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Kim H, Kang DY, Ahn JM, Lee J, Choi Y, Hur SH, Park HJ, Tresukosol D, Kang WC, Kwon HM, Rha SW, Lim DS, Jeong MH, Lee BK, Huang H, Lim YH, Bae JH, Kim BO, Ong TK, Ahn SG, Chung CH, Park DW, Park SJ. Everolimus-Eluting Stents or Bypass Surgery for Multivessel Disease in Diabetics: The BEST Extended Follow-Up Study. JACC Cardiovasc Interv 2023; 16:2412-2422. [PMID: 37821187 DOI: 10.1016/j.jcin.2023.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Diabetes mellitus is associated with more complex coronary artery diseases. Coronary artery bypass grafting (CABG) is a preferred revascularization strategy over percutaneous coronary intervention (PCI) in diabetics with multivessel coronary artery disease (MVD). OBJECTIVES This study sought to examine the different prognostic effects of revascularization strategies according to the diabetes status from the randomized BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease) trial. METHODS Patients (n = 880) with MVD were randomly assigned to undergo PCI with an everolimus-eluting stent vs CABG stratified by diabetics (n = 363) and nondiabetics (n = 517). The primary endpoint was the composite of death, myocardial infarction, or target vessel revascularization during a median follow-up of 11.8 years (IQR: 10.6-12.5 years). RESULTS In diabetics, the primary endpoint rate was significantly higher in the PCI group than in the CABG group (43% and 32%; HR: 1.53; 95% CI: 1.12-2.08; P = 0.008). However, in nondiabetics, no significant difference was found between the groups (PCI group, 29%; CABG group, 29%; HR: 0.97; 95% CI: 0.67-1.39; P = 0.86; Pinteraction= 0.009). Irrespective of the presence of diabetes, no significant between-group differences were found in the rate of a safety composite of death, myocardial infarction, or stroke and mortality rate. However, the rate of any repeat revascularization was significantly higher in the PCI group than in the CABG group. CONCLUSIONS In diabetics with MVD, CABG was associated with better clinical outcomes than PCI. However, the mortality rate was similar between PCI and CABG irrespective of diabetes status during an extended follow-up. (Ten-Year Outcomes of Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST Extended], NCT05125367; Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST], NCT00997828).
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Affiliation(s)
- Hoyun Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jinho Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeonwoo Choi
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hun-Jun Park
- Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | | | | | | | | | | | | | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Korea
| | - He Huang
- Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | | | | | - Byung Ok Kim
- Inje University Sanggye Paik Hospital, Seoul, Korea
| | | | - Sung Gyun Ahn
- Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Cheol-Hyun Chung
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yuk JS, Kim BG, Lee BK, Seo J, Kim GS, Min K, Lee HY, Byun YS, Kim BO, Yang SW, Kim MH, Yoon SH, Seo YS. Association of Early Hysterectomy With Risk of Cardiovascular Disease in Korean Women. JAMA Netw Open 2023; 6:e2317145. [PMID: 37307002 DOI: 10.1001/jamanetworkopen.2023.17145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Importance Women who undergo surgical hysterectomy before natural menopause may have an earlier increase in hematocrit and storage iron levels than those who continue menstruation, thereby increasing the risk of cardiovascular disease (CVD) at ages younger than usually seen. Examining this issue may provide important implications for women's cardiovascular health to both physicians and patients. Objective To evaluate the association of hysterectomy with the risk of incident CVD among women before age 50 years. Design, Setting, and Participants In this Korean population-based cohort study, 135 575 women aged 40 to 49 years were evaluated from January 1, 2011, to December 31, 2014. After propensity score matching in covariates including age, socioeconomic status, region, Charlson Comorbidity Index, hypertension, diabetes, dyslipidemia, menopause, menopausal hormone therapy, and adnexal surgery before inclusion, 55 539 pairs were included in the hysterectomy and nonhysterectomy groups. Participants were followed up until December 31, 2020. Data analysis was conducted from December 20, 2021, to February 17, 2022. Main Outcomes and Measures The primary outcome was an incidental CVD, a composite of myocardial infarction, coronary artery revascularization, and stroke. The individual components of the primary outcome were also evaluated. Results A total of 55 539 pairs were included; median age in the combined groups was 45 (IQR, 42-47) years. During median follow-up periods in the hysterectomy group of 7.9 (IQR, 6.8-8.9) years and nonhysterectomy group of 7.9 (IQR, 6.8-8.8) years, the incidence of CVD was 115 per 100 000 person-years for the hysterectomy group and 96 per 100 000 person-years for the nonhysterectomy group. After adjusting for confounding factors, the hysterectomy group had an increased risk of CVD compared with the nonhysterectomy group (hazard ratio [HR], 1.25; 95% CI, 1.09-1.44). The incidences of myocardial infarction and coronary artery revascularization were comparable between the groups, whereas the risk of stroke was significantly higher in the hysterectomy group (HR, 1.31; 95% CI, 1.12-1.53). Even after excluding women who underwent oophorectomy, the hysterectomy group had higher risks of CVD (HR, 1.24; 95% CI, 1.06-1.44). Conclusions and Relevance The findings of this cohort study suggest early menopause owing to hysterectomy was associated with increased risks for a composite of CVD, particularly stroke.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jongkwon Seo
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Kyongjin Min
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Seung-Woo Yang
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Hwan Kim
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hee Yoon
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Yong-Soo Seo
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
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Jin MN, Seo J, Kim BG, Kim GS, Lee HY, Byun YS, Kim BO. Association of physical activity with the risk of major adverse cardiac and cerebrovascular events and mortality in patients with concomitant atrial fibrillation and coronary artery disease. Int J Arrhythm 2022. [DOI: 10.1186/s42444-022-00082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Although regular physical activity benefits cardiovascular health, there is a concern that intense exercise is linked to the promotion of atrial fibrillation (AF) and coronary plaque rupture. However, the impact of physical activity on the outcomes of patients with concomitant AF and coronary artery disease (CAD) remains unclear. This study aimed to evaluate the association with clinical outcomes according to the level of physical activity in patients with concomitant AF and CAD.
Methods
We assessed 551 patients with AF and CAD (mean age, 67.1 ± 9.8 years) who completed a self-reported questionnaire for physical activity from 2015 to 2020 in a single tertiary-care hospital. Physical activity levels were converted into metabolic equivalent of task (MET) per week and categorized to correspond with multiple public health recommendations. We examined the association between physical activity, all-cause mortality, and major adverse cardiac and cerebrovascular events (MACCE).
Results
The risks of all-cause mortality (P for linear trend = 0.017) and MACCE (P for linear trend = 0.05) appeared inverse trend with a greater level of physical activity. Compared with inactive patients, patients who met the recommended target range of physical activity (500–1,000 MET-min/week: unadjusted hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.36–0.99) and highly active patients who exceeded the minimum recommended level (≥ 1,000 MET-min/week: unadjusted HR = 0.47, 95% CI = 0.25–0.88) had a lower risk of all-cause mortality in the unadjusted model; however, these associations did not remain significant after adjusting for the model. There was no evidence of increased risk of all-cause mortality and MACCE at levels of physical activity above the recommended target range, even with vigorous-intensity physical activity exceeding the recommended target range.
Conclusions
There appears to be an inverse trend between physical activity levels and all-cause mortality and MACCE in patients with concomitant AF and CAD. No excess risk of mortality or MACCE was found at exercise levels above the recommended target range. Further large-scale studies are warranted to create an improved evidence base concerning the effects of physical activity in patients with AF and CAD.
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Ahn JM, Kang DY, Yun SC, Ho Hur S, Park HJ, Tresukosol D, Chol Kang W, Moon Kwon H, Rha SW, Lim DS, Jeong MH, Lee BK, Huang H, Hyo Lim Y, Ho Bae J, Ok Kim B, Kiam Ong T, Gyun Ahn S, Chung CH, Park DW, Park SJ. Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Artery Disease: Extended Follow-Up Outcomes of Multicenter Randomized Controlled BEST Trial. Circulation 2022; 146:1581-1590. [PMID: 36121700 DOI: 10.1161/circulationaha.122.062188] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents and coronary artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease. METHODS This prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stents or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early because of slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target vessel revascularization. RESULTS During a median follow-up of 11.8 years (interquartile range, 10.6-12.5 years; maximum, 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI, 0.88-1.56]; P=0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75-1.53]; P=0.70), as well as the occurrence of death from any cause (20.5% and 19.9%; HR, 1.04 [95% CI, 0.65-1.67]; P=0.86). However, spontaneous myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06-3.27]; P=0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95% CI, 1.58-2.32]; P<0.001) were more frequent after PCI than after CABG. CONCLUSIONS In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT05125367 and NCT00997828.
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Affiliation(s)
- Jung-Min Ahn
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, South Korea (S.H.H.)
| | - Hun-Jun Park
- Catholic University of Korea, Seoul St. Mary's Hospital (H.-J.P.)
| | | | - Woong Chol Kang
- Gachon University Gil Hospital, Incheon, South Korea (W.C.K.)
| | | | | | - Do-Sun Lim
- Korea University Anam Hospital, Seoul (D.-S.L.)
| | - Myung-Ho Jeong
- Chonnam National University Hospital, Gwangju, South Korea (M.-H.J.)
