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Kim MC, Ahn JH, Hyun DY, Lim Y, Lee SH, Oh S, Cho KH, Sim DS, Hong YJ, Kim JH, Jeong MH, Cho JH, Lee SR, Kang DO, Hwang JY, Youn YJ, Jeong YH, Park Y, Kim DB, Choo EH, Kim CJ, Kim W, Rhew JY, Lee JH, Yoo SY, Ahn Y. Timing of fractional flow reserve-guided complete revascularization in patients with ST-segment elevation myocardial infarction with multivessel disease: Rationale and design of the OPTION-STEMI trial. Am Heart J 2024:S0002-8703(24)00078-4. [PMID: 38641031 DOI: 10.1016/j.ahj.2024.03.017] [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] [Received: 02/16/2024] [Revised: 03/19/2024] [Accepted: 03/31/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Current guidelines recommend complete revascularization (CR) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD). With regard to the timing of percutaneous coronary intervention (PCI) for non-infarct-related artery (non-IRA), recent randomized clinical trials have revealed that immediate CR was non-inferior to staged CR. However, the optimal timing of CR remains uncertain. The OPTION-STEMI trial compared immediate CR and in-hospital staged CR guided by fractional flow reserve (FFR) for intermediate stenosis of the non-IRA. METHODS The OPTION-STEMI is a multicenter, investigator-initiated, prospective, open-label, non-inferiority randomized clinical trial. The study included patients with at least one non-IRA lesion with ≥50% stenosis by visual estimation. Patients fulfilling the inclusion criteria were randomized into two groups at a 1:1 ratio: immediate CR (i.e., PCI for the non-IRA performed during primary angioplasty) or in-hospital staged CR. In the in-hospital staged CR group, PCI for non-IRA lesions was performed on another day during the index hospitalization. Non-IRA lesions with 50-69% stenosis by visual estimation were evaluated by FFR, whereas those with ≥70% stenosis were revascularized without FFR. The primary endpoint was the composite of all-cause death, non-fatal myocardial infarction, and all unplanned revascularization at 1 year after randomization. Enrolment began in December 2019 and was completed in January 2024. The follow-up for the primary endpoint will be completed in January 2025, and primary results will be available in the middle of 2025. CONCLUSIONS The OPTION-STEMI is a multicenter, non-inferiority, randomized trial that evaluated the timing of in-hospital CR with the aid of FFR in patients with STEMI and MVD. TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT04626882; and URL: https://cris.nih.go.kr. Unique identifier: KCT0004457.
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Affiliation(s)
- Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Joon Ho Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Yongwhan Lim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Seok Oh
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | | | - Sang-Rok Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
| | - Dong Oh Kang
- Cardiovascular Center, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea and Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yongwhi Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Eun-Ho Choo
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | | | - Jung-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea and Division of Cardiology, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Sang-Yong Yoo
- Good Morning Hospital, Pyeongtaek, Korea and Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea.
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Sim DS, Hyun DY, Hong YJ, Kim JH, Ahn Y, Jeong MH, Lee SR, Chae JK, Park KH, Koh YY, Yun KH, Oh SK, Joo SJ, Hwang SH, Park JP, Rhew JY, Kim SH, Cho JH, Lee SU, Kang DG. Clinical Outcome after Everolimus-Eluting Stent Implantation for Small Vessel Coronary Artery Disease: XIENCE Asia Small Vessel Study. Chonnam Med J 2024; 60:78-86. [PMID: 38304131 PMCID: PMC10828083 DOI: 10.4068/cmj.2024.60.1.78] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 02/03/2024] Open
Abstract
There are limited data on outcomes after implantation of everolimus-eluting stents (EES) in East Asian patients with small vessel coronary lesions. A total of 1,600 patients treated with XIENCE EES (Abbott Vascular, CA, USA) were divided into the small vessel group treated with one ≤2.5 mm stent (n=119) and the non-small vessel group treated with one ≥2.75 mm stent (n=933). The primary end point was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction (MI), and any repeat revascularization at 12 months. The key secondary end point was a device-oriented composite outcome (DOCO), a composite of cardiovascular death, target-vessel MI, and target lesion revascularization at 12 months. The small vessel group was more often female, hypertensive, less likely to present with ST-elevation MI, and more often treated for the left circumflex artery, whereas the non-small vessel group more often had type B2/C lesions, underwent intravascular ultrasound, and received unfractionated heparin. In the propensity matched cohort, the mean stent diameter was 2.5±0.0 mm and 3.1±0.4 mm in the small and non-small vessel groups, respectively. Propensity-adjusted POCO at 12 months was 6.0% in the small vessel group and 4.3% in the non-small vessel group (p=0.558). There was no significant difference in DOCO at 12 months (small vessel group: 4.3% and non-small vessel group: 1.7%, p=0.270). Outcomes of XIENCE EES for small vessel disease were comparable to those for non-small vessel disease at 12-month clinical follow-up in real-world Korean patients.
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Affiliation(s)
- Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Rok Lee
- Department of Cardiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Jei Keon Chae
- Department of Cardiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Keun Ho Park
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Young Youp Koh
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Kyeong Ho Yun
- Department of Cardiology, Wonkwang University Hospital, Iksan, Korea
| | - Seok Kyu Oh
- Department of Cardiology, Wonkwang University Hospital, Iksan, Korea
| | - Seung Jae Joo
- Department of Cardiology, Jeju National University Hospital, Jeju, Korea
| | - Sun Ho Hwang
- Department of Cardiology, KS Hospital, Gwangju, Korea
| | - Jong Pil Park
- Department of Cardiology, Presbyterian Medical Center, Jeonju, Korea
| | - Jay Young Rhew
- Department of Cardiology, Presbyterian Medical Center, Jeonju, Korea
| | - Su Hyun Kim
- Department of Cardiology, St. Carollo General Hospital, Suncheon, Korea
| | - Jang Hyun Cho
- Department of Cardiology, St. Carollo General Hospital, Suncheon, Korea
| | - Seung Uk Lee
- Department of Cardiology, Kwangju Christian Hospital, Gwangju, Korea
| | - Dong Goo Kang
- Department of Cardiology, Cheomdan Medical Center, Gwangju, Korea
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Doan KH, Liu TL, Yun WS, Kim YS, Yun KH, Oh SK, Park JP, Rhew JY, Lee SR. Intravascular Ultrasound Guided Intervention in Calcified Coronary Lesions Showed Good Clinical Outcomes during One Year Follow-Up. J Clin Med 2023; 12:4073. [PMID: 37373765 DOI: 10.3390/jcm12124073] [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: 05/11/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Calcified coronary lesions can cause stent under-expansion, malapposition, and polymer degradation, hence increasing the risk of adverse clinical outcomes. Percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) has been used regularly to improve outcomes. Our primary aim was to evaluate the clinical efficacy of IVUS-guided PCI in calcified coronary lesions. METHODS From August 2018 to December 2021, we prospectively included 300 patients in the CAPIRO study (CAlcified plaque in patients receiving Resolute Onyx®) at three educational hospitals in Jeonbuk Province. We studied 243 patients (265 lesions) who were followed up for over a year. Based on coronary calcification by IVUS analysis, the patient population was categorized into two groups (Group I: non/mild calcification; Group II: moderate/severe calcification (maximum calcium arc >180° and calcium length > 5 mm)). One-to-one Propensity Score Matching was used to match the baseline characteristics. The stent expansion rate was analyzed by recent criteria. The primary clinical outcome was Major Adverse Cardiac Events (MACE), which included Cardiac death, Myocardial Infarction (MI), and Target Lesion Revascularization (TLR). RESULTS After follow-up time, the MACE rate in Group I was 1.99%, comparable to Group II's 1.09% (p = 0.594). The components of MACE did not significantly differ between the two groups. Based on absolute MSA or MSA/MVA at MSA site criteria, the stent expansion rate in Group II was lower than that of Group I. Nevertheless, based on recent relative criteria, the stent expansion rate in both groups was comparable. CONCLUSIONS After more than a year of follow-up, IVUS-guided PCI in moderate/severe calcification lesions was associated with good clinical outcomes, which was comparable with non/mild calcification lesions. Future studies with a larger sample size and a more extended follow-up period are required to clarify our findings.
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Affiliation(s)
- Khanh-Hung Doan
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Tai-Li Liu
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Won-Sik Yun
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Yi-Sik Kim
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Kyeong Ho Yun
- Division of Cardiology, Wonkwang University Hospital, Iksan 54538, Republic of Korea
| | - Seok Kyu Oh
- Division of Cardiology, Wonkwang University Hospital, Iksan 54538, Republic of Korea
| | - Jong-Pil Park
- Division of Cardiology, Presbyterian Medical Center, Jeonju 54987, Republic of Korea
| | - Jay Young Rhew
- Division of Cardiology, Presbyterian Medical Center, Jeonju 54987, Republic of Korea
| | - Sang-Rok Lee
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea
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Lee KS, Park KH, Park KW, Rha SW, Hwang D, Kang J, Han JK, Yang HM, Kang HJ, Koo BK, Lee NH, Rhew JY, Chun KJ, Lim YH, Bong JM, Bae JW, Lee BK, Kim SY, Shin WY, Lim HS, Park K, Kim HS. Prasugrel dose de-escalation in diabetic patients with acute coronary syndrome receiving percutaneous coronary intervention: Results from HOST-REDUCE-POLYTECH-ACS trial. Eur Heart J Cardiovasc Pharmacother 2023; 9:262-270. [PMID: 36715152 DOI: 10.1093/ehjcvp/pvad008] [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] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/24/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
AIMS The aim of this study was to evaluate the efficacy and safety of prasugrel-dose de-escalation therapy in patients with diabetes mellitus (DM)-acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). METHODS AND RESULTS This was a post-hoc analysis of the HOST-REDUCE-POLYTECH-ACS randomized trial. The efficacy and safety of prasugrel dose de-escalation therapy (prasugrel 5 mg daily) were compared with conventional therapy (prasugrel 10 mg daily) in patients with DM. The primary endpoint was net adverse clinical events (NACE), defined as a composite of all-cause death, nonfatal myocardial infarction (MI), stent thrombosis (ST), clinically driven revascularization, stroke, and BARC class ≥ 2 bleeding events. The secondary ischemic outcome was major adverse cardiovascular and cerebrovascular events (MACE), defined as the composite of cardiac death, nonfatal MI, ST, or ischemic stroke. Of 2 338 patients randomized, 990 had DM. The primary endpoint of NACE occurred in 38 patients (7.6%) receiving prasugrel dose de-escalation and in 53 patients (11.3%) receiving conventional therapy among patients with DM (HR 0.66; 95% CI 0.43-0.99; P = 0.049). Prasugrel dose de-escalation as compared with conventional therapy did not increase the risk of ischemic events (HR 1.03; 95% CI 0.56-1.88; P = 0.927) but decreased BARC class ≥ 2 bleeding in patients with DM (HR 0.44; 95% CI 0.23-0.84; P = 0.012). CONCLUSION Prasugrel dose de-escalation compared with conventional therapy may reduce the risk of net clinical outcomes, mostly driven by a reduction in bleeding without an increase in ischemic events in patients with DM.
