Biomedical subjects

H Nosaka

Publications and source records attributed to H Nosaka.

7 recordsLinked to original sources

PubMed1992

Statistical analysis of clinical risk factors for coronary artery spasm: identification of the most important determinant.

Coronary artery spasm plays an important role in acute ischemic events, and it has a close relationship with coronary atherosclerosis. Thus we attempted to determine the most significant risk factor for coronary artery spasm. Among 3000 consecutive patients who underwent coronary cineangiography with ergonovine maleate testing, 330 with typical angina pectoris (group 1) and 294 with old myocardial infarction (group 2) were studied. We divided each group into three or four subgroups according to the presence of fixed organic stenosis (FOS+) or a positive reaction to ergonovine maleate (coronary artery spasm [CAS]+). We examined the relationship between coronary artery spasm and eight coronary risk factors: age, sex, hypertension, diabetes mellitus, smoking, and serum cholesterol, uric acid, and high-density lipoprotein cholesterol levels. The proportion of smokers in the subgroups with CAS(+) was significantly higher than in the subgroups with CAS(-)(p less than 0.01). There was no correlation between smoking and fixed organic stenosis. According to the results of multiple regression analysis, there was a positive correlation between smoking and CAS(+) and between serum high-density lipoprotein cholesterol levels and CAS(+)(p less than 0.01). Thus we concluded that smoking is the most significant risk factor in discriminating between patients with and without coronary artery spasm.

Cholesterol, HDL↗

PubMed1991

Progression of coronary atherosclerosis: is coronary spasm related to progression?

A total of 239 patients undergoing serial coronary angiography with a concomitant ergonovine provocation test were studied between July 1974 and June 1987. The progression of coronary artery disease was evaluated in relation to risk factors, especially coronary artery spasm. Patients were classified into three groups: 1) new myocardial infarction group (39 patients); 2) progression without infarction group (90 patients); and 3) nonprogression group (110 patients). To assess how risk factors and coronary spasm are related to the occurrence of new myocardial infarction and progression without infarction, 11 variables in the three groups were examined: age, gender, the time interval between the studies, fasting blood sugar, systolic blood pressure, diastolic blood pressure, smoking, serum cholesterol, triglyceride, uric acid and a positive response to the ergonovine provocation test. Multiple regression analysis selected three independent predictors of progression without infarction: cholesterol (p less than 0.01), systolic blood pressure (p less than 0.05) and a positive response to the ergonovine provocation test (p less than 0.001). Multiple regression analysis also selected three independent predictors of the occurrence of new myocardial infarction: fasting blood sugar (p less than 0.01), systolic blood pressure (p less than 0.05) and a positive response to the ergonovine provocation test (p less than 0.001). A positive response to the ergonovine provocation test was the strongest factor for occurrence of both new myocardial infarction and progression without infarction. To evaluate segmental arterial changes, 3,275 coronary artery segments were analyzed in the 239 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗

PubMed1991

Restenosis after percutaneous transluminal coronary angioplasty: pathologic observations in 20 patients.

Histopathologic examination was performed in 20 patients undergoing antemortem coronary angioplasty. Thirty-four lesions were dilated and the interval between coronary angioplasty and death ranged from several hours to 4 years. Intimal proliferation of smooth muscle cells, as a major cause of restenosis, was observed in 83% to 100% of 28 lesions examined 11 days to 2 years after coronary angioplasty. In 20 lesions examined within 6 months, proliferating smooth muscle cells were predominantly of the synthetic type and there was abundant extracellular matrix substance chiefly composed of proteoglycans. In eight lesions examined between 6 months and 2 years, contractile type smooth muscle cells were dominant and extracellular matrix was composed chiefly of collagen. In three lesions examined after 2 years, evidence of antemortem coronary angioplasty was hardly identifiable and these lesions were almost indistinguishable from conventional atherosclerotic plaque. These temporal changes in histologic pattern provide a pathologic background for clinical reports that restenosis is predominantly found within 6 months after coronary angioplasty. Morphometric analysis revealed that the extent of intimal proliferation was significantly greater in lesions with evidence of medial or adventitial tears than in lesions with no or only intimal tears.

