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Existing studies have yielded conflicting results regarding the relationship between the time of occurrence of out-of-hospital cardiac arrests and the associated outcomes. We examined whether the one-month survival rate for out-of-hospital cardiac arrests differed depending on whether the cardiac arrest occurred during the day or night. Further, we examined whether this rate differed when comparing the period succeeding the 2005 International Resuscitation Guidelines (2006-2010) with that following the 2010 guidelines (2011-2015).Using data from the All-Japan Utstein Registry for 2006-2015, adult out-of-hospital cardiac arrest patients whose collapse was witnessed and for whom the collapse-to-hospital-arrival interval was shorter than 120 min were included in this study. Patients were categorized in terms of whether their arrest occurred during the post-2005- or post-2010-guideline period. The primary measure was the one-month survival with a favorable neurological outcome.Of 481,624 cases analyzed, 20% occurred at night. For both guideline periods, nighttime out-of-hospital cardiac arrests were associated with significantly lower one-month survival rates than daytime incidents (used as a reference; adjusted odds ratio: 0.69 and 0.63, 95% confidence interval: 0.65-0.73 and 0.60-0.65, and P 0.001 and0.001 for the 2005 and 2010 guideline periods, respectively).One-month survival with a favorable neurological outcome was significantly lower for patients who experienced nighttime out-of-hospital cardiac arrests, compared to daytime out-of-hospital cardiac arrests. This could be addressed by improving cardiopulmonary resuscitation training for bystanders and expanding and improving nighttime emergency medical services.

Relationships between plaque morphology on optical coherence tomography (OCT) and biomarker levels in the patients with acute coronary syndrome (ACS) have not been fully investigated.ACS patients (n=128) were prospectively enrolled and their plasma levels of soluble lectin-like oxidized LDL receptor-1 (sLOX-1), high-sensitivity C-reactive protein (hs-CRP), and high-sensitivity troponin T (hs-TnT) were measured. Another set of 20 patients with stable angina pectoris (SAP) without plaque rupture or erosion served as controls. Among 128 ACS patients, 75 patients underwent OCT procedure to evaluate culprit plaque morphology, and were categorized into two groups; ACS with plaque rupture (ruptured ACS; R-ACS, n=54) and ACS without plaque rupture (non-ruptured ACS; N-ACS, n=21).Levels of sLOX-1 (p0.001), hs-CRP (p=0.048) and hs-TnT (p0.001) were significantly higher in R-ACS than SAP. Levels of sLOX-1 were also significantly higher in R-ACS than in N-ACS (p0.001); whereas levels of hs-CRP (p=0.675), as well as those of hs-TnT (p=0.055), were comparable between R-ACS and N-ACS. Comparison of receiver operating characteristic (ROC) curves among sLOX-1, hs-CRP and hs-TnT to differentiate R-ACS from N-ACS revealed that the area under the curve (AUC) values of sLOX-1, hs-CRP and hs-TnT were 0.782, 0.531 and 0.643, respectively. ROC curves, generated for these biomarkers, to differentiate ACS with thin-cap fibroatheroma (TCFA) from those without demonstrated that the AUC values of sLOX-1, hs-CRP and hs-TnT were 0.718, 0.506 and 0.524, respectively.sLOX-1, but not hs-CRP or hs-TnT, can differentiate ACS with plaque rupture from those without, and ACS with TCFA from those without.

Left ventricular (LV) dyssynchrony reduces LV systolic function in patients with heart failure (HF). However, it remains unknown whether this relationship is independent of impaired LV myocardial perfusion.A total of 105 patients with chronic HF (age 71 ± 13 years; 71 men) were enrolled in the present study. (99m)Tc-sestamibi (MIBI) gated myocardial scintigraphy was performed at rest to assess LV myocardial perfusion as evaluated by the total defect score of perfusion Single Photon Emission Computed Tomography images (TDS-MIBI), LV systolic function as evaluated by LV ejection fraction (LVEF), and LV systolic dyssynchrony as evaluated by the maximal difference of time to end systole (MD-TES), which is the time lag between the earliest and the latest end systole among 17 LV segments analyzed with a novel program, "cardioGRAF". The mean ± SD (minimum and maximum range) of the MD-TES was 147.8 ± 117.5 (14.0-458.3)ms. The MD-TES was significantly higher in patients with LVEF45% (199.4 ± 117.6 ms) than in those with LVEF ≥ 45% (60.5 ± 41.2 ms, p0.001). In a multiple logistic regression analysis, the MD-TES showed an increased odds ratio for LVEF45% (2.46 [95% CI; 1.51-4.01] per increment in decile of MD-TES rank, p0.001), after adjusting for the TDS-MIBI, history of myocardial infarction, and other potential confounders.LV dyssynchrony is a significant determinant of LV systolic dysfunction in patients with HF, and this relationship is independent of impaired LV myocardial perfusion and history of myocardial infarction.

