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Khanal S, Agarwal A, Kumar B. One-Year Outcomes of Long Coronary Drug-Eluting Stents (≥40 MM) in Patients With Diffuse Coronary Artery Disease: Findings From a Tertiary Care Hospital in North India. Cureus 2024; 16:e59611. [PMID: 38832189 PMCID: PMC11144946 DOI: 10.7759/cureus.59611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Background and objective Diffuse coronary artery disease (CAD) is associated with extensive involvement of coronary arteries, necessitating the use of long (≥40 mm) drug-eluting stents (DES) based on the lesion length. However, these long DES can lead to complications such as in-stent restenosis (ISR) and stent thrombosis. This study aimed to assess the safety, efficacy, and one-year clinical outcomes of using long DES in patients with diffuse CAD undergoing PCI at a tertiary care hospital in north India. Methodology Patients with diffuse CAD undergoing PCI with long DES between January 2017 and June 2022 were included in the study. Baseline characteristics were recorded, and patients were followed up telephonically or in the outpatient department (OPD) at one, three, six, and 12 months following the PCI. The primary endpoint was the target lesion failure (TLF) rate, with secondary endpoints constituting all-cause mortality, major adverse cardiovascular events (MACE), subacute stent thrombosis, and ISR. Results A total of 200 patients were recruited and followed up for one year. The median age of the patients was 58 years (range: 48.25-63 years), and 82% were men. The most frequently stented artery was the left anterior descending (LAD, 48%), followed by the right coronary artery (RCA, 36%). A total of 388 stents (mean: 1.94 ±0.79) were implanted, including both long and short stents. The mean length and diameter of long stents were 43.64 ±3.58 mm and 3 ±0.37 mm, respectively. At the one-year follow-up, patients undergoing PCI with long DES ≥40 mm had an overall TLF rate of 5%, all-cause mortality of 6% (12 patients), MACE of 6% (12 patients), subacute stent thrombosis of 4% (eight patients), and ISR of 1% (two patients). A large proportion of patients (90%) had an uneventful follow-up of up to a year. At the one-year follow-up, all 10 (5%) patients with a primary outcome had a smaller stent diameter than those without a primary outcome (2.5 ±0.25 mm vs. 3.03 ±0.35 mm, p=0.015). Conclusions Our results suggest that using extremely long stents (>40 mm) for diffuse coronary lesions is safe, efficacious, and associated with relatively low event rates. In addition, the stent diameter has a substantial correlation with the primary outcome. Further studies with larger sample sizes as well as longer follow-up periods are required to validate our findings.
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Affiliation(s)
- Suraj Khanal
- Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Ayush Agarwal
- Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Basant Kumar
- Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
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Lee DH, Oh S, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y, Han JB, Kim IS, Jeong MH. Comparative treatment outcomes of a single long stent vs. overlapped short stents in acute myocardial infarction. Front Cardiovasc Med 2023; 10:1284396. [PMID: 38179505 PMCID: PMC10766367 DOI: 10.3389/fcvm.2023.1284396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives There is no consensus regarding the optimal choice between single long stent (SLS) and overlapped double short stents (DSS) in patients with acute myocardial infarction (AMI). Therefore, we aimed to compare treatment outcomes among patients with AMI treated with these two different stenting methods. Methods In total, 537 patients with AMI from a single tertiary center were categorized into two groups: (1) those who received an SLS (stent length ≥38 mm) (n = 254; 47.3%) and (2) those who received overlapped DSS (individual stent lengths <38 mm) (n = 283; 52.7%). The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCEs) within 1 year. Results The mean age of participants was 65.4 years, and 75.0% were male. Patients receiving an SLS had a higher rate of serum creatinine level ≥1.5 mg/dl (16.3% vs. 8.9%, p = 0.009) but a lower rate of hypertension (46.8% vs. 55.8%, p = 0.038), lesser total stent length (38.26 ± 1.31 vs. 45.20 ± 9.25 mm, p < 0.001), total procedure time (41.40 ± 15.74 vs. 53.31 ± 21.75 min, p < 0.001) and total contrast volume (134.13 ± 30.72 vs. 160.57 ± 39.77 ml, p < 0.001) than in those receiving DSS. One-year MACCEs were comparable between the two groups before [hazard ratio (HR), 1.33; 95% confidence interval (CI), 0.80-2.24] and after adjusting for covariates (HR, 1.21; 95% CI, 0.67-2.19). Conclusions Stenting with an SLS demonstrated similar outcomes compared to those achieved when using stenting with overlapped DSS in patients with AMI. Therefore, if the deliverability is acceptable, stenting with an SLS appears to be a safe and effective strategy for AMI treatment.
