Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients

Byoung Geol Choi,Seung-Woon Rha,Taeshik Park,Se Yeon Choi,Jae Kyeong Byun,Min Suk Shim,Shaopeng Xu,Hu Li,Sang-Ho Park,Ji Young Park,Woong Gil Choi,Yun-Hyeong Cho,이선기,Jin Oh Na,Cheol Ung Choi,Hong Euy 대한심장학회 2016 Korean Circulation Journal Vol.46 No.5

However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients. Subjects and Methods: A total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395). All CAS patients were prescribed with anti-anginal medications for at least 6 months. The incidence of major clinical outcomes and recurrent angina of these groups were compared up to 3 years. Results: There were considerable differences in the baseline clinical and angiographic characteristics among the three groups, but there was no difference in the endpoints among the three groups (including individual and composite hard endpoints) such as death, myocardial infarction, de novo percutaneous coronary intervention, cerebrovascular accident, and major adverse cardiac events. However, there was a higher incidence of recurrent angina in both the non-smoking CAS group and smoking CAS group, as compared to the nonCAS group. In multivariable adjusted Cox-proportional hazards regression analysis, smoking CAS group exhibited a higher incidence of recurrent angina compared with the non-CAS group (hazard ratio [HR]; 2.46, 95% confidence interval [CI]; 1.46-4.14, p=0.001) and nonsmoking CAS group (HR; 1.76, 95% CI; 1.08-2.87, p=0.021). Conclusion: Cigarette smoking CAS group exhibited higher incidence of recurrent angina during the 3-year clinical follow-up compared with both the non-CAS group and non-smoking CAS group. Quitting of smoking, paired with intensive medical therapy and close clinical follow-up, can help to prevent recurrent angina.

Angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers in acute ST-segment elevation myocardial infarction patients with diabetes mellitus undergoing percutaneous coronary intervention

Choi, Se Yeon,Choi, Byoung Geol,Rha, Seung-Woon,Byun, Jae Kyeong,Shim, Min suk,Li, Hu,Mashaly, Ahmed,Choi, Cheol Ung,Park, Chang Gyu,Seo, Hong Seog,Oh, Dong Joo,Jeong, Myung Ho Elsevier 2017 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.249 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Diabetes Mellitus (DM) is an important factor of adverse cardiovascular events in acute ST-segment elevation myocardial infarction (STEMI) patients. Renin-angiotensin-aldosterone system (RAAS) inhibitors is associated with improved clinical outcomes, however, there are limited data comparing the effectiveness of two different RAAS inhibitors in STEMI patients with DM undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).</P> <P><B>Methods</B></P> <P>A total of 3811 eligible STEMI patients with DM were enrolled in Korea Acute Myocardial Infarction Registry (KAMIR). They were stratified into two groups: Angiotensin converting enzyme inhibitors (ACEI) group (n=2691) and angiotensin receptor blockers (ARB) group (n=1120). To adjust baseline confounding factors, we performed propensity score matching (PSM) analysis and evaluated individual and composite major clinical outcomes between the two groups up to 2years.</P> <P><B>Results</B></P> <P>After PSM, a total of 1049 well-matched pairs were generated. Baseline clinical, angiographic and procedural characteristics were well-balanced between the two groups. The incidence of death, recurrent myocardial infarction (MI), revascularization and major adverse cardiac events (MACE) were not significantly different between the two groups up to 2years,</P> <P><B>Conclusion</B></P> <P>In the present study, ACEI and ARB showed comparable effectiveness and safety on individual and composite clinical outcomes in STEMI patients with DM who underwent successful PCI with DES at least up to 2years.</P>

Effect of Pitavastatin Compared with Atorvastatin andRosuvastatin on New-Onset Diabetes Mellitus in PatientsWith Acute Myocardial Infarction

Choi, Jah Yeon,Choi, Cheol Ung,Hwang, Soon-Young,Choi, Byoung Geol,Jang, Won Young,Kim, Do Young,Kim, Woohyeun,Park, Eun Jin,Lee, Sunki,Na, Jin Oh,Kim, Jin Won,Kim, Eung Ju,Rha, Seung-Woon,Park, Chang Elsevier 2018 The American Journal of Cardiology Vol.122 No.6

