Hamada, and Katsuyoshi Kageyama
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- 1997
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24. De-Escalation of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndromes
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Shun Kohsaka, Azeem Latib, Alexandros Briasoulis, Thomas Cuisset, Pierre Deharo, Toshiki Kuno, Hisato Takagi, Tomohiro Fujisaki, Satoshi Shoji, Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), and Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
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medicine.medical_specialty ,Acute coronary syndrome ,Prasugrel ,low-dose ,[SDV]Life Sciences [q-bio] ,law.invention ,ticagrelor ,P2Y12 ,Randomized controlled trial ,systematic review ,law ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Acute Coronary Syndrome ,Stroke ,network meta-analysis ,ComputingMilieux_MISCELLANEOUS ,clopidogrel ,business.industry ,Dual Anti-Platelet Therapy ,medicine.disease ,Clopidogrel ,de-escalation ,prasugrel ,Purinergic P2Y Receptor Antagonists ,Cardiology and Cardiovascular Medicine ,business ,Ticagrelor ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Background Balancing the effects of dual antiplatelet therapy (DAPT) in the era of potent P2Y12 inhibitors has become a cornerstone of acute coronary syndrome (ACS) management. Recent randomized controlled trials (RCTs) have investigated DAPT de-escalation to decrease the risk of bleeding outcomes. Objectives The aim of this study was to compare the efficacy and safety outcomes of various DAPT strategies in patients with ACS, including de-escalation from a potent P2Y12 inhibitor to clopidogrel or low-dose prasugrel. Methods MEDLINE and EMBASE were searched through January 2021 for RCTs investigating the efficacy and safety of DAPT in patients with ACS, and a network meta-analysis was conducted. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, and stroke. The primary bleeding outcome was trial-defined major or minor bleeding. Results Our search identified 15 eligible RCTs, including 55,798 patients with ACS. De-escalation therapy was associated with reduced risk of primary bleeding outcomes (HR: 0.48 [95% CI: 0.30-0.77] vs clopidogrel; HR: 0.32 [95% CI: 0.20-0.52] vs ticagrelor; HR: 0.36 [95% CI: 0.24-0.55] vs standard-dose prasugrel; and HR: 0.40 [95% CI: 0.22-0.75] vs low-dose prasugrel) without negatively affecting primary efficacy outcomes. There were no significant differences in ischemic or bleeding outcomes between de-escalation to clopidogrel or low-dose prasugrel. Conclusions Compared with other established uses of DAPT, de-escalation was the most effective strategy for ACS treatment, resulting in fewer bleeding events without increasing ischemic events.
- Published
- 2021
25. Provisional or 2-Stent Technique for Bifurcation Lesions in the Second-Generation Drug-Eluting Stent Era
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Tomohiro Fujisaki, Toshiki Kuno, Yohei Numasawa, Hisato Takagi, Alexandros Briasoulis, Tak Kwan, Azeem Latib, Jacqueline Tamis-Holland, and Sripal Bangalore
- Published
- 2022
26. Biventricular takotsubo syndrome with COVID-19 in an Asian male
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Vasundhara Singh, Frida Kassim, Gassan Kassim, Bette Kim, Dhrubajyoti Bandyopadhyay, and Tomohiro Fujisaki
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medicine.medical_specialty ,Pediatrics ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Case Report ,Discharged alive ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Intubation ,030212 general & internal medicine ,Renal replacement therapy ,Takotsubo syndrome ,Ejection fraction ,Coronavirus disease 2019 ,business.industry ,Cardiogenic shock ,Acute kidney injury ,COVID-19 ,medicine.disease ,Cardiology ,business ,Cardiology and Cardiovascular Medicine - Abstract
Coronavirus disease 2019 (COVID-19) has been shown to affect the cardiovascular system, and several cases of takotsubo syndrome (TTS) induced by COVID-19 have been reported. TTS predominantly affects postmenopausal women in western countries, but the prevalence in men is higher in Asian populations. It should be noted that male patients with either TTS or COVID-19 are associated with higher mortality. Despite the higher prevalence of TTS in Asian men, little is known about Asian men with TTS induced by COVID-19. This is a case report of a 60-year-old Asian male with biventricular TTS precipitated by COVID-19. He presented with acute respiratory distress syndrome, cardiogenic shock, and acute kidney injury. He required intubation, multiple vasopressors, and renal replacement therapy. The left ventricular ejection fraction was 15%, but it normalized in 5 weeks. The patient had a prolonged hospital stay in a critical condition, but was eventually discharged alive. The scarce literature about this condition in Asian male populations and the increasing number of COVID-19 cases in Asian countries highlight the rarity and importance of this case. Further studies are warranted to investigate the uneven sex distribution and outcomes of TTS triggered by COVID-19 in an Asian population. .
