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  2. 齋藤 佑一

齋藤 佑一

サイトウ ユウイチ  (Yuichi Saito)

基本情報

所属
千葉大学 医学部附属病院循環器内科 助教
学位
博士（医学）(2016年3月 千葉大学大学院)
研究者番号
40797031
ORCID ID
 https://orcid.org/0000-0003-3574-0685
J-GLOBAL ID
202101015583946439
researchmap会員ID
R000023244

学歴

 2

論文

 148
  • Hiroaki Yaginuma, Yuichi Saito, Hiroki Goto, Kazunari Asada, Yuki Shiko, Takanori Sato, Osamu Hashimoto, Hideki Kitahara, Yoshio Kobayashi
    JACC. Asia 4(7) 507-516 2024年7月  
    BACKGROUND: The lack of standard modifiable cardiovascular risk factors (SMuRFs), including hypertension, diabetes, dyslipidemia, and smoking, is reportedly associated with poor outcomes in acute myocardial infarction (AMI). Among patients with no SMuRFs, cancer and chronic systemic inflammatory diseases (CSIDs) may be major etiologies of AMI. OBJECTIVES: The purpose of this study was to evaluate clinical characteristics and outcomes of patients with cancer, CSIDs, and no SMuRFs in AMI. METHODS: This multicenter registry included 2,480 patients with AMI undergoing percutaneous coronary intervention. Patients were divided into 4 groups: active cancer, CSIDs, no SMuRFs, and those remaining. The coprimary endpoint was major adverse cardiovascular events (MACE) and major bleeding events, during hospitalization and after discharge. RESULTS: Of 2,480 patients, 104 (4.2%), 94 (3.8%), and 120 (4.8%) were grouped as cancer, CSIDs, and no SMuRFs, respectively. During the hospitalization, MACE rates were highest in the no SMuRFs group, followed by the cancer, CSIDs, and SMuRFs groups (22.5% vs 15.4% vs 12.8% vs 10.2%; P < 0.001), whereas bleeding risks were highest in the cancer group, followed by the no SMuRFs, CSIDs, and SMuRFs groups (15.4% vs 10.8% vs 7.5% vs 4.9%; P < 0.001). After discharge, the rates of MACE (33.3% vs 22.7% vs 11.3% vs 9.2%; P < 0.001) and bleeding events (8.6% vs 6.7% vs 3.8% vs 2.9%; P = 0.01) were higher in the cancer group than in the CSIDs, no SMuRFs, and SMuRFs groups. CONCLUSIONS: Patients with active cancer, CSIDs, and no SMuRFs differently had worse outcomes after AMI in ischemic and bleeding endpoints during hospitalization and/or after discharge, compared with those with SMuRFs.
  • Yuichi Saito, Kazuya Tateishi, Masato Kanda, Yuki Shiko, Yohei Kawasaki, Yoshio Kobayashi, Takahiro Inoue
    Circulation journal : official journal of the Japanese Circulation Society 2024年6月27日  
    BACKGROUND: Acute myocardial infarction (AMI) is a major scenario for the use of an intra-aortic balloon pump (IABP), particularly when complicated by cardiogenic shock, although the utilization of mechanical circulatory support devices varies widely per hospital. We evaluated the relationship, at the hospital level, between the volume of IABP use and mortality in AMI.Methods and Results: Using a Japanese nationwide administrative database, 26,490 patients with AMI undergoing primary percutaneous coronary intervention (PCI) from 154 hospitals were included in this study. The primary endpoint was the observed-to-predicted in-hospital mortality ratio. Predicted mortality per patient was calculated using baseline variables and averaged for each hospital. The associations among PCI volume for AMI, observed and predicted in-hospital mortality, and observed and predicted IABP use were assessed per hospital. Of 26,490 patients, 2,959 (11.2%) were treated with IABP and 1,283 (4.8%) died during hospitalization. The annualized number of uses of IABP per hospital in AMI was 4.5. In lower-volume primary PCI centers, IABP was more likely to be underused than expected, and the observed-to-predicted in-hospital mortality ratio was higher than in higher-volume centers. CONCLUSIONS: A lower annual number of IABP use was associated with an increased mortality risk at the hospital level, suggesting that IABP use can be an institutional quality indicator in the setting of AMI.
  • Yuichi Saito, Kenichi Tsujita, Yoshio Kobayashi
    Cardiovascular intervention and therapeutics 2024年6月17日  
    Standard modifiable cardiovascular risk factors (SMuRFs), such as hypertension, diabetes, dyslipidemia, and current smoking, are associated with the development of atherosclerotic cardiovascular diseases including acute myocardial infarction (MI). Thus, therapeutic approaches against SMuRFs are important as primary and secondary prevention of cardiovascular diseases. In patients with acute MI, however, the prognosis is counterintuitively poor when SMuRFs are lacking. The growing evidence has explored the prevalence, pathophysiology, and prognosis of SMuRF-less patients in acute MI and suggested the potential underlying mechanisms. This review article summarizes the clinical evidence and relevance of the lack of SMuRFs in acute MI.
  • Yoshiyuki Okuya, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi
    The American journal of cardiology 219 71-76 2024年5月15日  
    The diagnosis of vasospastic angina (VSA) according to Japanese guidelines involves an initial intracoronary acetylcholine (ACh) provocation test in the left coronary artery (LCA) followed by testing in the right coronary artery (RCA). However, global variations in test protocols often lead to the omission of ACh provocation in the RCA, potentially resulting in the underdiagnosis of VSA. This study assessed the validity of the LCA-only ACh provocation approach for the VSA diagnosis and whether vasoreactivity in the LCA aids in determining further provocation in the RCA. A total of 273 patients who underwent sequential intracoronary ACh provocation testing in the LCA and RCA were included. Patients with a positive ACh provocation test in the LCA were excluded. Relations between vasoreactivity in the LCA and ACh test outcomes (positivity and adverse events) in the RCA were evaluated. In patients with negative ACh test results in the LCA, subsequent ACh testing was positive in the RCA in 23 of 273 (8.4%) patients. In patients with minimal LCA vasoconstriction (<25%), only 3.0% had a positive ACh test in the RCA, whereas the ACh test in the RCA was positive in 13.5% of those with LCA constriction of 25% to 90% (p = 0.002). No major adverse events occurred during ACh testing in the RCA. In conclusion, for the VSA diagnosis, the omission of ACh provocation in the RCA may be clinically acceptable, particularly when vasoconstriction induced by ACh injection was minimal in the LCA. Further studies are needed to define ACh provocation protocols worldwide.
  • Yoshiyuki Okuya, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi
    Journal of cardiology 2024年5月10日  
  • Yuichi Saito, Taku Inohara, Shun Kohsaka, Takashi Muramatsu, Hideki Ishii, Kyohei Yamaji, Tetsuya Amano, Yoshio Kobayashi, Ken Kozuma
    JACC. Asia 4(5) 421-422 2024年5月  
  • Kazunari Asada, Yuichi Saito, Hiroki Goto, Hiroaki Yaginuma, Takanori Sato, Osamu Hashimoto, Hideki Kitahara, Yoshio Kobayashi
    Journal of clinical medicine 13(9) 2024年4月24日  
    Background: We previously developed a risk-scoring system for heart failure (HF) in patients with acute myocardial infarction (MI), namely "HF time-points (HFTPs)". In the original HFTPs, the presence of HF on admission, during hospitalization, and at short-term follow-up was individually scored. This study examined whether the revised HFTPs, with additional scoring of previous HF, provide better predictivity. Methods: This multicenter registry included a total of 1331 patients with acute MI undergoing percutaneous coronary intervention. HF was evaluated at four time-points before and after acute MI onset: (1) a history of HF; (2) elevated natriuretic peptide levels on admission; (3) in-hospital HF events; and (4) elevated natriuretic peptide levels at a median of 31 days after the onset. When HF was present at each time-point, one point was assigned to a risk scoring system, namely the original and revised HFTPs, ranging from 0 to 3 and from 0 to 4. The primary endpoint was a composite of cardiovascular death and HF rehospitalization after discharge. Results: Of the 1331 patients, 65 (4.9%) had the primary outcome events during a median follow-up period of 507 (interquartile range, 335-1106) days. The increase in both original and revised HFTPs was associated with an increased risk of the primary outcomes in a stepwise fashion with similar diagnostic ability. Conclusions: The original and revised HFTPs were both predictive of long-term HF-related outcomes in patients with acute MI undergoing percutaneous coronary intervention. Yet, the original HFTPs may be sufficient to estimate HF risks after MI.