<P>Although statin use in patients with acute myocardial infarction (AMI) is mandatory, it has been suggested to be associated with new-onset diabetes mellitus (NODM). In real world practice, moderate-intensity statin therapy is more commonly used than high-intensity statin therapy. In this study, we investigated the impact of moderate-intensity pitavastatin (2 to 4 mg) compared with moderate-intensity atorvastatin (10 to 20 mg) and rosuvastatin (5 to 10 mg) on the development of NODM during a follow-up period of up to 3years. Between November 2011 and May 2015, 2001 patients with AMI who did not have diabetes mellitus were investigated. The cumulative incidence of NODM was evaluated in all groups. To adjust for potential confounders, multinomial propensity scores were used. Cox proportional hazard models were used to assess the hazard ratio of NODM in the atorvastatin and rosuvastatin groups compared with pitavastatin group. The cumulative incidence of NODM was significantly lower in pitavastatin group compared with the atorvastatin and rosuvastatin groups (3.0% vs 8.4% vs 10.4%, respectively; Log-rank p value = 0.001). After weighting the baseline characteristics of the 3 statin groups by multinomial propensity scores, atorvastatin (hazard ratio: 2.615, 95% confidence interval: 1.163 to 5.879) and rosuvastatin (hazard ratio: 3.906, 95% confidence interval: 1.756 to 8.688) were found to be associated with a higher incidence of NODM compared with pitavastatin therapy on multivariable analysis. Moderate-intensity pitavastatin therapy is associated with a lower incidence of NODM in patients with AMI andhas similar clinical outcomes to moderate-intensity atorvastatin and rosuvastatin therapy.</P>

The impact of myocardial bridge on coronary artery spasm and long-term clinical outcomes in patients without significant atherosclerotic stenosis

Nam, Purumeh,Choi, Byoung Geol,Choi, Se Yeon,Byun, Jae Kyeong,Mashaly, Ahmed,Park, Yoonjee,Jang, Won Young,Kim, Woohyeun,Choi, Jah Yeon,Park, Eun Jin,Na, Jin Oh,Choi, Cheol Ung,Lim, Hong Euy,Kim, Eung Elsevier 2018 Atherosclerosis Vol.270 No.-

<P><B>Abstract</B></P> <P><B>Background and aims</B></P> <P>Myocardial bridge (MB) and coronary artery spasm (CAS) can induce a sustained chest pain, acute coronary syndrome (ACS) and even sudden cardiac death. The aim of this study is to evaluate the relationship between MB and CAS and its impact on long-term clinical outcomes.</P> <P><B>Methods</B></P> <P>A total of 812 patients with MB without significant coronary artery disease (CAD), who underwent acetylcholine (ACH) provocation test, were enrolled. Significant CAS was defined as ≥70% temporary narrowing by ACH test, and MB was defined as the characteristic phasic systolic compression of the coronary artery with a decrease of more than 30% in diameter on the angiogram after intracoronary nitroglycerin infusion. To adjust baseline confounders, logistic regression analysis was performed. The primary endpoint was incidence of CAS, and secondary endpoints were major adverse cardiac events (MACE) and recurrent angina requiring repeat coronary angiography (CAG) at 5 years.</P> <P><B>Results</B></P> <P>MB is closely implicated in a high incidence of CAS, spontaneous spasm, ischemic ECG change and chest pain during ACH provocation test. In addition, MB of various severity and reference vessel size was substantially implicated in CAS incidence, and severe MB was a strong risk factor of CAS. MB patients with CAS were shown to have a higher rate of recurrent angina compared with MB patients without CAS, up to a 5-year follow-up. However, there were no differences regarding the incidence of MACE.</P> <P><B>Conclusions</B></P> <P>Severe MB was associated with high incidence of CAS, and MB patients with CAS were likely to have a higher incidence of recurrent angina. Intensive medical therapy and close clinical follow-up are needed for better clinical outcomes in MB patients with CAS.</P> <P><B>Highlights</B></P> <P> <UL> <LI> The aim of this study is to evaluate the relationship between myocardial bridge (MB) and coronary artery spasm (CAS). </LI> <LI> A total of 812 patients with MB without significant coronary artery disease who underwent acetylcholine test were enrolled. </LI> <LI> Severe MB was associated with high incidence of CAS, and MB patients with CAS had a higher incidence of recurrent angina. </LI> </UL> </P>

