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Delamain H, Buckman JEJ, O'Driscoll C, Suh JW, Stott J, Singh S, Naqvi SA, Leibowitz J, Pilling S, Saunders R. Predicting post-treatment symptom severity for adults receiving psychological therapy in routine care for generalised anxiety disorder: a machine learning approach. Psychiatry Res 2024; 336:115910. [PMID: 38608539 DOI: 10.1016/j.psychres.2024.115910] [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: 08/03/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
Approximately half of generalised anxiety disorder (GAD) patients do not recover from first-line treatments, and no validated prediction models exist to inform individuals or clinicians of potential treatment benefits. This study aimed to develop and validate an accurate and explainable prediction model of post-treatment GAD symptom severity. Data from adults receiving treatment for GAD in eight Improving Access to Psychological Therapies (IAPT) services (n=15,859) were separated into training, validation and holdout datasets. Thirteen machine learning algorithms were compared using 10-fold cross-validation, against two simple clinically relevant comparison models. The best-performing model was tested on the holdout dataset and model-specific explainability measures identified the most important predictors. A Bayesian Additive Regression Trees model out-performed all comparison models (MSE=16.54 [95 % CI=15.58; 17.51]; MAE=3.19; R²=0.33, including a single predictor linear regression model: MSE=20.70 [95 % CI=19.58; 21.82]; MAE=3.94; R²=0.14). The five most important predictors were: PHQ-9 anhedonia, GAD-7 annoyance/irritability, restlessness and fear items, then the referral-assessment waiting time. The best-performing model accurately predicted post-treatment GAD symptom severity using only pre-treatment data, outperforming comparison models that approximated clinical judgement and remaining within the GAD-7 error of measurement and minimal clinically important differences. This model could inform treatment decision-making and provide desired information to clinicians and patients receiving treatment for GAD.
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Affiliation(s)
- H Delamain
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom.
| | - J E J Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom; iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, United Kingdom
| | - C O'Driscoll
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - J W Suh
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - J Stott
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - S Singh
- Waltham Forest Talking Therapies, North East London NHS Foundation Trust, London, United Kingdom
| | - S A Naqvi
- Barking and Dagenham and Havering IAPT Services, North East London NHS Foundation Trust, London, United Kingdom
| | - J Leibowitz
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, United Kingdom
| | - S Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom; Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - R Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
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Kim JH, Lee SJ, Cha JJ, Park JH, Hong SJ, Ahn TH, Kim BK, Chang K, Park Y, Song YB, Ahn SG, Suh JW, Lee SY, Cho JR, Her AY, Jeong YH, Kim HS, Kim MH, Shin ES, Lim DS. Prognostic Impact of CYP2C19 Genotypes on Long-Term Clinical Outcomes in Older Patients After Percutaneous Coronary Intervention. J Am Heart Assoc 2024; 13:e032248. [PMID: 38761068 DOI: 10.1161/jaha.123.032248] [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: 01/03/2024] [Accepted: 04/17/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Carriers of CYP2C19 loss-of-function alleles have increased adverse events after percutaneous coronary intervention, but limited data are available for older patients. We aimed to evaluate the prognostic impact of CYP2C19 genotypes on clinical outcomes in older patients after percutaneous coronary intervention. METHODS AND RESULTS The study included 1201 older patients (aged ≥75 years) who underwent percutaneous coronary intervention and received clopidogrel-based dual antiplatelet therapy in South Korea. Patients were grouped on the basis of CYP2C19 genotypes. The primary outcome was 3-year major adverse cardiac events, defined as a composite of cardiac death, myocardial infarction, and stent thrombosis. Older patients were grouped into 3 groups: normal metabolizer (36.6%), intermediate metabolizer (48.1%), and poor metabolizer (15.2%). The occurrence of the primary outcome was significantly different among the groups (3.1, 7.0, and 6.2% in the normal metabolizer, intermediate metabolizer, and poor metabolizer groups, respectively; P=0.02). The incidence rate of all-cause death at 3 years was greater in the intermediate metabolizer and poor metabolizer groups (8.1% and 9.2%, respectively) compared with that in the normal metabolizer group (3.5%, P=0.03) without significant differences in major bleeding. In the multivariable analysis, the intermediate metabolizer and poor metabolizer groups were independent predictors of 3-year clinical outcomes. CONCLUSIONS In older patients, the presence of any CYP2C19 loss-of-function allele was found to be predictive of a higher incidence of major adverse cardiac events within 3 years following percutaneous coronary intervention. This finding suggests a need for further investigation into an optimal antiplatelet strategy for older patients. REGISTRATION URL: https://clinicaltrials.gov. Identifier: NCT04734028.
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Affiliation(s)
- Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center Korea University Anam Hospital, Korea University College of Medicine Seoul South Korea
| | | | - Jung-Joon Cha
- Department of Cardiology, Cardiovascular Center Korea University Anam Hospital, Korea University College of Medicine Seoul South Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center Korea University Anam Hospital, Korea University College of Medicine Seoul South Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center Korea University Anam Hospital, Korea University College of Medicine Seoul South Korea
| | - Tae Hoon Ahn
- Department of Cardiology Heart and Brain Institute, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine Gwangmyeong-si South Korea
| | | | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine College of Medicine, Catholic University of Korea Seoul South Korea
| | - Yongwhi Park
- Department of Internal Medicine Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital Changwon South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Sung Gyun Ahn
- Department of Cardiology Yonsei University Wonju Severance Christian Hospital Wonju South Korea
| | - Jung-Won Suh
- Department of Cardiology, Department of Internal Medicine Seoul National University Bundang Hospital, Seoul National University College of Medicine Seoul South Korea
| | - Sang Yeub Lee
- Department of Cardiology Heart and Brain Institute, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine Gwangmyeong-si South Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital Hallym University College of Medicine Seoul South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine Kangwon National University School of Medicine Chuncheon South Korea
| | - Young-Hoon Jeong
- Department of Cardiology Heart and Brain Institute, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine Gwangmyeong-si South Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Department of Internal Medicine Seoul National University Hospital Seoul South Korea
| | - Moo Hyun Kim
- Department of Cardiology Dong-A University Hospital Busan South Korea
| | - Eun-Seok Shin
- Division of Cardiology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center Korea University Anam Hospital, Korea University College of Medicine Seoul South Korea
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Won KB, Kim HJ, Cho JH, Lee SY, Her AY, Kim BK, Joo HJ, Park Y, Chang K, Song YB, Ahn SG, Suh JW, Cho JR, Kim HS, Kim MH, Lim DS, Kim SW, Jeong YH, Shin ES. Different association of atherogenic index of plasma with the risk of high platelet reactivity according to the presentation of acute myocardial infarction. Sci Rep 2024; 14:10894. [PMID: 38740817 DOI: 10.1038/s41598-024-60999-3] [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] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024] Open
Abstract
This study evaluated the association of atherogenic index of plasma (AIP) with platelet reactivity and clinical outcomes according to acute myocardial infarction (AMI). The composite of 3-year adverse outcomes of all-cause death, myocardial infarction, and cerebrovascular accident was evaluated in 10,735 patients after successful percutaneous coronary intervention with drug-eluting stents. AIP was defined as the base 10 logarithm of the ratio of triglyceride to high-density lipoprotein cholesterol concentration. High platelet reactivity (HPR) was defined as ≥ 252 P2Y12 reactivity unit. An increase of AIP (per-0.1 unit) was related to the decreased risk of HPR [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.96-0.99; P = 0.001] in non-AMI patients, not in AMI patients (OR 0.98, 95% CI 0.96-1.01; P = 0.138). The HPR was associated with the increased risk of composite outcomes in both non-AMI and AMI patients (all-P < 0.05). AIP levels were not independently associated with the risk of composite outcomes in both patients with non-AMI and AMI. In conclusion, an inverse association between AIP and the risk of HPR was observed in patients with non-AMI. This suggests that the association between plasma atherogenicity and platelet reactivity may play a substantial role in the development of AMI.Trial registration: NCT04734028.
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Affiliation(s)
- Ki-Bum Won
- Division of Cardiology, Chung-Ang University Gwangmyeong Medical Center, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - Hyeon Jeong Kim
- Division of Cardiology, Chung-Ang University Gwangmyeong Medical Center, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
- Division of Cardiology, Busan Veterance Hospital, Busan, South Korea
| | - Jun Hwan Cho
- Division of Cardiology, Chung-Ang University Gwangmyeong Medical Center, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - Sang Yup Lee
- Division of Cardiology, Chung-Ang University Gwangmyeong Medical Center, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - Ae-Young Her
- Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung Joon Joo
- Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yongwhi Park
- Division of Cardiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Kiyuk Chang
- Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Young Bin Song
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea
| | - Jung-Won Suh
- Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung Rae Cho
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Seoul National University Hospital, Seoul, South Korea
| | - Moo Hyun Kim
- Division of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Do-Sun Lim
- Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sang-Wook Kim
- Division of Cardiology, Chung-Ang University Gwangmyeong Medical Center, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - Young-Hoon Jeong
- Division of Cardiology, Chung-Ang University Gwangmyeong Medical Center, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea.
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Cha JJ, Lee SJ, Park JH, Hong SJ, Ahn TH, Chang K, Park Y, Song YB, Ahn SG, Suh JW, Lee SY, Cho JR, Her AY, Jeong YH, Kim HS, Kim MH, Shin ES, Kim BK, Lim DS. Association of Age- and Body Mass Index-Stratified High On-Treatment Platelet Reactivity With Coronary Intervention Outcomes in East Asian Patients. J Am Heart Assoc 2024; 13:e031819. [PMID: 38639339 DOI: 10.1161/jaha.123.031819] [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: 07/20/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Although age and body mass index (BMI) significantly affect platelet reactivity units and clinical outcomes after percutaneous coronary intervention, there are limited data on the relationship between high on-treatment platelet reactivity (HPR) and clinical outcomes on age and BMI differences. Thus, we investigated the association of HPR with clinical outcomes according to age and BMI. METHODS AND RESULTS The study analyzed 11 714 patients who underwent platelet function tests after percutaneous coronary intervention. The primary end point was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), whereas the secondary end point was major bleeding. HPR was defined as platelet reactivity units ≥252. Patients were categorized by age (<67 years of age or ≥67 years of age) and BMI (≤22.6 kg/m2 or >22.6 kg/m2). Patients <67 years of age with HPR had increases in both MACCEs (adjusted hazard ratio [HR], 1.436 [95% CI, 1.106-1.867]; P=0.007) and major bleeding (adjusted HR, 1.584 [95% CI, 1.095-2.290]; P=0.015) compared with the those with non-HPR, respectively. In patients ≥67 years of age with HPR, there were no differences in MACCEs, but there was a decrease in major bleeding (adjusted HR, 0.721 [95% CI, 0.542-0.959]; P=0.024). Meanwhile, patients with HPR with BMI >22.6 kg/m2 had increases in MACCEs (adjusted HR, 1.387 [95% CI, 1.140-1.688]; P=0.001). No differences were shown in major bleeding. CONCLUSIONS HPR was linked to an increase in MACCEs or a decrease in major bleeding in patients after percutaneous coronary intervention, depending on age and BMI. This study is the first to observe that clinical outcomes in patients with HPR after percutaneous coronary intervention may vary based on age and BMI. Because the study is observational, the results should be viewed as hypothesis generating and emphasize the need for randomized clinical trials.
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Affiliation(s)
- Jung-Joon Cha
- Department of Cardiology, Cardiovascular Center Korea University Anam Hospital, Korea University College of Medicine Seoul South Korea
| | | | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center Korea University Anam Hospital, Korea University College of Medicine Seoul South Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center Korea University Anam Hospital, Korea University College of Medicine Seoul South Korea
| | - Tae Hoon Ahn
- Cardiovascular Center Chung-Ang University Gwang-myeong Hospital, Chung-Ang University College of Medicine Gwang-myeong South Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine Catholic University of Korea Seoul South Korea
| | - Yongwhi Park
- Department of Internal Medicine Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital Changwon South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Sung Gyun Ahn
- Department of Cardiology Yonsei University Wonju Severance Christian Hospital Wonju South Korea
| | - Jung-Won Suh
- Department of Cardiology, Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam South Korea
| | - Sang Yeub Lee
- Cardiovascular Center Chung-Ang University Gwang-myeong Hospital, Chung-Ang University College of Medicine Gwang-myeong South Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine Kangnam Sacred Heart Hospital, Hallym University College of Medicine Seoul South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine Kangwon National University School of Medicine Chuncheon South Korea
| | - Young-Hoon Jeong
- Cardiovascular Center Chung-Ang University Gwang-myeong Hospital, Chung-Ang University College of Medicine Gwang-myeong South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Moo Hyun Kim
- Department of Cardiology Dong-A University Hospital Busan South Korea
| | - Eun-Seok Shin
- Division of Cardiology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
| | | | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center Korea University Anam Hospital, Korea University College of Medicine Seoul South Korea
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5
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Lee JM, Kim H, Park YS, Jo HH, Lim SM, Lee J, Choi Y, Kang DY, Ahn JM, Kim S, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Choi JW, Kim KS, Lee SN, Park SJ, Park DW. Surveillance Stress Testing After Percutaneous Intervention for Patients With Multivessel or Left Main Coronary Disease. J Am Coll Cardiol 2024; 83:890-900. [PMID: 38418002 DOI: 10.1016/j.jacc.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND The optimal surveillance strategy after percutaneous coronary intervention (PCI) for high-risk patients with multivessel or left main coronary artery disease (CAD) remains uncertain. OBJECTIVES This study aims to determine the prognostic role of routine functional testing in patients with multivessel or left main CAD who underwent PCI. METHODS The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) trial randomized high-risk PCI patients to routine functional testing at 1 year or standard care alone during follow-up. This analysis focused on participants with multivessel or left main CAD. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. RESULTS Among 1,706 initially randomized patients, 1,192 patients with multivessel (n = 833) or left main (n = 359) were identified, with 589 in the functional testing group and 603 in the standard care group. Two-year incidences of primary outcome were similar between the functional testing group and the standard care group (6.2% vs 5.7%, respectively; HR: 1.09; 95% CI: 0.68-1.74; P = 0.73). This trend persisted in both groups of multivessel (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.62-1.89; P = 0.78) and left main disease (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.46-2.56; P = 0.85) (P for interaction = 0.90). Routine surveillance functional testing was associated with increased rates of invasive angiography and repeat revascularization beyond 1 year. CONCLUSIONS In high-risk patients with multivessel or left main CAD who underwent PCI, there was no incremental clinical benefit from routine surveillance functional-testing compared with standard care alone during follow-up. (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention [POST-PCI]; NCT03217877).
