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Rha SW, Lee K, Choi SY, Byun JK, Cha J, Hyun S, Ahn WJ, Park S, Kang DO, Park EJ, Choi CU, Choi BG. Long-term prognostic factors for cardiovascular events in patients with chest pain without diabetes mellitus nor significant coronary stenosis. Heart Vessels 2024; 39:382-391. [PMID: 38324195 DOI: 10.1007/s00380-023-02348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024]
Abstract
Chest pain is the most common symptom of coronary artery disease (CAD) and diabetes mellitus (DM) is a well-known single strongest risk factor for cardiovascular diseases. Thus, the impact of CAD nor DM on long-term clinical effects is reported widely, but the prognostic factors of non-DM patients presenting with chest pain without significant CAD are limited. A total of 1,046 patients with chest pain without DM and significant CAD who underwent coronary angiography (CAG) and acetylcholine (ACH) provocation tests were finally enrolled. Propensity score matching and multivariate Cox-proportional hazard ratio analysis were performed to adjust for baseline potential confounders. Major adverse cardiac and cerebrovascular events (MACCE) were defined as the composite of total death, myocardial infarction (MI), revascularization, stroke, and recurrent angina. This study aimed to evaluate the long-term prognostic factors for MACCE in patients with chest pain without DM and CAD up to 5 years. Coronary artery spasm (CAS) was the most common cause of chest pain. However, long-term MACCE of CAS was not worse than those of patients with chest pain without CAS when patients with CAS had subsequent optimal antianginal medication therapy. However, a recurrent chest pain remains a problem even with continuous antianginal medication therapy. Up to 5 years, the incidence of MACCE was in 7.3%, including recurrent angina 6.9%. Dyslipidemia (HR: 2.010, 95% CI 1.166-3.466, P = 0.012), mild-moderate (30-70%) coronary stenosis (HR: 2.369, 95% CI 1.118-5.018, P = 0.024), the use of aspirin (HR: 2.885, 95% CI 1.588-5.238, P < 0.001), and the use of nitrates (HR: 1.938, 95% CI 1.094-3.433, P = 0.023) were independent risk factors for MACCE. Among the patients with chest pain without DM and significant CAD, the incidence of MACE were rare, but recurrent angina was still a challenging problem who had treated with antianginal medications.
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Affiliation(s)
- Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
| | - Kyuho Lee
- Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Suwon, Korea
- Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Seoul, Korea
| | - Se Yeon Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Jinah Cha
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Sujin Hyun
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Woo Jin Ahn
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Soohyung Park
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Dong Oh Kang
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Eun Jin Park
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Cheol Ung Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea.
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Rha SW, Lee K, Choi SY, Byun JK, Cha J, Hyun S, Ahn WJ, Park S, Kang DO, Park EJ, Choi CU, Choi BG. Correction: Long-term prognostic factors for cardiovascular events in patients with chest pain without diabetes mellitus nor significant coronary stenosis. Heart Vessels 2024; 39:392. [PMID: 38551702 DOI: 10.1007/s00380-024-02391-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
| | - Kyuho Lee
- Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Suwon, Korea
- Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Seoul, Korea
| | - Se Yeon Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Jinah Cha
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Sujin Hyun
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Woo Jin Ahn
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Soohyung Park
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Dong Oh Kang
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Eun Jin Park
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Cheol Ung Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea.
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An SJ, Ahn WJ, Rha SW, Park S, Hyun SJ, Cha JA, Byun JK, Choi SY, Choi CU, Oh DJ, Choi BG. Impact of hyperuricemia on 5-year clinical outcomes in patients with critical limb ischemia following percutaneous transluminal angioplasty. Coron Artery Dis 2024; 35:201-208. [PMID: 38451555 DOI: 10.1097/mca.0000000000001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/08/2024]
Abstract
BACKGROUND A growing evidence on the correlation between hyperuricemia and cardiovascular disease (CVD) has been previously reported. However, there have been limited data on the impact of hyperuricemia on long-term clinical outcomes in patients with critical limb ischemia (CLI) who underwent percutaneous transluminal angioplasty (PTA). METHODS A total of 425 peripheral artery disease patients who underwent PTA for CLI were enrolled. The patients were divided into the hyperuricemia group (n = 101) and the normal group (n = 324). The primary endpoint was major adverse cerebral and cardiovascular event (MACCE), including death, myocardial infarction, any coronary revascularization, and stroke, up to 5 years. The secondary endpoint was a major adverse limb event (MALE), including any repeated PTA, and target extremity surgery. Inverse probability weighting (IPTW) analysis, derived from the logistic regression model, was performed to adjust for potential confounders. RESULTS After IPTW matching analysis, compared to the normal group, the hyperuricemia group was associated with a higher incidence of MACCE (20.7% vs. 13.6%, hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.15-2.38, P = 0.006) including non-cardiac death (11.7% vs. 6.3%, HR: 1.95, 95% CI: 1.19-3.19, P = 0.006) and MALE (47.7% vs. 36.0%, HR: 1.62, 95% CI: 1.23-2.13, P = 0.001) including non-target extremity revascularization (15.0% vs. 6.8%, HR: 2.42, 95% CI: 1.52-3.84, P < 0.001). CONCLUSION In the present study, hyperuricemia was associated with worse clinical outcomes in patients with CLI following PTA during 5-year clinical follow-up. Efficacy of controlling hyperuricemia in improving clinical outcomes should be evaluated in further studies.
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Affiliation(s)
| | - Woo Jin Ahn
- Department of Medicine, Tongyeong Detention Center, Korea Correctional Service, Ministry of Justice, Tongyeong
| | | | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital
| | - Su Jin Hyun
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | - Jin Ah Cha
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | - Se Yeon Choi
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | | | - Dong Joo Oh
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University, Seoul, Korea
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Cha J, Choi SY, Rha SW, Choi BG, Byun JK, Hyun S, Lee MW, Kang J, Chu W, Park EJ, Kang DO, Choi CU, Kim SW, Jeong MH, Park S. Long-term air pollution exposure is associated with higher incidence of ST-elevation myocardial infarction and in-hospital cardiogenic shock. Sci Rep 2024; 14:4976. [PMID: 38424210 PMCID: PMC10904831 DOI: 10.1038/s41598-024-55682-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Previous studies have reported the association between myocardial infarction (MI) and air pollution (AP). However, limited information is available regarding the long-term effects of AP on the relative incidence rates of ST-elevation MI (STEMI) and Non-ST-elevation MI (NSTEMI). We investigated the association between long-term exposure to AP and the incidence of STEMI. Between January 2006 and December 2015, a total of 45,619 eligible patients with Acute Myocardial Infarction (AMI) were enrolled in the Korea Acute MI Registry (KAMIR) and KAMIR-National Institutes of Health. Mixed-effect regression models were used to examine the association between the annual average ambient AP before MI onset and the incidence of STEMI, and to evaluate the association of AP with the incidence of in-hospital cardiogenic shock. After mixed-effect regression model analysis, particulate matter (PM) 10 µm or less in diameter (PM10) was associated with increased incidence of STEMI compared with NSTEMI (odds ratio [OR] 1.009, 95% Confidence Interval [CI] 1.002-1.016; p = 0.012). For in-hospital cardiogenic shock complication, PM10 and SO2 were associated with increased risk, PM10 (OR 1.033, 95% CI 1.018-1.050; p < 0.001), SO2 (OR 1.104, 95% CI 1.006-1.212; p = 0.037), respectively. Policy-level strategies and clinical efforts to reduce AP exposure are necessary to prevent the incidence of STEMI and severe cardiovascular complications.
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Affiliation(s)
- Jinah Cha
- BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, 02841, Republic of Korea
- Department of Cardiology, Cardiovascular Center, Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea
| | - Se Yeon Choi
- Cardiovascular Research Institution, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Seung-Woon Rha
- BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, 02841, Republic of Korea.
| | - Byoung Geol Choi
- Cardiovascular Research Institution, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institution, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Sujin Hyun
- Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Seoul, 02841, Republic of Korea
| | - Min Woo Lee
- Research Institute of Health Science, Korea University, Seoul, 02841, Republic of Korea
| | - Jaeho Kang
- Department of Cardiology, Cardiovascular Center, Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea
| | - Wonsang Chu
- Department of Cardiology, Cardiovascular Center, Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea
| | - Eun Jin Park
- Department of Cardiology, Cardiovascular Center, Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea
| | - Dong Oh Kang
- Department of Cardiology, Cardiovascular Center, Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea
| | - Cheol Ung Choi
- Department of Cardiology, Cardiovascular Center, Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea
| | - Suhng Wook Kim
- School of Health and Environmental Science, College of Health Sciences, Korea University, Seoul, 02841, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Soohyung Park
- Department of Cardiology, Cardiovascular Center, Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea.