  • Yuichi Saito, Hiroaki Yaginuma, Kazunari Asada, Hiroki Goto, Takanori Sato, Hideki Kitahara, Yoshio Kobayashi
    The American journal of cardiology 217 18-24 2024年4月15日  
    Patients with previous atherosclerotic cardiovascular disease (ASCVD) are typically managed by secondary prevention modalities; however, they may experience recurrent events. In acute myocardial infarction (MI), the prognostic effect of preexisting ASCVD on the short- and long-term outcomes remains uncertain. This retrospective, multicenter registry included 2,475 patients with acute MI who underwent percutaneous coronary intervention. Previous ASCVD was defined as a history of ischemic events in the coronary, cerebral, and peripheral arterial territories. Patients were divided into 2 groups according to preexisting ASCVD. The primary end point was major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular death, recurrent MI, and ischemic stroke during hospitalization and after discharge. The bleeding outcomes were also evaluated. Of the 2,475 patients, 475 (19.2%) had previous ASCVD. Patients with previous ASCVD were older and likely to have more co-morbidities than those without ASCVD. During hospitalization, the MACE rates were higher in the ASCVD group than in the non-ASCVD group (16.4% vs 9.6%, p <0.001). Similarly, during a median follow-up of 542 days after discharge, patients with previous ASCVD had an increased risk of MACEs than those without ASCVD (13.4% vs 5.6%, p <0.001). The multivariable analyses identified previous ASCVD as a factor that was significantly associated with MACEs after discharge. Major bleeding events occurred more frequently in the ASCVD group than in the non-ASCVD group. In conclusion, preexisting ASCVD was often observed in patients with acute MI and was particularly associated with long-term ischemic outcomes after discharge; thus, further clinical investigations are needed in this vulnerable patient subset.
  • Ryota Watanabe, Yuichi Saito, Satoshi Tokimasa, Hiroyuki Takaoka, Hideki Kitahara, Masato Yamanouchi, Yoshio Kobayashi
    Journal of clinical medicine 13(8) 2024年4月12日  
    Background: Coronary artery calcification score (CACS) on electrocardiography (ECG)-gated computed tomography (CT) is used for risk stratification of atherosclerotic cardiovascular disease, which requires dedicated analytic software. In this study, we evaluated the diagnostic ability of manual calcification length assessment on non-ECG-gated CT for epicardial coronary artery disease (CAD). Methods: A total of 100 patients undergoing both non-ECG-gated plain CT scans with a slice interval of 1.25 mm and invasive coronary angiography were retrospectively included. We manually measured the length of the longest calcified lesions of coronary arteries on each branch. The relationship between the number of coronary arteries with the length of coronary calcium > 5, 10, or 15 mm and the presence of epicardial CAD on invasive angiography was evaluated. Standard CACS was also evaluated using established software. Results: Of 100 patients, 49 (49.0%) had significant epicardial CAD on angiography. The median standard CACS was 346 [7, 1965]. In both manual calcium assessment and standard CACS, the increase in calcium burden was progressively associated with the presence of epicardial CAD on angiography. The receiver operating characteristic curve analysis showed similar diagnostic abilities of the two diagnostic methods. The best cut-off values for CAD were 2, 1, and 1 for the number of vessels with calcium > 5, 10, and 15 mm, respectively. Overall, the diagnostic ability of manual calcium assessment was similar to that of standard CACS > 400. Conclusions: Manual assessment of coronary calcium length on non-ECG-gated plain CT provided similar diagnostic ability for the presence of significant epicardial CAD on invasive angiography, as compared to standard CACS.
  • Yuichi Saito, Taku Inohara, Shun Kohsaka, Hideki Wada, Hiraku Kumamaru, Kyohei Yamaji, Hideki Ishii, Tetsuya Amano, Hiroaki Miyata, Yoshio Kobayashi, Ken Kozuma
    JACC. Asia 4(4) 323-331 2024年4月  
    BACKGROUND: Quality indicators (QIs) have been developed to improve and standardize care quality in percutaneous coronary intervention (PCI). In Japan, consecutive PCI procedures are registered in a nationwide database (the Japanese Percutaneous Coronary Intervention registry), which introduces a benchmarking system for comparing individual institutional performance against the national average. OBJECTIVES: The aim of this study was to assess the impact of the benchmarking system implementation on QI improvement at the hospital level. METHODS: A total of 734,264 PCIs were conducted at 1,194 institutions between January 2019 and December 2021. In January 2018, a web-based benchmarking system encompassing 7 QIs for PCI at the institutional level, including door-to-balloon time and rate of transradial intervention, was introduced. The process by which institutions tracked their QIs was centrally monitored. RESULTS: During the 3-year study period, the benchmarking system was reviewed at least once at 742 institutions (62.1%) (median 4 times; Q1-Q3: 2-7 times). The institutions that reviewed their records had higher PCI volumes. Among these institutions, although door-to-balloon time was not directly associated, the proportion of transradial intervention increased by 2.3% in the system review group during the initial year compared with 0.7% in their counterparts. However, in the subsequent year, the association between system reviews and QI improvement was attenuated. CONCLUSIONS: The implementation of a benchmarking system, reviewed by participating institutions in Japan, was partially associated with improved QIs during the first year; however, this improvement was attenuated in the subsequent year, highlighting the need for further efforts to develop effective and sustainable interventions to enhance care quality in PCI.
  • 立石 和也, 齋藤 佑一, 中込 敦士, 北原 秀喜, 小林 欣夫, 田原 良雄, 米本 直裕, 池田 隆徳, 佐藤 直樹, 大倉 宏之
    日本循環器学会学術集会抄録集 88回 PJ095-1 2024年3月  
  • Kayo Yamamoto, Yuichi Saito, Osamu Hashimoto, Takashi Nakayama, Shinichi Okino, Yoshiaki Sakai, Yoshitake Nakamura, Shigeru Fukuzawa, Toshiharu Himi, Yoshio Kobayashi
    The American journal of cardiology 212 103-108 2024年2月1日  
    Type A acute aortic dissection (AAD) is a fatal disease and thus, accurate and objective risk stratification is essential. In this study, we evaluated the prognostic value of readily available and assessable biomarkers in patients with type A AAD. This was a retrospective, multicenter, observational study. A total of 703 patients with type A AAD diagnosed using contrast-enhanced computed tomography were included. Therapeutic strategies were left to the physician's discretion in a real-world clinical setting. The prognostic value for in-hospital mortality was examined in 15 circulating biomarkers on admission, which are routinely available in clinical practice. Of the 703 patients, 126 (17.9%) died during the hospitalization. Of the 15 biomarkers, the multivariable analysis identified positive cardiac troponin, a low total bilirubin (T-Bil) level, and increased levels of brain natriuretic peptide (BNP) and lactate dehydrogenase (LDH) as significant predictors of in-hospital death. The receiver operating characteristics curve analysis showed that these 4 biomarkers had an independent additive prognostic value. With the cut-off values of T-Bil, BNP, and LDH, in combination with positive troponin, the increase in the number of positive biomarkers was progressively associated with higher in-hospital mortality from 1.3% to 9.8%, 20.5%, 36.4%, and 75.0% (p <0.001). In conclusion, in patients with type A AAD, positive cardiac troponin, a low T-Bil level, and increased levels of BNP and LDH on admission were related to higher in-hospital mortality, with an incremental prognostic value, suggesting that the readily available and assessable biomarkers can aid in decision-making in therapeutic strategies.