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Affiliation(s)
- Joong Min Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hoyun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Sun Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha Hye Jo
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Min Lim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeonwoo Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seonok Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Se Hun Kang
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Chul Soo Park
- Cardiovascular Center and Cardiology Division, Yeouido St Mary's Hospital, Seoul, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Seoul, Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Su Nam Lee
- Division of Cardiology, St Vincent's Hospital, Suwon, Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Jin X, Jeong YH, Lee KM, Yun SC, Kim BK, Joo HJ, Chang K, Park YW, Song YB, Ahn SG, Suh JW, Lee SY, Cho JR, Her AY, Kim HS, Lim DS, Shin ES, Kim MH. Prognostic Implication of Platelet Reactivity According to Procedural Complexity After PCI: Subanalysis of PTRG-DES Consortium. JACC Asia 2024; 4:185-198. [PMID: 38463677 PMCID: PMC10920055 DOI: 10.1016/j.jacasi.2023.10.011] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 03/12/2024]
Abstract
Background Complex percutaneous coronary intervention (C-PCI) and high platelet reactivity (HPR) have been proposed as representative risk factors for the high ischemic phenotype. Uncertainty remains regarding the relative prognostic importance of these factors. Objectives This study aimed to investigate the prognostic implication of HPR according to procedural complexity. Methods Patients treated with drug-eluting stent implantation (PTRG-PFT cohort; N = 11,714) were classified according to procedural complexity. HPR criteria were determined using VerifyNow (≥252 P2Y12 reaction units). The major adverse cardiac and cerebrovascular events (MACCE) (the composite of all-cause death, myocardial infarction, definite stent thrombosis, or stroke) and major bleeding were assessed for up to 3 years. Results C-PCI was performed in 3,152 patients (26.9%). C-PCI significantly increased the risk of MACCE (HRadjusted: 1.21; 95% CI: 1.01-1.44; P = 0.035), driven by a higher rate of all-cause death (HRadjusted: 1.45; 95% CI: 1.15-1.83; P = 0.002), although it did not increase the risk of major bleeding. Irrespective of procedural complexity, the HPR phenotype was significantly associated with MACCE (Pinteraction = 0.731) and all-cause mortality (Pinteraction = 0.978), in which the prognostic implication appeared prominent within 1 year. The HPR phenotype did not show a significant interaction with any type of C-PCI. In addition, the number of complexity features per procedure did not proportionally increase the risk of MACCE. Conclusions C-PCI was significantly associated with 3-year risk of MACCE and all-cause death. The HPR phenotype appears to have a similar prognostic implication irrespective of the type and extent of procedural complexity. (Platelet Function and Genotype-Related Long-Term Prognosis in DES-Treated Patients [PTRG-DES]; NCT04734028).
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Affiliation(s)
- Xuan Jin
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, China
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kwang Min Lee
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Sung Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Yong Whi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Gyun Ahn
- Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Yeub Lee
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - PTRG-DES Consortium Investigators
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, China
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, South Korea
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
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Kim H, Kang DY, Lee J, Choi Y, Ahn JM, Kim S, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Choi JW, Kim KS, Lee SN, Park SJ, Park DW. Routine stress testing in diabetic patients after percutaneous coronary intervention: the POST-PCI trial. Eur Heart J 2024; 45:653-665. [PMID: 37933514 DOI: 10.1093/eurheartj/ehad722] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND AND AIMS The optimal follow-up surveillance strategy for high-risk diabetic patients with had undergone percutaneous coronary intervention (PCI) remains unknown. METHODS The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) study was a randomized trial comparing a follow-up strategy of routine functional testing at 1 year vs. standard care alone after high-risk PCI. Randomization was stratified according to diabetes status. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. RESULTS Among 1706 randomized patients, participants with diabetes (n = 660, 38.7%) had more frequent comorbidities and a higher prevalence of complex anatomical or procedural characteristics than those without diabetes (n = 1046, 61.3%). Patients with diabetes had a 52% greater risk of primary composite events [hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.02-2.27; P = .039]. The 2-year incidences of the primary composite outcome were similar between strategies of routine functional testing or standard care alone in diabetic patients (7.1% vs. 7.5%; HR 0.94; 95% CI 0.53-1.66; P = .82) and non-diabetic patients (4.6% vs. 5.1%; HR 0.89; 95% CI 0.51-1.55; P = .68) (interaction term for diabetes: P = .91). The incidences of invasive coronary angiography and repeat revascularization after 1 year were higher in the routine functional-testing group than the standard-care group irrespective of diabetes status. CONCLUSIONS Despite being at higher risk for adverse clinical events, patients with diabetes who had undergone high-risk PCI did not derive incremental benefit from routine surveillance stress testing compared with standard care alone during follow-up.
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Affiliation(s)
- Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Seonok Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Se Hun Kang
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Chul Soo Park
- Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Seoul, South Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Su Nam Lee
- Division of Cardiology, St. Vincent's Hospital, Suwon, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
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8
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Han D, Kim SH, Shin DG, Kang MK, Choi S, Lee N, Kim BK, Joo HJ, Chang K, Park Y, Song YB, Ahn SG, Suh JW, Lee SY, Her AY, Jeong YH, Kim HS, Kim MH, Lim DS, Shin ES, Cho JR. Prognostic Implication of Platelet Reactivity According to Left Ventricular Systolic Dysfunction Status in Patients Treated With Drug-Eluting Stent Implantation: Analysis of the PTRG-DES Consortium. J Korean Med Sci 2024; 39:e27. [PMID: 38258362 PMCID: PMC10803212 DOI: 10.3346/jkms.2024.39.e27] [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: 05/17/2023] [Accepted: 11/08/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated. METHODS From the multicenter PTRG-DES (Platelet function and genoType-Related long-term prognosis in DES-treated patients) consortium, the patients were classified as preserved-EF (PEF: LVEF ≥ 50%) and reduced-EF (REF: LVEF< 5 0%) group by echocardiography. Platelet reactivity was measured using VerifyNow P2Y12 assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3-5. RESULTS A total of 13,160 patients from PTRG-DES, 9,319 (79.6%) patients with the results of both PRU and LVEF were analyzed. The incidence of MACCE and major bleeding was higher in REF group as compared with PEF group (MACCEs: hazard ratio [HR] 2.17, P < 0.001, 95% confidence interval [CI] 1.85-2.55; major bleeding: HR 1.78, P < 0.001, 95% CI 1.39-2.78). The highest rate of MACCEs was found in patients with REF and HPR, and the difference between the groups was statistically significant (HR 3.14 in REF(+)/HPR(+) vs. PEF(+)/HPR(-) group, P < 0.01, 95% CI 2.51-3.91). The frequency of major bleeding was not associated with the HPR in either group. CONCLUSION LV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04734028.
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Affiliation(s)
- Donghoon Han
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sun-Hwa Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Geum Shin
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min-Kyung Kang
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seonghoon Choi
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Namho Lee
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Gyun Ahn
- Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Yeub Lee
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Young-Hoon Jeong
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
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9
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Lim S, Hong SJ, Kim JH, Cha JJ, Joo HJ, Park JH, Yu CW, Kim BK, Chang K, Park Y, Song YB, Ahn SG, Suh JW, Lee SY, Cho JR, Her AY, Jeong YH, Kim HS, Kim MH, Shin ES, Lim DS. High platelet reactivity strongly predicts early stent thrombosis in patients with drug-eluting stent implantation. Sci Rep 2024; 14:520. [PMID: 38177178 PMCID: PMC10766995 DOI: 10.1038/s41598-023-50920-9] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
Stent thrombosis (ST) is a fatal complication after percutaneous coronary intervention (PCI). The association between P2Y12 reaction unit (PRU) level and stent thrombosis occurrence remains unclear. Based on the multicenter, observational PTRG-DES (Platelet function and genoType-Related long-term proGnosis in DES-treated patients) registry of patients with drug-eluting stents (DES) implantation, a total of 11,714 patients with PRU values were analyzed. We sought to identify the predictors of early stent thrombosis (EST) and compared the primary outcome, a composite of cardiac death, myocardial infarction, and revascularization, between EST and non-EST groups. EST, defined as definite ST within 1 month after index PCI, occurred in 51 patients. PRU values were significantly higher in the EST group (263.5 ± 70.8 vs. 217.5 ± 78.7, p < 0.001). In multivariable analysis, PRU ≥ 252 (OR, 5.10; 95% CI 1.58-16.46; p = 0.006) and aspirin reaction unit ≥ 414 (OR 4.85; 95% CI 1.07-21.97; p = 0.040) were independent predictors of EST. The cumulative incidence of primary composite outcome at one year was significantly higher in the EST group (38.2% vs. 3.9%, Log-rank p < 0.001). In patients treated with clopidogrel after successful DES implantation, EST was associated with higher platelet reactivities, and a greater risk of cardiovascular events.Trial Registration: clinicaltrials.gov Identifier: NCT04734028.
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Affiliation(s)
- Subin Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jung-Joon Cha
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | | | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Gyun Ahn
- Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang Yeub Lee
- Department of Cardiology, Chung Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Young-Hoon Jeong
- Department of Cardiology, Chung Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
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Suh JW, Memtsas V, Gue YX, Cho HW, Lee W, Kang SH, Gorog DA. Ethnic Differences in Thrombotic Profiles of Acute Coronary Syndrome Patients and Relationship to Cardiovascular Outcomes: A Comparison of East Asian and White subjects. Thromb Haemost 2023. [PMID: 38158199 DOI: 10.1055/s-0043-1777794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND East Asians (EAs), compared to white Caucasians (W), have a lower risk of ischemic heart disease and a higher risk of bleeding with antithrombotic medications. The underlying mechanisms are incompletely understood. OBJECTIVES We sought to compare thrombotic profiles of EA and W patients with myocardial infarction (MI) and relate these to cardiovascular outcomes. METHODS In a prospective study in the United Kingdom and Korea, blood samples from patients (n = 515) with ST- or non-ST-elevation MI (STEMI and NSTEMI) were assessed using the Global Thrombosis Test, measuring thrombotic occlusion (OT) and endogenous fibrinolysis (lysis time [LT]). Patients were followed for 1 year for major adverse cardiovascular events (MACE) and bleeding. RESULTS EA patients showed reduced OT (longer OT) compared to W (646 seconds [470-818] vs. 436 seconds [320-580], p < 0.001), with similar LT. In STEMI, OT (588 seconds [440-759] vs. 361 seconds [274-462], p < 0.001) and LT (1,854 seconds [1,389-2,729] vs. 1,338 seconds [1,104-1,788], p < 0.001) were longer in EA than W. In NSTEMI, OT was longer (OT: 734 seconds [541-866] vs. 580 seconds [474-712], p < 0.001) and LT shorter (1519 seconds [1,058-2,508] vs. 1,898 seconds [1,614-2,806], p = 0.004) in EA than W patients. MACE was more frequent in W than EA (6.3 vs. 1.9%, p = 0.014) and bleeding infrequent. While OT was unrelated, LT was a strong independent predictor of MACE event after adjustment for risk factors (hazard ratio: 3.70, 95% confidence interval: 1.43-9.57, p = 0.007), predominantly in W patients, and more so in STEMI than NSTEMI patients. CONCLUSION EA patients exhibit different global thrombotic profiles to W, associated with a lower rate of cardiovascular events.
