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

Functional Dissection of BH3 Only Protein BNIP3

BNIP3 is a pro-apoptotic protein, which contains BH3 and trans-membrane domains. Previous studies demonstrated an association between ceBNIP3, C. elegans homologue of BNIP3, and ced-3. It seemed likely that the interaction between ceBNIP3 and ced-3 was an alternative cascade of caspase activation in C. elegans, however the detailed mechanism of this interaction is yet to be elucidated. We constructed several deletion mutants of BNIP3 and investigated their biological functions. As we expected, the trans-membrane domain of BNIP3 was not required for the association between BNIP3 and ced-3, however trans-membrane deletion mutant could not initiate the apoptotic cascade. Immunofluorescence study demonstrated that wild type BNIP3 and ced-3 co-localized on mitochondria, but trans-membrane deletion mutant did not. These results suggest that the recruitment of ced-3/caspase onto the mitochondrial membrane is essential for BNIP3 initiated apoptosis

Involuntary Measurement System for Respiratory Waveform for Prevention of Accidental Drowning during Bathing

Death rate of accidental drowning in the bathtub was the highest among casualties occurring at home, according to the annual report of the Japanese Ministry of Health, Labour and Welfare in 2007. To prevent accidental drowning during bathing at home, we obtained respiratory waveforms from bioelectric impedance (BEI) measurement using non-contact electrodes. The BEI measurement is an involuntary measurement method, from which respiratory waveform during bathing can be extracted. In the present study, to find the most appropriate electrode configuration as well as the optimal measuring frequency, we calculated the frequency dependence of impedance amplitude by numerical technique based on a three-dimensional finite difference method for a composite system consisting of a human body submerged in bath water. The results of model calculation agreed with the experimental results. Next, to obtain respiratory waveforms with large amplitudes, we investigated the optimal frequency experimentally. The frequency of 1MHz was suitable for involuntary measurement of respiratory waveform during bathing