BACKGROUND:Advancing age is associated with epicardial atherosclerosis and coronary microvascular dysfunction (CMD), complicating reliable assessment of CMD using coronary flow reserve (CFR). Whether prevalence of functional and structural CMD varies with age remains unclear. OBJECTIVES:The authors sought to evaluate the prevalence of CMD endotypes by age strata and compare CFR with microvascular resistance reserve (MRR) for diagnosis and stratification. METHODS:Data from 1,704 patients (2,283 lesions) with stable angina in the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry) were analyzed, including obstructive (fractional flow reserve ≤0.80) and nonobstructive (fractional flow reserve >0.80) lesions. CMD was classified as no CMD (MRR ≥3.0), functional CMD (MRR <3.0, normal resistance), or structural CMD (MRR <3.0, abnormal resistance). CMD classification was repeated using CFR (<2.5 abnormal). Patients were stratified per age decade: <50, 50-59, 60-69, 70-79, and ≥80 years. RESULTS:CMD prevalence by MRR was 48.2%, and increased across age strata (37.2% to 78.0%; P < 0.001), driven by structural CMD (10.9% to 40.0%; P < 0.001), while functional CMD prevalence remained unchanged (26.3% to 38.0%; P = 0.220). Age independently predicted functional (OR/y: 1.02; P < 0.001) and structural CMD (OR/y: 1.05; P < 0.001). In obstructive lesions, age predicted structural CMD (OR/y: 1.03; P = 0.0055); in nonobstructive lesions, age predicted functional (OR/y: 1.02; P = 0.0032) and structural CMD (OR/y: 1.06; P < 0.001). Overall CMD prevalence by CFR exceeded MRR across groups (53.3% vs 48.2%; P < 0.001), irrespective of epicardial disease. CONCLUSIONS:Structural CMD increases with age regardless of obstructive CAD, while functional CMD prevalence increases only in nonobstructive CAD. CFR may overestimate CMD in epicardial disease, whereas MRR provides a more consistent assessment regardless of obstructive CAD, underscoring the need for prospective studies on their clinical relevance.
Although prompt treatment is desirable for malignancies, surgical delays are sometimes unavoidable. Previous studies show conflicting results on the effect of diagnosis-to-surgery delay in esophageal cancer, mainly focusing on advanced stages treated preoperatively. Early stage disease, particularly cT1bN0, often involves longer waiting times, but the acceptable delay remains unclear. We conducted this study to evaluate the impact of surgical waiting time on postoperative survival in patients with clinical T1bN0M0 esophageal squamous cell carcinoma (ESCC) undergoing upfront esophagectomy. This multicenter retrospective study included 160 patients with cT1bN0M0 ESCC undergoing subtotal esophagectomy with lymphadenectomy at seven Japanese institutions between 2008 and 2021. Receiver operating characteristic (ROC) analysis identified the optimal waiting time cutoff predicting recurrence. Survival outcomes were compared between short and long waiting groups using the Kaplan–Meier method and Cox regression analyses. ROC analysis identified 66.5 days as the optimal cutoff value. The long waiting group (≥ 67 days) showed significantly worse 3-year recurrence-free survival (87.9
Background: Although the COVID-19 pandemic has impacted the management of acute coronary syndrome (ACS), the prognostic implications for ACS patients with concurrent COVID-19 undergoing percutaneous coronary intervention (PCI) remain to be determined, particularly in large nationwide cohorts. This study investigated the association between concomitant COVID-19 and clinical outcomes in patients undergoing emergent PCI for ACS. Methods and Results: This retrospective cohort study utilized data from the Japanese Percutaneous Coronary Intervention (J-PCI) nationwide registry, encompassing all patients presenting with ACS who underwent primary or emergent PCI between January 2021 and December 2023. Multivariable logistic regression models were employed to ascertain the independent association between COVID-19 positivity and in-hospital all-cause and cardiovascular mortality. The analysis included 279,662 ACS patients, of whom 1,812 (0.65%) tested positive for COVID-19. After multivariable adjustment, COVID-19 remained an independent predictor of in-hospital all-cause mortality (adjusted odds ratio [aOR] 1.46; 95% confidence interval [CI] 1.21-1.77). The association between COVID-19 and cardiovascular mortality was significant in univariable analysis but not after multivariable adjustment (aOR 1.22; 95% CI 0.98-1.52). Conclusions: In this nationwide cohort, concomitant COVID-19 was independently associated with higher in-hospital all-cause mortality among patients with ACS undergoing PCI. These findings highlight the need for heightened surveillance and consideration of tailored therapeutic strategies in this high-risk population.
Goreisan is an herbal medicine that regulates water metabolism, exerting a diuretic effect that does not alter urine volume in dehydrated conditions but increases urine output in edematous conditions without affecting plasma electrolyte levels, thereby demonstrating an anti-edema action. We report a case of severe lupus nephritis (LN) accompanied by nephrotic syndrome (NS) in which Goreisan proved effective in managing intractable edema. Goreisan is considered potentially beneficial for controlling intractable edema associated with nephritic NS, including severe LN.