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Affiliation(s)
- Jung-Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Vassilios Memtsas
- Cardiovascular Division, Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ying X Gue
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Hyoung-Won Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Wonjae Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Diana A Gorog
- Cardiovascular Division, Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
- Centre for Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom
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11
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Kim SE, Jeon HS, Go TH, Lee JH, Lee JW, Youn YJ, Kim BK, Joo HJ, Lim DS, Chang K, Park Y, Song YB, Suh JW, Lee SY, Cho JR, Her AY, Kim HS, Kim MH, Shin ES, Gorog DA, Tantry US, Gurbel PA, Jeong YH, Ahn SG. High Platelet Reactivity Combined with CYP2C19 Genotype in Predicting Outcomes in East Asian Patients Undergoing Percutaneous Coronary Intervention. Clin Pharmacol Ther 2023; 114:1104-1115. [PMID: 37597219 DOI: 10.1002/cpt.3026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
Loss-of-function (LoF) alleles of cytochrome P450 2C19 (CYP2C19), which are prevalent in East Asians, are linked to high platelet reactivity (HPR) phenotype and poor prognosis. We aimed to investigate the incremental predictive value of HPR combined with CYP2C19 genotype in predicting outcomes after drug-eluting stent (DES) implantation. The patients treated with platelet function and genotype-related long-term prognosis in drug-eluting stent (PTRG-DES) consortium enrolled a total of 13,160 Korean patients treated with DES who had platelet function test (PFT) or CYP2C19 genotype, of which, 6,717 patients with PFT and genotype together were categorized. HPR was defined as VerifyNow ≥ 252 P2Y12 reaction unit. The primary outcome was the incidence of major adverse cardiac and cerebrovascular event (MACCE) 5 years after treatment. The patients with both HPR and CYP2C19 LoF/LoF had the highest MACCE rates (6.2%) and increased MACCE risk (adjusted hazard ratio: 1.89, 95% confidence interval: 1.20-2.91, P = 0.006) compared with those without both HPR and CYP2C19 LoF/LoF. There was no effect of interaction between HPR and CYP2C19 genotype on the primary outcome (P = 0.424). Adding combined HPR and CYP2C19 genotype to the conventional model had an incremental influence in predicting MACCE and stent thrombosis. Compared to the model including HPR or CYP2C19 genotype alone, a combination model significantly improved the risk stratification for stent thrombosis but not MACCE. In DES-treated East Asian patients, the combined evaluation of PFT results and CYP2C19 genotyping might improve risk prediction of ischemic events during clopidogrel treatment.
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Affiliation(s)
- Se-Eun Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ho-Sung Jeon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Tae-Hwa Go
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jung-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Yeob Lee
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Diana A Gorog
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Young-Hoon Jeong
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea
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12
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Jeon KH, Jeong YH, Chae IH, Kim BK, Joo HJ, Chang K, Park Y, Song YB, Ahn SG, Lee SY, Cho JR, Her AY, Kim HS, Kim MH, Lim DS, Shin ES, Suh JW. Implication of diabetic status on platelet reactivity and clinical outcomes after drug-eluting stent implantation: results from the PTRG-DES consortium. Cardiovasc Diabetol 2023; 22:245. [PMID: 37679760 PMCID: PMC10486029 DOI: 10.1186/s12933-023-01976-4] [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: 06/17/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with thrombogenicity, clinically manifested with atherothrombotic events after percutaneous cutaneous intervention (PCI). This study aimed to investigate association between DM status and platelet reactivity, and their prognostic implication in PCI-treated patients. METHODS The Platelet function and genoType-Related long-term Prognosis-Platelet Function Test (PTRG-PFT) cohort was established to determine the linkage of platelet function test (PFT) with long-term prognosis during dual antiplatelet therapy including clopidogrel in patients treated with drug-eluting stent (DES). We assessed platelet reactivity using VerifyNow and 'high platelet reactivity (HPR)' was defined as ≥ 252 P2Y12 reaction unit (PRU). Major adverse cardiac and cerebrovascular event (MACCE) was a composite of all-cause death, myocardial infarction, stent thrombosis or stroke. RESULTS Between July 2003 and Aug 2018, DES-treated patients with available PFT were enrolled (n = 11,714). Diabetic patients demonstrated significant higher levels of platelet reactivity (DM vs. non-DM: 225.7 ± 77.5 vs. 213.6 ± 79.1 PRU, P < 0.001) and greater prevalence of HPR compared to non-diabetic patients (38.1% vs. 32.0%, P < 0.001). PRU level and prevalence of HPR were significantly associated with insulin requirement and HbA1c level, as well as diabetic status. DM status and HPR phenotype had a similar prognostic implication, which showed the synergistic clinical impact on MACCE. Association between PRU level and MACCE occurrence seemed higher in diabetic vs. non-diabetic patients. In non-DM patients, HPR phenotype did not significantly increase the risk of MACCE (adjusted hazard ratio [HRadj]: 1.073; 95% confidence interval [CI]: 0.869-1.325; P = 0.511), whereas HPR was an independent determinant for MACCE occurrence among diabetic patients (HRadj: 1.507; 95% CI: 1.193-1.902; P < 0.001). CONCLUSION The levels of on-clopidogrel platelet reactivity are determined by diabetic status and the severity of DM. In addition, HPR phenotype significantly increases the risk of MACCE only in diabetic patients. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov . Unique identifier: NCT04734028.
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Affiliation(s)
- Ki-Hyun Jeon
- Department of Internal Medicine, Department of Cardiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Seoul, South Korea
| | - In-Ho Chae
- Department of Internal Medicine, Department of Cardiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yongwhi Park
- Department of Internal Medicine, Cardiovascular Center, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Gyun Ahn
- Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Department of Cardiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Lee SH, Jeong YH, Hong D, Choi KH, Lee JM, Park TK, Yang JH, Hahn JY, Choi SH, Gwon HC, Jeong MH, Kim BK, Joo HJ, Chang K, Park Y, Ahn SG, Suh JW, Lee SY, Cho JR, Her AY, Kim HS, Kim MH, Lim DS, Shin ES, Song YB. Clinical Impact of CYP2C19 Genotype on Clopidogrel-Based Antiplatelet Therapy After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:829-843. [PMID: 37045504 DOI: 10.1016/j.jcin.2023.01.363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Although there is a growing body of evidence that CYP2C19 genotyping can be beneficial when considering treatment with clopidogrel after percutaneous coronary intervention (PCI), whether a genotype-guided strategy can be generally adopted in routine practice remains unclear among East Asians. OBJECTIVES This study sought to investigate long-term outcomes of patients undergoing clopidogrel-based antiplatelet therapy after drug-eluting stent (DES) implantation according to CYP2C19 genotypes. METHODS From the nationwide multicenter PTRG-DES (Platelet function and genoType-Related long-term proGnosis in DES-treated patients) consortium, patients who underwent CYP2C19 genotyping were selected and classified according to CYP2C19 loss-of-function allele: rapid metabolizers (RMs) or normal metabolizers (NMs) vs intermediate metabolizers (IMs) or poor metabolizers (PMs). The primary outcome was a composite of cardiac death, myocardial infarction, and stent thrombosis at 5 years after the index procedure. RESULTS Of 8,163 patients with CYP2C19 genotyping, 56.7% presented with acute coronary syndrome. There were 3,098 (37.9%) in the RM or NM group, 3,906 (47.9%) in the IM group, and 1,159 (14.2%) in the PM group. IMs or PMs were associated with an increased risk of 5-year primary outcome compared with RMs or NMs (HRadj: 1.42; 95% CI: 1.01-1.98; P = 0.041), and the effect was more pronounced in the first year (HRadj: 1.67; 95% CI: 1.10-2.55; P = 0.016). The prognostic implication of being an IM and PM was significant in acute coronary syndrome patients (HRadj: 1.88; 95% CI: 1.20-2.93; P = 0.005) but not in those with stable angina (HRadj: 0.92; 95% CI: 0.54-1.55; P = 0.751) (interaction P = 0.028). CONCLUSIONS Among East Asians with clopidogrel-based antiplatelet therapy after DES implantation, CYP2C19 genotyping could stratify patients who were likely to have an increased risk of atherothrombotic events. (Platelet Function and genoType-Related Long-term progGosis in DES-treated Patients: A Consortium From Multi-centered Registries [PTRG-DES]; NCT04734028).
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14
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Yoon CH, Kwun JS, Choi YJ, Park JJ, Kang SH, Kim SH, Suh JW, Youn TJ, Kim MK, Cha KS, Lee SH, Hong BK, Rha SW, Kang WC, Lee JH, Kim SH, Chae IH. BioMatrix Versus Orsiro Stents for Coronary Artery Disease: A Multicenter, Randomized, Open-Label Study. Circ Cardiovasc Interv 2023; 16:e012307. [PMID: 36475473 DOI: 10.1161/circinterventions.122.012307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Comparative studies of ultrathin-strut biodegradable polymer sirolimus-eluting stent (BP-SES) have reported promising results and validated its excellent outcomes in terms of safety and efficacy. However, there are limited studies comparing BP drug-eluting stents with struts of different thicknesses. We compared the long-term clinical outcomes of patients treated with an ultrathin-strut BP-SES or a thick-strut biodegradable polymer biolimus-eluting stent (BP-BES). METHODS The BIODEGRADE trial (Biomatrix and Orsiro Drug-Eluting Stents in Angiographic Result in Patients With Coronary Artery Disease) is a multicenter prospective randomized study comparing coronary revascularization in patients with ultrathin-strut BP-SES and thick-strut BP-BES with the primary end point of target lesion failure at 18 months posttreatment. We performed the prespecified analysis of 3-year clinical outcomes. RESULTS In total, 2341 patients were randomized to receive treatment with ultrathin-strut BP-SES (N=1175) or thick-strut BP-BES (N=1166). The 3-year incidence rate of target lesion failure was 3.2% for BP-SES and 5.1% for BP-BES (P=0.023). The difference was primarily due to differences in ischemia-driven target lesion revascularization (BP-SES, 1.5%; BP-BES, 2.8%; P=0.035) between groups. A landmark analysis of the late follow-up period showed significant differences in target lesion failure, with outcomes being better in BP-SES. Cardiac death and target lesion revascularization were significantly lower in the BP-SES group. CONCLUSIONS In a large, randomized trial, the long-term clinical outcome of target lesion failure at 3 years was significantly better among patients treated with the ultrathin-strut BP-SES. The results indicate the superiority of the ultrathin-strut BP-SES compared with the thick-strut BP-BES. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT02299011.
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Affiliation(s)
- Chang-Hwan Yoon
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Ju-Seung Kwun
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Young Jin Choi
- Sejong General Hospital, Bucheon, Republic of Korea (Y.J.C.)
| | - Jin Joo Park
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Si-Hyuck Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Sun-Hwa Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Jung-Won Suh
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Tae-Jin Youn
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Myeong-Kon Kim
- Catholic Kwandong University International St Mary's Hospital, Incheon, Republic of Korea (M.-K.K.)
| | - Kwang Soo Cha
- Pusan National University Hospital, Republic of Korea (K.S.C.)
| | - Seung-Hwan Lee
- Wonju Severance Hospital, Yonsei University College of Medicine, Republic of Korea (S.-H.L.)
| | - Bum-Kee Hong
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (B.K.H.)
| | - Seung-Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea (S.-W.R.)
| | - Woong Chol Kang
- Gachon University Gil Medical Center, Incheon, Republic of Korea (W.C.K.)
| | - Jae-Hwan Lee
- Chungnam National University Hospital, Daejeon, Republic of Korea (J.-H.L.)
| | - Sang-Hyun Kim
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea (S.-H.K.)
| | - In-Ho Chae
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
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15
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Lee SJ, Cha JJ, Jeong YH, Hong SJ, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y, Joo HJ, Chang K, Park Y, Song YB, Ahn SG, Suh JW, Lee SY, Cho JR, Her AY, Kim HS, Kim MH, Shin ES, Lim DS, Kim BK. Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2022; 15:2253-2265. [DOI: 10.1016/j.jcin.2022.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/11/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022]
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16
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Park DW, Kang DY, Ahn JM, Yun SC, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ. Routine Functional Testing or Standard Care in High-Risk Patients after PCI. N Engl J Med 2022; 387:905-915. [PMID: 36036496 DOI: 10.1056/nejmoa2208335] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 12/25/2022]
Abstract
BACKGROUND There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-risk patients who have undergone percutaneous coronary intervention (PCI) is uncertain. METHODS We randomly assigned 1706 patients with high-risk anatomical or clinical characteristics who had undergone PCI to a follow-up strategy of routine functional testing (nuclear stress testing, exercise electrocardiography, or stress echocardiography) at 1 year after PCI or to standard care alone. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Key secondary outcomes included invasive coronary angiography and repeat revascularization. RESULTS The mean age of the patients was 64.7 years, 21.0% had left main disease, 43.5% had bifurcation disease, 69.8% had multivessel disease, 70.1% had diffuse long lesions, 38.7% had diabetes, and 96.4% had been treated with drug-eluting stents. At 2 years, a primary-outcome event had occurred in 46 of 849 patients (Kaplan-Meier estimate, 5.5%) in the functional-testing group and in 51 of 857 (Kaplan-Meier estimate, 6.0%) in the standard-care group (hazard ratio, 0.90; 95% confidence interval [CI], 0.61 to 1.35; P = 0.62). There were no between-group differences with respect to the components of the primary outcome. At 2 years, 12.3% of the patients in the functional-testing group and 9.3% in the standard-care group had undergone invasive coronary angiography (difference, 2.99 percentage points; 95% CI, -0.01 to 5.99), and 8.1% and 5.8% of patients, respectively, had undergone repeat revascularization (difference, 2.23 percentage points; 95% CI, -0.22 to 4.68). CONCLUSIONS Among high-risk patients who had undergone PCI, a follow-up strategy of routine functional testing, as compared with standard care alone, did not improve clinical outcomes at 2 years. (Funded by the CardioVascular Research Foundation and Daewoong Pharmaceutical; POST-PCI ClinicalTrials.gov number, NCT03217877.).
