Single-Session Versus Staged Multivessel Optimal IVUS-Guided PCI in Patients With CCS or NSTE-ACS

[Background] There are no studies comparing single-session vs staged multivessel intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome (CCS) or non–ST-segment-elevation acute coronary syndrome (NSTE-ACS). [Objectives] The authors aimed to compare single-session vs staged multivessel IVUS-guided PCI in patients with CCS or NSTE-ACS. [Methods] The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1, 021 patients with CCS or NSTE-ACS undergoing multivessel PCI including left anterior descending coronary artery using IVUS aiming to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared single-session vs staged multivessel PCI. The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization. [Results] There were 246 patients (24.1%) undergoing single-session multivessel PCI, and 775 patients (75.9%) undergoing staged multivessel PCI. There was a wide variation in the prevalence of single-session multivessel PCI across the participating centers. The staged multivessel PCI group more often had complex coronary anatomy such as 3-vessel disease, chronic total occlusion, and calcified lesions requiring an atherectomy device compared with the single-session multivessel PCI group. The rates of PCI success, procedural complications, and meeting OPTIVUS criteria were not different between groups. The cumulative 1-year incidence of the primary endpoint was not different between single-session and staged multivessel PCI groups (9.0% vs 10.8%, log-rank P = 0.42). After adjusting confounders, the effect of single-session multivessel PCI relative to staged multivessel PCI was not significant for the primary endpoint (HR: 0.95; 95% CI: 0.58-1.55; P = 0.84). [Conclusions] Single-session and staged multivessel IVUS-guided PCI had similar 1-year outcomes

Details on the effect of very short dual antiplatelet therapy after drug-eluting stent implantation in patients with high bleeding risk: insight from the STOPDAPT-2 trial

Previously we briefly reported the effect of 1-month dual antiplatelet therapy (DAPT) for patients with high bleeding risk (HBR) receiving percutaneous coronary intervention (PCI) in the STOPDAPT-2 trial, but full analysis data have not been available. We conducted post hoc subgroup analysis regarding the effect of very short DAPT for HBR patients in STOPDAPT-2 trial. The primary endpoint was a 1-year composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) and bleeding (TIMI major/minor bleeding) outcomes. Major secondary endpoints were 1-year cardiovascular composite endpoint and bleeding endpoint. HBR was defined by the academic research consortium (ARC) HBR criteria. Among the 3009 study patients, 1054 (35.0%) were classified as HBR and 1955 (65.0%) were as non-HBR. There were no significant interactions between HBR/non-HBR subgroups and the assigned DAPT group on the primary endpoint (HBR; 3.48% vs. 5.98%, HR 0.57, 95% CI 0.32-1.03, and non-HBR; 1.81% vs. 2.36%, HR 0.78, 95% CI 0.42-1.45; P for interaction = 0.48), the major secondary cardiovascular endpoint (HBR; 3.07% vs. 4.03%, HR 0.77, 95% CI 0.40-1.48, and non-HBR; 1.41% vs. 1.61%, HR 0.89, 95% CI 0.43-1.84; P for interaction = 0.77), and the major secondary bleeding endpoint (HBR; 0.41% vs. 2.71%, HR 0.15, 95% CI 0.03-0.65, and non-HBR; 0.40% vs. 0.85%, HR 0.48, 95% CI 0.14-1.58; P for interaction = 0.22). In conclusion, the effects of 1-month DAPT for the primary and major secondary endpoints were consistent in HBR and non-HBR patients without any significant interactions. The benefit of 1-month DAPT in reducing major bleeding was numerically greater in HBR patients.Clinical trial registration Short and optimal duration of dual antiplatelet therapy after everolimus-eluting cobalt-chromium stent-2 [STOPDAPT-2]; NCT02619760