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Affiliation(s)
- Doo Hwan Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Radiological Science, Dongshin University, Naju, Republic of Korea
| | - Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Jae Bok Han
- Department of Radiological Science, Dongshin University, Naju, Republic of Korea
| | - In Soo Kim
- Department of Radiological Science, Dongshin University, Naju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
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Polavarapu RS, Pamidimukkala V, Polavarapu A, Siripuram Y, Ravella KC, Rachaputi MBR, Polavarapu N, Pulivarthi KC, Byrapaneni S, Gangasani S, Noronha M, Chinta SR. Ultra-thin everolimus-eluting stents in atherosclerotic lesions: Three years follow-up with subgroup analysis of ultra-long stents. Indian Heart J 2023; 75:279-284. [PMID: 36972762 PMCID: PMC10421990 DOI: 10.1016/j.ihj.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To assess the long-term (3 years) safety and efficacy of Tetrilimus everolimus-eluting stent (EES) and subgroup analysis of outcomes of ultra-long (44/48 mm) Tetrilimus EES implantation in patients with long coronary lesions. MATERIAL AND METHODS In this observational, single-centre, single-arm, investigator-initiated registry, 558 patients who underwent implantation of Tetrilimus EES for the treatment of coronary artery disease were retrospectively included. The primary endpoint was occurrence of any major adverse cardiac event (MACE) at 12 months follow-up (composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and we hereby report 3 years follow-up data. Stent thrombosis was assessed as a safety endpoint. A subgroup analysis of patients with long coronary lesions is also reported. RESULTS A total of 558 patients (57.0 ± 10.2 years) received 766 Tetrilimus EES (1.3 ± 0.5 stents/patient) to treat 695 coronary lesions. In subgroup analysis of 143 patients implanted with ultra-long EES, 155 lesions were intervened successfully with only one Tetrilimus EES (44/48 mm) implanted per lesion. At 3 years, event rates of 9.1% MACE with predominance of MI (4.4%), followed by 2.9% TLR and 1.7% cardiac death, and only 1.0% stent thrombosis were reported in overall population, while in a subgroup of patients implanted with ultra-long EES, 10.4% MACE and 1.5% stent thrombosis were reported. CONCLUSIONS Three years clinical outcomes showed favourable long-term safety and excellent performance of Tetrilimus EES in high-risk patients and complex coronary lesions in routine clinical practice, including a subgroup of patients with long coronary lesions, with acceptable primary and safety endpoints.
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Affiliation(s)
| | - Vijaya Pamidimukkala
- Department of Neurosciences, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Anurag Polavarapu
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Yudhistar Siripuram
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | | | | | - Naren Polavarapu
- Department of General Medicine, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | | | - Sravanthi Byrapaneni
- Department of Oncology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Sirichandana Gangasani
- Department of General Medicine, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Michael Noronha
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Srinivasa Rao Chinta
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
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Shin DH, Kang HJ, Jang JS, Moon KW, Song YB, Park DW, Bae JW, Kim J, Hur SH, Kim BO, Jeon DW, Choi D, Han KR. The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 & 2016 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2019; 49:1136-1151. [PMID: 31347316 PMCID: PMC6875596 DOI: 10.4070/kcj.2018.0413] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/16/2019] [Accepted: 06/05/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In this second report from Korean percutaneous coronary intervention (K-PCI) registry, we sought to describe the updated information of PCI practices and Korean practice pattern of PCI (KP3). METHODS In addition to K-PCI registry of 2014, new cohort of 2016 from 92 participating centers was appended. Demographic and procedural information, as well as in-hospital outcomes, of PCI was collected using a web-based reporting system. KP3 class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or bypass-surgery. RESULTS In 2016, total 48,823 PCI procedures were performed at 92 participating centers. Mean age of the patients was 65.7±11.6 years, and 71.7% were males. Overall patient characteristics and PCI practices in 2016 were similar to those in 2014. The biggest change was the decrease in the in-hospital occurrence of myocardial infarction (MI;1.6%→0.7%, p<0.001). Many associations between PCI volumes and demographic/procedural characteristics observed in 2014 have disappeared. The median of door-to-balloon time was 62 minutes, and 83.3% of ST-elevation MI patients received primary PCI within 90 minutes, while the median of total ischemic time was 168 minutes and patients who had total ischemic time within 120 and 180 minutes were 29.1% and 54.1%, respectively. The proportion of KP3 class C cases in non-acute coronary syndrome patients decreased from 13.5% in 2014 to 12.1% in 2016 (p<0.001). CONCLUSIONS In this second report from K-PCI registry, we described the current practices of PCI and changes from 2014 to 2016 in Korea.