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Affiliation(s)
- Duk-Woo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Do-Yoon Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Min Ahn
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Sung-Cheol Yun
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Yong-Hoon Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Ho Hur
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Cheol Hyun Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Won-Jang Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Se Hun Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Chul Soo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Bong-Ki Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Won Suh
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung Han Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jae Woong Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Kee-Sik Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Si Wan Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Su Nam Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Jung Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
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Park DW, Kang DY, Ahn JM, Yun SC, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ. Routine Functional Testing or Standard Care in High-Risk Patients after PCI. N Engl J Med 2022. [PMID: 36036496 DOI: 10.1056/nejmoa2208335jonesd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-risk patients who have undergone percutaneous coronary intervention (PCI) is uncertain. METHODS We randomly assigned 1706 patients with high-risk anatomical or clinical characteristics who had undergone PCI to a follow-up strategy of routine functional testing (nuclear stress testing, exercise electrocardiography, or stress echocardiography) at 1 year after PCI or to standard care alone. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Key secondary outcomes included invasive coronary angiography and repeat revascularization. RESULTS The mean age of the patients was 64.7 years, 21.0% had left main disease, 43.5% had bifurcation disease, 69.8% had multivessel disease, 70.1% had diffuse long lesions, 38.7% had diabetes, and 96.4% had been treated with drug-eluting stents. At 2 years, a primary-outcome event had occurred in 46 of 849 patients (Kaplan-Meier estimate, 5.5%) in the functional-testing group and in 51 of 857 (Kaplan-Meier estimate, 6.0%) in the standard-care group (hazard ratio, 0.90; 95% confidence interval [CI], 0.61 to 1.35; P = 0.62). There were no between-group differences with respect to the components of the primary outcome. At 2 years, 12.3% of the patients in the functional-testing group and 9.3% in the standard-care group had undergone invasive coronary angiography (difference, 2.99 percentage points; 95% CI, -0.01 to 5.99), and 8.1% and 5.8% of patients, respectively, had undergone repeat revascularization (difference, 2.23 percentage points; 95% CI, -0.22 to 4.68). CONCLUSIONS Among high-risk patients who had undergone PCI, a follow-up strategy of routine functional testing, as compared with standard care alone, did not improve clinical outcomes at 2 years. (Funded by the CardioVascular Research Foundation and Daewoong Pharmaceutical; POST-PCI ClinicalTrials.gov number, NCT03217877.).
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Affiliation(s)
- Duk-Woo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Do-Yoon Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Min Ahn
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Sung-Cheol Yun
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Yong-Hoon Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Ho Hur
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Cheol Hyun Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Won-Jang Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Se Hun Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Chul Soo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Bong-Ki Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Won Suh
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung Han Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jae Woong Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Kee-Sik Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Si Wan Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Su Nam Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Jung Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
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Jeon KH, Jeong YH, Kim BK, Joo HJ, Chang K, Park Y, Song YB, Ahn SG, Lee SY, Cho JR, Kim HS, Kim MH, Lim DS, Shin ES, Suh JW. TCT-29 Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation in East Asian Patients With Diabetes: Results From the PTRG-DES Registry. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.041] [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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Lee SJ, Cha JJ, Jeong YH, Hong SJ, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y, Joo HJ, Chang K, Park Y, Song YB, Ahn SG, Suh JW, Lee SY, Cho JR, Her AY, Kim HS, Kim MH, Shin ES, Lim DS, Kim BK. TCT-30 Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation in East Asian Patients: Results From the PTRG-DES Consortium. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.042] [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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Kim KM, Yoon YE, La Yun B, Suh JW. Association between Bone Mineral Density and Coronary Atherosclerotic Plaque According to Plaque Composition: Registry for the Women Health Cohort for Bone, Breast, and Coronary Artery Disease Study. J Bone Metab 2022; 29:123-131. [PMID: 35718929 PMCID: PMC9208904 DOI: 10.11005/jbm.2022.29.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although biological links are unclear, low bone density and atherosclerosis are inversely associated. This study evaluated the association between bone mineral density (BMD) and coronary computed tomographic angiography (CCTA) findings, including coronary artery calcification (CAC) score and the presence, extent, and composition of coronary atherosclerotic plaque (CAP) in asymptomatic women. Methods A symptomatic women aged ≥40 years (N=2, 100; median age, 52 years; range, 40–80 years) were selected from a retrospective observational cohort and stratified into normal, osteopenia, and osteoporosis groups according to BMD T-score grades. We evaluated CAC score and assessed the presence, extent, and stenosis severity of CAP on CCTA. Additionally, CAP was categorized as calcified, mixed, or non-calcified according to calcified component valiums (>130 Hounsfield units). Results Osteopenia and osteoporosis were found in 28.8% and 5.3% of participants, respectively. CAC score and CAC severity significantly increased with decreased BMD grades (from normal to osteoporosis). The presence of CAP (overall, 15.6%; normal, 12.6%; osteopenia, 20.2%; osteoporosis, 28.8%; P<0.001) and number of segments with CAP significantly increased with decreased BMD grades. Furthermore, the number of segments with calcified or mixed plaques, excluding non-calcified plaques, increased with decreased BMD grades. Although most associations were attenuated or disappeared after adjusting for age and other covariates, calcified plaques showed a strong and age-independent association with BMD grades. Conclusions The presence and severity of CAC and CAP were significantly associated with BMD severity in asymptomatic women, particularly for the presence of calcified plaques. Further studies are required to determine the association between vascular calcification and bone health status.
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Affiliation(s)
- Kyoung Min Kim
- Division of Endocrinology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Yeonyee E. Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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21
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Her AY, Jeong YH, Kim BK, Joo HJ, Chang K, Park Y, Song YB, Ahn SG, Suh JW, Lee SY, Cho JR, Kim HS, Kim MH, Lim DS, Shin ES. Platelet Function and Genotype after DES Implantation in East Asian Patients: Rationale and Characteristics of the PTRG-DES Consortium. Yonsei Med J 2022; 63:413-421. [PMID: 35512743 PMCID: PMC9086699 DOI: 10.3349/ymj.2022.63.5.413] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Platelet function test (PFT) results and genotype hold unique prognostic implications in East Asian patients. The aim of the PTRG-DES (Platelet function and genoType-Related long-term proGnosis in Drug-Eluting Stent-treated Patients with coronary artery disease) consortium is to assess the clinical impact thereof on long-term clinical outcomes in Korean patients with coronary artery disease during dual antiplatelet therapy (DAPT) including clopidogrel. MATERIALS AND METHODS Searching publications on the PubMed, we reviewed clopidogrel treatment studies with PFT and/or genotype data for potential inclusion in this study. Lead investigators were invited to share PFT/genotype results, patient characteristics, and clinical outcomes to evaluate relationships among them. RESULTS Nine registries from 32 academic centers participated in the PTRG-DES consortium, contributing individual patient data from 13160 patients who underwent DES implantation between July 2003 and August 2018. The PTRG-PFT cohort was composed of 11714 patients with available VerifyNow assay results. Platelet reactivity levels reached 218±79 P2Y12 reaction units (PRU), and high on-clopidogrel platelet reactivity based on a consensus-recommended cutoff (PRU >208) was observed in 55.9%. The PTRG-Genotype cohort consisted of 8163 patients with candidate genotypes related with clopidogrel responsiveness. Of those with cytochrome P450 (CYP) 2C19 genotype, frequencies of carrying one and two loss-of-function allele (s) (*2 or *3) were 47.9% (intermediate metabolizers) and 14.2% (poor metabolizers), respectively. CONCLUSION The PTRG-DES consortium highlights unique values for on-clopidogrel platelet reactivity and CYP2C19 phenotype that may be important to developing optimal antiplatelet regimens in East Asian patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04734028.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Gyun Ahn
- Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Yeup Lee
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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22
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Suh JW, Kang H, Kim J, Cho HW, Lee W, Yoon CH, Youn TJ, Chae IH. Prediction of endogenous thrombolytic activity in patients with coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1284] [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
Endogenous thrombolytic activity (ETA) has been suggested as an essential factor related to the acute coronary syndrome. However, there have been little data regarding clinical characteristics of ETA in East Asians.
Method
As an interim study of the entire cohort (n=2,000), we analyzed a total of 278 patients who underwent percutaneous coronary intervention (PCI) due to coronary artery disease (CAD). Informed consent was obtained from all research subjects. Blood samples of patients were brought before the procedure. The Global Thrombosis Test (GTT, Thromboquest, UK), a novel test for examining ETA, was used. Lysis time (LT), which means the time interval between blood flow occlusion and restart, was used as an indicator for ETA. Clinical, laboratory and angiographic characteristics were obtained. LT=3000 seconds was used as a cut-off value to divide patients into two groups. P value<0.05 was regarded as significant.
Results
LT of Korean CAD patients showed bimodal distribution. Median value was 1695 [IQR: 1099, 5932] and it was higher than previous data from Europeans (Figure 1). Patients with impaired ETA (LT>3000) were older and more diabetic. They showed higher creatinine, aPTT, fibrinogen, D-dimer, c-reactive protein, and proBNP values. Moreover, they had lower hemoglobin and platelet levels. Intracoronary thrombus was more frequently observed in LT>3000 group. In the multivariable regression analysis, hemoglobin (per g/dL, odds ratio 0.766, 95% confidence interval (CI) 0.632–0.928) and fibrinogen level(per 10mg/L, odds ratio 1.054, 95% CI 1.015–1.095) could significantly predict impaired ETA.
Conclusion
East Asian patients showed a right-shifted distribution of ETA compared to that of Europeans. Patients with impaired ETA had different clinical, laboratory and angiographic characteristics from those with intact ETA. Hemoglobin and fibrinogen level were significantly associated with impaired ETA. Further studies are warranted to confirm causal relationship among these factors.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Foundation, Republic of Korea
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Affiliation(s)
- J W Suh
- Seoul National University Bundang Hospital, Seongnam, Korea (Republic of)
| | - H Kang
- Seoul National University College of Medicine, Seoul, Korea (Republic of)
| | - J Kim
- Seoul National University College of Medicine, Seoul, Korea (Republic of)
| | - H W Cho
- Seoul National University Bundang Hospital, Seongnam, Korea (Republic of)
| | - W Lee
- Seoul National University Bundang Hospital, Seongnam, Korea (Republic of)
| | - C H Yoon
- Seoul National University Bundang Hospital, Seongnam, Korea (Republic of)
| | - T J Youn
- Seoul National University Bundang Hospital, Seongnam, Korea (Republic of)
| | - I H Chae
- Seoul National University Bundang Hospital, Seongnam, Korea (Republic of)
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Moon IT, Kang SH, Lee W, Cho Y, Park JJ, Yoon YE, Oh IY, Yoon CH, Suh JW, Youn TJ, Chae IH, Choi DJ, Cho YS. Impact of statin intensity on adverse cardiac and cerebrovascular events in older adult patients with myocardial infarction. J Geriatr Cardiol 2021; 18:609-622. [PMID: 34527027 PMCID: PMC8390935 DOI: 10.11909/j.issn.1671-5411.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is insufficient evidence regarding the effect of high-intensity statin therapy in older adults. This study aimed to investigate the effects of high-intensity statin treatment on the clinical outcomes in older adults with myocardial infarction (MI). METHODS Consecutive patients with MI aged at least 75 years were analyzed retrospectively. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of all-cause death, MI, rehospitalization due to unstable angina, repeat revascularization, and ischemic stroke. The high-intensity group was compared to the low-to-moderate intensity group in the propensity score-matched cohort. RESULTS Average age of total 546 patients was 81 years. Among them, 84% of patients underwent percutaneous coronary intervention. The unadjusted seven-year MACCE rate differed by statin intensity (high-intensity statin group: 38%, moderate-intensity statin group: 42%, low-intensity statin group: 56%, and no-statin group: 61%, P = 0.004). However, among these groups, many baseline characteristics were significantly different. Among the 74 propensity score-matched pairs, which lacked any significant differences in all baseline characteristics, the high-intensity group had a significantly lower rate of MACCE than the low-to-moderate intensity group (37% vs. 53%, P = 0.047). Follow-up low-density lipoprotein cholesterol levels were significantly lower in the high-intensity group than that in the low-to-moderate intensity group (69.4 ± 16.0 mg/dL vs. 77.9 ± 25.9 mg/dL, P = 0.026). CONCLUSIONS In older adult patients with MI, the use of high-intensity statin caused significantly less occurrence of MACCE in comparison to that in low-to-moderate intensity for up to seven years of follow-up.