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Affiliation(s)
- Kyu-Sun Lee
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keun-Ho Park
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kyung Woo Park
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Doyeon Hwang
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeehoon Kang
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Mo Yang
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jae Kang
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam-Ho Lee
- Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | | | - Kook Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Young-Hyo Lim
- Hanyang University Hospital, Seoul, Republic of Korea
| | | | - Jang-Whan Bae
- Chungbuk National University, Cheongju, Republic of Korea
| | - Bong Ki Lee
- Kangwon National University, Chuncheon, Republic of Korea
| | | | - Won-Yong Shin
- Soonchunyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Hong-Seok Lim
- Ajou University Medical Center, Suwon, Republic of Korea
| | - Kyungil Park
- Dong-A University Hospital, Busan, Republic of Korea
| | - Hyo-Soo Kim
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
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Shin ES, Jun EJ, Han JK, Kong MG, Kang J, Zheng C, Garg S, Choi YJ, Bae JW, Chun KJ, Kim DI, Rha SW, Lee SY, Rhew JY, Woo SI, Lee HC, Jeong JO, Yang HM, Park KW, Kang HJ, Koo BK, Chae IH, Kim HS. Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry. Cardiol J 2023; 30:105-116. [PMID: 33634845 PMCID: PMC9987552 DOI: 10.5603/cj.a2021.0008] [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: 04/17/2020] [Revised: 10/22/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The contribution of sex and initial clinical presentation to the long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated. METHODS Individual patient data from 5 Korean-multicenter drug-eluting stent (DES) registries (The GRAND-DES) were pooled. A total of 17,286 patients completed 3-year follow-up (5216 women and 12,070 men). The median follow-up duration was 1125 days (interquartile range 1097-1140 days), and the primary endpoint was cardiac death at 3 years. RESULTS The clinical indication for PCI was stable angina pectoris (SAP) in 36.8%, unstable angina pectoris (UAP) or non-ST-segment elevation myocardial infarction (NSTEMI) in 47.4%, and ST-segment elevation myocardial (STEMI) in 15.8%. In all groups, women were older and had a higher proportion of hypertension and diabetes mellitus compared with men. Women presenting with STEMI were older than women with SAP, with the opposite seen in men. There was no sex difference in cardiac death for SAP or UAP/NSTEMI. In STEMI patients, the incidence of cardiac death (7.9% vs. 4.4%, p = 0.001), all-cause mortality (11.1% vs. 6.9%, p = 0.001), and minor bleeding (2.2% vs. 1.2%, p = 0.043) was significantly higher in women. After multivariable adjustment, cardiac death was lower in women for UAP/NSTEMI (HR 0.69, 95% CI 0.53-0.89, p = 0.005), while it was similar for STEMI (HR 0.97, 95% CI 0.65-1.44, p = 0.884). CONCLUSIONS There was no sex difference in cardiac death after PCI with DES for SAP and UAP/NSTEMI patients. In STEMI patients, women had worse outcomes compared with men; however, after the adjustment of confounders, female sex was not an independent predictor of mortality.
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Affiliation(s)
- Eun-Seok Shin
- Department of Cardiology, Ulsan Hospital, Ulsan, Korea; Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Jung Jun
- Department of Cardiology, Ulsan Hospital, Ulsan, Korea; Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung-Kyu Han
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Gyu Kong
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeehoon Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chengbin Zheng
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom
| | - Young Jin Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kook-Jin Chun
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Sung Yun Lee
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Jay Young Rhew
- Department of Internal Medicine and Cardiovascular Center, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Seong-Ill Woo
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejon, Republic of Korea
| | - Han-Mo Yang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Woo Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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Lee KS, Park KW, Hwang D, Kang J, Han JK, Yang HM, Kang HJ, Koo BK, Rhew JY, Chun KJ, Lim YH, Bae JW, Lee BK, Kim SY, Lee N, Kim HS. PRASUGREL DE-ESCALATION THERAPY IN ACUTE CORONARY SYNDROME WITH DIABETES MELLITUS: HOST-REDUCE-POLYTECH-ACS DM SUBGROUP ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02025-3] [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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Park J, Han JK, Kang J, Chae IH, Lee SY, Choi YJ, Rhew JY, Rha SW, Shin ES, Woo SI, Lee HC, Chun KJ, Kim D, Jeong JO, Bae JW, Yang HM, Park KW, Kang HJ, Koo BK, Kim HS. The Clinical Impact of β-Blocker Therapy on Patients With Chronic Coronary Artery Disease After Percutaneous Coronary Intervention. Korean Circ J 2022; 52:544-555. [PMID: 35491482 PMCID: PMC9257156 DOI: 10.4070/kcj.2021.0395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/06/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
The general knowledge that β-blockers are cardioprotective for patients with chronic coronary artery disease (CAD) is mainly extrapolated from positive evidence in patients with myocardial infarction (MI) or heart failure. In this propensity score-matched cohort study of 1,170 pairs of patients with chronic CAD who underwent percutaneous coronary intervention, we analysed medical records for β-blockers with prescription doses and types in each patient at 3-month intervals after discharge. β-blockers were not associated with better clinical outcomes for mortality and MI. Additionally, no significant associations were found for the clinical outcomes with different doses and types of β-blockers. Background and Objectives The outcome benefits of β-blockers in chronic coronary artery disease (CAD) have not been fully assessed. We evaluated the prognostic impact of β-blockers on patients with chronic CAD after percutaneous coronary intervention (PCI). Methods A total of 3,075 patients with chronic CAD were included from the Grand Drug-Eluting Stent registry. We analyzed β-blocker prescriptions, including doses and types, in each patient at 3-month intervals from discharge. After propensity score matching, 1,170 pairs of patients (β-blockers vs. no β-blockers) were derived. Primary outcome was defined as a composite endpoint of all-cause death and myocardial infarction (MI). We further analyzed the outcome benefits of different doses (low-, medium-, and high-dose) and types (conventional or vasodilating) of β-blockers. Results During a median (interquartile range) follow-up of 3.1 (3.0–3.1) years, 134 (5.7%) patients experienced primary outcome. Overall, β-blockers demonstrated no significant benefit in primary outcome (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.63–1.24), all-cause death (HR, 0.87; 95% CI, 0.60–1.25), and MI (HR, 1.25; 95% CI, 0.49–3.15). In subgroup analysis, β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/or revascularization (HR, 0.38; 95% CI, 0.14–0.99) (p for interaction=0.045). No significant associations were found for the clinical outcomes with different doses and types of β-blockers. Conclusions Overall, β-blocker therapy was not associated with better clinical outcomes in patients with chronic CAD undergoing PCI. Limited mortality benefit of β-blockers may exist for patients with previous MI and/or revascularization. Trial Registration ClinicalTrials.gov Identifier: NCT03507205
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Affiliation(s)
- Jiesuck Park
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung-Kyu Han
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeehoon Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Yun Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Young Jin Choi
- Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Jay Young Rhew
- Department of Internal Medicine and Cardiovascular Center, Presbyterian Medical Center, Jeonju, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seong-Ill Woo
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Han Cheol Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Kook-Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - DooIl Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin-Ok Jeong
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Han-Mo Yang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Park J, Han JK, Kang J, Chae IH, Lee SY, Choi YJ, Rhew JY, Rha SW, Shin ES, Woo SI, Lee HC, Chun KJ, Kim DI, Jeong JO, Bae JW, Yang HM, Park KW, Kang HJ, Koo BK, Kim HS. Optimal Dose and Type of β-blockers in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2020; 137:12-19. [PMID: 32998005 DOI: 10.1016/j.amjcard.2020.09.044] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022]
Abstract
The clinical benefit of β-blockers in modern reperfusion era is not well determined. We investigated the impact of β-blockers in acute coronary syndrome (ACS) after percutaneous coronary intervention. From the Grand-DES registry, a patient-level pooled registry consisting of 5 Korean multicenter prospective drug-eluting stent registries, a total of 6,690 ACS patients were included. Prescription records of dose and type of β-blockers were investigated trimonthly from discharge. Patients were categorized by the mean value of doses during the follow-up (≥50% [high-dose], ≥25% to <50% [medium-dose], and <25% [low-dose] of the full dose that was used in each randomized clinical trial) and vasodilating property of β-blockers. Three-year cumulative risk of all-cause death, cardiac death, and myocardial infarction were assessed. Patients receiving β-blockers were associated with a lower risk of all-cause and cardiac death compared with those not receiving β-blockers (adjusted hazard ratio [aHR] 0.29, 95% confidence interval [CI] 0.24 to 0.35 for all-cause death; aHR 0.27, 95% CI 0.21 to 0.34 for cardiac death). Medium-dose β-blocker group was associated with a lower risk of cardiac death compared with high- and low-dose β-blocker groups (aHR 0.49, 95% CI 0.25 to 0.96, for high-dose; aHR 0.46, 95% CI 0.29 to 0.74, for low-dose). Patients receiving vasodilating β-blockers were associated with a lower risk of cardiac death compared with those receiving conventional β-blockers (aHR 0.58, 95% CI 0.40 to 0.84). In conclusion, β-blocker therapy was associated with better clinical outcomes in patients with ACS, especially with medium-dose and vasodilating β-blockers.
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Affiliation(s)
- Jiesuck Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeehoon Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sung Yun Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Young Jin Choi
- Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jay Young Rhew
- Department of Internal Medicine and Cardiovascular Center, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan Medical Center, Ulsan, Republic of Korea
| | - Seong-Ill Woo
- Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Han Cheol Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kook-Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University college of Medicine, Busan, Republic of Korea
| | - Jin-Ok Jeong
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejon, Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Han-Mo Yang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Woo Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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Kim HS, Kang J, Hwang D, Han JK, Yang HM, Kang HJ, Koo BK, Rhew JY, Chun KJ, Lim YH, Bong JM, Bae JW, Lee BK, Park KW. Prasugrel-based de-escalation of dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (HOST-REDUCE-POLYTECH-ACS): an open-label, multicentre, non-inferiority randomised trial. Lancet 2020; 396:1079-1089. [PMID: 32882163 DOI: 10.1016/s0140-6736(20)31791-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND A potent P2Y12 inhibitor-based dual antiplatelet therapy is recommended for up to 1 year in patients with acute coronary syndrome receiving percutaneous coronary intervention (PCI). The greatest benefit of the potent agent is during the early phase, whereas the risk of excess bleeding continues in the chronic maintenance phase. Therefore, de-escalation of antiplatelet therapy might achieve an optimal balance between ischaemia and bleeding. We aimed to investigate the safety and efficacy of a prasugrel-based dose de-escalation therapy. METHODS HOST-REDUCE-POLYTECH-ACS is a randomised, open-label, multicentre, non-inferiority trial done at 35 hospitals in South Korea. We enrolled patients with acute coronary syndrome receiving PCI. Patients meeting the core indication for prasugrel were randomly assigned (1:1) to the de-escalation group or conventional group using a web-based randomisation system. The assessors were masked to the treatment allocation. After 1 month of treatment with 10 mg prasugrel plus 100 mg aspirin daily, the de-escalation group received 5 mg prasugrel, while the conventional group continued to receive 10 mg. The primary endpoint was net adverse clinical events (all-cause death, non-fatal myocardial infarction, stent thrombosis, repeat revascularisation, stroke, and bleeding events of grade 2 or higher according to Bleeding Academic Research Consortium [BARC] criteria) at 1 year. The absolute non-inferiority margin for the primary endpoint was 2·5%. The key secondary endpoints were efficacy outcomes (cardiovascular death, myocardial infarction, stent thrombosis, and ischaemic stroke) and safety outcomes (bleeding events of BARC grade ≥2). The primary analysis was in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02193971. RESULTS From Sept 30, 2014, to Dec 18, 2018, 3429 patients were screened, of whom 1075 patients did not meet the core indication for prasugrel and 16 were excluded due to randomisation error. 2338 patients were randomly assigned to the de-escalation group (n=1170) or the conventional group (n=1168). The primary endpoint occurred in 82 patients (Kaplan-Meier estimate 7·2%) in the de-escalation group and 116 patients (10·1%) in the conventional group (absolute risk difference -2·9%, pnon-inferiority<0·0001; hazard ratio 0·70 [95% CI 0·52-0·92], pequivalence=0·012). There was no increase in ischaemic risk in the de-escalation group compared with the conventional group (0·76 [0·40-1·45]; p=0·40), and the risk of bleeding events was significantly decreased (0·48 [0·32-0·73]; p=0·0007). INTERPRETATION In east Asian patients with acute coronary syndrome patients receiving PCI, a prasugrel-based dose de-escalation strategy from 1 month after PCI reduced the risk of net clinical outcomes up to 1 year, mainly driven by a reduction in bleeding without an increase in ischaemia. FUNDING Daiichi Sankyo, Boston Scientific, Terumo, Biotronik, Qualitech Korea, and Dio.
