Percutaneous coronary intervention using new-generation drug-eluting stents versus coronary arterial bypass grafting in stable patients with multi-vessel coronary artery disease: From the CREDO-Kyoto PCI/CABG registry Cohort-3

AIMS: There is a scarcity of studies comparing percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) with coronary artery bypass grafting (CABG) in patients with multi-vessel coronary artery disease. METHODS AND RESULTS: The CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who underwent first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. The current study population consisted of 2464 patients who underwent multi-vessel coronary revascularization including revascularization of left anterior descending coronary artery (LAD) either with PCI using new-generation DES (N = 1565), or with CABG (N = 899). Patients in the PCI group were older and more often had severe frailty, but had less complex coronary anatomy, and less complete revascularization than those in the CABG group. Cumulative 5-year incidence of a composite of all-cause death, myocardial infarction or stroke was not significantly different between the 2 groups (25.0% versus 21.5%, P = 0.15). However, after adjusting confounders, the excess risk of PCI relative to CABG turned to be significant for the composite endpoint (HR 1.27, 95%CI 1.04-1.55, P = 0.02). PCI as compared with CABG was associated with comparable adjusted risk for all-cause death (HR 1.22, 95%CI 0.96-1.55, P = 0.11), and stroke (HR 1.17, 95%CI 0.79-1.73, P = 0.44), but with excess adjusted risk for myocardial infarction (HR 1.58, 95%CI 1.05-2.39, P = 0.03), and any coronary revascularization (HR 2.66, 95%CI 2.06-3.43, P<0.0001). CONCLUSIONS: In this observational study, PCI with new-generation DES as compared with CABG was associated with excess long-term risk for major cardiovascular events in patients who underwent multi-vessel coronary revascularization including LAD

Mitogen-activated protein kinases MpkA and MpkB independently affect micafungin sensitivity in <i>Aspergillus nidulans</i>

<div><p>The transcriptional regulation of the MAPK <i>mpkA</i> and cell wall-related genes in <i>Aspergillus nidulans</i> differs from that of their counterparts in <i>Saccharomyces cerevisiae</i>. The <i>A. nidulans</i> MAPK MpkB is putatively orthologous to the yeast MAPKs Kss1p and Fus3p. To investigate MpkB and its contribution to cell wall integrity in <i>A. nidulans</i>, we constructed <i>mpkB</i>-disruptant (<i>mpkB∆</i>) strains. We previously showed that <i>mpkA</i>∆ strains exhibited reduced colony growth and increased sensitivity to the β-1,3-glucan synthase inhibitor micafungin. Like <i>mpkA</i>∆ strains, <i>mpkB∆</i> strains exhibited slight growth retardation and increased sensitivity to micafungin. Although MpkB-dependent signaling modulated the transcription of some cell wall-related genes, the sugar composition of cell wall fractions was similar among wild-type, <i>mpkA</i>∆, and <i>mpkB</i>∆ strains<i>.</i> To elucidate the relationship between MpkA and MpkB pathways, we compared conditional mutants of <i>mpkB</i> with those with <i>mpkA</i> deletion. Sensitivity testing suggested that MpkA and MpkB additively contribute to micafungin activity in <i>A. nidulans</i>.</p></div

List of clinical research coordinators.

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Kaplan-Meier event curves for clinical outcomes in patients with two-vessel disease including LAD.

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Baseline characteristics, medications, angiographic and procedural characteristics during the index hospitalization in the propensity score-matched cohort.

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Kaplan-Meier event curves for clinical outcomes in patients with two-vessel or three-vessel disease including proximal LAD.

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