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Affiliation(s)
- Dong Ho Shin
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jae Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Sik Jang
- Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Keon Woong Moon
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Juhan Kim
- Department of Cardiovascular Medicine, Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Seung Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Dong Woon Jeon
- Department of Cardiology, National Health Insurance Service (NHIS) Ilsan Hospital, Goyang, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo Rok Han
- Department of Internal Medicine, Gangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
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Kim BS, Eom SY, Kim SH, Hwang HK, Park JS, Kim W, Lee JW, Rha SW, Kim GY, Lim SW, Lee SH, Chae JK, Woo SI, Bae JW, Kim HJ. Effect of Pre-Procedural Beta-Blocker on Clinical Outcome after Percutaneous Coronary Intervention in Acute Coronary Syndrome. Int Heart J 2019; 60:1284-1292. [PMID: 31735782 DOI: 10.1536/ihj.19-175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The efficacy of pre-procedural beta-blocker use in patients with acute coronary syndrome (ACS) is not well established in the current percutaneous coronary intervention (PCI) era. We investigate the effect of pre-procedural beta-blocker use on clinical outcomes in patients with ACS undergoing PCI. Among 44,967 consecutive cases of PCI enrolled in the nationwide, retrospective, multicenter registry (K-PCI registry), 31,040 patients with ACS were selected and analyzed. We classified patients into pre-procedural beta-blocker group (n = 8,678) and pre-procedural no-beta-blocker group (n = 22,362) according to the use of beta-blockers at least for two weeks before index PCI. Propensity score-matching analysis was performed and resulted in 7,445 pairs. The primary outcome was in-hospital cardiac death. In propensity score-matched populations, the pre-procedural beta-blocker group had a lower incidence of in-hospital cardiac death compared with the pre-procedural no-beta-blocker group (1.1% versus 2.0%, unadjusted odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.42-0.73, P < 0.01). In subgroup analysis, the pre-procedural beta-blocker group had a lower incidence of in-hospital cardiac death, compared with the pre-procedural no-beta-blocker group in ST-segment elevation myocardial infarction subpopulation (3.1% versus 6.1%, unadjusted OR: 0.49, 95% CI: 0.34-0.71, P < 0.01) and non-ST-segment elevation myocardial infarction subpopulation (1.5% versus 2.9%, unadjusted OR: 0.51, 95% CI: 0.33-0.79, P < 0.01). However, in unstable angina subpopulation, the in-hospital cardiac death rate was comparable between both groups. In conclusion, the use of pre-procedural beta-blocker was associated with a lower risk of in-hospital cardiac death in patients with ACS undergoing PCI. This result adds to the body of evidence that use of pre-procedural beta-blocker in patients with ACS might be reasonable.