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, South Korea (B.-K.L.)
| | - He Huang
- Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China (H.H.)
| | - Young Hyo Lim
- Hanyang University Hospital, Seoul, South Korea (Y.H.L.)
| | - Jang Ho Bae
- Konyang University Hospital, Daejeon, South Korea (J.H.B.)
| | - Byung Ok Kim
- Inje University Sanggye Paik Hospital, Seoul, South Korea (B.O.K.)
| | - Tiong Kiam Ong
- Sarawak General Hospital, Kuching, Sarawak, Malaysia (T.K.O.)
| | - Sung Gyun Ahn
- Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea (S.G.A.)
| | - Cheol-Hyun Chung
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kim BG, Yuk JS, Kim GS, Seo JK, Jin MN, Lee HY, Seo YS, Kim MH, Yang SW, Yoon SH, Byun YS, Kim BO. Effect of early hysterectomy on a risk of incident cardiovascular disease in women: a nationwide population-based cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aim
Women who inevitably underwent surgical hysterectomy before natural menopause may have an earlier increase in hematocrit and storage iron than women who continue menstruation, thereby increasing the risk of cardiovascular disease (CVD) early. We aimed to evaluate the association of women with hysterectomy vs. without hysterectomy before their 50s with the risk of incident CVD.
Methods
This was a retrospective-cohort study, 135,575 women aged 40 to 50 years in 2011–2014 were extracted from the Korean Health Insurance Review and Assessment Service data and after propensity score matching, 55,539 pairs were included in hysterectomy and non-hysterectomy group respectively. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiovascular death, myocardial infarction (MI), stroke, and coronary artery revascularization.
Results
After adjustment for confounding factors, hysterectomy group had an increased risk of MACCE compared with non-hysterectomy group (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.09–1.44). Regarding individual outcomes, cardiovascular death, MI, and coronary revascularization were comparable between the groups, whereas, the risk of stroke was significantly higher in hysterectomy group than non-hysterectomy group (HR, 1.31; 95% CI, 1.12–1.53). Even after excluding women who underwent oophorectomy, hysterectomy group had a higher risk of MACCE than non-hysterectomy group (HR, 1.24; 95% CI 1.06–1.44).
Conclusions
Early surgical menopause due to hysterectomy, not hormonal menopause, was associated with an increased risk for a composite of CVD, especially stroke. This suggest that the role of “uterus” as well as sex hormones may be important for the sharp increase in the risk of CVD in women after menopause.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B G Kim
- Inje University Sanggye Paik Hospital, Cardiology , Seoul , Korea (Republic of)
| | - J S Yuk
- Sanggye Paik Hospital, Obstetrics and Gynecology , Seoul , Korea (Republic of)
| | - G S Kim
- Inje University Sanggye Paik Hospital, Cardiology , Seoul , Korea (Republic of)
| | - J K Seo
- Inje University Sanggye Paik Hospital, Cardiology , Seoul , Korea (Republic of)
| | - M N Jin
- Inje University Sanggye Paik Hospital, Cardiology , Seoul , Korea (Republic of)
| | - H Y Lee
- Inje University Sanggye Paik Hospital, Cardiology , Seoul , Korea (Republic of)
| | - Y S Seo
- Sanggye Paik Hospital, Obstetrics and Gynecology , Seoul , Korea (Republic of)
| | - M H Kim
- Sanggye Paik Hospital, Obstetrics and Gynecology , Seoul , Korea (Republic of)
| | - S W Yang
- Sanggye Paik Hospital, Obstetrics and Gynecology , Seoul , Korea (Republic of)
| | - S H Yoon
- Sanggye Paik Hospital, Obstetrics and Gynecology , Seoul , Korea (Republic of)
| | - Y S Byun
- Inje University Sanggye Paik Hospital, Cardiology , Seoul , Korea (Republic of)
| | - B O Kim
- Inje University Sanggye Paik Hospital, Cardiology , Seoul , Korea (Republic of)
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Kim GS, Seo JK, Kim BG, Byun YS, Kim BO. Optimal strategy for antiplatelet therapy after endovascular revascularization in patients with lower extremity artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The duration of antiplatelet therapy after endovascular revascularization in patients with lower extremity artery disease (LEAD) has not been well established. This study aimed to evaluate the clinical outcome according to the duration of dual antiplatelet therapy (DAPT) in real practice.
Methods
From April 2009 to June 2019, 376 patients with LEAD underwent successful endovascular revascularization. After the procedure, the received single antiplatelet therapy (SAPT) or DAPT of various durations were classified into two groups (SAPT or DAPT <6 months vs. DAPT ≥6 months). The primary outcomes were major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). The safety outcome was moderate-to-severe bleeding according to the Global Use of Strategies to Open Occluded Arteries (GUSTO) criteria.
Results
Over the 40-month follow-up period, MACE occurred less frequently in the DAPT ≥6 months group than that in the SAPT or DAPT <6 months group (12.4% vs. 23.8%; hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.35–0.89; p=0.014) after inverse probability-weighted adjustment and propensity-score matching analysis (HR: 0.55, 95% CI; 0.30–0.99, p=0.048). The incidence of MALE did not show significant difference between the two groups (DAPT ≥6 months group: 17.1% vs. SAPT or DAPT <6 months group: 13.1%; HR: 1.05; 95% CI: 0.62–1.78; p=0.846). A significant difference between the DAPT ≥6 months group and the SAPT or DAPT <6 months group was not observed regarding the incidence of moderate-to-severe GUSTO bleeding.
Conclusions
In patients with LEAD, DAPT for ≥6 months after endovascular revascularization was associated with a lower incidence of MACE.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Research Foundation of Korea (NRF) grant funded by the government of Korea (MSIT) (No. 2019R1G1A1100442).
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Affiliation(s)
- G S Kim
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - J K Seo
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - B G Kim
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - Y S Byun
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - B O Kim
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
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Kim GS, Kim BK, Seo JK, Kim BO, Byun YS. The impact of statin treatment intensity after endovascular revascularization for lower extremity peripheral artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
There are few Asian studies on the clinical impact of statin intensity on clinical outcomes in patients with peripheral artery disease (PAD). This study investigated the clinical impact of statin intensity in patients with PAD after endovascular revascularization.
Material and methods
From April 2009 to June 2019, 376 patients with lower extremity PAD treated with endovascular revascularization were enrolled. They were classified into three groups according to statin intensity: no-statin, low-to-moderate intensity (LMI), and high-intensity (HI) groups. The primary outcomes were major adverse cardiovascular events (MACE) and major adverse limb events (MALE).
Results
During the 40-month follow-up, MACE occurred less in the HI and LMI groups than the no-statin group (11.4% vs. 16.0% vs. 39%, p<0.001). In the adjusted Cox models, the HI group had the lowest MACE (hazard ratio [HR]: 0.347; 95% confidence interval [CI] 0.144–0.834; p=0.018) and MALE (HR: 0.344; 95% CI 0.120–0.989, p=0.048), while the LMI group had fewer MACE (HR: 0.319; 95% CI 0.169–0.604, p=0.048) than the no-statin group. HI therapy was associated with better outcomes in terms of MALE (HR: 0.377; 95% CI: 0.208–0.684; p=0.001) and repeat revascularization (HR: 0.449; 95% CI: 0.243–0.830; p=0.011) than the LMI group after the inverse probability treatment weighting analysis.
Conclusions
HI and LMI statin use is associated with a significant reduction of MACE than no statin use. Regarding MALE, HI statin use was associated with better outcomes than no statin or LMI statin use.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2019R1G1A1100442).
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Affiliation(s)
- G S Kim
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - B K Kim
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - J K Seo
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - B O Kim
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
| | - Y S Byun
- Inje University, Sanggye Paik Hospital , Seoul , Korea (Republic of)
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Kim BG, Cho SW, Seo J, Kim GS, Jin MN, Lee HY, Byun YS, Kim BO. Effect of direct stenting on microvascular dysfunction during percutaneous coronary intervention in acute myocardial infarction: a randomized pilot study. J Int Med Res 2022; 50:3000605221127888. [PMID: 36177850 PMCID: PMC9528029 DOI: 10.1177/03000605221127888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective Whether direct stenting (DS) without predilatation during primary percutaneous coronary intervention (PPCI) reduces microvascular dysfunction in patients with ST-elevation myocardial infarction is unclear. We performed a randomized study to assess the effect of DS on microvascular reperfusion. Methods Seventy-two patients undergoing PPCI were randomly assigned to the DS or conventional stenting (CS) with predilatation groups. The primary endpoint was the post-PPCI index of microcirculatory resistance (IMR). We compared thrombolysis in myocardial infarction myocardial perfusion (TMP) grades, ST-segment resolution, and long-term clinical outcomes between the groups. Results Microvascular reperfusion parameters immediately after PPCI (e.g., the IMR, TMP grade, and ST-segment resolution) were not different between the groups. However, significantly fewer patients in the DS group had the IMR measured because of no-reflow or cardiogenic shock during PPCI than those in the CS group. No differences were found in left ventricular functional recovery or clinical outcomes between the groups. Conclusions This trial showed no effect of DS on the IMR. However, our finding should be interpreted with caution because the number of patients who could not have the IMR measured was higher in the CS group than in the DS group. A larger randomized trial is required (Research Registry number: 8079).