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- 2021
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27. Bifurcation PCI Technique in the Era of Newer-Generation Drug-Eluting Stents: Insights from a Systematic Review and Meta-Analysis of Randomized Trials
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Tomohiro Fujisaki
- Published
- 2021
28. Potent P2Y12 Inhibitors versus Clopidogrel in Elderly Patients with Acute Coronary Syndrome: Systematic Review and Meta-Analysis: P2Y12 inhibitors and elderly patients with ACS
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Tomohiro Fujisaki
- Published
- 2021
29. Large bowel obstruction caused by urinary retention from benign prostate hyperplasia
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Hiroyuki Mizuta, Tomohiro Fujisaki, Yasuhiko Fujita, Naohisa Niina, Atsushi Tashiro, Nodoka Miyazaki, Norio Tomono, Takahiro Hayashi, and Naotsuna Tada
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Gastrointestinal ,Rectosigmoid Colon ,Urinary retention ,lcsh:R895-920 ,Urology ,urologic and male genital diseases ,030218 nuclear medicine & medical imaging ,Large bowel obstruction ,03 medical and health sciences ,0302 clinical medicine ,Benign prostate hyperplasia ,Medicine ,Radiology, Nuclear Medicine and imaging ,Surgical emergency ,business.industry ,digestive, oral, and skin physiology ,Hyperplasia ,Sacrum ,medicine.disease ,digestive system diseases ,Bowel obstruction ,Bladder distention ,Etiology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Although large bowel obstruction is a common surgical emergency, its occurrence due to bladder distension is rarely reported in the literature. We report a case of large bowel obstruction caused by bladder distention secondary to benign prostate hyperplasia in a 67-year-old man. This case demonstrates a grossly distended urinary bladder compressing the rectosigmoid colon against the sacrum, presenting as a complete large bowel obstruction. Management consisted of transurethral urinary catheter insertion, which resulted in complete resolution of the bowel obstruction with drainage of a large amount of urine. Early recognition of the underlying etiology resulted in the expeditious treatment of large bowel obstruction. Keywords: Large bowel obstruction, Urinary retention, Bladder distention, Benign prostate hyperplasia
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- 2019
30. [The role of advance care planning and palliative care in new york city during COVID-19 pandemic]
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Satoshi Miyashita and Tomohiro Fujisaki
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Advance care planning ,Palliative care ,Coronavirus disease 2019 (COVID-19) ,media_common.quotation_subject ,03 medical and health sciences ,Dignity ,Advance Care Planning ,0302 clinical medicine ,Nursing ,Japan ,030502 gerontology ,Informed assent ,Political science ,Pandemic ,Health care ,Humans ,030212 general & internal medicine ,Pandemics ,media_common ,business.industry ,SARS-CoV-2 ,Palliative Care ,COVID-19 ,humanities ,Intervention (law) ,New York City ,Geriatrics and Gerontology ,0305 other medical science ,business - Abstract
New York City faced an explosive spread of Coronavirus disease 2019 (COVID-19), causing the city's death toll to spike owing to the high virulence of COVID-19. The health care system was on the verge of collapse. Advance care planning (ACP), informed assent, and palliative care played significant roles in supporting patient self-determination and dignity, facilitating decision making, and promoting better care. The importance of these strategies was revisited. Learning from the COVID-19 pandemic in New York City, it is anticipated that several approaches such as ACP and palliative intervention may attract more attention and become increasingly essential to the healthcare system in Japan.