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Affiliation(s)
- Bum Sung Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University
| | - Sang-Youg Eom
- Department of Preventive Medicine, College of Medicine, Chungbuk National University
| | - Sung Hea Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University
| | - Hweung Kon Hwang
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital
| | - Weon Kim
- Cardiovascular Division, Department of Internal Medicine, Kyung Hee University Hospital
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital
| | | | | | | | | | - Jei Keon Chae
- Division of Cardiology, Chonbuk National University Hospital
| | | | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University, College of Medicine
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University
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Ahn SG, Lee SJ. Dose Coronary Angiography Suffice for Assessment of Intermediate Coronary Stenosis? Korean Circ J 2019; 49:1033-1034. [PMID: 31456370 PMCID: PMC6813155 DOI: 10.4070/kcj.2019.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sung Gyun Ahn
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Sang Jun Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Oh PC, Han SH. Diffuse Long Coronary Artery Disease is Still an Obstacle for Percutaneous Coronary Intervention in the Second-Generation Drug-Eluting Stent Era? Korean Circ J 2019; 49:721-723. [PMID: 31347314 PMCID: PMC6675689 DOI: 10.4070/kcj.2019.0150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gachon University Gil Medical Center, Incheon, Korea.
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Kim JH, Choi W, Kim KC, Nam CW, Hong BK, Kim JH, Jeon DS, Bae JW, Kim SH, Moon KW, Cho BR, Kim DI, Jang JS. The Current Status of Intervention for Intermediate Coronary Stenosis in the Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2019; 49:1022-1032. [PMID: 31190480 PMCID: PMC6813154 DOI: 10.4070/kcj.2019.0074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/22/2019] [Accepted: 05/16/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Intermediate coronary lesion that can be under- or over-estimated by visual estimation frequently results in stenting of functionally nonsignificant lesions or deferral of percutaneous coronary intervention (PCI) of significant lesions inappropriately. We evaluated current status of PCI for intermediate lesions from a standardized database in Korea. METHODS We analyzed the Korean percutaneous coronary intervention (K-PCI) registry data which collected a standardized PCI database of the participating hospitals throughout the country from January 1, 2014, through December 31, 2014. Intermediate lesion was defined as a luminal narrowing between 50% and 70% by visual estimation and then compared whether the invasive physiologic or imaging study was performed or not. RESULTS Physiology-guided PCI for intermediate lesions was performed in 16.8% for left anterior descending artery (LAD), 9.8% for left circumflex artery (LCX), 13.2% for right coronary artery (RCA). PCI was more frequently performed using intravascular ultrasound (IVUS) than using fractional flow reserve (FFR) for coronary artery segments (27.7% vs. 13.9% for LAD, 32.9% vs. 8.1% for LCX, and 33.8% vs. 10.8% for RCA). In accordance with or without FFR, PCI for intermediate lesions was more frequently performed in the hospitals with available FFR device than without FFR, especially in left main artery (LM), proximal LAD lesion (40.9% vs. 5.9% for LM, 24.6% vs 7.6% for proximal LAD). CONCLUSIONS These data provide the current PCI practice pattern with the use of FFR and IVUS in intermediate lesion. More common use of FFR for intermediate lesion should be encouraged.
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Affiliation(s)
- Jin Ho Kim
- Department of Cardiology, Konkuk University School of Medicine, Chungju, Korea
| | - Woonggil Choi
- Department of Cardiology, Konkuk University School of Medicine, Chungju, Korea
| | - Ki Chang Kim
- Department of Cardiology, Konkuk University School of Medicine, Chungju, Korea
| | - Chang Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Bum Kee Hong
- Division of Cardiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - June Hong Kim
- Department of Cardiology, Pusan National University Yangsan Hospital, Busan, Korea
| | - Doo Soo Jeon
- Department of Cardiology, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea
| | - Jang Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical center, Seoul, Korea
| | - Keon Woong Moon
- Division of Cardiology, The Catholic University of Korea, St.Vincent's Hospital, Suwon, Korea
| | - Byung Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Doo Il Kim
- Division of Cardiology, University of Inje College of Medicine, Inje University Heaundae Paik Hospital, Busan, Korea
| | - Jae Sik Jang
- Division of Cardiology, University of Inje College of Medicine, Busan Paik Hospital, Busan, Korea.
