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Heart and Vessels

, Volume 34, Issue 4, pp 564–571 | Cite as

Frequency and prognostic impact of intravascular imaging-guided urgent percutaneous coronary intervention in patients with acute myocardial infarction: results from J-MINUET

  • Hiroyuki OkuraEmail author
  • Yoshihiko Saito
  • Tsunenari Soeda
  • Koichi Nakao
  • Yukio Ozaki
  • Kazuo Kimura
  • Junya Ako
  • Teruo Noguchi
  • Satoshi Yasuda
  • Satoru Suwa
  • Kazuteru Fujimoto
  • Yasuharu Nakama
  • Takashi Morita
  • Wataru Shimizu
  • Atsushi Hirohata
  • Yasuhiro Morita
  • Teruo Inoue
  • Atsunori Okamura
  • Masaaki Uematsu
  • Kazuhito Hirata
  • Kengo Tanabe
  • Yoshisato Shibata
  • Mafumi Owa
  • Kenichi Tsujita
  • Kunihiro Nishimura
  • Yoshihiro Miyamoto
  • Masaharu Ishihara
  • The J-MINUET investigators
Original Article
  • 119 Downloads

Abstract

Previous studies have demonstrated that use of intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) was associated with lower incidence of death, myocardial infarction, and target vessel revascularization. Recently, optical coherence tomography (OCT) has emerged as an alternative intravascular imaging device with better resolution. The aim of this study was to investigate frequency and prognostic impact of IVUS or OCT-guided PCI during urgent revascularization for acute myocardial infarction diagnosed by the universal definition. A total of 2788 patients who underwent urgent PCI were selected from a multicenter, Japanese registry of acute myocardial infarction diagnosed by universal definition (J-MINUET). Frequency, clinical characteristics and prognostic impact of the IVUS-, or OCT- guided PCI were investigated. Clinical endpoint was in-hospital death. Angiography-, IVUS-, and OCT-guided urgent PCI were performed in 689 (24.7%), 1947 (69.8%), and 152 (5.5%) patients. In-hospital death in each group was 10.4%, 5.1%, and 3.3%, respectively (P < 0.01). By univariate and multivariate logistic regression analysis, IVUS-guided PCI (vs. angiography-guided PCI, OR 0.49, 95% CI 0.30–0.81, P = 0.006) was a significant independent predictor of in-hospital death. Intravascular imaging guided-PCI was frequently adopted during urgent PCI for acute myocardial infarction diagnosed by universal definition and was associated with better in-hospital survival.

Keywords

Intravascular imaging IVUS OCT Acute myocardial infarction PCI 

Notes

Acknowledgments

This study was supported by the Intramural Research Fund, Grant number 23-4-5, for Cardiovascular Diseases of the National Cerebral and Cardiovascular Center. The authors thank all the enrolled patients, participating cardiologists, medical and other staffs who have contributed to this study. The J-MINUET investigators are listed in Appendix. J-MINUET Investigators: Masaharu Ishihara, Hyogo College of Medicine; Ogawa Hisao, National Cerebral and Cardiovascular Center, Kumamoto University Graduate School of Medical Sciences; Nobuaki Kokubu, Sapporo Medical University; Tadaya Sato, Akita Medical Center; Teruo Inoue, Dokkyo Medical University; Shigeru Oshima, Gunma Prefectural Cardiovascular Center; Hiroshi Funayama, Saitama Medical Center Jichi Medical University; Ken Kozuma, Hiroyuki Kyono, Teikyo University; Wataru Shimizu, Nippon Medical School; Satoru Suwa, Juntendo University Shizuoka Hospital; Kengo Tanabe, Mitsui Memorial Hospital; Tetsuya Tobaru, Sakakibara Heart Institute; Kazuo Kimura, Yokohama City University Medical Center; Junya Ako, Kitasato University; Mafumi Owa, Suwa Red Cross Hospital; Yasuhiro Morita, Ogaki Municipal Hospital; Yukio Ozaki, Fujita Health University; Satoshi Yasuda, Teruo Noguchi, Masashi Fujino, National Cerebral and Cardiovascular Center, Junichi Kotani, Osaka University Graduate School of Medicine; Takashi Morita, Osaka General Medical Center; Atsunori Okamura, Sakurabashi Watanabe Hospital; Yoshihiko Saito, Nara Medical University; Masaaki Uematsu, Kansai Rosai Hospital; Hiroyuki Okura, Kawasaki Medical School; Atsushi Hirohata, The Sakakibara Heart Institute of Okayama; Yasuharu Nakama, Hiroshima City Hospital; Keijiro Saku, Fukuoka University School of Medicine; Seiji Hokimoto, Kumamoto University Graduate School of Medical Sciences; Koichi, Saiseikai Kumamoto Hospital; Kazuteru Fujimoto, National Hospital Organization Kumamoto Medical Center; Yoshisato Shibata, Miyazaki Medical Association Hospital; Kazuhito Hirata, Okinawa Prefectural Chubu Hospital. Yoshihiro Miyamoto, Kunihiro Nishimura, Michikazu Nakai, National Cerebral and Cardiovascular Center.

