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Takeshi Morimoto - One of the best experts on this subject based on the ideXlab platform.

  • effect of glycemic control during follow up on late Target Lesion Revascularization after implantation of new generation drug eluting stents in patients with diabetes a single center observational study
    Circulation Reports, 2020
    Co-Authors: Takanari Fujita, Takeshi Morimoto, Teruki Takeda, Masayuki Yamaji, Tomoko Sakaguchi, Keiko Maeda, Hiroshi Mabuchi, Tomoyuki Murakami, Yasushi Tsujino, Takeshi Kimura
    Abstract:

    Background: Few studies have investigated the importance of glycemic control in patients with diabetes mellitus (DM) for reducing the incidence of late Target Lesion Revascularization (TLR) after implantation of new-generation drug-eluting stents (DES). Methods and Results: We retrospectively identified 1,568 patients who underwent new-generation DES implantation. Patients were divided into 3 groups based on diabetic status and glycemic control 1 year after the procedure: those without DM (non-DM group; n=1,058) and those with DM at follow-up with either good (HbA1c <7%; n=328) or poor (HbA1c ≥7%; n=182) control. The cumulative 5-year incidence of clinically driven late TLR after the index procedure was significantly higher in DM with poor control at follow-up than in those with good control at follow-up or non-DM (14%, 4.8%, and 2.9%, respectively; P<0.0001). Multivariate analysis revealed that poor control at follow-up was significantly associated with a higher risk of clinically driven late TLR compared with the non-DM group (hazard ratio [HR] 4.58, 95% confidence interval [CI] 2.50-8.16, P<0.0001). However, good control at follow-up group was not associated with a higher risk of clinically driven late TLR compared with the non-DM group (HR 1.35, 95% CI 0.68-2.56, P=0.38). Conclusions: DM patients with poor glycemic control at follow-up had a significantly higher risk of clinically driven late TLR than non-DM patients.

  • association between j cto score and long term Target Lesion Revascularization rate after successful chronic total coronary occlusion angioplasty from the j cto registry
    Catheterization and Cardiovascular Interventions, 2019
    Co-Authors: Mitsuru Abe, Toshiya Muramatsu, Takeshi Morimoto, Yasuhiko Hayashi, Yoshihiro Morino, Hiroyuki Tanaka, Masaharu Akao, Masahiko Ochiai, Yuichi Noguchi, Kazuhiko Yumoto
    Abstract:

    Objectives The aim of this study was to evaluate the impact of the J-CTO score on long-term Target Lesion Revascularization (TLR) after successful native chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). Background We previously reported that the J-CTO score could be used to stratify the Lesion complexity and procedural success rate in CTO Lesions. Methods We evaluated the prognostic significance of a high J-CTO score for long-term TLR rate in the J-CTO Registry. Results In the 425 Lesions of 408 patients who underwent successful CTO-PCI during a median follow-up of 63.0 (interquartile range: 21.2-72.9) months in the J-CTO Registry, the cumulative incidence of TLR of Lesions with a J-CTO score ≥ 2 (n = 216) was significantly higher than in those with a J-CTO score ≤ 1 (n = 209) (27.0 versus 19.4% at 5 years, respectively, P = 0.04). Among 323 Lesions of 309 patients with a complete 5-year follow-up, the rate of TLR was 28% (n = 91). A J-CTO score ≥ 2 was independently associated with a higher risk of TLR (odds ratio, 1.73; 95% confidence interval, 1.01-2.99, P = 0.048) even after adjustment for clinically relevant baseline factors. Conclusions Patients with high J-CTO score Lesions had a higher 5-year risk of TLR.

  • Post-intervention minimal stent area as a predictor of Target Lesion Revascularization after everolimus-eluting stent implantation for in-stent restenosis: a single-center observational study.
    Coronary artery disease, 2019
    Co-Authors: Takanari Fujita, Teruki Takeda, Yoshifumi Hano, Noriyuki Takashima, Masayuki Yamaji, Tomoko Sakaguchi, Keiko Maeda, Hiroshi Mabuchi, Tomoyuki Murakami, Takeshi Morimoto
    Abstract:

    BackgroundEverolimus-eluting stent (EES) is effective for treating in-stent restenosis (ISR). However, the long-term incidence of Target Lesion Revascularization (TLR) is unknown. Further, the role of post-intervention minimal stent area (MSA) measured by intravascular ultrasound (IVUS) in TLR is un

  • two year outcomes and predictors of Target Lesion Revascularization for non left main coronary bifurcation Lesions following two stent strategy with 2nd generation drug eluting stents
    Circulation, 2017
    Co-Authors: Masanobu Ohya, Takeshi Morimoto, Katsuya Miura, Takenobu Shimada, Hidewo Amano, Suguru Otsuru, Akimune Kuwayama, Shunsuke Kubo, Seiji Habara, Takeshi Tada
    Abstract:

