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  • 1
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    Online Resource
    An overview of percutaneous coronary intervention in dialysis patients: Insights from a Japanese nationwide registry
    Wiley ; 2019
    In:  Catheterization and Cardiovascular Interventions Vol. 94, No. 1 ( 2019-07)
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 94, No. 1 ( 2019-07)
    Abstract: This study sought to provide an overview of percutaneous coronary intervention (PCI) in dialysis patients from a Japanese nationwide registry. Background Little is known about dialysis patients undergoing PCI because few are enrolled in clinical trials. Methods We analyzed 624,900 PCI cases including 41,384 dialysis patients (6.6%) from 1,017 Japanese hospitals between 2014 and 2016. We investigated differences in characteristics and in‐hospital outcomes between dialysis and nondialysis patients, and assessed factors associated with an increased risk of adverse outcomes. Results Dialysis patients had more comorbidities than nondialysis patients and higher rates of complications including in‐hospital mortality (3.3% vs. 1.5%, respectively, in the acute coronary syndrome [ACS] cohort, 0.2% vs. 0.1% in the non‐ACS cohort) and bleeding complications requiring blood transfusion (1.1% vs. 0.4% in ACS, 0.5% vs. 0.2% in non‐ACS). Dialysis was significantly associated with an increased risk of in‐hospital mortality (odds ratio [OR] : 1.42, 95% confidence interval [CI]: 1.24–1.62 in ACS, OR: 2.25, 95% CI: 1.66–3.05 in non‐ACS) and bleeding (OR: 1.60, 95% CI: 1.30–1.96 in ACS, OR: 1.55, 95% CI: 1.27–1.88 in non‐ACS). For dialysis patients, age, acute heart failure, and cardiogenic shock were associated with an increased risk of in‐hospital mortality in the ACS cohort, whereas age, female gender, and history of heart failure were associated with higher in‐hospital mortality in the non‐ACS cohort. Conclusions PCI was widely performed for dialysis patients with either ACS or non‐ACS in Japan. Dialysis patients had a greater risk of adverse outcomes than nondialysis patients after PCI.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v94.1
    DOI: 10.1002/ccd.27986
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2001555-0
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  • 2
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    Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan
    Wiley ; 2018
    In:  European Journal of Heart Failure Vol. 20, No. 8 ( 2018-08), p. 1179-1190
    Details
    In: European Journal of Heart Failure, Wiley, Vol. 20, No. 8 ( 2018-08), p. 1179-1190
    Abstract: Prognostic models for hospitalized heart failure (HHF) were developed predominantly for patients of European origin in the United States of America; it is unclear whether they perform similarly in other health care systems or for different ethnicities. We sought to validate published prediction models for HHF in the United Kingdom (UK) and Japan. Methods and results Patients in the UK ( n  =894) and Japan ( n  =3158) were prospectively enrolled and were similar in terms of sex (∼60% men) and median age (∼77 years). Models predicted that British patients would have a higher mortality than Japanese, which was indeed true both for in‐hospital (4.8% vs. 2.5%) and 180‐day (20.7% vs. 9.5%) mortality. The model c‐statistics for the published/derivation (range 0.70–0.76) and Japanese (range 0.75–0.77) cohorts were similar and higher than for the UK (0.62–0.75) but models consistently overestimated mortality in Japan. For in‐hospital mortality, the OPTIMIZE‐HF model performed best, providing similar discrimination in published/derivation, UK and Japanese cohorts [c‐indices: 0.75 (0.74–0.77); 0.75 (0.68–0.81); and 0.77 (0.70–0.83), respectively], and least overestimated mortality in Japan. For 180‐day mortality, the c‐statistics for the ASCEND‐HF model were similar in published/derivation (0.70) and UK [0.69 (0.64–0.74)] cohorts but higher in Japan [0.75 (0.71–0.79)]; calibration was good in the UK but again overestimated mortality in Japan. Conclusion Calibration of published prediction models appears moderately accurate and unbiased when applied to British patients but consistently overestimates mortality in Japan. Identifying the reason why patients in Japan have a better than predicted prognosis is of great interest.
