Publications by authors named "Ko Yamamoto"
Low-Gradient Severe Aortic Stenosis: Insights From the CURRENT AS Registry-2.
JACC Cardiovasc Interv
November 2024
Background: Low-gradient (LG) aortic stenosis (AS) has not been fully characterized compared with high-gradient (HG) AS in terms of cardiac damage, frailty, aortic valve calcification, and clinical outcomes.
Objectives: The aim of this study was to compare the clinical characteristics and outcomes between each hemodynamic type of LG AS and HG AS.
Methods: The current study included 3,363 patients in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) Registry-2 after excluding patients without indexed stroke volume or left ventricular ejection fraction (LVEF) data.
There is a scarcity of data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and chronic kidney disease (CKD). The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1015 patients who underwent multivessel IVUS-guided PCI including left anterior descending coronary artery target with an intention to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared the clinical outcomes between patients with and without CKD.
View Article and Find Full Text PDFBackground: There is a paucity of data on safety of calcium channel blockers (CCB) in patients with severe aortic stenosis (AS) and hypertension.
Methods And Results: Among 2,460 patients with severe AS and hypertension receiving antihypertensive therapy in the CURRENT AS registry-2, we compared the clinical outcomes between patients taking antihypertensive therapy with CCB (CCB group) and without CCB (no CCB group). In the entire study population, CCB was prescribed in 1,763 patients (71.
Article Synopsis
- * TAVI centers preferred aortic valve replacement (AVR) treatments, with a higher percentage opting for transcatheter aortic valve implantation (TAVI) compared to non-TAVI centers (71% vs. 23%).
- * Despite the differences in treatment frequency, both types of centers showed similar rates of all-cause death or heart failure hospitalizations over three years, indicating no significant outcome difference.
Aims: Safety of aspirin-free strategy immediately after percutaneous coronary intervention (PCI) for cardiovascular events in patients with diabetes was unknown.
Methods And Results: We conducted the prespecified subgroup analysis on diabetes in the STOPDAPT-3 trial, which randomly compared prasugrel (3.75 mg/day) monotherapy (2984 patients) to dual antiplatelet therapy (DAPT) with prasugrel and aspirin (2982 patients) in patients with acute coronary syndrome or high bleeding risk.
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View Article and Find Full Text PDFBackground: Cognitive impairment assessed using the Mini-Mental Status Examination (MMSE) is associated with short-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of cognitive impairment in patients with severe aortic stenosis post-TAVI.
Methods And Results: We enrolled 1,057 consecutive patients who underwent TAVI at the Kokura Memorial Hospital and prospectively assessed them using the MMSE.
Article Synopsis
- A trial, STOPDAPT-3, was conducted to compare aspirin monotherapy and clopidogrel monotherapy after short-term dual antiplatelet therapy in patients who underwent percutaneous coronary intervention using drug-eluting stents.
- The study involved 5,833 patients who were followed for 30 days, focusing on cardiovascular events (like heart attacks) and bleeding complications as primary endpoints.
- Results showed that aspirin and clopidogrel monotherapy had similar rates of cardiovascular and bleeding events up to one year after the intervention, indicating both treatments are equally effective in these contexts.
Article Synopsis
- Proton pump inhibitors (PPIs) were studied for their effects on upper gastrointestinal bleeding (UGIB) in patients who underwent percutaneous coronary intervention (PCI), with findings from a large patient registry of 24,563 participants.
- Over a median follow-up of 5.6 years, PPIs significantly reduced the risk of UGIB but showed no impact on myocardial infarction or ischemic strokes, regardless of high-risk patient subgroups.
- Although PPIs helped lower UGIB risk, they were also linked to higher mortality rates, suggesting a complex benefit-risk profile in these patients.
Article Synopsis
- - The study analyzed the impact of using an aspirin-free strategy versus dual antiplatelet therapy (DAPT) in patients undergoing coronary intervention while on oral anticoagulation (OAC).
- - Among nearly 6,000 patients, the outcomes showed no significant difference in major bleeding events between the two strategies, regardless of OAC use.
- - However, there was a slightly higher risk of cardiovascular events with the aspirin-free approach in patients taking OAC, suggesting potential concerns about this strategy's safety in high-risk groups.
Article Synopsis
- A study investigated the prevalence and effects of cerebrovascular disease found on pre-procedure CT scans in patients undergoing aortic valve replacement (AVR) due to severe aortic stenosis.
- Out of 567 patients, 35.3% had cerebrovascular disease, but only 28.5% of these patients reported prior strokes.
- The findings revealed that those with cerebrovascular disease had a significantly higher 3-year incidence of death or stroke (40.7%) compared to those without (24.1%), indicating they faced worse clinical outcomes regardless of their history of symptomatic stroke.
