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Jeong JH, Kook H, Lee SH, Joo HJ, Park JH, Hong SJ, Kim M, Park S, Jung JS, Yang JH, Gwon H, Ahn C, Jang WJ, Kim H, Bae J, Kwon SU, Lee WS, Jeong J, Park S, Lim S, Lee J, Lee J, Yu CW. Prediction of In-Hospital Mortality for Ischemic Cardiogenic Shock Requiring Venoarterial Extracorporeal Membrane Oxygenation. J Am Heart Assoc 2024; 13:e032701. [PMID: 38362865 PMCID: PMC11010074 DOI: 10.1161/jaha.123.032701] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Clinical outcome of ischemic cardiogenic shock (CS) requiring extracorporeal membrane oxygenation is highly variable, necessitating appropriate assessment of prognosis. However, a systemic predictive model estimating the mortality of refractory ischemic CS is lacking. The PRECISE (Prediction of In-Hospital Mortality for Patients With Refractory Ischemic Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation Support) score was developed to predict the prognosis of refractory ischemic CS due to acute myocardial infarction. METHODS AND RESULTS Data were obtained from the multicenter CS registry RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With Cardiogenic Shock) that consists of 322 patients with acute myocardial infarction complicated by refractory ischemic CS requiring extracorporeal membrane oxygenation support. Fifteen parameters were selected to assess in-hospital mortality. The developed model was validated internally and externally using an independent external cohort (n=138). Among 322 patients, 138 (42.9%) survived postdischarge. Fifteen predictors were included for model development: age, diastolic blood pressure, hypertension, chronic kidney disease, peak lactic acid, serum creatinine, lowest left ventricular ejection fraction, vasoactive inotropic score, shock to extracorporeal membrane oxygenation insertion time, extracorporeal cardiopulmonary resuscitation, use of intra-aortic balloon pump, continuous renal replacement therapy, mechanical ventilator, successful coronary revascularization, and staged percutaneous coronary intervention. The PRECISE score yielded a high area under the receiver-operating characteristic curve (0.894 [95% CI, 0.860-0.927]). External validation and calibration resulted in competent sensitivity (area under the receiver-operating characteristic curve, 0.895 [95% CI, 0.853-0.930]). CONCLUSIONS The PRECISE score demonstrated high predictive performance and directly translates into the expected in-hospital mortality rate. The PRECISE score may be used to support clinical decision-making in ischemic CS (www.theprecisescore.com). REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Hyungdon Kook
- Division of Cardiology, Department of Internal Medicine, College of MedicineHanyang UniversitySeoulKorea
| | - Seung Hun Lee
- Department of Internal MedicineKorea University Graduate SchoolSeoulKorea
| | - Hyung Joon Joo
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Jae Hyoung Park
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Soon Jun Hong
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Mi‐Na Kim
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Seong‐Mi Park
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular SurgeryAnam Hospital, Korea University College of MedicineSeoulKorea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulKorea
| | - Hyeon‐Cheol Gwon
- Division of Cardiology, Department of MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulKorea
| | - Chul‐Min Ahn
- Division of Cardiology, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulSouth Korea
| | - Woo Jin Jang
- Department of CardiologyEwha Woman’s University Seoul Hospital, Ehwa Woman’s University School of MedicineSeoulKorea
| | - Hyun‐Joong Kim
- Division of Cardiology, Department of MedicineKonkuk University Medical CenterSeoulKorea
| | - Jang‐Whan Bae
- Department of Internal MedicineChungbuk National University College of MedicineCheongjuKorea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik HospitalInje University College of MedicineGoyangKorea
| | - Wang Soo Lee
- Division of Cardiology, Department of MedicineChung‐Ang University HospitalSeoulKorea
| | - Jin‐Ok Jeong
- Division of Cardiology, Department of Internal MedicineChungnam National University HospitalDaejeonKorea
| | - Sang‐Don Park
- Division of Cardiology, Department of MedicineInha University HospitalIncheonKorea
| | - Seong‐Hoon Lim
- Division of Cardiovascular Medicine, Department of Internal MedicineDankook University Hospital, Dankook University College of MedicineCheonanKorea
| | - Jiyoon Lee
- Department of Biostatistics, College of MedicineKorea UniversitySeoulKorea
| | - Juneyoung Lee
- Department of Biostatistics, College of MedicineKorea UniversitySeoulKorea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