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Affiliation(s)
- In Tae Moon
- Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Si-Hyuck Kang
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Wonjae Lee
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Youngjin Cho
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin Joo Park
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yeonyee E. Yoon
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Il-Young Oh
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chang-Hwan Yoon
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung-Won Suh
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tae-Jin Youn
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ho Chae
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Ju Choi
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Seok Cho
- Department of Cardiology, Incheon Sejong Hospital, Incheon, South Korea
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Park Y, Koh JS, Lee JH, Park JH, Shin ES, Oh JH, Chun W, Lee SY, Bae JW, Kim JS, Kim W, Suh JW, Yang DH, Hong YJ, Chan MY, Kang MG, Park HW, Hwang SJ, Hwang JY, Ahn JH, Choi SW, Jeong YH. Effect of Ticagrelor on Left Ventricular Remodeling in Patients With ST-Segment Elevation Myocardial Infarction (HEALING-AMI). JACC Cardiovasc Interv 2021; 13:2220-2234. [PMID: 33032710 DOI: 10.1016/j.jcin.2020.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of ticagrelor versus clopidogrel on left ventricular (LV) remodeling after reperfusion of ST-segment elevation myocardial infarction (STEMI) in humans. BACKGROUND Animal studies have demonstrated that ticagrelor compared with clopidogrel better protects myocardium against reperfusion injury and improves remodeling after myocardial infarction. METHODS In this investigator-initiated, randomized, open-label, assessor-blinded trial performed at 10 centers in Korea, patients were enrolled if they had naive STEMI successfully treated with primary percutaneous coronary intervention (PCI) and at least 6-month planned duration of dual-antiplatelet treatment. The coprimary endpoints were LV remodeling index (LVRI) (a relative change of LV end-diastolic volume) measured on 3-dimensional echocardiography and N-terminal pro-B-type natriuretic peptide level at 6 months. RESULTS Among initially enrolled patients with STEMI (n = 336), 139 in each group completed the study. LVRI at 6 months was numerically lower with ticagrelor versus clopidogrel (0.6 ± 18.6% vs. 4.5 ± 16.5%; p = 0.095). Ticagrelor significantly reduced the 6-month level of N-terminal pro-B-type natriuretic peptide (173 ± 141 pg/ml vs. 289 ± 585 pg/ml; p = 0.028). These differences were prominent in patients with pre-PCI TIMI (Thrombolysis In Myocardial Infarction) flow grade 0. By multivariate analysis, ticagrelor versus clopidogrel reduced the risk for positive LV remodeling (LVRI >0%) (odds ratio: 0.56; 95% confidence interval: 0.33 to 0.95; p = 0.030). The LV end-diastolic volume index remained unchanged during ticagrelor treatment (from 54.7 ± 12.2 to 54.2 ± 12.2 ml/m2; p = 0.629), but this value increased over time during clopidogrel treatment (from 54.6 ± 11.3 to 56.4 ± 13.9 ml/m2; p = 0.056) (difference -2.3 ml/m2; 95% confidence interval: -4.8 to 0.2 ml/m2; p = 0.073). Ticagrelor reduced LV end-systolic volume index (from 27.0 ± 8.5 to 24.7 ± 8.4 ml/m2; p < 0.001), whereas no reduction was seen with clopidogrel (from 26.2 ± 8.9 to 25.6 ± 11.0 ml/m2; p = 0.366) (difference -1.8 ml/m2; 95% confidence interval: -3.5 to -0.1 ml/m2; p = 0.040). CONCLUSIONS Ticagrelor was superior to clopidogrel for LV remodeling after reperfusion of STEMI with primary PCI. (High Platelet Inhibition With Ticagrelor to Improve Left Ventricular Remodeling in Patients With ST Segment Elevation Myocardial Infarction [HEALING-AMI]; NCT02224534).
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Affiliation(s)
- Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Jin Sin Koh
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Jae-Hwan Lee
- Department of Cardiology, Chungnam National University Hospital, Daejeon, South Korea
| | - Jae-Hyeong Park
- Department of Cardiology, Chungnam National University Hospital, Daejeon, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan, South Korea
| | - Ju Hyeon Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Woojung Chun
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Sang Yeub Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Jeong Su Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Weon Kim
- Cardiovascular Department of Internal Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong Heon Yang
- Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea
| | - Young-Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Mark Y Chan
- Singapore National University Heart Center, Singapore National University Hospital, Singapore, Singapore
| | - Min Gyu Kang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Hyun-Woong Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Seok-Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Jong-Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Si Wan Choi
- Department of Cardiology, Chungnam National University Hospital, Daejeon, South Korea.
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea.
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Yoon CH, Choi Y, Park J, Kang SH, Kim SH, Suh JW, Cho YS, Youn TJ, Kim MK, Cha K, Lee SH, Hong BK, Rha SW, Kang WC, Lee JH, Kim SH, Chae IH. BioMatrix versus Orsiro biodegradable polymer stents in all-comer patients with coronary artery disease: the multicentre, randomised BIODEGRADE trial. EUROINTERVENTION 2021; 16:1404-1412. [PMID: 32958459 PMCID: PMC9725076 DOI: 10.4244/eij-d-20-00185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this trial was to compare the safety and efficacy of a thin-strut biodegradable polymer sirolimus-eluting cobalt-chromium stent (Orsiro) to a thick-strut biodegradable polymer biolimus-eluting stent (BioMatrix). METHODS AND RESULTS This randomised, open-label, non-inferiority trial was conducted among patients undergoing percutaneous coronary intervention. The primary endpoint was target lesion failure (TLF). Between July 2014 and September 2017, we randomly assigned 2,341 patients to BioMatrix stents (n=1,166) or Orsiro stents (n=1,175). We analysed 2,327 patients who completed 18-month follow-up. The mean patient age was 63.5 years, and 1,565 (67.3%) patients presented with acute coronary syndrome. At 18 months, 34 (2.9%) patients with BioMatrix stents and 24 (2.1%) with Orsiro stents experienced TLF (hazard ratio [HR] 0.70, upper limit of one-sided 95% confidence interval: 1.18, p for non-inferiority <0.0001). No significant differences were noted in rates of cardiac death (16 [1.4%] vs 12 [1.0%], p=0.558), target lesion-related myocardial infarction (0 [0%] vs 3 [0.3%], p=0.250), target lesion revascularisation (18 [1.6%] vs 10 [0.9%], p=0.124), or stent thrombosis (0 [0%] vs 2 [0.2%], p=0.50). CONCLUSIONS In patients with a high prevalence of acute coronary syndrome, Orsiro stents were not inferior to BioMatrix stents. Both showed good clinical outcomes.
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Affiliation(s)
- Chang-Hwan Yoon
- Seoul National University Bundang Hospital, Seongnam, Rebublic of Korea
| | - Young Choi
- Sejong General Hospital, Bucheon, Republic of Korea
| | - Jin Park
- Seoul National University Bundang Hospital, Seongnam, Rebublic of Korea
| | - Si-Hyuck Kang
- Seoul National University Bundang Hospital, Seongnam, Rebublic of Korea
| | - Sun-Hwa Kim
- Seoul National University Bundang Hospital, Seongnam, Rebublic of Korea
| | - Jung-Won Suh
- Seoul National University Bundang Hospital, Seongnam, Rebublic of Korea
| | - Young-Seok Cho
- Seoul National University Bundang Hospital, Seongnam, Rebublic of Korea
| | - Tae-Jin Youn
- Seoul National University Bundang Hospital, Seongnam, Rebublic of Korea
| | - Myeong-Kon Kim
- Catholic Kwandong University International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Kwang Cha
- Pusan National University Hospital, Pusan, Republic of Korea
| | - Seung-Hwan Lee
- Wonju Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bum-Kee Hong
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Woong-Chol Kang
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jae-Hwan Lee
- Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sang-Hyun Kim
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumiro 173, Bundang-gu, 13620, Seongnam, Republic of Korea
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Yoon YE, Yun BL, Kim KM, Suh JW. Breast Arterial Calcification: A Potential Biomarker for Atherosclerotic Cardiovascular Disease Risk? Curr Atheroscler Rep 2021; 23:21. [PMID: 33772359 DOI: 10.1007/s11883-021-00924-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW We aimed to summarize the current evidence regarding the association between breast arterial calcification (BAC) and atherosclerotic cardiovascular disease (ASCVD) in women and discuss the potential role of BAC in the risk stratification and preventive approaches for ASCVD. RECENT FINDINGS BAC has emerged as a potential women-specific risk marker for ASCVD. Although BAC presents as a medial calcification of the arteries, notably different from the intimal atherosclerotic process, current evidence supports a correlation between BAC and ASCVD risk factors or subclinical and clinical ASCVD, such as coronary artery disease or stroke. As millions of women undergo mammograms each year, the potential clinical application of BAC in enhanced ASCVD risk estimation, with no additional cost or radiation, has tremendous appeal. Although further research regarding optimal risk assessment and management in women with BAC is required, the presence of BAC should prompt healthy cardiovascular lifestyle modifications.
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Affiliation(s)
- Yeonyee E Yoon
- Department of Radiology, New York-Presbyterian Hospital, and Weill Cornell Medicine, New York, NY, USA.
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Division of Endocrinology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kwun JS, Kang SH, Lee HJ, Park HK, Lee WJ, Yoon CH, Suh JW, Cho YS, Youn TJ, Chae IH. Comparison of thrombus, gut, and oral microbiomes in Korean patients with ST-elevation myocardial infarction: a case-control study. Exp Mol Med 2020; 52:2069-2079. [PMID: 33339953 PMCID: PMC8080616 DOI: 10.1038/s12276-020-00543-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
ST-segment elevation myocardial infarction (STEMI) is characterized by thrombotic coronary artery occlusions caused by atherosclerotic plaque rupture. The gut microbiome potentially contributes to the pathogenesis of coronary artery diseases. This study investigated the microbial diversity and composition of coronary thrombi in STEMI patients and the composition of the thrombus microbiome relative to that of the oral and gut microbiomes. A case–control study was performed with 22 STEMI patients and 20 age- and sex-matched healthy controls. Coronary thrombi were acquired from STEMI patients via manual thrombus aspiration during primary coronary intervention. Oral swab and stool samples were collected from both groups, and 16S rRNA sequencing and metagenomic microbiome analyses were performed. Microbial DNA was detected in 4 of 22 coronary thrombi. Proteobacteria (p) and Bacteroidetes (p) were the most abundant phyla. The oral and gut microbiomes significantly differed between patients and healthy controls. The patient group presented microbial dysbiosis, as follows: a higher relative abundance of Proteobacteria (p) and Enterobacteriaceae (f) in the gut microbiome and a lower abundance of Firmicutes (p) and Haemophilus (g) in the oral microbiome. Furthermore, 4 significantly abundant genera were observed in the coronary thrombus in the patients: Escherichia, 1.25%; Parabacteroides, 0.25%; Christensenella, 0.0%; and Bacteroides, 7.48%. The present results indicate that the relative abundance of the gut and oral microbiomes was correlated with that of the thrombus microbiome. Disruption to microbiome composition and functioning may contribute to heart attacks. The most serious form of heart attack is ST-segment elevation myocardial infarction (STEMI), where the coronary artery is blocked by ruptured plaques. Previous research has linked cardiovascular diseases with disruption to the microbiome, but links between STEMI and the microbiome are not yet clear. Si-Hyuck Kang at Seoul National University in Seongnam-si, South Korea, and co-workers analyzed oral, fecal, and coronary thrombus (blood clot) microbial samples from 22 STEMI patients and 20 healthy controls. They found significant differences in oral and gut microbiome composition between the two groups, including increased Proteobacteria phylum and Enterobacteriaceae species and decreased Firmicutes phylum in STEMI patients. Microbes matching patients’ oral and gut bacteria were present in four thrombus samples, suggesting that microbes may influence clot formation and plaque rupture.
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Affiliation(s)
- Ju-Seung Kwun
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Han-Ki Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Won-Jae Lee
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Seok Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Jin Youn
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kim S, Lim HJ, Kim JR, Oh KJ, Hong JS, Suh JW. Longitudinal change in arterial stiffness after delivery in women with preeclampsia and normotension: a prospective cohort study. BMC Pregnancy Childbirth 2020; 20:685. [PMID: 33176736 PMCID: PMC7661192 DOI: 10.1186/s12884-020-03374-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022] Open
Abstract
Background Preeclampsia is associated with increased arterial stiffness during pregnancy. However, data on the longitudinal change in arterial stiffness after delivery in women with preeclampsia are lacking. In this pilot study, we aimed to examine the longitudinal change in arterial stiffness using the cardio-ankle vascular index after delivery in women with preeclamptic and normotensive pregnancies. Methods We enrolled pregnant women with preeclampsia (n = 37) and normotension (n = 36) who gave birth at Seoul National University Bundang Hospital between March 2013 and May 2016, and followed-up at day 1, 6 months, and 12 months after delivery. The longitudinal change in the cardio-ankle vascular index and other variables (blood pressure, lipid profiles, serum creatinine, and liver enzymes) were compared between the two groups using the mixed-effects model, and interactions among the main predictors were examined. Results The longitudinal change in the cardio-ankle vascular index did not significantly differ between the two groups (β = 0.11, 95% CI: − 0.31–0.54, p = 0.60). Predictors of the longitudinal change in the cardio-ankle vascular index included age, time since delivery, body mass index, and diabetes mellitus. Women with preeclampsia showed significantly elevated blood pressure, lipid profiles, serum creatinine, and liver enzymes compared to women with normotension over the course of 1 year of follow-up. Conclusions Preeclampsia is associated with unfavorable blood pressure and metabolic indices after delivery. However, we found no difference in the longitudinal change in arterial stiffness between women with preeclampsia and normotension over the course of 1 year after delivery. Trial registration Retrospectively registered at ClinicalTrials.gov on October 29, 2019 (NCT04142268).