    BACKGROUND Data on outcomes of non-left main coronary bifurcation Lesions treated with the 2-stent strategy using 2nd-generation drug-eluting stents (DES) are insufficient.Methods and Results:The 2-year outcomes and predictors of Target Lesion Revascularization (TLR) in 356 patients with 364 non-left main coronary bifurcation Lesions treated with the 2-stent strategy using 2nd-generation DES were retrospectively evaluated. The primary outcome measure was defined as TLR. The median follow-up duration was 3.6 years (interquartile range, 2.7-4.9 years). A 2-year clinical follow-up was achieved in 99.2%. The 2-year cumulative incidence of TLR was 9.2%. Multiple stents implanted in either the main branch (adjusted odds ratio [OR] 3.01; 95% confidence interval [CI]: 1.37-6.62; P=0.006) or the side branch (adjusted OR 4.55; 95% CI: 1.99-10.4; P<0.001) and the culprit in the left anterior descending artery and its diagonal branch (adjusted OR 0.33; 95% CI: 0.15-0.75: P=0.008) were independent predictors of TLR within 2 years. CONCLUSIONS The 2-year outcomes for the 2-stent strategy using 2nd-generation DES in non-left main coronary bifurcation Lesions were acceptable. Coronary bifurcation location in the left anterior descending artery and its diagonal branch is protective against TLR, whereas multiple stents implanted in either the main branch or the side branch was associated with TLR.

  • final 3 year outcome of a randomized trial comparing second generation drug eluting stents using either biodegradable polymer or durable polymer nobori biolimus eluting versus xience promus everolimus eluting stent trial
    Circulation-cardiovascular Interventions, 2015
    Co-Authors: Masahiro Natsuaki, Toshiya Muramatsu, Takeshi Morimoto, Yoshihisa Nakagawa, Kazushige Kadota, Ken Kozuma, Kengo Tanabe, Keiichi Igarashi, Takashi Akasaka, Yoshihiro Morino
    Abstract:

    Background— There is a paucity of data reporting the clinical outcomes of biodegradable polymer biolimus-eluting stent (BP-BES) compared with durable polymer everolimus-eluting stent (DP-EES) beyond 1 year after stent implantation when the polymer is fully degraded. Methods and Results— The NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial (NEXT) is a prospective, multicenter, randomized, open-label, noninferiority trial comparing BP-BES with DP-EES in patients scheduled for percutaneous coronary intervention using drug-eluting stent (DES) without any exclusion criteria among 98 participating centers in Japan. The trial was designed to evaluate noninferiority of BP-BES relative to DP-EES in terms of any Target-Lesion Revascularization at 1 year and death or myocardial infarction at 3 years. Between May and October 2011, 3235 patients were randomly assigned to receive either BP-BES (1617 patients) or DP-EES (1618 patients). Complete 3-year follow-up was achieved in 97.6% of patients. At 3 years, the primary safety end point of death or myocardial infarction occurred in 159 patients (9.9%) in the BP-BES group and in 166 patients (10.3%) in the DP-EES group, demonstrating noninferiority of BP-BES relative to DP-EES ( P noninferiority<0.0001 and P superiority=0.7). Cumulative incidence of Target-Lesion Revascularization was not significantly different between the 2 groups (7.4% versus 7.1%; P =0.8). By a landmark analysis at 1 year, the cumulative incidences of death or myocardial infarction and Target-Lesion Revascularization were also not significantly different between the 2 groups (4.6% versus 5.2%; P =0.46 and 3.3% versus 2.7%; P =0.39, respectively). Conclusions— Safety and efficacy outcomes of BP-BES were non inferior to those of DP-EES 3 years after stent implantation. Clinical Trial Registration— URL: . Unique identifier: [NCT01303640][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01303640&atom=%2Fcirccvint%2F8%2F10%2Fe002817.atom

Yoshihisa Nakagawa - One of the best experts on this subject based on the ideXlab platform.

  • final 3 year outcome of a randomized trial comparing second generation drug eluting stents using either biodegradable polymer or durable polymer nobori biolimus eluting versus xience promus everolimus eluting stent trial
    Circulation-cardiovascular Interventions, 2015
    Co-Authors: Masahiro Natsuaki, Toshiya Muramatsu, Takeshi Morimoto, Yoshihisa Nakagawa, Kazushige Kadota, Ken Kozuma, Kengo Tanabe, Keiichi Igarashi, Takashi Akasaka, Yoshihiro Morino
    Abstract:

    Background— There is a paucity of data reporting the clinical outcomes of biodegradable polymer biolimus-eluting stent (BP-BES) compared with durable polymer everolimus-eluting stent (DP-EES) beyond 1 year after stent implantation when the polymer is fully degraded. Methods and Results— The NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial (NEXT) is a prospective, multicenter, randomized, open-label, noninferiority trial comparing BP-BES with DP-EES in patients scheduled for percutaneous coronary intervention using drug-eluting stent (DES) without any exclusion criteria among 98 participating centers in Japan. The trial was designed to evaluate noninferiority of BP-BES relative to DP-EES in terms of any Target-Lesion Revascularization at 1 year and death or myocardial infarction at 3 years. Between May and October 2011, 3235 patients were randomly assigned to receive either BP-BES (1617 patients) or DP-EES (1618 patients). Complete 3-year follow-up was achieved in 97.6% of patients. At 3 years, the primary safety end point of death or myocardial infarction occurred in 159 patients (9.9%) in the BP-BES group and in 166 patients (10.3%) in the DP-EES group, demonstrating noninferiority of BP-BES relative to DP-EES ( P noninferiority<0.0001 and P superiority=0.7). Cumulative incidence of Target-Lesion Revascularization was not significantly different between the 2 groups (7.4% versus 7.1%; P =0.8). By a landmark analysis at 1 year, the cumulative incidences of death or myocardial infarction and Target-Lesion Revascularization were also not significantly different between the 2 groups (4.6% versus 5.2%; P =0.46 and 3.3% versus 2.7%; P =0.39, respectively). Conclusions— Safety and efficacy outcomes of BP-BES were non inferior to those of DP-EES 3 years after stent implantation. Clinical Trial Registration— URL: . Unique identifier: [NCT01303640][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01303640&atom=%2Fcirccvint%2F8%2F10%2Fe002817.atom

  • impact of statin therapy on late Target Lesion Revascularization after sirolimus eluting stent implantation from the credo kyoto registry cohort 2
    American Journal of Cardiology, 2012
    Co-Authors: Masahiro Natsuaki, Takeshi Morimoto, Yoshihisa Nakagawa, Kazushige Kadota, Koh Ono, Satoshi Shizuta, Yutaka Furukawa, Masashi Iwabuchi, Yoshihiro Kato, Satoru Suwa
    Abstract:

    Therapeutic strategies preventing late Target Lesion Revascularization (TLR) after drug-eluting stent implantation have not been yet adequately investigated. In 13,087 consecutive patients undergoing first percutaneous coronary intervention in the CREDO-Kyoto Registry Cohort-2, we identified 10,221 patients who were discharged alive after implantation of sirolimus-eluting stents (SESs) only (SES stratum 5,029) or bare-metal stents (BMSs) only (BMS stratum 5,192). Impact of statin therapy at time of discharge from the index hospitalization on early (within the first year) and late (1 year to 4 years) TLR, was assessed in the SES stratum (statin group 2,735; nonstatin group 2,294) and in the BMS stratum (statin group 2,576; nonstatin group 2,616). Despite a significantly lower incidence of early TLR (7.8% vs 22.2%, p

  • impact of statin therapy on late Target Lesion Revascularization after sirolimus eluting stent implantation from the credo kyoto registry cohort 2
    American Journal of Cardiology, 2012
    Co-Authors: Masahiro Natsuaki, Takeshi Morimoto, Yoshihisa Nakagawa, Kazushige Kadota, Koh Ono, Satoshi Shizuta, Yutaka Furukawa, Masashi Iwabuchi, Yoshihiro Kato, Satoru Suwa
    Abstract:

    Therapeutic strategies preventing late Target Lesion Revascularization (TLR) after drug-eluting stent implantation have not been yet adequately investigated. In 13,087 consecutive patients undergoing first percutaneous coronary intervention in the CREDO-Kyoto Registry Cohort-2, we identified 10,221 patients who were discharged alive after implantation of sirolimus-eluting stents (SESs) only (SES stratum 5,029) or bare-metal stents (BMSs) only (BMS stratum 5,192). Impact of statin therapy at time of discharge from the index hospitalization on early (within the first year) and late (1 year to 4 years) TLR, was assessed in the SES stratum (statin group 2,735; nonstatin group 2,294) and in the BMS stratum (statin group 2,576; nonstatin group 2,616). Despite a significantly lower incidence of early TLR (7.8% vs 22.2%, p <0.0001), SES use compared to BMS use was associated with a significantly higher incidence of late TLR (7.7% vs 3.0%, p <0.0001). In the SES and BMS strata, the incidence of early TLR was similar regardless of statin use. In the SES stratum, the incidence of late TLR was significantly lower in the statin group than in the nonstatin group (6.1% vs 9.6%, p = 0.002), whereas no significant difference was found in the BMS stratum (2.6% vs 3.3%, p = 0.38). After adjusting confounders, risk for late TLR significantly favored statin use in the SES stratum (hazard ratio 0.73, 95% confidence interval 0.54 to 0.98, p = 0.04), whereas the risk decrease was not significant in the BMS stratum (hazard ratio 0.74, 95% confidence interval 0.46 to 1.20, p = 0.23). In conclusion, statin therapy at hospital discharge was associated with a significantly lower risk for late TLR after SES implantation.