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Ahn WJ, An SJ, Rha SW, Park S, Hyun SJ, Cha JA, Byun JK, Choi SY, Choi CU, Oh DJ, Choi BG. Impact of hyperuricemia on 5-year clinical outcomes following percutaneous transluminal angioplasty. Cardiovasc Revasc Med 2024:S1553-8389(24)00045-9. [PMID: 38369415 DOI: 10.1016/j.carrev.2024.02.006] [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: 08/29/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Although the correlation between hyperuricemia and cardiovascular disease (CVD) is well known, there have been limited data regarding the impact of hyperuricemia on long-term clinical outcomes in patients with peripheral arterial disease (PAD) after percutaneous transluminal angioplasty (PTA). METHODS A total of 718 patients who underwent PTA for PAD were enrolled. The patients were divided into the hyperuricemia group (N = 168) and the normal group (N = 550). Hyperuricemia was defined as a uric acid level ≥ 7.0 mg/dL in men, and ≥ 6.5 mg/dL in women. The primary endpoint was major adverse cerebral and cardiovascular event (MACCE), including death, myocardial infarction (MI), any coronary revascularization, and stroke, up to 5 years. The secondary endpoint was major adverse limb event (MALE), including any repeated PTA, and target extremity surgery (TES). Inverse probability weighting (IPTW) analysis, derived from the logistic regression model, was performed to adjust potential confounders. RESULTS After IPTW matching analysis, compared to the normal group, the hyperuricemia group was not associated with increased MACCE but was associated with an increased incidence of MI (2.6 % vs. 0.5 %, p = 0.001), and coronary revascularization (6.7 % vs. 3.9 %, p = 0.018). Also, the hyperuricemia group was associated with a higher incidence of MALE (45.3 % vs. 28.9 %, p < 0.001), including target extremity revascularization (TER; 25.1 % vs. 15.9 %, p < 0.001), non-TER (11.5 % vs. 5.6 %, p < 0.001), and TES (22.8 % vs. 16.2 %, p = 0.002). CONCLUSIONS In the present study, hyperuricemia was associated with worse clinical outcomes in PAD patients following PTA during 5-year clinical follow-up. Further investigations should be made regarding the clinical benefit of controlling hyperuricemia on clinical outcomes.
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Affiliation(s)
- Woo Jin Ahn
- Department of Medicine, Tongyeong Detention Center, Korea Correctional Service, Ministry of Justice, Republic of Korea
| | - Seong Joon An
- Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Su Jin Hyun
- Cardiovascular Research Institute, Korea University, Seoul, Republic of Korea
| | - Jin Ah Cha
- Cardiovascular Research Institute, Korea University, Seoul, Republic of Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institute, Korea University, Seoul, Republic of Korea
| | - Se Yeon Choi
- Cardiovascular Research Institute, Korea University, Seoul, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Dong Joo Oh
- Cardiovascular Research Institute, Korea University, Seoul, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University, Seoul, Republic of Korea.
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Park S, Rha SW, Choi BG, Kim W, Choi WG, Lee SJ, Lee JB, Park JY, Park SM, Jeong MH, Kim YH, Her AY, Kim MW, Chen KY, Kim BK, Shin ES, Seo JB, Ahn J, Choi SY, Byun JK, Cha JA, Hyun SJ, Choi CU, Park CG. Efficacy and safety of cilostazol-based triple antiplatelet therapy compared with clopidogrel-based dual antiplatelet therapy in patients with acute ST-elevation myocardial infarction undergoing percutaneous coronary intervention: A multicenter, randomized, open-label, phase 4 trial. Am Heart J 2023; 265:11-21. [PMID: 37406923 DOI: 10.1016/j.ahj.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Previous studies reported that compared to conventional dual antiplatelet therapy (DAT; aspirin + clopidogrel), triple antiplatelet therapy (TAT), involving the addition of cilostazol to DAT, had better clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). However, the optimal duration of TAT is yet to be determined. METHODS In total, 985 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) were prospectively enrolled in 15 PCI centers in South Korea and China. We randomly assigned patients into 3 groups: DAT (aspirin and clopidogrel for 12 months), TAT 1M (aspirin, clopidogrel, and cilostazol for 1 month), and TAT 6M (aspirin, clopidogrel, and cilostazol for 6 months). The primary endpoint was 1-year major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, recurrent myocardial infarction, stroke, or repeat revascularization. RESULTS The primary endpoint did not differ among the 3 groups (8.8% in DAT, 11.0% in TAT 1M, and 11.6% in TAT 6M; hazard ratio for TAT 1M vs DAT, 1.302; 95% confidence interval [CI], 0.792-2.141; P = .297; hazard ratio for TAT 6M vs DAT, 1.358; 95% CI, 0.829-2.225; P = .225). With respect to in-hospital outcomes, more bleeding events occurred in the TAT group than in the DAT group (1.3% vs 4.7% vs 2.6%, P = .029), with no significant differences in major bleeding events. Additionally, the TAT group had a higher incidence of headaches (0% vs 1.6% vs 2.6%, P = .020). CONCLUSIONS The addition of cilostazol to DAT did not reduce the incidence of 1-year MACEs compared with DAT alone. Instead, it may be associated with an increased risk of drug intolerance and side effects, including in-hospital bleeding and headaches.
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Affiliation(s)
- Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea; Cardiovascular Research Institute, Korea University, Seoul, South Korea.
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea; Cardiovascular Research Institute, Korea University, Seoul, South Korea
| | - Woohyeun Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Woong Gil Choi
- Cardiovascular Center, Chungbuk National University Hospital, Cheongju, South Korea
| | - Seung Jin Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, South Korea
| | - Jae Beom Lee
- Division of Cardiology, Department of Internal Medicine, Anyang SAM Hospital, Anyang, South Korea
| | - Ji Young Park
- Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Sang Min Park
- Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Myung Ho Jeong
- Heart Research Center, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Min Woong Kim
- Hanyang University Hanmaeum Changwon Hospital, Changwon, South Korea
| | - Kang-Yin Chen
- Cardiology Department, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Bae Keun Kim
- Department of Internal Medicine, Sungae Hospital, Seoul, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jihun Ahn
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, South Korea
| | - Se Yeon Choi
- Cardiovascular Research Institute, Korea University, Seoul, South Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institute, Korea University, Seoul, South Korea
| | - Jin Ah Cha
- Cardiovascular Research Institute, Korea University, Seoul, South Korea
| | - Su Jin Hyun
- Cardiovascular Research Institute, Korea University, Seoul, South Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
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Park S, Rha SW, Choi BG, Cho JH, Park SH, Lee JB, Kim YH, Park SM, Choi JW, Park JY, Shin ES, Lee JB, Suh J, Chae JK, Choi YJ, Jeong MH, Cha KS, Lee SW, Kim U, Kim GC, Choi WG, Cho YH, Cho DK, Ahn J, Suh SY, Choi SY, Byun JK, Cha JA, Hyun SJ, Kim JB, Choi CU, Park CG. Immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: results from a prematurely discontinued randomized multicenter trial. Am Heart J 2023; 259:58-67. [PMID: 36754106 DOI: 10.1016/j.ahj.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/30/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND We aimed to compare clinical outcomes between immediate and staged complete revascularization in primary percutaneous coronary intervention (PCI) for treating ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD). METHODS A total of 248 patients were enrolled in a prospective, randomized, and multicenter registry. Immediate revascularization was defined as one-time PCI of culprit and non-culprit lesions at the initial procedure. Staged revascularization was defined as PCI of non-culprit lesions at a later date (mean, 4.4 days; interquartile range, 1-11.4), following initial culprit revascularization. The end points were major adverse cardiovascular events (MACE; composite of total death, recurrent myocardial infarction, and revascularization), any individual components of MACE, cardiac death, stent thrombosis, and stroke at 12 months. RESULTS During a follow-up of 1 year, MACE occurred in 12 patients (11.6%) in the immediate revascularization group and in 8 patients (7.5%) in staged revascularization group (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.65-3.91). The incidence of total death was numerically higher in the immediate group than in the staged group (9.7% vs 2.8%, HR 3.53, 95% CI 0.97-12.84); There were no significant differences between the 2 groups in risks of any individual component of MACE, cardiac death, stroke, and in-hospital complications, such as need for transfusion, bleeding, acute renal failure, and acute heart failure. This study was prematurely terminated due to halt of production of everolimus-eluting stents (manufactured as PROMUS Element by Boston Scientific, Natick, Massachusetts). CONCLUSIONS Due to its limited power, no definite conclusion can be drawn regarding complete revascularization strategy from the present study. Further large randomized clinical trials would be warranted to confirm optimal timing of complete revascularization for patients with STEMI and MVD.
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Affiliation(s)
- Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea; Cardiovascular Research Institute, Korea University, Seoul, Korea.