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Kim HL, Jang JS, Kim MA, Seo JB, Chung WY, Kim SH, Park SJ, Youn TJ, Yoon MH, Lee JH, Chang K, Jeong MH, Choi RK, Hong MK, Kim HS. Gender differences of in-hospital outcomes in patients undergoing percutaneous coronary intervention in the drug-eluting stent era. Medicine (Baltimore) 2019; 98:e15557. [PMID: 31096458 PMCID: PMC6531253 DOI: 10.1097/md.0000000000015557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Most studies on gender difference of the in-hospital outcome of percutaneous coronary intervention (PCI) were performed in the pre-drug-eluting stents (DES) era. This study was performed to investigate whether gender influences the in-hospital outcome of PCI in the DES era.A total of 44,967 PCI procedure between January and December of 2014 from the nationwide PCI registry database in Korea were analyzed. The study population was male predominant (70.2%). We examined the association of gender with unadjusted and adjusted in-hospital mortality and composite events of PCI, including mortality, nonfatal myocardial infarction, stent thrombosis, stroke, urgent repeat PCI and bleeding requiring transfusion.Most of the study patients (91.3%) received DES. The incidence rates of in-hospital mortality (2.95% vs 1.99%, P <.001) and composite events (7.01% vs 5.48%, P <.001) were significantly higher in women compared to men. Unadjusted analyses showed that women had a 1.49 times higher risk of in-hospital mortality and a 1.30 times higher risk of composite events than men (P <.001 for each). After adjustment for potential confounders, female gender was not a risk factor for mortality (P = .258), but the risk of composite events remained 1.20 times higher in women than in men (P = .008).Among patients undergoing PCI in the contemporary DES era, female gender was associated with an increased risk of in-hospital composite events, but not in-hospital mortality. More careful attention should be emphasized to minimize procedure-related risks and to improve prognosis in women undergoing PCI.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Boramae Medical Center, Seoul National University College of Medicine, Seoul
| | - Jae-Sik Jang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan
| | - Myung-A Kim
- Division of Cardiology, Boramae Medical Center, Seoul National University College of Medicine, Seoul
| | - Jae-Bin Seo
- Division of Cardiology, Boramae Medical Center, Seoul National University College of Medicine, Seoul
| | - Woo-Young Chung
- Division of Cardiology, Boramae Medical Center, Seoul National University College of Medicine, Seoul
| | - Sang-Hyun Kim
- Division of Cardiology, Boramae Medical Center, Seoul National University College of Medicine, Seoul
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Tae-Jin Youn
- Cardiovascular Center, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam
| | - Myeong-Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, Suwon
| | - Jae-Hwan Lee
- Department of Cardiology, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon
| | - Kiyuk Chang
- Division of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul
| | - Myung Ho Jeong
- Department of Internal Medicine and Heart Center, Chonnam National University Hospital, Gwangju
| | - Rak Kyeong Choi
- Division of Cardiology, Mediplex Sejong General Hospital, Incheon
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Ahn SG, Lee JW, Youn YJ, Lee SH, Cho JH, Kang WC, Park JP, Shin WY, Lim SH, Choi YJ, Kim K, Lim DS, Chun W, Kim JH, Yoon J. In-hospital outcome differences between transradial and transfemoral coronary approaches: Data from the Korean percutaneous coronary intervention registry. Catheter Cardiovasc Interv 2019; 94:378-384. [PMID: 30604498 DOI: 10.1002/ccd.28032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/02/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to investigate specific subgroups in which the benefit of transradial coronary interventions (TRIs) would be enhanced. BACKGROUND The advantage of TRIs over transfemoral coronary interventions (TFIs) might differ according to a given clinical condition, urgency of the procedure, and operator volume pattern. METHODS Using a cohort from the 2014 Korean Percutaneous Coronary Intervention Registry, in-hospital outcomes of the TRI group (n = 22,993) were matched to those of the TFI group (n = 15,581). After propensity score matching, the composite endpoints between the groups and subgroups for all-cause death, nonfatal myocardial infarctions (MIs), or transfusions were analyzed. RESULTS The composite endpoints occurred less frequently in the TRI group than the TFI group [2.1% vs. 5.5%, OR 0.63, 95% CI 0.55-0.72]. The TRI group had a lower rate of death (OR 0.44, 95% CI 0.33-0.60) and nonfatal MI (OR 0.66, 95% CI 0.54-0.81) than the TFI group. The TRI group required fewer transfusions than the TFI group (OR 0.72, 95% CI 0.59-0.88). TRI benefits were consistent across subgroups except patients with chronic kidney disease and those treated in low tertile PCI volume centers. The favorable outcome of TRI was greater in the elderly (≥75 years), patients with ST-elevation MI, those who underwent emergent PCI, and those treated in high tertile PCI volume hospitals (P for the interaction <0.001 for all). CONCLUSIONS Compared to TFI, TRI had favorable composite in-hospital outcomes. TRI benefits were pronounced in high-risk clinical settings and in high PCI volume centers.
