Publications by authors named "Shun Kohsaka"
This study aims to compare 1-year outcomes after transcatheter aortic valve replacement (TAVR) between patients with moderate-severe MR and severe MR preoperatively using the Japan Transcatheter Valve Therapy (J-TVT) registry. Patients undergoing TAVR for aortic stenosis between August 2013 and December 2019 with preoperative mitral regurgitation of moderate-severe (group MR3) or severe (group MR4) were included. Patients with a history of valve surgery and dialysis patients were excluded.
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- Diabetes is a significant risk factor for cardiovascular diseases but exhibits a "diabetes paradox" in Takotsubo syndrome, where it may not negatively affect outcomes, although this remains debated.
- In a study analyzing 1,226 Takotsubo syndrome patients, the prevalence of diabetes was found to be similar to that of the general population (17.0% vs. 15.8%).
- The study concluded that diabetes does not have a protective effect in Takotsubo syndrome and may even be linked to higher in-hospital mortality rates, challenging the belief that diabetes could be beneficial in this context.
Article Synopsis
- Multidisciplinary self-care education is vital for managing hospitalized heart failure (HF) patients, and the study examines if confidence in self-care during hospitalization impacts post-discharge performance and outcomes.
- Researchers assessed 100 HF patients' self-care confidence and behaviors during hospitalization and one year post-discharge, using questionnaires and logistic regression analysis to find links between self-care confidence, performance, and long-term health outcomes.
- Results showed that low self-care confidence during hospitalization led to poor post-discharge self-care performance, particularly affecting patients with reduced ejection fraction and those with previous HF hospitalizations, but overall, post-discharge self-care behavior did not significantly impact 2-year mortality and readmission rates.
Obesity hypoventilation syndrome (OHS) is caused by complex interactions between multiple pathological processes, including diminished respiratory drive and sleep-related breathing alterations, leading to structural and functional respiratory impairment and ultimately, pulmonary hypertension (PH). Because PH is closely associated with OHS, thoroughly evaluating its etiology is essential, and individualized treatments must be considered. We describe two patients with OHS exhibiting severe PH with pulmonary vascular resistance exceeding 5 Wood units; both were classified as Group 1 PH, i.
View Article and Find Full Text PDFCardiovascular diseases (CVD) have imposed a substantial burden on population health and society. In Japan, the National Plan for the Promotion of Measures Against Cerebrovascular and Cardiovascular Disease, grounded in national legislation, seeks to improve the quality of care and standardize treatment for cerebrovascular disease and CVD. The plan emphasizes the need to develop standardized systems for collecting and disseminating medical information, as well as promoting data-driven research.
View Article and Find Full Text PDFPatients hospitalized for heart failure (HF) experience impairments in functional status, primarily affecting basic activities of daily living (ADL). We investigated the independent effect of functional status for ADL on patient-centered outcomes (i.e.
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- The study examines the use and outcomes of P2Y inhibitor pretreatment in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the U.S. from 2013 to 2023.
- P2Y inhibitor pretreatment rates decreased significantly from 24.8% to 12.4% over the study period, with only 15.9% in a recent cohort showing such treatment.
- There was notable variability in pretreatment rates among different operators and institutions, with no significant difference in in-hospital mortality between those who received pretreatment and those who did not.
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- The study investigates gender disparity in interventional cardiology, focusing on the outcomes of percutaneous coronary interventions (PCIs) performed by female interventionalists in Japan.
- A total of 447 female operators conducted 35,211 PCIs during the study, showing that female doctors treated more patients with severe heart conditions but had a higher overall success rate than male doctors.
- Results indicate that female operators had similar in-hospital mortality rates compared to male operators, but the findings highlight the need for increased gender diversity in the field.
Aim: To assess the cost-effectiveness of diabetic nephropathy treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors in Japanese clinical practice, considering diabetes-related complications.
Materials And Methods: A population-based Monte Carlo simulation was used to estimate the cost-effectiveness for people with diabetic nephropathy who initiated pharmacotherapy with an SGLT2 inhibitor plus conventional treatment or conventional treatment alone, based on quality-adjusted life-years (QALYs) and healthcare costs. The Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation study (CREDENCE) and the Japanese Society for Dialysis Research statistical survey were the primary sources of probability and mortality, while Japanese Health Insurance Claims Data were the cost source.
Background: The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results.
Methods: We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions.
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- In patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), careful use of antiplatelet medications is vital to prevent blood clots but poses a risk for severe bleeding complications, especially gastrointestinal bleeding (GIB).
- This study analyzed data from the JCD-KiCS-PCI registry, focusing on 8,864 CAD patients, categorizing them based on the occurrence of GIB within two years post-PCI.