- Published
- 2021
31. Abstract 12659: Improved Heart Transplant Outcomes Among Patients With Hepatitis C Virus Infection in the Era of Direct-acting Antiviral Agents
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Toshiki Kuno, Tomohiro Fujisaki, Takahisa Mikami, N. Moss, and Shinobu Itagaki
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business.industry ,Physiology (medical) ,Hepatitis C virus ,medicine ,Cardiology and Cardiovascular Medicine ,medicine.disease_cause ,business ,Virology ,Direct acting - Abstract
Introduction: The effect of hepatitis C virus (HCV) infection in recipients or donors on heart transplants is less known in the era after the introduction of direct-acting antiviral agents (DAAs). Methods: Using the United Network for Organ Sharing registry, 25,581 adult heart transplant recipients between 2005 and 2019 were identified. The trend in prevalence of HCV infected recipients and in utilization of HCV infected donors and their effect on the transplant outcomes were investigated in the pre-DAAs era versus the DAAs era separated by May 13, 2011, using Cox proportional hazard regression. Results: HCV antibody positive recipients (n=532, 2.1%) had stable prevalence ( P =0.18) with a higher mortality risk in the pre-DAAs era (50.8% versus 38.8% at 10 years; hazard ratio (HR), 1.50; 95% confidence interval (CI), 1.22-1.85; P P =0.79) ( P interactionP P =0.84) regardless of the recipient HCV antibody status. The similar findings were confirmed with a subgroup cohort with positive nucleic acid amplification test (NAT). Conclusions: In the DAAs era, positive HCV antibody in recipients did not adversely affect the long-term transplant outcomes. Graft utilization from positive HCV antibody or NAT positive donors are rapidly more prevalent and appeared to be promising up to 2 years post-transplant.
- Published
- 2020
32. Potent P2Y12 inhibitors versus Clopidogrel in elderly patients with acute coronary syndrome: Systematic review and meta-analysis
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Toshiki Kuno, Alexandros Briasoulis, Tomo Ando, Tomohiro Fujisaki, Sripal Bangalore, and Hisato Takagi
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medicine.medical_specialty ,Acute coronary syndrome ,Prasugrel ,Administration, Oral ,Subgroup analysis ,030204 cardiovascular system & hematology ,Risk Assessment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Medicine ,Humans ,030212 general & internal medicine ,Acute Coronary Syndrome ,Aged ,Dose-Response Relationship, Drug ,business.industry ,Hazard ratio ,Age Factors ,medicine.disease ,Clopidogrel ,Treatment Outcome ,Purinergic P2Y Receptor Antagonists ,Cardiology and Cardiovascular Medicine ,business ,Ticagrelor ,Mace ,medicine.drug - Abstract
Background Potent P2Y12 inhibitors reduce cardiovascular events but increase bleeding in patients presenting with acute coronary syndrome (ACS). Elderly patients are at increased risk of bleeding and whether the benefit-risk ratio of potent P2Y12 inhibitors remains favorable is not known. Objectives To investigate the efficacy and safety of potent P2Y12 inhibitors versus clopidogrel in elderly patients with ACS. Methods PUBMED and EMBASE were searched through July 2020 for randomized control trials (RCTs) or subgroup analyses of RCTs investigating potent P2Y12 inhibitors (prasugrel or ticagrelor) or clopidogrel in elderly (age ≥ 65 years) patients with ACS. The primary outcome was major adverse cardiovascular events (MACE). Results Our search identified 9 RCTs with a total of 10,792 elderly patients. When compared with clopidogrel, potent P2Y12 inhibitors had similar risk of MACE (hazard ratio (HR): 0.94; 95%; confidence interval (CI) [0.85-1.06], P = .31, I2 = 9%), all-cause mortality (HR: 0.89; 95% CI [0.74-1.07], P = .22, I2 = 29%), reduced the risk of cardiovascular death (HR: 0.82; 95% CI [0.68-0.98], P = .03, I2 = 16%) but increased the risk of major bleeding (HR: 1.27; 95% CI [1.04-1.56], P = .02, I2 = 0%). In a subgroup analysis, ticagrelor reduced all-cause mortality (HR: 0.73; 95% CI [0.55-0.98]) and cardiovascular death (HR: 0.70; 95% CI [0.54-0.90]) compared with clopidogrel. Conclusions Among elderly patients with ACS, potent P2Y12 inhibitors reduce cardiovascular death but increase bleeding with no difference in MACE or all-cause death when compared with clopidogrel. Further RCTs are needed to refine P2Y12 inhibitor selection for elderly patients with ACS.