Funding

Grant This study was supported by the Intramural Research Fund, Grant number 23-4-5, for Cardiovascular Diseases of the National Cerebral and Cardiovascular Center.

Compliance with ethical standards

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

References

  1. 1.
    Chieffo A, Latib A, Caussin C, Presbitero P, Galli S, Menozzi A, Varbella F, Mauri F, Valgimigli M, Arampatzis C, Sabate M, Erglis A, Reimers B, Airoldi F, Laine M, Palop RL, Mikhail G, Maccarthy P, Romeo F, Colombo A (2013) A prospective, randomized trial of intravascular-ultrasound guided compared to angiography guided stent implantation in complex coronary lesions: the AVIO trial. Am Heart J 165:65–72CrossRefGoogle Scholar
  2. 2.
    Hong SJ, Kim BK, Shin DH, Nam CM, Kim JS, Ko YG, Choi D, Kang TS, Kang WC, Her AY, Kim YH, Hur SH, Hong BK, Kwon H, Jang Y, Hong MK, Investigators I-X (2015) Effect of intravascular ultrasound-guided vs angiography-guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial. JAMA 314:2155–2163CrossRefGoogle Scholar
  3. 3.
    Witzenbichler B, Maehara A, Weisz G, Neumann FJ, Rinaldi MJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Brodie BR, Stuckey TD, Mazzaferri EL Jr, Xu K, Parise H, Mehran R, Mintz GS, Stone GW (2014) Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study. Circulation 129:463–470CrossRefGoogle Scholar
  4. 4.
    Ahn JM, Han S, Park YK, Lee WS, Jang JY, Kwon CH, Park GM, Cho YR, Lee JY, Kim WJ, Park DW, Kang SJ, Lee SW, Kim YH, Lee CW, Kim JJ, Park SW, Park SJ (2013) Differential prognostic effect of intravascular ultrasound use according to implanted stent length. Am J Cardiol 111:829–835CrossRefGoogle Scholar
  5. 5.
    Ahn JM, Kang SJ, Yoon SH, Park HW, Kang SM, Lee JY, Lee SW, Kim YH, Lee CW, Park SW, Mintz GS, Park SJ (2014) Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies. Am J Cardiol 113:1338–1347CrossRefGoogle Scholar
  6. 6.
    Jang JS, Song YJ, Kang W, Jin HY, Seo JS, Yang TH, Kim DK, Cho KI, Kim BH, Park YH, Je HG, Kim DS (2014) Intravascular ultrasound-guided implantation of drug-eluting stents to improve outcome: a meta-analysis. JACC Cardiovasc Interv 7:233–243CrossRefGoogle Scholar
  7. 7.
    Zhang YJ, Pang S, Chen XY, Bourantas CV, Pan DR, Dong SJ, Wu W, Ren XM, Zhu H, Shi SY, Iqbal J, Gogas BD, Xu B, Chen SL (2015) Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis. BMC Cardiovasc Disord 15:153CrossRefGoogle Scholar
  8. 8.
    Elgendy IY, Mahmoud AN, Elgendy AY, Bavry AA (2016) Outcomes with intravascular ultrasound-guided stent implantation: a meta-analysis of randomized trials in the era of drug-eluting stents. Circ Cardiovasc Interv 9:e003700Google Scholar
  9. 9.
    Shin DH, Hong SJ, Mintz GS, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK (2016) Effects of intravascular ultrasound-guided versus angiography-guided new-generation drug-eluting stent implantation: meta-analysis with individual patient-level data from 2345 randomized patients. JACC Cardiovasc Interv 9:2232–2239CrossRefGoogle Scholar
  10. 10.