  • very late stent thrombosis and late Target Lesion Revascularization after sirolimus eluting stent implantation five year outcome of the j cypher registry
    Circulation, 2012
    Co-Authors: Takeshi Kimura, Kazuya Kawai, Nobuo Shiode, Masanobu Namura, Shunichi Miyazaki, Toshiya Muramatsu, Takeshi Morimoto, Yoshihisa Nakagawa, Takahito Sone, Shigeru Oshima
    Abstract:

    BACKGROUND: There is a scarcity of long-term data from large-scale drug-eluting stent registries with a large enough sample to evaluate low-frequency events such as stent thrombosis (ST). METHODS AND RESULTS: Five-year outcomes were evaluated in 12 812 consecutive patients undergoing sirolimus-eluting stent (SES) implantation in the j-Cypher registry. Cumulative incidence of definite ST was low (30 day, 0.3%; 1 year, 0.6%; and 5 years, 1.6%). However, late and very late ST continued to occur without attenuation up to 5 years after sirolimus-eluting stent implantation (0.26%/y). Cumulative incidence of Target Lesion Revascularization within the first year was low (7.3%). However, late Target Lesion Revascularization beyond 1 year also continued to occur without attenuation up to 5 years (2.2%/y). Independent risk factors of ST were completely different according to the timing of ST onset, suggesting the presence of different pathophysiological mechanisms of ST according to the timing of ST onset: acute coronary syndrome and Target of proximal left anterior descending coronary artery for early ST; side-branch stenting, diabetes mellitus, and end-stage renal disease with or without hemodialysis for late ST; and current smoking and total stent length >28 mm for very late ST. Independent risk factors of late Target Lesion Revascularization beyond 1 year were generally similar to those risk factors identified for early Target Lesion Revascularization. CONCLUSION: Late adverse events such as very late ST and late Target Lesion Revascularization are continuous hazards, lasting at least up to 5 years after implantation of the first-generation drug-eluting stents (sirolimus-eluting stents), which should be the Targets for developing improved coronary stents.

  • very late stent thrombosis and late Target Lesion Revascularization after sirolimus eluting stent implantation five year outcome of the j cypher registry
    Circulation, 2012
    Co-Authors: Takeshi Kimura, Kazuya Kawai, Nobuo Shiode, Masanobu Namura, Shunichi Miyazaki, Toshiya Muramatsu, Takeshi Morimoto, Yoshihisa Nakagawa, Takahito Sone, Shigeru Oshima
    Abstract:

    Background—There is a scarcity of long-term data from large-scale drug-eluting stent registries with a large enough sample to evaluate low-frequency events such as stent thrombosis (ST). Methods and Results—Five-year outcomes were evaluated in 12 812 consecutive patients undergoing sirolimus-eluting stent (SES) implantation in the j-Cypher registry. Cumulative incidence of definite ST was low (30 day, 0.3%; 1 year, 0.6%; and 5 years, 1.6%). However, late and very late ST continued to occur without attenuation up to 5 years after sirolimus-eluting stent implantation (0.26%/y). Cumulative incidence of Target Lesion Revascularization within the first year was low (7.3%). However, late Target Lesion Revascularization beyond 1 year also continued to occur without attenuation up to 5 years (2.2%/y). Independent risk factors of ST were completely different according to the timing of ST onset, suggesting the presence of different pathophysiological mechanisms of ST according to the timing of ST onset: acute coron...

Takeshi Kimura - One of the best experts on this subject based on the ideXlab platform.

  • effect of glycemic control during follow up on late Target Lesion Revascularization after implantation of new generation drug eluting stents in patients with diabetes a single center observational study
    Circulation Reports, 2020
    Co-Authors: Takanari Fujita, Takeshi Morimoto, Teruki Takeda, Masayuki Yamaji, Tomoko Sakaguchi, Keiko Maeda, Hiroshi Mabuchi, Tomoyuki Murakami, Yasushi Tsujino, Takeshi Kimura
    Abstract:

    Background: Few studies have investigated the importance of glycemic control in patients with diabetes mellitus (DM) for reducing the incidence of late Target Lesion Revascularization (TLR) after implantation of new-generation drug-eluting stents (DES). Methods and Results: We retrospectively identified 1,568 patients who underwent new-generation DES implantation. Patients were divided into 3 groups based on diabetic status and glycemic control 1 year after the procedure: those without DM (non-DM group; n=1,058) and those with DM at follow-up with either good (HbA1c <7%; n=328) or poor (HbA1c ≥7%; n=182) control. The cumulative 5-year incidence of clinically driven late TLR after the index procedure was significantly higher in DM with poor control at follow-up than in those with good control at follow-up or non-DM (14%, 4.8%, and 2.9%, respectively; P<0.0001). Multivariate analysis revealed that poor control at follow-up was significantly associated with a higher risk of clinically driven late TLR compared with the non-DM group (hazard ratio [HR] 4.58, 95% confidence interval [CI] 2.50-8.16, P<0.0001). However, good control at follow-up group was not associated with a higher risk of clinically driven late TLR compared with the non-DM group (HR 1.35, 95% CI 0.68-2.56, P=0.38). Conclusions: DM patients with poor glycemic control at follow-up had a significantly higher risk of clinically driven late TLR than non-DM patients.

  • abstract 13696 very long term 15 23 years outcomes of bare metal stenting and plain old balloon angioplasty
    Circulation, 2012
    Co-Authors: Kyohei Yamaji, Takeshi Kimura, Shinichi Shirai, Katsumi Inoue, Masashi Iwabuchi, Shoichi Kuramitsu, Hiroyoshi Yokoi, Hideyuki Nosaka, Masakiyo Nobuyoshi
    Abstract:

    Background: Target Lesion Revascularization (TLR) continued to occur beyond 4 years after the bare metal stent (BMS) implantation after an apparent plateau phase between 1 and 4 years. However, lon...