- Published
- 2020
33. UNGUIDED VERSUS GUIDED ALTERATION OF DUAL ANTIPLATELET THERAPY AFTER ACUTE CORONARY SYNDROME: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
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Tomohiro Fujisaki, Toshiki Kuno, Satoshi Shoji, Yuki Sahashi, Hisato Takagi, Alexandros Briasoulis, Pierre Deharo, Thomas Cuisset, Azeem Latib, and Shun Kohsaka
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Cardiology and Cardiovascular Medicine - Published
- 2022
34. Effect of renin-angiotensin system blockers on contrast-induced acute kidney injury in patients with normal or mild-to-moderate reduced kidney function undergoing coronary angiography: A systematic review and meta-analysis
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Nitin Chopra, Hiromichi Wakui, Kengo Azushima, Daniel I. Steinberg, Shingo Urate, Ryu Kobayashi, Eriko Abe, Sho Kinguchi, Kouichi Tamura, Toru Suzuki, Takayuki Yamada, Tomohiro Fujisaki, and Takahiro Yamaji
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Renal function ,Contrast Media ,Angiotensin-Converting Enzyme Inhibitors ,urologic and male genital diseases ,Coronary Angiography ,Gastroenterology ,law.invention ,03 medical and health sciences ,Angiotensin Receptor Antagonists ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,business.industry ,Acute kidney injury ,Percutaneous coronary intervention ,General Medicine ,Odds ratio ,Publication bias ,Acute Kidney Injury ,medicine.disease ,Nephrology ,Meta-analysis ,business ,Kidney disease ,Glomerular Filtration Rate - Abstract
Introduction Contrast-induced acute kidney injury (CI-AKI) is a major complication after coronary angiography (CAG) or percutaneous coronary intervention (PCI) and is associated with increased morbidity and mortality. It remains controversial whether renin-angiotensin system (RAS) blockers increase or decrease CI-AKI. In this meta-analysis, we investigated the association between RAS blockers and CI-AKI in patients with normal kidney function or mild-to-moderate chronic kidney disease (CKD). Materials and methods We performed a systematic search of PubMed, EMBASE, clinicaltrials.gov, and the Cochrane Library up to December 2019 for studies that assessed the association between RAS blockers and CI-AKI events after CAG/PCI. The primary outcome was the development of CI-AKI. Odds ratios (ORs) with corresponding 95% confidence interval (CI) were synthesized. Results Five randomized controlled trials (RCTs) and five observational studies were included, accounting for a total of 7,420 patients. Unstratified, RAS blocker administration was significantly associated with an increased risk of CI-AKI (pooled OR = 1.63, 95% CI 1.19 - 2.25, p = 0.003). However, the effect was not observed in RCTs (pooled OR = 1.22, 95% CI 0.54 - 2.74, p = 0.63). Sensitivity analysis in observational studies showed significant association (pooled OR = 1.77, 95% CI 1.22 - 2.55, p = 0.003) with high heterogeneity and evidence of publication bias. Conclusion In patients with relatively-preserved renal function, the association of RAS blockers with an increased risk of CI-AKI after contrast media exposure was inconclusive, as sensitivity analysis showed conflicting results and bias. Although this study did not demonstrate significant evidence, it indicated that clinicians need to be vigilant in assessing the potential risk for RAS blockers to cause CI-AKI in low-risk patients.