  • Tatsuro Yamazaki, Yuichi Saito, Daichi Yamashita, Hideki Kitahara, Yoshio Kobayashi
    The American journal of cardiology 211 282-286 2024年1月15日  
    In the international guidelines, higher thrombolysis in myocardial infarction frame count (TFC) is indicated as evidence of coronary microvascular dysfunction (CMD). However, the association of TFC with invasively measured coronary physiologic parameters such as coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) remains unclear. Patients without significant epicardial coronary lesions underwent invasive coronary physiologic assessment using a thermodilution method in the left anterior descending artery. Corrected TFC (cTFC) was evaluated on coronary angiography. The cut-off values of CFR and IMR were defined as ≤2.0 and >25, and patients with abnormal CFR and/or IMR were defined as having CMD. This study aimed to assess whether cTFC >25, a cut-off value in the guidelines, was diagnostic of the presence of CMD. Of the 137 patients, 34 (24.8%) and 32 (23.3%) had cTFC >25 and CMD, respectively. The rate of CMD was not significantly different between patients with and without cTFC >25. cTFC was weakly correlated with at rest and hyperemic mean transit time and IMR, whereas no significant correlation was observed between cTFC and CFR. The receiver operating characteristic curve analysis showed the poor diagnostic ability of cTFC for abnormal CFR and IMR and the presence of CMD. In conclusion, in patients without epicardial coronary lesions, cTFC as a continuous value and with the cut-off value of 25 was not diagnostic of abnormal CFR and IMR and the presence of CMD. Our results did not support the use of cTFC in CMD evaluation.
  • Yuichi Saito, Kazuya Tateishi, Masato Kanda, Yuki Shiko, Yohei Kawasaki, Yoshio Kobayashi, Takahiro Inoue
    Cardiovascular intervention and therapeutics 2023年12月26日  
    Acute myocardial infarction (MI) is one of the major scenarios of extracorporeal membrane oxygenation (ECMO) use. The utilization of mechanical circulatory support systems including ECMO varies widely at the hospital level, while whether ECMO volume per hospital is associated with outcomes in acute MI is unclear. Using a Japanese nationwide administrative database, a total of 26,913 patients with acute MI undergoing percutaneous coronary intervention from 154 hospitals were included. The relations among PCI volume for acute MI, observed and predicted in-hospital mortality, and observed and predicted rates of ECMO use were evaluated at the hospital level. Of 26,913 patients, 423 (1.6%) were treated with ECMO, and 1561 (5.8%) died during the hospitalization. Median ECMO use per hospital per year was 0.5. An observed rate of ECMO use was linearly correlated with the predicted probability of ECMO use and was not associated with the observed/predicted in-hospital mortality ratio. The observed/predicted mortality ratio was lowest in hospitals with the observed/predicted ECMO use ratio of around one. In conclusion, ECMO was infrequently used in a setting of acute MI at each hospital annually. An observed rate of ECMO use was not associated with observed/predicted in-hospital mortality ratio, while the observed/predicted in-hospital mortality ratio was lowest when ECMO was used as predicted, suggesting that standardized ECMO use may be an institutional quality indicator in acute MI.
  • Tatsuro Yamazaki, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi
    Medicina (Kaunas, Lithuania) 59(12) 2023年12月15日  
    Background and Objectives: An interventional diagnostic procedure (IDP), including intracoronary acetylcholine (ACh) provocation and coronary physiological testing, is recommended as an invasive diagnostic standard for patients suspected of ischemia with no obstructive coronary arteries (INOCA). Recent guidelines suggest Thrombolysis In Myocardial Infarction frame count (TFC) as an alternative to wire-based coronary physiological indices for diagnosing coronary microvascular dysfunction. We evaluated trajectories of TFC during IDP and the impact of ACh provocation on TFC. Materials and Methods: This was a single-center, retrospective study. Patients who underwent IDP to diagnose INOCA were included and divided into two groups according to the positive or negative ACh provocation test. Wire-based invasive physiological assessment was preceded by ACh provocation tests and intracoronary isosorbide dinitrate (ISDN). We evaluated TFC at three different time points during IDP; pre-ACh, post-ISDN, and post-hyperemia. Results: Of 104 patients, 58 (55.8%) had positive ACh provocation test. In the positive ACh group, resting mean transit time (Tmn) and baseline resistance index were significantly higher than in the negative ACh group. Post-ISDN TFC was significantly correlated with resting Tmn (r = 0.31, p = 0.002). Absolute TFC values were highest at pre-ACh, followed by post-ISDN and post-hyperemia in both groups. All between-time point differences in TFC were statistically significant in both groups, except for the change from pre-ACh to post-ISDN in the positive ACh group. Conclusions: In patients suspected of INOCA, TFC was modestly correlated with Tmn, a surrogate of coronary blood flow. The positive ACh provocation test influenced coronary blood flow assessment during IDP.
  • Teruaki Kanagami, Yuichi Saito, Osamu Hashimoto, Takashi Nakayama, Shinichi Okino, Yoshiaki Sakai, Yoshitake Nakamura, Shigeru Fukuzawa, Toshiharu Himi, Yoshio Kobayashi
    International journal of cardiology 391 131355-131355 2023年11月15日  
    BACKGROUND: Although type A acute aortic dissection (AAD) including classic double-channel aorta and intramural hematoma (IMH) is a life-threatening condition, the prognostic impact and predictors of IMH remain to be established. The present study evaluated the prevalence, baseline characteristics, and outcomes of IMH as compared with classic non-thrombosed type A AAD. METHODS: This multicenter registry in Japan retrospectively included 703 patients with type A AAD. IMH was defined as a crescentic or circular area along the ascending aortic wall without contrast enhancement on computed tomography (CT). Non-thrombosed type A AAD was defined as the classic double-channel ascending aorta on contrast-enhanced CT. The primary endpoint was in-hospital mortality. RESULTS: Of the 703 patients with type A AAD, 312 (44.3%) had IMH. Older age was an only baseline patient factor significantly associated with the presence of IMH in the multivariable analysis. The longitudinal extent of dissection was greater in patients with classic non-thrombosed AAD than those with IMH, resulting in an increased risk of end-organ malperfusion in the classic AAD group. During the hospitalization, 41 (13.1%) and 85 (21.7%) patients with and without IMH died (p < 0.001). IMH was associated with lower in-hospital mortality in a multivariable model, irrespective of age and the implementation of surgery. CONCLUSIONS: The present study showed that IMH on CT was frequent among patients with type A AAD. Although IMH was more likely to be present in the elderly, its effect on the better survival was independent of age and surgical treatment.
  • Yuichi Saito, Shinya Ichihara, Osamu Hashimoto, Takashi Nakayama, Haruka Sasaki, Keita Yumoto, Susumu Oshima, Tetsuya Tobaru, Shunichi Kushida, Junji Kanda, Yoshiaki Sakai, Shinichi Okino, Shigeru Fukuzawa, Akihiko Abiko, Tomonori Itoh, Yoshitake Nakamura, Takahiro Nakashima, Satoshi Yasuda, Kenji Goto, Hideo Takebayashi, Takashi Oshitomi, Tomohiro Sakamoto, Sunao Kojima, Yoritaka Otsuka, Toshiharu Himi, Yusuke Inagaki, Junichi Yamaguchi, Kenichi Hagiya, Mamoru Nanasato, Yoshio Kobayashi
    The American journal of cardiology 207 428-430 2023年11月15日  
  • Kazuya Tateishi, Yuichi Saito, Yuichi Yasufuku, Atsushi Nakagomi, Hideki Kitahara, Yoshio Kobayashi, Yoshio Tahara, Naohiro Yonemoto, Takanori Ikeda, Naoki Sato, Hiroyuki Okura
    Scientific reports 13(1) 16180-16180 2023年9月27日  
    The effect of prehospital factors on favorable neurological outcomes remains unclear in patients with witnessed out-of-hospital cardiac arrest (OHCA) and a shockable rhythm. We developed a decision tree model for these patients by using prehospital factors. Using a nationwide OHCA registry database between 2005 and 2020, we retrospectively analyzed a cohort of 1,930,273 patients, of whom 86,495 with witnessed OHCA and an initial shockable rhythm were included. The primary endpoint was defined as favorable neurological survival (cerebral performance category score of 1 or 2 at 1 month). A decision tree model was developed from randomly selected 77,845 patients (development cohort) and validated in 8650 patients (validation cohort). In the development cohort, the presence of prehospital return of spontaneous circulation was the best predictor of favorable neurological survival, followed by the absence of adrenaline administration and age. The patients were categorized into 9 groups with probabilities of favorable neurological survival ranging from 5.7 to 70.8% (areas under the receiver operating characteristic curve of 0.851 and 0.844 in the development and validation cohorts, respectively). Our model is potentially helpful in stratifying the probability of favorable neurological survival in patients with witnessed OHCA and an initial shockable rhythm.