    Kume T, Akasaka T, Kawamoto T, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2005) Assessment of coronary intima-media thickness by optical coherence tomography: comparison with intravascular ultrasound. Circ J 69:903–907CrossRefGoogle Scholar
  11. 11.
    Kume T, Okura H, Yamada R, Kawamoto T, Watanabe N, Neishi Y, Sadahira Y, Akasaka T, Yoshida K (2009) Frequency and spatial distribution of thin-cap fibroatheroma assessed by 3-vessel intravascular ultrasound and optical coherence tomography: an ex vivo validation and an initial in vivo feasibility study. Circ J 73:1086–1091CrossRefGoogle Scholar
  12. 12.
    Kume T, Akasaka T, Kawamoto T, Okura H, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Measurement of the thickness of the fibrous cap by optical coherence tomography. Am Heart J 152:755 e1–755 e4CrossRefGoogle Scholar
  13. 13.
    Kume T, Okura H, Kawamoto T, Yamada R, Miyamoto Y, Hayashida A, Watanabe N, Neishi Y, Sadahira Y, Akasaka T, Yoshida K (2011) Assessment of the coronary calcification by optical coherence tomography. EuroIntervention 6:768–772CrossRefGoogle Scholar
  14. 14.
    Kobayashi Y, Okura H, Kume T, Yamada R, Kobayashi Y, Fukuhara K, Koyama T, Nezuo S, Neishi Y, Hayashida A, Kawamoto T, Yoshida K (2014) Impact of target lesion coronary calcification on stent expansion. Circ J 78:2209–2214CrossRefGoogle Scholar
  15. 15.
    Habara M, Nasu K, Terashima M, Kaneda H, Yokota D, Ko E, Ito T, Kurita T, Tanaka N, Kimura M, Ito T, Kinoshita Y, Tsuchikane E, Asakura K, Asakura Y, Katoh O, Suzuki T (2012) Impact of frequency-domain optical coherence tomography guidance for optimal coronary stent implantation in comparison with intravascular ultrasound guidance. Circ Cardiovasc Interv 5:193–201CrossRefGoogle Scholar
  16. 16.
    Prati F, Di Vito L, Biondi-Zoccai G, Occhipinti M, La Manna A, Tamburino C, Burzotta F, Trani C, Porto I, Ramazzotti V, Imola F, Manzoli A, Materia L, Cremonesi A, Albertucci M (2012) Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l'Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study. EuroIntervention 8:823–829CrossRefGoogle Scholar
  17. 17.
    Viceconte N, Chan PH, Barrero EA, Ghilencea L, Lindsay A, Foin N, Di Mario C (2013) Frequency domain optical coherence tomography for guidance of coronary stenting. Int J Cardiol 166:722–728CrossRefGoogle Scholar
  18. 18.
    Miyamoto Y, Okura H, Kume T, Kawamoto T, Neishi Y, Hayashida A, Yamada R, Imai K, Saito K, Yoshida K (2011) Plaque characteristics of thin-cap fibroatheroma evaluated by OCT and IVUS. JACC Cardiovasc Imaging 4:638–646CrossRefGoogle Scholar
  19. 19.
    Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97:1713–1717CrossRefGoogle Scholar
  20. 20.
    Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, Tanimoto T, Matsuo Y, Masho T, Kitabata H, Tsuda K, Tomobuchi Y, Akasaka T (2007) Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol 50:933–939CrossRefGoogle Scholar
  21. 21.
    Okura H, Taguchi H, Kubo T, Toda I, Yoshida K, Yoshiyama M, Yoshikawa J (2007) Atherosclerotic plaque with ultrasonic attenuation affects coronary reflow and infarct size in patients with acute coronary syndrome: an intravascular ultrasound study. Circ J 71:648–653CrossRefGoogle Scholar
  22. 22.