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Affiliation(s)
- Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Sung Woo Cho
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Jongkwon Seo
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Moo-Nyun Jin
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
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Kim G, Byun YS, Kim BO. TCT-219 Optimal Strategy for Antiplatelet Therapy After Endovascular Revascularization in Patients With Lower Extremity Artery Disease. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Kim GS, Seo J, Kim BG, Jin MN, Lee HY, Kim BO, Byun YS. Impact of Statin Treatment Intensity after Endovascular Revascularization on Lower Extremity Peripheral Artery Disease. Yonsei Med J 2022; 63:333-341. [PMID: 35352884 PMCID: PMC8965427 DOI: 10.3349/ymj.2022.63.4.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/06/2021] [Accepted: 12/13/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Only a few Asian studies have discussed the impact of statin intensity on clinical outcomes in patients with peripheral artery disease (PAD). We aimed to investigate the clinical impact of statin intensity in patients with PAD after endovascular revascularization. MATERIALS AND METHODS From April 2009 to June 2019, 376 patients with lower extremity PAD treated with endovascular revascularization were enrolled. They were classified into three groups according to statin intensity: no-statin, low-to-moderate intensity (LMI), and high-intensity (HI). The primary outcomes were major adverse cardiovascular events (MACE) and major adverse limb events (MALE). RESULTS During the 40-month follow-up, MACE occurred less frequently in the HI and LMI groups than the no-statin group (11.4% vs. 16.0% vs. 39%, p<0.001). In adjusted Cox models, the HI group had the fewest MACE [hazard ratio (HR): 0.447; 95% confidence interval (CI): 0.244-0.834; p=0.018] and MALE (HR: 0.360; 95% CI: 0.129-1.006; p=0.051) events, while the LMI group had fewer MACE (HR: 0.571; 95% CI: 0.326-1.0; p=0.050) events than the no-statin group. HI statin therapy was associated with better outcomes in terms of MALE (HR: 0.432; 95% CI: 0.223-0.837; p=0.003) than LMI statin therapy after inverse probability treatment weighting analysis. CONCLUSION HI and LMI statin use is associated with a significant reduction in MACE events than no-statin use. HI statin use was associated with better MALE outcomes than no-statin or LMI statin use.
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Affiliation(s)
- Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Jongkwon Seo
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Moo-Nyun Jin
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Seoul, Korea.
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Kim BG, Seo J, Kim GS, Jin MN, Lee HY, Byun YS, Kim BO. TCTAP A-067 Elevated C-Reactive Protein/Albumin Ratio Is Associated With Lesion Complexity, Multilevel Involvement, and Adverse Outcomes in Patients With Peripheral Artery Disease. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.03.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Kim BG, Seo J, Kim GS, Jin MN, Lee HY, Byun YS, Kim BO. Elevated C-Reactive Protein/Albumin Ratio Is Associated With Lesion Complexity, Multilevel Involvement, and Adverse Outcomes in Patients With Peripheral Artery Disease. Angiology 2022; 73:843-851. [PMID: 35236141 DOI: 10.1177/00033197221075853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Inflammation plays an important role in the progression of peripheral artery disease (PAD). We investigated the predictive value of the C-reactive protein-to-albumin ratio (CAR) on the severity of PAD and outcomes after endovascular therapy (EVT). Patients (n = 307) with PAD who underwent EVT were retrospectively reviewed and categorized according to CAR tertiles. The groups were compared for the prevalence of complex lesions and multilevel involvement as well as the incidence of major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). The rates of complex lesions and multilevel involvement increased with increasing CAR tertiles (all P < .001). These associations remained significant even after adjustment for other confounders (complex lesion odds ratio, 1.22 [1.03-1.50]; P = .036; multilevel disease odds ratio, 1.20 [1.01-1.44]; P = .041). The third CAR tertile showed a significantly higher incidence of MACEs and MALEs than the second and first tertiles within a year (log-rank P < .001). A higher CAR as a continuous variable was also independently associated with the 4-year rate of MACE (hazard ratio, 1.20 [1.04-1.38]; P = .015). Elevated CAR was a powerful surrogate marker of severe PAD and worse outcomes. Thus, CAR might become a predictor of poor prognosis in patients with PAD.
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Affiliation(s)
- Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, 65509Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Jongkwon Seo
- Division of Cardiology, Department of Internal Medicine, 65509Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, 65509Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Moo-Nyun Jin
- Division of Cardiology, Department of Internal Medicine, 65509Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, 65509Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, 65509Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, 65509Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
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Kown H, Seo J, Kim BG, Kim GS, Jin MN, Lee HY, Byun YS, Kim BO. Takotsubo syndrome presenting with high-degree atrioventricular block with ventricular asystole. J Cardiol Cases 2022; 25:193-197. [DOI: 10.1016/j.jccase.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022] Open
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Jin MN, Lee HY, Lee JH, Seo J, Kim BG, Kim GS, Byun YS, Kim BO. Successful Catheter Ablation for an Extremely Rare Case of Speech Induced Atrial Tachycardia. Korean Circ J 2022; 52:847-850. [DOI: 10.4070/kcj.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Moo-Nyun Jin
- Division of Cardiology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
- Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jeong Ho Lee
- Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jongkwon Seo
- Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Gyu Kim
- Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Gwang Sil Kim
- Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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15
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Jung IH, Seo J, Kim GS, Lee HY, Byun YS, Kim BO, Rhee KJ, Hong SJ, Kim C. Comparison of the improvement of flow-mediated dilatation in patients with acute coronary syndrome versus stable angina after six-month cardiac rehabilitation. Cardiovasc J Afr 2021; 32:123-128. [PMID: 34128948 DOI: 10.5830/cvja-2020-022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/23/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We investigated whether the improvement in endothelial function, measured using flow-mediated dilatation (FMD), an important predictor of cardiovascular outcomes, was comparable in acute coronary syndrome (ACS) versus stable angina patients after percutaneous coronary intervention (PCI) and a six-month cardiac rehabilitation (CR) programme. METHODS We analysed the results from 119 patients who completed a six-month CR programme after successful PCI for stable angina (n = 50) and ACS (n = 69). RESULTS After six months of CR, the results of FMD were significantly improved in both groups. There were no significant between-group differences in the FMD results at the six-month follow up. CONCLUSIONS After successful PCI and a six-month CR programme, FMD values were equally improved in both stable angina and ACS patients.
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Affiliation(s)
- In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsci University College of Medicine, Yongin, Korea
| | - Jongkwon Seo
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea.
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea.
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sung-Jin Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Kim
- Department of Rehabilitation Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Kim J, Song YB, Oh JH, Cho DK, Lee JB, Kim SH, Jeong JO, Bae JH, Kim BO, Cho JH, Suh IW, Kim DI, Park HK, Park JS, Choi WG, Lee WS, Choi KH, Park TK, Lee JM, Yang JH, Choi JH, Choi SH, Gwon HC, Doh JH, Hahn JY. Effects of Prolonged Dual Antiplatelet Therapy in ST-Segment Elevation vs. Non-ST-Segment Elevation Myocardial Infarction. Circ J 2021; 85:817-825. [PMID: 33431720 DOI: 10.1253/circj.cj-20-0704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The benefits and risks of prolonged dual antiplatelet therapy (DAPT) have not been studied extensively across a broad spectrum of acute coronary syndromes. In this study we investigated whether treatment effects of prolonged DAPT were consistent in patients presenting with ST-segment elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI).Methods and Results:As a post hoc analysis of the SMART-DATE trial, effects of ≥12 vs. 6 months DAPT were compared among 1,023 patients presenting with STEMI and 853 NSTEMI patients. The primary outcome was a composite of recurrent myocardial infarction (MI) or stent thrombosis at 18 months after the index procedure. Compared with the 6-month DAPT group, the rate of the composite endpoint was significantly lower in the ≥12-month DAPT group (1.2% vs. 3.8%; hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12-0.77; P=0.012). The treatment effect of ≥12- vs. 6-month DAPT on the composite endpoint was consistent among NSTEMI patients (0.2% vs. 1.2%, respectively; HR 0.20, 95% CI 0.02-1.70; P=0.140; Pinteraction=0.718). In addition, ≥12-month DAPT increased Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding among both STEMI (4.4% vs. 2.0%; HR 2.18, 95% CI 1.03-4.60; P=0.041) and NSTEMI (5.1% vs. 2.2%; HR 2.37, 95% CI 1.08-5.17; P=0.031; Pinteraction=0.885) patients. CONCLUSIONS Compared with 6-month DAPT, ≥12-month DAPT reduced recurrent MI or stent thrombosis regardless of the type of MI at presentation.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ju-Hyeon Oh
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | | | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Kang WC, Park SM, Jang AY, Oh PC, Shin ES, Yu CW, Oh SJ, Kim YH, Won H, Lee SR, Lee SY, Hong YJ, Lee SY, Kim BO, Kim SW. Predictors of Favorable Angiographic Outcomes After Drug-Coated Balloon Use for de novo Small Vessel Coronary Disease (DCB-ONLY). Angiology 2021; 72:986-993. [PMID: 33982603 DOI: 10.1177/00033197211015534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We evaluated the angiographic parameter and clinical outcomes of drug-coated balloon (DCB) to assess the optimal angiographic criteria in de novo small vessel disease (SVD). Patients (n = 424, mean age: 64.4 ± 11.2 years, men: 69.8%) at 20 sites in Korea were prospectively enrolled. The primary end point was late luminal loss (LLL) at 9-month follow-up angiography. Secondary end points included restenosis rates, target lesion failure (TLF), and DCB-related thrombosis during the 12-month follow-up period. We included 403 patients for analysis excluding 21 patients who required bailout stenting. Baseline mean reference vessel .diameter was 2.52 ± 0.39 mm and mean minimal luminal diameter (MLD) was 0.71 ± 0.40 mm. The mean MLD was 1.54 ± 0.37 mm after DCB. Late luminal loss was -0.01 ± 0.43 mm and restenosis was noted in 26 patients (12.2%). Minimal luminal diameter >1.6 mm and %diameter stenosis (DS) <45% after DCB was associated maintenance of MLD without LLL at 9-months. Multivariate analysis demonstrated that %DS at baseline and post-MLD was associated with the restenosis. During 12-month follow-up, TLF was 2.6% including 1 cardiac death, 1 myocardial infarction, and 10 ischemia-driven target lesion revascularizations. Drug-coated balloon showed a low restenosis and lower LLL despite high in-segment DS. Post-MLD and % DS may be helpful to get optimal results in de novo SVD after DCB.