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Affiliation(s)
- Hyo-Soo Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Jeehoon Kang
- Seoul National University Hospital, Seoul, South Korea
| | - Doyeon Hwang
- Seoul National University Hospital, Seoul, South Korea
| | - Jung-Kyu Han
- Seoul National University Hospital, Seoul, South Korea
| | - Han-Mo Yang
- Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Jae Kang
- Seoul National University Hospital, Seoul, South Korea
| | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, South Korea
| | | | - Kook-Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, Seoul, South Korea
| | | | | | - Bong Ki Lee
- Kangwon National University, Chuncheon, South Korea
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Kim CH, Park KW, Kang J, Park BE, Cha KS, Rhew JY, Jeon HK, Shin ES, Oh JH, Jeong MH, Kim S, Hwang KK, Yoon JH, Lee SY, Park TH, Moon KW, Kwon HM, Hur SH, Ryu JK, Lee BR, Park YW, Chae IH, Kim HS. Long-Term Comparison of Platinum Chromium Everolimus-Eluting Stent vs. Cobalt Chromium Zotarolimus-Eluting Stent - 3-Year Outcomes From the HOST-ASSURE Randomized Clinical Trial. Circ J 2019; 83:1489-1497. [PMID: 31155604 DOI: 10.1253/circj.cj-18-1303] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are limited data on the long-term outcome of platinum chromium-based everolimus-eluting stents (PtCr-EES) vs. cobalt chromium-based zotarolimus-eluting stents (CoCr-ZES).Methods and Results:A total of 3,755 patients undergoing percutaneous coronary intervention (PCI) were randomized 2:1 to PtCr-EES or CoCr-ZES, and 96.0% of patients completed the 3-year clinical follow-up. The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target vessel-related myocardial infarction (MI), and clinically-driven target lesion revascularization (TLR). At 3 years, TLF occurred in 5.3% and in 5.4% of the PtCr-EES and CoCr-ZES groups, respectively (hazard ratio 0.978; 95% confidence interval 0.730-1.310, P=0.919). There were no significant differences in the individual components of TLF. Routine angiographic follow-up was performed in 38.9% of the total patients. In a landmark analysis of the subgroup that had follow-up angiography, the clinically-driven TLR rate of CoCr-ZES was significantly higher than PtCr-EES group during the angiography follow-up period (P=0.009). Overall definite and probable stent thrombosis rates were very low in both groups (0.5% vs. 0.6%, P=0.677). CONCLUSIONS PtCr-EES and CoCr-ZES had similar and excellent long-term outcomes in both efficacy and safety after PCI in an all-comer population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - In-Ho Chae
- Seoul National University Bundang Hospital
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Park KH, Ahn Y, Koh YY, Ki YJ, Kim SS, Kim HK, Choi DH, Hong YJ, Hwang JY, Kim DH, Rhew JY, Ryu JK, Park JS, Park TH, Yang TH, Oh SK, Lee BR, Lee SU, Lee SG, Chun KJ, Cho JH, Cha KS, Chae JK, Hur SH, Hwang SH, Park HS, Kim DI. Effectiveness and Safety of Zotarolimus-Eluting Stent (Resolute™ Integrity) in Patients with Diffuse Long Coronary Artery Disease. Korean Circ J 2019; 49:709-720. [PMID: 31165595 PMCID: PMC6675695 DOI: 10.4070/kcj.2019.0018] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/13/2019] [Accepted: 04/10/2019] [Indexed: 01/07/2023] Open
Abstract
Background and Objectives Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD. Methods From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months. Results Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE. Conclusions Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.
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Affiliation(s)
- Keun Ho Park
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Young Youp Koh
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Young Jae Ki
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Sung Soo Kim
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hyun Kuk Kim
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Dong Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jin Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Do Hoi Kim
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital Gumi, Gumi, Korea
| | - Jay Young Rhew
- Division of Cardiology, Presbyterian Medical Center, Jeonju, Korea
| | - Jae Kean Ryu
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jong Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Tae Ho Park
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Tae Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Seok Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Bong Ryeol Lee
- Division of Cardiology, Daegu Fatima Hospital, Daegu, Korea
| | - Seung Uk Lee
- Division of Cardiology, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang Gon Lee
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Kook Jin Chun
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jang Hyun Cho
- Division of Cardiology, St. Carollo Hospital, Suncheon, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jei Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sun Ho Hwang
- Division of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea
| | - Hun Sik Park
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Doo Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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12
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Oh GC, Han JK, Han KH, Hyon MS, Doh JH, Kim MH, Jeong JO, Bae JH, Kim SH, Yoo BS, Baek SH, Rhee MY, Ihm SH, Sung JH, Choi YJ, Kim SJ, Hong KS, Lee BK, Cho J, Shin ES, Rhew JY, Kim H, Kim HS. Efficacy and Safety of Fixed-dose Combination Therapy With Telmisartan and Rosuvastatin in Korean Patients With Hypertension and Dyslipidemia: TELSTA-YU (TELmisartan-rosuvaSTAtin from YUhan), a Multicenter, Randomized, 4-arm, Double-blind, Placebo-controlled, Phase III Study. Clin Ther 2018; 40:676-691.e1. [DOI: 10.1016/j.clinthera.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/16/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
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Sim DS, Jeong MH, Hong YJ, Kim JH, Ahn Y, Park KH, Hwang SH, Kang DG, Lee SU, Kim JW, Park JP, Rhew JY, Lee SR, Chae JK, Yun KH, Oh SK, Kang WY, Kim SH, Cho JH. Safety and Efficacy of the Endeavor Resolute® Stent in Patients with Multivessel Disease: The HEART (Honam EndeAvor ResoluTe) Prospective, Multicenter Trial. Chonnam Med J 2018; 54:55-62. [PMID: 29399567 PMCID: PMC5794480 DOI: 10.4068/cmj.2018.54.1.55] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/08/2018] [Accepted: 01/15/2018] [Indexed: 12/01/2022] Open
Abstract
The Endeavor Resolute® (ER) is a zotarolimus-eluting stent (ZES) with a biocompatible BioLinx polymer. This study prospectively compared the clinical outcomes of 2 versions of ZES, ER and Endeavor Sprint® (ES), in patients with multivessel disease. A total of 488 patients who underwent multivessel percutaneous coronary intervention (PCI) were divided into 2 groups the ER group (n=288) and the ES group (n=200). The primary endpoint was a composite of major adverse cardiac events (MACE) consisting of death, myocardial infarction, and target vessel revascularization after 12 months. In all patients, the prevalence of diabetes was higher in the ER group (42.7% vs. 31.0%, p=0.009). The rate of post-PCI Thrombolysis in Myocardial Infarction flow grade 3 was higher in the ER group (100.0% vs. 98.0%, p=0.028). There were no between-group differences in the in-hospital, 1-month and 12-month clinical outcomes. In the propensity score matched cohort (n=200 in each group), no differences were observed in the baseline and procedural characteristics. There were no statistical differences in the rates of in-hospital, 1-month and 12-month events (12-month MACE in the ER and ES groups: 6.0% vs. 3.5%, p=0.240, respectively). The safety and efficacy of both versions of ZES were comparable in patients with multivessel disease during a 12-month clinical follow-up.
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Affiliation(s)
- Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Keun Ho Park
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Sun Ho Hwang
- Department of Cardiology, Kwangju Veterans Hospital, Gwangju, Korea
| | - Dong Goo Kang
- Department of Cardiology, Kwangju Christian Hospital, Gwangju, Korea
| | - Seung Uk Lee
- Department of Cardiology, Kwangju Christian Hospital, Gwangju, Korea
| | - Joon Woo Kim
- Department of Cardiology, Mokpo Jungang Hospital, Mokpo, Korea
| | - Jong Pil Park
- Department of Cardiology, Jeonju Presbyterian Medical Center, Jeonju, Korea
| | - Jay Young Rhew
- Department of Cardiology, Jeonju Presbyterian Medical Center, Jeonju, Korea
| | - Sang Rok Lee
- Department of Cardiology, Chunbuk National University Hospital, Jeonju, Korea
| | - Jei Keon Chae
- Department of Cardiology, Chunbuk National University Hospital, Jeonju, Korea
| | - Kyeong Ho Yun
- Department of Cardiology, Wonkwang University Hospital, Iksan, Korea
| | - Seok Kyu Oh
- Department of Cardiology, Wonkwang University Hospital, Iksan, Korea
| | - Won You Kang
- Department of Cardiology, St. Carollo Hospital, Suncheon, Korea
| | - Su Hyun Kim
- Department of Cardiology, St. Carollo Hospital, Suncheon, Korea
| | - Jang Hyun Cho
- Department of Cardiology, St. Carollo Hospital, Suncheon, Korea
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14
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Park KH, Jeong MH, Hong YJ, Ahn Y, Kim HK, Koh YY, Kim DI, Kim SW, Kim W, Rha SW, Rhew JY, Park JS, Park HS, Bae JH, Bae JW, Oh SK, Lee SY, Lee SW, Lee JH, Lim SY, Cho JH, Cha KS, Chae JK, Hur SH, Hwang SH, Hwang JY. Effectiveness and Safety of Biolimus A9™-Eluting stEnt in Patients with AcUTe Coronary sYndrome; A Multicenter, Observational Study (BEAUTY Study). Yonsei Med J 2018; 59:72-79. [PMID: 29214779 PMCID: PMC5725367 DOI: 10.3349/ymj.2018.59.1.72] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/02/2017] [Accepted: 11/07/2017] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study sought to determine the 1-year clinical effectiveness and safety of a biodegradable, polymer-containing Biolimus A9™-eluting stent (BES) in Korean patients with acute coronary syndrome (ACS). MATERIALS AND METHODS A total of 1000 ACS patients with 1251 lesions who underwent implantation of BESs at 22 centers in Korea were enrolled between May 2011 and July 2013. We assessed major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinical-driven target vessel revascularization at 12 months. RESULTS Patient mean age was 62.6±11.4 years. 72.8% of the patients were male, 28.5% had diabetes, 32.8% had multi-vessel disease (MVD), and 47.9% presented with acute MI (AMI). The mean global registry of acute coronary events risk score of all patients was 103.0±27.6. The number of stents per patient was 1.3±0.6. The incidences of MACE and definite stent thrombosis at 12 months were 3.9% and 0.2%, respectively. On multivariate Cox-regression analysis, age ≥65 years was identified as an independent predictors of 1-year MACE (hazard ratio=2.474; 95% confidence interval=1.202-5.091). Subgroup analyses revealed no significant differences in the incidence of MACE between patients with and without diabetes (4.3% vs. 3.7%, p=0.667), between those who presented with and without AMI (4.4% vs. 3.4%, p=0.403), and between those with and without MVD (4.6% vs. 3.5%, p=0.387). CONCLUSION Our study demonstrated excellent 1-year clinical outcomes of BES implantation in patients at low-risk for ACS.