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | | | - Sang Ho Park
- Soonchunhyang University Hospital, Cheonan, Korea
| | - Jin Bae Lee
- Daegu Catholic University Medical Center, Daegu, Korea
| | - Yong Hoon Kim
- Kangwon National University School of Medicine, Chuncheon, Korea
| | | | | | | | | | | | - Jon Suh
- Soonchunhyang University Hospital, Bucheon, Korea
| | | | | | | | | | | | - Ung Kim
- Yeungnam University, Daegu, Korea
| | | | | | | | | | - Jihun Ahn
- Daejeon Eulji Medical Center, Eulji University Hospital, Daejeon, Korea
| | | | - Se Yeon Choi
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | - Jin Ah Cha
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | - Soo Jin Hyun
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | - Ji Bak Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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Cha J, Rha SW, Choi BG, Choi SY, Byun JK, Hyun S, Park S, Kim JB, Choi CU, Jeong MH. CRT-100.9 Comparison for Use of Telmisartan and Candesartan on 3-Year Clinical Outcomes After Acute Myocardial Infarction in Korean Population: From the Korea Acute Myocardial Infarction Registry-National Institutes of Health. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.082] [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: 02/22/2023]
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Cha J, Rha SW, Choi SY, Choi BG, Byun JK, Hyun S, Park S, Kim JB, Choi CU, Jeong MH. CRT-101.07 The Association Between Air Pollution and Relative Incidence of ST-Elevation Myocardial Infarction Compared With Non-ST-Elevation Myocardial Infarction. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.059] [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: 02/22/2023]
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Byun JK, Rha SW, Choi BG, Choi SY, Cha J, Hyun S, Park S, Kim JB, Choi CU. CRT-100.79 Differences in Clinical and Angiographic Parameters of Intracoronary Ergonovine and Acetylcholine to Coronary Spasm Provocation Test in Smokers. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.133] [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: 02/22/2023]
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11
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Byun JK, Rha SW, Choi BG, Choi SY, Cha J, Hyun S, Park S, Kim JB, Choi CU. CRT-101.05 Differences in Clinical and Angiographic Parameters of Intracoronary Ergonovine and Acetylcholine to Coronary Spasm Provocation Test in Dyslipidemia. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.140] [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: 02/22/2023]
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12
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Cha J, Rha SW, Choi BG, Choi SY, Byun JK, Hyun S, Park S, Kim JB, Choi CU. CRT-100.45 Differences in Clinical and Angiographic Parameters Following Intracoronary Ergonovine and Acetylcholine Provocation Test in Elderly Patients. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.127] [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: 02/22/2023]
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13
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Cha J, Rha SW, Lee SY, Choi SY, Byun JK, Kang DO, Kim JB, Kim EJ, Park CG. TCT-292 Differences in Clinical and Angiographic Parameters Following Intracoronary Ergnovine and Acetylcholine Provocation Test in Young Patients. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.343] [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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14
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Rha SW, Lee SY, Choi SY, Byun JK, Cha J, Kang DO, Kim JB, Kim EJ. TCT-161 Evaluation of Effectiveness and Safety of Ultimaster Stent in Routine Clinical Practice; A Multicenter, Prospective, Observational Study. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.189] [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: 10/14/2022]
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15
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Choi SY, Rha SW, Cha J, Byun JK, Choi BG, Jeong MH. Association of air pollution and 1-year clinical outcomes of patients with acute myocardial infarction. PLoS One 2022; 17:e0272328. [PMID: 35913935 PMCID: PMC9342741 DOI: 10.1371/journal.pone.0272328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Exposure to air pollution (AP) is an important environmental risk factor for increased risk of cardiovascular morbidity and triggering acute myocardial infarction (AMI). However, there are limited data regarding the clinical impact of AP on long-term major clinical outcomes of AMI patients. This study aimed to evaluate the clinical effects of ambient AP concentration on short-term and 1-year clinical outcomes of AMI patients.
Methods
A total of 46,263 eligible patients were enrolled in the Korea Acute Myocardial Infarction (KAMIR) and KAMIR-National Institutes of Health (NIH) registry from January 2006 to December 2015. We performed Cox proportional hazard regression to assess the risk of all-cause death and any-revascularization according to the annual average concentration of AP during one-year follow-up period.
Results
The assessment of the annual average of air pollutants before symptom date and all-cause death up to 30 days showed the hazard ratio (HR) of SO2 per 1 part per billion (ppb) increase was 1.084 (95% confidence interval [CI]: 1.016–1.157), and particulate matter with diameter of 10 microns or less (PM10) per 1 μg/m3 increase was 1.011 (95% CI: 1.002–1.021). The results of the 30-day and one-year all-cause death showed a similar trend. For SO2, the HR per 1 ppb increase was 1.084 (95% CI: 1.003–1.172), and the HR of PM10 was 1.021 (95% CI: 1.009–1.033) per 1 μg/m3 increase. We observed that SO2, CO, and PM10 were associated with an increased risk of incidence for any-revascularization up to one-year.
Conclusion
In some air pollutants, a higher AP concentration was an environmental risk factor for poor prognosis in AMI patients up to 1 year. AMI patients and high-risk individuals need a strategy to reduce or prevent exposure to high AP concentrations.
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Affiliation(s)
- Se Yeon Choi
- Cardiovascular Research Institution, Korea University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
- * E-mail:
| | - Jinah Cha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
- BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institution, Korea University College of Medicine, Seoul, Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institution, Korea University College of Medicine, Seoul, Korea
| | - Myung ho Jeong
- Division of Cardiology, Department of Medicine, Chonnam National University Hospital, Gwangju, Korea
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Choi SY, Rha SW, Choi BG, Byun JK, Cha J, Battumur B. Comparison of Atorvastatin and Pitavastatin Therapy in Acute Myocardial Infarction Patients With Diabetes Mellitus Who Underwent Successful Percutaneous Coronary Intervention. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Byun JK, Rha SW, Choi SY, Cha J, Battumur B. The Predictors of Mortality for Acute Myocardial Infarction Patients Without Co-Morbidity Disease (From KAMIR-NIH Registry). Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cha J, Rha SW, Choi BG, Choi SY, Byun JK, Battumur B. The Predictors of New-Onset Heart Failure Hospitalization in the Elderly With Acute Myocardial Infarction: From the Korea Acute Myocardial Infarction Registry – National Institutes of Health (KAMIR-NIH). Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Rha SW, Choi BG, Choi SY, Byun JK, Cha J, Battumur B, Park S, Lee J. Impact of Complete Revascularization in Chronic Total Occlusion Patients With Multi-Vessel Disease on Long-Term Clinical Outcomes. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rha SW, Choi BG, Choi SY, Byun JK, Cha J, Battumur B, Park S, Lee J. Comparison for Use of Telmisartan and Losartan on 3-Year Clinical Outcomes After Acute Myocardial Infarction in Korean Population. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Choi BG, Rha SW, Choi SY, Byun JK, Cha J, Battumur B. Comparison for Use of Losartan and Ramipril on 3-Year Clinical Outcomes After Acute Myocardial Infarction in Korean Population. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Lee H, Park HE, Chun EJ, Chang HJ, Sung J, Jung HO, Choi SY. The impact of nonoptimal lipids on the progression of coronary artery calcification in asymptomatic young adults: results from the KOICA registry. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Recently, as cumulative exposure of lipids for a lifetime has become important to prevent and predict atherosclerotic cardiovascular disease (ASCVD), it is recommended to obtain the optimal lipid levels from a young age. However, questions remain regarding the vascular changes in young adulthood by nonoptimal lipid levels.
Purpose
We aimed to investigate the progression of coronary artery calcification (CAC) according to lipid profiles in Korean young adults.
Methods
From the KOrea Initiative on Coronary Artery calcification registry, we collected 2,940 statin-naïve adults under 45-year-old, undergoing serial coronary artery calcium scans for the purpose of routine health check-ups between 2002 and 2017. CAC progression was assessed according to the optimality of lipid levels and each lipid variable.
Results
In this cohort (mean age, 41.3 years; man 82.4%), only 477 subjects (16.2%) had the optimal lipid profile, defined as triglycerides <150 mg/dl, LDL cholesterol <100 mg/dl, and HDL cholesterol ≥45 mg/dl. During follow-up (median 39.7 months), CAC progression was observed in 438 participants (14.8%) and more frequent in nonoptimal lipid group (16.5% vs 5.9%; p<0.001). Nonoptimal lipid levels during young adulthood increased the risk of CAC progression after adjusting for other cardiovascular risk factors (adjusted HR, 2.36; p=0.001), with a stepwise risk increase according to lipid levels. In particular, in the subjects with an initial calcium score of zero (adjusted HR, 2.13; p=0.014), those in their 20s or 30s (adjusted HR 2.70; p=0.029), and those without any other risk factors (adjusted HR 2.51; p=0.025), deemed as very low-risk groups, nonoptimal lipid levels more than doubled the risk of CAC progression, respectively. Among lipid variables, high triglycerides appeared to provide the greatest impact on CAC progression of young adults.
Conclusions
The proportion of young adults with optimal lipid levels was lower than expected. Nonoptimal lipid level was significantly associated with the risk of CAC progression in young adults, even with low-risk. Triglycerides had the strongest association with the risk of CAC progression. Screening and intervention for nonoptimal lipid levels, particularly triglycerides, from an early age might be of clinical value.