    Kawamoto T, Okura H, Koyama Y, Toda I, Taguchi H, Tamita K, Yamamuro A, Yoshimura Y, Neishi Y, Toyota E, Yoshida K (2007) The relationship between coronary plaque characteristics and small embolic particles during coronary stent implantation. J Am Coll Cardiol 50:1635–1640CrossRefGoogle Scholar
  23. 23.
    Ueda T, Uemura S, Watanabe M, Sugawara Y, Soeda T, Okayama S, Takeda Y, Kawata H, Kawakami R, Saito Y (2014) Colocalization of thin-cap fibroatheroma and spotty calcification is a powerful predictor of procedure-related myocardial injury after elective coronary stent implantation. Coron Artery Dis 25:384–391CrossRefGoogle Scholar
  24. 24.
    Soeda T, Higuma T, Abe N, Yamada M, Yokoyama H, Shibutani S, Ong DS, Vergallo R, Minami Y, Lee H, Okumura K, Jang IK (2017) Morphological predictors for no reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction caused by plaque rupture. Eur Heart J Cardiovasc Imaging 18:103–110CrossRefGoogle Scholar
  25. 25.
    Ishihara M, Fujino M, Ogawa H, Yasuda S, Noguchi T, Nakao K, Ozaki Y, Kimura K, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Tsujita K, Nishimura K, Miyamoto Y, investigators JM, (2015) Clinical presentation, management and outcome of Japanese patients with acute myocardial infarction in the troponin era—Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET). Circ J 79:1255–1262CrossRefGoogle Scholar
  26. 26.
    Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Joint ESCAAHAWHFTFfUDoMI, Authors/Task Force Members C, Thygesen K, Alpert JS, White HD, Biomarker S, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Subcommittee ECG, Chaitman BR, Clemmensen PM, Johanson P, Hod H, Imaging S, Underwood R, Bax JJ, Bonow JJ, Pinto F, Gibbons RJ, Classification S, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Intervention S, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J, Trials, Registries S, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Trials, Registries S, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Trials, Registries S, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Trials, Registries S, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S, Guidelines ESCCfP, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Document R, Morais J, Aguiar C, Almahmeed W, Arnar DO, Barili F, Bloch KD, Bolger AF, Botker HE, Bozkurt B, Bugiardini R, Cannon C, de Lemos J, Eberli FR, Escobar E, Hlatky M, James S, Kern KB, Moliterno DJ, Mueller C, Neskovic AN, Pieske BM, Schulman SP, Storey RF, Taubert KA, Vranckx P, Wagner DR(2012) Third universal definition of myocardial infarction. J Am Coll Cardiol 60:1581–1598Google Scholar
  27. 27.
    Yamada R, Okura H, Kume T, Hayashida A, Neishi Y, Kawamoto T, Yoshida K (2013) Comparison of quantitative measurements between two different intravascular ultrasound systems: in vitro and in vivo studies. J Cardiol 61:201–205CrossRefGoogle Scholar
  28. 28.
    Kobayashi Y, Kitahara H, Tanaka S, Okada K, Kimura T, Ikeno F, Yock PG, Fitzgerald PJ, Honda Y (2016) Quantitative precision of optical frequency domain imaging: direct comparison with frequency domain optical coherence tomography and intravascular ultrasound. Cardiovasc Interv Ther 31:79–88CrossRefGoogle Scholar
