Antiatherosclerotic phenotype of perivascular adipose tissue surrounding the saphenous vein in coronary artery bypass grafting

冠動脈バイパス術（CABG）で大伏在静脈（SV）グラフトの血管周囲脂肪組織（PVAT）を温存したまま使用するNo-touch法が良好な成績を収め注目されている．本研究では術中に各種PVATを採取して組織性状と遺伝子発現を比較検討した．SV-PVATは冠動脈や大動脈のPVATに比してM1マクロファージの浸潤や炎症性サイトカイン発現が低く，No-touch法の成績向上に寄与している可能性が示唆された

Effect of combination of non-slip element balloon and drug-coating balloon for in-stent restenosis lesions (ELEGANT study)

Background: In-stent restenosis (ISR) remains a problematic issue of coronary intervention. The non-slip element balloon (NSE) is a balloon catheter with 3 longitudinal nylon elements which are attached proximally and distally to the balloon component. The expectation is that this design of balloon is able to achieve a larger lumen area due to the elements, as well as reducing balloon slippage. We investigated whether NSE pre-dilatation improves angiographic outcomes compared to a high pressure non-compliant balloon pre-dilatation, followed by a drug-coating balloon (DCB) for treatment of ISR lesions with optical coherence tomographic imaging (OCT). Methods: Patients were eligible for the study if one or more in-stent restenosis lesions were treated with a paclitaxel-coating balloon. Patients were randomized to NSE pre-dilatation (NSE group) or high pressure non-compliant balloon pre-dilatation (POBA group) in a 1:1 fashion in 17 hospitals. The primary endpoint was in-segment late loss [post minimal lumen diameter (MLD) − follow-up MLD] at 8 months. Results: One hundred and five patients were allocated to each group. Balloon slippage (7.9% versus 22.9%, p = 0.002) and geographical miss (6.9% versus 21.9%, p = 0.002) were observed less in the NSE group compared to the POBA group. Acute gain was significantly larger in the NSE group (1.17 ± 0.42 mm versus 1.06 ± 0.35 mm, p = 0.04), but post minimum stent lumen area analyzed by OCT was similar between the two groups (3.85 ± 1.67 mm2 versus 3.81 ± 1.93 mm2, p = 0.64). At 8 months, average lesion length was significantly shorter than the POBA group (5.78 ± 3.26 mm versus 6.97 ± 4.59 mm, p = 0.04), but average in-segment late loss was similar between the two groups (0.28 ± 0.45 mm versus 0.27 ± 0.38 mm, p = 0.75). Conclusion: Eight-month angiographic outcomes were similar between NSE and non-compliant balloon pre-dilatation with DCB for treatment of ISR lesions. However, NSE pre-dilatation has advantages such as reduction of balloon slippage and geographical miss during the procedure

Impact of COVID-19 pandemic on emergency medical system and management strategies in patients with acute coronary syndrome

Abstract The global coronavirus disease-2019 (COVID-19) pandemic is associated with reduced rate of percutaneous coronary intervention (PCI). However, there were a few data showing how emergency medical system (EMS) and management strategies for acute coronary syndrome (ACS) changed during the pandemic. We sought to clarify changes on characteristics, treatments, and in-hospital mortality of patients with ACS transported via EMS between pre- and post-pandemic. We examined consecutive 656 patients with ACS admitted to Sapporo City ACS Network Hospitals between June 2018 and November 2021. The patients were divided into pre- and post-pandemic groups. The number of ACS hospitalizations declined significantly during the pandemic (proportional reduction 66%, coefficient −0.34, 95% CI −0.50 to −0.18, p < 0.001). The median time from an EMS call to hospital was significantly longer in post-pandemic group than in pre-pandemic group (32 [26–39] vs. 29 [25–36] min, p = 0.008). There were no significant differences in the proportion of patients with ACS receiving PCI, and in-hospital mortality between the groups. The COVID-19 pandemic had a significant impact on EMS and management in patients with ACS. Although a significant decline was observed in ACS hospitalizations, the proportion of patients with ACS receiving emergency PCI remained during the pandemic

A prospective multicenter study on genome wide associations to ranibizumab treatment outcome for age-related macular degeneration

We conducted a genome-wide association study (GWAS) on the outcome of anti-VEGF treatment for exudative age-related macular degeneration (AMD) in a prospective cohort. Four hundred and sixty-one treatment-naïve AMD patients were recruited at 13 clinical centers and all patients were treated with 3 monthly injections of ranibizumab followed by pro re nata regimen treatment for one year. Genomic DNA was collected from all patients for a 2-stage GWAS on achieving dry macula after the initial treatment, the requirement for an additional treatment, and visual acuity changes during the 12-month observation period. In addition, we evaluated 9 single-nucleotide polymorphisms (SNPs) in 8 previously reported AMD-related genes for their associations with treatment outcome. The discovery stage with 256 patients evaluated 8, 480, 849 SNPs, but no SNPs showed genome-wide level significance in association with treatment outcomes. Although SNPs with P-values of <5 × 10[−6] were evaluated in replication samples of 205 patients, no SNP was significantly associated with treatment outcomes. Among AMD-susceptibility genes, rs10490924 in ARMS2/HTRA1 was significantly associated with additional treatment requirement in the discovery stage (P = 0.0023), and pooled analysis with the replication stage further confirmed this association (P = 0.0013). ARMS2/HTRA1 polymorphism might be able to predict the frequency of injection after initial ranibizumab treatment