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Affiliation(s)
- Sehun Kim
- Department of Internal Medicine, Seongnam Citizens Hospital, Seongnam, Republic of Korea
| | - Hyun Ja Lim
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Jeung-Ran Kim
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
| | - Jung-Won Suh
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
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29
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Lee JH, Kim SH, Lee W, Cho Y, Kang SH, Park JJ, Oh IY, Yoon CH, Suh JW, Cho YS, Youn TJ, Chae IH, Choi DJ. New-onset paroxysmal atrial fibrillation in acute myocardial infarction: increased risk of stroke. BMJ Open 2020; 10:e039600. [PMID: 32967885 PMCID: PMC7513639 DOI: 10.1136/bmjopen-2020-039600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To investigate the long-term prognostic implications of transient new-onset atrial fibrillation (AF) in patients with acute myocardial infarction (AMI). DESIGN Retrospective observational study. SETTING Single tertiary centre. PARTICIPANTS This study included 2523 patients who presented with AMI from 3 June 2003 to 24 February 2015, after the exclusion of those with prior AF or in-hospital death. OUTCOME MEASURES Patients were divided into three groups according to the occurrence and type of new-onset AF: (1) sinus rhythm (SR) group; (2) paroxysmal AF (PaAF: AF converted to SR prior to discharge) group and (3) persistent AF (PeAF: AF persisted during the hospitalisation) group. Post-discharge all-cause mortality and stroke incidences were compared between the groups. RESULTS New-onset AF was observed in 271 patients (10.7%; PaAF: 230, PeAF: 41). The median follow-up period was 7.2 years (IQR: 5.2-9.4). The incidence of all-cause death and stroke was highest in the PeAF group, followed by the PaAF and SR groups (all-cause mortality: 48.8% vs 26.5% vs 14.7%, p<0.001; stroke 22.0% vs 8.3% vs 4.4%, p<0.001). In the multivariable analysis, PaAF and PeAF were associated with an increased risk of stroke (PaAF, HR: 1.972, 95% CI: 1.162-3.346; PeAF, HR: 5.160, CI: 2.242-11.873) compared with SR. The PaAF group showed a higher incidence of post-discharge AF than the SR group (29.1% vs 4.2%, p<0.001). CONCLUSIONS New-onset AF following AMI is associated with poor long-term outcomes. Even when AF episodes are brief and are converted to SR, new-onset AF remains associated with an increased risk of recurrent AF and stroke.
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Affiliation(s)
- Ji Hyun Lee
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Sun-Hwa Kim
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Wonjae Lee
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Youngjin Cho
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Si-Hyuck Kang
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Jin Joo Park
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Il-Young Oh
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Chang-Hwan Yoon
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Jung-Won Suh
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Young-Seok Cho
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Tae-Jin Youn
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - In-Ho Chae
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Dong-Ju Choi
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, The Republic of Korea
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Lee CJ, Park WJ, Suh JW, Choi EK, Jeon DW, Lim SW, Kim DH, Cha KS, Lee BR, Kim NH, Kang TS, Ha JW. Relationship between health-related quality of life and blood pressure control in patients with uncontrolled hypertension. J Clin Hypertens (Greenwich) 2020; 22:1415-1424. [PMID: 32652901 DOI: 10.1111/jch.13941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/30/2020] [Accepted: 05/17/2020] [Indexed: 11/27/2022]
Abstract
We sought to investigate the psychosocial characteristics of patients with uncontrolled hypertension and examine factors that influence blood pressure (BP) control. A total of 1011 patients with uncontrolled hypertension were enrolled in 13 tertiary hospitals. Uncontrolled hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg despite on antihypertensive therapy. Socio-demographics, anthropometrics, behavioral risk factors, medication pattern, adherence, and measures of health-related quality of life (HRQoL; EuroQol 5D visual analog scale [EQ-5D VAS]) were assessed at baseline and during follow-up visits (3 and 6 months). Patients were divided into 2 groups based on BP control status at 6 months (controlled group [n = 532] vs uncontrolled group [n = 367]). There were no differences in clinical characteristics except the proportion of smokers and baseline BP between patients with controlled BP and uncontrolled BP. At 6 months, the adherence of antihypertensive medication did not differ between the groups but the proportion of combination therapy with ≥3 antihypertensives was significantly higher in patients with uncontrolled BP. EQ-5D VAS at follow-up was significantly lower in patients with uncontrolled BP despite similar baseline values. Multivariate logistic regression analysis revealed that EQ-5D VAS at follow-up significantly correlated with BP control. Patients with worse HRQoL had higher Charlson Comorbidity Index and higher proportion of taking ≥3 antihypertensives, but medication adherence was similar to those with better HRQoL. These findings suggest that along with pharmacologic intervention of hypertension, management of comorbid conditions or psychological support might be helpful for optimizing BP control in patients with uncontrolled hypertension.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Pyeongchon Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Woon Jeon
- Department of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sang-Wook Lim
- Division of Cardiology, Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Dae-Hyeok Kim
- Department of Cardiology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Bong-Ryeol Lee
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Nam-Ho Kim
- Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Tae-Soo Kang
- Division of Cardiology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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31
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Lee KY, Lee BK, Kim WJ, Kang SH, Park TK, Kim SY, Suh JW, Yoon CH, Yang DH, Ryu SK, Kim SH, Lee SY, Chae IH. Consensus statement on coronary intervention during the coronavirus disease 19 pandemic: from the Korean Society of Interventional Cardiology. Korean J Intern Med 2020; 35:749-757. [PMID: 32668513 PMCID: PMC7373961 DOI: 10.3904/kjim.2020.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus 2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities; the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.
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Affiliation(s)
- Kwan Yong Lee
- Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Song-Yi Kim
- Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Heon Yang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sung Yun Lee
- Cardiac and Vascular Center, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to In-Ho Chae, M.D. Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7012 Fax: +82-31-787-4290 E-mail:
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Yoon YH, Ahn JM, Kang DY, Park H, Cho SC, Lee PH, Hur SH, Kim WJ, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ, Park DW. Pragmatic trial comparing routine versus no routine functional testing in high-risk patients who underwent percutaneous coronary intervention: Rationale and design of POST-PCI trial. Am Heart J 2020; 224:156-165. [PMID: 32402702 DOI: 10.1016/j.ahj.2020.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/20/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although the need to detect restenosis has diminished in the contemporary practice of percutaneous coronary intervention (PCI) with drug-eluting stents (DES), the surveillance of ischemia owing to restenosis or disease progression deserves attention in high-risk PCI settings. It is unknown whether follow-up strategy of routine noninvasive functional testing potentially reduces the risk of major cardiovascular events in high-risk PCI patients. METHODS The POST-PCI study is an investigator-initiated, multicenter, prospective randomized trial comparing the effectiveness of two follow-up strategies in patients with high-risk anatomic or clinical characteristics who underwent PCI. Study participants were randomly assigned to either (1) the routine noninvasive stress testing (exercise electrocardiography, nuclear stress imaging, or stress echocardiography) at 12 months post-PCI or (2) the standard-care without routine testing. In the routine stress testing group, depending on the testing results, all clinical decisions regarding subsequent diagnostic or therapeutic procedures were at the treating physician's discretion. The primary endpoint was a composite outcome of death from any causes, myocardial infarction, or hospitalization for unstable angina at 2 years post-PCI. RESULTS More than 1700 high-risk PCI patients have been randomized over 2.0 years at 11 major cardiac centers in Korea. CONCLUSION This pragmatic POST-PCI trial will provide valuable clinical evidence on the effectiveness of follow-up strategy of routine noninvasive stress testing in high-risk PCI patients.
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Lee W, Kim SH, Yoon CH, Suh JW, Cho YS, Youn TJ, Chae IH. Impact of Long-term Glycosylated Hemoglobin in Patients with Acute Myocardial Infarction: a retrospective cohort study. Sci Rep 2020; 10:6726. [PMID: 32317703 PMCID: PMC7174312 DOI: 10.1038/s41598-020-63802-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/06/2020] [Indexed: 01/21/2023] Open
Abstract
Little clinical evidence supports the strict implementation of glycemic control for diabetic patients with AMI. We aimed to demonstrate the effect of long-term glycemic control on mortality in patients with diabetes mellitus after acute myocardial infarction (AMI). Eight hundred and twenty-four consecutive diabetic patients were divided into three groups according to the mean hemoglobin (HbA1c) value: <6% (group A), ≥6% to <7.5% (group B), and ≥7.5% (group C). The best long-term mortality outcome was observed in Group B, followed by groups C and A. Groups B and C were further compared in-depth because the baseline characteristics of group A differed significantly. A Cox regression analysis indicated that Group C was associated with an adjusted hazard ratio (HR) of 1.55 [95% confidence interval (CI): 1.02–2.34, P = 0.038]. An inverse probability of treatment weight analysis was performed to compare groups B and C. Group C had significantly higher mortality, compared to group B (adjusted HR: 1.58; 95% CI: 1.21–2.06, P < 0.001). In conclusion, Glycemic status was associated with the long-term survival outcome in diabetic patients after AMI. However, further study is needed to prove whether HbA1c-targeted glycemic control can effectively improve survival after AMI.
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Affiliation(s)
- Wonjae Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sun-Hwa Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
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Kim M, Kang SH, Kim JR, Park JJ, Cho YS, Youn TJ, Chae IH, Suh JW. Comparison of Shear Stress-Induced Thrombotic and Thrombolytic Effects Among 3 Different Antithrombotic Regimens in Patients With Acute Coronary Syndrome. Clin Appl Thromb Hemost 2020; 26:1076029620912814. [PMID: 32191493 PMCID: PMC7289065 DOI: 10.1177/1076029620912814] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Shear stress (SS)-induced platelet activation is suggested as an essential mechanism of the acute coronary syndrome (ACS). We aimed to compare SS-induced thrombotic and thrombolytic activities among 3 treatment regimens in patients with ACS who underwent percutaneous coronary intervention (PCI). Patients were nonrandomly enrolled and treated with one of 3 regimens (TICA: ticagrelor 180 mg/d; RIVA: clopidogrel 75 mg/d and rivaroxaban 5 mg/d; CLP: clopidogrel 75 mg/d), administered in addition to aspirin (100 mg/d) for 30 days. The global thrombosis test was applied to measure SS-induced thrombotic (occlusion time [OT]) and thrombolytic activity (lysis time [LT]) at day 2 and 30. Aspirin reaction unit (ARU) and P2Y12 reaction unit (PRU) were simultaneously measured using VerifyNow. Group differences in the OT, LT, ARU, and PRU were evaluated. Seventy-five patients (25 patients in each group) finished 30 days of follow-up. Clinical and angiographic characteristics did not differ among the 3 groups, except ACS subtype and pre-PCI coronary flow. No major adverse cardiovascular events occurred in any group during follow-up. The OT and LT did not differ among the 3 groups at day 30 (OT: TICA, 447.2 ± 87.1 vs RIVA, 458.5 ± 70.3, vs CLP, 471.9 ± 90.7, LT: 1522.3 ± 426.5 vs 1734.6 ± 454.3 vs 1510.2 ± 593.9) despite significant differences in the PRU among the 3 groups. Shear stress–induced thrombotic and thrombolytic activities did not differ among the 3 investigated antithrombotic treatments.