  29. 29.
    Fitzgerald PJ, Oshima A, Hayase M, Metz JA, Bailey SR, Baim DS, Cleman MW, Deutsch E, Diver DJ, Leon MB, Moses JW, Oesterle SN, Overlie PA, Pepine CJ, Safian RD, Shani J, Simonton CA, Smalling RW, Teirstein PS, Zidar JP, Yeung AC, Kuntz RE, Yock PG (2000) Final results of the can routine ultrasound influence stent expansion (CRUISE) study. Circulation 102:523–530CrossRefGoogle Scholar
  30. 30.
    Morino Y, Honda Y, Okura H, Oshima A, Hayase M, Bonneau HN, Kuntz RE, Yock PG, Fitzgerald PJ (2001) An optimal diagnostic threshold for minimal stent area to predict target lesion revascularization following stent implantation in native coronary lesions. Am J Cardiol 88:301–303CrossRefGoogle Scholar
  31. 31.
    Sonoda S, Morino Y, Ako J, Terashima M, Hassan AH, Bonneau HN, Leon MB, Moses JW, Yock PG, Honda Y, Kuntz RE, Fitzgerald PJ, Investigators S (2004) Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial. J Am Coll Cardiol 43:1959–1963CrossRefGoogle Scholar
  32. 32.
    Kume T, Okura H, Miyamoto Y, Yamada R, Saito K, Tamada T, Koyama T, Neishi Y, Hayashida A, Kawamoto T, Yoshida K (2012) Natural history of stent edge dissection, tissue protrusion and incomplete stent apposition detectable only on optical coherence tomography after stent implantation—preliminary observation. Circ J 76:698–703CrossRefGoogle Scholar
  33. 33.
    Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, Brodie BR, Madonna O, Eijgelshoven M, Lansky AJ, O'Neill WW, Morice MC (1999) Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 341:1949–1956CrossRefGoogle Scholar
  34. 34.
    Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Carroll JD, Rutherford BD, Lansky AJ, Controlled A, Investigation Device, to Lower Late Angioplasty Complications I (2002) Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med 346:957–966CrossRefGoogle Scholar
  35. 35.
    Stone GW, Webb J, Cox DA, Brodie BR, Qureshi M, Kalynych A, Turco M, Schultheiss HP, Dulas D, Rutherford BD, Antoniucci D, Krucoff MW, Gibbons RJ, Jones D, Lansky AJ, Mehran R, Enhanced Myocardial E, Recovery by Aspiration of Liberated Debris I (2005) Distal microcirculatory protection during percutaneous coronary intervention in acute ST-segment elevation myocardial infarction: a randomized controlled trial. JAMA 293:1063–1072CrossRefGoogle Scholar
  36. 36.
    Muramatsu T, Kozuma K, Tsukahara R, Ito Y, Fujita N, Suwa S, Koyama S, Saitoh M, Kamiya H, Nakamura M, Investigators AT (2007) Comparison of myocardial perfusion by distal protection before and after primary stenting for acute myocardial infarction: angiographic and clinical results of a randomized controlled trial. Catheter Cardiovasc Interv 70:677–682CrossRefGoogle Scholar
  37. 39.
    Nakatsuma K, Shiomi H, Morimoto T, Ando K, Kadota K, Watanabe H, Taniguchi T, Yamamoto T, Furukawa Y, Nakagawa Y, Horie M, Kimura T, investigators CR-KA (2016) Intravascular ultrasound guidance vs. angiographic guidance in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction-long-term clinical outcomes from the CREDO-Kyoto AMI Registry. Circ J 80:477–484Google Scholar