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Affiliation(s)
- Keun Ho Park
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Kuk Kim
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Young Yub Koh
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Doo Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sang Wook Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Seung Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jay Young Rhew
- Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jong Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Hun Sik Park
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jang Ho Bae
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Jang Whan Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Seok Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Sung Yun Lee
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Seung Wook Lee
- Division of Cardiology, Department of Internal Medicine, Gwangju Christian Hospital, Gwangju, Korea
| | - Jae Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sang Yeob Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jang Hyun Cho
- Division of Cardiology, Department of Internal Medicine, Saint Carollo Hospital, Suncheon, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jai Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sun Ho Hwang
- Division of Cardiology, Department of Internal Medicine, Gwangju Veterans Hospital, Gwangju, Korea
| | - Jin Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
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Rhee TM, Park KW, Lee JM, Lee MS, Jeon KH, Kang HJ, Koo BK, Rhew JY, Cha KS, Bae JH, Han KR, Park SH, Park WJ, Rha SW, Oh SK, Kwon HM, Seung KB, Ahn T, Kim SH, Kim HS. Predictors and Long-Term Clinical Outcome of Longitudinal Stent Deformation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005518. [DOI: 10.1161/circinterventions.117.005518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/18/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Tae-Min Rhee
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Kyung Woo Park
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Joo Myung Lee
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Michael S. Lee
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Ki-Hyun Jeon
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Hyun-Jae Kang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Bon-Kwon Koo
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Jay Young Rhew
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Kwang Soo Cha
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Jang-Ho Bae
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Kyoo-Rok Han
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Si-Hoon Park
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Woo-Jung Park
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Seung-Woon Rha
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Seok-Kyu Oh
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Hyuck Moon Kwon
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Ki-Bae Seung
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Taehoon Ahn
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Sang-Hyun Kim
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Hyo-Soo Kim
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
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16
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Lee JM, Jung JH, Park KW, Shin ES, Oh SK, Bae JW, Rhew JY, Lee N, Kim DB, Kim U, Han JK, Lee SE, Yang HM, Kang HJ, Koo BK, Kim S, Cho YK, Shin WY, Lim YH, Rha SW, Kim SY, Lee SY, Kim YD, Chae IH, Cha KS, Kim HS. Harmonizing Optimal Strategy for Treatment of coronary artery diseases--comparison of REDUCtion of prasugrEl dose or POLYmer TECHnology in ACS patients (HOST-REDUCE-POLYTECH-ACS RCT): study protocol for a randomized controlled trial. Trials 2015; 16:409. [PMID: 26374625 PMCID: PMC4570043 DOI: 10.1186/s13063-015-0925-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022] Open
Abstract
Background Antiplatelet treatment is an important component in optimizing the clinical outcomes after percutaneous coronary intervention (PCI) especially in patients with acute coronary syndrome (ACS). Prasugrel, which is a new P2Y12 inhibitor, has been confirmed as efficacious in a large trial in Western countries, and a similar trial is also to be launched in Asian countries. Although a 60-mg loading dose of prasugrel followed by 10 mg per day should be acceptable, there have been no data regarding the optimal dose in Asian patients. Furthermore, serum levels of prasugrel and the rates of platelet inhibition are known to be higher in Asians than Caucasians with the same dose of the drug. Polymer, a key component of drug-eluting stents (DES), has been suggested as the cause of inflammation leading to late complications, and has driven many companies to develop biodegradable-polymer DES. Currently, there are limited data regarding the head-to-head comparison between BP-BES and the biostable polymer CoCr-EES or the newest platinum-chromium everolimus-eluting stent (PtCr-EES). Furthermore, the polymer issue may be more important in ACS where there is ruptured thrombotic plaque where polymer-induced inflammation may affect the local milieu of the stented artery. Therefore, the present study dedicated only to ACS patients, will offer important information on the optimal prasugrel dose in the Asian population by comparing a 10-mg versus a 5-mg maintenance dose beyond 1 month after PCI, as well as giving important insight into the polymer issue by comparing BP-BES versus biostable-polymer PtCr-EES. Method/Design Harmonizing Optimal Strategy for Treatment of coronary artery diseases – comparison of REDUCtion of prasugrEl dose or POLYmer TECHnology in ACS patients (HOST-REDUCE-POLYTECH-ACS) trial is a multicenter, randomized and open-label clinical study with a 2 × 2 factorial design, according to the type of stent (PtCr-EES versus BP-BES) and prasugrel maintenance dose (5 mg versus 10 mg), to demonstrate non-inferiority of PtCr-EES relative to BP-BES or the reduced prasugrel dose relative to conventional dose in an Asian all-comers PCI population presenting with ACS. Approximately 3400 patients will undergo prospective, random assignment separately to either stent or prasugrel arm (1:1 ratio, respectively). When the patients have contraindications to prasugrel, they are categorized into an antiplatelet observation group after stent-randomization. The primary endpoint is the patient-oriented composite outcome, which is a composite of all-cause mortality, any myocardial infarction (MI), any repeat revascularization in the stent arm at 12 months after index PCI. In the prasugrel arm, primary endpoint is any major adverse cardiovascular event, which is a composite of all-cause mortality, any MI, any stent thrombosis (Academic Research Consortium (ARC)-defined), any repeat revascularization, stroke, or bleeding (BARC class ≥ 2). Discussion The HOST-REDUCE-POLYTECH-ACS RCT is the first study exploring the optimal maintenance dose of prasugrel beyond 1 month after PCI for ACS in Asian all-comers. In addition, this is the largest study dedicated only to ACS patients to evaluate the polymer issue in the situation of ACS by directly comparing biostable-polymer PtCr-EES versus BP-BES. Trial registration ClinicalTrials.gov (ID: NCT02193971, 13 July 2014).
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Ji-Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Kyung Woo Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| | - Seok Kyu Oh
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea.
| | - Jang-Whan Bae
- Chungbuk National University, Cheongju, Republic of Korea.
| | - Jay Young Rhew
- Department of Internal Medicine and Cardiovascular Center, Presbyterian Medical Center, Jeonju, Republic of Korea.
| | - Namho Lee
- Cardiology Division, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
| | - Dong-Bin Kim
- Cardiovascular Center, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea.
| | - Ung Kim
- Division of Cardiology, Yeungnam University Medical Center, Daegu, Korea.
| | - Jung-Kyu Han
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Sang Eun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Han-Mo Yang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Hyun-Jae Kang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Bon-Kwon Koo
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Sanghyun Kim
- Cardiovascular Center, Seoul National University, Boramae Medical Center, Seoul, Korea.
| | - Yun Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.
| | - Won-Yong Shin
- Department of Cardiology, Soon Chun Hyang University Hospital Cheonan, Cheonan, Korea.
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, Korea.
| | - Seung-Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Seok-Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Korea.
| | - Sung Yun Lee
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
| | - Young-Dae Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea.
| | - In-Ho Chae
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
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Lee SE, Rhew JY, Jeong MH, Lee DY, Park JP, Kim YJ, Park SJ. TCT-35 The Length of Stay in Hospital after Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction: a data from KAMIR registry. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.060] [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: 10/24/2022]
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Park KW, Lee JM, Kang SH, Ahn HS, Kang HJ, Koo BK, Rhew JY, Hwang SH, Lee SY, Kang TS, Kwak CH, Hong BK, Yu CW, Seong IW, Ahn T, Lee HC, Lim SW, Kim HS. Everolimus-Eluting Xience V/Promus Versus Zotarolimus-Eluting Resolute Stents in Patients With Diabetes Mellitus. JACC Cardiovasc Interv 2014; 7:471-81. [DOI: 10.1016/j.jcin.2013.12.201] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/29/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
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Jeong HC, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. Comparative assessment of angiotensin II type 1 receptor blockers in the treatment of acute myocardial infarction: surmountable vs. insurmountable antagonist. Int J Cardiol 2013; 170:291-7. [PMID: 24239100 DOI: 10.1016/j.ijcard.2013.07.146] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 12/08/2012] [Revised: 06/23/2013] [Accepted: 07/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). METHODS We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. RESULTS In the overall population, the MACEs rate in 1 year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p=0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p=0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p=0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function. CONCLUSIONS In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI.
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Affiliation(s)
- Hae Chang Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea.
