Six months of DAPT was not inferior to 18 months of DAPT following implantation of a DES with a biodegradable abluminal coating. However, this result needs to be interpreted with caution given the open-label design and wide noninferiority margin of the present study. (Nobori Dual Antiplatelet Therapy as Appropriate Duration [NIPPON]; NCT01514227).

Backgrounds: Several studies have shown the serum high sensitive cardiac troponin I (hs-TnI) a biomarker of myocardium injury, and C-reactive protein (CRP), a biomarker of inflammation, are associated with worse cardiovascular outcomes. We evaluated the relationship between the hs-TnI level in patients with paroxysmal atrial fibrillation (PAF) after pulmonary vein isolation (PVI) and atrial fibrillation (AF) recurrence. Methods and Results:We enrolled 263 consecutive PAF patients who underwent PVI from May 2017 to April 2018. We investigated the difference in the relationship between the myocardial injury marker (serum hs-TnI), inflammatory marker (CRP, white blood cell) at 36 to 48 hours after the PVI, and early or late recurrence of AF (ERAF; <3 months and LRAF; from 3 months to 1 year) between the radiofrequency ablation group (R group) and cryoballoon ablation group (C group). The R group consisted of 147 patients and the C groups consisted of 116 patients. The serum hs-TnI level in R group was significantly lower than in the C group (2.33 vs 5.08 ng/mL; P < .001), while the CRP was significantly higher in the R group than C group (2.02 vs 1.10 mg/dL; P < .001). The incidences of an ERAF/LRAF were similar between the two groups.Conclusion: Cryoballoon ablation may cause more myocardial injury than radiofrequency catheter ablation, on the contrary, radiofrequency catheter ablation, may cause more inflammation than cryoballoon ablation. However, these phenomena may not affect the recurrence of AF after the PVI in patient with PAF. K E Y W O R D Shigh-sensitive cardiac troponin-T, inflammation, myocardial injury, paroxysmal atrial fibrillation, pulmonary vein isolation, recurrence of AF

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Acute myocardial infarctions are common in bacteraemia but are seldom diagnosed during life. A 64 year old man with severe chest pain who had fever for several days due to possible bacteraemia was shown by ECG and echocardiography to have possible lateral infarction. Immediate coronary angiography showed possible thrombus in the left circumflex artery, which was treated by thrombectomy catheter. Bacterial thrombus was removed and was verified by histological examination. A stent was implanted without complications. Acute myocardial infarction caused by septic embolism is usually fatal; however, thrombectomy may be useful in these cases. P erera et al 1 described a fatal case of acute myocardial infarction that arose from embolism of bacterial vegetation. Thromboembolic complications including myocardial infarction are common in patients with bacteraemia with or without endocarditis, but acute myocardial infarctions are seldom diagnosed during life. Recently, thrombectomy catheters have been used to treat acute myocardial infarctions in clinical settings. 3 We report a case of acute myocardial infarction caused by bacterial embolism in a major epicardial artery, diagnosed and treated with a RESCUE thrombectomy catheter (Scimed/BSC, Natick, Massachusetts, USA).A 64 year old man with chest pain was referred to the Division of Cardiology from the Division of Nephrology in our hospital. He had been receiving haemodialysis for 10 years and one month previously had undergone femoral-popliteal artery bypass surgery because of arteriosclerosis obliterans. After surgery, he remained in the Division of Nephrology for haemodialysis and rehabilitation. Owing to occlusion of the dialysis shunt, a transient dialysis catheter was inserted into his jugular vein one week before the onset of chest pain. He consequently developed a fever and thus the catheter was removed three days later. On the day of severe chest pain (two days after removal of the catheter) he was febrile, an ECG showed ST segment depression in leads I, II, III, aVF, and V 3 to V 6 , and echocardiography showed lateral wall motion abnormality but no findings indicating infective endocarditis. Urgent coronary angiography showed almost abrupt occlusion of the proximal left circumflex coronary artery caused by possible thrombus ( fig 1A). We immediately performed coronary aspiration with a RESCUE thrombectomy catheter ( fig 1B) and as a result a large amount of material was collected. After aspiration, we performed balloon angioplasty and implanted a stent, which achieved successful reperfusion (TIMI (thrombolysis in myocardial infarction) flow grade 3 4 ). The maximum creatine kinase concentration was 880 IU/l and the patient was treated with antibiotics and anticoagulants.The material collected by the RESCUE catheter measured 2 mm. Histological findings were Gram positive streptococcus in a fibrin thrombus (fig 2). We feared that implanting the stent without aspiration might have caused a mycotic coronary aneurysm at the location of stent implantation. 6The mecha...