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Affiliation(s)
- Woong Chol Kang
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sang Min Park
- Eulji University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Albert Youngwoo Jang
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eun-Seok Shin
- Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea
| | - Cheol Woong Yu
- Korea University Anam Hospital, Seoul, Republic of Korea
| | | | - Yong Hoon Kim
- Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hoyoun Won
- Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Sang-Rok Lee
- Chonbuk National University, School of Medicine, Jeonju, Republic of Korea
| | - Sang Yeub Lee
- Chungbuk National University, School of Medicine, Cheongju, Republic of Korea
| | - Young Joon Hong
- Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung Yun Lee
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Byung Ok Kim
- Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Sang-Wook Kim
- Chung-Ang University Hospital, Seoul, Republic of Korea
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Wang JM, Kim BO, Bae JW, Oh DJ. Implementation of National Health Policy for the Prevention and Control of Cardiovascular Disease in South Korea: Regional-Local Cardio-Cerebrovascular Center and Nationwide Registry. Korean Circ J 2021; 51:383-398. [PMID: 33975386 PMCID: PMC8112182 DOI: 10.4070/kcj.2021.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity, mortality, and health care costs in South Korea. The prevalence of preventable and treatable risk factors for CVD such as obesity, hypercholesterolemia, and smoking has continued to increase, despite improvements management of hypertension. Active leadership, participation, and support of professional organizations and medical institutions in national cardiovascular registries and regional treatment network have proven to be effective models to reduce the global burden of CVD in the Europe and North America. Regional treatment network systems for ST-segment elevation myocardial infarction have established to coordinate percutaneous coronary intervention (PCI) treatment centers, non-PCI treatment centers, and emergency centers especially across the Europe. The Act on the Prevention and Management of Cardio-cerebrovascular Disease was enacted in South Korea in 2017 to establish the legal frameworks and a comprehensive plan for the prevention and management CVD and risk factors. To fully achieve the goal of a National Health Plan for Cardiovascular Disease, it is necessary to embark on a nationwide registry project and to promote the regional acute treatment accessibility which can therefore play a key role in achieving the objectives of the 2017 Act. In this regard, the Korean Society of Cardiology advocates a national project for health promotion and cardiovascular prevention to improve cardiovascular outcomes, which includes the expansion and establishment of regional cardio-cerebrovascular centers (CCVCs) and new local CCVCs.
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Affiliation(s)
- Ju Mee Wang
- The Korean Cardiac Research Foundation, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea.
| | - Jang Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Chungbuk National University Hospital, Cheongju, Korea
| | - Dong Jin Oh
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
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Seo J, Jung IH, Park JH, Kim GS, Lee HY, Byun YS, Kim BO, Rhee KJ. The prognostic value of 2D strain in assessment of the right ventricle in patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020; 20:1043-1050. [PMID: 30796431 DOI: 10.1093/ehjci/jez015] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/22/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Several studies have been reported using right ventricular (RV) strain as a method for evaluating RV function in patients with various cardiovascular diseases; however, the clinical relevance of RV strain in dilated cardiomyopathy (DCM) patients with sinus rhythm is unknown. The aim of this study was to investigate the relationship between RV strain and adverse events in DCM patients with sinus rhythm. METHODS AND RESULTS We enrolled 143 DCM patients with sinus rhythm who had been first diagnosed, evaluated, and followed at Sanggye Paik Hospital between March 2013 and August 2017. We performed echocardiography and measured RV strain values using the apical four-chamber view. The mean age was 64.6 years. During the median follow-up period of 40.0 months, adverse cardiovascular events developed in 21 patients (14.7%). By Cox proportional hazards multivariate analysis, only RV free wall longitudinal strain (RV-FWLS) independently predicted the primary outcome. Receiver-operating characteristic curve analysis showed that the optimal RV-FWLS cut-off value to identify patients with an event was -16.5% (area under the curve = 0.703, P = 0.003). When we divided the subjects into two groups based on the RV-FWLS of -16.5%, patients with RV-FWLS <-16.5% showed more favourable clinical outcomes than that in those with RV-FWLS ≥-16.5% (log-rank test, P < 0.001). CONCLUSION RV-FWLS was associated with a significant prognostic impact in DCM patients with sinus rhythm.
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Affiliation(s)
- Jongkwon Seo
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - In Hyun Jung
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Jin Hye Park
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Gwang Sil Kim
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Hye Young Lee
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Young Sup Byun
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Byung Ok Kim
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Kun Joo Rhee
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
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20
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Jung IH, Park JH, Lee JA, Kim GS, Lee HY, Byun YS, Kim BO. Left Ventricular Global Longitudinal Strain as a Predictor for Left Ventricular Reverse Remodeling in Dilated Cardiomyopathy. J Cardiovasc Imaging 2020; 28:137-149. [PMID: 32233166 PMCID: PMC7114450 DOI: 10.4250/jcvi.2019.0111] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/25/2019] [Accepted: 01/13/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A considerable number of patients with dilated cardiomyopathy (DCM) experience left ventricular reverse remodeling (LVRR). LV global longitudinal strain (LV GLS) offers sensitive and reproducible measurement of myocardial dysfunction. The authors sought to evaluate whether LV GLS at the time of diagnosis may predict LVRR in DCM patients with sinus rhythm and investigate its prognostic role in long-term follow-up in this population. METHODS We enrolled 160 DCM patients with sinus rhythm who had been initially diagnosed, evaluated, and followed at our institute. We analyzed their medical records and echocardiographic data. RESULTS During the mean follow-up duration of 37.3 ± 21.7 months, LVRR occurred in 28% of patients (n = 45). The initial LV ejection fraction (LVEF) of patients who recovered LV function was 26.1 ± 7.9%, which was not significantly different from the value of 27.1 ± 7.4% (p = 0.49) in those who did not recover. There was a moderate and highly significant correlation between baseline LV GLS (−%) and follow-up LVEF (r = 0.717; p < 0.001). Using multivariate Cox analysis, LV GLS (hazard ratio: 1.474, 95% confidence interval: 1.170-1.856; p = 0.001) was an independent predictor of LVRR. CONCLUSIONS We demonstrated that LV GLS was an independent predictor for LVRR and the optimal cut-off point of LV GLS for LVRR was −10% in DCM patients with sinus rhythm. There was a significant correlation between baseline LV GLS and follow-up LVEF.
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Affiliation(s)
- In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea.
| | - Jin Hye Park
- Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Jeong A Lee
- Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Gwang Sil Kim
- Division of Cardiology, Sanggye-Paik Hospital, Inje University, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Sanggye-Paik Hospital, Inje University, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Sanggye-Paik Hospital, Inje University, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Sanggye-Paik Hospital, Inje University, Seoul, Korea
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21
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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome. Korean Circ J 2019; 49:1066-1111. [PMID: 31646772 PMCID: PMC6813162 DOI: 10.4070/kcj.2019.0194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023] Open
Abstract
Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine-Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine-Regional Cardiocerebrovascular Center, Dong-A Medical Center, Busan, Korea
| | - Won Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine-Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Il Young Jung
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine-Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University School of Medicine, Goyang, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyung Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Wook Kim
- Department and Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyoune Jung
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | | | - In Hyun Jung
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Young Han
- Department of Rehabilitation Medicine, Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Woosik Han
- Department of Thoracic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine-Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyung Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon, Korea
| | - Sook Joung Lee
- Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byeong Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
| | - Soon Kim
- Research Institute for Social Science, Ewha Woman's University, Seoul, Korea
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22
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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea. Korean J Thorac Cardiovasc Surg 2019; 52:248-285. [PMID: 31404368 PMCID: PMC6687042 DOI: 10.5090/kjtcs.2019.52.4.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/29/2019] [Accepted: 07/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine,
Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine–Heart Vascular Stroke Institute, Samsung Medical Center, Seoul,
Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine–Regional Cardiocerebrovascular Center, Dong-A Medical Center, Busan,
Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine,
Korea
- Gyeonggi Regional Cardiocerebrovascular Center, Seongnam,
Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Il-Young Jung
- Department of Rehabilitation Medicine, Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon,
Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine,
Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University School of Medicine, Goyang,
Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Yong Wook Kim
- Department and Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Heeyoune Jung
- National Traffic Injury Rehabilitation Hospital, Yangpyeong,
Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | | | - In Hyun Jung
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine,
Korea
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jae-Young Han
- Department of Rehabilitation Medicine, Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju,
Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju,
Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University–Biomedical Research Institute of Chonbuk National University Hospital, Jeonju,
Korea
| | - Woosik Han
- Department of Thoracic Surgery, Chungnam National University Hospital, Daejeon,
Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine–Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon,
Korea
| | - Kyung-Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon,
Korea
| | - Sook Joung Lee
- Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon,
Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju,
Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan,
Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan,
Korea
| | - Soon Kim
- Research Institute for Social Science, Ewha Woman’s University, Seoul,
Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Lee HY, Hong SJ, Jung IH, Kim GS, Byun YS, Kim BO. Effect of Cardiac Rehabilitation on Outcomes in Patients with ST-Elevation Myocardial Infarction. Yonsei Med J 2019; 60:535-541. [PMID: 31124336 PMCID: PMC6536392 DOI: 10.3349/ymj.2019.60.6.535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/27/2019] [Accepted: 04/02/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Whether cardiac rehabilitation (CR) improves clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) has not been thoroughly evaluated. Moreover, few studies have sought to identify patients who would benefit most from CR among STEMI patients. MATERIALS AND METHODS Consecutively, 265 STEMI patients who underwent primary PCI with implantation of DESs and follow-up angiography were examined. Seventy-six patients (30%) who received CR were assigned to the CR+ group. Another 178 patients (70%) who did not participate in CR were assigned to the CR- group. Second generation DESs were implanted in 238 (94%) patients. RESULTS Major adverse cardiovascular events (MACEs), including death, myocardial infarction, and revascularization, were compared. The CR+ group tended to have lower MACE than the CR- group at 3 years, although the difference was not statistically significant (9.9% vs. 18.3%, hazard ratio=0.54, p=0.138). Subgroup analysis revealed a significant interaction according to CR and preprocedural thrombolysis in myocardial infarction (TIMI) flow (p value for interaction=0.011). In patients with low preprocedural TIMI flow (TIMI flow ≤1, n=161), those in the CR+ group had significantly lower MACE than those in the CR- group (p=0.005), whereas MACE was not different among patients with higher TIMI flow (TIMI flow ≥2, n=93). CONCLUSION CR including exercise training was associated with lower MACE, particularly in patients with lower preprocedural TIMI flow during primary PCI for STEMI in the current DES era.
