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).
Background Scarce data exist about the outcomes after percutaneous coronary intervention ( PCI ) in old patients. This study sought to provide an overview of PCI in elderly patients, especially nonagenarians, in a Japanese large prospective nationwide registry. Methods and Results We analyzed 562 640 patients undergoing PCI (≥60 years of age) from 1018 Japanese hospitals between 2014 and 2016 in the J‐PCI (Japanese percutaneous coronary intervention) registry. Among them, 10 628 patients (1.9%), including 6780 (1.2%) with acute coronary syndrome ( ACS ) and 3848 (0.7%) with stable coronary artery disease, were ≥90 years of age. We investigated differences in characteristics and in‐hospital outcomes among sexagenarians, septuagenarians, octogenarians, and nonagenarians. Older patients were more frequently women and had a greater frequency of heart failure and chronic kidney disease than younger patients. In addition, older patients had a higher rate of in‐hospital mortality, cardiac tamponade, cardiogenic shock after PCI , and bleeding complications requiring blood transfusion. Nonagenarians had the highest risk of in‐hospital mortality (odds ratio, 3.60; 95% CI , 3.10–4.18 in ACS ; odds ratio , 6.24; 95% CI, 3.82–10.20 in non‐ ACS ) and bleeding complications ( odds ratio, 1.79; 95% CI, 1.35–2.36 in ACS ; odds ratio , 2.70; 95% CI, 1.68–4.35 in non‐ ACS ) when referenced to sexagenarians. More important, transradial intervention was an inverse independent predictor of both in‐hospital mortality and bleeding complications. Conclusions Older patients, especially nonagenarians, carried a greater risk of in‐hospital death and bleeding compared with younger patients after PCI . Transradial intervention might contribute to risk reduction for periprocedural complications in elderly patients undergoing PCI .
Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity.
BackgroundObesity is associated with advanced cardiovascular disease. However, some studies have reported the “obesity paradox” after percutaneous coronary intervention (PCI). The relationship between body mass index (BMI) and clinical outcomes after PCI has not been thoroughly investigated, especially in Asian populations.MethodsWe studied 10,142 patients who underwent PCI at 15 Japanese hospitals participating in the JCD-KICS registry from September 2008 to April 2013. Patients were divided into four groups according to BMI: underweight, BMI <18.5 (n=462); normal, BMI ≥18.5 and <25.0 (n=5,945); overweight, BMI ≥25.0 and <30.0 (n=3,100); and obese, BMI ≥30.0 (n=635).ResultsPatients with a high BMI were significantly younger (p<0.001) and had a higher incidence of coronary risk factors such as hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes mellitus (p<0.001), and current smoking (p<0.001), than those with a low BMI. Importantly, patients in the underweight group had the worst in-hospital outcomes, including overall complications (underweight, normal, overweight, and obese groups: 20.4%, 11.5%, 8.4%, and 10.2%, p<0.001), in-hospital mortality (5.8%, 2.1%, 1.2%, and 2.7%, p<0.001), cardiogenic shock (3.5%, 2.0%, 1.5%, and 1.6%, p=0.018), bleeding complications (10.0%, 4.5%, 2.6%, and 2.8%, p<0.001), and receiving blood transfusion (7.6%, 2.7%, 1.6%, and 1.7%, p<0.001). BMI was inversely associated with bleeding complications after adjustment by multivariate logistic regression analysis (odds ratio, 0.95; 95% confidence interval, 0.92–0.98; p=0.002). In subgroup multivariate analysis of patients without cardiogenic shock, BMI was inversely associated with overall complications (OR, 0.98; 95% CI, 0.95–0.99; p=0.033) and bleeding complications (OR, 0.95; 95% CI, 0.91–0.98; p=0.006). Furthermore, there was a trend that BMI was moderately associated with in-hospital mortality (OR, 0.94; 95% CI, 0.88–1.01; p=0.091).ConclusionsLean patients, rather than obese patients are at greater risk for in-hospital complications during and after PCI, particularly for bleeding complications.
The present study was undertaken to investigate the nificant positive correlation was found between the 24-h LF/HF power ratio and the percentage nocturnal changes in autonomic nervous system activity in essential hypertension.reduction of the daytime systolic ABP in hypertensive subjects (r = +0.40, P Ͻ 0.01). The 24-h LF/HF power Fourteen normotensive controls and 33 age-matched untreated hypertensive subjects, diagnosed by ambulatratio was significantly lower in non-dippers than in dippers (2.09 ± 1.06 vs 3.24 ± 0.97, P Ͻ 0.01). The mean dayory blood pressure (ABP) measurement (24-h systolic ABP value over 140 mm Hg or 24-h diastolic ABP over time LF/HF power ratio was significantly lower in nondippers than in dippers (2.50 ± 1.43 vs 4.08 ± 1.27, 90 mm Hg, or both) were recruited. ABP and 24-h electrocardiogram were monitored simultaneously. Power P Ͻ 0.01). The night-time LF/HF power ratio was not significantly different between the two groups. The LF/HF spectral analysis of the R-R interval was performed by a fast Fourier transformation method and the powers of power ratio increased significantly in dippers (from 1.32 ± 1.95 to 4.65 ± 1.54, P Ͻ 0.001) during 90؇ tilt, but low frequency (LF; 0.04 to 0.15 Hz) and high frequency (HF; 0.15 to 0.4 Hz) components were obtained. Hyperthere was no significant change in the LF/HF power ratio in non-dippers during tilt (from 1.13 ± 0.28 to tensive subjects were divided into 'dippers', whose night-time systolic ABP fell by more than 10% of their 1.36 ± 0.78, NS). The 24-h LF/HF power ratio decreased according as daytime ABP, and 'non-dippers' in whom this phenomenon was absent. In hypertensive subjects, electrocarthe night-time systolic BP elevated in hypertensive subjects. During ambulatory monitoring, the non-dippers diogram monitoring and power spectral analysis were also performed for 5 min before and during 90؇ tilt.showed a significantly lower LF/HF power ratio than the dippers. The LF/HF power ratio increased significantly There were no significant differences in the 24-h mean LF/HF power ratio, LF power or HF power between norin dippers, but not in non-dippers during tilting. These results suggest that impaired cardiovascular reflexes motensive and hypertensive subjects. A significant negative correlation between the night-time systolic might contribute to the decreased sympathovagal balance in non-dipper type hypertension. ABP level and the 24-h LF/HF power ratio was found (r = −0.36, P Ͻ 0.05) in the hypertensive subjects. A sigKeywords: ambulatory blood pressure; heart rate variability; non-dipper; sympathetic nervous activity sive subjects were elevated compared with normo-
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