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Hong D, Lee SH, Shin D, Choi KH, Kim HK, Ha SJ, Joh HS, Park TK, Yang JH, Song YB, Hahn J, Choi S, Gwon H, Lee JM. Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death. J Am Heart Assoc 2023; 12:e027690. [PMID: 36695307 PMCID: PMC9973631 DOI: 10.1161/jaha.122.027690] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Coronary microvascular dysfunction (CMD) has been considered as a possible cause of cardiac diastolic dysfunction. The current study evaluated the association between cardiac diastolic dysfunction and CMD, and their prognostic implications in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. Methods and Results A total of 330 patients without left ventricular systolic dysfunction (ejection fraction ≥50%) and significant epicardial coronary stenosis (fractional flow reserve >0.80) were analyzed. Cardiac diastolic dysfunction was defined by echocardiographic parameters (early diastolic transmitral flow velocity/early diastolic mitral annular velocity, e' velocity, tricuspid regurgitation velocity, and left atrial volume index). Overt CMD was defined as coronary flow reserve <2.0 and index of microcirculatory resistance ≥25 U. The primary end point was cardiovascular death or admission for heart failure during 5 years of follow-up. In patients without left ventricular systolic dysfunction and significant epicardial coronary stenosis, prevalence of cardiac diastolic dysfunction and overt CMD was 25.5% and 11.2%, respectively. Overt CMD was independently associated with cardiac diastolic dysfunction (adjusted odds ratio, 3.440 [95% CI, 1.599-7.401]; P=0.002). Patients with cardiac diastolic dysfunction showed significantly higher risk of the primary outcome than those without (adjusted hazard ratio [HR], 2.996 [95% CI, 1.888-4.755]; P<0.001). Patients with overt CMD also showed significantly higher risk of the primary outcome than those without (adjusted HR, 2.939 [95% CI, 1.642-5.261]; P<0.001). Presence of overt CMD was associated with significantly increased risk of cardiovascular death among the patients with cardiac diastolic dysfunction (43.8% versus 14.5%; P=0.006) but not in patients without cardiac diastolic dysfunction (interaction P<0.001). Inclusion of overt CMD into the model with cardiac diastolic dysfunction significantly improved predictive ability for cardiovascular death or heart failure admission (conconrdance index, 0.719 versus 0.737; P for comparison=0.034). Conclusions There was significant association between the presence of cardiac diastolic dysfunction and overt CMD. Both cardiac diastolic dysfunction and overt CMD were associated with increased risk of cardiovascular death or admission for heart failure. Integration of overt CMD into cardiac diastolic dysfunction showed improvement of the risk stratification in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. Registration DIAST-CMD (Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function) registry; Unique identifier: NCT05058833.
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Affiliation(s)
- David Hong
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular CenterChonnam National University Hospital, Chonnam National University Medical SchoolGwangjuSouth Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal MedicineDuke University Medical CenterDurhamNC
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular CenterChosun University Hospital, University of Chosun College of MedicineGwangjuSouth Korea
| | - Sang Jin Ha
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan HospitalUniversity of Ulsan College of MedicineGangneungRepublic of Korea
| | - Hyun Sung Joh
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Joo‐Yong Hahn
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Seung‐Hyuk Choi
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hyeon‐Cheol Gwon
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
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Lim Y, Kim MC, Ahn Y, Cho KH, Sim DS, Hong YJ, Kim JH, Jeong MH, Baek SH, Her S, Lee KY, Han SH, Rha S, Choi D, Gwon H, Kwon HM, Yang T, Park K, Jo S. Prognostic Impact of Chronic Vasodilator Therapy in Patients With Vasospastic Angina. J Am Heart Assoc 2022; 11:e023776. [PMID: 35347998 PMCID: PMC9075493 DOI: 10.1161/jaha.121.023776] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Chronic vasodilator therapy with long‐acting nitrate is frequently used to treat vasospastic angina. However, the clinical benefits of this approach are controversial. We investigated the prognostic impact of vasodilator therapy in patients with vasospastic angina from the multicenter, prospective VA‐KOREA (Vasospastic Angina in KOREA) registry. Methods and Results We analyzed data from 1895 patients with positive intracoronary