  • Yuichi Saito, Kazuya Tateishi, Koichi Toda, Goro Matsumiya, Yoshio Kobayashi
    Journal of the American Heart Association 12(17) 2023年9月5日  査読有り筆頭著者責任著者
    Background <p lang="en">In patients with cardiogenic shock (CS), acute myocardial infarction (AMI) is the most common cause, and a percutaneous microaxial ventricular assist device (Impella, Abiomed, Danvers, MA) is a choice for temporary mechanical circulatory support. However, data are limited on complications and outcomes of Impella treatment in patients with CS with and without AMI. </p> Methods and Results <p lang="en"> Using nationwide prospective registry data in Japan, we included a total of 2047 patients with CS in whom the Impella devices were successfully placed between February 2020 and December 2021. Patients were divided into 2 groups according to the primary indication for the Impella use: AMI versus non‐AMI. The primary end point was a composite of in‐hospital all‐cause death and major complications. Of the 2047 patients, the Impella was indicated for AMI in 1337 (65.3%). In the group without AMI, myocarditis was the leading cause of CS. Patients with AMI‐CS were older and more likely to have cardiovascular risk factors than those with non‐AMI‐CS. The rates of in‐hospital mortality (46.0% versus 43.9%, P =0.38) and major complications (35.2% versus 34.7%, P =0.85) were similar between the 2 groups. Overall, multivariable analysis identified older age, higher body mass index, previous transient ischemic attack or stroke, out‐of‐hospital cardiac arrest, and the Impella 5.0 as factors significantly associated with the primary end point. </p> Conclusions <p lang="en">The use of Impella in patients with and without AMI was related to similar clinical outcomes with high mortality and complication rates. Further studies are needed to identify patients who may benefit from the Impella devices in CS. </p> Registration <p lang="en"> URL: https://www.umin.ac.jp/english . Identifier: UMIN000033603. </p>
  • Yuichi Saito, Yoshio Kobayashi, Kenichi Fujii, Shinjo Sonoda, Kenichi Tsujita, Kiyoshi Hibi, Yoshihiro Morino, Hiroyuki Okura, Yuji Ikari, Ken Kozuma, Junko Honye
    Cardiovascular Intervention and Therapeutics 2023年9月1日  招待有り筆頭著者責任著者
    Abstract Intravascular ultrasound (IVUS) provides precise anatomic information in coronary arteries including quantitative measurements and morphological assessment. To standardize the IVUS analysis in the current era, this updated expert consensus document summarizes the methods of measurements and assessment of IVUS images and the clinical evidence of IVUS use in percutaneous coronary intervention.
  • Yuichi Saito, Yoshio Kobayashi
    Cardiovascular Intervention and Therapeutics 2023年9月1日  招待有り筆頭著者責任著者
  • Daichi Yamashita, Hideki Kitahara, Yuichi Saito, Ken Kato, Yoshio Kobayashi
    JACC: Case Reports 21 101976-101976 2023年9月  査読有り
  • Tatsuro Yamazaki, Yuichi Saito, Daichi Yamashita, Hideki Kitahara, Yoshio Kobayashi
    Journal of Cardiology 82(3) 215-219 2023年9月  査読有り責任著者
  • Hiroaki Yaginuma, Yuichi Saito, Takanori Sato, Daichi Yamashita, Tadahiro Matsumoto, Sakuramaru Suzuki, Shinichi Wakabayashi, Hideki Kitahara, Koichi Sano, Yoshio Kobayashi
    PLOS ONE 18(8) e0289794-e0289794 2023年8月24日  査読有り責任著者
    Background Chronic systemic inflammatory diseases (CSIDs) such as rheumatoid arthritis (RA) are reportedly associated with an increased risk of ischemic cardiovascular events including acute myocardial infarction (MI). However, data are limited on clinical characteristics and ischemic and bleeding outcomes after acute MI in patients with CSIDs. Methods This bi-center registry included a total of 1001 patients with acute MI undergoing percutaneous coronary intervention. CSIDs included inflammatory rheumatological conditions (RA, systemic lupus erythematosus, vasculitis, etc.) and organ-specific diseases (chronic hepatitis, psoriasis, inflammatory bowel disease, etc.). The primary endpoint was net adverse clinical events (NACE), a composite of ischemic (all-cause death, MI, and ischemic stroke) and major bleeding (Bleeding Academic Research Consortium type 3 or 5) events, during hospitalization and after discharge. Results Of the 1001 patients, 58 (5.8%) had CSIDs. The proportion of women was higher in patients with CSIDs than those without (37.9% vs. 22.1%, p = 0.009). During the hospitalization, no significant differences in the primary endpoint of NACE were observed between patients with and without CSIDs (10.3% vs. 12.7%, p = 0.84). During the median follow-up of 42.6 months after discharge, patients with CSIDs had a higher risk of NACE (22.5% vs. 10.1%, p = 0.01) than those without, mainly driven by an increased risk of ischemic events (18.4% vs. 8.4%, p = 0.03). Conclusions A small but significant proportion of patients with acute MI (5.8%) had CSIDs. While the incidence of in-hospital events was similar, patients with CSIDs had worse outcomes after discharge, suggesting that further clinical investigations and therapeutic approaches are needed in this patient subset.