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- 2020
35. Cardiovascular and Renal Outcomes with SGLT-2 Inhibitors Versus GLP-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis
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Yusuke Saigusa, Tomohiro Fujisaki, Toru Suzuki, Eriko Abe, Kengo Azushima, Mako Wakabayashi, Takahisa Mikami, Shingo Urate, Hirotaka Miyashita, Hiroki Ueyama, Abhinav Bhalla, Hiromichi Wakui, Kouichi Tamura, Takayuki Yamada, Takahiro Yamaji, and Nitin Chopra
- Subjects
Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,GLP-1 receptor agonist ,Endocrinology, Diabetes and Metabolism ,Network Meta-Analysis ,Lower risk ,Incretins ,Risk Assessment ,Gastroenterology ,Glucagon-Like Peptide-1 Receptor ,Diabetes mellitus ,Risk Factors ,Chronic kidney disease ,Internal medicine ,medicine ,Humans ,Renal Insufficiency, Chronic ,Adverse effect ,Sodium-Glucose Transporter 2 Inhibitors ,Glucagon-like peptide 1 receptor ,Aged ,Original Investigation ,business.industry ,Type 2 Diabetes Mellitus ,Cardiovascular disease ,medicine.disease ,Renal outcomes ,Meta-analysis ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,lcsh:RC666-701 ,Cardiovascular Diseases ,Relative risk ,Disease Progression ,Female ,Cardiology and Cardiovascular Medicine ,business ,SGLT2 inhibitors ,Mace ,Kidney disease - Abstract
Background Emerging evidence suggests that sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with decreased risk of cardiovascular and renal events in type 2 diabetes mellitus (DM) patients. However, no study to date has compared the effect of SGLT-2 inhibitors with that of GLP-1 RAs in type 2 DM patients with chronic kidney disease (CKD). We herein investigated the benefits of SGLT-2 inhibitors and GLP-1 RAs in CKD patients. Methods We performed a systematic literature search through November 2020. We selected randomized control trials that compared the risk of major adverse cardiovascular events (MACE) and a composite of renal outcomes. We performed a network meta-analysis to compare SGLT-2 inhibitors with GLP-1 RAs indirectly. Risk ratios (RRs) with corresponding 95% confidence intervals (CI) were synthesized. Results Thirteen studies were selected with a total of 32,949 patients. SGLT-2 inhibitors led to a risk reduction in MACE and renal events (RR [95% CI]; 0.85 [0.75–0.96] and 0.68 [0.59–0.78], respectively). However, GLP-1 RAs did not reduce the risk of cardiovascular or renal adverse events (RR 0.91 [0.80–1.04] and 0.86 [0.72–1.03], respectively). Compared to GLP-1 RAs, SGLT-2 inhibitors did not demonstrate a significant difference in MACE (RR 0.94 [0.78–1.12]), while SGLT-2 inhibitors were associated with a lower risk of renal events compared to GLP-1 RAs (RR 0.79 [0.63–0.99]). A sensitivity analysis revealed that GLP-1 analogues significantly decreased MACE when compared to placebo treatment (RR 0.81 [0.69–0.95]), while exendin-4 analogues did not (RR 1.03 [0.88–1.20]). Conclusions In patients with type 2 DM and CKD, SGLT-2 inhibitors were associated with a decreased risk of cardiovascular and renal events, but GLP-1 RAs were not. SGLT-2 inhibitors significantly decreased the risk of renal events compared to GLP-1 RAs. Among GLP-1 RAs, GLP-1 analogues showed a positive impact on cardiovascular and renal outcomes, while exendin-4 analogues did not.