ergonovine provocation test results. The patients were divided into 4 groups: no vasodilator (n=359), nonnitrate vasodilator (n=1187), conventional nitrate (n=209), and a combination of conventional nitrate and other vasodilators (n=140). The primary end point was a composite of cardiac death, acute coronary syndrome, and new‐onset arrhythmia at 2 years. Secondary end points were the individual components of the primary end point, all‐cause death, and rehospitalization due to recurrent angina. The groups did not differ in terms of the risk of the primary end point. However, the acute coronary syndrome risk was significantly higher in the conventional nitrate (hazard ratio [HR], 2.49; 95% CI, 1.01–6.14; P=0.047) and combination groups (HR, 3.34; 95% CI, 1.15–9.75, P=0.027) compared with the no‐vasodilator group, as assessed using the inverse probability of treatment weights. Subgroup analyses revealed prominent adverse effects of nitrate in patients with an intermediate positive ergonovine provocation test result and in those with low Japanese Coronary Spasm Association scores. Conclusions Long‐acting nitrate‐based chronic vasodilator therapy was associated with an increased 2‐year risk of acute coronary syndrome in patients with vasospastic angina, especially in low‐risk patients.
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Affiliation(s)
- Yongwhan Lim
- Department of Cardiology Chonnam National University School of MedicineChonnam National University Hospital Gwangju South Korea
| | - Min Chul Kim
- Department of Cardiology Chonnam National University School of MedicineChonnam National University Hospital Gwangju South Korea
| | - Youngkeun Ahn
- Department of Cardiology Chonnam National University School of MedicineChonnam National University Hospital Gwangju South Korea
| | - Kyung Hoon Cho
- Department of Cardiology Chonnam National University School of MedicineChonnam National University Hospital Gwangju South Korea
| | - Doo Sun Sim
- Department of Cardiology Chonnam National University School of MedicineChonnam National University Hospital Gwangju South Korea
| | - Young Joon Hong
- Department of Cardiology Chonnam National University School of MedicineChonnam National University Hospital Gwangju South Korea
| | - Ju Han Kim
- Department of Cardiology Chonnam National University School of MedicineChonnam National University Hospital Gwangju South Korea
| | - Myung Ho Jeong
- Department of Cardiology Chonnam National University School of MedicineChonnam National University Hospital Gwangju South Korea
| | - Sang Hong Baek
- Department of Cardiology Seoul St. Mary’s Hospital Seoul South Korea
| | - Sung‐Ho Her
- Department of Cardiology St. Vincent Hospital Suwon South Korea
| | - Kwan Yong Lee
- Department of Cardiology Incheon St. Mary’s Hospital Incheon South Korea
| | - Seung Hwan Han
- Department of Cardiology Gachon University Gil Medical Center Incheon South Korea
| | - Seung‐Woon Rha
- Department of Cardiology Korea University Guro Hospital Seoul South Korea
| | - Dong‐Ju Choi
- Department of Cardiology Seoul National University Bundang Hospital Seongnam South Korea
| | - Hyeon‐Cheol Gwon
- Department of Cardiology Sungkyunkwan University Samsung Medical Center Seoul South Korea
| | - Hyuck Moon Kwon
- Department of Cardiology Gangnam Severance Hospital Seoul South Korea
| | - Tae‐Hyun Yang
- Department of Cardiology Busan Paik Hospital Busan South Korea
| | - Keun‐Ho Park
- Department of Cardiology Chosun University Hospital Gwangju South Korea
| | - Sang‐Ho Jo
- Department of Cardiology Pyeongchon Sacred Heart Hospital Anyang South Korea
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Park J, Oh AR, Lee S, Lee J, Min JJ, Kwon J, Kim J, Yang K, Choi J, Lee S, Gwon H, Kim K, Ahn J, Lee SM. Associations Between Preoperative Glucose and Hemoglobin A1c Level and Myocardial Injury After Noncardiac Surgery. J Am Heart Assoc 2021; 10:e019216. [PMID: 33728934 PMCID: PMC8174354 DOI: 10.1161/jaha.120.019216] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/01/2020] [Accepted: 02/09/2021] [Indexed: 12/17/2022]
Abstract
