Models for Estimating Genetic Parameters of Milk Production Traits Using Random Regression Models in Korean Holstein Cattle

The objectives of the study were to estimate genetic parameters for milk production traits of Holstein cattle using random regression models (RRMs), and to compare the goodness of fit of various RRMs with homogeneous and heterogeneous residual variances. A total of 126,980 test-day milk production records of the first parity Holstein cows between 2007 and 2014 from the Dairy Cattle Improvement Center of National Agricultural Cooperative Federation in South Korea were used. These records included milk yield (MILK), fat yield (FAT), protein yield (PROT), and solids-not-fat yield (SNF). The statistical models included random effects of genetic and permanent environments using Legendre polynomials (LP) of the third to fifth order (L3–L5), fixed effects of herd-test day, year-season at calving, and a fixed regression for the test-day record (third to fifth order). The residual variances in the models were either homogeneous (HOM) or heterogeneous (15 classes, HET15; 60 classes, HET60). A total of nine models (3 orders of polynomials×3 types of residual variance) including L3-HOM, L3-HET15, L3-HET60, L4-HOM, L4-HET15, L4-HET60, L5-HOM, L5-HET15, and L5-HET60 were compared using Akaike information criteria (AIC) and/or Schwarz Bayesian information criteria (BIC) statistics to identify the model(s) of best fit for their respective traits. The lowest BIC value was observed for the models L5-HET15 (MILK; PROT; SNF) and L4-HET15 (FAT), which fit the best. In general, the BIC values of HET15 models for a particular polynomial order was lower than that of the HET60 model in most cases. This implies that the orders of LP and types of residual variances affect the goodness of models. Also, the heterogeneity of residual variances should be considered for the test-day analysis. The heritability estimates of from the best fitted models ranged from 0.08 to 0.15 for MILK, 0.06 to 0.14 for FAT, 0.08 to 0.12 for PROT, and 0.07 to 0.13 for SNF according to days in milk of first lactation. Genetic variances for studied traits tended to decrease during the earlier stages of lactation, which were followed by increases in the middle and decreases further at the end of lactation. With regards to the fitness of the models and the differential genetic parameters across the lactation stages, we could estimate genetic parameters more accurately from RRMs than from lactation models. Therefore, we suggest using RRMs in place of lactation models to make national dairy cattle genetic evaluations for milk production traits in Korea.

Combined effect of individual and neighborhood socioeconomic status on mortality in patients with newly diagnosed dyslipidemia: A nationwide Korean cohort study from 2002 to 2013

BACKGROUND AND AIM

The study aims to determine whether dyslipidemia patients living in less affluent neighborhood are at a higher risk of mortality compared to those living in more affluent neighborhoods.

METHODS AND RESULTS

A population-based cohort study was conducted using a stratified representative sampling from the National Health Insurance claim data from 2002 to 2013. The target subjects comprise patients newly diagnosed with dyslipidemia receiving medication. We performed a survival analysis using the Cox proportional hazard model. Of 11,946 patients with dyslipidemia, 1053 (8.8%) subjects died during the follow-up period. Of the dyslipidemia patients earning a middle-class income, the adjusted HR in less affluent neighborhoods was higher than that in the more affluent neighborhoods compared to the reference category of high individual SES in more affluent neighborhoods (less affluent; hazard ratio (HR) = 1.64, 95% confidence interval (CI): 1.35-1.99 vs. more affluent; HR = 1.48, 95% CI: 1.20-1.81, respectively). We obtained consistent results in patients with lower income, wherein the adjusted HR in less affluent neighborhoods was higher than that in more affluent neighborhoods (less affluent; HR = 1.52, 95% CI: 1.16-1.97 vs. more affluent; HR = 1.41, 95% CI: 1.04-1.92, respectively).

CONCLUSION

Living in a less affluent neighborhood contributes to higher mortality among dyslipidemia patients. The individual- and neighborhood-level variables cumulatively affect individuals such that the most at-risk individuals include those having both individual- and neighborhood-level risk factors. These findings raise important clinical and public health concerns and indicate that neighborhood SES approaches should be essentially considered in health-care policies similar to individual SES.