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Affiliation(s)
- H Lee
- Seoul National University Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - HE Park
- Seoul National University Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - EJ Chun
- Seoul National University Bundang Hospital, Division of Radiology, Seongnam, Korea (Republic of)
| | - HJ Chang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J Sung
- Samsung Medical Center, Division of Cardiology, Seoul, Korea (Republic of)
| | - HO Jung
- The Catholic University of Korea Seoul St. Mary's Hospital, Division of Cardiology, Seoul, Korea (Republic of)
| | - SY Choi
- Seoul National University Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
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Ali J, Rha SW, Choi BG, Byun JK, Choi SY, Cha JA, Park S, Lee K, Back S, Lee J, Kang DO, Choi JY, Roh SY, Na JO, Choi CU, Kim JW, Kim EJ, Park CG, Seo HS, Wasim M, Hassan Z. Impact of Drug-Eluting Stent-associated Coronary Artery Spasm on 3-Year Clinical Outcomes: A Propensity Score Matching Analysis. Indian Heart J 2022; 74:182-186. [PMID: 35576993 PMCID: PMC9243619 DOI: 10.1016/j.ihj.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/26/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background It has been reported that significant endothelial dysfunction or clinically evident vasospasm can be associated with drug-eluting stents (DESs). However, the impact of DES associated coronary artery spasm (CAS) on long-term clinical outcomes has not been fully elucidated as compared with those of patients with vasospastic angina. Methods A total of 2797 consecutive patients without significant coronary artery lesion (<70%), who underwent the Acetylcholine (Ach) provocation test, were enrolled between Nov 2004 and Oct 2010. DES-associated spasm was defined as significant CAS in proximal or distal to previously implanted DES site at follow-up angiography with Ach test. Patients were divided into two groups (DES-CAS; n = 108, CAS; n = 1878). For adjustment, propensity score matching (PSM) was done (C-statistics = 0.766, DES-CAS; n = 102, CAS; n = 102). SPSS 20 (Inc., Chicago, Illinois) was used to analyze this data. Results Baseline characteristics were worse in the DES-CAS group. After PSM, both baseline characteristics and the Ach test results were balanced except higher incidence of diffuse CAS and ECG change in the DES-CAS group. During Ach test, the incidence of diffuse spasm (93.1% vs. 81.3%, p = 0.012) and ST-T change (10.7% vs. 1.9%, p = 0.010) were higher in the DES-CAS group. At 3-year, before and after adjustment, the DES-CAS group showed a higher incidence of coronary revascularization (9.8% vs. 0.0%, p = 0.001), recurrent chest pain requiring follow up coronary angiography (CAG, 24.5% vs. 7.8%, p = 0.001) and major adverse cardiac events (MACEs, 9.8% vs. 0.9%, p < 0.005). Conclusion In this study, DES associated CAS was associated with higher incidence of diffuse spasm, ST-T change and adverse 3-year clinical outcomes. Special caution should be exercised in this particular subset of patients.
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Rha SW, Choi BG, Choi SY, Byun JK, Cha J, Battumur B, Park S, Lee J. CRT-100.30 Comparison for Use of Telmisartan and Losartan on 3-Year Clinical Outcomes After Acute Myocardial Infarction in Korean Population. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.093] [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: 11/15/2022]
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25
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Rha SW, Choi BG, Choi SY, Byun JK, Cha J, Battumur B, Park S, Lee J. CRT-100.66 Impact of Complete Revascularization in Chronic Total Occlusion Patients With Multi-Vessel Disease on Long-Term Clinical Outcomes. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Choi SY, Rha SW, Choi BG, Byun JK, Cha J, Battumur B. CRT-100.61 Comparison of Atorvastatin and Pitavastatin Therapy in Acute Myocardial Infarction Patients With Diabetes Mellitus Who Underwent Successful Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.117] [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: 11/16/2022]
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27
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Rha SW, Choi BG, Choi SY, Byun JK, Cha J, Battumur B, Park S, Lee J. CRT-100.91 Impact of Coronary Artery Spasm on Long-Term Clinical Outcomes for Patients With Chest Pain Without Diabetes Mellitus in Korean Population. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.139] [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: 10/19/2022]
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28
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Kim MJ, Kim JW, Kim MS, Choi SY, Na JI. Generalized erythema multiforme-like skin rash following the first dose of COVID-19 vaccine (Pfizer-BioNTech). J Eur Acad Dermatol Venereol 2021; 36:e98-e100. [PMID: 34661942 PMCID: PMC8656619 DOI: 10.1111/jdv.17757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022]
Affiliation(s)
- M J Kim
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - J W Kim
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - M S Kim
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - S Y Choi
- Department of Dermatology, Ilsan Paik Hospital, Inje University, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, Korea
| | - J I Na
- Department of Dermatology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
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29
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Li H, Rha SW, Choi BG, Choi SY, Moon SK, Jang WY, Kim W, Ahn JH, Park SH, Choi WG, Yang RF, Bai WW, Choi CU, Ryu YG, Baek MJ, Oh DJ. Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent. BMC Cardiovasc Disord 2021; 21:323. [PMID: 34193057 PMCID: PMC8246708 DOI: 10.1186/s12872-021-02141-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/24/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. METHODS In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. RESULTS We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). CONCLUSIONS COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting.
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Affiliation(s)
- Hu Li
- Department of Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.,Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Sang Ki Moon
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Ji Hun Ahn
- Department of Cardiology, Soon Chun Hyang University Gumi Hospital, Gumi-si, Republic of Korea
| | - Sang-Ho Park
- Department of Cardiology, Soonchunhyang University Cheonan Hospital Korea, Cheonan-Ii, Republic of Korea
| | - Woong Gil Choi
- Department of Internal Medicine, School of Medicine, Konkuk University, Chungju, Republic of Korea
| | - Rui Feng Yang
- Department of Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wen Wei Bai
- Department of Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Yang Gi Ryu
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Man Jong Baek
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Dong Joo Oh
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
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Choi JY, Rha SW, Choi BG, Choi SY, Byun JK, Jang WY, Kim W, Na JO, Choi CU, Kim EJ, Park CG, Seo HS. Percutaneous Coronary Intervention for Chronic Total Occlusion in Single Coronary Arteries. Tex Heart Inst J 2021; 48:466220. [PMID: 34111277 DOI: 10.14503/thij-19-7023] [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] [Indexed: 11/23/2022]
Abstract
We retrospectively compared the results of percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) for chronic total occlusion (CTO) in single coronary arteries to determine whether outcomes depend on the artery involved. From January 2004 through November 2015, a total of 731 patients were treated at our center for CTO in the left anterior descending coronary artery (LAD) (234 patients, 32%), left circumflex coronary artery (LCx) (184, 25.2%), or right coronary artery (RCA) (313, 42.8%). We further classified patients by treatment (PCI or OMT) and compared the cumulative incidence of major adverse cardiac events (MACE) and the composite of total death or myocardial infarction, as well as change in left ventricular ejection fraction from baseline. The 5-year cumulative incidence of MACE was similar between the treatment groups regardless of target vessel. The 5-year cumulative incidence of the composite of total death or myocardial infarction was significantly lower after PCI than after OMT or failed PCI in the LCx (2.6% vs 11.5%; P=0.020; log-rank) and RCA (5.8% vs 17.2%; P=0.002) groups, but not in the LAD group. Cox proportional hazards regression analysis indicated that PCI independently predicted a lower incidence of the composite of total death or myocardial infarction in the LCx group (hazard ratio [HR]=0.184; 95% CI, 0.0035-0.972; P=0.046) and the RCA group (HR=0.316; 95% CI, 0.119-0.839; P=0.021). The artery involved does not appear to affect clinical outcomes of successful PCI for single-vessel CTO. Further investigation in a randomized clinical trial is warranted.
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Affiliation(s)
- Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jae Kyeong Byun
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
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Ahn J, Byeon J, Choi BG, Choi SY, Byun JK, Cha J, Yu H, Lee C, Na JO, Choi CU, Kim EJ, Park CG, Seo HS, Choi WG, Rha SW. Stenting versus balloon angioplasty alone in patients with below-the-knee disease: A propensity score-matched analysis. PLoS One 2021; 16:e0251755. [PMID: 34111147 PMCID: PMC8191955 DOI: 10.1371/journal.pone.0251755] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022] Open
Abstract
Percutaneous transluminal angioplasty (PTA) is considered an effective treatment in patients with critical limb ischemia (CLI). However, the long-term durability of below-the-knee (BTK) PTA is known to be limited. This study sought to compare the 1-year clinical outcomes following stenting versus balloon angioplasty alone in BTK lesions. This study included 357 consecutive patients (400 limbs, 697 lesions) with BTK lesions who underwent PTA from September 2010 to December 2016. All enrolled patients were treated either by stenting (stent group; 111 limbs of 102 patients) or plain old balloon angioplasty (POBA group; 289 limbs of 255 patients). Stent group includes both primary and provisional stenting. Angiographic outcomes, procedural success, complications, and clinical outcomes were compared between the two groups up to 1 year. After propensity score matching (PSM) analysis, 56 pairs were generated, and the baseline and angiographic characteristics were balanced. The procedural success and complications were similar between the two groups; however, the incidence of procedure-related perforation was higher in the POBA group than in the stenting group [5(11.9%) vs.1 (0.9%), P = 0.009]. Six- to 9-month computed tomography or angiographic follow-up showed similar incidences of binary restenosis, primary patency, and secondary patency. In the 1-year clinical follow-up, there were similar incidences of individual hard endpoints, including mortality, myocardial infarction, limb salvage, and amputation rate, with the exception of target extremity revascularization (TER), which tended to be higher in the stenting group than in the POBA group [21 (20.8%) vs. 11 (10.9%), P = 0.054]. Although there was a trend toward a higher incidence of TER risk in the stenting group, stent implantation, particularly in bail-out stenting seemed to have acceptable 1-year safety and efficacy compared to POBA alone in patients undergoing BTK PTA.
