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Six months of DAPT was not inferior to 18 months of DAPT following implantation of a DES with a biodegradable abluminal coating. However, this result needs to be interpreted with caution given the open-label design and wide noninferiority margin of the present study. (Nobori Dual Antiplatelet Therapy as Appropriate Duration [NIPPON]; NCT01514227).

Stent boost (SB) imaging is an enhancement of the radiologic edge of the stent by digital management of regular X-ray images. The purpose of the present study was to validate SB imaging by comparison with the anatomical standard using intravascular ultrasound (IVUS). We investigated SB and IVUS after stent implantation in 68 arteries in 60 patients. Based on those findings, we added high-pressure dilatation in four patients and another stent implantation in four patients. We defined the SB criteria for adequate stent deployment as: complete stent expansion, stent minimum diameter ≥70% of reference diameter, and stent minimum diameter ≥2.0 mm; and IVUS criteria for adequate stent deployment as: minimal stent area ≥5.0 mm(2). If the reference vessel was <2.8 mm, adequate stent deployment was defined as minimum stent area ≥4.5 mm(2). IVUS findings indicated inadequate stent deployment in 21/72 observations (29%). Seven SB images showed inadequate stent expansion. SB predicted inadequate findings of IVUS with 100% specificity, 33% sensitivity, and 81% agreement. Although the sensitivity of SB image for adequate stent deployment is low, the specificity is sufficiently high for it to be the first-line for monitoring just after stent implantation in centers where IVUS is not used routinely.

The major determinant for exercise-induced myocardial stunning was a severe flow-limiting coronary stenosis, which was more important than anatomical evaluation based on luminal narrowing alone.

The range (0.75-0.80) of fractional flow reserve (FFR) is known as the gray zone. Although the FFR of 0.80 was recently adopted as the cutoff value for coronary revascularization, the long-term clinical outcomes of patients with angiographically moderate coronary artery stenosis (FFR: 0.75-0.80) remain unknown. The objective of the present study was to investigate the clinical outcomes of patients with angiographically moderate coronary artery stenosis, whose FFR was 0.75-0.80. One hundred and twenty consecutive patients, for whom coronary revascularization was deferred based on FFR, were categorized to groups I and II, in which 55 and 65 patients had FFRs of 0.75-0.80 and 0.81-0.85, respectively. Adverse cardiac events included all-cause death, cardiac death, myocardial infarction, coronary revascularization for the FFR-measured and -unmeasured arteries, congestive heart failure, and admission for chest symptoms. Patients were followed up for 7 years after coronary angiography. Event-free survival rates of all adverse cardiac events were 73 % in group I and 63 % in group II (P = 0.35) and those of adverse cardiac events related to the FFR-measured artery were 94 and 85 % (P = 0.08). Throughout the follow-up period, the medication rate of statins was significantly lower in group II than in group I (P = 0.008). Seven-year clinical outcomes of patients with the gray-zone FFR were good. Furthermore, FFR-measured artery-related events in patients with the gray-zone FFR tended to occur less frequently than in patients with better FFR of 0.81-0.85. Optimal medical therapy is required for them, regardless of coronary stenosis severity and FFR.

BackgroundThe aim of the present study was to quantitatively assess the physiological acute recoil after percutaneous coronary intervention (PCI), and to determine the relation between it and target lesion revascularization (TLR) in the chronic phase. Methods and ResultsThis study evaluated 76 patients who underwent elective PCI between May 1997 and December 2001: plain old balloon angioplasty (POBA) in 50 patients and bare metal stent implantation in 26 patients. Fractional flow reserve (FFR) was measured immediately (FFR0m) and 15 min (FFR15m) after the final dilation, and the difference (dif-FFR) was calculated. In POBA patients with TLR, FFR15m was significantly low (0.79±0.05 vs 0.87±0.08, p<0.001) and dif-FFR was significantly high (0.06±0.04 vs -0.01±0.04, p<0.001) compared with the patients without TLR. The patients with a larger dif-FFR value (≥0.05) had a higher rate of TLR (92%). Dif-FFR was the strongest independent predictor of TLR. Conclusions The changes in FFR during the time course shortly after coronary intervention can be detected and a decrease in the first 15 min after PCI is associated with a higher rate of TLR.

To assess the coronary flow velocity - pressure relationship distal to a stenosis, and to evaluate the influence of microvascular abnormalities on this relationship, coronary flow velocity and coronary pressure were measured simultaneously in 38 patients (42 vessels). The instantaneous peak coronary flow velocity was plotted against the simultaneous measured distal coronary pressure, and the slope of the relation in the phase of diastolic flow decrease was calculated as the flow - pressure slope index (FPSI) and the X-intercept of the slope was calculated as zero-flow pressure (Pzf). The slope of the curve increased from 2.0+/-2.6 to 4.5+/-4.1 (p<0.001) and the X-intercept decreased from 42+/-16 to 27+/-13 mmHg (p<0.001) after papaverine injection. After successful coronary intervention, Pzf increased from 23+/-10 to 35+/-11 (p<0.01) and FPSI decreased from 6.8+/-5.1 to 3.5+/-1.8 (p<0.05). Pzf was higher in patients with an old myocardial infarction. It is feasible to assess the relationship between coronary flow and pressure distal to a stenosis in the clinical setting, and the relationship may provide additional information regarding coronary microcirculation. Microvascular abnormalities may play an important role in the coronary flow - pressure relationship distal to stenosis.

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