Effect of Heart Failure on Long‐Term Clinical Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Severe Coronary Artery Disease

[Background] Heart failure might be an important determinant in choosing coronary revascularization modalities. There was no previous study evaluating the effect of heart failure on long‐term clinical outcomes after percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG). [Methods and Results] Among 14 867 consecutive patients undergoing first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013 in the CREDO‐Kyoto PCI/CABG registry Cohort‐3, we identified the current study population of 3380 patients with three‐vessel or left main coronary artery disease, and compared clinical outcomes between PCI and CABG stratified by the subgroup based on the status of heart failure. There were 827 patients with heart failure (PCI: N=511, and CABG: N=316), and 2553 patients without heart failure (PCI: N=1619, and CABG: N=934). In patients with heart failure, the PCI group compared with the CABG group more often had advanced age, severe frailty, acute and severe heart failure, and elevated inflammatory markers. During a median 5.9 years of follow‐up, there was a significant interaction between heart failure and the mortality risk of PCI relative to CABG (interaction P=0.009), with excess mortality risk of PCI relative to CABG in patients with heart failure (HR, 1.75; 95% CI, 1.28–2.42; P<0.001) and no excess mortality risk in patients without heart failure (HR, 1.04; 95% CI, 0.80–1.34; P=0.77). [Conclusions] There was a significant interaction between heart failure and the mortality risk of PCI relative to CABG with excess risk in patients with heart failure and neutral risk in patients without heart failure

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

ラット マンセイ シンキン コウソク モデル ニ オケル コッカクキン ガサイボウ イショク ノ シンキノウ カイゼン コウカ オ インスリンヨウ セイチョウ インシ - 1 ガ ゾウキョウスル コト ニ カンスル ケンキュウ

京都大学0048新制・課程博士博士(医学)甲第12917号医博第3077号新制||医||944(附属図書館)UT51-2007-H190京都大学大学院医学研究科外科系専攻(主査)教授 中尾 一和, 教授 野間 昭典, 教授 開 祐司学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA

Free Carriers versus Excitons in CH₃NH₃PbI₃ Perovskite Thin Films at Low Temperatures: Charge Transfer from the Orthorhombic Phase to the Tetragonal Phase

We have investigated the dynamic optical properties of CH₃NH₃PbI₃ (MAPbI₃) perovskite thin films at low temperatures using time-resolved photoluminescence, optical transient absorption (TA), and THz TA spectroscopy. Optical spectroscopic results indicate that the high-temperature tetragonal phase still remains in the MAPbI₃ thin films at low temperatures in addition to the major orthorhombic phase. The fast charge transfer from the orthorhombic phase to the tetragonal phase is likely to suppress the formation of excitons in the orthorhombic phase. Consequently, the near-band-edge optical responses of the photocarriers in both the tetragonal and orthorhombic phases of the MAPbI₃ thin films are more accurately described by a free-carrier model, rather than an excitonic model even at low temperatures

Impact of Postsynthetic Surface Modification on Photoluminescence Intermittency in Formamidinium Lead Bromide Perovskite Nanocrystals

We study the origin of photoluminescence (PL) intermittency in formamidinium lead bromide (FAPbBr₃, FA = HC­(NH₂)₂) nanocrystals and the impact of postsynthetic surface treatments on the PL intermittency. Single-dot spectroscopy revealed the existence of different individual nanocrystals exhibiting either a blinking (binary on–off switching) or flickering (gradual undulation) behavior of the PL intermittency. Although the PL lifetimes of blinking nanocrystals clearly correlate with the individual absorption cross sections, those of flickering nanocrystals show no correlation with the absorption cross sections. This indicates that flickering has an extrinsic origin, which is in contrast to blinking. We demonstrate that the postsynthetic surface treatment with sodium thiocyanate improves the PL quantum yields and completely suppresses the flickering, while it has no significant effect on the blinking behavior. We conclude that the blinking is caused by Auger recombination of charged excitons, and the flickering is due to a temporal drift of the exciton recombination rate induced by surface-trapped electrons

Dynamic Optical Properties of CH₃NH₃PbI₃ Single Crystals As Revealed by One- and Two-Photon Excited Photoluminescence Measurements

The dynamic optical properties of perovskite CH₃NH₃PbI₃ single crystals were studied by means of time-resolved photoluminescence (PL) spectroscopy at room temperature. The PL peak under one-photon excitation exhibits a red-shift with elapsing time, while two-photon PL is time-independent and appears at lower energy levels. The low-energy two-photon PL can be attributed to emissions from the localized states because of strong band-to-band absorption and photon re-absorption of the emitted light in the interior region. We revealed that the PL behaviors can be explained by the diffusion of photocarriers generated in the near-surface region to the interior region. The excitation fluence dependence of the one-photon PL dynamics is also discussed in terms of the electron–hole radiative recombination and carrier diffusion effects

Dynamics of Charged Excitons and Biexcitons in CsPbBr₃ Perovskite Nanocrystals Revealed by Femtosecond Transient-Absorption and Single-Dot Luminescence Spectroscopy

Metal–halide perovskite nanocrystals (NCs) are promising photonic materials for use in solar cells, light-emitting diodes, and lasers. The optoelectronic properties of these devices are determined by the excitons and exciton complexes confined in their NCs. In this study, we determined the relaxation dynamics of charged excitons and biexcitons in CsPbBr₃ NCs using femtosecond transient-absorption (TA), time-resolved photoluminescence (PL), and single-dot second-order photon correlation spectroscopy. Decay times of ∼40 and ∼200 ps were obtained from the TA and PL decay curves for biexcitons and charged excitons, respectively, in NCs with an average edge length of 7.7 nm. The existence of charged excitons even under weak photoexcitation was confirmed by the second-order photon correlation measurements. We found that charged excitons play a dominant role in luminescence processes of CsPbBr₃ NCs. Combining different spectroscopic techniques enabled us to clarify the dynamical behaviors of excitons, charged excitons, and biexcitons