Comparison of the effects of two low-density lipoprotein cholesterol goals for secondary prevention after acute myocardial infarction in real-world practice: ≥ 50% reduction from baseline versus <70 mg/dL

BACKGROUND

The present study compared the effects of two low-density lipoprotein cholesterol (LDL-C) goals for secondary prevention after acute myocardial infarction (AMI) in real-world practice.

METHODS AND RESULTS

Of 3091 consecutive patients with AMI who had baseline LDL-C levels ≥ 70 mg/dL and underwent successful percutaneous coronary intervention, 1305 eligible patients who received discharge statin prescriptions were analyzed. Patients were categorized into 2 groups according to the values of LDL-C at 1 year in two different manners using percent reduction from baseline (≥ 50% reduction, n=428 versus <50% reduction, n=877) and fixed levels (< 70 mg/dL, n=625 versus ≥ 70 mg/dL, n=680). The primary outcome was defined by the composite of 2-year major cardiac events including cardiac death, non-fatal myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting after hospital discharge. At 2 years, major cardiac events occurred in 139 patients (10.7%). Compared with <50% LDL-C reduction from baseline, patients with ≥ 50% LDL-C reduction had a 47% risk reduction in major cardiac events (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79; P=0.002). But, compared with LDL-C levels ≥ 70 mg/dL at 1 year, patients with LDL-C levels < 70 mg/dL at 1 year had a similar risk of major cardiac events (adjusted hazard ratio, 0.96; 95% confidence interval, 0.68 to 1.34; P=0.793).

CONCLUSIONS

Obtaining a ≥ 50% reduction in LDL-C was associated with better clinical outcomes after AMI in real-world practice, whereas achieving a < 70 mg/dL was not.

The pharmacokinetics, pharmacodynamics and safety of oral doses of ilaprazole 10, 20 and 40 mg and esomeprazole 40 mg in healthy subjects: a randomised, open-label crossover study

BACKGROUND

Ilaprazole, a proton pump inhibitor (PPI) currently in clinical use, may provide improved acid suppression vs. other PPIs.

AIM

To compare the pharmacodynamic and pharmacokinetic profiles of ilaprazole and esomeprazole.

METHODS

A phase 1, randomised, open-label, single-centre, 4-period crossover study was conducted in 40 healthy volunteers. Ilaprazole 10, 20 or 40 mg or esomeprazole 40 mg was administered once daily for 5 days with ≥5-day washout intervals. Pharmacokinetic blood samples and intragastric pH measurements were collected at scheduled timepoints for 24 h after dosing on Days 1 and 5.

RESULTS

Esomeprazole 40 mg provided significantly better pH control during the initial hours (0-4 h) after a single dose, but ilaprazole (particularly 20 and 40 mg) provided significantly better pH control for the entire 24-h period and during evening and overnight hours after single and multiple doses. Increasing ilaprazole doses resulted in dose-proportional increases in peak plasma concentration and area under the plasma concentration vs. time curve following single and multiple doses. Ilaprazole was safe and generally well tolerated; an unexpectedly high incidence of allergic eye and skin reactions were observed but were not specific to any dosing regimen. Plasma gastrin concentrations did not increase proportionately with increasing ilaprazole dose.

CONCLUSIONS

Ilaprazole provided significantly better pH control over 24 h and during evening and overnight hours compared with esomeprazole in healthy volunteers, which may translate to greater relief of night-time heartburn in the clinical setting for patients with gastric acid-related disorders.

QRS morphology and ventricular dyssynchrony in patients with chronic right ventricular pacing

BACKGROUND

Mechanical dyssynchrony (MD) is associated with poor outcomes in many different populations. However, the predictors for the development of MD after chronic right ventricular (RV) pacing are not well known.

METHODS

Pacing QRS morphology and MD using echocardiography was analyzed in 175 consecutive patients that have pacemaker implantation during a 7.6 year median follow-up. Predictive score for MD was constructed using QRS morphology variables and calculated by summing the points of the 4 variables: duration (≥150 ms, 1 point), transition (1 point), notching (2 points), and left-axis deviation (1 point), based on a multivariate-adjusted risk relationship with MD.