Dark Halo : Enigmatic Features of Dark Streaks at Martian Volcanoes

On the planets having atmosphere such as Mars, there are various types of interactions between the atmosphere and the ground surface. Such interactions cause observable changes in the surface patterns. Polar caps and aeolian features are typical examples. With the accumulation of satellite-based exploratory data, time-variable surface patterns have been recognized and investigated extensively, because they can be direct indicators of the changing surface environments. Here we report a new kind of time-variable surface pattern called“ Dark Halo ”near the top of high altitude volcanoes in Tharsis region. Recent continual and high-resolution observations have revealed enigmatic features of “ Dark Halo ”: 1. “ Dark Halo ”is composed of assemblage of dark spire-shaped streaks, hereafter we call“ Spire Streaks ”. 2. Each streak starts from a point-like very narrow region. 3. In most cases, no topographical obstacle can be identified at the initiation point. 4. Each“ Spire Streak ”starts at high position and increases its width downward. 5. “ Dark Halo ”and“ Spire Streak ”universally exist near the top of high mountains (Olympus, Elysium, Pavonis and Ascraeus) although the actual heights are not uniform. 6. ”Dark Halo” shows temporal changes in its pattern. These features are not compatible with existing models of aeolian streaks. Data from visible imagers, imaging spectrometers, a laser altimeter and a numerical modeling are investigated to understand the formation process of“ Spire Streak ”and “ Dark Halo ”. As a result of such investigations, the author proposes two possible origins of“ Spire Streaks ”and“ Dark Halo ”: 1) erosion of fine dust by gusty strong slope wind, and 2) deposition of wind-blown volatiles. Both origins are completely new kind of wind-surface interactions that haven ’t ever discovered. Future work will contain analysis of spectral data that are produced by recent highresolution instruments to know the difference between surface materials on“ Dark Halo ” and on its surrounding region.火星のように大気をもつ惑星では、大気と地面の間に様々な相互作用がある。そのような相互作用の結果として、観測可能な変化が惑星表面に生じる。火星における代表的な例が風成痕(Wind Streak) や極冠の氷などである。周回軌道からの長期観測によって、表面の様子が時間変化することがわかった。こういった変化は表層環境を知るための重要な手掛りと考えられており、多くの科学者が研究の対象としている。本研究の目的は、火星表面の時間変化する模様の一つである「Dark Halo」の成因を明らかにすることにある。最近の継続的かつ高解像度の観測によって、これまでの理論では説明できない「Dark Halo」の特徴が明らかになってきた。すなわち、1. 尖塔形をした「Spire Streak」という構造の集合体が「Dark Halo」を形成している。2. 「Spire Streak」の先端は尖っており、ほぼ点に近い。3. ほとんどの場合、「Spire Streak」の先端部には特別な地形や障害物が無い。4. 「Spire Streak」の尖った部分は高度が高い側に存在し、高度が低い側にいくにつれて広がっている。5. 火星の高度が高い火山では、「Dark Halo」と「Spire Streak」が共通して見られる。6. 「Dark Halo」の形は時間変化する。ということである。このような特徴は既存の理論では説明がつかない。「Dark Halo」の形成過程が明らかになれば、表面に残された模様から表層環境に関する定量的なデータが得られるようになる。すなわち、着陸機が存在しない場所の表面情報を推定する方法として、画像解析が有効になるのである。著者は「Dark Halo」の形成過程を明らかにするため、NASA 及びESA の探査機が取得した可視・赤外の画像を解析した。その際、レーザー高度計による地形モデルや数値気候モデルとの比較も行った。その結果、著者は「Spire Streak」と「Dark Halo」の形成過程として2 つの可能性を導きだした。すなわち、• 突発的な強い斜面風によって、表面の細かなダストが侵食される過程。• 地下からの噴出物が拡散し、堆積する過程。である。さらに2 つの可能性から1 つに絞るため、解像度の高い分光画像を解析し「Dark Halo」とその周辺部分の構成物質の違いを明かにするのが今後の課題である。報告番号: ; 学位授与年月日: 2009-03-23 ; 学位の種別: 修士 ; 学位の種類: 修士(理学) ; 学位記番号:第11592号 ; 研究科・専攻: 理学系研究科地球惑星科学専