Background Perioperative blood glucose level has shown an association with postoperative outcomes. We compared the incidences of myocardial injury after noncardiac surgery (MINS) and 30-day mortality, according to preoperative blood glucose and hemoglobin A1c (HbA1c) levels. Methods and Results The patients were divided according to blood glucose level within 1 day before surgery. The hyperglycemia group was defined with fasting glucose >140 mg/dL or random glucose >180 mg/dL. In addition, we compared the outcomes according to HbA1c >6.5% among patients with available HbA1c within 3 months before surgery. The primary outcome was MINS, and 30-day mortality was also compared. A total of 12 304 patients were enrolled and divided into 2 groups: 8324 (67.7%) in the normal group and 3980 (32.3%) in the hyperglycemia group. After adjustment with inverse probability of weighting, the hyperglycemia group exhibited significantly higher incidences of MINS and 30-day mortality (18.7% versus 27.6%; odds ratio, 1.29; 95% CI, 1.18-1.42; P<0.001; and 2.0% versus 5.1%; hazard ratio, 2.00; 95% CI, 1.61-2.49; P<0.001, respectively). In contrast to blood glucose, HbA1c was not associated with MINS or 30-day mortality. Conclusions Preoperative hyperglycemia was associated with MINS and 30-day mortality, whereas HbA1c was not. Immediate glucose control may be more crucial than long-term glucose control in patients undergoing noncardiac surgery. Registration URL: https://www.cris.nih.go.kr; Unique identifier: KCT0004244.
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Affiliation(s)
- Jungchan Park
- Department of Anesthesiology and Pain MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Ah Ran Oh
- Department of Anesthesiology and Pain MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Seung‐Hwa Lee
- Division of CardiologyDepartment of MedicineHeart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jong‐Hwan Lee
- Department of Anesthesiology and Pain MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jeong Jin Min
- Department of Anesthesiology and Pain MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Ji‐Hye Kwon
- Department of Anesthesiology and Pain MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jihoon Kim
- Division of CardiologyDepartment of MedicineHeart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Kwangmo Yang
- Center for Health PromotionSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jin‐Ho Choi
- Division of CardiologyDepartment of MedicineHeart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
- Department of Emergency MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Sang‐Chol Lee
- Division of CardiologyDepartment of MedicineHeart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Hyeon‐Cheol Gwon
- Division of CardiologyDepartment of MedicineHeart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Kyunga Kim
- Statistics and Data CenterResearch Institute for Future MedicineSamsung Medical CenterSeoulKorea
- Department of Digital HealthSamsung Advanced Institute for Health Sciences & TechnologySungkyunkwan UniversitySeoulKorea
| | - Joonghyun Ahn
- Statistics and Data CenterResearch Institute for Future MedicineSamsung Medical CenterSeoulKorea
| | - Sangmin Maria Lee
- Department of Anesthesiology and Pain MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
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Park TK, Lee SH, Choi KH, Lee JM, Yang JH, Song YB, Hahn J, Choi J, Gwon H, Lee SH, Choi S. Late Survival Benefit of Percutaneous Coronary Intervention Compared With Medical Therapy in Patients With Coronary Chronic Total Occlusion: A 10-Year Follow-Up Study. J Am Heart Assoc 2021; 10:e019022. [PMID: 33660515 PMCID: PMC8174228 DOI: 10.1161/jaha.120.019022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Indexed: 01/02/2023]
Abstract
Background As an initial treatment strategy, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) did not show midterm survival benefits compared with optimal medical therapy (OMT). We sought to evaluate the benefit of PCI compared with OMT in patients with CTO over extended long‐term follow‐up. Methods and Results Between March 2003 and February 2012, 2024 patients with CTO were enrolled in a single‐center registry and followed for ≈10 years. We excluded patients with CTO who underwent coronary artery bypass graft (n=477) and classified patients into the CTO‐PCI group (n=883) or OMT group (n=664) according to initial treatment strategy. Patients with multivessel disease received PCI for obstructive non‐CTO lesions in both groups. In the CTO‐PCI group, 699 patients (79.2%) underwent successful revascularization. The CTO‐PCI group had a lower 10‐year rate of cardiac death (10.4% versus 22.3%; hazard ratio [HR], 0.44 [95% CI, 0.32–0.59]; P<0.001) than the OMT group. After propensity score matching analyses, the CTO‐PCI group had a lower 10‐year rate of cardiac death (13.6% versus 20.8%; HR, 0.64 [95% CI, 0.45–0.91]; P=0.01) than the OMT group. The relative reduction in cardiac death at 10 years was mainly driven by a relative reduction between 3 and 10 years (8.3% versus 16.6%; HR, 0.43 [95% CI, 0.27–0.71]; P<0.001) but not at 3 years (5.7% versus 5.0%; HR, 1.12 [95% CI, 0.63–2.00]; P=0.71). The beneficial effects of CTO‐PCI were consistent among subgroups. Conclusions As an initial treatment strategy, CTO‐PCI might reduce late cardiac death compared with OMT in patients with CTO. Extended follow‐up of randomized trials may confirm the findings of the present study.