  38. 39.
    Okura H, Kataoka T, Matsushita N, Shimeno K, Yoshiyama M, Yoshikawa J, Yoshida K (2013) Culprit lesion remodelling and long-term prognosis in patients with acute coronary syndrome: an intravascular ultrasound study. Eur Heart J Cardiovasc Imaging 14:758–764CrossRefGoogle Scholar
  39. 38.
    Soeda T, Uemura S, Park SJ, Jang Y, Lee S, Cho JM, Kim SJ, Vergallo R, Minami Y, Ong DS, Gao L, Lee H, Zhang S, Yu B, Saito Y, Jang IK (2015) Incidence and clinical significance of post-stent OCT findings: one year follow-up study from a multicenter registry. Circulation 132:1020–1029CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Hiroyuki Okura
    • 1
    Email author
  • Yoshihiko Saito
    • 1
  • Tsunenari Soeda
    • 1
  • Koichi Nakao
    • 2
  • Yukio Ozaki
    • 3
  • Kazuo Kimura
    • 4
  • Junya Ako
    • 5
  • Teruo Noguchi
    • 6
  • Satoshi Yasuda
    • 6
  • Satoru Suwa
    • 7
  • Kazuteru Fujimoto
    • 8
  • Yasuharu Nakama
    • 9
  • Takashi Morita
    • 10
  • Wataru Shimizu
    • 11
  • Atsushi Hirohata
    • 12
  • Yasuhiro Morita
    • 13
  • Teruo Inoue
    • 14
  • Atsunori Okamura
    • 15
  • Masaaki Uematsu
    • 16
  • Kazuhito Hirata
    • 17
  • Kengo Tanabe
    • 18
  • Yoshisato Shibata
    • 19
  • Mafumi Owa
    • 20
  • Kenichi Tsujita
    • 21
  • Kunihiro Nishimura
    • 6
  • Yoshihiro Miyamoto
    • 6
  • Masaharu Ishihara
    • 22
  • The J-MINUET investigators
  1. 1.Department of Cardiovascular MedicineNara Medical UniversityKashiharaJapan
  2. 2.Cardiovascular CenterSaiseikai Kumamoto HospitalKumamotoJapan
  3. 3.Department of CardiologyFujita Health UniversityToyoakeJapan
  4. 4.Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
  5. 5.Department of Cardiovascular MedicineKitasato UniversitySagamiharaJapan
  6. 6.Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
  7. 7.Department of CardiologyJuntendo University Shizuoka HospitalShizuokaJapan
  8. 8.Department of CardiologyNational Hospital Organization Kumamoto Medical CenterKumamotoJapan
  9. 9.Department of CardiologyHiroshima City HospitalHiroshimaJapan
  10. 10.Division of CardiologyOsaka General Medical CenterOsakaJapan
  11. 11.Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
  12. 12.Department of CardiologyThe Sakakibara Heart Institute of OkayamaOkayamaJapan
  13. 13.Department of CardiologyOgaki Municipal HospitalOgakiJapan
  14. 14.Department of Cardiovascular MedicineDokkyo Medical UniversityTochigiJapan
  15. 15.Department of CardiologySakurabashi Watanabe HospitalOsakaJapan
  16. 16.Cardiovascular CenterKansai Rosai HospitalAmagasakiJapan
  17. 17.Department of CardiologyOkinawa Prefectural Chubu HospitalUrumaJapan
  18. 18.Division of CardiologyMitsui Memorial HospitalTokyoJapan
  19. 19.Department of CardiologyMiyazaki Medical Association HospitalMiyazakiJapan
  20. 20.Department of Cardiovascular MedicineSuwa Red Cross HospitalSuwaJapan
  21. 21.Department of Cardiovascular MedicineKumamoto University Graduate School of Medical SciencesKumamotoJapan
  22. 22.Division of Coronary Artery DiseaseHyogo College of MedicineNishinomiyaJapan

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