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Affiliation(s)
- Jihun Ahn
- Cardiovascular Center, Konkuk Univesrity Chungju Hospital, Chungju, Korea
| | - JinSu Byeon
- Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University, Seoul, Korea
| | - Se Yeon Choi
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Jae Kyeong Byun
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Jinah Cha
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - HyeYon Yu
- School of Nursing, College of Medicine, Soonchunhyang University, Asan, Korea
| | - Cheolho Lee
- Cardiovascular Center, Konkuk Univesrity Chungju Hospital, Chungju, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Woong-gil Choi
- Cardiovascular Center, Konkuk Univesrity Chungju Hospital, Chungju, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
- * E-mail:
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Choi SY, Hong JY, Kim HJ, Lee GY, Cheong SH, Jung HJ, Bang CH, Lee DH, Jue MS, Kim HO, Park EJ, Ko JY, Son SW. Mask-induced dermatoses during the COVID-19 pandemic: a questionnaire-based study in 12 Korean hospitals. Clin Exp Dermatol 2021; 46:1504-1510. [PMID: 34081799 PMCID: PMC8239570 DOI: 10.1111/ced.14776] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/08/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, various adverse skin reactions to long-term mask wearing have been reported. AIM To assess the clinical features of mask-induced dermatoses and to recommend prevention and treatment options. METHODS From April to August 2020, questionnaires including topics such as demographic information, pre-existing skin disorders, reported mask-related symptoms, daily mask-wearing duration and frequency, types of masks used and whether the participant was a healthcare worker, were distributed to patients in 12 hospitals. Dermatologists assessed skin lesions, confirmed diagnosis and recorded treatments. RESULTS Itchiness was the most frequent symptom, mostly affecting the cheeks. The most common skin disease was new-onset contact dermatitis (33.94%), followed by new-onset acne (16.97%) and worsening of pre-existing acne (16.97%). Daily wearing of masks was significantly (P = 0.02) associated with new-onset contact dermatitis. More than half of patients with pre-existing skin problems experienced disease worsening while wearing masks. Longer duration of wearing (> 6 h/day, P = 0.04) and use of cotton masks (P < 0.001) significantly increased acne flare-up. Healthcare workers had a higher incidence of skin disease. Skin lesions were generally mild and well tolerated with topical treatment. The study had some limitations: the effect of seasonal characteristics and other risk factors were not assessed, and the patients were visiting dermatological clinics and had interest in their skin status, thus, there may have been selection bias. CONCLUSION Mask-induced/-triggered dermatoses contribute to increase the dermatological burden during the pandemic.
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Affiliation(s)
- S Y Choi
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - J Y Hong
- Department of Dermatology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - H J Kim
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - G-Y Lee
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S H Cheong
- Department of Dermatology, Konyang University, Daejeon, Korea
| | - H J Jung
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - C H Bang
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - D H Lee
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - M-S Jue
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - H O Kim
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - E J Park
- Department of Dermatology, College of Medicine, Hallym University, Seoul, Korea
| | - J Y Ko
- Department of Dermatology, Hanyang University College of Medicine and Hanyang University Seoul Hospital, Seoul, Korea
| | - S W Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
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Park SJ, Park JW, Ahn GR, Choi SY, Yoo KH, Li K, Kim BJ. A study of the microbiological profile of filler-induced skin necrosis. Clin Exp Dermatol 2021; 46:901-905. [PMID: 33763910 DOI: 10.1111/ced.14653] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
Skin necrosis is one of the most severe complications following filler injections, and can result in permanent aesthetic defects. Although an increasing number of studies have addressed the management of dermal filler complications, no study has described the spectrum of microbial pathogens. The aim of this study was to delineate the bacterial profile and prognostic factors of filler-related skin necrosis by reviewing the clinical and microbiological features of these patients. A retrospective medical record review of patients undergoing treatment for skin necrosis induced by fillers was conducted. In total, 10 cases were identified, with injection sites being the nasolabial fold (70%; n = 7), nasal dorsum (20%; n = 2) and nasal tip (10%; n = 1). Reviewing the culture results, the true culture-positive rate was found to be 50% after cases of contamination were excluded. To avoid permanent sequelae, all physicians should be aware of possible secondary infections when treating filler-induced skin necrosis.
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Affiliation(s)
- S J Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - J W Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - G R Ahn
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - S Y Choi
- Department of Dermatology, Seoul Paik Hospital, Inje University, Seoul, South Korea
| | - K H Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - K Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - B J Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
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Nam SH, Yamano A, Kim JA, Lim J, Baek SH, Kim JE, Kwon TG, Saito Y, Teruya T, Choi SY, Kim YK, Bae YC, Shin HI, Woo JT, Park EK. Prenylflavonoids isolated from Macaranga tanarius stimulate odontoblast differentiation of human dental pulp stem cells and tooth root formation via the mitogen-activated protein kinase and protein kinase B pathways. Int Endod J 2021; 54:1142-1154. [PMID: 33641170 DOI: 10.1111/iej.13503] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/09/2023]
Abstract
AIM To identify odontogenesis-promoting compounds and examine the molecular mechanism underlying enhanced odontoblast differentiation and tooth formation. METHODOLOGY Five different nymphaeols, nymphaeol B (NB), isonymphaeol B (INB), nymphaeol A (NA), 3'-geranyl-naringenin (GN) and nymphaeol C (NC) were isolated from the fruit of Macaranga tanarius. The cytotoxic effect of nymphaeols on human DPSCs was observed using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The effect of nymphaeols on odontoblast differentiation was analysed with Alizarin Red S staining and odontoblast marker expression was assessed using real-time polymerase chain reaction and Western blot analysis. The molecular mechanism was investigated with Western blot analysis. In order to examine the effect of INB on dentine formation in the developing tooth germ, INB-soaked beads were placed under the tooth bud explants in the collagen gel; thereafter, the tooth bud explant-bead complexes were implanted into the sub-renal capsules for 3 weeks. Tooth root formation was analysed using micro-computed tomography and histological analysis. Data are presented as mean ± standard error (SEM) values of three independent experiments, and results are compared using a two-tailed Student's t-test. The data were considered to have statistical significance when the P-value was less than 0.05. RESULTS Three of the compounds, NB, INB, and GN, did not exert a cytotoxic effect on human DPSCs. However, INB was most effective in promoting the deposition of calcium minerals in vitro (P < 0.001) and induced the expression of odontogenic marker genes (P < 0.05). Moreover, this compound strongly induced the phosphorylation of mitogen-activated protein (MAP) kinases and protein kinase B (AKT) (P < 0.05). The inhibition of p38 MAP, c-Jun N-terminal kinase (JNK), and AKT substantially suppressed the INB-induced odontoblast differentiation (P < 0.001). In addition, isonymphaeol B significantly induced the formation of dentine and elongation of the tooth root in vivo (P < 0.05). CONCLUSIONS Prenylflavonoids, including INB, exerted stimulatory effects on odontoblast differentiation and tooth root and dentine formation via the MAP kinase and AKT signalling pathways. These results suggest that nymphaeols could stimulate the repair processes for dentine defects or injuries.
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Affiliation(s)
- S H Nam
- Department of Oral Pathology and Regenerative Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - A Yamano
- Faculty of Education, University of the Ryukyu, Nakagami-gun, Japan
| | - J A Kim
- Department of Oral Pathology and Regenerative Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - J Lim
- Department of Oral Pathology and Regenerative Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - S H Baek
- Orthognathic/Oral & Maxillofacial Surgery, Cha & Baek Dental Clinic, Daegu, Korea
| | - J E Kim
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - T G Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Y Saito
- Faculty of Education, University of the Ryukyu, Nakagami-gun, Japan
| | - T Teruya
- Faculty of Education, University of the Ryukyu, Nakagami-gun, Japan
| | - S Y Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Y K Kim
- Department of Conservative Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Y C Bae
- Department of Oral Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - H I Shin
- Department of Oral Pathology and Regenerative Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - J T Woo
- Department of Biological Chemistry, College of Bioscience and Biotechnology, Chubu University, Kasugai, Japan
| | - E K Park
- Department of Oral Pathology and Regenerative Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea
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Park W, Park M, Choi K, Heo Y, Choi SY, Cho J, Ko YH, Jeong HS. Analysis of local invasion and regional spread in malignant sublingual gland tumour: Implications for surgical planning. Int J Oral Maxillofac Surg 2021; 50:1280-1288. [PMID: 33602646 DOI: 10.1016/j.ijom.2021.01.016] [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: 08/27/2020] [Revised: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
Malignant tumours arising from the sublingual glands are very rare, and the extent and frequency of local invasion or regional spread in malignant sublingual gland tumour (MSLT) has not been fully studied due to the disease rarity. To provide comprehensive features of local and regional spread of MSLT, we reviewed 20 surgical cases for detailed pathological analyses among 26 cases diagnosed as having primary MSLT. Adenoid cystic carcinoma (ACC) was the most common pathological subtype, followed by mucoepidermoid carcinoma. Disease-free and overall survivals at 5 years were 76.1 % and 77.7 %, respectively. High-grade malignant tumours and grade 2-3 ACC accounted for 41.7 % and 85.7 %. Clinical and pathological extraparenchymal extensions were found in 34.6 % and 80.0 %, respectively. Tumour invasion to the lingual nerve and submandibular gland/ductal system were also detected in 40.0 % and 28.6 %. The incidences of lingual nerve invasion in ACC and ACC ≥4 cm were 30.8 % and 42.9 %. Regional nodal involvement occurred in seven of 26 cases, and all metastatic lymph nodes were found in neck levels Ib and IIa. In summary, a significant portion of MSLT cases consisted of high-grade tumours and grade 2-3 ACC; therefore local invasion into adjacent structures should be cautiously evaluated in cases of MSLT.