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Affiliation(s)
- Taek Kyu Park
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Seung Hun Lee
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Ki Hong Choi
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Joo Myung Lee
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Jeong Hoon Yang
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Young Bin Song
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Joo‐Yong Hahn
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Jin‐Ho Choi
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Hyeon‐Cheol Gwon
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Sang Hoon Lee
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Seung‐Hyuk Choi
- Division of CardiologyDepartment of MedicineHeart Vascular and Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
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6
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Park J, Kwon JH, Lee SH, Lee JH, Min JJ, Kim J, Oh AR, Seo W, Hyeon CW, Yang K, Choi JH, Lee SC, Kim K, Ahn J, Gwon H. Intraoperative blood loss may be associated with myocardial injury after non-cardiac surgery. PLoS One 2021; 16:e0241114. [PMID: 33626048 PMCID: PMC7904206 DOI: 10.1371/journal.pone.0241114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/29/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the association between intraoperative blood loss and myocardial injury after non-cardiac surgery (MINS), which is a severe and common postoperative complication. METHODS We compared the incidence of MINS based on significant intraoperative bleeding, defined as an absolute hemoglobin level < 7 g/dL, a relative hemoglobin level less than 50% of the preoperative measurement, or need for packed red cell transfusion. We also estimated a threshold for intraoperative hemoglobin level associated with MINS. RESULTS We stratified a total of 15,926 non-cardiac surgical patients with intraoperative hemoglobin and postoperative cardiac troponin (cTn) measurements according to the occurrence of significant intraoperative bleeding; 13,416 (84.2%) had no significant bleeding while 2,510 (15.8%) did have significant bleeding. After an adjustment with inverse probability weighting, the incidence of MINS was higher in the significant bleeding group (35.2% vs. 16.4%; odds ratio, 1.58; 95% confidence interval, 1.43-1.75; p < 0.001). The threshold of intraoperative hemoglobin associated with MINS was estimated to be 9.9 g/dL with an area under the curve of 0.643. CONCLUSION Intraoperative blood loss appeared to be associated with MINS. Further studies are needed to confirm these findings. CLINICAL REGISTRATION The cohort was registered before patient enrollment at https://cris.nih.go.kr (KCT0004244).