Aged↗

PubMed1991

Initial success rate and complications of elective PTCA in 5064 patients.

From October 1981 to May 1990, 7000 elective percutaneous transluminal coronary angioplasties (PTCA) were performed at the Kokura Memorial Hospital, of which 5064 were analyzed using our computer system. The primary success rate of PTCA was 85%, in 1 vessel disease 88%, in 2 vessel disease 85%, and in 3 vessel disease 79%. Complications of PTCA were as follows: myocardial infarction, 2.1%; emergency CABG, 0.5%; death, 0.6%. We analyzed predictive factors for in-hospital death or emergency CABG. Five significant factors are significantly related: cerebral vascular accident, chronic renal failure, jeopardized collateral, abrupt closure, and dilatation of the left anterior descending artery.

Adult↗

PubMed1991

[Long-term follow-up of patients treated with intracoronary thrombolysis or percutaneous transluminal coronary angioplasty for acute myocardial infarction].

Long-term follow-up data concerning coronary patients treated for acute myocardial infarction with intracoronary thrombolysis (ICT) or percutaneous transluminal coronary angioplasty (PTCA) are sparse. In this study, the early and long-term outcomes in 95 patients undergoing only ICT (group I) and 190 patients undergoing only PTCA (group II) were retrospectively evaluated. Cardiogenic shock cases in group II were excluded from this study because of the absence of comparable shock cases in group I. The overall in-hospital mortality was 3.5% (10 patients). Treatment by reperfusion therapy during the acute phase was not a significant factor in predicting the in-hospital mortality (5.4% in group I vs 2.6% in group II), but a Forrester subset (p < 0.001) and the extent of coronary artery disease (p < 0.05) were reliable predictors. In a discrimination analysis, a Forrester subset (3, 4) was the most reliable predictor followed by age (> 70 years). Follow-up was completed for 263 of 273 (96%) hospital survivors (88 patients in group I and 185 in group II). Mean follow-up periods of groups I and II (+/- SD) were 57 +/- 35 and 23 +/- 15 months, respectively. Five-year cardiac death-free survival for hospital survivors after ICT was 87% compared with 96% after PTCA (p was not significant). In a univariate analysis, a Forrester subset (p < 0.001) and the extent of residual coronary disease on discharge from the hospital (p < 0.01) were reliable predictors of subsequent cardiovascular deaths. Multivariate analysis also identified these 2 factors as independent predictors. We concluded that the most significant determinant factor of in-hospital and long-term mortality after intervention might be a Forrester subset; namely, left ventricular function at the time of emergency admission, and that long-term survival seemed to relate to the extent of coronary artery disease on discharge from the hospital. This suggested that interventional reperfusion therapy did not necessarily improve left ventricular function at the time of hospital discharge.

Aged↗

PubMed1991

[Angiography of silent myocardial ischemia].

From March 1986 through October 1987, elective diagnostic coronary angiography was performed in 1,542 consecutive patients. Among them, silent myocardial ischemia was investigated based on the histories in their medical questionnaires, the results of exercise stress tests and the presence of significant coronary artery stenosis. Exercise-induced silent myocardial ischemia was documented only in 3% in the non-infarction group, and in 2.1% of those with significant coronary stenosis. However, asymptomatic post-infarction patients comprised 33%. With regard to the extent of coronary artery disease in the non-infarction group, one-, two- and three-vessel disease accounted for 42%, 29% and 29%, respectively (NS). However, one-vessel disease was predominant among the asymptomatic post-infarction patients (p < 0.01). Among the non-infarction group, those with asymptomatic coronary stenosis had a relatively high incidence of diabetes mellitus (p < 0.01), but such a difference was not significant among the asymptomatic post-infarction patients. Among the post-infarction group, many of those who had chest pain during exercise showed redistribution on exercise thallium scintigraphy. Angioplasty was performed in most of the patients in the asymptomatic group, but its long-term effects are yet unknown.

Adult↗

PubMed1978

[Nitroprusside].

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Cardiac Output↗