Objective: The objective of this study was to evaluate the effectiveness of continuous cardiac rehabilitation after coronary artery bypass grafting (CABG). Method: We surveyed 107 patients about six months after isolated CABG from January 2010 to June 2015 in our hospital. Result: Cardiac rehabilitation was maintained in 57 patients (53%) (CR group). 50 patients self-suspended cardiac rehabilitation (NCR group). During a mean (±SD) follow-up of 42 ± 18 months, 15 patients died. The 3-year survival rate in the CR group was 98% versus 88% in the NCR group (p=0.09). Cardiac events occurred in 20 patients. The 3-year cardiac event-free rate was 95% for the CR group versus 79% for the NCR group (p=0.02). Conclusion: Continuous cardiac rehabilitation might improve the prognosis of the patients after coronary artery bypass grafting.

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We report a rare case in which a pressure wire for fractional flow reserve (FFR) measurement was eventfully fractured within the lumen of the coronary artery during percutaneous coronary intervention. A 70-year-old man had a fractured and retained pressure wire entrapped in the right coronary artery. We successfully removed the total length of the fractured wire from a small incision of distal right coronary artery and performed Off-Pump CABG using the incision as an anastomosis. Cardiac interventionists should be aware of this complication. Since intravascular device fragments cause highly thrombogenic and coronary perforation, surgical removal should be considered promptly if percutaneous removal is impossible.

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A 66-year-old Southeast Asian male with medical history of hypertension, dyslipidemia, and diabetes developed dyspnea and was admitted to our hospital. He was diagnosed as acute myocardial infarction. The coronary angiography (CAG) revealed 75% stenosis in the proximal right coronary artery (RCA) and total occlusion of the distal RCA, and 90% stenosis in the proximal left anterior descending artery (LAD). The patient underwent percutaneous coronary intervention (PCI) with drug-eluting stent placement in the proximal LAD. Following PCI, the patient received dual antiplatelet therapy (DAPT) with aspirin and prasugrel. On day-14 of hospitalization, the patient suddenly developed hypotension and hypoxemia. Emergency CAG revealed subacute stent thrombosis in the proximal LAD and total occlusion of the proximal RCA. The patient underwent thrombus aspiration and the balloon dilatation. We switched the treatment of prasugrel to ticagrelor. After the DAPT with aspirin and ticagrelor no additional stenosis events were occurred. On day-49, the patient was discharged our hospital and went back to his country. The approved prasugrel loading and maintenance doses in Japan are respectively 20 mg/day and 3.75 mg/day, which are approximately 1/3 of other countries (60 mg/day loading and 10 mg/day maintenance) including China and South Korea. Therefore, treatment of prasugrel for foreign visitors may have the residual thrombosis risk and the dose adjustment after they return to home country. In contrast, ticagrelor dose in Japan is the same as other countries. Thus, it is necessary to consider the drug dosage and availability in other countries when the antiplatelet therapy is required.

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