RESULTS

Sixty-eight (38.9%) patients developed MD. Patients with MD had worsened left ventricular systolic function (ejection fraction from 64.6±10.6% to 59.1±10.4%, p<0.001) and heart failure symptoms (New York Heart Association functional class increase from 1.1±0.3 to 1.9±0.8, p<0.001). In an electrocardiographic analysis, QRS duration≥150 ms, the presence of precordial axis transition, notching, and left-axis deviation were strongly associated with MD. Predictive score for MD using QRS morphology parameters displayed an excellent graded relationship with MD (score 0: 3.4% vs. 1: 12.5% vs. 2: 22.6% vs. 3: 45.0% vs. 4: 57.9% vs. 5: 72.7%, linear p<0.001) (model performance c-static 0.78, 95% confidence interval 0.72-0.85, p<0.001).

CONCLUSION

Patients with MD experienced a decline in left ventricular systolic function and an increase in heart failure symptoms after chronic RV pacing. A new scoring system using QRS morphology is considered a simple and efficient tool for predicting the development of MD after chronic RV pacing.

Effect of carcass traits on carcass prices of holstein steers in Korea

The present study investigated the contribution of carcass traits on carcass prices of Holstein steers in Korea. Phenotypic data consisted of 76,814 slaughtered Holsteins (1 to 6 yrs) from all over Korea. The means for live body weight at slaughter (BWT), chilled carcass weight (CWT), dressing percentage (DP), quantity grade index (QGI), eye muscle area (EMA), backfat thickness (BF) and marbling score (MS), carcass unit price (CUP), and carcass sell prices (CSP) were 729.0 kg, 414.2 kg, 56.79%, 64.42, 75.26 cm², 5.77 mm, 1.98, 8,952.80 Korean won/kg and 3,722.80 Thousand Korean won/head. Least squares means were significantly different by various age groups, season of slaughter, marbling scores and yield grades. Pearson’s correlation coefficients of CUP with carcass traits ranged from 0.12 to 0.62. Besides, the relationships of carcass traits with CSP were relatively stronger than those with CUP. The multiple regression models for CUP and CSP with carcass traits accounted 39 to 63% of the total variation, respectively. Marbling score had maximum economic effects (partial coefficients) on both prices. In addition, the highest standardized partial coefficients (relative economic weights) for CUP and CSP were calculated to be on MS and CWT by 0.608 and 0.520, respectively. Path analyses showed that MS (0.376) and CWT (0.336) had maximum total effects on CUP and CSP, respectively; whereas BF contributed negatively. Further sub-group (age and season of slaughter) analyses also confirmed the overall outcomes. However, the relative economic weights and total path contributions also varied among the animal sub-groups. This study suggested the significant influences of carcass traits on carcass prices; especially MS and CWT were found to govern the carcass prices of Holstein steers in Korea.

Eating rate is associated with cardiometabolic risk factors in Korean adults

BACKGROUND AND AIM

Eating slowly is a crucial concept in behavioural nutrition and is recommended for weight management as it is believed to have an important effect on satiety control. This study aimed to determine whether or not eating rate is associated with cardiometabolic risk factors.

METHODS AND RESULTS

This was a cross-sectional study involving 8775 Korean adults, who visited the Center for Health Promotion of Korea University Anam Hospital in Seoul, Korea. In male study participants, weight and body mass index (BMI) were found to depend on eating rate after adjusting for age, alcohol consumption, smoking, exercise and total energy intake. When adjusted for age, alcohol consumption, smoking, exercise and BMI, differences were found between the eating rate groups with respect to high-density lipoprotein (HDL)-cholesterol, alanine aminotransferase (ALT) and alkaline phosphatase (ALP) values, white blood cell (WBC) count and total energy intake. Female participants were found to be different from males in that diastolic blood pressure and low-density lipoprotein (LDL)- and HDL-cholesterol values were significantly different between each eating rate group, while ALT and ALP values, WBC count and total energy intake were not. Compared with the slow eating rate group (>15 min), the fastest eating rate group (<5 min) had significantly increased odds ratios for cardiometabolic risk factors such as high glucose and low HDL-cholesterol levels in males, even after adjusting for BMI.

CONCLUSION

Fast eating rates are associated with obesity and other cardiometabolic risk factors, particularly in men. Thus, eating slowly is recommended for weight reduction and to decrease cardiovascular risk factors.