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Affiliation(s)
- Minsuk Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ran Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Joo Park
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Seok Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Jin Youn
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kwun JS, Kang SH, Lee HJ, Yoon CH, Suh JW, Cho YS. 1. METAGENOMIC ANALYSIS OF MICROBIOTA IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION 2. ORAL, GUT, AND THROMBUS MICROBIOME IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yoon YE, Kim KM, Lee W, Han JS, Chun EJ, Ahn S, Choi SI, Yun BL, Suh JW. Breast Arterial Calcification is Associated with the Progression of Coronary Atherosclerosis in Asymptomatic Women: A Preliminary Retrospective Cohort Study. Sci Rep 2020; 10:2755. [PMID: 32066804 PMCID: PMC7026413 DOI: 10.1038/s41598-020-59606-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/30/2020] [Indexed: 11/09/2022] Open
Abstract
We evaluated whether breast arterial calcification (BAC) is associated with the progression of coronary atherosclerosis in asymptomatic women. This retrospective observational cohort study analysed asymptomatic women from the BBC registry. In 126 consecutive women (age, 54.5 ± 7.0 years) who underwent BAC evaluation and repeated coronary computed tomography angiography (CCTA) examinations, the coronary arterial calcification score (CACS) and segment stenosis score (SSS) were evaluated to assess the progression of coronary arterial calcification (CAC) and coronary atherosclerotic plaque (CAP). CAC and CAP progression were observed in 42 (33.3%) and 26 (20.6%) women, respectively (median interscan time, 4.3 years), and were associated with the presence of BAC and a higher BAC score at baseline. Women with BAC demonstrated higher CAC and CAP progression rates and showed higher chances for CAC and CAP progression during follow-up (p < 0.001 for both). In multivariable analyses, the BAC score remained independently associated with both CAC and CAP progression rates after adjustment for clinical risk factors (β = 0.087, p = 0.029; and β = 0.020, p = 0.010, respectively) and with additional adjustment for baseline CACS (β = 0.080, p = 0.040; and β = 0.019, p = 0.012, respectively) or SSS (β = 0.079, p = 0.034; and β = 0.019, p = 0.011, respectively). Thus, BAC may be related to the progression of coronary atherosclerosis and its evaluation may facilitate decision-making.
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Affiliation(s)
- Yeonyee Elizabeth Yoon
- Departments of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Departments of Endocrinology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wonjae Lee
- Departments of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Soo Han
- Departments of Health Promotion Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Chun
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soyeon Ahn
- Departments of Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sang Il Choi
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Departments of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bo La Yun
- Departments of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Departments of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jung-Won Suh
- Departments of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kim SH, Kang SH, Lee JM, Chung WY, Park JJ, Yoon CH, Suh JW, Cho YS, Doh JH, Cho JM, Bae JW, Youn TJ, Chae IH. Three-year clinical outcome of biodegradable hybrid polymer Orsiro sirolimus-eluting stent and the durable biocompatible polymer Resolute Integrity zotarolimus-eluting stent: A randomized controlled trial. Catheter Cardiovasc Interv 2019; 96:1399-1406. [PMID: 31859438 PMCID: PMC7754280 DOI: 10.1002/ccd.28654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/07/2019] [Indexed: 01/09/2023]
Abstract
AIMS We compared long-term clinical outcomes between patients treated with Orsiro sirolimus-eluting stent (O-SES) and those treated with durable biocompatible polymer Resolute Integrity zotarolimus-eluting stent (R-ZES). METHODS AND RESULTS The ORIENT trial was a randomized controlled noninferiority trial to compare angiographic outcomes between O-SES and R-ZES. We performed a post hoc analysis of 3-year clinical outcomes and included 372 patients who were prospectively enrolled and randomly assigned to O-SES (n = 250) and R-ZES (n = 122) groups in a 2:1 ratio. The primary endpoint was target lesion failure defined as a composite of cardiac death, nonfatal myocardial infarction, and target lesion revascularization. At 3 years, target lesion failure occurred in 4.7% and 7.8% of O-SES and R-ZES groups, respectively (hazard ratio, 0.58; 95% confidence intervals, 0.24-1.41; p = .232 by log-rank test). Secondary endpoints including cardiac death, myocardial infarction, and target lesion revascularization showed no significant differences between the groups. Stent thrombosis occurred in two patients in R-ZES group (0.0% vs. 1.6%, p = .040). CONCLUSION This study confirms long-term safety and efficacy of the two stents. We found a trend for lower target lesion failure with O-SES compared to R-ZES, although statistically insignificant.
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Affiliation(s)
- Soo-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Jin Joo Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Jin Man Cho
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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Park JJ, Kim SH, Kang SH, Yoon CH, Suh JW, Cho YS, Youn TJ, Chae IH, Choi DJ. Differential Effect of β-Blockers According to Heart Rate in Acute Myocardial Infarction Without Heart Failure or Left Ventricular Systolic Dysfunction: A Cohort Study. Mayo Clin Proc 2019; 94:2476-2487. [PMID: 31806101 DOI: 10.1016/j.mayocp.2019.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/26/2019] [Accepted: 05/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effect of β-blockers according to heart rate in patients with acute myocardial infarction (AMI) without heart failure (HF) or left ventricular systolic dysfunction (LVSD). PATIENTS AND METHODS We enrolled patients with AMI without HF or LVSD between June 1, 2003, and February 28, 2015, from Seoul National University Hospital Acute Myocardial Infarction Registry. Patients were categorized according to discharge heart rate recorded on electrocardiographs and β-blocker use. Low heart rate was defined as less than 75 beats/min. The primary end point was 5-year all-cause mortality according to discharge heart rate and β-blocker use. RESULTS Of 2271 patients, 1696 (74.7%) received β-blockers and 1427 (62.8%) had low heart rates. At 5 years after discharge, 205 patients died. Overall, patients with low heart rates (P<.001) and those with β-blocker treatment had lower mortality (P<.001). After adjustment for covariates, β-blocker use was associated with 48% reduced risk for 5-year mortality in patients with high heart rates (hazard ratio, 0.52; 95% CI, 0.35-0.76), but not in those with low heart rates (P=.97). In an inverse-probability treatment-weighted cohort, β-blocker use was also associated with improved mortality in those with a high heart rate. Findings were similar for 5-year cardiovascular mortality. CONCLUSION Among survivors with AMI without HF or LVSD, β-blocker use was associated with reduced 5-year all-cause mortality in patients who have high heart rates, but not in those with low heart rates.
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Affiliation(s)
- Jin Joo Park
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sun-Hwa Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young-Seok Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae-Jin Youn
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Ju Choi
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Cho SS, Jo SH, Han SH, Lee KY, Her SH, Lee MH, Seo WW, Kim SE, Yang TH, Park KH, Suh JW, Lee BK, Rha SW, Gwon HC, Baek SH. Clopidogrel plus Aspirin Use is Associated with Worse Long-Term Outcomes, but Aspirin Use Alone is Safe in Patients with Vasospastic Angina: Results from the VA-Korea Registry, A Prospective Multi-Center Cohort. Sci Rep 2019; 9:17783. [PMID: 31780809 PMCID: PMC6883054 DOI: 10.1038/s41598-019-54390-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022] Open
Abstract
Anti-platelet agents are commonly used in vasospastic angina (VA) patients with comorbidity like coronary artery disease. However, long-term clinical outcomes in the use of aspirin, clopidogrel or the two agents together have rarely been investigated in VA patients. In a prospective study, we enrolled 2960 patients who received coronary angiography and ergonovine provocation test at 11 university hospitals in Korea. Among them, 1838 patients were diagnosed either with definite (n = 680) or intermediate (n = 1212) VA, using the criteria of chest pain, ECG changes and ergonovine provocation test results. They were analyzed according to their use of aspirin, clopidogrel or both, or no anti-platelet agent at all. The primary outcome was time to composite events of death from any cause, acute coronary syndrome (ACS) and symptomatic arrhythmia during a 3-year follow-up. A primary composite outcome was significantly more common in the aspirin plus clopidogrel group, at 10.8% (14/130), as compared with the non-antiplatelet group, at 4.4% (44/1011), (hazard ratio [HR] 2.41, 95% confidence interval [CI], 1.32–4.40, p = 0.004). With regard to the person-time event rate, similar results were shown, with the highest rate in the aspirin plus clopidogrel user at 4.72/1000 person months (95% CI, 2.79–7.96, log-rank test for primary outcome p = 0.016). The person-time event of the ACS rate was also highest in that group, at 2.81 (95% CI, 1.46–5.40, log-rank test for ACS p = 0.116). Kaplan-Meier survival analysis demonstrated poor prognosis in primary outcomes and ACS in aspirin plus clopidogrel users (log-rank test, p = 0.005 and p = 0.0392, respectively). Cox-proportional hazard regression analysis, adjusting for age, sex, history of coronary heart disease, hypertension, diabetes, presence or not of definite spasm, use of calcium channel blocker, demonstrated that the use of aspirin plus clopidogrel is an independent risk for the primary outcome (HR 2.01, CI: 1.07–3.81, p = 0.031). The aspirin-alone group had a similar primary and individual event rate compared to the no-antiplatelet agent group (HR 0.96, CI, 0.59–1.55, p = 0.872). Smokers using aspirin plus clopidogrel had poorer outcomes than non-smokers, with HR 6.36 (CI 2.31–17.54, p = 0.045 for interaction). In conclusion, among VA patients, aspirin plus clopidogrel use is associated with a poor clinical outcome at 3 years, especially in ACS. Aspirin alone appears to be safe for use in those patients.
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Affiliation(s)
- Seong-Sik Cho
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea.
| | - Seung Hwan Han
- Department of Cardiovascular Medicine, Gil Medical Center, Gachon University, Incheon, South Korea
| | - Kwan Yong Lee
- Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Ho Her
- Department of Cardiovascular Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, South Korea
| | - Min-Ho Lee
- Department of Cardiovascular Medicine, Soonchunhyang Seoul Hospital, Seoul, South Korea
| | - Won-Woo Seo
- Department of Cardiovascular Medicine Hallym University Kangdong Hospital, Seoul, South Korea
| | - Sung Eun Kim
- Department of Cardiovascular Medicine Hallym University Kangdong Hospital, Seoul, South Korea
| | - Tae-Hyun Yang
- Department of Cardiovascular Medicine, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Keun-Ho Park
- Department of Cardiovascular Medicine, Chosun Medical Center, Gwangju, South Korea
| | - Jung-Won Suh
- Department of Cardiovascular Medicine, Bundang Hospital, Seoul National University, Seongnam, South Korea
| | - Byoung-Kwon Lee
- Department of Cardiovascular Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, South Korea
| | - Seung-Woon Rha
- Department of Cardiovascular Medicine, Guro Hospital, Korea University, Seoul, South Korea
| | - Hyeon-Cheol Gwon
- Department of Cardiovascular Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Sang Hong Baek
- Department of Cardiovascular Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Kim K, Lim C, Kim G, Chung JH, Cho YS, Cho JH, Seo JB, Chung WY, Oh SJ, Choi JS, Kim JS, Park JJ, Suh JW, Youn TJ, Chae IH, Choi DJ. Association of Plasma Marker of Oxidized Lipid with Histologic Plaque Instability in Patients with Peripheral Artery Disease. Ann Vasc Surg 2019; 66:554-565. [PMID: 31706994 DOI: 10.1016/j.avsg.2019.11.004] [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] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/05/2019] [Accepted: 11/01/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between oxidized low-density lipoprotein (OxLDL) and plaque instability in coronary and carotid artery disease is well established. However, the association between OxLDL and the histologic changes of plaque in peripheral artery disease has not been clearly elucidated. This study aims to investigate the association between plasma OxLDL and histologic plaque instability in patients with peripheral artery disease. METHODS Prospectively obtained plaques from 48 patients who underwent endovascular atherectomy (n = 20), surgical endarterectomy (n = 9), or bypass surgery (n = 19) for treatment of atherosclerotic femoropopliteal artery disease were evaluated for histologic fibrosis, sclerosis, calcification, necrosis, cholesterol cleft, and foamy macrophages using hematoxylin and eosin, oil red O, and immunohistochemical staining. Unstable plaques were defined as plaques that were positive for foamy macrophages and with lipid content of more than 10% of the total plaque area. Plasma OxLDL levels were measured using an enzyme-linked immunosorbent assay (Mercodia AB, Uppsala, Sweden). RESULTS Of the 48 patients, 26 (54%) had unstable plaques. The unstable plaque group was younger, had fewer angiographic total occlusions, less calcification, and more CD68-positive and LOX-1-positive cells than the stable plaque group. Plasma OxLDL levels were significantly higher in the unstable plaque group than in the stable plaque group (57.4 ± 13.9 vs. 47.2 ± 13.6 U/L, P = 0.014). Multivariate analysis revealed that plasma OxLDL level, smoking, angiographic nontotal occlusion, and statin nonuse were independent predictors of unstable plaque. CONCLUSIONS Among patients with peripheral artery disease, the histologic instability of femoropopliteal plaque was independently associated with high plasma OxLDL, smoking, nontotal occlusion, and statin nonuse. Further large-scale studies are necessary to evaluate the role of noninvasive OxLDL measurement for predicting plaque instability and future adverse vascular event.