- Published
- 2020
36. Effect of Renin-Angiotensin System Blockers on Contrast Induced Acute Kidney Injury in Patients with Normal or Mild to Moderate Reduced Kidney Function Undergoing Coronary Angiography: A Systematic Review and Meta-analysis
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Daniel Steinberg, Nitin Chopra, Tomohiro Fujisaki, and Takayuki Yamada
- Published
- 2020
37. A CASE REPORT OF KOUNIS SYNDROME PRESENTING WITH A RASH, VERY LATE STENT THROMBOSIS AND CORONARY EVAGINATIONS
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Tomohiro Fujisaki
- Published
- 2020
38. Meta-Analysis Evaluating the Effects of Renin-Angiotensin-Aldosterone System Blockade on Outcomes of Heart Failure With Preserved Ejection Fraction
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Toshiki Kuno, Hisato Takagi, Alexandros Briasoulis, Hiroki Ueyama, Artemis Briasouli, and Tomohiro Fujisaki
- Subjects
medicine.medical_specialty ,Network Meta-Analysis ,Tetrazoles ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,Spironolactone ,Renin-Angiotensin System ,03 medical and health sciences ,chemistry.chemical_compound ,Angiotensin Receptor Antagonists ,0302 clinical medicine ,Irbesartan ,Internal medicine ,medicine ,Perindopril ,Humans ,030212 general & internal medicine ,Mortality ,Mineralocorticoid Receptor Antagonists ,Randomized Controlled Trials as Topic ,Heart Failure ,business.industry ,Aminobutyrates ,Biphenyl Compounds ,Stroke Volume ,Odds ratio ,medicine.disease ,Hospitalization ,Candesartan ,Drug Combinations ,Treatment Outcome ,chemistry ,Valsartan ,Cardiovascular Diseases ,Heart failure ,Cardiology ,Benzimidazoles ,Cardiology and Cardiovascular Medicine ,Heart failure with preserved ejection fraction ,business ,Angiotensin II Type 1 Receptor Blockers ,medicine.drug - Abstract
Clinical trials of renin-angiotensin-aldosterone system (RAAS) antagonists in heart failure with preserved ejection fraction (HFpEF) have suggested neutral results and treatment is focused on associated symptoms and comorbidities. MEDLINE and EMBASE were searched through October 2019 for randomized controlled studies investigating the effects of different RAAS antagonists in patients with HFpEF. The main outcomes were all-cause mortality, trial defined cardiovascular mortality, and heart failure (HF) hospitalizations. To compare different RAAS antagonists, a random-effects restricted-maximum-likelihood network meta-analysis based on a frequentist framework for indirect and mixed comparisons was used. We used p scores to rank best treatments per outcome. Our search identified 5 eligible clinical trials (PEP-CHF, perindopril; CHARM-preserved, candesartan; I-PRESERVE, irbesartan; TOPCAT, spironolactone; PARAGON-HF, sacubitril-valsartan and valsartan) enrolling a total 10,523 on RAAS antagonists and 6,259 controls. We did not identify any statistical difference in all-cause and cardiovascular mortality among RAAS antagonists and placebo. The combination of sacubitril-valsartan was associated with significantly decreased HF hospitalization risk compared with controls (odds ratio 0.73, 95% confidence interval 0.61 to 0.87) and angiotensin II receptor blockers (odds ratio 0.80, 95% confidence interval 0.71 to 0.91), without heterogeneity among studies (I2 = 0). Angiotensin receptor neprilysin inhibitor (ARNI) ranked better than other RAAS antagonists for HF hospitalizations (p value 0.9). In conclusion, RAAS antagonists do not affect mortality but the combination of sacubitril-valsartan is associated with lower HF hospitalizations in HFpEF patients.
- Published
- 2019
39. BIFURCATION PCI TECHNIQUE IN THE ERA OF NEWER GENERATION DRUG ELUTING STENTS. INSIGHTS FROM A SYSTEMATIC REVIEW AND META ANALYSIS OF RANDOMIZED TRIALS
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Toshiki Kuno, Hisato Takagi, Sripal Bangalore, Yohei Numasawa, and Tomohiro Fujisaki
- Subjects
Drug ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,law.invention ,Randomized controlled trial ,law ,Meta-analysis ,Conventional PCI ,medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,media_common - Published
- 2021
40. Network Management System Development Using an Application Framework.
- Author
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Tomohiro Fujisaki
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- 1996
- Full Text
- View/download PDF
41. Effect of Hepatitis C Virus Infection on Heart Transplants in the current Era
- Author
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Tomohiro Fujisaki
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