- Results indicated that the rates of dual and triple antiplatelet therapy varied significantly among patients with GIB compared to those without, highlighting the importance of monitoring bleeding risks associated with long-term antiplatelet use.
Background: The increasing prevalence of frailty has gained considerable attention due to its profound influence on clinical outcomes. However, our understanding of the progression of frailty and long-term clinical outcomes in older individuals with atrial fibrillation remains scarce.
Methods: Using data from 2012 to 2018 from a comprehensive claims database incorporating primary and hospital care records in Shizuoka, Japan, we selected patients aged ≥65 years with atrial fibrillation who initiated oral anticoagulant therapy.
Background: Although the use of intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes, its utilization remains inconsistent. We aimed to assess the association between IVUS-guided PCI and long-term outcomes in Japan, where a high proportion of patients undergo IVUS.
Methods: We analyzed 8721 consecutive patients in a multicenter PCI registry.
Percutaneous coronary intervention for left main coronary artery disease (LM-PCI) represents a high-risk yet life-saving procedure that has evolved significantly over the years. This review outlines the current state-of-the-art practices for LM-PCI in Japan in detail, emphasizing the integration of coronary physiology and intracoronary imaging alongside with evidence-based standardized technique using latest drug-eluting stents. These advancements enable precise lesion assessment, stent sizing, and optimal deployment, thereby enhancing procedural safety and efficacy.
View Article and Find Full Text PDFBackground: Low-dose prasugrel (3.75 mg) is used as maintenance therapy for percutaneous coronary intervention; however, data on long-term outcomes are scarce.
Methods And Results: We analyzed 5,392 participants in the KiCS-PCI registry who were administered low-dose prasugrel or clopidogrel at discharge between 2008 and 2018 and for whom 2-year follow-up data were available.
In this study of 19,824 ST-elevated myocardial infarction (STEMI) patients from the J-PCI OUTCOME registry (January 1, 2017, to December 31, 2018), we investigated the association between door-to-balloon time (DTB) and 1-year post-discharge cardiovascular outcomes. Patients with DTB >90 min were older and had higher comorbidities. The incidence of 1-year major adverse cardiovascular events (MACE) showed an incremental increase: 3.
View Article and Find Full Text PDFBecause of its superior safety profile and improved outcomes, trans-radial percutaneous coronary intervention (TRI) has become the preferred access in percutaneous coronary intervention (PCI) of native coronary disease. This study investigated the impact of TRI on in-hospital outcomes after PCI for coronary artery bypass graft vessels (GV-PCI). We analyzed patients who underwent GV-PCI in 2019-2022 from the Japanese nationwide registry.
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- - The study analyzed data from 3,089 patients with DeBakey type I/II acute aortic dissection to assess the differences in clinical presentation and outcomes based on sex during treatment.
- - Findings indicated that women generally presented with more severe conditions (e.g., hyperlipidemia, altered consciousness) and had higher rates of specific complications, while men had higher surgical mortality and preoperative complications.
- - In surgical patients, male sex was linked to a significantly higher in-hospital mortality rate, but no similar association was observed in medically treated patients, highlighting the need for further investigation into these outcomes.
Background: Although technological improvements in intravascular ultrasound (IVUS) may reduce technical failures in endovascular therapy (EVT), perioperative complications (POCs) associated with IVUS use may increase.
Aims: This study investigated the impact of IVUS on periprocedural outcomes in symptomatic lower-extremity artery disease (LEAD) patients undergoing EVT.
Methods: This study evaluated 28,088 symptomatic LEAD patients who underwent EVT between January 2021 and December 2021 using a prospective nationwide registry in Japan.
Primary Prevention of Coronary and Other Cardiovascular Diseases: A Focused Review.
J Atheroscler Thromb
August 2024
In 2022, the Japan Atherosclerosis Society (JAS) updated its prevention guidelines, the "Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022" (JAS2022GL), expanding its scope from coronary artery disease (CAD) to atherosclerotic cardiovascular diseases (ASCVDs), including atherothrombotic stroke. The following year, the Japanese Circulation Society (JCS) updated its guidelines for primary prevention entitled "JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease" (JCS2023GL). Since those publications, scientific advancements in relevant fields have continued.
View Article and Find Full Text PDFBackground: Renin-angiotensin system inhibitors (RASI) reduce adverse cardiovascular events in patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤40% and mild or moderate chronic kidney disease (CKD). However, RASI administration rate and its association with long-term outcomes in patients with CKD complicated by HF with LVEF >40% remain unclear.
Methods: We analyzed 1923 consecutive patients with LVEF >40% registered within the multicenter database for hospitalized HF.