Background: Prasugrel is taken overseas at 10 mg/day (loading dose: 60 mg). However it is taken at 3.75 mg/day (loading dose: 20 mg) in Japan. The Japanese dose is prescribed for the health insurance covered treatment when prasugrel is administered to non-Japanese patients in Japan. The best practice for use of prasugrel in non-Japanese patients in Japan is not clear. Objective: To confirm the efficacy of prasugrel in foreign patients in Japan. Method: Our subjects for this study were European and American patients who received percutaneous coronary intervention (PCI) in our hospital between 2010 and 2018. We retrospectively compared the incidence of major adverse cardiac event (MACE) and bleeding in patients taking prasugrel (3.75 mg/day, loading dose: 20 mg) and patients taking clopidogrel (75 mg/day, loading dose: 300 mg) during the administration period of each drug. Results: Twenty-six patients were treated with prasugrel, and 85 with clopidogrel. Characteristics of patients (prasugrel/clopidogrel) were: age 57/56, body weight 87.4/88.5kg. The incidence rate of MACE was 5 (19.2%) in the prasugrel group, and 4 (4.7%) in the clopidogrel group (RR:4.1, 95%CI:1.18-14.1, p=0.03). The types of MACE (prasugrel/clopidogrel) were revascularization (4/4), nonfatal MI [1(stent thrombosis)/0], cardiovascular death (0/0). There were no differences in bleeding events. Conclusions: The use of the Japanese health insurance mandated dose of prasugrel had a higher incidence of MACE than clopidogrel in PCI for foreign patients. Clopidogrel may be more useful than Japanese doses of prasugrel for foreign patients in Japan.

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Objective: To assess the beneficial effects of no-touch saphenous vein graft (NT-SVG) obtained by endoscopic vessel harvesting (EVH) on the long-term patency and wound complications in coronary artery bypass grafting at our hospital. Method: From August 2018 to February 2020, 44 SVGs obtained by EVH were divided into two groups: group “C,” were the saphenous vein (SV) was conventionally stripped and distended; group “NT,” were the SV was neither stripped nor distended, retaining its perivascular tissue pedicle. In addition to the evaluation of early clinical outcomes, such as graft patency and wound complications, the postoperative alteration in the SVG diameter was compared among the two groups. Result: There were no significant differences in the preoperative characteristics and postoperative outcomes among the two groups, with no early graft obstruction or delayed wound healing reported. Concerning the alteration in the SVG diameter postoperatively, the difference of the diameter was significantly lesser in the NT group (p < 0.05). Histopathological analysis revealed that the structure of the SVG wall was well preserved in the NT group. Conclusion: The NT-SVG obtained by EVH would be an ideal technique showing higher long-term patency and fewer wound complications.

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Objective: To evaluate the effectiveness of nutritional guidance with supervised cardiac rehabilitation after acute myocardial infarction (AMI). Method: The subjects were 102 patients (85 males, mean age 67±10 years) who underwent supervised cardiac rehabilitation after AMI between December 2015 and June 2019. Nutritional guidance was provided 1 and 3 months after discharge, and three individual dietary changes were recommended for each patient. At 3 months after discharge, the rate of implementation of the three recommendations was evaluated. High and low adherence was defined as rates of ≥67% (HA group) and <67% (LA group), respectively. Risk factors for diet adherence were examined in these groups. Result: Nutritional guidance was conducted for 85 patients (83%) at 1 month and for 63 patients (62%) at 3 months. The median implementation rates were 80% at 1 month and 79% at 3 months. Low adherence was found in 12 patients (19%). Patients living alone and drinking excessive alcohol were more frequently observed in the LA group than in the HA group (p=0.04, p=0.03). Body mass index (BMI) had a tendency to be higher at baseline in the LA group (24.6±3.5 vs. 22.9±2.9 kg/m², p = 0.07) and showed a tendency to increase in this group after 5 months (p=0.08). Conclusion: Individual Nutritional guidance with three recommendations may be effective for patients who underwent supervised cardiac rehabilitation. However, particular care may be recommended for patients living alone, drinking excessive alcohol, or with higher BMI.

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