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Affiliation(s)
- Kichun Kim
- The Armed Forces Medical Command, Seongnam, South Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Gilhyang Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Jun Hwan Cho
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jae-Bin Seo
- Department of Internal Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Se-Jin Oh
- Department of Cardiothoracic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jae-Sung Choi
- Department of Cardiothoracic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jun-Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin Joo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tae-Jin Youn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Kang J, Chun EJ, Park HJ, Cho YS, Park JJ, Kang SH, Cho YJ, Yoon YE, Oh IY, Yoon CH, Suh JW, Youn TJ, Chae IH, Choi DJ. Clinical and Computed Tomography Angiographic Predictors of Coronary Lesions That Later Progressed to Chronic Total Occlusion. JACC Cardiovasc Imaging 2019; 12:2196-2206. [DOI: 10.1016/j.jcmg.2018.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/22/2018] [Accepted: 12/06/2018] [Indexed: 12/24/2022]
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Choi W, Chang HW, Kang SH, Yoon CH, Cho YS, Youn TJ, Chae IH, Kim DJ, Kim JS, Park KH, Kim HS, Lim C, Suh JW. Comparison of Minimally Invasive Direct Coronary Artery Bypass and Percutaneous Coronary Intervention Using Second-Generation Drug-Eluting Stents for Coronary Artery Disease - Propensity Score-Matched Analysis. Circ J 2019; 83:1572-1580. [PMID: 31130585 DOI: 10.1253/circj.cj-18-1330] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Some studies comparing minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) have reported MIDCAB's superiority, but they did not investigate contemporary PCI with newer generation drug-eluting stents (DES). We compared clinical outcomes after MIDCAB with previously reported outcomes after PCI with second-generation DES.Methods and Results:We retrospectively reviewed the records of patients treated with MIDCAB. Baseline characteristics and clinical outcomes after MIDCAB were compared with those for left anterior descending artery disease treated via PCI. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), a composite of cardiovascular death, non-fatal myocardial infarction, ischemic stroke, and target vessel revascularization (TVR). A propensity score-matching (PSM) analysis was conducted to adjust for between-group differences in baseline characteristics. We analyzed 77 patients treated with MIDCAB and 2,206 treated with PCI. The MIDCAB group was older and had more severe coronary disease and a higher incidence of left ventricular dysfunction. Over a 3-year follow-up, the PCI group had favorable MACCE outcomes. After PSM, there were no between-group differences in MACCE (MIDCAB, 15.6% vs. PCI, 23.4%; hazard ratio [HR], 0.80; 95% CI: 0.38-1.68, P=0.548) or TVR (MIDCAB, 2.6% vs. PCI, 5.2%; HR, 0.51; 95% CI: 0.10-3.09, P=0.509). CONCLUSIONS Clinical outcomes were similar between MIDCAB and PCI using second-generation DES over 3 years of follow-up.
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Affiliation(s)
- Wonsuk Choi
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Hyoung Woo Chang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Young-Seok Cho
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Tae-Jin Youn
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Dong Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Seo WW, Suh JW, Oh IY, Yoon CH, Cho YS, Youn TJ, Chae IH, Choi DJ. Efficacy of IntraCoronary Erythropoietin Delivery BEfore Reperfusion-Gauging Infarct Size in Patients with Acute ST-segment Elevation Myocardial Infarction (ICEBERG). Int Heart J 2019; 60:255-263. [PMID: 30799375 DOI: 10.1536/ihj.18-035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous clinical studies have shown inconsistent results regarding the effect of erythropoietin in ST-segment elevation myocardial infarction (STEMI). This study investigated whether directed intracoronary infusion of darbepoetin-α into ischemic myocardium before reperfusion would reduce infarct size or post-infarct remodeling in STEMI patients.Eighty STEMI patients received one of the following treatments simultaneously with the first balloon inflation: intracoronary darbepoetin-α 300 μg (n = 40) or saline (n = 40), administered via the over-the-wire balloon system. The primary endpoint was infarct size estimated by serial cardiac enzyme levels after procedure. The secondary endpoints were (1) infarct size and proportion of salvaged myocardium measured with cardiac magnetic resonance (CMR) at baseline; (2) post-infarct remodeling (PIR), defined as an increase in left ventricular end-diastolic volume more than 20% at 4 months compared to the baseline on CMR; and (3) composite cardiovascular endpoints assessed at 4 months.The peak CK-MB [median 270.0 (interquartile range 139.8-356.3) versus 231.5 (131.0-408.5) ng/mL, P = 0.55] and troponin-I [128.5 (63.5-227.8) versus 109.0 (43.8-220.0) ng/mL, P = 0.52) ] did not differ between the darbepoetin-α and control group. Fifty-seven patients completed the baseline and 4-month follow-up CMR. There were no differences in infarct size [30.6 (18.1-49.8) versus 31.5 (22.5-47.3) cm3, P = 0.91), proportion of salvaged myocardium [26.7% (15.9-42.6%) versus 35.8% (22.4-48.8%), P = 0.12) or PIR (8.0% versus 6.7%, P = 0.62) between the two groups. Composite cardiovascular outcomes did not differ between the two groups.In conclusion, administration of intracoronary darbepoetin-α before reperfusion did not reduce infarct size or post-infarct remodeling in STEMI patients.
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Affiliation(s)
- Won-Woo Seo
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Bundang Hospital
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Bundang Hospital
| | - Chang-Hwan Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Bundang Hospital
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Bundang Hospital
| | - Tae-Jin Youn
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Bundang Hospital
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Bundang Hospital
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Bundang Hospital
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Lee W, Suh JW, Park JJ, Yoon CH, Cho YS, Youn TJ, Chae IH. Effect of tailored use of tirofiban in patients with Non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention: a randomized controlled trial. BMC Cardiovasc Disord 2018; 18:201. [PMID: 30348101 PMCID: PMC6198526 DOI: 10.1186/s12872-018-0938-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022] Open
Abstract
Background We conducted a randomized controlled trial to investigate whether an additional platelet inhibition with tirofiban would reduce the extent of myocardial damage and prevent periprocedural myonecrosis in patients with Non-ST-elevation acute coronary syndrome (NSTE-ACS) with a high residual platelet activity (HPR). Methods Patients with an HPR, defined as P2Y12 reaction unit (PRU) > 230, were randomly assigned to group A (tirofiban treatment, n = 30) or C1 (n = 30) and patients without an HPR to C2 (n = 78). Periprocedural myocardial damage was assessed using the area under the curve (AUC) of serial cardiac enzyme levels from the time of the procedure to post-36 h. Periprocedural myonecrosis incidence was evaluated. Results The troponin I AUC was not different between the groups (197.2 [41.5395.7], 37.9 [8.9313.9], 121.3 [43.7481.8] h∙ng/mL; p = 0.088). The results did not change when the baseline levels were adjusted (365.3 [279.5, 451.1], 293.0 [207.1, 379.0], and 298.0 [244.7, 351.3] h∙ng/mL; p = 0.487). The rate of periprocedural myonecrosis was also not different between the groups (53.0% vs. 50.0% vs. 33.3%, p = 0.092). The CK-MB isoenzyme analysis showed similar results. No difference in complications was noted. Conclusion Additional tirofiban administration was not beneficial to patients with NSTE-ACS even with an HPR. Trial registration Clinical trial no. NCT03114995, registered 11 April, 2017, retrospectively. Electronic supplementary material The online version of this article (10.1186/s12872-018-0938-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wonjae Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Jin Joo Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea. .,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
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Suh JW, Yun BL. Breast Arterial Calcification: A Potential Surrogate Marker for Cardiovascular Disease. J Cardiovasc Imaging 2018; 26:125-134. [PMID: 30310879 PMCID: PMC6160812 DOI: 10.4250/jcvi.2018.26.e20] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
Breast arterial calcifications (BAC), frequently observed on screening mammography, have been considered as an incidental finding without increased risk for breast cancer. They are medial calcifications and therefore, are indicative of arteriosclerosis. Previous studies indicated that the risk factors of BAC partly overlap with those of cardiovascular disease (CVD), and the presence of BAC is associated with prevalent and incident CVD. This suggests that medial arterial calcification might contribute to CVD through a pathway distinct from the intimal atherosclerotic process. A recent study showed that the presence and severity of BAC are associated with the presence of coronary artery calcification or plaques on coronary computed tomography angiography in asymptomatic women aged more than 40 years. In addition, BAC provided an independent and incremental predictive value over conventional risk factors. Given that population-based mammography screening is currently recommended in asymptomatic women, the evaluation of BAC may be helpful in identifying high-risk women without additional cost or radiation exposure.
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Affiliation(s)
- Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Seoul National University College of Medicine, Seongnam, Korea
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Kim M, Kang SH, Park J, Cho YS, Youn TJ, Chae IH, Suh JW. TCTAP A-022 Comparison of High Shear Stress-induced Thrombotic and Thrombolytic Effect Between Aspirin/Clopidogrel/Very Low Dose Rivaroxaban and Aspirin/Ticagrelor Treatments in Patients with Acute Coronary Syndrome. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.03.048] [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: 11/27/2022]
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Kang SH, Joe B, Yoon Y, Cho GY, Shin I, Suh JW. Cardiac Auscultation Using Smartphones: Pilot Study. JMIR Mhealth Uhealth 2018; 6:e49. [PMID: 29490899 PMCID: PMC5853766 DOI: 10.2196/mhealth.8946] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/29/2017] [Accepted: 01/09/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiac auscultation is a cost-effective, noninvasive screening tool that can provide information about cardiovascular hemodynamics and disease. However, with advances in imaging and laboratory tests, the importance of cardiac auscultation is less appreciated in clinical practice. The widespread use of smartphones provides opportunities for nonmedical expert users to perform self-examination before hospital visits. OBJECTIVE The objective of our study was to assess the feasibility of cardiac auscultation using smartphones with no add-on devices for use at the prehospital stage. METHODS We performed a pilot study of patients with normal and pathologic heart sounds. Heart sounds were recorded on the skin of the chest wall using 3 smartphones: the Samsung Galaxy S5 and Galaxy S6, and the LG G3. Recorded heart sounds were processed and classified by a diagnostic algorithm using convolutional neural networks. We assessed diagnostic accuracy, as well as sensitivity, specificity, and predictive values. RESULTS A total of 46 participants underwent heart sound recording. After audio file processing, 30 of 46 (65%) heart sounds were proven interpretable. Atrial fibrillation and diastolic murmur were significantly associated with failure to acquire interpretable heart sounds. The diagnostic algorithm classified the heart sounds into the correct category with high accuracy: Galaxy S5, 90% (95% CI 73%-98%); Galaxy S6, 87% (95% CI 69%-96%); and LG G3, 90% (95% CI 73%-98%). Sensitivity, specificity, positive predictive value, and negative predictive value were also acceptable for the 3 devices. CONCLUSIONS Cardiac auscultation using smartphones was feasible. Discrimination using convolutional neural networks yielded high diagnostic accuracy. However, using the built-in microphones alone, the acquisition of reproducible and interpretable heart sounds was still a major challenge. TRIAL REGISTRATION ClinicalTrials.gov NCT03273803; https://clinicaltrials.gov/ct2/show/NCT03273803 (Archived by WebCite at http://www.webcitation.org/6x6g1fHIu).
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic Of Korea
| | - Byunggill Joe
- School of Computing, Korea Advanced Institute of Science and Technology, Daejeon, Republic Of Korea
| | - Yeonyee Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic Of Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic Of Korea
| | - Insik Shin
- School of Computing, Korea Advanced Institute of Science and Technology, Daejeon, Republic Of Korea
| | - Jung-Won Suh
- Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic Of Korea
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Baek H, Suh JW, Kang SH, Kang S, Lim TH, Hwang H, Yoo S. Enhancing User Experience Through User Study: Design of an mHealth Tool for Self-Management and Care Engagement of Cardiovascular Disease Patients. JMIR Cardio 2018; 2:e3. [PMID: 31758783 PMCID: PMC6857966 DOI: 10.2196/cardio.9000] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/23/2017] [Accepted: 01/27/2018] [Indexed: 01/22/2023] Open
Abstract
Background As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and other diseases that require behavioral improvements in daily life are now capable of being managed and prevented more effectively. However, to increase patient engagement through mHealth, it is important for the initial design to consider functionality and usability factors and accurately assess user demands during the developmental process so that the app can be used continuously. Objective The purpose of the study was to provide insightful information for developing mHealth service for patients with CVD based on user research to help enhance communication between patients and doctors. Methods To drive the mobile functions and services needed to manage diseases in CVD patients, user research was conducted on patients and doctors at a tertiary general university hospital located in the Seoul metropolitan area of South Korea. Interviews and a survey were performed on patients (35 participants) and a focus group interview was conducted with doctors (5 participants). A mock-up mobile app was developed based on the user survey results, and a usability test was then conducted (8 participants) to identify factors that should be considered to improve usability. Results The majority of patients showed a positive response in terms of their interest or intent to use an app for managing CVD. Functional features, such as communication with doctors, self-risk assessment, exercise, tailored education, blood pressure management, and health status recording had a score of 4.0 or higher on a 5-point Likert scale, showing that these functions were perceived to be useful to patients. The results of the mock-up usability test showed that inputting and visualizing blood pressure and other health conditions was required to be easier. The doctors requested a function that offered a comprehensive view of the patient’s daily health status by linking the mHealth app data with the hospital’s electronic health record system. Conclusions Insights derived from a user study for developing an mHealth tool for CVD management, such as self-assessment and a communication channel between patients and doctors, may be helpful to improve patient engagement in care.
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Affiliation(s)
- Hyunyoung Baek
- Healthcare Information and Communication Technology Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Si-Hyuck Kang
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Seungjin Kang
- Healthcare Information and Communication Technology Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Tae Ho Lim
- HealthConnect Co, Ltd, Seoul, Republic Of Korea
| | - Hee Hwang
- Healthcare Information and Communication Technology Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Sooyoung Yoo
- Healthcare Information and Communication Technology Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
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