  • Tadahiro Matsumoto, Yuichi Saito, Takanori Sato, Daichi Yamashita, Sakuramaru Suzuki, Kan Saito, Shinichi Wakabayashi, Hideki Kitahara, Koichi Sano, Yoshio Kobayashi
    Heart and Vessels 2023年8月20日  査読有り責任著者
  • Yoshiyuki Okuya, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi
    Journal of Cardiology 2023年8月  査読有り責任著者
  • Hirotoshi Kato, Yuichi Saito, Yuri Isaka, Yoshio Kobayashi
    Journal of Cardiology Cases 28(2) 58-61 2023年8月  査読有り責任著者
  • Yuichi Saito, Atsushi Tanaka, Tomoko Ishizu, Hisako Yoshida, Yoshiaki Kubota, Mamoru Nanasato, Munehide Matsuhisa, Yusuke Ohya, Yoshio Kobayashi, Koichi Node, Toyoaki Murohara, Teruo Inoue, Masataka Sata, Mitsuru Ohishi, Kotaro Yokote, Kazuomi Kario, Hirotaka Watada, Iichiro Shimomura, Munehide Matsuhisa, Yoshihiro Fukumoto, Koji Maemura, Yusuke Ohya, Yuichi Akasaki, Junya Ako, Hirohisa Amano, Kazutaka Aonuma, Yutaka Aoyama, Hirofumi Arai, Kuniya Asai, Machiko Asaka, Yoshifumi Awaji, Noriko Ban, Toshiaki Ban, Yasuko K. Bando, Hiroyuki Daida, Shunsuke Eguchi, Mami Enomoto, Yuichi Fujii, Akinori Fujikake, Masanori Fujimoto, Tomohiro Fujisaka, Shuichi Fujita, Satoki Fukae, Daiju Fukuda, Mieko Fukui, Yuhei Goriki, Shuichi Hamasaki, Tomoya Hara, Hiroshi Hasegawa, Kenichi Hashimoto, Mitsumasa Hata, Shiro Hata, Ryo Hayashida, Akihiro Higashi, Seiichiro Higuchi, Akihiro Honda, Satoshi Hoshide, Masaaki Hoshiga, Junko Hotchi, Sachiyo Igata, Yumi Ikehara, Teruo Inoue, Youhei Inoue, Hiroko Ishigami, Masaharu Ishihara, Hideki Ishii, Tetsuya Ishikawa, Takashi Ishimatsu, Yusuke Ishiyama, Takahide Ito, Ayumi Ito, Toshiaki Kadokami, Haruo Kamiya, Soichiro Kashihara, Yoshihiro Kawamura, Kazuo Kitagawa, Yoshio Kobayashi, Satoshi Kodera, Seiji Koga, Hisashi Koide, Yuji Koide, Hiroshi Koiwaya, Hiroki Kojima, Eri Komai, Takaaki Komatsu, Shingo Kono, Takashi Kono, Yoshiaki Kubota, Akio Kuroda, Takanori Kuroyanagi, Akifumi Kushiyama, Kenya Kusunose, Tatsuya Maruhashi, Kazuo Matsunaga, Tomomi Matsuura, Takafumi Mayama, Daigo Mine, Masatoshi Miyamura, Ryota Morimoto, Hideaki Morita, Hidekazu Nagano, Hidemitsu Nakagawa, Katsunori Nakamura, Ryo Nakamura, Ikuko Nakamura, Hitoshi Nakashima, Mamoru Nanasato, Isao Nishi, Shinichi Niwano, Shuichi Nomura, Nozomu Oda, Shio Oguchi, Mitsutoshi Oguri, Arihide Okahara, Masaaki Okutsu, Fumitake Ozaki, Michishige Ozeki, Tomoko Saisu, Yuichi Saito, Makoto Saitoh, Yosuke Saka, Yoshihiko Sakai, Kazushi Sakane, Ikki Sakuma, Shakya Sandeep, Hiroaki Sano, Hisakuni Sekino, Yuka Senoo, Kensaku Shibata, Yoshisato Shibata, Takahisa Shibata, Akina Shiga, Kazuki Shiina, Michio Shimabukuro, Yusaku Shimbo, Wataru Shimizu, Masahisa Shimpo, Takeshi Soeki, Koichi Sohmiya, Hiroyuki Suzuki, Susumu Suzuki, Makoto Suzuki, Nobuhiro Tahara, Tazu Tahara, Sadako Takahashi, Bonpei Takase, Kaoru Takegami, Tomoko Takiguchi, Tomonobu Takikawa, Ai Tamura, Tomoaki Tanaka, Akihito Tanaka, Hiroyuki Tanaka, Jun Tanigawa, Daisuke Tanimura, Yosuke Tatami, Takashi Terano, Fumio Terasaki, Tomoyuki Tobushi, Seiko Tokoi, Toshiyuki Tsubouchi, Daigaku Uchida, Tomohiro Ueda, Rie Ueno, Hiromi Ueno, Chikara Ueyama, Tetsuzo Wakatsuki, Tomohiko Watanabe, Masato Watarai, Isao Yaguchi, Ayumu Yajima, Jiko Yamada, Kyohei Yamamoto, Sachiko Yamauchi, Yohei Yamauchi, Naoto Yokota, Tomohiko Yoshida, Goro Yoshioka, Hiroyuki Daida, Junya Ako, Kazuo Kitagawa, Wataru Shimizu, Yoshio Kobayashi, Masaharu Ishihara, Tomoko Ishizu, Shinichiro Ueda, Atsushi Tanaka, Jun-ichi Oyama, Mikiko Kagiyama
    Scientific Reports 13(1) 2023年7月5日  査読有り筆頭著者責任著者
    Abstract Hyperuricemia is reportedly associated with the progression of carotid intima-media thickness (IMT), a surrogate of cardiovascular risks and events. However, factors associated with carotid IMT progression in patients with asymptomatic hyperuricemia are largely unknown. In this post-hoc analysis of the multicenter, randomized PRIZE study, we analyzed data from a total of 326 patients who underwent carotid ultrasonography in a blind manner at baseline and 24 months to evaluate carotid IMT. Mean and maximum IMT at the common carotid artery (CCA) were measured at a central core laboratory. Factors related to the absolute change in mean and maximum IMT from baseline to 24 months were explored. Overall, the adjusted mean [0.0032 (− 0.0214 to 0.0278) mm] and maximum [0.0011 (− 0.0327 to 0.0351) mm] CCA-IMT increased numerically from baseline to 24 months. Multivariable analysis identified higher body mass index, history of atherosclerotic cardiovascular disease (ASCVD), and lower mean CCA-IMT at baseline as significant factors associated with the increase in mean CCA-IMT. In addition, older age and lower mean CCA-IMT at baseline were significant factors for an increased absolute change in the maximum CCA-IMT at 24 months. The present sub-analysis of the PRIZE study showed higher body mass index, history of ASCVD, and older age as significant factors associated with CCA-IMT progression in patients with asymptomatic hyperuricemia. These factors may be considered when identifying the possible risk of atherosclerotic progression in this specific patient population of hyperuricemia. Trial registration: UMIN000012911 and UMIN000041322.
  • Tatsuro Yamazaki, Sho Okada, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi
    JACC: Case Reports 15 101851-101851 2023年6月  査読有り
  • Shinya Ichihara, Yuichi Saito, Osamu Hashimoto, Haruka Sasaki, Keita Yumoto, Susumu Oshima, Tetsuya Tobaru, Junji Kanda, Yoshiaki Sakai, Satoshi Yasuda
    JACC: Asia 3(3) 531-533 2023年6月  査読有り責任著者
  • Tadahiro Matsumoto, Hideki Kitahara, Tatsuro Yamazaki, Takashi Hiraga, Daichi Yamashita, Takanori Sato, Yuichi Saito, Ken Kato, Yoshio Kobayashi
    Cardiovascular Intervention and Therapeutics 38(4) 381-387 2023年5月19日  査読有り
  • Yuichi Saito, Taku Inohara, Shun Kohsaka, Hirohiko Ando, Hideki Ishii, Kyohei Yamaji, Tetsuya Amano, Yoshio Kobayashi, Ken Kozuma
    The American journal of cardiology 192 182-189 2023年4月1日  査読有り筆頭著者責任著者
    A lower institutional primary percutaneous coronary intervention (PCI) volume is associated with a higher risk of postprocedural poor outcomes, particularly in urgent or emergent settings (e.g., PCI for acute myocardial infarction [MI]). However, the individual prognostic impact of PCI volume stratified by indication and the relative ratio remains unclear. Using the Japanese nationwide PCI database, we investigated 450,607 patients from 937 institutions who underwent either primary PCI for acute MI or elective PCI. The primary end point was the observed/predicted in-hospital mortality ratio. The predicted mortality per patient was calculated using the baseline variables and averaged for each institution. The relation between the annual primary, elective, and total PCI volumes and institutional in-hospital mortality after acute MI was evaluated. The association between the primary-to-total PCI volume per hospital and mortality was also investigated. Of the 450,607 patients, 117,430 (26.1%) underwent primary PCI for acute MI, of whom 7,047 (6.0%) died during hospitalization. The median total PCI volume and primary-to-total PCI volume ratio were 198 (interquartile range 115 to 311) and 0.27 (0.20 to 0.36). Overall, the observed in-hospital mortality and observed/predicted mortality ratio in patients with acute MI were higher in institutions with lower primary, elective, and total PCI volumes. The observed/predicted mortality ratio was also higher in institutions with lower primary-to-total PCI volume ratios, even in high-PCI volume hospitals. In conclusion, in this nationwide registry-based analysis, lower institutional PCI volumes, regardless of setting, were associated with higher in-hospital mortality after acute MI. The primary-to-total PCI volume ratio provided independent prognostic information.