  • comparison of five year outcome of sirolimus eluting stent implantation for chronic total occlusions versus for non chronic total occlusion from the j cypher registry
    American Journal of Cardiology, 2012
    Co-Authors: Masafumi Kato, Takeshi Morimoto, Takeshi Kimura, Kazushige Kadota, Yasuhiko Hayashi, Hideo Nishikawa, Fumiya Uchida, Hiroyuki Suzuki, Kazuaki Mitsudo
    Abstract:

    The aim of this study was to evaluate the 5-year clinical outcomes of patients who underwent sirolimus-eluting stent implantation for chronic total occlusion (CTO). Among 10,759 patients treated exclusively with sirolimus-eluting stent in the j-Cypher registry, clinical outcomes were compared between 1,210 patients with Revascularization for CTO and 9,549 patients with Revascularization for non-CTO only. The cumulative 5-year incidence of all-cause death (13.2% vs 14.3%, p = 0.56) and definite stent thrombosis (1.9% vs 1.6%, p = 0.76) was similar between the 2 groups. The adjusted risk for CTO relative to non-CTO for all-cause death and definite stent thrombosis was insignificant (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.81 to 1.16, and HR 0.99, 95% CI 0.6 to 1.65, respectively). The cumulative incidence of Target Lesion Revascularization was significantly higher in the CTO group (20.7% vs 14.8%, p <0.001). The adjusted risk for Target Lesion Revascularization was significant (HR 1.31, 95% CI 1.13 to 1.52, p <0.001). In the subgroup analysis, the risk for CTO for all-cause death tended to be lower in the subgroup of patients with left ventricular ejection fractions ≤40% (HR 0.68, 95% CI 0.45 to 1.01, p = 0.053), while the risk was significantly higher in the subgroup of patients with end-stage renal disease without hemodialysis (HR 1.66, 95% CI 1.02 to 2.70, p = 0.04). In conclusion, sirolimus-eluting stent implantation for CTO appears to be as safe as that for non-CTO for up to 5 years, except for the modestly elevated risk for Target Lesion Revascularization and the higher risk for all-cause death in patients with end-stage renal disease without hemodialysis.

  • comparison of everolimus eluting and sirolimus eluting coronary stents 1 year outcomes from the randomized evaluation of sirolimus eluting versus everolimus eluting stent trial reset
    Circulation, 2012
    Co-Authors: Takeshi Kimura, Takeshi Morimoto, Kazushige Kadota, Kengo Tanabe, Masahiro Natsuaki, Yoshihiro Morino, Hiroki Shiomi, Keiichi Igarashi, Takashi Akasaka, Yoshiki Takatsu
    Abstract:

    Background—Several recent randomized trials comparing everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) reported similar outcomes. However, only 1 trial was powered for a clinical end point, and no trial was powered for evaluating Target-Lesion Revascularization. Methods and Results—Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial is a prospective multicenter randomized open-label trial comparing EES with SES in Japan. The trial was powered for evaluating noninferiority of EES relative to SES in terms of Target-Lesion Revascularization. From February and July 2010, 3197 patients were randomly assigned to receive either EES (1597 patients) or SES (1600 patients). At 1 year, the primary efficacy end point of Target-Lesion Revascularization occurred in 65 patients (4.3%) in the EES group and in 76 patients (5.0%) in the SES group, demonstrating noninferiority of EES to SES (Pnoninferiority<0.0001, and Psuperiority=0.34). Cumulative incidence of definite stent th...

  • very late stent thrombosis and late Target Lesion Revascularization after sirolimus eluting stent implantation five year outcome of the j cypher registry
    Circulation, 2012
    Co-Authors: Takeshi Kimura, Kazuya Kawai, Nobuo Shiode, Masanobu Namura, Shunichi Miyazaki, Toshiya Muramatsu, Takeshi Morimoto, Yoshihisa Nakagawa, Takahito Sone, Shigeru Oshima
    Abstract:

    BACKGROUND: There is a scarcity of long-term data from large-scale drug-eluting stent registries with a large enough sample to evaluate low-frequency events such as stent thrombosis (ST). METHODS AND RESULTS: Five-year outcomes were evaluated in 12 812 consecutive patients undergoing sirolimus-eluting stent (SES) implantation in the j-Cypher registry. Cumulative incidence of definite ST was low (30 day, 0.3%; 1 year, 0.6%; and 5 years, 1.6%). However, late and very late ST continued to occur without attenuation up to 5 years after sirolimus-eluting stent implantation (0.26%/y). Cumulative incidence of Target Lesion Revascularization within the first year was low (7.3%). However, late Target Lesion Revascularization beyond 1 year also continued to occur without attenuation up to 5 years (2.2%/y). Independent risk factors of ST were completely different according to the timing of ST onset, suggesting the presence of different pathophysiological mechanisms of ST according to the timing of ST onset: acute coronary syndrome and Target of proximal left anterior descending coronary artery for early ST; side-branch stenting, diabetes mellitus, and end-stage renal disease with or without hemodialysis for late ST; and current smoking and total stent length >28 mm for very late ST. Independent risk factors of late Target Lesion Revascularization beyond 1 year were generally similar to those risk factors identified for early Target Lesion Revascularization. CONCLUSION: Late adverse events such as very late ST and late Target Lesion Revascularization are continuous hazards, lasting at least up to 5 years after implantation of the first-generation drug-eluting stents (sirolimus-eluting stents), which should be the Targets for developing improved coronary stents.