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | | | - Seung Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | | | | | - In Whan Seong
- Chungnam National Univ. Hosp., Daejon, Republic of Korea
| | - Jei Keon Chae
- Chunbuk National Univ. Hosp., Jeonju, Republic of Korea
| | - Jay Young Rhew
- Jeonju Presbyterian Medical Center, Jeonju, Republic of Korea
| | - In Ho Chae
- Seoul National University Bundang Hospital, Republic of South Korea
| | - Myeong Chan Cho
- Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jang Ho Bae
- Konyang University, Daejon, Republic of Korea
| | - Seung Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea
| | | | - Donghoon Choi
- Yonsei University Hospital, Seoul, Republic of Korea
| | - Yang Soo Jang
- Yonsei University Hospital, Seoul, Republic of Korea
| | - Junghan Yoon
- Wonju University Hospital, Wonju, Republic of Korea
| | | | - Jeong Gwan Cho
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ki Bae Seung
- Catholic University Hospital, Seoul, Republic of Korea
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Park KW, Kang SH, Park JJ, Yang HM, Kang HJ, Koo BK, Park BE, Cha KS, Rhew JY, Jeon HK, Shin ES, Oh JH, Jeong MH, Kim S, Hwang KK, Yoon JH, Lee SY, Park TH, Moon KW, Kwon HM, Chae IH, Kim HS. Adjunctive Cilostazol Versus Double-Dose Clopidogrel After Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2013; 6:932-42. [DOI: 10.1016/j.jcin.2013.04.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/27/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
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Yamanaka F, Jeong MH, Saito S, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. Comparison of clinical outcomes between octogenarians and non-octogenarians with acute myocardial infarction in the drug-eluting stent era: analysis of the Korean Acute Myocardial Infarction Registry. J Cardiol 2013; 62:210-6. [PMID: 23731919 DOI: 10.1016/j.jjcc.2013.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 04/30/2012] [Revised: 11/18/2012] [Accepted: 04/13/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Octogenarians (age ≥ 80 years) with coronary artery disease constitute a high-risk group. However, octogenarian patients with acute myocardial infarction (AMI) in the drug-eluting stents (DES) era have not been widely reported. We aimed to identify clinical outcomes in octogenarian compared with non-octogenarian AMI patients. METHODS AND SUBJECTS We retrospectively analyzed 9877 patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and who were enrolled in the Korean Acute Myocardial Infarction Registry (KAMIR). They were divided into 2 groups, octogenarians (n=1494) and non-octogenarians (n=8383), in order to compare the incidence of 1-year all-cause death and 1-year major adverse cardiac events (MACE), where MACE included all-cause death, recurrent myocardial infarction, target vessel revascularization (TVR), target lesion revascularization (TLR), and coronary artery bypass grafting (CABG). RESULTS The clinical status was significantly inferior in octogenarians compared to non-octogenarians: Killip class ≥ II (34.8% vs. 22.5%, p<0.001), multivessel disease (65.8% vs. 53.7%, p<0.001). Rates of 1-year all-cause death were significantly higher in octogenarians than in non-octogenarians (22.3% vs. 6.5%, p<0.001). However, the rates of 1-year recurrent myocardial infarction (1.3% vs. 0.9%, p=0.68), TLR (2.4% vs. 3.1%, p=0.69), TVR (3.6% vs. 4.3%, p=0.96), and CABG (0.9% vs. 0.9%, p=0.76) did not differ significantly between the 2 groups. CONCLUSIONS Octogenarian AMI patients have higher rates of mortality and MACE even in the DES era. According to KAMIR subgroup analysis, the TLR/TVR rates in octogenarians were comparable to those in non-octogenarian AMI patients.
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Affiliation(s)
- Futoshi Yamanaka
- Chonnam National University Hospital, Gwangju, Republic of Korea; Shonan Kamakura Hospital, Japan
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Jeong HC, Jeong JM, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. Effect of single or dual blockade of renin-angiotensin system in acute myocardial infarction patients according to renal function. Int J Cardiol 2012; 157:408-11. [PMID: 22513185 DOI: 10.1016/j.ijcard.2012.03.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 11/27/2022]
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23
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Park KW, Park BE, Kang SH, Park JJ, Lee SP, Cha KS, Rhew JY, Jeon HK, Shin ES, Oh JH, Jeong MH, Kim S, Hwang KK, Yoon JH, Lee SY, Park TH, Moon KW, Kwon HM, Chae IH, Kim HS. The 'Harmonizing Optimal Strategy for Treatment of coronary artery stenosis - sAfety & effectiveneSS of drug-elUting stents & antiplatelet REgimen' (HOST-ASSURE) trial: study protocol for a randomized controlled trial. Trials 2012; 13:29. [PMID: 22463698 PMCID: PMC3342216 DOI: 10.1186/1745-6215-13-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 03/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Second-generation drug-eluting stents (DES) have raised the bar of clinical performance. These stents are mostly made from cobalt chromium alloy. A newer generation DES has been developed from platinum chromium alloy, but clinical data regarding the efficacy and safety of the platinum chromium-based everolimus-eluting stent (PtCr-EES) is limited, with no comparison data against the cobalt chromium-based zotarolimus-eluting stent (CoCr-ZES). In addition, an antiplatelet regimen is an integral component of medical therapy after percutaneous coronary intervention (PCI). A 1-week duration of doubling the dose of clopidogrel (double-dose antiplatelet therapy (DDAT)) was shown to improve outcome at 1 month compared with conventional dose in acute coronary syndrome (ACS) patients undergoing PCI. However in Asia, including Korea, the addition of cilostazol (triplet antiplatelet therapy (TAT)) is used more commonly than doubling the dose of clopidogrel in high-risk patients. METHODS In the 'Harmonizing Optimal Strategy for Treatment of coronary artery stenosis - sAfety & effectiveneSS of drug-elUting stents & antiplatelet REgimen' (HOST-ASSURE) trial, approximately 3,750 patients are being prospectively and randomly assigned in a 2 × 2 factorial design according to the type of stent (PtCr-EES vs CoCr-ZES) and antiplatelet regimen (TAT vs DDAT). The first primary endpoint is target lesion failure at 1 year for the stent comparison, and the second primary endpoint is net clinical outcome at 1 month for comparison of antiplatelet therapy regimen. DISCUSSION The HOST-ASSURE trial is the largest study yet performed to directly compare the efficacy and safety of the PtCr-EES versus CoCr-ZES in an 'all-comers' population. In addition, this study will also compare the clinical outcome of TAT versus DDAT for 1-month post PCI. TRIAL REGISTRATION ClincalTrials.gov number NCT01267734.
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Affiliation(s)
- Kyung Woo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehang-no, Seoul 110-744, South Korea
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Yamanaka F, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB. COMPARISON OF CLINICAL OUTCOMES BETWEEN OCTOGENARIAN AND NON-OCTOGENARIAN ACUTE MYOCARDIAL INFARCTION PATIENTS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60016-3] [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: 11/29/2022]
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25
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Jo HS, Park JS, Sohn JW, Yoon JC, Sohn CW, Lee SH, Hong GR, Shin DG, Kim YJ, Jeong MH, Chae SC, Hur SH, Hong TJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi DH, Jang YS, Yoon JH, Chung WS, Seung KB, Park SJ. Culprit-Lesion-Only Versus Multivessel Revascularization Using Drug-Eluting Stents in Patients With ST-Segment Elevation Myocardial Infarction: A Korean Acute Myocardial Infarction Registry-Based Analysis. Korean Circ J 2011; 41:718-25. [PMID: 22259602 PMCID: PMC3257455 DOI: 10.4070/kcj.2011.41.12.718] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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: 02/22/2011] [Revised: 03/16/2011] [Accepted: 06/20/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. SUBJECTS AND METHODS From the Korean Acute Myocardial Infarction Registry (KAMIR) database, 1,094 STEMI patients with multivessel disease who underwent primary PCI with drug-eluting stents were enrolled in this study. The patients were divided into two groups: culprit-vessel-only revascularization (COR, n=827) group; multivessel revascularization, including non-IRA (MVR, n=267) group. The primary endpoint of this study included major adverse cardiac events (MACEs), such as death, myocardial infarction, or target or nontarget lesion revascularization at one year. RESULTS There was no difference in clinical characteristics between the two groups. During the one-year follow-up, 102 (15.2%) patients in the COR group and 32 (14.2%) in the MVR group experienced at least one MACE (p=0.330). There were no differences between the two groups in terms of rates of death, myocardial infarction, or revascularization (2.1% vs. 2.0%, 0.7% vs. 0.8%, and 11.7% vs. 10.1%, respectively; p=0.822, 0.910, and 0.301, respectively). The MACE rate was higher in the incompletely revascularized patients than in the completely revascularized patients (15% vs. 9.5%, p=0.039), and the difference was attributable to a higher rate of nontarget vessel revascularization (8.6% vs. 1.8%, p=0.002). CONCLUSION Although multivessel angioplasty during primary PCI for STEMI did not reduce the MACE rate compared with culprit-vessel-only PCI, CR was associated with a lower rate of repeat revascularization after multivessel PCI.
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Affiliation(s)
- Hyun Su Jo
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
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26
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Lee MG, Jeong MH, Ahn Y, Cho JG, Park JC, Kang JC, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Seung KB, Park SJ. Comparison of paclitaxel-, sirolimus-, and zotarolimus-eluting stents in patients with acute ST-segment elevation myocardial infarction and metabolic syndrome. Circ J 2011; 75:2120-7. [PMID: 21757819 DOI: 10.1253/circj.cj-11-0263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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: 11/09/2022]
Abstract
BACKGROUND The purpose of the present study was to compare the efficacy and safety of paclitaxel-eluting stent (PES), sirolimus-eluting stent (SES), and zotarolimus-eluting stent (ZES) in primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI) with metabolic syndrome (MS). METHODS AND RESULTS Using data from Korea Acute Myocardial Infarction Registry (KAMIR; November 2005-December 2007), a total of 1,768 MS patients with STEMI who underwent primary PCI were enrolled: The PES group was 634, SES group, 906, and ZES group, 228. The primary endpoint was major adverse cardiac event (all-cause death, re-myocardial infarction, target lesion revascularization) during 12 months follow-up. At 12 months, the cumulative incidence of primary endpoint in the PES, SES, and ZES groups was 10.9%, 9.1%, and 11.0%, respectively (P=0.086). Incidence of death, recurrent myocardial infarction, or target lesion revascularization did not differ among the 3 groups. There were 7 episodes of acute (0.3% in PES group, 0.4% in SES group, and 0.4% in ZES group, respectively, P=0.773) and 18 episodes of cumulative stent thrombosis including late stent thrombosis (0.9% in PES group, 1.0% in SES group, and 1.3% in ZES group, respectively, P=0.448). CONCLUSIONS Implantation of SES, PES, and ZES in MS patients with STEMI undergoing primary PCI provided comparable clinical outcomes in patients enrolled in KAMIR.
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Affiliation(s)
- Min Goo Lee
- Chonnam National University Hospital, Gwangju, Korea
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27
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Lee MG, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Chung WS, Kim CJ, Choi D, Jang YS, Yoon J, Seung KB, Park SJ. AS-194 Comparison of Paclitaxel-, Sirolimus-, and Zotarolimus-Eluting Stents in Patients with Acute ST-Segment Elevation Myocardial Infarction Accompanied with Metabolic Syndrome. Am J Cardiol 2011. [DOI: 10.1016/j.amjcard.2011.02.172] [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: 11/26/2022]
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28
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Choi SG, Jeong MH, Ahn Y, Cho JG, Kang JC, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Seung KB, Park SJ. Relationship between obesity and N-terminal brain natriuretic Peptide level as a prognostic value after acute myocardial infarction. Korean Circ J 2010; 40:558-64. [PMID: 21217932 PMCID: PMC3008826 DOI: 10.4070/kcj.2010.40.11.558] [Citation(s) in RCA: 4] [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: 01/22/2010] [Revised: 03/09/2010] [Accepted: 04/13/2010] [Indexed: 12/22/2022] Open
Abstract
Background and Objectives Recently, the prognostic value of N-terminal brain natriuretic peptide (NT-proBNP) in acute coronary syndrome has been demonstrated in many studies. However, NT-proBNP levels are influenced by various factors such as sex, age, renal function, heart failure severity, and obesity. NT-proBNP concentrations tend to decrease with higher body mass index (BMI). The aim of this study was to examine the influence of obesity on NT-proBNP as a predictive prognostic factor in acute myocardial infarction (AMI) patients. Subjects and Methods Using data from the Korea Acute Myocardial Infarction Registry (January 2005 to September 2008), 2,736 AMI patients were included in this study. These patients were divided into men (n=1,972, 70%) and women (n=764, 30%), and were grouped according to their BMIs. Major adverse cardiac events (MACE) during 1 year clinical follow-up were evaluated. Results NT-proBNP was significantly higher in lower BMI (p<0.001). Mean NT-proBNP levels of each obesity group were 2,393±4,022 pg/mL in the lean group (n=875), 1,506±3,074 pg/mL in the overweight group (n=724) and 1,100±1,137 pg/mL in the obese group (n=1,137) (p<0.01). NT-proBNP was an independent prognostic factor of AMI in obese patients by multivariative analysis of independent risk factors of MACE (p=0.01). Conclusion NT-proBNP is lower in obese AMI patients than in non-obese AMI patients, but NT-proBNP is still of independent prognostic value in obese AMI patients.