    Type of Medium: Online Resource
    ISSN: 1388-9842 , 1879-0844
    URL: Issue
    URL: Article
    DOI: 10.1002/ejhf.2018.20.issue-8
    DOI: 10.1002/ejhf.1210
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 1500332-2
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  • 3
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    Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides
    Wiley ; 2018
    In:  ESC Heart Failure Vol. 5, No. 4 ( 2018-08), p. 610-619
    Details
    In: ESC Heart Failure, Wiley, Vol. 5, No. 4 ( 2018-08), p. 610-619
    Abstract: Predictive models for heart failure patients are widely used in the clinical practice to stratify patients' mortality and enable clinicians to tailor and intensify their approach. However, such models have not been validated internationally. In addition, biomarkers are now frequently measured to obtain prognostic information, and the implications of this practice are not known. In this study, we aimed to validate the model performance of the Meta‐analysis Global Group in Chronic Heart Failure (MAGGIC) score in a Japanese acute heart failure registry and further explore the incremental prognostic value of discharge B‐type natriuretic peptide (BNP) level. Methods and Results In this study, we evaluated the registered data of 2215 consecutive acute HF patients (with 694 119 person‐years follow‐up) from a prospective multicentre registry (the West Tokyo Heart Failure) conducted in Japan from April 2006 to August 2016. The mean age was 73.0 ± 13.0, and 61.2% were male. The MAGGIC score demonstrated modest discrimination (c‐index = 0.71, 95% confidence interval 0.67–0.74) and good calibration ( R 2 value = 0.97); there was constant overestimation for 1 year mortality. However, when the BNP level was added to the original MAGGIC variables, the model demonstrated good discrimination (c‐index = 0.74, 95% confidence interval 0.70–0.78) with adequate calibration ( R 2 value = 0.91). The modified MAGGIC BNP score was externally validated in a separate Japanese registry (NaDEF) and demonstrated moderate discrimination (c‐index = 0.69, 95% confidence interval 0.65–0.73) and calibration ( R 2 value = 0.85). Conclusion The original MAGGIC score performed modestly in Japanese patients, but the addition of discharge BNP level enhanced model performance. The addition of objective biomarkers may result in effective modification of preexisting internationally recognized risk models and aid in multinational comparisons of heart failure patients' outcomes.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v5.4
    DOI: 10.1002/ehf2.12278
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2814355-3
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  • 4
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    Overview of in‐hospital outcomes in patients undergoing percutaneous coronary intervention with the revived directional coronary atherectomy
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 100, No. 1 ( 2022-07), p. 51-58
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 100, No. 1 ( 2022-07), p. 51-58
    Abstract: We sought to provide clinical insights on the usage rate, indications, and in‐hospital outcomes of the revived directional coronary atherectomy (DCA) catheter (Atherocut™) in a Japanese nationwide percutaneous coronary intervention (PCI) registry. Background Debulking devices such as the revived DCA catheter have become increasingly important in the era of complex PCI. However, little is known about PCI outcomes using a novel DCA catheter in contemporary real‐world practice. Methods We analyzed 188,324 patients who underwent PCI in 1112 hospitals from January to December 2018. Baseline characteristics and in‐hospital outcomes of patients with stable coronary artery disease or unstable angina who underwent PCI with or without the DCA were analyzed. Results Overall, 1696 patients (0.9%) underwent PCI with the DCA during the study period, predominantly for left main trunk or proximal left anterior descending artery lesions under a transfemoral approach. Patients in the DCA group were younger and had fewer comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease than patients in the non‐DCA group. Stentless PCI using the DCA with drug‐coated balloon angioplasty was a preferred treatment strategy in the DCA group (50.0%). Predefined in‐hospital adverse outcomes, including mortality (0.2% vs. 0.3%, p  = 0.446) and periprocedural complications (1.8% vs. 1.7%, p  = 0.697), were comparable between the two groups, whereas the fluoroscopy time was longer and the total contrast volume was higher in the DCA group. Conclusions In Japan, PCI using the revived DCA catheter is safely performed with low complication rates in patients with stable coronary artery disease or unstable angina.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v100.1