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Affiliation(s)
- Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sung Jin Hong
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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25
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Seo J, Kim GS, Lee HY, Byun YS, Jung IH, Rhee KJ, Kim BO. Prevalence and Clinical Outcomes of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Concurrent Coronary and Carotid Angiography. Yonsei Med J 2019; 60:542-546. [PMID: 31124337 PMCID: PMC6536396 DOI: 10.3349/ymj.2019.60.6.542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The prevalence and clinical outcomes of asymptomatic carotid artery stenosis (CAS) in patients with coronary artery disease (CAD) have not been thoroughly studied. We examined the prevalence and predictors of asymptomatic CAS detected by carotid angiography and determined the impact of concomitant CAS on prognosis in patients undergoing coronary angiography (CAG) due to CAD. MATERIALS AND METHODS Between January 2013 and July 2015, 395 patients who underwent carotid digital subtraction angiography to screen for CAS during CAG were analyzed. The presence of CAS was defined as angiographically significant stenosis (≥50%). Major adverse cardiac and cerebrovascular event (MACCE) rates were compared between patients with and without CAS. MACCEs included a composite of cardiac death, cerebrovascular death, acute myocardial infarction, and stroke. RESULTS Of the 395 patients, 101 (25.5%) patients had significant CAS. The independent predictors of CAS were age, male sex, hypertension, diabetes, and multi-vessel disease. In patients with CAD, the presence of CAS was as an independent predictor for MACCEs after adjusting for confounding factors (hazard ratio 2.47, 95% confidence interval 1.16-5.24, p=0.018). CONCLUSION Asymptomatic CAS was documented in up to 25% of patients with CAD. The presence of CAS in patients with CAD was associated with a higher rate of MACCEs. Therefore, detection of CAS by carotid angiography during CAG may be important for risk stratification for CAD patients, particularly those with multi-vessel disease.
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Affiliation(s)
- Jongkwon Seo
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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26
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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea. Ann Rehabil Med 2019; 43:355-443. [PMID: 31311260 PMCID: PMC6637050 DOI: 10.5535/arm.2019.43.3.355] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine–Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine–Regional Cardiocerebrovascular Center, Dong-A Medical Center, Busan, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Cheongju, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine–Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Il-Young Jung
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine–Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University School of Medicine, Goyang, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Cheongju, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Yong Wook Kim
- Department and Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyoune Jung
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | | | - In Hyun Jung
- Department of Internal Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Young Han
- Department of Rehabilitation Medicine, Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University–Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Woosik Han
- Department of Thoracic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine–Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyung-Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon, Korea
| | - Sook Joung Lee
- Daejeon St. Mary’s Hospital. College of Medicine, The Catholic university of Korea, Daejeon, Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine Kyungpook National University, Daegu, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
| | - Soon Kim
- Research Institute for Social Science, Ewha Woman’s University, Seoul, Korea
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Lee BK, Kim JS, Lee OH, Min PK, Yoon YW, Hong BK, Shin DH, Kang TS, Kim BO, Cho DK, Jeon DW, Woo SI, Choi S, Kim YH, Kang WC, Kim S, Kim BK, Hong MK, Jang Y, Kwon HM. Safety of six-month dual antiplatelet therapy after second-generation drug-eluting stent implantation: OPTIMA-C Randomised Clinical Trial and OCT Substudy. EUROINTERVENTION 2019; 13:1923-1930. [PMID: 29104179 DOI: 10.4244/eij-d-17-00792] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS There are few randomised studies concerning the optimal duration of dual antiplatelet therapy (DAPT) for patients who receive a second-generation drug-eluting stent (DES). This trial aimed to investigate the safety of six-month compared with 12-month DAPT maintenance after second-generation DES implantation. METHODS AND RESULTS A prospective, randomised, multicentre trial was performed at 10 medical centres. The 1,368 patients included in the study received a biolimus-eluting stent (BES) or a zotarolimus-eluting stent (ZES). The primary outcome measured was the composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), or ischaemia-driven target lesion revascularisation at the 12-month follow-up. The secondary outcome was the percentage of uncovered struts at six months in 60 patients (30 ZES, 30 BES) using optical coherence tomography (OCT) assessment. Each patient was randomly assigned to six-month (n=684) or 12-month DAPT (n=684). Major adverse cardiac events at 12 months occurred in eight patients (1.2%) in the six-month DAPT group and in four patients (0.6%) in the 12-month DAPT group (risk difference 0.6%; 95% confidence interval [CI]: -0.4-1.6%; p=0.24). The upper 95% CI limit was lower than the pre-specified limit of 4% non-inferiority (p for non-inferiority <0.05). The percentage of uncovered struts was 3.16±4.30% at six months in 60 stents of 60 patients. CONCLUSIONS After second-generation DES implantation, six-month DAPT was not inferior to 12-month DAPT in terms of MACE occurrence over the 12-month follow-up period. OCT examination revealed favourable stent strut coverage at six months after stent implantation.
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Affiliation(s)
- Byoung-Kwon Lee
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Kim GS, Oh HH, Kim SH, Kim BO, Byun YS. Association between prediabetes (defined by HbA1 C, fasting plasma glucose, and impaired glucose tolerance) and the development of chronic kidney disease: a 9-year prospective cohort study. BMC Nephrol 2019; 20:130. [PMID: 30992067 PMCID: PMC6469043 DOI: 10.1186/s12882-019-1307-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/21/2019] [Indexed: 01/03/2023] Open
Abstract
Background The aim of the present study was to investigate the clinical impact of prediabetes on the development of incident chronic kidney disease (CKD) in a Korean adult population, using data from the Korea Genome and Epidemiology Study. Methods This prospective cohort study included 7728 Korean adults without baseline CKD and type 2 diabetes. Prediabetes was defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and HbA1C level. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. We assessed the predictive value of prediabetes for the incidence of CKD, and investigated the incidence of cardiovascular disease including coronary artery disease and stroke. Results Over a median follow-up period of 8.7 years, 871 of 7728 (11.3%) subjects developed incident CKD. Patients with prediabetes, as defined by IGT or HbA1C, developed incident CKD more frequently than the non-prediabetic group did. The risk of CKD development at follow-up was analyzed according to different prediabetes definitions. Compared with the non-prediabetic group, the IGT- (Hazard ratio [HR] = 1.135, 95% confidence interval [CI] = 1.182–1.310, P = 0.043) and HbA1C-defined prediabetic groups (HR = 1.391, 95% CI = 1.213–1.595, P < 0.001) were significantly associated with incident CKD after adjusting for traditional CKD risk factors; however, IFG was not associated with incident CKD. Conclusion IGT- or HbA1C-defined prediabetes is an independent predictor of incident CKD. The measurement of these parameters might enable early detection of CKD risk, allowing physicians to initiate preventive measures and improve patient outcomes.
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Affiliation(s)
- Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, 01757, South Korea
| | - Hyun Ho Oh
- Division of Nephrology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul, South Korea
| | - Sang Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Seoul, South Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, 01757, South Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, 01757, South Korea.