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Affiliation(s)
- Seon Gyu Choi
- Department of Internal Medicine, Yeosu Chonnam Hospital, Yeosu, Korea
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29
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Cho JS, Her SH, Baek JY, Park MW, Kim HD, Jeong MH, Ahn YK, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. Clinical benefit of low molecular weight heparin for ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with glycoprotein IIb/IIIa inhibitor. J Korean Med Sci 2010; 25:1601-8. [PMID: 21060749 PMCID: PMC2966997 DOI: 10.3346/jkms.2010.25.11.1601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 05/04/2010] [Accepted: 06/16/2010] [Indexed: 11/20/2022] Open
Abstract
The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.
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Affiliation(s)
- Jung Sun Cho
- Cardiovascular Center, Seoul St. Mary's Hospital, Seoul, Korea
| | - Sung-Ho Her
- Cardiovascular Center, Seoul St. Mary's Hospital, Seoul, Korea
| | - Ju Yeal Baek
- Cardiovascular Center, Seoul St. Mary's Hospital, Seoul, Korea
| | - Mahn-Won Park
- Cardiovascular Center, Seoul St. Mary's Hospital, Seoul, Korea
| | - Hyoung Doo Kim
- Cardiovascular Center, Seoul St. Mary's Hospital, Seoul, Korea
| | - Myung Ho Jeong
- Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young keun Ahn
- Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Shung Chull Chae
- Cardiovascular Center, Kyungpook National University, Daegu, Korea
| | - Seung Ho Hur
- Cardiovascular Center, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Taek Jong Hong
- Cardiovascular Center, Pusan National University Hospital, Busan, Korea
| | - Young Jo Kim
- Cardiovascular Center, Yeungnam University Hostpial, Daegu, Korea
| | - In Whan Seong
- Cardiovascular Center, Chungnam National University Hostpial, Daejon, Korea
| | - Jei Keon Chae
- Cardiovascular Center, Chonbuk National University Hospital, Jeonju, Korea
| | - Jay Young Rhew
- Cardiovascular Center, Jeonju Presbyterian Medical Center, Jeonju, Korea
| | - In Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myeong Chan Cho
- Cardiovascular Center, Chungbuk National University, Cheongju, Korea
| | - Jang Ho Bae
- Cardiovascular Center, Konyang University, Daejon, Korea
| | - Seung Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chong Jim Kim
- Cardiovascular Center, Kyunghee University Hospital, Seoul, Korea
| | - Donghoon Choi
- Cardiovascular Center, Yonsei University Hospital, Seoul, Korea
| | - Yang Soo Jang
- Cardiovascular Center, Yonsei University Hospital, Seoul, Korea
| | - Junghan Yoon
- Cardiovascular Center, Wonju University Hospital, Wonju, Korea
| | - Wook Sung Chung
- Cardiovascular Center, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jeong Gwan Cho
- Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ki Bae Seung
- Cardiovascular Center, Seoul St. Mary's Hospital, Seoul, Korea
| | - Seung Jung Park
- Cardiovascular Center, Ulsan University Asan Medical Center, Seoul, Korea
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30
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Lee MG, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. Impact of the metabolic syndrome on the clinical outcome of patients with acute ST-elevation myocardial infarction. J Korean Med Sci 2010; 25:1456-61. [PMID: 20890426 PMCID: PMC2946655 DOI: 10.3346/jkms.2010.25.10.1456] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 11/13/2009] [Accepted: 04/12/2010] [Indexed: 11/30/2022] Open
Abstract
We sought to determine the prevalence of metabolic syndrome (MS) in patients with acute myocardial infarction and its effect on clinical outcomes. Employing data from the Korea Acute Myocardial Infarction Registry, a total of 1,990 patients suffered from acute ST-elevation myocardial infarction (STEMI) between November 2005 and December 2006 were categorized according to the National Cholesterol Education Program-Adult Treatment Panel III criteria of MS. Primary study outcomes included major adverse cardiac events (MACE) during one-year follow-up. Patients were grouped based on existence of MS: group I: MS (n=1,182, 777 men, 62.8±12.3 yr); group II: Non-MS (n=808, 675 men, 64.2±13.1 yr). Group I showed lower left ventricular ejection fraction (LVEF) (P=0.005). There were no differences between two groups in the coronary angiographic findings except for multivessel involvement (P=0.01). The incidence of in-hospital death was higher in group I than in group II (P=0.047), but the rates of composite MACE during one-year clinical follow-up showed no significant differences. Multivariate analysis showed that low LVEF, old age, MS, low high density lipoprotein cholesterol and multivessel involvement were associated with high in-hospital death rate. In conclusion, MS is an important predictor for in-hospital death in patients with STEMI.
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Affiliation(s)
- Min Goo Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | | | - Seung Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | | | - In Whan Seong
- Chungnam National University Hospital, Daejon, Korea
| | | | | | - In Ho Chae
- Seoul National University Bundang Hospital, Seongnam, Korea
| | | | | | | | | | | | | | - Junghan Yoon
- Yonsei University Wonju Christian Hospital, Wonju, Korea
| | - Wook Sung Chung
- Catholic University of Korea St. Mary's Hospital, Seoul, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ki Bae Seung
- Catholic University of Korea St. Mary's Hospital, Seoul, Korea
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31
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Jeong HC, Ahn Y, Jeong MH, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. Long-Term clinical outcomes according to initial management and thrombolysis in myocardial infarction risk score in patients with acute non-ST-segment elevation myocardial infarction. Yonsei Med J 2010; 51:58-68. [PMID: 20046515 PMCID: PMC2799982 DOI: 10.3349/ymj.2010.51.1.58] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 02/03/2009] [Revised: 05/03/2009] [Accepted: 05/06/2009] [Indexed: 11/27/2022] Open
Abstract
PURPOSE There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR). MATERIALS AND METHODS 2,845 patients with acute NSTEMI (65.6 +/- 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 +/- 12.6 years, 856 males) and late invasive treatment (65.3 +/- 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score. RESULTS There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p < 0.001, 10.0% vs. 13.5%, p = 0.004, respectively). According to the TIMI risk score, there was no significant difference of long-term clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (>or= 5 points). CONCLUSIONS The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI.
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Affiliation(s)
- Hae Chang Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Taek Jong Hong
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - In Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jei Keon Chae
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Jay Young Rhew
- Department of Internal Medicine, Jeonju Presbyterian Medical Center, Jeonju, Korea
| | - In Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jang Ho Bae
- Department of Internal Medicine, National University, Cheongju, Korea
| | - Seung Woon Rha
- Department of Internal Medicine, Konyang University, Daejeon, Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Donghoon Choi
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Yang Soo Jang
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Junghan Yoon
- Department of Internal Medicine, Yonsei University Wonju Hospital, Wonju, Korea
| | - Wook Sung Chung
- Department of Internal Medicine, Wonju University Hospital, Wonju, Korea
| | - Jeong Gwan Cho
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ki Bae Seung
- Department of Internal Medicine, Catholic University Hospital, Seoul, Korea
| | - Seung Jung Park
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
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Lee SE, Jeong MH, Park JP, John SH, Lim JH, Rhew JY. Congenital anomaly of the true double-lumen right coronary artery: An extremely rare case. J Cardiol Cases 2009; 1:e6-e8. [PMID: 30615764 DOI: 10.1016/j.jccase.2009.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/31/2009] [Revised: 04/30/2009] [Accepted: 05/28/2009] [Indexed: 11/25/2022] Open
Abstract
Double right coronary artery is a rare anomaly which is mostly identified by two separate pathways with a common ostium (one-two way). We report herein an extremely rare case of congenital true double-lumen right coronary artery, an anomaly, where a common pathway from the ostium to the proximal segment diverged into two separate pathways from the proximal to the mid-segment and then converged into one pathway (one-two-one way).
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Affiliation(s)
- Shin Eun Lee
- Department of Cardiology, Presbyterian Medical Center, Jeonju, South Korea
| | - Myung Ho Jeong
- Cardiovascular Research Institute of Chonnam National University, The Heart Center of Chonnam National University Hospital, 671 Jaebongro, Donggu, Gwangju, South Korea
| | - Jong Pil Park
- Department of Cardiology, Presbyterian Medical Center, Jeonju, South Korea
| | - Sung Hee John
- Department of Cardiology, Presbyterian Medical Center, Jeonju, South Korea
| | - Ji Hyun Lim
- Department of Cardiology, Presbyterian Medical Center, Jeonju, South Korea
| | - Jay Young Rhew
- Department of Cardiology, Presbyterian Medical Center, Jeonju, South Korea
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Kang DG, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Jang YS, Yoon J, Seung KB, Park SJ. Clinical effects of hypertension on the mortality of patients with acute myocardial infarction. J Korean Med Sci 2009; 24:800-6. [PMID: 19794974 PMCID: PMC2752759 DOI: 10.3346/jkms.2009.24.5.800] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 07/04/2008] [Accepted: 11/22/2008] [Indexed: 11/20/2022] Open
Abstract
The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.
