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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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Suh SY, Kim MJ, Choi J, Kim SJ. Outcomes of surgery in children with early-onset exotropia. Eye (Lond) 2013; 27:836-40. [PMID: 23619215 DOI: 10.1038/eye.2013.75] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 02/18/2013] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To evaluate the clinical characteristics and surgical outcomes of early-onset exotropia and to compare differences between constant and intermittent exotropia at presentation. METHODS The medical records of 45 exotropia patients with a reported onset before 1 year of age who were operated on between 2008 and 2011 were reviewed, and the clinical characteristics and surgical outcomes of these patients were analyzed retrospectively. Patients were then divided into two groups according to type of exotropia at presentation: a constant (XT) group and an intermittent (X(T)) group. Clinical features and surgical results of exotropia were then compared between these two groups. RESULTS The mean age of onset of exodeviation in 45 patients was 9.3±3.8 months. Mean age at surgery was 4.5±2.4 years, and the mean postoperative follow-up period was 17.3 months (range, 6-37 months). Of the 45 patients, 67% showed alignment of less than±10 prism diopters (PD) at final visit. Gross stereopsis was achieved in all 34 testable patients, and bifixation developed in 10 patients (29%). Eleven patients were included in XT group and 34 patients in X(T) group. No significant intergroup difference was found between surgical success rates and binocularities. CONCLUSION Surgical outcomes, both motor and sensory, were not poor in early-onset exotropia patients, even in patients with constant deviation. Good binocular results following surgery can be achieved in children presenting with apparently constant early-onset exotropia.
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Affiliation(s)
- S Y Suh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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Kim JW, Seo HS, Na JO, Suh SY, Choi CU, Kim EJ, Rha SW, Park CG, Oh DJ. Myocardial bridging is related to endothelial dysfunction but not to plaque as assessed by intracoronary ultrasound. Heart 2007; 94:765-9. [PMID: 17881476 DOI: 10.1136/hrt.2007.115980] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [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: 02/06/2023] Open
Abstract
BACKGROUND Myocardial bridge (MB) is characterised by focal compression of a coronary artery in systole by an overlying band of myocardium. Chronic compression and relaxation of the MB may produce endothelial dysfunction by direct stress. OBJECTIVE To determine whether MB alters endothelial function, thus influencing the plaque formation. METHODS 128 patients (mean (SD) age 54.7 (10.9) years, 56 men) with typical angiographic systolic milking effects and >30% reduction in diameter of the coronary artery during systole after intracoronary nitrate (glyceryl trinitrate, 200 mug) infusion were studied. 231 control patients (mean (SD) age 52.9 (12.1) years, 111 men) without overt coronary artery disease including MB were also studied. Endothelial function was estimated by incremental acetylcholine (Ach) infusion into the left coronary ostium. Intracoronary ultrasound assessments were obtained in 74/128 patients with MB and 81/231 controls. RESULTS The mean (SD) vasoconstrictive response to maximal Ach was more pronounced at the bridging segments than at matched segments in controls (-71.9 (14.9) vs -30.3 (22.6), p = 0.009). Coronary vasoconstriction (>50%) to Ach was seen more often in the MB group than in controls (114/128 (89.1%) vs 81/231 (35.1%), p = 0.007). No significant correlation was found between the severity of MB and vasoconstriction in response to Ach. A typical half-moon phenomenon was seen in 71/74 (95.9%) cases of the MB group, but not in controls (p<0.001). Plaques at the bridging segments were absent in 67/74 (90.5%) and mild in 7/74 (9.5%) cases, as compared with those of matched segments of the left anterior descending coronary artery in controls (plaque burden 5.91 (1.37)% vs 24.71 (24.21)%, p = 0.002). CONCLUSION Despite the prominent relationship between MB and endothelial dysfunction, bridging segments are spared from atherosclerotic plaque formation.
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Affiliation(s)
- J W Kim
- Guro Hospital, Cardiovascular Centre, Korea University, 97 Gurodong-Gil, Guro-gu, Seoul, Republic of Korea 152-703
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Kim EJ, Park CG, Park JS, Suh SY, Choi CU, Kim JW, Kim SH, Lim HE, Rha SW, Seo HS, Oh DJ. Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study. J Hum Hypertens 2006; 21:141-8. [PMID: 17136108 DOI: 10.1038/sj.jhh.1002120] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Blood pressure (BP) is one of the most important contributing factors to pulse wave velocity (PWV), a classic measure of arterial stiffness. Although there have been many non-invasive studies to show the relation between arterial stiffness and BP, the results are controversial. The aim of this study is to evaluate the role of BP as an influencing factor on PWV using invasive method. We observed 174 normotensive and untreated hypertensive subjects using coronary angiography. Arterial stiffness was assessed through aorto-femoral PWV by foot-to-foot velocity method using fluid-filled system. And BP was measured by pressure wave at the right common femoral artery. From univariate analysis, age, diabetes mellitus (DM), hypertension, waist, waist-to-hip ratio, total cholesterol-to-high-density lipoprotein cholesterol ratio, systolic BP (SBP), pulse pressure (PP) and mean arterial pressure (MAP) showed significant association with PWV. To avoid multiple colinearity among SBP, PP and MAP, we performed multiple regression analysis predicting PWV thrice. Age, DM and each BP were significantly and consistently correlated to PWV. In the first and third modules, compared to age, SBP and MAP were less strong predictors, respectively. However, PP was the stronger predictor than age and DM in the second module. Lastly, we simultaneously forced MAP and PP with other variables in the fourth multivariate analysis. Age, DM and PP remained significantly correlated with PWV, but the significance of MAP was lost. This is the first invasive study to suggest that PP has the strongest correlation with PWV among a variety of BP parameters.