    DOI: 10.1002/ccd.30233
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 5
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    Acute heart failure management in the USA and Japan: overview of practice patterns and review of evidence
    Wiley ; 2018
    In:  ESC Heart Failure Vol. 5, No. 5 ( 2018-10), p. 931-947
    Details
    In: ESC Heart Failure, Wiley, Vol. 5, No. 5 ( 2018-10), p. 931-947
    Abstract: Globally, acute heart failure (AHF) remains an ongoing public health issue with its prevalence and mortality increasing in the east and the west. Effective treatment strategies to stabilize AHF are important to alleviate clinical symptoms and to improve clinical outcomes. However, despite the progress in the management of stable and chronic heart failure, no single agent has been proven to play a definitive role in the management of AHF. As a consequence, contemporary treatment strategies for patients with AHF vary greatly by region. This manuscript reviews the medical treatment options for AHF, with an emphasis on the differences between the treatment strategies in the USA and Japan. This information would provide a framework for clinicians to evaluate and manage patients with AHF and highlight the remaining questions to improve clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v5.5
    DOI: 10.1002/ehf2.12305
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2814355-3
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  • 6
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    Sudden cardiac death after acute decompensation in heart failure patients: implications of discharge haemoglobin levels
    Wiley ; 2021
    In:  ESC Heart Failure Vol. 8, No. 5 ( 2021-10), p. 3917-3928
    Details
    In: ESC Heart Failure, Wiley, Vol. 8, No. 5 ( 2021-10), p. 3917-3928
    Abstract: Heart failure (HF) patients have a high risk of mortality due to sudden cardiac death (SCD) and non‐SCD, including pump failure death (PFD). Anaemia predicts more severe symptomatic burden and higher morbidity, as noted by markedly increased hospitalizations and readmission rates, and mortality, underscoring its importance in HF management. Herein, we aimed to determine whether haemoglobin (Hb) level at discharge affects the mode of death and influences SCD risk prediction. Methods We evaluated the data of 3020 consecutive acute HF patients from a Japanese prospective multicentre registry. Patients were divided into four groups based on discharge Hb levels. SCD was defined as an unexpected and otherwise unexplained death in a previously stable patient or death due to documented or presumed cardiac arrhythmia without a clear non‐cardiovascular cause. The mode of death (SCD, PFD or other cause) was adjudicated by a central committee. Finally, we investigated whether adding Hb level to the Seattle Proportional Risk Model (SPRM; established risk score utilized to estimate ‘proportion’ of SCD among death events) would affect its performance. Results The mean age of studied patients was 74.3 ± 12.9 years, and 59.8% were male. The mean Hb level was 12.0 ± 2.1 g/dL (61.3% of patients had anaemia defined by World Health Organization criteria). During the 2‐year follow‐up, 474 deaths (15.7%) occurred, including 93 SCDs (3.1%), 171 PFDs (5.7%) and 210 other deaths (7.0%; predominantly non‐cardiac death). Absolute risk of PFD ( P   〈  0.001) or other death ( P   〈  0.001) increased along with the severity of anaemia, whereas the incidence of SCD was low but remained consistent across all four groups ( P  = 0.440). As a proportion of total deaths in each Hb level group, the contributions from non‐SCD increased and from SCD decreased along with anaemia severity ( P  = 0.007). Adding Hb level to the SPRM improved the overall discrimination (c‐index: 0.62 [95% confidence interval (CI) 0.56–0.69] to 0.65 [95% CI 0.59–0.71] ), regardless of the baseline ejection fraction (EF) (c‐index: 0.64 [95% CI 0.55–0.73] to 0.67 [95% CI 0.58–0.75] for reduced EF and 0.55 [95% CI 0.45–0.66] to 0.61 [95% CI 0.52–0.70] for preserved EF). Conclusions The discharge Hb level provides information about both absolute and proportional risks for each mode of death in acute HF patients, and the addition of Hb level improves the performance of SPRM by identifying more non‐SCD cases. Future ‘proportional’ SCD risk models should incorporate Hb level as a covariate to meet this high performance.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v8.5
    DOI: 10.1002/ehf2.13414
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2814355-3
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