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Affiliation(s)
| | | | | | | | - Seung Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | | | - In Whan Seong
- Chungnam National University Hospital, Daejeon, Korea
| | | | | | - In Ho Chae
- Seoul National University Bundang Hospital, Seongam, Korea
| | | | | | | | | | | | | | - Ki Bae Seung
- Catholic University of Seoul St. Mary's Hospital, Seoul, Korea
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Lee MG, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. Comparison of clinical outcomes following acute myocardial infarctions in hypertensive patients with or without diabetes. Korean Circ J 2009; 39:243-50. [PMID: 19949630 PMCID: PMC2771834 DOI: 10.4070/kcj.2009.39.6.243] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 12/18/2008] [Revised: 01/16/2009] [Accepted: 02/17/2009] [Indexed: 01/19/2023] Open
Abstract
Background and Objectives It is thought that patients with diabetes mellitus (DM) have a poor prognosis after an acute myocardial infarction (AMI), but the effect of diabetes on the outcomes of hypertensive patients with AMIs has not been elucidated in the Korean population. The aim of this study was to investigate the effects of diabetes on long-term clinical outcomes following AMIs in patients with hypertension. Subjects and Methods Using data from the Korea Acute Myocardial Infarction Registry (November 2005 to December 2006), 2,233 hypertensive patients with AMIs were grouped as follows based on the presence of DM: group I, diabetic hypertension (n=892, 544 men, mean age=66.2±10.9 years); and group II, non-diabetic hypertension (n=1341, 938 men, mean age=63.9±12.8 years). The primary study outcomes included in-hospital death and major adverse cardiac events (MACE; cardiac death, myocardial infarction (MI), repeat percutaneous coronary intervention, and coronary artery bypass surgery) at the 1 year follow-up. Results Hypertensive patients with DM were older and more likely to be women. The diabetic group had lower blood pressure (p<0.001), a lower left ventricular ejection fraction (p<0.001), a more severe degree of heart failure (p<0.001), a longer duration of coronary care unit admission (p<0.001), and a higher incidence of hyperlipidemia (p=0.007). The N-terminal pro-brain natriuretic peptide level (4602.5±8710.6 pg/mL vs. 2320.8±5837.9 pg/mL, p<0.001) was higher and the creatinine clearance (62.4±29.9 mL/min vs. 73.0±40.8 mL/min, p<0.001) was lower in the diabetic group than the non-diabetic group. Coronary angiographic findings revealed more frequent involvement of the left main stem (p=0.002) and multiple vessels (p<0.001) in the diabetic group. The rate of in-hospital death was higher in the diabetic group (p<0.001). During follow-up, the rates of composite MACE at 1 month, 6 months, and 12 months were higher in the diabetic group (p<0.001). Conclusion In hypertensive patients with AMI, DM was associated with worse clinical and angiographic features, with a higher risk of development of severe heart failure, and an increased risk of MACE on long-term clinical follow-up.
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Affiliation(s)
- Min Goo Lee
- Korea Acute Myocardial Infarction Registry Investigators of Korean Society of Cardiology, Korea
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35
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Hong YJ, Jeong MH, Ahn Y, Jeong HC, Chull Chae S, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. AS-65: Effects of Statins on 1-Year Cardiac Mortality after Drug-Eluting Stent Implantation in Diabetic Acute Myocardial Infarction Patients. Am J Cardiol 2009. [DOI: 10.1016/j.amjcard.2009.01.113] [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: 10/20/2022]
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36
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Kang DK, Jeong MH, Ahn Y, Chae SC, Kim JH, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Jang YS, Yoon J, Seung KB, Park SJ. AS-227: Clinical Effects of Hypertension on the Mortality of Patients with Acute Myocardial Infarction. Am J Cardiol 2009. [DOI: 10.1016/j.amjcard.2009.01.279] [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: 10/20/2022]
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37
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Lee MG, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Chae JK, Rhew JY, Chae IH, Seong IW, Cho MC, Bae JH, Rha SW, Kim CJ, Choi DH, Jang YS, Yoon J, Chung WS, Seung KB, Park SJ. AS-92: Effect of Metabolic Syndrome on the Long-Term Clinical Outcome of Patients with Acute Myocardial Infarction. Am J Cardiol 2009. [DOI: 10.1016/j.amjcard.2009.01.140] [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: 10/20/2022]
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Cho JY, Jeong MH, Ahn Y, Chae SC, Hur SH, Seong IW, Kim JH, Hong TJ, Koo BK, Chae JK, Choi D, Yoon J, Bae JH, Rha SW, Rhew JY, Kim DI, Kim KS, Kim BO, Oh SK, Chae IH, Lee MY, Cho MC, Jung KT, Kim CJ, Kim YJ. AS-82: Hyperglycemic Patients without Diabetes Mellitus Have Worse Outcomes than Normoglycemic Patients after Non-ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2009. [DOI: 10.1016/j.amjcard.2009.01.130] [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: 11/28/2022]
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Lee KH, Jeong MH, Ahn YK, Lee WS, Jung DH, Cho JG, Park JC, Kang JC, Oh SK, Kim NH, Yun KH, Yoo NJ, Moon Y, Rhew JY, Lim JH, Jeon SH, Park OY, Lee SU, Kang DG. The Comparative Clinical Effects of Valsartan and Ramipril in Patients With Heart Failure. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.2.101] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ki Hong Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Keun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Woo Seok Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Dae Ho Jung
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Seok Kyu Oh
- Department of Cardiovascular Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Nam Ho Kim
- Department of Cardiovascular Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Kyung Ho Yun
- Department of Cardiovascular Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Nam Jin Yoo
- Department of Internal Medicine, Gunsan Medical Center, Gunsan, Korea
| | - Yong Moon
- Department of Cardiovascular Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jay Young Rhew
- Department of Cardiovascular Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Ji Hyun Lim
- Department of Cardiovascular Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Seong Hee Jeon
- Department of Cardiovascular Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Ok Young Park
- Department of Internal Medicine, College of Seonam University, Namwon, Korea
| | - Seung Uk Lee
- Department of Cardiovascular Medicine, Gwangju Christian Hospital, Gwangju, Korea
| | - Dong Goo Kang
- Department of Cardiovascular Medicine, Gwangju Christian Hospital, Gwangju, Korea
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Cho JY, Jeong MH, Ahn Y, Chae SC, Seong IH, Kim YJ, Yoon J, Rhew JY, Chae JK, Chae IH, Lee NH, Hwang JY, Cho MC, Kim KS, Kim CJ, Chung WS, Rha SW, Jang YS, Seung KB, Park SJ. Predictive Factors of Major Adverse Cardiac Events and Clinical Outcomes of Acute Myocardial Infarction in Young Korean Patients. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.3.161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jae Yeong Cho
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Myung Ho Jeong
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Youngkeun Ahn
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Shung Chull Chae
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - In Hwan Seong
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Young Jo Kim
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Junghan Yoon
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Jay Young Rhew
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Jei Keon Chae
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - In Ho Chae
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Nae Hee Lee
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Jin Yong Hwang
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Myeong Chan Cho
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Kee Sik Kim
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Chong Jin Kim
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Wook Sung Chung
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Seung Woon Rha
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Yang Soo Jang
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Ki Bae Seung
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
| | - Seung Jung Park
- Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea
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John SH, Kim NH, Lim JH, Rhew JY, Yoo NJ, Oh SK, Shin SH, Lee EM, Moon Y, Choi JB, Jeong JW. Floating Thrombus in the Aortic Arch: A Case Report. Korean Circ J 2005. [DOI: 10.4070/kcj.2005.35.2.180] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sung Hee John
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Nam Ho Kim
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Ji Hyun Lim
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jay Young Rhew
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Nam Jin Yoo
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Seok Kyu Oh
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Sung Hee Shin
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Eun Mi Lee
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Yong Moon
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jong Bum Choi
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jin Won Jeong
- Depratment of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
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Kim JH, Jeong MH, Rhew JY, Lim JH, Yun KH, Kim KH, Kang DK, Hong SN, Lim SY, Lee SH, Lee YS, Hong YJ, Park HW, Kim W, Ahn YK, Moon Y, Cho JG, Park JC, Kang JC. Long-Term Clinical Outcomes of Platelet Glycoprotein IIb/IIIa Inhibitor Combined With Low Molecular Weight Heparin in Patients With Acute Coronary Syndrome. Circ J 2005; 69:159-64. [PMID: 15671606 DOI: 10.1253/circj.69.159] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Platelet activation and aggregation with resultant arterial thrombus formation play a pivotal role in the pathophysiology of acute coronary syndrome (ACS). In the present study the efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin or low-molecular-weight heparin (dalteparin), was evaluated for the management of ACS. METHODS AND RESULTS One hundred and sixty patients (60.9+/-11.1 years, 104 male) with unstable angina or non-ST elevation myocardial infarction and who had ST-T changes and elevated troponin were randomly assigned to 4 groups: group I (n=40: heparin alone), group II (n=40: dalteparin alone), group III (n=40: tirofiban + heparin) and group IV (n=40: tirofiban + dalteparin). The occurrence of major adverse cardiac events (MACE) was compared prospectively during a 6-month clinical follow-up. Percutaneous coronary intervention or coronary artery bypass graft was performed in 32 cases in group I, 29 in group II, 28 in group III and 31 in group IV (p=0.72). Minor bleeding complication developed in 2 patients (5.0%) in group I, 2 (5.0%) in group II, 4 (10.0%) in group III and 3 (7.5%) in group IV (p=0.78). During the follow-up MACE occurred in 10 patients (31.3%) in group I, 9 (31.0%) in group II, 4 (14.3%) in group III and 4 (12.9%) in group IV (p=0.02: Group I and II vs Group III and IV). CONCLUSIONS Tirofiban combined with dalteparin was associated with relatively more bleeding complications in the short term, but was effective in reducing the incidence of MACE during long-term clinical follow-up in patients with ACS.
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Affiliation(s)
- Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
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John SH, Jung GM, Choi HJ, Park JP, Lee YJ, Park WS, Rhew JY, Moon Y. A Case of Huge Right Atrial Thrombi Treated with Thrombolytic Agent. Korean Circ J 2004. [DOI: 10.4070/kcj.2004.34.3.328] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sung Hee John
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Gum Mo Jung
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Hyun Jong Choi
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jong Pil Park
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Youn Jeong Lee
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Woo Seok Park
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jay Young Rhew
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Young Moon
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
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Lim JH, Jeong MH, Park WS, Rhew JY, Moon Y, Kim W, Hong YJ, Park HW, Kim HG, Park OY, Kim JH, Ahn YK, Cho JG, Park JC, Kang JC. A Successful Stenting of the Coarctation of the Distal Thoracic Aorta (Middle Aortic Syndrome) in an Adult. Korean Circ J 2004. [DOI: 10.4070/kcj.2004.34.4.420] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ji Hyun Lim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Woo Seok Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jay Young Rhew
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Yong Moon
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Weon Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Han Gyun Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ok Young Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Joo Han Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Keun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Hong YJ, Jeong MH, Lee SH, Park OY, Kim JH, Kim W, Rhew JY, Ahn YK, Cho JG, Park JC, Suh SP, Ahn BH, Kim SH, Kang JC. The use of low molecular weight heparin to predict clinical outcome in patients with unstable angina that had undergone percutaneous coronary intervention. Korean J Intern Med 2003; 18:167-73. [PMID: 14619386 PMCID: PMC4531631 DOI: 10.3904/kjim.2003.18.3.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Antithrombotic therapy with heparin reduces the rate of ischemic events in patients with acute coronary syndrome. Low-molecular-weight heparin, given subcutaneously twice daily, has a more predictable anticoagulant effect than standard unfractionated heparin. Moreover, it is easier to administer and does not require monitoring. METHODS We prospectively analyzed 180 patients with unstable angina who had undergone percutaneous coronary intervention (PCI) between 1999 and 2001 at Chonnam National University Hospital and had received either 120 U/kg of dalteparin (Fragmin), administered subcutaneously twice daily (Group I; n = 90, 61.8 +/- 8.9 years, male 67.8%), or had received continuous intravenous unfractionated heparin (Group II; n = 90, 62.6 +/- 9.7 years, male 70.0%). During hospitalization and at 6 month after PCI, major adverse cardiac events such as acute myocardial infarction, target vessel revascularization, death, and restenosis were examined. RESULTS During hospitalization, the incidence of acute myocardial infarction, target vessel revascularization and death were not different between the two groups. At follow-up coronary angiography 6 months after PCI, the incidence of restenosis was lower in group I than in group II (Group I; 26/90, 28.8% vs. Group II; 32/90, 35.6%, p = 0.041) and the incidence of target vessel revascularization was lower in group I than in group II (Group I; 21/90, 23.3% vs. Group II; 27/90, 30.0%, p = 0.039). No difference was found in the rates of major and minor hemorrhages, ischemic strokes or thrombocytopenia between two groups. By multivariate analysis, the factors related to restenosis were lesion length, postprocedural minimal luminal diameter, CRP on admission, diabetes mellitus, the type of heparin, and stent use. CONCLUSION Dalteparin, a low molecular weight heparin, is superior to standard unfractionated heparin in terms of reducing the restenosis rate and target vessel revascularization without increasing bleeding complications.