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Affiliation(s)
- E J Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea
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Abstract
The purpose of this study was to develop the Korean version of World Health Organization Quality of Life study assessment instrument (WHOQOL) and WHOQOL-BREF, an abbreviated version of WHOQOL and to identify contributing factors in the quality of life of Koreans. The WHOQOL and WHOQOL-BREF were translated into colloquial Korean according to instructions of the WHOQOL study group. Then the Korean questionnaire was applied to 538 subjects, composed of 171 medical patients and 367 healthy subjects who volunteered to rate the scale. Finally, 486 subjects completed the rating. Collected data were analyzed statistically. The Korean version of WHOQOL and WHOQOL-BREF domain scores demonstrated good test-retest reliability, internal consistency, criterion validity, content validity and discriminant validity. The physical, psychological, social and environmental domains made a significant contribution to explaining the variance in the quality of life while the independence and spiritual domains made a lesser contribution. The domain scores produced by the WHOQOL-BREF correlated highly with the WHOQOL. The physical health domain contributed most in overall quality of life, while the social domain made the least contribution. These results suggest that the Korean version of WHOQOL and WHOQOL-BREF are valid and reliable in the assessment of quality of life and that physical domain is contributing most and social and spiritual factors are contributing least to the quality of life in Koreans.
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Affiliation(s)
- S K Min
- Department of Psychiatry, College of Medicine Yonsei University, Seoul, Korea.
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Huh BY, Yoo T, Cho S, Suh SY, O SW, Park MS. Standardization of the nationwide health examination in Korea. Stud Health Technol Inform 1999; 52 Pt 1:429-32. [PMID: 10384493] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The Korea Medical Insurance Corporation has held the periodic Health Examination for the public servants and teachers from 1977 as a nationwide health preventive task. But the Health Examination result is not computerized rather than paperwork, so the use of the Health Examination is limited and the results of Health Examination can not be stored or interchangeable between hospitals or health examination centers in this system. So we planed the Standardization of the Nationwide Health Examination project and developed the Health Examination computer program in 1996. The object of standardized program is to contribute to cost-effective analysis of each item or other studies about the factors influences development of diseases. And now, an Exhibition work for the standardization is being held with the Health Examination computer program. At the ending of the Exhibition work, we will evaluation and revision the computerized program for standardization process.
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Affiliation(s)
- B Y Huh
- Seoul National University Hospital Family Medicine, Korea.
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Abstract
To evaluate and compare the therapeutic efficacy of adenine arabinoside (Ara-A) and alpha-interferon (alpha-INF), 40 patients with biopsy proven chronic active hepatitis B were chosen at random to receive Ara-A (15 mg/Kg, iv, for 10 day) or alpha-INF (3 million unit, sc, every other day for 12 wks) and followed up to 12 months after completion of the therapy. All patients were HBeAg positive. The clinical effects of Ara-A and alpha-INF on seroconversion of HBeAg positive. The clinical effects of Ara-A AND alpha-INF on seroconversion of HBeAg and the levels of serum aminotransferase (ALT) were closely matched and compared with those of the untreated control group (20 cases). Eighteen out of 20 patients received Ara-A, 19 patients received alpha-INF, and 19 out of 20 control cases were evaluated at 12 months after completion of treatment. Seroconversion of HBeAg in the alpha-INF treated group (19 cases) was observed in seven cases (36.8%), showing a higher seroconversion rate as compared to Ara-A-treated (2/18 cases, 11.1%) and to the control patients (1/19 cases, 5.3%). There were no effects of Ara-A on serum ALT levels in the treated patients compared with the untreated control patients. However there was a remarkable drop in serum ALT levels in the INF-treated patients (p less than 0.005, ALT levels at 12 months after treatment; 87.4 +/- 98.8 IU/L) compared to the pretreatment levels (256.7 +/- 175.8 IU/L).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S U Lee
- Department of Internal Medicine, Kosin Medical College, Busan, Korea
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