Background High-sensitivity C-reactive protein (hsCRP) has emerged as an independent predictor of coronary heart disease (CHD) in Western countries. However, it is still uncertain regarding whether hsCRP is associated with the risk of CHD in Japan. Methods The serum hsCRP levels were measured in 687 middle-aged Japanese male workers (age range; 40–59 years) during an annual health examination at a company in Kanagawa, Japan, in 2005. All participants were free from any cardiovascular diseases and any medications for hypertension, hyperlipidemia, or diabetes. The Framingham Risk Score (FRS) was calculated as an individual's risk level of future development of CHD. Associations between hsCRP and the FRS were then evaluated. Results The distribution of hsCRP was skewed to the left with a median value (interquartile range) of 0.3 (0.2, 0.6) mg/L. Log-transformed hsCRP significantly correlated with all components of the FRS except for age. The FRS gradually and significantly increased ( p =0.001 for trend) with an increase in the quartiles of hsCRP after adjusting for multiple potential confounders such as triglycerides, the body mass index, alcohol intake, and a family history of cardiovascular disease. For the highest quartile of hsCRP, crude and above-listed confounders-adjusted odds ratios of the high-risk for CHD (FRS≥6 point) compared to the lowest quartile were 6.97 (95% CI: 3.20–15.17, p p =0.001), respectively. Conclusions These results suggest that hsCRP is associated with the risk of CHD, as estimated by the FRS, in middle-aged Japanese men.

A worse prognosis of peri-procedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) has been reported in patients displaying an isolated elevation of cardiac troponin-T (TnT) or troponin-I [1,2]. Highly sensitive assay for TnT (hs-TnT) is newly developed, permitting measurement of TnT than those measurable limit with conventional assays [3,4]. Thus, procedural changes in TnT values following PCI using the hs-TnT assay may identify more minute myocardial injury. Optical coherence tomography (OCT) with high-resolution images (≈15 μm) allows detailed information such as fibrous cap thickness, and lipid distribution of the atherosclerotic plaque in vivo [5]. Therefore, this study has focused on precise assessments for PMI and lesion characteristics using both the hs-TnT measurements and OCT imaging. We enrolled 79 patients (59 males, age range: 42 to 86 years) who underwent elective coronary stent implantationwith OCTguidance for de novo atherosclerotic lesions. All patients were diagnosed as having stable angina pectoris (SAP) defined as a positive stress test for myocardial ischemia and no change in clinical symptoms within 4 weeks. The quantitative coronary angiography (QCA) findings were analyzed with a computer-assisted, automated edge detection algorithm(CMS,MEDIS, Nuenen, TheNetherlands). TheOCTprocedure has been previously reported [5]. Characterizations of the plaque components, such as lipid, fibrous, or calcified tissue and thrombus were validated based on the established criteria [6]. For all images with an OCT-determined lipid plaque, the angle of lipid tissue (AL), thinnest fibrous cap thickness (TFCT) and length of lipid tissue (LL) were measured as previously reported [5]. Blood samples were obtained before PCI and from 18 to 24 h following PCI. Serum hs-TnT was measured using an electrochemiluminescence pre-commercial immunoassay (Roche Diagnostics Ltd, Rotkreuz, Switzerland) [3]. According to the recent universal definition, the current study defined PMI as hsTnT values increased more than three times the 99th percentile upper reference limit (0.014 ng/ml) during PCI [7]. The patientswere divided into two groups, PMI and non-PMI groups. Thereafter, we analyzed which factors correspond to PMI by considering the patients' demographics, angiographic findings or lesion characteristics, and procedures. All statistical analyses were performed using the SPSS software program (version 11.0.1, SPSS Inc., Chicago, IL) and the MedCalc software package (version 10.1.4, MedCalc Software, Mariakerke, Belgium). A univariate logistic regression analysis was performed to obtain the odds ratio for PMI. Thereafter, a multivariate logistic regression analysis was performed using the variables with P values b 0.10 in the univariate analysis for examining their independent association with PMI. The receiver operating characteristic (ROC) curve analyseswereperformed to examine the ability of the OCTfindings to identify subjects at high-risk for PMI. All statistical tests were 2-sided, and a P value b 0.05 was considered to be significant. The mean patient age was higher than that of non-PMI group (71.0 ± 10.9 vs. 65.2 ± 9.7, P = 0.016), while the other baseline characteristics including coronary risk factors, prescription of pharmacological agents, lipid profile, estimated glomerular filtration rate or ejection fraction did not differ significantly between the groups. There were significant differences in the American Heart Association/American College of Cardiology's (AHA/ACC) classification (P = 0.023) and bifurcation lesions between the groups (20% vs. 5%, P = 0.013). Other angiographic parameters such as reference vessel diameter, minimum lumen diameter, or diameter stenosis were not different between the 2 groups. In a univariate logistic regression analysis (Table 1), age, AHA/ACC classification, thrombus, plaque rupture/fissure and each quartile increment in the AL, TFCT, and LL had a significantly increased odds ratio for PMI, and a International Journal of Cardiology 168 (2013) 2860–3148