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Affiliation(s)
| | - Myung Ho Jeong
- Correspondence to : Myung Ho Jeong, M.D., Ph.D., FACC, FESC, FSCAI, Chief of Cardiovascular Medicine, Director of Cardiac Catheterization Laboratory, The Heart Center of Chonnam National University Hospital, 8 Hak-dong, Dong-gu, Gwangju, 501-757, Korea, Tel : 82-62-220-6243, Fax : 82-62-228-7174, E-mail :
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Sim DS, Jeong MH, Kim W, Rhew JY, Yum JH, Kim JH, Cho JG, Ahn YK, Park JC, Ahn BH, Kim SH, Kang JC. Long-term clinical benefits of a platelet glycoprotein IIb/IIIa receptor blocker, abciximab (ReoPro), in high-risk diabetic patients undergoing percutaneous coronary intervention. Korean J Intern Med 2003; 18:129-37. [PMID: 14619381 PMCID: PMC4531627 DOI: 10.3904/kjim.2003.18.3.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND High-risk percutaneous coronary interventions (PCIs) are associated with a high complication rate, a low procedural success rate and a high restenosis rate, especially in diabetics. We sought to determine whether abciximab (ReoPro) therapy affects long-term clinical outcomes of Korean patients with diabetes undergoing high-risk PCI. METHODS One hundred and nineteen patients with 152 lesion sites were administered ReoPro among 2,231 patients who underwent PCI at Chonnam National University Hospital from March 1999 to Feb 2001. These 119 patients were divided into two groups, 30 were allocated to a diabetic group (Group 1, 57.7 +/- 8.2 years, 22 male), and 89 to a non-diabetic group (Group II, 59.6 +/- 10.8 years, 68 male). Early and long-term clinical outcomes after PCI were analyzed. RESULTS In terms of clinical diagnosis, the number of acute myocardial infarctions in Group I was 25 (83.3%) and 76 in Group II (85.4%). As for risk factors, target artery lesions, and ACC/AHA types, no differences were found between the two groups. The number of patients with total occlusion was 21 (55.3%) and 62 (53.9%), and the number with a thrombus-containing lesion was 28 (93.3%) and 88 (98.9%) in Groups I and II, respectively. The procedure was successful in 27 (90.0%) in Group I, and in 80 (89.9%) in Group II, and no differences were evident between the two groups in terms of bleeding complications. No major adverse cardiac events (MACE), including myocardial infarction, repeat revascularization or cardiac death, were observed in Group I, but 8 cases of MACE occurred in Group II during hospitalization. Clinical follow-up was performed in 116 patients (97.5%) over 18.5 +/- 6.7 (5-28) months. The number of overall MACEs was 10 (3.3%) in Group I and 14 (15.7%) in Group II (p = 0.038). CONCLUSION ReoPro used in high-risk PCI in diabetics was effective in terms of early clinical outcomes, but its long-term clinical benefits were not proven.
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Affiliation(s)
| | - Myung Ho Jeong
- Correspondence to: Myung Ho Jeong, M.D., Ph.D., FACC, FESC, FSCAI, Chief of Cardiovascular Medicine, Director of Cardiac Catheterization Laboratory, The Heart Center of Chonnam National University Hospital, Hakdong 8, Dongku, Gwangju, 501-757, Korea, Tel : 82-62-220-6243, Fax : 82-62-228-7174, E-mail:
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Kim W, Jeong MH, Park OY, Rhew JY, Bom HS, Choi SJ, Park KB, Kim EH, Kim JH, Ahn YK, Park JT, Cho JG, Park JC, Kang JC. Effects of beta-radiation using a holmium-166 coated balloon on neointimal hyperplasia in a porcine coronary stent restenosis model. Circ J 2003; 67:625-9. [PMID: 12845188 DOI: 10.1253/circj.67.625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Brachytherapy is a promising method of preventing and treating coronary stent restenosis. The present study was designed to observe the therapeutic effects of a radioactive balloon loaded with Holmium-166 ((166)Ho) in a porcine coronary stent restenosis model. A radioisotope of (166)Ho was coated onto the balloon surface using polyurethane (20 Gy at 0.5 mm depth). Stent overdilation injuries were induced in 2 coronary arteries in each pig (n=8). Four weeks after the injury, control balloon dilation was performed in one coronary artery (Group I) and radiation therapy using the (166)Ho coated balloon in the other coronary artery (Group II) in each pig. Follow-up coronary angiography and histopathologic assessment were performed at 4 weeks after the radiation therapy or the control balloon dilations. With regard to complete blood cell counts, liver function tests, lipid profiles and coagulation tests, there were no differences between the baseline and after radiation. On quantitative coronary angiographic analysis, reference and target artery diameter showed no differences between the 2 groups before, or 4 and 8 weeks after stenting. On histopathologic analysis of groups I and II, the injury score was 1.34+/-0.09 and 1.32+/-0.10, the area of internal elastic lamina was 4.99+/-0.17 mm(2) and 4.82+/-0.20 mm(2), and the luminal area was 3.20+/-0.10 mm(2) and 3.45+/-0.14 mm(2), respectively (p=NS). The neointimal area was 1.78+/-0.11 mm(2) in group I and 1.36+/-0.12 mm(2) in group II (p=0.017), and the histopathologic area of stenosis was 35.1+/-1.6% in group I and 27.6+/-1.9% in group II (p=0.005). In conclusion, beta-radiation of the stented porcine coronary artery using a radioactive (166)Ho coated balloon inhibited stent restenosis without any side effects.
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Affiliation(s)
- Weon Kim
- The Heart Center, Chonnam National University Hospital, Gwang Ju, Korea
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Hong YJ, Jeong MH, Lee SH, Park OY, Jeong WK, Lee SR, Kim W, Rhew JY, Lee SH, Ahn YK, Cho JG, Ahn BH, Park JC, Kim SH, Kang JC. The long-term clinical outcomes after rescue percutaneous coronary intervention in patients with acute myocardial infarction. J Interv Cardiol 2003; 16:209-16. [PMID: 12800398 DOI: 10.1034/j.1600-0854.2003.8048.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rescue percutaneous coronary intervention (PCI) has been used to treat patients after failed thrombolysis in acute myocardial infarction. However, the short- and long-term benefits of rescue PCI have not been known exactly. The goal of this study was to examine the clinical and angiographic outcomes, the success rate of the procedure, and the long-term survival rate after rescue PCI. The clinical and angiographic outcomes of 31 patients (Group I; 59.7 +/- 11.4 years, 80.6% male), who underwent rescue PCI were compared with those of 177 patients (Group II; 59.7 +/- 9.7 years, 79.7% male), who underwent primary PCI at Chonnam National University Hospital between January 1997 and December 1999. There were no significant differences in the risk factors for coronary artery diseases except for smoking (Group I; 24/31, 77.4% vs. Group II; 76/177, 42.9%, P = 0.011). The incidence of cardiogenic shock was higher in Group I than in Group II (Group I; 7/31, 22.6% vs. Group II; 11/177, 6.2%, P = 0.021). The coronary angiographic findings were not different between two groups, except for Thrombolysis in Myocardial Infarction (TIMI) flow of Group I was lower than in Group II (Group I; 1.14 +/- 0.93 vs. Group II; 1.61 +/- 1.14, P = 0.001). The primary success rate was 93.6% (29/31) in Group I and 94.9% (168/177) in Group II (P = 0.578). The baseline ejection fraction was lower in Group I than in Group II (Group I; 44.2 +/- 8.9% vs. Group II; 50.8 +/- 11.7, P = 0.023), which improved in both groups (Group I; 51.7 +/- 7.9% vs. Group II; 60.7 +/- 13.4%, P = 0.001 respectively) at 6 months after the procedures. The survival rates of Group I were 93.5%, 93.5%, and 90.3% and those of Group II were 94.5%, 93.7%, and 91% at 1, 6, and 12 months, respectively. Rescue PCI is associated with the risk factor of smoking. The indication for rescue PCI was more common in patents with cardiogenic shock. The success rate of rescue PCI was comparable to that of primary PCI, and left ventricular function is improved after rescue PCI on long-term clinical follow-up with relatively high survival rate.
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Affiliation(s)
- Young Joon Hong
- Heart Center of Chonnam National University Hospital, Research Institute of Medical Sciences, Chonnam National University, 8 Hak Dong, Dong Ku, Gwang Ju 501-757, Korea
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Lee SR, Jeong MH, Rhew JY, Ahn YK, Na KJ, Song HC, Bom HS, Cho JG, Ahn BH, Park JC, Kim SH, Kang JC. Simultaneous coronary - subclavian and vertebral - subclavian steal syndrome. Circ J 2003; 67:464-6. [PMID: 12736489 DOI: 10.1253/circj.67.464] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Atherosclerotic disease of the coronary artery may simultaneously involve the subclavian artery, and a significant stenosis of the left subclavian artery may result in recurrent myocardial ischemia in patients with patent left internal mammary artery (LIMA) grafts because of 'coronary steal' through the LIMA. Isometric exercise of the left arm may improve myocardial perfusion through vertebral - subclavian steal by flow reversal in the ipsilateral vertebral artery because of the change in the pressure gradient between the circle of Willis and the distal subclavian artery. The present patient had coronary steal through a LIMA after coronary artery bypass surgery and a transient vertebral - subclavian steal with improved myocardial perfusion as a result of exercise of the left arm.
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Affiliation(s)
- Sang Rok Lee
- The Heart Center, Chonnam National University Hospital and Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
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Kim JH, Jeong MH, Rhew JY, Yang B, Sim DS, Lim SY, Hong YJ, Park OY, Park WS, Kim W, Ahn YK, Moon Y, Cho JG, Chun J. The Long-Term Clinical Outcomes of Low Molecular Weight Heparin Combined with Platelet Glycoprotein IIb/IIIa Inhibitor in Patients with Acute Coronary Syndrome. Korean Circ J 2003. [DOI: 10.4070/kcj.2003.33.7.559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jay Young Rhew
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Bora Yang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Du Sun Sim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Sang Yup Lim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ok Young Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Woo Seok Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Weon Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Keun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Yong Moon
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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