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Affiliation(s)
- Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jang Hyun Cho
- Department of Cardiology, St. Carollo Hospital, Republic of Korea
| | - Woong Chol Kang
- Department of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jong-Pil Park
- Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Won-Yong Shin
- Department of Cardiology, Soon Chun Hyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Seong-Hoon Lim
- Division of Cardiovascular disease, College of Medicine, Dankook University Hospital, Cheonan, Republic of Korea
| | - Yu Jeong Choi
- Eulji University School of Medicine, Division of Cardiology, Eulji Medical Center, Daejeon, Republic of Korea
| | - Kyungsoo Kim
- Department of Cardiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Woojung Chun
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ju Han Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Republic of Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
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Won H, Kim SW. The Second Report from K-PCI Registry: a Step toward Continuous Systemic Monitoring of Korean Percutaneous Coronary Intervention Practice. Korean Circ J 2019; 49:1152-1154. [PMID: 31642216 PMCID: PMC6875588 DOI: 10.4070/kcj.2019.0247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/09/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hoyoun Won
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang-Wook Kim
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Han S, Park GM, Kim YG, Park MW, Her SH, Lee SW, Kim YH. Trends, Characteristics, and Clinical Outcomes of Patients Undergoing Percutaneous Coronary Intervention in Korea between 2011 and 2015. Korean Circ J 2018; 48:310-321. [PMID: 29625513 PMCID: PMC5889980 DOI: 10.4070/kcj.2017.0359] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/07/2018] [Accepted: 01/17/2018] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives We sought to evaluate nationwide trends, characteristics, and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) in Korea. Methods From National Health Insurance claims data in Korea, 81,115 patients, who underwent PCI for the first episode of coronary artery disease between 2011 and 2015, were enrolled. Patients were categorized into angina (n=49,288) or acute myocardial infarction (AMI, n=31,887) groups and analyzed. Results The mean age of patients was 64.4±12.2 years and 56,576 (69.7%) were men. Diabetes, hyperlipidemia, and hypertension were observed in 27,086 (33.4%), 30,675 (37.8%), and 45,389 (56.0%) patients, respectively. There was a 10% increase in the number of patients undergoing PCI for angina between 2011–2012 and 2014–2015 (11,105 vs. 13,261; p=0.021). However, the number of patients undergoing PCI for AMI marginally decreased between 2011–2012 and 2014–2015 (8,068 vs. 7,823; p=0.052). In procedures, drug-eluting stent was the most frequently used device (93.2%), followed by balloon angioplasty (5.5%) and bare metal stents (1.3%). The mean number of stents per patient was 1.39±0.64. At discharge, dual-anti platelet therapy, statin, beta-blockers, and angiotensin converting enzyme inhibitor or angiotensin receptor blocker were provided to 76,292 (94.1%), 71,411 (88.0%), 57,429 (70.8%), and 54,418 (67.1%) patients, respectively. The mean in-hospital and 1-year total medical costs were 8,628,768±4,832,075 and 13,128,158±9,758,753 Korean Won, respectively. In-hospital mortality occurred in 2,094 patients (2.6%). Conclusions Appropriate healthcare strategies reflecting trends, characteristics, and clinical outcomes of PCI are needed in Korea.
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Affiliation(s)
- Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Korea
| | - Gyung Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| | - Yong Giun Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Mahn Won Park
- Department of Cardiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Sung Ho Her
- Department of Cardiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Seung Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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