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Affiliation(s)
- W Park
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - M Park
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K Choi
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y Heo
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S Y Choi
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y-H Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - H-S Jeong
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Choi BG, Kim JB, Rha SW, Kim SW, Lee MW, Lee MS, Choi SY, Byun JK, Cha J, Na JO, Choi CU, Park CG, Seo HS, Oh DJ, Hong S. A relationship between unrecognized anaemia and the development of type 2 diabetes mellitus in patient with cardiovascular risks. Clin Exp Pharmacol Physiol 2020; 48:455-462. [PMID: 33340144 DOI: 10.1111/1440-1681.13440] [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: 03/23/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
Studies on anaemia in diabetic patients are well known. However, the data regarding association of anaemia on the development of diabetes mellitus (DM) are very limited. We aimed to evaluate the association of anaemia on the development of DM and major clinical outcomes in a series of the Korean population during 5-year clinical follow-up. The patients were retrospectively enrolled using the electronic database of Korea University Guro Hospital from January 2004 to February 2013. A total of 17 515 subjects without a history of DM were analysed. The World Health Organization definition of anaemia was used. Patients were divided into the anaemia group (n = 2907 patients) and the non-anaemia group (n = 14 608 patients). The primary endpoint was the development of DM. To adjust baseline potential confounders, a propensity score matching (PSM) analysis was performed. After PSM analysis, two matched groups (2731 pairs) were generated and their baselines characteristics were balanced. During 5-year follow-up, the anaemia group had a higher incidence of type 2 DM (10.7% vs 7.7%; hazard ratio [HR], 1.356; 95% confidence interval [CI], 1.021-1.802; P = .035), and total death (2.6% vs 1.2%; HR, 2.449; 95% CI, 1.337-4.486; P = .004) compared to the non-anaemia group. In the present study, anaemia was associated with higher rate of the development of DM and mortality during 5-year clinical follow-up. A randomized trial is needed to determine whether this results can be reproducible or not for the final conclusion.
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Affiliation(s)
- Byoung Geol Choi
- Cardiovascular Intervention Research Institute, Seoul, Korea.,Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jung Boone Kim
- Department of Integrated Biomedical and Life Sciences, Korea University Graduate School, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Intervention Research Institute, Seoul, Korea.,Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Suhng Wook Kim
- School of Health and Environmental Science, Korea University, Seoul, Korea
| | - Min Woo Lee
- Research Institute of Health Science, Korea University, Seoul, South Korea
| | | | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jae Kyeong Byun
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jinah Cha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Joo Oh
- Cardiovascular Intervention Research Institute, Seoul, Korea
| | - Sunghoi Hong
- Department of Integrated Biomedical and Life Sciences, Korea University Graduate School, Seoul, Korea
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Cho YS, Ko HG, Han HM, Park SK, Moozhayil SJ, Choi SY, Bae YC. Vesicular glutamate transporter-immunopositive axons that coexpress neuropeptides in the rat and human dental pulp. Int Endod J 2020; 54:377-387. [PMID: 33090483 DOI: 10.1111/iej.13427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/25/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022]
Abstract
AIM To examine the type of vesicular glutamate transporter (VGLUT)-immunopositive (+) axons that coexpress neuropeptides in the rat and human dental pulp, which may help understand peripheral mechanism of pulpal inflammatory pain in rats and humans. METHODOLOGY The trigeminal ganglia (TG) and the dental pulp of the maxillary molar teeth from three male Sprague-Dawley rats weighing 300-330 g and dental pulps of three healthy human (male) maxillary premolar teeth from three 16 to 28-year-old patients extracted for orthodontic treatment were used. The type of VGLUT + axons that coexpress substance P (SP)- and/or calcitonin gene-related peptide (CGRP) and parvalbumin in the rat TG and in the axons of the rat and the human dental pulp was examined by double fluorescence immunohistochemistry and quantitative analysis. Results were analyzed using one-way anova and the Kruskal-Wallis test. RESULTS SP and CGRP were expressed in many human VGLUT1 + pulpal axons but not in the rat VGLUT1 + TG neurons and pulpal axons (P < 0.05). SP and CGRP were expressed in a considerable number of human VGLUT2 + pulpal axons and also in many rat TG neurons and pulpal axons. The fraction of VGLUT1 + axons expressing parvalbumin was about three times higher in the rat than in the human dental pulp (P < 0.05). CONCLUSIONS These findings suggest that the types of VGLUT + axons, which release neuropeptides, may be different between the rat and the human dental pulp, raising a possibility that peripheral mechanism of pulpal inflammatory pain may be different between rats and humans.
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Affiliation(s)
- Y S Cho
- Department of Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - H G Ko
- Department of Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - H M Han
- Department of Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - S K Park
- Department of Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - S J Moozhayil
- Department of Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - S Y Choi
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Y C Bae
- Department of Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, South Korea
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Sentell T, Choi SY, Ching L, Uchima O, Keliikoa LB, Irvin L, Pirkle C. Potentially Preventable Hospitalizations for Chronic Conditions among Youth. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Chronic, preventable conditions like diabetes and hypertension previously seen primarily in adults are increasing among young people. Chronic disease-related potentially preventable hospitalizations (PPH) are costly. The study goal was to quantify potentially preventable hospitalizations (PPH) for chronic disease in those aged 5-29 years in one diverse state of the USA.
Methods
With Hawai'i statewide inpatient 2015-2016 data across all payers, we used standard metrics to capture asthma, diabetes, and hypertension PPH. Denominators were obtained by age group, gender, race/ethnicity, and living in O'ahu vs. other Hawaiian Islands from American Community Survey data. A multivariable negative binomial regression model predicted having a PPH adjusting for age group, gender, race/ethnicity, and O'ahu residency.
Results
Six percent (775) of inpatient hospitalizations among young people, representing 455 unique individuals, were PPH for a chronic disease. The types of PPH inpatient hospitalizations include diabetes (436), asthma (261), heart disease (64) and hypertension (14). The number of PPH visits per individual ranged from 1-20 with a mean of 1.7 (SD: 2.28) visits. The total cost of these PPH during this 2-year time period was $16,762,262. Among unique individuals with a chronic disease PPH (N = 455), the mean age was 17.5 (SD: 8.2); 55% were male. In the multivariable model, those who were between 10-14 years (RR:0.47;0.32-0.69) and 15-19 years (RR:0.46;0.31-0.69) were significantly less likely to have a PPH compared to those aged 5-9 years. Other Pacific Islanders were significantly more likely to have a PPH (RR: 3.08; 2.05-4.63) compared to whites.
Conclusions
Many hospitalizations by those aged 5-29 years were PPH. Pacific Islander youth had PPH chronic disease disparities. Chronic disease prevention and management is critical. Solutions may include equitable chronic disease prevention policies and improving access to culturally relevant care.
Key messages
This study reveals important disparities in youth that may lead to future health risks as well as current poor outcomes.
Other Pacific Islanders were at significantly increased risk for PPH for chronic disease compared to other racial/ethnic groups from early childhood to young adulthood.
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Affiliation(s)
- T Sentell
- OPHS, University of Hawaii at Manoa, Honolulu, USA
| | - S Y Choi
- JABSOM, University of Hawaii, Honolulu, USA
| | - L Ching
- Hawaii Department of Health, Honolulu, USA
| | - O Uchima
- OPHS, University of Hawaii at Manoa, Honolulu, USA
| | - L B Keliikoa
- OPHS, University of Hawaii at Manoa, Honolulu, USA
| | - L Irvin
- Hawaii Department of Health, Honolulu, USA
| | - C Pirkle
- OPHS, University of Hawaii at Manoa, Honolulu, USA
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39
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Sentell T, Choi SY, Ching L, Quensell M, Keliikoa LB, Corriveau E, Pirkle C. Chronic conditions among children, adolescents, and young adults in acute care settings. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Despite a growing prevalence of chronic disease risk factors, such as obesity, among young people in the United States and other countries, little is known about actual disease prevalence in this population. Almost nothing is known about this topic in many racial/ethnic groups that are rapidly growing in the United States, including Native Hawaiians, Other Pacific Islanders, and Filipinos. Yet these understudied groups are at high risk. The study goal was to determine the statewide prevalence of chronic disease in acute care for those aged 5-29 years, including Native Hawaiians, Filipinos, and Pacific Islanders.
Methods
Using Hawai'i statewide inpatient and emergency department (ED) data across all payers from 2015-2016, we considered the presence of at least one of five target chronic conditions (asthma, hypertension, chronic kidney disease, diabetes, stroke) from 13,514 inpatient stays by 9,467 unique individuals and 228,548 ED visits by 127,854 individuals.
Results
Twenty-eight percent of youth who were hospitalized and 12% with an ED visit had at least one chronic condition. In both inpatient and ED settings, race/ethnicity, age group, and payer varied significantly when comparing those with a chronic condition to those without a chronic condition. Notably, those with a chronic condition were disproportionately Native Hawaiian, Filipino, and Pacific Islander; 32.3% percent of those with an inpatient chronic condition and 34.9% of those with an ED chronic condition were Native Hawaiian.