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Kim GS, Byun YS, Lee HY, Jung IH, Rhee KJ, Kim BO. Difference in SBP between arms is a predictor of chronic kidney disease development in the general Korean population. J Hypertens 2019; 37:790-794. [PMID: 30817460 DOI: 10.1097/hjh.0000000000001931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An increased inter-arm SBP difference (IASBPD) is associated with mortality and cardiovascular events, as well as peripheral vascular disease, which is attributed to subclavian stenosis. The aim of the present study was to investigate the association between the IASBPD and incident chronic kidney disease (CKD) in the Korean population. METHODS A retrospective cohort study was performed on 8780 Korean adults without baseline CKD. The bilateral blood pressure was measured sequentially and repeatedly at the first visit. IASBPD was defined as a BP at least 15 mmHg according to the National Institutes for Health and Clinical Excellence guidelines, and CKD was defined as an estimated glomerular filtration rate less than 60 ml/min per 1.73 m. We assessed the value of IASBPD to predict the incidence of CKD and investigated cardiovascular disease, including coronary heart disease and stroke. RESULTS Over a mean follow-up period of 8.5 years, 96 of 581 (16.5%) patients in the IASBPD group and 1037 of 8199 (12.6%) patients in the non-IASBPD group developed incident CKD. Compared with the non-IASBPD, an IASBPD was associated with incident CKD [hazard ratio (HR): 1.336, 95% confidence interval (CI): 1.08-1.65, P = 0.007]. After adjusting for potential confounders, including age, sex, hypertension, diabetes, and obesity, we found that the hazard ratio was also robust (hazard ratio 1.275, 95% CI 1.03-1.58, P = 0.024). CONCLUSION Increased IASBPD is an independent predictor of incident CKD in the general population.
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Lee SJ, Koh S, Kim BO, Kim B, Kim C. Effect of Type D Personality on Short-Term Cardiac Rehabilitation in Patients With Coronary Artery Disease. Ann Rehabil Med 2018; 42:748-757. [PMID: 30404424 PMCID: PMC6246854 DOI: 10.5535/arm.2018.42.5.748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/13/2018] [Indexed: 01/20/2023] Open
Abstract
Objective To investigate the effect of type D personality on cardiac rehabilitation (CR) participation rates and the effect of a short-term CR program. Methods Study participants included patients diagnosed with acute coronary syndrome who underwent percutaneous coronary intervention. Patients completed the Type D personality Scale (DS-14) and the Hospital Anxiety and Depression Scale (HADS) at program entry. Subjects were recommended participation in 6 weeks of CR exercise training. Cardiopulmonary exercise test (CPET) was conducted before and after completion of the training. CR participation refers to completion of the 6-week CR exercise program and performance of the secondary CPET. Drop-out refers to the subjects who were unable to participate in the 6-week CR exercise program or to perform the secondary CPET. Results At baseline, type D personality was evident in 21 of 63 patients (33.3%). Type D patients were more often depressed (57.1%) and anxious (38.1%) than non-type D patients (31.0% and 9.5%, respectively). At baseline, participants with type D personality showed a decreased body mass index (24.6 vs. 26.1 kg/m2, p=0.025). The type D group displayed a lower CR participation rate (5/21, 23.8%) compared with the non-type D group of (22/42, 52.4%). Logistic regression analysis revealed the association of type D personality with CR drop-out rate (odds ratio=3.87; 95% confidence interval, 1.2–12.5; p<0.05). Conclusion Type D personality was independently associated with drop-out from CR program and with significantly higher levels of anxiety and depressive mood.
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Affiliation(s)
- Sang Jae Lee
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sunghoon Koh
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Bongseog Kim
- Department of Psychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
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Kim BO, Seo JK, Kim GS, Lee HY. P3515Systolic blood pressure difference between arms and chronic kidney disease in the community based 10-year cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B O Kim
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
| | - J K Seo
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
| | - G S Kim
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
| | - H Y Lee
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
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Kim GS, Kim BO, Seo JK, Lee HY, Jung IH, Byun YS. P1280Non-alcoholic fatty liver disease and hypertension in the community based cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G S Kim
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
| | - B O Kim
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
| | - J K Seo
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
| | - H Y Lee
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
| | - I H Jung
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
| | - Y S Byun
- Inje University, Sanggye-Paik Hospital, Cardiology, SEOUL, Korea Republic of
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Li H, Rha SW, Choi BG, Shim MS, Choi SY, Choi CU, Kim EJ, Oh DJ, Cho BR, Kim MH, Kim DI, Jeong MH, Yoo SY, Jeong SS, Kim BO, Hyun MS, Youn YJ, Yoon J. Transradial versus transfemoral intervention in ST-segment elevation myocardial infarction patients in Korean population. Korean J Intern Med 2018; 33:716-726. [PMID: 28859467 PMCID: PMC6030401 DOI: 10.3904/kjim.2016.316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/09/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/AIMS Transradial intervention (TRI) is becoming the preferred method over transfemoral intervention (TFI) because TRI is associated with lower incidence of major bleeding and vascular complications. However, there has been limited published data regarding the clinical outcomes of TRI versus TFI in Korean patients with ST-elevation myocardial infarction (STEMI). METHODS A total of 689 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) from January to December of 2009 at nine university hospitals were enrolled in this study. Mid-term angiographic and 12-month cumulative clinical outcomes of the TRI group (n = 220, 31.9%) were compared to those of the TFI group (n = 469, 28.1%). RESULTS After propensity score matching, in-hospital complications and the 12-month major clinical outcomes during follow-up in the two groups were similar to each other. However, the incidence rates of repeat revascularization (6.4% vs. 0.5%, p = 0.003), target vessel revascularization (6.4% vs. 0.5%, p = 0.003), and major adverse cardiac events (MACE; 11.6% vs. 4.6%, p = 0.018) in the TFI group were higher than those in the TRI group during the 12-month of follow-up. CONCLUSIONS In our study, TRI in STEMI patients undergoing primary PCI with DESs was associated with lower incidence of access site hematoma, 12-month repeat revascularization, and MACE compared to TFI. Therefore, TRI might play an important role in reducing bleeding complications while improving major clinical outcomes in STEMI patients undergoing primary PCI with DESs.
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Affiliation(s)
- Hu Li
- Department of Cardiovascular, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
- Correspondence to Seung-Woon Rha, M.D. Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: +82-2-2626-3020 Fax: +82-2-864-3062 E-mail:
| | - Byoung Geol Choi
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Min Suk Shim
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Se Yeon Choi
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Cheol Ung Choi
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Eung Ju Kim
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Dong Joo Oh
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Byung Ryul Cho
- Department of Cardiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Moo Hyun Kim
- Cardiovascular Center, Dong-A University Hospital, Busan, Korea
| | - Doo-Il Kim
- Cardiovascular Center, Inje University Busan Paik Hospital, Busan, Korea
| | - Myung-Ho Jeong
- Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Yong Yoo
- Cardiovascular Center, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang-Sik Jeong
- Cardiovascular Center, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Byung Ok Kim
- Cardiovascular Center, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Min Su Hyun
- Cardiovascular Center, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Young-Jin Youn
- Cardiovascular Center, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Junghan Yoon
- Cardiovascular Center, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Gwon HC, Jeon DW, Kang HJ, Jang JS, Park DW, Shin DH, Moon KW, Kim JS, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Han KR, Kim HS. The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:320-327. [PMID: 28567082 PMCID: PMC5449526 DOI: 10.4070/kcj.2017.0070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Appropriate use criteria (AUC) was developed to improve the quality of percutaneous coronary intervention (PCI). However, these criteria should consider the current practice pattern in the country where they are being applied. Materials and Methods The algorithm for the Korean PCI practice pattern (KP3) was developed by modifying the United States-derived AUC in expert consensus meetings. KP3 class A was defined as any strategy with evidence from randomized trials that was more conservative for PCI than medical therapy or coronary artery bypass graft (CABG). Class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or CABG. Class B was defined as a strategy that was partly class A and partly class C. We applied the KP3 classification system to the Korean PCI registry. Results The KP3 class A was noted in 67.7% of patients, class B in 28.8%, and class C in 3.5%. The median proportion of class C cases per center was 2.0%. The distribution of KP3 classes varied significantly depending on clinical and angiographic characteristics. The proportion of KP3 class C cases per center was not significantly dependent on PCI volume, but rather on the percentage of ACS cases in each center. Conclusion We report the current PCI practice pattern by applying the new KP3 classification in a nationwide PCI registry. The results should be interpreted carefully with due regard for the complex relationships between the determining variables and the healthcare system in Korea.
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Affiliation(s)
- Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Woon Jeon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Sik Jang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keon-Woong Moon
- Division of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Juhan Kim
- Division of Cardiology, Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Ok Kim
- Division of Cardiology, Sanggye-Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo-Rok Han
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Jang JS, Han KR, Moon KW, Jeon DW, Shin DH, Kim JS, Park DW, Kang HJ, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Gwon HC, Kim HS. The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:328-340. [PMID: 28567083 PMCID: PMC5449527 DOI: 10.4070/kcj.2017.0071] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country. MATERIALS AND METHODS Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data. RESULTS A total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively. CONCLUSION These data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research.
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Affiliation(s)
- Jae-Sik Jang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Kyoo-Rok Han
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Keon-Woong Moon
- Division of Cardiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Dong Woon Jeon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Juhan Kim
- Division of Cardiology, Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Ok Kim
- Division of Cardiology, Sanggye-Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Gwon HC, Jeon DW, Kang HJ, Jang JS, Park DW, Shin DH, Moon KW, Kim JS, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Han KR, Kim HS. Erratum: The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:541. [PMID: 28765752 PMCID: PMC5537162 DOI: 10.4070/kcj.2016.0446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Woon Jeon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Sik Jang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keon-Woong Moon
- Division of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Juhan Kim
- Division of Cardiology, Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Ok Kim
- Division of Cardiology, Sanggye-Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo-Rok Han
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Sung JM, Hong SJ, Chung IH, Lee HY, Lee JH, Kim HJ, Byun YS, Kim BO, Rhee KJ. Rupture of Right Ventricular Free Wall Following Ventricular Septal Rupture in Takotsubo Cardiomyopathy with Right Ventricular Involvement. Yonsei Med J 2017; 58:248-251. [PMID: 27873520 PMCID: PMC5122644 DOI: 10.3349/ymj.2017.58.1.248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/29/2015] [Accepted: 10/28/2015] [Indexed: 11/27/2022] Open
Abstract
Most patients diagnosed with takotsubo cardiomyopathies are expected to almost completely recover, and their prognosis is excellent. However, complications can occur in the acute phase. We present a case of a woman with takotsubo cardiomyopathy with right ventricular involvement who developed a rupture of the right ventricular free wall following ventricular septal rupture, as a consequence of an acute increase in right ventricular afterload by left-to-right shunt. Our case report illustrates that takotsubo cardiomyopathy can be life threatening in the acute phase. Ventricular septal rupture in biventricular takotsubo cardiomyopathy may be a harbinger of cardiac tamponade by right ventricular rupture.