  • Kazuya Tateishi, Yuichi Saito, Hideki Kitahara, Yuki Shiko, Yohei Kawasaki, Hiroshi Nonogi, Yoshio Tahara, Naohiro Yonemoto, Ken Nagao, Takanori Ikeda, Naoki Sato, Yoshio Kobayashi
    Resuscitation 186 109779-109779 2023年3月22日  査読有り
    AIM OF THE STUDY: Defibrillation plays a crucial role in early return of spontaneous circulation (ROSC) and survival of patients with out-of-hospital cardiac arrest (OHCA) and shockable rhythm. Prehospital adrenaline administration increases the probability of prehospital ROSC. However, little is known about the relationship between number of prehospital defibrillation attempts and neurologically favourable survival in patients treated with and without adrenaline. METHODS: Using a nationwide Japanese OHCA registry database from 2006 to 2020, 1,802,084 patients with OHCA were retrospectively analysed, among whom 81,056 with witnessed OHCA and initial shockable rhythm were included. The relationship between the number of defibrillation attempts before hospital admission and neurologically favourable survival rate (cerebral performance category score of 1 or 2) at 1 month was evaluated with subgroup analysis for patients treated with and without adrenaline. RESULTS: At 1 month, 18,080 (22.3%) patients had a cerebral performance category score of 1 or 2. In the study population, the probability of prehospital ROSC and favourable neurological survival rate were inversely associated with number of defibrillation attempts. Similar trends were observed in patients treated without adrenaline, whereas a greater number of defibrillation attempts was counterintuitively associated with favourable neurological survival rate in patients treated with prehospital adrenaline. CONCLUSIONS: Overall, a greater number of prehospital defibrillation attempts was associated with lower neurologically favourable survival at 1 month in patients with OHCA and shockable rhythm. However, an increasing number of shocks (up to the 4th shock) was associated with better neurological outcomes when considering only patients treated with adrenaline.
  • Tatsuro Yamazaki, Yuichi Saito, Daichi Yamashita, Hideki Kitahara, Yoshio Kobayashi
    Diagnostics (Basel, Switzerland) 13(5) 2023年3月2日  
    Coronary microvascular dysfunction (CMD) is described as an important subset of ischemia with no obstructive coronary artery disease. Resistive reserve ratio (RRR) and microvascular resistance reserve (MRR) have been proposed as novel physiological indices evaluating coronary microvascular dilation function. The aim of this study was to explore factors associated with impaired RRR and MRR. Coronary physiological indices were invasively evaluated in the left anterior descending coronary artery using the thermodilution method in patients suspected of CMD. CMD was defined as a coronary flow reserve <2.0 and/or index of microcirculatory resistance ≥25. Of 117 patients, 26 (24.1%) had CMD. RRR (3.1 ± 1.9 vs. 6.2 ± 3.2, p < 0.001) and MRR (3.4 ± 1.9 vs. 6.9 ± 3.5, p < 0.001) were lower in the CMD group. In the receiver operating characteristic curve analysis, RRR (area under the curve 0.84, p < 0.001) and MRR (area under the curve 0.85, p < 0.001) were both predictive of the presence of CMD. In the multivariable analysis, previous myocardial infarction, lower hemoglobin, higher brain natriuretic peptide levels, and intracoronary nicorandil were identified as factors associated with lower RRR and MRR. In conclusion, the presence of previous myocardial infarction, anemia, and heart failure was associated with impaired coronary microvascular dilation function. RRR and MRR may be useful to identify patients with CMD.
  • Takanori Sato, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi
    Life (Basel, Switzerland) 13(3) 2023年2月24日  
    The GRACE risk score is established to predict thrombotic events in patients with acute coronary syndrome (ACS). Although thrombotic events including myocardial infarction after ACS are mainly attributable to vulnerable plaque formation, whether the GRACE score correlates with coronary lipid-rich plaque is unclear. A total of 54 patients with ACS undergoing primary percutaneous coronary intervention under near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) guidance were included in a prospective manner. Patients were divided into two groups according to the median of the GRACE risk score. Coronary lipid plaques in the target vessel were assessed by NIRS-IVUS with lipid core burden index (LCBI) and a maximum LCBI in 4 mm (maxLCBI4mm). The receiver operating characteristics (ROC) curve analysis was performed based on the major adverse cardiovascular events as an exploratory analysis. The GRACE risk score was significantly and positively correlated with LCBI (r = 0.31, p = 0.03) and maxLCBI4mm (r = 0.38, p = 0.006). LCBI (111.7 ± 85.7 vs. 169.0 ± 83.5, p = 0.02) and maxLCBI4mm (428.5 ± 227.1 vs. 600.6 ± 227.7, p = 0.009) in the target vessel were significantly higher in the high GRACE risk score group than their counterpart. In the ROC curve analysis, LCBI and maxLCBI4mm were predictive for clinical events. In conclusion, the higher GRACE risk score may serve as a discriminator of risk comprising more lipid-rich plaques as an underlying mechanism of an increased risk of thrombotic events after ACS. In patients with ACS, the higher GRACE risk score was significantly and modestly associated with greater coronary lipid plaques in the target vessel.
  • Yuichi Saito, Yoshio Kobayashi
    Cardiovascular Intervention and Therapeutics 2023年1月7日  招待有り筆頭著者責任著者
  • Daichi Yamashita, Yuichi Saito, Takanori Sato, Tadahiro Matsumoto, Sakuramaru Suzuki, Kan Saito, Shinichi Wakabayashi, Hideki Kitahara, Koichi Sano, Yoshio Kobayashi
    Internal Medicine 2023年  査読有り責任著者
  • Hiroki Goto, Yuichi Saito, Tadahiro Matsumoto, Takanori Sato, Daichi Yamashita, Sakuramaru Suzuki, Shinichi Wakabayashi, Hideki Kitahara, Koichi Sano, Yoshio Kobayashi
    Journal of Atherosclerosis and Thrombosis 2023年  査読有り責任著者
  • Yuichi Saito, Taku Inohara, Shun Kohsaka, Hideki Wada, Itaru Takamisawa, Kyohei Yamaji, Tetsuya Amano, Yoshio Kobayashi, Ken Kozuma
    American Heart Journal 258 69-76 2023年1月  査読有り筆頭著者責任著者
    BACKGROUND: Identification of and therapeutic approaches to standard modifiable risk factors (SMuRFs), including hypertension, diabetes, dyslipidemia, and smoking, have led to improved survival of patients at risk for coronary events. However, recent studies have indicated that a significant proportion of patients with acute myocardial infarction (AMI) have no SMuRFs. We aimed to assess in-hospital outcomes and the prevalence of these patients using the Japanese nationwide percutaneous coronary intervention (J-PCI) registry. METHODS: The J-PCI is a procedure-based registration program in Japan. A total of 115,437 PCI procedures were performed on patients with AMI between January 2019 and December 2020. The participants were divided into 2 groups: those with at least 1 SMuRF and those without any SMuRFs. The primary outcome was in-hospital mortality. RESULTS: Of the 115,437 patients with AMI, 1,777 (1.6%) had no SMuRFs. Patients without SMuRFs were older; more likely to have left main disease; and more likely to present with heart failure, cardiogenic shock, and cardiac arrest than those with SMuRFs, resulting in higher rates of mechanical circulatory support use and impaired post-PCI coronary blood flow. In-hospital mortality was significantly higher in patients without SMuRFs than in those with SMuRFs (18.3% vs 5.3%, P < .001), irrespective of the presence or absence of ST-segment elevation. CONCLUSIONS: In Japan, where annual health checks are mandated under universal health care coverage, the vast majority of patients with AMI undergoing PCI have SMuRFs. However, although small in number, patients without SMuRFs are more likely to present with life-threatening conditions and have worse in-hospital survival.