Conclusions
Chronic diseases, including those more often seen in adulthood, are prevalent in young people in acute care settings in the state of Hawai'i with notable disparities. This data can help justify, guide, and support programs urgently needed to address these changing epidemiological trends, which may be of particular interest for Medicaid.
Key messages
We show that chronic conditions are prevalent in young people in acute care settings in the state of Hawai‘i with notable disparities. This can help justify, guide, and support programs to address these troubling epidemiological trends.
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Affiliation(s)
- T Sentell
- OPHS, University of Hawaii at Manoa, Honolulu, USA
| | - S Y Choi
- John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - L Ching
- Hawaii Department of Health, Honolulu, USA
| | - M Quensell
- OPHS, University of Hawaii at Manoa, Honolulu, USA
| | - L B Keliikoa
- OPHS, University of Hawaii at Manoa, Honolulu, USA
| | - E Corriveau
- OPHS, University of Hawaii at Manoa, Honolulu, USA
| | - C Pirkle
- OPHS, University of Hawaii at Manoa, Honolulu, USA
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40
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Kim YH, Her AY, Rha SW, Choi BG, Choi SY, Byun JK, Kang DO, Jang WY, Kim W, Baek JY, Choi WG, Kang TS, Ahn J, Park SH, Park SH, Hong JY, Park JY, Lee MH, Choi CU, Park CG, Seo HS. Comparison between calcium channel blocker with angiotensin converting enzyme inhibitor or angiotensin II type 1 receptor blocker combination on the development of new-onset diabetes in hypertensive Korean patients. J Diabetes Metab Disord 2020; 19:405-413. [PMID: 32550191 DOI: 10.1007/s40200-020-00521-4] [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: 11/27/2019] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
Background and purpose Rare comparative studies investigated the relationship between combination therapy of antihypertensive drugs and the incidence of new-onset diabetes mellitus (NODM). The aim of this study was to evaluate which combination therapy, calcium channel blocker (CCB) with angiotensin converting enzyme inhibitor (ACEI) or CCB with angiotensin II type 1 receptor blocker (ARB), is best in reducing/preventing the development of NODM during 4-year follow-up periods in non-diabetic hypertensive Korean patients. Materials and methods Finally, a total of 1221 consecutive hypertensive patients without a history of diabetes mellitus who had been prescribed CCB were retrospectively enrolled and divided into the two groups, an ACEI group (combination CCB with ACEI, n = 251) and an ARB group (combination CCB with ARB, n = 970). The primary endpoint was NODM, defined as a fasting blood glucose ≥126 mg/dL or hemoglobin A1c ≥ 6.5%. Secondary endpoint was major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI) and percutaneous coronary intervention (PCI). Results After propensity-score matched (PSM) analysis, two propensity-matched groups (243 pairs, n = 486, C-statistic = 0.696) were generated. During 4-year follow-up periods, there were similar incidence of NODM (Hazard ratio [HR]; 1.198, 95% confidence interval [CI]; 0.591-2.431, P = 0.616), MACE (HR; 1.324, 95% CI; 0.714-2.453, P = 0.373), total death, MI and PCI between the two groups after PSM analysis. Conclusion CCB with ACE or CCB with ARB combination strategies are equally acceptable in hypertensive Korean patients regarding the occurrence of NODM.
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Affiliation(s)
- Yong Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Ae-Young Her
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Jae Kyeong Byun
- Department of Medicine, Korea University Graduate School, Seoul, South Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Ju Yeol Baek
- Cardiovascular Center, Seoul St. Mary's Hospital, the Catholic University of Korea, Seoul, South Korea
| | - Woong Gil Choi
- Cardiology Department, Konkuk University Chungju Hospital, Chungju, South Korea
| | - Tae Soo Kang
- Department of Internal Medicine, Cardiovascular Division, Dankook University Hospital, Cheonan, South Korea
| | - Jihun Ahn
- Department of Cardiology, Soonchunhyang University Gumi Hospital, Gumi, South Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Sung Hun Park
- Department of Internal Medicine, Division of Cardiology, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Ji Yeon Hong
- Department of Internal Medicine, Division of Cardiology, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Ji Young Park
- Department of Internal Medicine, Division of Cardiology, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Min-Ho Lee
- Department of Cardiology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
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Kim W, Kim JS, Rha SW, Choi BG, Jang WY, Kang DO, Park Y, Choi JY, Roh SY, Na JO, Choi CU, Kim EJ, Park CG, Seo HS, Choi SY, Byun JK, Cha J, Oh DJ, Jeong MH. Cilostazol-based triple versus potent P2Y12 inhibitor-based dual antiplatelet therapy in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Heart Vessels 2020; 35:1181-1192. [PMID: 32270356 DOI: 10.1007/s00380-020-01598-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
Although potent P2Y12 inhibitor-based dual antiplatelet therapy (DAPT) has replaced clopidogrel-based therapy as the standard treatment in patients with acute myocardial infarction (AMI), there is a concern about the risk of bleeding in East Asian patients. We compared the efficacy and safety of cilostazol-based triple antiplatelet therapy (TAT) with potent P2Y12 inhibitor-based DAPT in Korean patients. A total of 4152 AMI patients who underwent percutaneous coronary intervention (PCI) in the Korea Acute Myocardial Infarction Registry were analyzed retrospectively. Patients were divided into two groups: the TAT group (aspirin + clopidogrel + cilostazol, n = 3161) and the potent DAPT group (aspirin + potent P2Y12 inhibitors [ticagrelor or prasugrel], n = 991). Major clinical outcomes at 30 days and 2 years were compared between the two groups using propensity score matching (PSM) analysis. After PSM (869 pairs), there were no significant differences between the two groups in the incidence of total death, cardiac death, myocardial infarction (MI), target vessel revascularization, stent thrombosis, and stroke at 30 days and 2 years. However, the Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding rates were significantly lower in the TAT group compared with the potent DAPT group at 2 years (6.4% vs. 3.6%, p = 0.006). In Korean AMI patients undergoing PCI, TAT with cilostazol was associated with lower bleeding than the potent P2Y12 inhibitor-based DAPT without increased ischemic risk. These results could provide a rationale for the use of TAT in East Asian AMI patients.
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Affiliation(s)
- Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea. .,Cardiovascular Intervention Research Institute, Seoul, Republic of Korea.
| | - Byoung Geol Choi
- College of Medicine, Institute of Health Science, Korea University, Seoul, Republic of Korea
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Yoonjee Park
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Seung-Young Roh
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jae Kyeong Byun
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jinah Cha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Dong Joo Oh
- Cardiovascular Intervention Research Institute, Seoul, Republic of Korea
| | - Myung Ho Jeong
- Heart Center of Chonnam, National University Hospital, Gwangju, Republic of Korea
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Rha SW, Cha J, Choi SY, Choi BG, Byun JK, Park Y, Kang DO, Jang WY, Kim W, Choi JY, Na JO, Choi CU, Park CG, Seo HS. CRT-100.37 Long-Term Clinical Outcomes of Long Coronary Lesions in Acute Myocardial Infarction Patients Who Underwent Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.026] [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: 10/25/2022]
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43
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Rha SW, Cha J, Choi SY, Choi BG, Byun JK, Park Y, Kang DO, Jang WY, Kim W, Choi JY, Na JO, Choi CU, Park CG, Seo HS. CRT-100.77 Long-Term Outcomes of Percutaneous Coronary Intervention on Chronic Total Occlusion in Patients With Low Left Ventricular Ejection Fraction. JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.059] [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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44
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Rha SW, Cha J, Choi BG, Choi SY, Byun JK, Park Y, Kang DO, Jang WY, Kim W, Choi JY, Na JO, Choi CU, Park CG, Seo HS. CRT-100.33 The Predictors of Hospital Readmission for Acute Myocardial Infarction Patients With Heart Failure: From the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH). JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.022] [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: 10/25/2022]
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45
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Lee MS, Choi BG, Hollowed J, Han SK, Baek MJ, gi Ryu Y, Choi SY, Byun JK, Mashaly A, Park Y, Jang WY, Kim W, Choi JY, Park EJ, Na JO, Choi CU, Kim EJ, Park CG, Seo HS, Rha SW. Assessment of Sex Differences in 5-Year Clinical Outcomes Following Endovascular Revascularization for Peripheral Artery Disease. Cardiovascular Revascularization Medicine 2020; 21:110-115. [DOI: 10.1016/j.carrev.2019.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/24/2019] [Accepted: 03/22/2019] [Indexed: 11/28/2022]
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46
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Cho IJ, Lee JH, Choi SY, Chun EJ, Park SH, Han HW, Sung JD, Jung HO, Chang HJ. 430 Relation of blood pressure to coronary artery calcium and mortality. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diastolic blood pressure has a J-curve relation with coronary heart disease and death, but it is debating whether a J-curve association exists in general population. We aimed to assess the relation of blood pressure to mortality, and whether their association is interacted with presence of high coronary artery calcium (CAC).
Methods
The KOICA registry is a retrospective, multicenter observational study designed to investigate the effectiveness and prognostic value of CAC score for primary prevention of cardiovascular disease in asymptomatic Korean adults. The association between CAC score and blood pressure was assessed. Patients were divided into 2 groups according to the baseline CACS (> 300 and ≤ 300), and all-cause mortality was assessed.