Article Synopsis
- Current guidelines suggest avoiding anticoagulation after PCI for acute coronary syndrome (ACS), but this recommendation lacks strong evidence.
- In a study analyzing outcomes of patients with ACS who did or did not receive post-PCI heparin, those receiving heparin had a significantly higher risk of bleeding and a slightly increased risk of cardiovascular events.
- The use of post-PCI heparin in ACS patients was common, but it was linked to increased bleeding without demonstrating any clear benefit in reducing serious cardiovascular outcomes.
Background: The semiquantitative Clinical Frailty Scale (CFS) is reportedly a useful marker for predicting short- and mid-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of CFS in patients with severe aortic stenosis undergoing TAVI.
Methods: We prospectively assessed patients undergoing TAVI in Kokura Memorial Hospital using a 9-level CFS and enrolled 1594 patients after excluding patients with CFS 8-9.
Article Synopsis
- The study examined the impact of very low levels of low-density lipoprotein cholesterol (LDL-C) on patients with coronary artery disease, using data from over 39,000 patients who underwent coronary revascularization.
- It was found that patients with very low LDL-C levels (<85 mg/dL) had more health issues and a higher risk of all-cause mortality compared to those with higher levels, revealing significant risks for various types of death and heart failure.
- Overall, the research suggests that lower LDL-C levels correlate with more serious health problems and increased mortality risk, highlighting the need for careful management of cholesterol levels in at-risk patients.
Background: There is a scarcity of data on the prevalence of abnormal findings on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with aortic stenosis (AS).
Methods: Among consecutive 593 patients with severe AS who were planned to undergo AVR, we evaluated the prevalence of clinically significant incidental noncardiac findings on preprocedural CT. Clinically significant incidental noncardiac findings were defined as newly detected abnormalities that required therapy, consultation for expert, further investigation, or clinical follow-up.
Background: There was no study evaluating the effects of an aspirin-free strategy in patients undergoing complex percutaneous coronary intervention (PCI).
Objectives: The authors aimed to evaluate the efficacy and safety of an aspirin-free strategy in patients undergoing complex PCI.
Methods: We conducted the prespecified subgroup analysis based on complex PCI in the STOPDAPT-3 (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3), which randomly compared low-dose prasugrel (3.
There is a scarcity of data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and diabetes. The Optimal Intravascular Ultrasound Guided Complex Percutaneous Coronary Intervention study multivessel cohort was a prospective, multicenter, single-arm trial enrolling 1,021 patients who underwent multivessel PCI, including left anterior descending coronary artery using IVUS, aiming to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared the clinical outcomes between those patients with and without diabetes.
View Article and Find Full Text PDFArticle Synopsis
- The study analyzed the presence of mitral regurgitation (MR) in patients with severe aortic stenosis (AS) and how it relates to different treatment methods: TAVI, SAVR, and conservative management.
- Among the 3,365 patients examined, 384 (11.4%) had moderate/severe MR, and this group showed a significantly higher 3-year incidence of death or heart failure (HF) hospitalization compared to those with no/mild MR.
- The risk of death or HF hospitalization was notably higher in patients treated with SAVR and conservative strategies, while this risk was less clear in those who underwent TAVI.
The sex disparity in outcomes of patients with cardiovascular disease is well-described and has persisted across recent decades. While there have been several proposed mechanisms to explain this disparity, there are limited data on female patient-physician sex concordance and its association with outcomes. The authors review the existing literature on the relationship between patient-physician sex concordance and clinical outcomes in patients with cardiovascular disease, the evidence of a benefit in clinical outcomes with female patient-physician sex concordance, and the possible drivers of such a benefit and highlight directions for future study.
View Article and Find Full Text PDFAspirin-free strategy for percutaneous coronary intervention in acute coronary syndrome based on the subtypes of acute coronary syndrome and high bleeding risk: the STOPDAPT-3 trial.
Eur Heart J Cardiovasc Pharmacother
August 2024
Article Synopsis
Article Synopsis
- A study analyzed long-term mortality in patients with severe coronary artery disease who underwent either PCI or CABG, focusing on those with peripheral artery disease (PAD).
- Out of 14,867 patients, 3,380 were assessed, revealing a higher cumulative 5-year mortality rate of 31.2% for patients with PAD compared to 16.2% for those without.
- The findings indicated that while both procedures carried a higher risk of all-cause death for PCI versus CABG, there was no significant difference in cardiovascular deaths based on PAD status.
Background: Left atrial appendage closure (LAAC) usually requires contrast medium during the procedure. However, patients with chronic kidney disease (CKD) are at high risk of developing contrast nephropathy. This study aimed to assess the safety and feasibility of zero-contrast LAAC in patients with CKD.
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