  • Yuichi Saito, Osamu Hashimoto, Takashi Nakayama, Haruka Sasaki, Keita Yumoto, Susumu Oshima, Tetsuya Tobaru, Shunichi Kushida, Junji Kanda, Yoshiaki Sakai, Shinichi Okino, Shigeru Fukuzawa, Akihiko Abiko, Tomonori Itoh, Yoshitake Nakamura, Takahiro Nakashima, Satoshi Yasuda, Kenji Goto, Hideo Takebayashi, Takashi Oshitomi, Tomohiro Sakamoto, Sunao Kojima, Yoritaka Otsuka, Toshiharu Himi, Yusuke Inagaki, Junichi Yamaguchi, Kenichi Hagiya, Mamoru Nanasato, Yoshio Kobayashi
    International Journal of Cardiology 371 49-53 2023年1月  査読有り筆頭著者責任著者
    BACKGROUND: Type A acute aortic dissection (AAD) complicated by coronary malperfusion is a life-threatening disease. In the present study, we compared the clinical characteristics and prognostic impact of treatment strategies including surgical treatment and percutaneous coronary intervention (PCI) in type A AAD patients with RCA and LCA involvement. METHODS: This multicenter registry included 220 patients with type A AAD and either RCA or LCA involvement. Treatment strategies were left to treating physicians. The primary endpoint was in-hospital death. RESULTS: Of 220 patients, 115 (52.3%) and 105 (47.7%) had RCA and LCA involvement. Patients with LCA involvement were more1 likely to present with Killip class IV on admission than those with RCA involvement. Coronary angiography was performed in 52 of 220 (23.6%) patients, among whom 39 (75.0%) underwent subsequent PCI. During the hospitalization, 93 (42.3%) patients died. Patients with LCA involvement had an increased risk of in-hospital mortality compared to those with RCA involvement (54.3% vs. 31.3%, p < 0.001). In patients with RCA involvement, multivariable analysis identified Killip class IV and no surgical treatment as predictors of in-hospital death, while PCI and surgical treatment were indicated as factors associated with lower in-hospital mortality in patients with LCA involvement. CONCLUSIONS: The rates of RCA and LCA involvement were similar in type A AAD. Immediate PCI as a bridge to subsequent surgical treatment might improve survival in patients with type A AAD complicated by coronary malperfusion, especially in those with LCA involvement.
  • Tatsuro Yamazaki, Yuichi Saito, Daichi Yamashita, Hideki Kitahara, Yoshio Kobayashi
    Heart and Vessels 2022年12月9日  査読有り責任著者
  • Kazunari Asada, Yuichi Saito, Takanori Sato, Tadahiro Matsumoto, Daichi Yamashita, Sakuramaru Suzuki, Shinichi Wakabayashi, Hideki Kitahara, Koichi Sano, Yoshio Kobayashi
    Circulation Journal 2022年11月23日  査読有り責任著者
    BACKGROUND: In patients with acute myocardial infarction (AMI), elevated natriuretic peptide (NP) concentrations are reportedly associated with worse clinical outcomes. This study evaluated the prognostic value of NP concentrations and in-hospital heart failure (HF) events after AMI.Methods and Results: The present bicenter registry included 600 patients with AMI undergoing percutaneous coronary intervention. HF was evaluated at 3 different time points after AMI: on admission, during hospitalization, and at the short-term follow-up at 1 month. When HF was present at each time point, 1 point was assigned to the "HF time points" (HFTP) risk scoring system; possible total scores on this system ranged from 0 to 3. The primary endpoint was a composite of all-cause death and HF rehospitalization after discharge. Among the 600 patients who survived to discharge, the primary outcome occurred in 69 (11.5%) during a mean follow-up period of 488 days. HF on admission, during hospitalization, and at the short-term follow-up were all significantly associated with subsequent clinical outcomes. Higher scores on the HFTP scoring system were related to an increased risk of the primary endpoint. Multivariable analysis indicated scores of 2 and 3 were independently associated with outcome events in a stepwise manner. CONCLUSIONS: Among patients with AMI, HF evaluation at different time points was useful in stratifying risks of mortality and HF rehospitalization after discharge.
  • Takanori Sato, Yuichi Saito, Sakuramaru Suzuki, Tadahiro Matsumoto, Daichi Yamashita, Kan Saito, Shinichi Wakabayashi, Hideki Kitahara, Koichi Sano, Yoshio Kobayashi
    Life 12(10) 1672-1672 2022年10月21日  査読有り責任著者
    Among patients with acute myocardial infarction (MI) complicated by cardiogenic shock (CS), in-hospital mortality remains high. In the present study, we aimed to identify factors associated with clinical outcomes of acute MI patients with CS in a contemporary setting. A total of 1102 patients with acute MI undergoing primary percutaneous coronary intervention were included, among whom 196 (17.8%) were complicated by CS. The primary outcome was all-cause death during hospitalization, and factors associated with in-hospital mortality were explored in patients with acute MI and CS. Of the 196 patients with acute MI complicated by CS, 77 (39.3%) died during hospitalization. The rates of non-ST-segment elevation MI (NSTEMI) (33.8% vs. 19.3%, p = 0.02) and culprit lesion in the left main or left anterior descending coronary artery (68.8% vs. 47.9%, p = 0.004) were higher, while left ventricular ejection fraction (LVEF) was lower (24.4 ± 11.7% vs. 39.7 ± 13.8%, p &lt; 0.001) in non-survivors than in survivors. Multivariable analysis identified NSTEMI presentation and lower LVEF as independent predictors of in-hospital death. In conclusion, NSTEMI and low LVEF were identified as factors associated with higher in-hospital mortality. The identification of even higher-risk subsets and targeted therapeutic strategies may be warranted to improve survival of patients with acute MI and CS.
  • Takashi Hiraga, Yuichi Saito, Kazuya Tateishi, Naoto Mori, Takayo Murase, Takashi Nakamura, Seigo Akari, Kan Saito, Hideki Kitahara, Yoshio Kobayashi
    Medicina 58(10) 1423-1423 2022年10月10日  査読有り責任著者
    Background and Objectives: Although previous studies showed that an activity of xanthine oxidoreductase (XOR), a rate-limiting enzyme in purine metabolism, beyond the serum uric acid level, was associated with the development of coronary artery disease (CAD), the underlying mechanisms are unclear. Because endothelial dysfunction and a greater blood pressure (BP) variability may play a role, we investigated the relations among the endothelial function, XOR, and BP variability. Materials and Methods: This was a post-hoc study using pooled data of patients with a stable CAD from two prospective investigations, in which the systemic endothelial function was assessed with the reactive hyperemia index (RHI) and the XOR activity was measured. The BP variability was evaluated using BP measurements during the three- and four-day hospitalization. Results: A total of 106 patients with a stable CAD undergoing a percutaneous coronary intervention were included. Of the 106 patients, 46 (43.4%) had a systemic endothelial dysfunction (RHI &lt; 1.67). The multivariable analysis identified a higher body mass index (BMI), female gender, and diabetes as factors associated with an endothelial dysfunction. A higher BMI was also related to an elevated XOR activity, in addition to current smoking. No significant correlation was observed between the RHI and XOR activity. Similarly, the in-hospital BP variability was associated with neither the endothelial function nor XOR. Conclusions: Among patients with a stable CAD, several factors were identified as being associated with a systemic endothelial dysfunction or an elevated XOR activity. However, no direct relations between the endothelial function, XOR, and BP variability were found.