Results
The study population composed 48903 subjects with a mean age of 54 ± 9. There were 425 (0.9%) deaths during follow-up. At baseline, SBP (systolic blood pressure) more than 110 mmHg and DBP (diastolic blood pressure) more than 80 mmHg was associated with increased risk for CACS > 300. In patients with baseline CACS ≤ 300, all-cause mortality was increased in patients with SBP of 110-119 mmHg (HR 1.47, p = 0.023), 130-139 mmHg (HR 1.72, p = 0.002) and ≥ 140 mmHg (HR 1.47, p = 0.042) compared to SBP of 120-129 mmHg, whereas DBP did not predict all-cause mortality. In contrast, SBP was not associated to all-cause mortality in patients with CACS > 300, whereas DBP < 60 mmHg (HR 3.53, p =0.018) and 70-79 mmHg (HR 2.21, p = 0.042) was associated with increased risk for all-cause mortality compared to DBP of 80-89 mmHg.
Conclusion
Low DBP was associated with increased risk for all-cause mortality in subjects with high CAC score, suggesting high-risk for coronary artery disease. However, this J-curve relation was not shown in the population with low CAC score.
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Affiliation(s)
- I J Cho
- Ewha Womans University Seoul Hospital, Seoul, Korea (Republic of)
| | - J H Lee
- Hospital Myongji, Goyang, Korea (Republic of)
| | - S Y Choi
- Seoul National University, Seoul, Korea (Republic of)
| | - E J Chun
- Seoul National University, Seoul, Korea (Republic of)
| | - S H Park
- Gangnam Heartscan Clinic, Seoul, Korea (Republic of)
| | - H W Han
- Gangnam Heartscan Clinic, Seoul, Korea (Republic of)
| | - J D Sung
- Samsung Medical Center, Seoul, Korea (Republic of)
| | - H O Jung
- The Catholic University of Korea, Seoul, Korea (Republic of)
| | - H J Chang
- Yonsei University College of Medicine, Cardiology Division, Seoul, Korea (Republic of)
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47
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Rha SW, Oh DJ, Mashaly A, Choi BG, Choi SY, Byun JK, Cha J, Park Y, Kang DO, Jang WY, Kim W, Choi JY, Na JO, Choi CU, Park CG, Seo HS. TCT-127 Long-Term Clinical Outcomes of Young Acute Myocardial Infarction Patients Underwent Percutaneous Coronary Intervention. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.175] [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: 10/25/2022]
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48
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Choi SY, Kim MH, Lee KM, Jang CH, Choi JY. P4791Performance of the HAS-BLED, ATRIA, and PRECISE-DAPT Bleeding Risk Scores in Atrial Fibrillation Patients Using Antiplatelet Agents or Oral Anticoagulants. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Various bleeding risk scores have been proposed to assess the risk of bleeding in atrial fibrillation (AF) patients undergoing anticoagulation. PRECISE DAPT score has been developed to assess the out-of hospital bleeding risk in patients receiving dual antiplatelet therapy (DAPT). Our objective was to compare the predictive performance between the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and PRECISE-DAPT (Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet therapy) score in AF patients using antiplatelet agents or anticoagulants
Methods
We recruited 1,114 consecutive AF patients (51% male; median age, 71 years) receiving antiplatelet agents or oral anticoagulants from January 2014 through December 2018. Major bleeding was defined as according to the Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥3 g, and intracranial, intraocular or fatal bleeding). The performance of risk scores were assessed by C-statistic.
Results
Bleeding events occurred in 135 patients (12.1%) during 30 days, and 72 patients (6.5%) from 30 days till 1-year follow-up. Based on the C-statistic, PRECISE-DAPT score (AUC: 0.72, 95% CI: 0.69–0.75) had a good performance, significantly better than HAS-BLED (AUC: 0.64, 95% CI: 0.61–0.67) (p=0.008) or ATRIA scores (AUC: 0.57, 95% CI: 0.54–0.60) (p<0.001) for 30-days bleeding prediction. Also, PRECISE-DAPT score had a good C-statistic (AUC: 0.72, 95% CI: 0.69–0.75) for 1-year bleeding events compared with HAS-BLED (AUC: 0.64, 95% CI: 0.60–0.67) (p=0.02) or ATRIA (AUC: 0.61, 95% CI: 0.58–0.65) (p=0.01).
ROC curve for bleeding
Conclusions
The PRECISE-DAPT score has been used for assessing bleeding events during DAPT. Also, the PRECISE-DAPT score predicted bleedings better than HAS-BLED or ATRIA scores in AF patients. So, the PRECISE-DAPT score may be considered as bleeding risk score during DAPT or oral anticoagulation in clinical practice.
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Affiliation(s)
- S Y Choi
- Daeu Health College, Department of Biomedical Laboratory Science, Daegu, Korea (Republic of)
| | - M H Kim
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - K M Lee
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - C H Jang
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - J Y Choi
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
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49
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Lee KM, Kim MH, Choi SY, Kim SJ, Kim SW, Park JS. P4776Age-dependent anti-thrombotic therapy for atrial fibrillation patients with intermediate risk (CHA2DS2-VASc Score of 1 or 2) of ischemic stroke. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although older age is one of the most important risk factor for stroke in atrial fibrillation (AF), it is unclear whether oral anticoagulants are beneficial for AF patients with intermediate CHA2DS2-VASc score (1 for male or 2 for female) according to age threshold. We sought to investigate the effect of age-dependent antithrombotic therapy for ischemic stroke in Korean intermediate risk AF patients.
Methods
We enrolled 29,592 patients (males with CHA2DS2-VASc score of 1 and females with CHA2DS2-VASc score of 2) using the Korean National Health Insurance Service database. The clinical endpoint was the occurrence of ischemic stroke. The propensity score matching method was used to balance covariates across treated and untreated patients.
Results
Treated male AF patients were 6,570 (67.1%) with age <55 years, 7,115 (70.9%) with 55–64 years and 6,470 (68.3%) with 65–74 years in each age risk criterion. Also, treated female AF patients were 3,156 (71.3%) with age <55 years, 2,838 (71.0%) with 55–64 years and 3,440 (72.6%) with 65–74 years in each age risk criterion. Among male and female patients (age <55 years and 55–64 years) with 1 risk factor, an annual ischemic stroke rate was not significantly different between treated and untreated patients at full follow-up. However, treated AF patients who are in age 65–74 year without other risk factor had a much lower annual risk of ischemic stroke [(1.05%/year (male) and 1.04%/year (female)] compared with untreated patients [(1.77%/year (male) (p<0.026) and 1.86%/year (female) (p<0.041).
Conclusions
Age is an important predictor in determining the risk of ischemic stroke in AF patients with intermediate CHA2DS2-VASc scores (1 for male or 2 for female). We suggest that the benefit of anti-thrombotic therapy for intermediate risk AF patients depends on age threshold.
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Affiliation(s)
- K M Lee
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - M H Kim
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - S Y Choi
- Daeu Health College, Department of Biomedical Laboratory Science, Daegu, Korea (Republic of)
| | - S J Kim
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - S W Kim
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - J S Park
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
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50
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Choi SY, Kim MH, Lee KM, Kim JK, Woo JY, Cho YR. P5661Validation of CHA2DS2-VA score (excluding female sex) in non-valvular atrial fibrillation patients: a nationwide population-based study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sex category (Sc, ie, female sex) confers 1 point on CHA2DS2-VASc score. So, no woman with atrial fibrillation (AF) can have a CHA2DS2-VASc score of 0. This study aimed to compare CHA2DS2-VA (excluding female sex) and CHA2DS2-VASc score in Korean AF patients.
Methods
Using the Korean National Health Insurance Service database, we analyzed the risk of ischemic stroke in non-valvular AF patients between 2013 and 2017. The predictive value of the CHA2DS2-VA and CHA2DS2-VASc scores for ischemic stroke was evaluated by c-statistic difference and net reclassification improvement (NRI). The propensity score matching method was used to balance covariates across male and female AF patients.
Results
A total of 182,133 patients with AF (49.2% women) were included to this study. The adjusted incidence rate (IR) of ischemic stroke was not significantly different between males and females (0.89%/y and 0.90%/y, respectively, p=0.411) in low-risk patients without risk factor. Also, no sex difference was found in high-risk patients with above 2 risk factors for ischemic stroke (4.46%/y for male and 4.49%/y for male, p=0.498). In c-statistic analysis for ischemic stroke, there was no significant difference between the CHA2DS2-VA and CHA2DS2-VASc scores (AUC 0.662 vs. 0.664, z=1.572, p=0.116). When compared with CHA2DS2-VASc score, CHA2DS2-VA score was not significantly inferior in net reclassification improvement (NRI 0.031, 95% CI 0.002–0.037, p=0.118) for ischemic stroke.
C-statistics
Conclusions
In Korean AF patients, the CHA2DS2-VA score excluding female sex is a useful risk scoring system for ischemic stroke.
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Affiliation(s)
- S Y Choi
- Daeu Health College, Department of Biomedical Laboratory Science, Daegu, Korea (Republic of)
| | - M H Kim
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - K M Lee
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - J K Kim
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - J Y Woo
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
| | - Y R Cho
- Dong-A University, Department of Cardiology, College of Medicine, Busan, Korea (Republic of)
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