Modeling transport of Escherichia coli in a creek during and after artificial high-flow events: three-year study and analysis

Escherichia coli is the leading indicator of microbial contamination of natural waters, and so its in-stream fate and transport needs to be understood to eventually minimize surface water contamination by microorganisms. To better understand mechanisms of E. coli release and transport from soil sediment in a creek the artificial high-water flow events were created by releasing 60-80 m(3) of city water on a tarp-covered stream bank in four equal allotments in July 2008, 2009 and 2010. A conservative tracer difluorobenzoic acid (DFBA) was added to the released water in 2009 and 2010. Water flow rate, E. coli and DFBA concentrations as well as water turbidity were monitored with automated samplers at three in-stream weirs. A one-dimensional model was applied to simulate water flow, and E. coli and DFBA transport during these experiments. The Saint-Venant equations were used to calculate water depth and discharge while a stream solute transport model accounted for release of bacteria by shear stress from bottom sediments, advection-dispersion, and exchange with transient storage (TS). Reach-specific model parameters were estimated by evaluating observed time series of flow rates and concentrations of DFBA and E. coli at all three weir stations. Observed DFBA and E. coli breakthrough curves (BTC) exhibited long tails after the water pulse and tracer peaks had passed indicating that transient storage (TS) might be an important element of the in-stream transport process. Comparison of simulated and measured E. coli concentrations indicated that significant release of E. coli continued when water flow returned to the base level after the water pulse passed and bottom shear stress was small. The mechanism of bacteria continuing release from sediment could be the erosive boundary layer exchange enhanced by changes in biofilm properties by erosion and sloughing detachment.

Effect of early statin treatment in patients with cardiogenic shock complicating acute myocardial infarction

Background and Objectives

The benefit of early statin treatment following acute myocardial infarction (MI) complicated with cardiogenic shock (CS) has not been well studied. We sought to assess the effect of early statin therapy in patients with CS complicating acute MI.

Subjects and Methods

We studied 553 statin-naive patients with acute MI and CS (Killip class IV) who underwent revascularization therapy between November 2005 and January 2008 at 51 hospitals in the Korea Acute Myocardial Infarction Registry. Patients were divided into 2 groups: those who received statins during hospitalization (n=280) and those who did not (n=273). The influence of statin treatment on a 12-month clinical outcome was examined using a matched-pairs analysis (n=200 in each group) based on the propensity for receiving statin therapy during hospitalization.

Results

Before adjustment, patients receiving statin, compared to those not receiving statin, had a more favorable clinical profile, were less likely to suffer procedural complications, and more likely to receive adequate medical therapy. Patients receiving statin had lower unadjusted in-hospital mortality and composite rate of mortality, MI, and repeat revascularization at 12 months, which remained significantly lower after adjustment for patient risk, procedural characteristics, and treatment propensity.

Conclusion

In CS patients with acute MI undergoing revascularization therapy, early statin treatment initiated during hospitalization was associated with lower rates of in-hospital death and 12-month adverse cardiac events.

In vivo and in vitro analysis of low level light therapy: a useful therapeutic approach for sensitive skin

Sensitive skin is a relatively common dermatologic condition and no optimal treatments have been established so far. Low-level laser/light therapy (LLLT) has been used for its biostimulative effect in various clinical settings. The purpose of this study was to investigate whether low-level laser/light therapy can improve sensitive skin clinically and to evaluate the effects of LLLT on skin in vitro. Twenty-eight patients complaining of sensitive skin were treated with low-level polarized light, and clinical results were evaluated using subjective and objective method. To investigate possible working mechanism of LLLT on skin, cultured human keratinocytes pretreated with nontoxic concentration of sodium lauryl sulfate (SLS) were used. Cytokines released from irritated keratinocytes after LLLT were analyzed. All patients showed subjective and objective improvement after treatment. No adverse effects were reported. The average number of LLLT sessions required to achieve clinical improvement was 9.9, and cumulative dose of LLLT was 71.3 J/cm(2) on the average. Erythema index decreased significantly after LLLT treatment (p = 0.017). In vitro assay showed that LLLT significantly reduced the release of VEGF from SLS-pretreated keratinocytes (p = 0.021). Our results suggest that LLLT could be a useful and safe treatment modality for sensitive skin, and modification of inflammatory cytokines released from irritated keratinocytes may be considered as one of plausible mechanisms in sensitive skin treated with LLLT.

Comparison of drug-eluting stents in acute myocardial infarction patients with chronic kidney disease

BACKGROUND/AIMS

To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD).