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Affiliation(s)
- June Min Sung
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sung Jin Hong
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea.
| | - In Hyun Chung
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Pathology, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Lee SH, Jeong MH, Han KR, Sim DS, Yoon J, Youn YJ, Cho BR, Cha KS, Hyon MS, Rha SW, Kim BO, Shin WY, Park KS, Cheong SS. Comparison of Transradial and Transfemoral Approaches for Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome and Anemia. Am J Cardiol 2016; 117:1582-1587. [PMID: 27018932 DOI: 10.1016/j.amjcard.2016.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
Anemia is an independent predictor of bleeding complications and poor clinical outcomes after percutaneous coronary intervention. Percutaneous coronary transradial intervention (TRI) is better than percutaneous coronary transfemoral intervention (TFI) in terms of reducing bleeding complications that can affect the prognosis. This study aims to investigate the clinical outcomes between TRI and TFI for patients with anemia. We analyzed periprocedure complications, in-hospital mortality, and major adverse cardiac events for one year in the Korean TRI registry from January 2013 to April 2014. Patients with chronic kidney disease for whom TFI is preferred were excluded. Anemia was defined as hemoglobin <13 g/dl for men and <12 g/dl for women. A total of 1,279 patients were finally enrolled. Of these, 348 patients had anemia. Among them, 253 patients (72.7%) underwent TRI and 95 patients (27.3%) underwent TFI. There were no significant differences of baseline demographic characteristics between the TRI and TFI groups, except for the incidence of dyslipidemia (TRI 23.7% vs TFI 12.6%, p = 0.023). Multivariate logistic regression analysis revealed lower incidence of composite severe bleeding complications (hazard ratio 0.34, 95% CI 0.12 to 0.99, p = 0.049) and lower incidence of in-hospital mortality than TFI group (hazard ratio 0.74, 95% CI 0.62 to 0.88, p = 0.042). In conclusion, this study suggests that the TRI for patients with anemia may be translated into better prognosis in terms of lower rates of bleeding complications and in-hospital mortality.
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Seo J, Ahn Y, Zheng Z, Kim BO, Choi MJ, Bang D, Kim DY. Clinical significance of serum YKL-40 in Behçet disease. Br J Dermatol 2016; 174:1337-44. [PMID: 26708309 DOI: 10.1111/bjd.14376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Serum YKL-40 is an inflammatory biomarker of endothelial dysfunction and may play a role in the inflammatory process of Behçet disease (BD). OBJECTIVES Serum YKL-40 levels were evaluated in patients with BD in order to identify associations with other inflammatory cytokines and establish laboratory parameters. Serum YKL-40 levels were also compared with BD clinical features and disease activity. METHODS In total, 112 patients with BD and 45 age- and sex-matched healthy volunteers were included. Disease activity was assessed with BD Current Activity Form score and Electronic Medical Record-based Activity Index (EMRAI) score. RESULTS Serum YKL-40 levels were significantly higher in patients with BD (median 41·88, range 12·52-171·30 ng mL(-1) ) than in healthy volunteers (median 20·92, range 5·01-64·20 ng mL(-1) ; P < 0·01). The cut-off value for YKL-40 (30·005 ng mL(-1) ) was determined from the receiver operating characteristic curve. EMRAI scores and the proportion of patients in the active phase of BD presenting with two or more major criteria were significantly higher in patients with elevated YKL-40 levels (P = 0·04 and P = 0·04, respectively). A statistically significant elevation in YKL-40 levels was observed in patients with active BD compared with patients with inactive BD (P = 0·05). Serum YKL-40 values were positively correlated with interleukin-6 and EMRAI scores (both P = 0·04), indicating that serum YKL-40 levels are increased in patients with BD and positively correlate with disease activity. CONCLUSIONS YKL-40 may play a role in the pathophysiology of BD and provide a useful marker for monitoring patients with BD.
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Affiliation(s)
- J Seo
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Y Ahn
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Z Zheng
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Dermatology, Yanbian University Hospital, Yanji, China
| | - B O Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - M J Choi
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - D Bang
- Department of Dermatology, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
| | - D Y Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Cho SW, Kim BG, Kim BO, Byun YS, Goh CW, Rhee KJ, Kwon HM, Lee BK. Hemorheological and Glycemic Parameters and HDL Cholesterol for the Prediction of Cardiovascular Events. Arq Bras Cardiol 2015; 106:56-61. [PMID: 26690693 PMCID: PMC4728596 DOI: 10.5935/abc.20150146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/14/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hemorheological and glycemic parameters and high density lipoprotein (HDL) cholesterol are used as biomarkers of atherosclerosis and thrombosis. OBJECTIVE To investigate the association and clinical relevance of erythrocyte sedimentation rate (ESR), fibrinogen, fasting glucose, glycated hemoglobin (HbA1c), and HDL cholesterol in the prediction of major adverse cardiovascular events (MACE) and coronary heart disease (CHD) in an outpatient population. METHODS 708 stable patients who visited the outpatient department were enrolled and followed for a mean period of 28.5 months. Patients were divided into two groups, patients without MACE and patients with MACE, which included cardiac death, acute myocardial infarction, newly diagnosed CHD, and cerebral vascular accident. We compared hemorheological and glycemic parameters and lipid profiles between the groups. RESULTS Patients with MACE had significantly higher ESR, fibrinogen, fasting glucose, and HbA1c, while lower HDL cholesterol compared with patients without MACE. High ESR and fibrinogen and low HDL cholesterol significantly increased the risk of MACE in multivariate regression analysis. In patients with MACE, high fibrinogen and HbA1c levels increased the risk of multivessel CHD. Furthermore, ESR and fibrinogen were significantly positively correlated with HbA1c and negatively correlated with HDL cholesterol, however not correlated with fasting glucose. CONCLUSION Hemorheological abnormalities, poor glycemic control, and low HDL cholesterol are correlated with each other and could serve as simple and useful surrogate markers and predictors for MACE and CHD in outpatients.
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Affiliation(s)
- Sung Woo Cho
- College of Medicine, Inje University, Seoul, Korea
| | | | - Byung Ok Kim
- College of Medicine, Inje University, Seoul, Korea
| | | | | | - Kun Joo Rhee
- College of Medicine, Inje University, Seoul, Korea
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Kim BG, Cho SW, Lee HY, Kim DH, Byun YS, Goh CW, Rhee KJ, Kim BO. Reduced systemic vascular resistance is the underlying hemodynamic mechanism in nitrate-stimulated vasovagal syncope during head-up tilt-table test. J Arrhythm 2015; 31:196-200. [PMID: 26336559 DOI: 10.1016/j.joa.2014.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nitroglycerin (NTG) challenge during head-up tilt-table testing (HUTT) is often utilized to determine the etiology of unexplained vascular syncope. However, conflicting results concerning nitrate-induced hemodynamic changes during HUTT have been reported. The purpose of this study was to assess the determinants of presyncopal symptoms during NTG-stimulated HUTT. METHODS We evaluated 40 patients with suspected vasovagal syncope. Beat-to-beat changes in blood pressure, heart rate (HR), cardiac index (CI), and systemic vascular resistance (SVR) during HUTT were measured with thoracic impedance cardiography and a plethysmographic finger arterial pressure monitoring device. RESULTS None of the 40 patients complained of presyncopal symptoms during passive HUTT. However, after the administration of NTG 28 patients showed presyncopal symptoms (NTG+ group) and the remaining 12 patients did not (NTG- group). HR, CI, and the stroke index did not significantly differ between the two groups, whereas mean arterial pressure and SVR were significantly lower in the NTG+ group. CONCLUSIONS Presyncopal symptoms during NTG-stimulated HUTT are SVR mediated, not cardiac output mediated. This study challenges the conventional idea of a decrease in cardiac output mediated by NTG as the overriding cause of presyncopal symptoms during HUTT.