  • Kazuya Tateishi, Yuichi Saito, Tatsuro Yamazaki, Hideki Kitahara, Yoshio Kobayashi
    Diabetes Epidemiology and Management 8 100104-100104 2022年10月  査読有り
  • Yuichi Saito, Atsushi Tanaka, Yuji Koide, Hisako Yoshida, Daigaku Uchida, Kazuo Matsunaga, Naoto Yokota, Chikara Ueyama, Yoshio Kobayashi, Koichi Node
    RMD Open 8(2) e002505-e002505 2022年9月  査読有り筆頭著者責任著者
    Objectives Although uric acid lowering therapies, including xanthine oxidase (XO) inhibition, may reduce the absolute level of blood pressure (BP), the effect of XO inhibition on BP variability is largely unknown. The aim of the present analysis was to evaluate the impact of febuxostat, an XO inhibitor, on BP variability in a randomised trial setting. Methods This was a subanalysis of the PRIZE Study, a randomised trial to evaluate the potential effect of febuxostat on carotid intima–media thickness progression. Patients with hyperuricemia and carotid plaques were randomly assigned to the febuxostat or control group. During a 24-month period, office BP and pulse rate (PR) were measured ≥3 times. BP and PR variabilities were assessed with SD and coefficient of variation (CV). The effect of febuxostat on BP and PR variabilities was adjusted with age, sex and baseline BP or PR, expressed with 95% CIs. Results A total of 472 patients were included into the present subanalysis. During the 24-month follow-up period, the febuxostat group had a significantly lower adjusted mean systolic BP (128.4 (126.8–130.0) vs 130.7 (129.1–132.2) mm Hg, p=0.04) and CV of systolic BP (7.4 (6.7–8.0) vs 8.2 (7.6–8.8), p=0.04) than the control group. Adjusted SD of PR was also lower in the febuxostat group than their counterpart (5.95 (4.93–6.97) vs 7.33 (6.32–8.33), p=0.04). Conclusion XO inhibition with febuxostat was associated with reduced visit-to-visit BP variability as well as reduced PR variability in patients with hyperuricemia and carotid plaques. Trial registration numbers University Hospital Medical Information Network Clinical Trial Registry (UMIN000012911 and UMIN000041322).
  • Daichi Yamashita, Yuichi Saito, Takanori Sato, Tadahiro Matsumoto, Sakuramaru Suzuki, Kan Saito, Shinichi Wakabayashi, Hideki Kitahara, Koichi Sano, Yoshio Kobayashi
    Internal Medicine 2022年9月  査読有り責任著者
    Objective Oral diseases, including periodontitis and stomatitis, are highly prevalent worldwide and reportedly associated with the development of cardiovascular disease. Given the high rate of stomatitis in individuals wearing dentures, denture users may be at high risk of poor cardiovascular outcomes. We therefore investigated whether or not the use of dentures is associated with a poor clinical outcome in patients with acute myocardial infarction (MI). Methods This two-center retrospective observational study was conducted between January 2012 and March 2020. A total of 1046 patients with acute MI who underwent primary percutaneous coronary intervention were divided into two groups according to denture use status. The primary outcomes included ischemic events (cardiovascular death, recurrent MI, and ischemic stroke) and major bleeding (Bleeding Academic Research Consortium type 3 or 5). Results Of the 1046 patients with acute MI, 387 (37.0%) used dentures. An older age and prior MI were associated with an increased likelihood of denture use. During the mean 660-day follow-up period, ischemic and major bleeding events occurred in 169 (16.2%) and 102 (9.8%) patients, respectively. Denture use was associated with an increased risk of ischemic events, whereas no significant intergroup differences were observed in major bleeding outcomes. The results were similar among patients ≥75 years old. Conclusions More than one-third of the patients with acute MI wore dentures. Our findings suggest that denture use is significantly associated with an increased risk of ischemic events but not bleeding outcomes after acute MI.
  • Sakuramaru Suzuki, Yuichi Saito, Daichi Yamashita, Tadahiro Matsumoto, Takanori Sato, Shinichi Wakabayashi, Hideki Kitahara, Koichi Sano, Yoshio Kobayashi
    Heart, Lung and Circulation 31(9) 1228-1233 2022年9月  査読有り責任著者
    BACKGROUND: Recently, the impact of the lack of standard modifiable risk factors, including hypertension, diabetes, dyslipidaemia, and current smoking, has been investigated in ST-segment elevation myocardial infarction (MI). The present study aimed to evaluate clinical characteristics and prognosis of the patients with no standard risk factors in acute MI. METHODS: This bi-centre registry included 1,093 patients with acute MI undergoing percutaneous coronary intervention. The participants were divided into two groups: patients having at least one of the four standard risk factors and those having none of the risk factors. The study endpoints included major adverse cardiovascular events (MACE) (death, recurrent MI, and stroke) and major bleeding events during hospitalisation. Any MACE and major bleeding events after discharge were also evaluated as an exploratory analysis. RESULTS: Of 1,093 patients, 64 (5.9%) had none of the four standard risk factors. The patients with no standard risk factors were likely to present with Killip class IV and cardiac arrest. The rate of in-hospital MACE was higher in patients with no risk factors than in their counterparts (25.0% vs 9.9%; p<0.001), whereas the incidence of in-hospital major bleeding was not significantly different between the two groups (9.4% vs 6.7%; p=0.44). Active cancer and autoimmune/inflammatory diseases were often found in patients with no standard risk factors. After discharge, no significant differences were observed in the risks of MACE and major bleeding events between the two groups. CONCLUSIONS: No standard modifiable risk factors were not uncommon and were associated with poor short-term outcomes in patients with acute MI.
  • Takahiro Kobayashi, Hideki Kitahara, Ken Kato, Yuichi Saito, Yoshio Kobayashi
    Circulation journal : official journal of the Japanese Circulation Society 2022年8月27日  
    BACKGROUND: Dialysis patients have strong intracoronary calcification, accelerated by secondary hyperparathyroidism as well as atherosclerosis. We evaluated the association of intact parathyroid hormone (iPTH) level with intracoronary calcification evaluated by intravascular ultrasound (IVUS), and its impact on both stent expansion after percutaneous coronary intervention (PCI) and long-term clinical outcomes, in dialysis patients with coronary artery disease (CAD).Methods and Results: A total of 116 patients on dialysis, who underwent PCI with IVUS guidance between March 2012 and December 2020, were enrolled. Patients were divided into 2 groups based on their median iPTH level. The degree of intracoronary calcification was evaluated by calcification score using grayscale IVUS in the target lesions. Preprocedural calcification scores were significantly higher in the high iPTH group compared with the low iPTH group (2.9±1.1 vs. 2.1±0.7, P<0.001). After PCI, the high iPTH group had a significantly lower stent expansion index (0.6±0.2 vs. 0.7±0.1, P<0.001) and stent symmetry index (0.5±0.1 vs. 0.7±0.1, P<0.001) compared with the low iPTH group. The incidence of major adverse cardiac or cerebrovascular events within 3 years was significantly higher in the high iPTH group (log-rank P<0.05). CONCLUSIONS: High iPTH level is likely to increase intracoronary calcification, and cause inadequate stent expansion, which may be associated with increased risk of future adverse events in dialysis patients with CAD requiring PCI.
  • Kan Saito, Yuichi Saito, Hideki Kitahara, Yoshio Kobayashi
    Heart and Vessels 38(1) 32-39 2022年7月8日  査読有り
    This study aims to clarify the impact of myocardial bridge (MB) on the presence and progression of atherosclerosis in left descending coronary artery (LAD) in patients with acute coronary syndrome (ACS). Ninety-eight patients who underwent percutaneous coronary intervention with the diagnosis of ACS and follow-up coronary angiography but had no significant stenosis in the LAD were included. MB was defined based on coronary angiography. Quantitative coronary angiography was performed to determine the segments where MB was present and proximal to the MB (proximal segment) in patients with MB. In patients without MB, a corresponding region was quantitatively analyzed. The primary endpoint was changes in minimum lumen diameter (MLD) and percentage of diameter stenosis (%DS) in the proximal segment from baseline to follow-up angiography, namely ΔMLD and Δ%DS. MB was identified in 29 (29.6%) patients. Patients with MB had larger MLD and smaller %DS in the proximal segment than their counterpart. During the mean follow-up period of 12.9 ± 5.7 months, MLD and %DS in the proximal segment did not change significantly from baseline to follow-up in patients with and without MB. No significant between-group differences were observed in ΔMLD and Δ%DS. Baseline MLD was identified as the only factor associated with ΔMLD in the proximal segment. ACS patients who had MB but no significant stenosis in the LAD had larger MLD and smaller %DS at the segment proximal to MB compared to those without. In this selected population, serial lumen changes assessed by ΔMLD were not associated with the presence of MB in the LAD.

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