METHODS

This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) calculated by the modification of diet in renal disease method.

RESULTS

At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049).

CONCLUSIONS

Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.

Volumetric response evaluation after intensity modulated radiotherapy in patients with supratentorial gliomas

Radiotherapy is frequently indicated to treat cerebral gliomas. Accurate response evaluation after radiotherapy is essential to determine the efficacy of treatment. We retrospectively analyzed the volumetric tumor response after simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in patients with gliomas. Thirty-five patients (Grade II, 7 patients; Grade III, 12; and Grade IV, 16) were treated with SIB-IMRT with a median total dose of 55.9 Gy/26 fractions for Grade II and 60 Gy/25 fractions for Grade III-IV tumors. Tumor responses were evaluated for enhancing volume on post-gadolinium T1-weighted images (Vgd) and hyper-intensity volume on T2-weighted FLAIR images (V(fl)) on serial MRIs. With the median follow-up of 24.0 months, overall response rates (RRs) were 57% for V(gd) and 51% for V(fl). Tumor grade was predictive of response favoring the lower grade in Vfl with RRs of 86% for Grade II, 75% for Grade III, and 19% for Grade IV tumors (p = 0.004). Time to 50% or greater volume reduction (T50) in Vgd was 8 months for grade III. The T50 in V(fl) was approximately 24 months both for Grade II and III tumors. Majority of Grade IV tumors continued to progress and never reached the T50 in Vgd or Vfl. Responders survived longer than non-responders for V(gd) and V(fl). Volume response after radiotherapy was dependent upon tumor grade and time. LGGs are very responsive to radiotherapy with the RRs of 86% in V(fl). The response of Vfl is more protracted compared to V(gd). Further investigation is needed to determine the clinical significance of volumetric response evaluation.

Daily skin care habits and the risk of skin eruptions and symptoms in cancer patients

BACKGROUND

Cancer patients are at high risk for skin problems because rapidly proliferating skin cells are susceptible to anticancer therapies. However, the effects of daily skin care habits on development of skin problems in cancer patients have rarely been studied.

PATIENTS AND METHODS

We conducted a survey of daily skin care habits and the presence of skin problems in 866 cancer patients.

RESULTS

Hot water bath>1 h significantly increased the risk of definite eruptions [odds ratio (OR) 4.09] and the risk of itching or pain on the skin (OR 1.73). Diligent use of moisturizers did not decrease the risk of definite eruptions and symptoms, and daily bathing, scrubbing off the skin while bathing, and sun protection did not influence the risk of definite eruptions and symptoms. Subgroup analysis of 183 breast cancer patients showed results similar to the total results, including that hot water bath>1 h significantly increased the risk of definite eruptions (OR 3.41).

CONCLUSIONS

Being a cross-sectional study, our study could not prove causality. However, at the present stage of knowledge, avoidance of hot water baths of protracted duration should be first emphasized in patient education to prevent skin problems in cancer patients.

Development of the deep flexor tendons and lumbricalis muscle in the hand and foot: a histological study using human mid-term foetuses

To revisit foetal development of the deep flexor tendons of the hand and foot, we examined the paraffin-embedded histology of 20 mid-term foetuses at 8-15 weeks of estimated gestational age (35-118 mm crown-rump length or CRL). At 8-9 weeks, in front of the metacarpal bones, the flexor pollicis longus and flexor digitorum profundus (FDP) muscles provided a plate-like, common tendon from which the lumbricalis muscles originated. However, in the foot, we had no evidence of such a common tendon. The flexor pollicis tendon was separated from the common tendon at 9-10 weeks possibly due to mechanical stress from the laterally growing thumb. Notably, at the lumbricalis muscle origins at 10-12 weeks, the FDP and flexor digitorum longus tendons remained undifferentiated and the primitive tenocytes were dispersed from them. The dispersed cells seemed to develop into an interface tissue between the lumbricalis muscle fibre and the deep tendon. In 3 of 5 specimens at 15 weeks, we found an excess number of the FDP tendons (5-7) in the proximal side of the lumbricalis muscle origin. However, the excess tendons dispersed in the lumbricalis muscle origin. The development of the lumbricalis muscle origin might follow the tendon splitting for four fingers. However, conversely, we hypothesised that the developing lumbricalis muscles re-arranged the deep flexor tendons to provide a configuration of one deep tendon per one finger (or toe). The quadrates plantae muscle seemed not to contribute on the re-arrangement.