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Affiliation(s)
- Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Sung Woo Cho
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea ; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Deok Hee Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Choong Won Goh
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik hospital, Inje University College of Medicine, Seoul 139-707, Republic of Korea
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Kim BG, Cho SW, Kim DH, Kim JH, Byun YS, Goh CW, Rhee KJ, Lee BK, Kim BO. Stent length is a contributing factor of suboptimal stent expansion in drug-eluting stents. Kardiol Pol 2015; 73:598-605. [PMID: 25733175 DOI: 10.5603/kp.a2015.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/24/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Failure to achieve optimal stent expansion poses a risk of treatment failure in percutaneous coronary intervention (PCI). Although intravascular ultrasound provides useful information for suboptimal stent expansion, a substantial portion of PCIs are currently being performed under angiographic guidance only. AIM In order to evaluate the adequacy of stent expansion of four widely used drug-eluting stents in angiography-guided PCI, we performed a retrospective analysis of lesions undergoing PCI using quantitative coronary angiography. METHODS A total of 112 de novo lesions were analysed. Minimal lumen diameter (MLD) was measured at peak pressure during stent deployment (MLD1), after stent deployment (MLD2), and after postdilatation (MLD3). Stent underexpansion, stent elastic recoil, and stent deficit were calculated. Optimal stent deployment was defined as final MLD ≥ 90% of predicted diameter. RESULTS For deploying a stent balloon, higher than nominal pressure was used in 83% of cases (93/112). However, optimal deployment was observed in only 32% (36/112). Adjuvant post-dilatation was performed in 59% (45/76) of lesions with suboptimal expansion, which increased the optimal deployment rate by 60% (27/45). Final optimal stent deployment rate was achieved in 56% (63/112). We found that the MLD1 (p = 0.04), MLD3 (p = 0.02), final MLD (p = 0.04), and optimal stent deployment rate (p = 0.036) were significantly reduced in longer stent deployment lesions (≥ 20 mm) compared to shorter lesions (< 20 mm). CONCLUSIONS Stent length may be a contributing factor of suboptimal stent expansion in angiography-guided PCI.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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Cho SW, Kim BG, Kim DH, Kim BO, Byun YS, Rhee KJ, Lee BK, Goh CW. Prediction of Coronary Artery Disease in Patients With Lower Extremity Peripheral Artery Disease. Int Heart J 2015; 56:209-12. [DOI: 10.1536/ihj.14-284] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sung Woo Cho
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST)
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine
| | - Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine
| | - Deok Hee Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine
| | - Byoung Kwon Lee
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Choong Won Goh
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine
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Cho SW, Kim BG, Kim DH, Kim BO, Goh CW, Rhee KJ, Byun YS. Three-dimensional echocardiographic views of bicuspid pulmonic valve. J Cardiovasc Ultrasound 2014; 22:162-3. [PMID: 25309698 PMCID: PMC4192419 DOI: 10.4250/jcu.2014.22.3.162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/26/2014] [Accepted: 08/20/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sung Woo Cho
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea. ; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Deok Hee Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Choong Won Goh
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Shin JS, Tahk SJ, Yang HM, Yoon MH, Choi SY, Choi BJ, Lim HS, Lee YH, Seo KW, Park SJ, Choi YW, Yoon J, Youn YJ, Cho BR, Cha KS, Han KR, Hyon MS, Rha SW, Kim BO, Shin WY, Park KS, Cheong SS, Jeong MH. Impact of female gender on bleeding complications after transradial coronary intervention (from the Korean Transradial Coronary Intervention registry). Am J Cardiol 2014; 113:2002-6. [PMID: 24793670 DOI: 10.1016/j.amjcard.2014.03.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 12/20/2022]
Abstract
Besides poor clinical outcomes, female gender has been known as a high-risk factor for bleeding complications. This study aimed to investigate the impact of gender on clinical outcomes and bleeding complications after transradial coronary intervention (TRI). The Korean TRI registry is a retrospective multicenter registry with 4,890 patients who underwent percutaneous coronary intervention in 2009 at 12 centers. To compare clinical outcomes and bleeding complications between the male and female groups, we performed a propensity score matching in patients who received TRI. A total of 1,194 patients (597 in each group) were studied. The primary outcome was 1-year major adverse cardiac events, including all-cause mortality, myocardial infarction, target vessel revascularization, and stroke. The secondary outcome was major bleeding (composite of bleeding requiring transfusion of ≥2 units of packed cells or bleeding that was fatal). The proportion of major adverse cardiac events was similar between the 2 groups (6.2% vs 4.7%, p = 0.308). The female group had a greater incidence of major bleeding (0.3% vs 3.2%, p <0.001). On multivariate analysis, female gender (odds ratio [OR] 7.748, 95% confidence interval [CI] 1.767 to 13.399), age ≥75 years (OR 5.824, 95% CI 2.085 to 16.274), and chronic kidney disease (OR 7.264, 95% CI 2.369 to 12.276) were independent predictors of major bleeding. In conclusion, the female gender had a tendency for more bleeding complications than male gender after TRI without difference in the clinical outcome.
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Park JY, Rha SW, Choi BG, Oh DJ, Choi JW, Ryu SK, Jeong MH, Jung SS, Kim MH, Yang HM, Yoon J, Park KS, Han KR, Cho BR, Cha KS, Kim BO, Hyun MS, Shin WY, Choe H, Bae JW, Kim HY. TCTAP A-001 Twelve-month Clinical Outcomes of Transradial Coronary Artery Intervention: Comparison of the Right and Left Radial Artery Approach. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Park KH, Jeong MH, Ahn Y, Jung SS, Kim MH, Yang HM, Yoon J, Rha SW, Park KS, Han KR, Cho BR, Cha KS, Kim BO, Hyon MS, Shin WY, Choe H, Bae JW, Kim HY. The impact of vascular access for in-hospital major bleeding in patients with acute coronary syndrome at moderate- to very high-bleeding risk. J Korean Med Sci 2013; 28:1307-15. [PMID: 24015035 PMCID: PMC3763104 DOI: 10.3346/jkms.2013.28.9.1307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 07/11/2013] [Indexed: 11/20/2022] Open
Abstract
The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.
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Affiliation(s)
- Keun-Ho Park
- Chonnam National University Hospital, Gwangju, Korea
| | | | - Youngkeun Ahn
- Chonnam National University Hospital, Gwangju, Korea
| | | | | | | | | | | | | | - Kyoo Rok Han
- Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | | | | | - Byung Ok Kim
- Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Min Soo Hyon
- Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Won-Yong Shin
- Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyunmin Choe
- Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jang-Whan Bae
- Chungbuk National University Hospital, Cheongju, Korea
| | - Hee Yeol Kim
- The Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea
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Kwon SW, Kim BO, Kim MH, Lee SJ, Yoon JH, Chung H, Shim CY, Cho DK, Ryu SK, Yoon SJ, Yoon YW, Chang HJ, Rim SJ, Kwon HM, Jang Y, Hong BK. Diverse left ventricular morphology and predictors of short-term outcome in patients with stress-induced cardiomyopathy. Int J Cardiol 2013; 168:331-7. [DOI: 10.1016/j.ijcard.2012.09.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/19/2012] [Accepted: 09/15/2012] [Indexed: 01/27/2023]
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Cho SW, Kim BK, Kim JH, Byun YS, Goh CW, Rhee KJ, Ahn HS, Lee BK, Kim BO. Non-invasively measured aortic wave reflection and pulse pressure amplification are related to the severity of coronary artery disease. J Cardiol 2013; 62:131-7. [PMID: 23731925 DOI: 10.1016/j.jjcc.2013.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/12/2013] [Accepted: 03/18/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Augmentation index (AIx) and pulse pressure amplification (PPA, here the aortic/brachial pulse pressure ratio) are an age-related emerging risk factor for cardiovascular disease. However, it has not been clearly shown that AIx and PPA predict a high risk of coronary artery disease (CAD). OBJECTIVES The aim of the study was to investigate the association between non-invasively measured aortic wave reflection (AWR) and PPA and CAD. METHODS The study group consisted of 80 patients who were admitted to our institute for elective coronary angiography. We non-invasively measured augmentation pressure (AP), AIx, and PPA using radial applanation tonometry. RESULTS When the extent of CAD was divided by no or minimal CAD, 1- or 2- and 3-vessel disease (VD), there was a significant association between the extent of CAD and AIx and PPA in patients aged <65 years, but not in patients aged ≥ 65 years. In multivariate regression analysis after controlling the traditional risk factors, the odds ratio of having 3VD was significant in patients aged <65 years: 2.15 (1.04-4.44; p=0.039) per 5% increase of AIx and 2.02 (1.15-3.55; p=0.015) per 0.05 increase of PPA, but not in patients aged ≥ 65 years. The severity of CAD expressed as a Gensini score showed a significant correlation with AP, AIx, and PPA in patients aged <65 years, but not in patients aged ≥ 65 years. CONCLUSION Increasing of non-invasively measured AWR and PPA is related to the severity of CAD, particularly in younger patients up to 65 years of age.
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Affiliation(s)
- Sung Woo Cho
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
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Cho SW, Kim BK, Hwang JT, Kim JH, Kim BO, Goh CW, Rhee KJ, Ahn HS, Kim HJ, Byun YS. A case of primary cardiac lymphoma mimicking acute coronary and aortic syndrome. Korean Circ J 2012; 42:776-80. [PMID: 23236331 PMCID: PMC3518713 DOI: 10.4070/kcj.2012.42.11.776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 03/19/2012] [Accepted: 04/30/2012] [Indexed: 12/03/2022] Open
Abstract
Primary cardiac lymphoma (PCL) is a rare disorder, but the incidence is increasing and its clinical manifestations are various. We report a case of PCL, which mimics an acute coronary and aortic syndrome. A 51 year-old female was presented with chest pain radiating to the back. Her initial electrocardiogram revealed T wave inversion in the leads of V 5-6, II, III and aVF. Additionally, cardiac troponin-T was slightly elevated. Chest radiography showed marked mediastinal widening. Computed tomography scan showed a huge pericardial mass. The histopathologic findings of the mass were compatible with diffuse large B cell lymphoma. She died of refractory ventricular tachycardia, probably, due to an extensive infiltration of PCL to the myocardium.
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Affiliation(s)
- Sung Woo Cho
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea. ; Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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