Kazushige Kadota - One of the best experts on this subject based on the ideXlab platform.

  • TCT-317 Ten-year impact of stent fracture and peri-stent contrast staining after sirolimus-eluting stent implantation on Target Lesion Revascularization
    Journal of the American College of Cardiology, 2016
    Co-Authors: Kohei Osakada, Katsuya Miura, Kazushige Kadota, Takenobu Shimada, Masanobu Ohya, Hidewo Amano, Yusuke Hyodo, Akimune Kuwayama, Shunsuke Kubo, Suguru Otsuru
    Abstract:

    Stent fracture (SF) and peri-stent contrast staining (PSS) after sirolimus-eluting stent implantation are reported to be associated with Target Lesion Revascularization (TLR). We aimed to assess the impact of SF and PSS on TLR at 10 years after the procedure. Between 2002 and 2005, 972 patients (

  • final 3 year outcome of a randomized trial comparing second generation drug eluting stents using either biodegradable polymer or durable polymer nobori biolimus eluting versus xience promus everolimus eluting stent trial
    Circulation-cardiovascular Interventions, 2015
    Co-Authors: Masahiro Natsuaki, Toshiya Muramatsu, Takeshi Morimoto, Yoshihisa Nakagawa, Kazushige Kadota, Ken Kozuma, Kengo Tanabe, Keiichi Igarashi, Takashi Akasaka, Yoshihiro Morino
    Abstract:

    Background— There is a paucity of data reporting the clinical outcomes of biodegradable polymer biolimus-eluting stent (BP-BES) compared with durable polymer everolimus-eluting stent (DP-EES) beyond 1 year after stent implantation when the polymer is fully degraded. Methods and Results— The NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial (NEXT) is a prospective, multicenter, randomized, open-label, noninferiority trial comparing BP-BES with DP-EES in patients scheduled for percutaneous coronary intervention using drug-eluting stent (DES) without any exclusion criteria among 98 participating centers in Japan. The trial was designed to evaluate noninferiority of BP-BES relative to DP-EES in terms of any Target-Lesion Revascularization at 1 year and death or myocardial infarction at 3 years. Between May and October 2011, 3235 patients were randomly assigned to receive either BP-BES (1617 patients) or DP-EES (1618 patients). Complete 3-year follow-up was achieved in 97.6% of patients. At 3 years, the primary safety end point of death or myocardial infarction occurred in 159 patients (9.9%) in the BP-BES group and in 166 patients (10.3%) in the DP-EES group, demonstrating noninferiority of BP-BES relative to DP-EES ( P noninferiority<0.0001 and P superiority=0.7). Cumulative incidence of Target-Lesion Revascularization was not significantly different between the 2 groups (7.4% versus 7.1%; P =0.8). By a landmark analysis at 1 year, the cumulative incidences of death or myocardial infarction and Target-Lesion Revascularization were also not significantly different between the 2 groups (4.6% versus 5.2%; P =0.46 and 3.3% versus 2.7%; P =0.39, respectively). Conclusions— Safety and efficacy outcomes of BP-BES were non inferior to those of DP-EES 3 years after stent implantation. Clinical Trial Registration— URL: . Unique identifier: [NCT01303640][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01303640&atom=%2Fcirccvint%2F8%2F10%2Fe002817.atom

  • comparison of five year outcome of sirolimus eluting stent implantation for chronic total occlusions versus for non chronic total occlusion from the j cypher registry
    American Journal of Cardiology, 2012
    Co-Authors: Masafumi Kato, Takeshi Morimoto, Takeshi Kimura, Kazushige Kadota, Yasuhiko Hayashi, Hideo Nishikawa, Fumiya Uchida, Hiroyuki Suzuki, Kazuaki Mitsudo
    Abstract:

    The aim of this study was to evaluate the 5-year clinical outcomes of patients who underwent sirolimus-eluting stent implantation for chronic total occlusion (CTO). Among 10,759 patients treated exclusively with sirolimus-eluting stent in the j-Cypher registry, clinical outcomes were compared between 1,210 patients with Revascularization for CTO and 9,549 patients with Revascularization for non-CTO only. The cumulative 5-year incidence of all-cause death (13.2% vs 14.3%, p = 0.56) and definite stent thrombosis (1.9% vs 1.6%, p = 0.76) was similar between the 2 groups. The adjusted risk for CTO relative to non-CTO for all-cause death and definite stent thrombosis was insignificant (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.81 to 1.16, and HR 0.99, 95% CI 0.6 to 1.65, respectively). The cumulative incidence of Target Lesion Revascularization was significantly higher in the CTO group (20.7% vs 14.8%, p <0.001). The adjusted risk for Target Lesion Revascularization was significant (HR 1.31, 95% CI 1.13 to 1.52, p <0.001). In the subgroup analysis, the risk for CTO for all-cause death tended to be lower in the subgroup of patients with left ventricular ejection fractions ≤40% (HR 0.68, 95% CI 0.45 to 1.01, p = 0.053), while the risk was significantly higher in the subgroup of patients with end-stage renal disease without hemodialysis (HR 1.66, 95% CI 1.02 to 2.70, p = 0.04). In conclusion, sirolimus-eluting stent implantation for CTO appears to be as safe as that for non-CTO for up to 5 years, except for the modestly elevated risk for Target Lesion Revascularization and the higher risk for all-cause death in patients with end-stage renal disease without hemodialysis.

  • comparison of everolimus eluting and sirolimus eluting coronary stents 1 year outcomes from the randomized evaluation of sirolimus eluting versus everolimus eluting stent trial reset
    Circulation, 2012
    Co-Authors: Takeshi Kimura, Takeshi Morimoto, Kazushige Kadota, Kengo Tanabe, Masahiro Natsuaki, Yoshihiro Morino, Hiroki Shiomi, Keiichi Igarashi, Takashi Akasaka, Yoshiki Takatsu
    Abstract:

    Background—Several recent randomized trials comparing everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) reported similar outcomes. However, only 1 trial was powered for a clinical end point, and no trial was powered for evaluating Target-Lesion Revascularization. Methods and Results—Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial is a prospective multicenter randomized open-label trial comparing EES with SES in Japan. The trial was powered for evaluating noninferiority of EES relative to SES in terms of Target-Lesion Revascularization. From February and July 2010, 3197 patients were randomly assigned to receive either EES (1597 patients) or SES (1600 patients). At 1 year, the primary efficacy end point of Target-Lesion Revascularization occurred in 65 patients (4.3%) in the EES group and in 76 patients (5.0%) in the SES group, demonstrating noninferiority of EES to SES (Pnoninferiority<0.0001, and Psuperiority=0.34). Cumulative incidence of definite stent th...

  • impact of statin therapy on late Target Lesion Revascularization after sirolimus eluting stent implantation from the credo kyoto registry cohort 2
    American Journal of Cardiology, 2012
    Co-Authors: Masahiro Natsuaki, Takeshi Morimoto, Yoshihisa Nakagawa, Kazushige Kadota, Koh Ono, Satoshi Shizuta, Yutaka Furukawa, Masashi Iwabuchi, Yoshihiro Kato, Satoru Suwa
    Abstract:

    Therapeutic strategies preventing late Target Lesion Revascularization (TLR) after drug-eluting stent implantation have not been yet adequately investigated. In 13,087 consecutive patients undergoing first percutaneous coronary intervention in the CREDO-Kyoto Registry Cohort-2, we identified 10,221 patients who were discharged alive after implantation of sirolimus-eluting stents (SESs) only (SES stratum 5,029) or bare-metal stents (BMSs) only (BMS stratum 5,192). Impact of statin therapy at time of discharge from the index hospitalization on early (within the first year) and late (1 year to 4 years) TLR, was assessed in the SES stratum (statin group 2,735; nonstatin group 2,294) and in the BMS stratum (statin group 2,576; nonstatin group 2,616). Despite a significantly lower incidence of early TLR (7.8% vs 22.2%, p

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  • Abstract 17597: Intravascular Ultrasound and Angiographic Predictors of 5-Year Target Lesion Revascularization: Very Long-Term Clinical Follow-Up of the SPIRIT III Trial
    Circulation, 2012
    Co-Authors: Kenji Sakamoto, Katsuhisa Waseda, Gregg W. Stone, Takao Shimohama, Masao Yamasaki, Ichizo Tsujino, Paul G. Yock, Shigeru Saito, Manejeh Yaqub, Sherry Cao
    Abstract:

    BACKGROUND: This study aimed to assess the hypothesis that intravascular ultrasound (IVUS) or angiographic parameters can predict very long-term Target Lesion Revascularization (TLR) in de novo cor...

  • everolimus eluting versus paclitaxel eluting stents in coronary artery disease
    The New England Journal of Medicine, 2010
    Co-Authors: Gregg W. Stone, Ronald P Caputo, Ali Rizvi, William P Newman, Kourosh Mastali, John C Wang, Julie Doostzadeh, Charles A Simonton, Krishnankutty Sudhir, Alexandra J. Lansky
    Abstract:

    Background Previous studies have established the superiority of coronary everolimus-eluting stents over paclitaxel-eluting stents with respect to angiographic findings. However, these trials were not powered for superiority in clinical end points. Methods We randomly assigned 3687 patients at 66 U.S. sites to receive everolimus-eluting stents or paclitaxel-eluting stents without routine follow-up angiography. The primary end point was the 1-year composite rate of Target-Lesion failure (defined as cardiac death, Target-vessel myocardial infarction, or ischemia-driven Target-Lesion Revascularization). Results Everolimus-eluting stents were superior to paclitaxel-eluting stents with respect to the primary end point of Target-Lesion failure (4.2% vs. 6.8%; relative risk, 0.62; 95% confidence interval, 0.46 to 0.82; P=0.001). Everolimus-eluting stents were also superior with respect to the major secondary end point of the 1-year rate of ischemia-driven Target-Lesion Revascularization (P=0.001) and were noninfe...

  • offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel eluting and bare metal stent implantation
    Circulation, 2007
    Co-Authors: Gregg W. Stone, Donald E Cutlip, Antonio Colombo, Stephen G Ellis, Eberhard Grube, Keith D Dawkins, Mark I Friedman, Donald S Baim, Joerg Koglin
    Abstract:

    Background— Drug-eluting stents compared with bare metal stents (BMS) may increase late stent thrombosis (ST), although an accompanying increase in the rates of death and myocardial infarction (MI) has not been observed. We hypothesized that the prevention of restenosis-related adverse events by drug-eluting stents might offset some or all of the excess risk from ST. Methods and Results— We analyzed a pooled patient-level database from 4 prospective, double-blind trials in which 3445 patients were randomized to paclitaxel-eluting stents or BMS. The occurrence of death or MI within 7 days of ST or Target Lesion Revascularization was assessed. With a median follow-up of 3.2 years, ST occurred in 34 patients (1.0%), 31 (91.1%) of whom sustained death or MI within 7 days. Target Lesion Revascularization was performed in 425 patients (12.3%), 15 (3.5%) of whom died or had MI within 7 days. ST occurred in 14 BMS and 20 paclitaxel-eluting stent patients, resulting in 12 and 19 deaths or MIs within 7 days, respec...

  • optimal final lumen area and predictors of Target Lesion Revascularization after stent implantation in small coronary arteries
    American Journal of Cardiology, 2003
    Co-Authors: Ioannis Iakovou, Roxana Mehran, George Dangas, Alexandra J. Lansky, Yoshio Kobayashi, Alexandre Abizaid, Makoto Hirose, Dale T Ashby, Gregg W. Stone
    Abstract:

    Abstract Despite similar early clinical events, patients who undergo treatment of small vessels are at an increased risk for Target Lesion Revascularization (TLR) after coronary artery stenting. We sought to determine predictors of TLR after stent implantation in small coronary arteries. We identified 423 consecutive patients who underwent intravascular ultrasound (IVUS)-guided small vessel stenting procedures in 465 coronary Lesions with an angiographic reference vessel diameter of 2 (n = 345 Lesions, group I) and >6.0 mm 2 (n = 115, group II). Baseline patient characteristics and in-hospital outcomes were similar between the 2 groups, except for a higher rate of restenotic Lesions in group I and bifurcation Lesions in group II. Group I had higher TLR rates at 1 year compared with group II patients (39% vs 26%, p = 0.02). The TLR rate appeared to decrease with greater stent expansion, especially at >90% of the reference vessel area, as assessed by IVUS. By multivariate analysis, an IVUS final stent area of ≤6 mm 2 , diabetes, absence of prior myocardial infarction, and history of intervention were independent predictors of 1-year TLR in this population. Final stent area of >6.0 mm 2 and greater stent expansion were associated with a decrease in TLR. Therefore, there does not appear to be any “downside” to aggressive stent implantation strategies in small vessels. In contrast, IVUS allows maximization of final lumen dimensions to minimize clinical restenosis.

  • Stent implantation neutralizes the impact of preintervention arterial remodeling on subsequent Target Lesion Revascularization.
    The American journal of cardiology, 2000
    Co-Authors: George Dangas, Roxana Mehran, Alexandra J. Lansky, Javed Ahmed, Gregg W. Stone
    Abstract:

    Positive remodeling of the atherosclerotic arterial wall occurs to compensate for plaque accumulation. However, more recent studies, primarily using intravascular ultrasound (IVUS) in vivo, have emphasized that in certain Lesions, inadequate or negative arterial remodeling contributes to lumen compromise. Possible explanatory mechanisms include failure of positive adaptive remodeling, initial positive remodeling followed by late arterial shrinkage, and restriction of the extent of positive remodeling due to certain plaque elements (i.e., calcium or dense fibrous tissue). A number of studies have documented that positive remodeling Lesions may be associated with unstable coronary syndromes and, therefore, may be more biologically active. In this regard, we recently reported that the preintervention pattern of remodeling is an independent predictor of clinical restenosis after non-stent coronary intervention: positive remodeling Lesions had more frequent Target Lesion Revascularization events than negative remodeling Lesions. In the present study, we evaluated the interaction of baseline remodeling characteristics and clinical restenosis in native coronary Lesions treated with stent implantation. It was our hypothesis that stent implantation would equalize the event rate between positive and negative remodeling Lesions.