PXR ligand classification model with SFED-weighted WHIM and CoMMA descriptors

Understanding which type of endogenous and exogenous compounds serve as agonists for the nuclear pregnane X receptor (PXR) would be valuable for drug discovery and development, because PXR regulates a large number of genes related to xenobiotic metabolism. Although several models have been proposed to classify human PXR activators and non-activators, models with better predictability are necessary for practical purposes in drug discovery. Grid-weighted holistic invariant molecular (G-WHIM) and comparative molecular moment analysis (G-CoMMA) type 3D descriptors that contain information about the solvation free energy of target molecules were developed. With these descriptors, prediction models built using decision tree (DT)-, support vector machine (SVM)-, and Kohonen neural network (KNN)-based models exhibited better predictability than previously proposed models. Solvation free energy density-weighted G-WHIM and G-CoMMA descriptors reveal new insights into PXR ligand classification, and incorporation with machine learning methods (DT, SVM, KNN) exhibits promising results, especially SVM and KNN. SVM- and KNN-based models exhibit accuracy around 0.90, and DT-based models exhibit accuracy around 0.8 for both the training and test sets.

Is Myocardial Infarction in Patients without Significant Stenosis on a Coronary Angiogram as Benign as Believed?

The present study aimed to investigate the clinical characteristics and 1-year outcomes of acute myocardial infarction (AMI) patients without significant stenosis on a coronary angiogram comparison with the clinical characteristics and outcomes of patients with significant coronary artery stenosis. A total of 1,220 patients with AMI were retrospectively classified into Group I (≥50% diameter stenosis, n=1,120) and Group II (<50%, n=100). Group II was further divided into two subgroups according to the underlying etiology: cryptogenic (Group II-a, n=54) and those with possible causative factors (Group II-b, n=46). Patients in Group II were younger, were more likely to be women, and were less likely to smoke and to have diabetes mellitus than were patients in Group I. The levels of cardiac enzymes, LDL-cholesterol levels, and the apo-B/A1 ratio were lower in Group II. However, 1-month and 12-month rates of major adverse cardiac events (MACE) were not significantly different between the two groups. The Group II-b subgroup comprised 29 patients with vasospasm, 11 with myocardial bridge, and 6 with spontaneous thrombolysis. Left ventricular ejection fraction and creatinine clearance were lower and levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) were higher in Group II-a than in Group II-b. However, outcomes including MACE and mortality at 12 months were not significantly different between the two subgroups. The 1-year outcomes of patients in Group II were similar to those of patients in Group I. The clinical outcomes in Group II-a were also similar to those of Group II-b, although the former group showed higher levels of NT-proBNP and hs-CRP.

Prognostic impact of baseline high-sensitivity C-reactive protein in patients with acute myocardial infarction undergoing percutaneous coronary intervention based on body mass index

BACKGROUND AND OBJECTIVES

Serum high sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and may lead to the development of atherosclerosis, adversely affecting mortality. The aim of this study was to evaluate the relationship between baseline hs-CRP level and 12-month clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) according to their body mass index (BMI) status.

SUBJECTS AND METHODS

Using data from the Korea Acute Myocardial Infarction Registry from November 2005 to September 2008, a total of 8174 consecutive AMI patients were studied. Cox proportional hazard model revealed that higher baseline levels of hs-CRP was associated with 12-month all-cause mortality (p=0.045). To further understand this association, patients were divided into 3 groups based on their body mass index: 1) overweight/obese, 2) normal weight, and 3) underweight patients. Then each group was stratified into quartiles based on their hs-CRP.

RESULTS

In overweight/obese patients, Cox model showed significant association of hs-CRP with 12-month mortality when adjusted for age and gender (p<0.001), however, after adjustment with multiple covariates, mortality was highest in the 4th quartile {HR 2.382, (1.079-5.259), p=0.032} though statistically insignificant (p=0.172). We observed no significant association of serum hs-CRP with 12-month mortality in normal weight (p=0.681) and underweight (p=0.760) patients.

CONCLUSION

Higher baseline hs-CRP level (≥4.08 mg/dL) in overweight/obese AMI patients showed significant association with 12-month all-cause mortality independent of other prognostic markers.