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Affiliation(s)
- Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hwa Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wonho Seo
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol Won Hyeon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwangmo Yang
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-ho Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Joonghyun Ahn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Hyeon‐Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gwon H, Haeri M, Hoffmann DE, Khan A, Kelmenson A, Kraus JF, Onyegwara C, Paradissis C, Povar G, Schwartz J, Sheikh F, Tarzian AJ. Maryland's Experience With the COVID-19 Surge: What Worked, What Didn't, What Next? Am J Bioeth 2020; 20:150-152. [PMID: 32716787 DOI: 10.1080/15265161.2020.1779404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- H Gwon
- Johns Hopkins University Bloomberg School of Public Health
| | - M Haeri
- University of Maryland Medical Center
| | | | - A Khan
- University of Maryland Medical Center
| | | | | | | | | | - G Povar
- George Washington University Hospital
| | - J Schwartz
- University of Maryland Carey School of Law
| | - F Sheikh
- Johns Hopkins School of Medicine
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Burzotta F, Lassen JF, Louvard Y, Lefèvre T, Banning AP, Daremont O, Pan M, Hildick‐Smith D, Chieffo A, Chatzizisis YS, Džavík V, Gwon H, Hikichi Y, Murasato Y, Koo BK, Chen S, Serruys P, Stankovic G. European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions. Catheter Cardiovasc Interv 2020; 96:1067-1079. [DOI: 10.1002/ccd.29071] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/26/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Jens Flensted Lassen
- Department of Cardiology B Odense Universitetshospital and University of Southern Denmark Odense Denmark
| | - Yves Louvard
- Ramsay Générale de Santé—Institut cardiovasculaire Paris Sud Hopital Privé Jacques Cartier Massy France
| | - Thierry Lefèvre
- Ramsay Générale de Santé—Institut cardiovasculaire Paris Sud Hopital Privé Jacques Cartier Massy France
| | - Adrian P. Banning
- Cardiovascular Medicine Division, Radcliffe Department of Medicine John Radcliffe Hospital Oxford UK
| | | | - Manuel Pan
- Department of Cardiology Reina Sofia Hospital, University of Cordoba (IMIBIC) Cordoba Spain
| | | | - Alaide Chieffo
- Interventional Cardiology Unit San Raffaele Scientific Institute Milan Italy
| | | | - Vladimír Džavík
- Interventional Cardiology Program, Division of Cardiology Toronto General Hospital Toronto Ontario Canada
| | - Hyeon‐Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Yutaka Hikichi
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Institute National Hospital Organization Kyushu Medical Center Fukuoka Japan
| | - Bon Kwon Koo
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Shao‐Liang Chen
- Division of Cardiology, Nanjing First Hospital and Key Laboratory of Targeted Intervention of Cardiovascular Disease Collaboratory Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University Nanjing China
| | - Patrick Serruys
- National Heart and Lung Institute, Imperial College London London UK
| | - Goran Stankovic
- Medical Faculty, Department of Cardiology Clinical Center of Serbia, University of Belgrade Belgrade Serbia
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Song E, Hwang J, Choi J, Gwon H, Chun J, Choi SG, Chang Y. MON-LB675: Dracocephlaum Moldavica L. Seed Extracts Ameliorate Photo-Aging Andwound Healing in HaCat Cell and 3D Skin Model. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32130-2] [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] [Indexed: 11/26/2022]
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Song E, Choi J, Gwon H, Choi SG, Chun J, Chang Y, Hwang J. MON-LB674: Dracocephalum Moldavica L. Seed Extracts Modulate Inflammation and Oxidative Stress in Human Skin Cells. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32129-6] [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] [Indexed: 10/26/2022]
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Shin T, Sim M, Jo I, Choi J, Song H, Jeong Y, Choi S, Hahn J, Gwon H. 50: The Effectiveness of Using Percutaneous Cardiopulmonary Support in Cardiopulmonary Arrest and Postresuscitation Care. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.115] [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] [Indexed: 10/21/2022]
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12
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Kang M, Jang S, Bae S, Gwon H, Lee S, Hong K, Choi YH, Park J. 2P-0349 The characteristics of risk profiles in CAD patients with family history of CAD in Korea. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90492-2] [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] [Indexed: 11/17/2022]
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Abstract
In 1989 Johns Hopkins Hospital modified the Meyer 3 short-stay psychiatric service, which has allowed the hospital to comply with state requirements to control inpatient costs and has increased revenues. Strategies and organizational changes that were implemented to reduce length of stay include use of a screening tool by the admitting physician to ensure appropriate referrals to the service, modification of morning and afternoon rounds and strengthening of linkages with the psychiatric emergency department and outpatient services to enhance communication, replacement of inexperienced first-year residents in the emergency department with senior residents on 24-hour call who are closely supervised by short-stay service staff, and enhanced training for service nurses. Patients who are functionally disabled and who need assistance in activities of daily living have longer stays. Patients with substance use disorders are now referred to an ultra-short-stay unit.
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Affiliation(s)
- G Jayaram
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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