Impact of alcohol drinking on acetylcholine-induced coronary artery spasm in Korean populations

Sohn, Sung Min,Choi, Byoung Geol,Choi, Se Yeon,Byun, Jae Kyeong,Mashaly, Ahmed,Park, Yoonjee,Jang, Won Young,Kim, Woohyeun,Choi, Jah Yeon,Park, Eun Jin,Na, Jin Oh,Choi, Cheol Ung,Lim, Hong Euy,Kim, Eu Elsevier 2018 Atherosclerosis Vol.268 No.-

<P><B>Abstracts</B></P> <P><B>Background and aims</B></P> <P>Generally, immoderate alcohol consumption is associated with variant angina and accepted as one of the risk factors for coronary artery spasm (CAS), but evidence is lacking in this regard. The aim of this study is to evaluate the impact of alcohol consumption and drinking pattern on CAS by acetylcholine (ACH) provocation test and long-term clinical outcomes.</P> <P><B>Methods</B></P> <P>A total of 5491 patients with typical or atypical chest pain, without significant coronary artery disease, who underwent intracoronary ACH provocation test, were enrolled prospectively, and retrospectively analyzed in this study. They were divided into two groups according to their alcohol drinking status; the current alcohol (CA) drinking group (n = 1792), and non-CA group (n = 3699). To adjust for potential confounders, a propensity score matching (PSM) analysis was performed. The primary endpoint was incidence of CAS, and secondary endpoints were major adverse cardiac events (MACE) and recurrent angina requiring repeat coronary angiography (CAG) at 5 years.</P> <P><B>Results</B></P> <P>After PSM analysis, alcohol consumption was a strong risk factor for CAS. Furthermore, excessive alcohol consumption was correlated with a higher risk for CAS. As compared with the non-CA group, the CA group showed worse angiographic and clinical findings, including higher incidence of CAS (58% <I>vs.</I> 62%, <I>p</I> = 0.016), spontaneous spasm (17% <I>vs.</I> 22%, <I>p</I> = 0.004), multi-vessel spasm (31% <I>vs.</I> 37%, <I>p</I> = 0.009), proximal epicardial spasm (39% <I>vs.</I> 46%, <I>p</I> = 0.002), ischemic electrocardiography changes such as T-inversion (0.4% <I>vs.</I> 1.2%, <I>p</I> < 0.001) and chest pain (42% <I>vs.</I> 46%, <I>p</I> = 0.047) during ACH provocation test. However, the status and pattern of alcohol drinking had no influence on long-term clinical outcomes such as MACE or recurrent angina.</P> <P><B>Conclusions</B></P> <P>Alcohol consumption is a strong risk factor for CAS, and excessive alcohol consumption was correlated with a higher risk for CAS. Further well-designed studies are needed to confirm the results.</P> <P><B>Highlights</B></P> <P> <UL> <LI> The aim of study is to evaluate the impact of alcohol consumption on coronary spasm (CAS) and long-term clinical outcomes. </LI> <LI> Alcohol consumption is a strong risk factor for CAS. </LI> <LI> Furthermore, excessive alcohol consumption was correlated with a higher risk for CAS. </LI> </UL> </P>

S-239 Hs-CRP Predicts New-Onset HF in Patients Treated with Statin for Primary Prevention

( Yoonjee Park ),( Byoung-geol Choi ),( Seung-woon Rha ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Background: The inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) is known to be associated with the progression and worsening of heart failure (HF). We evaluated the impact of hsCRP on the development of new onset HF in patients (pts) taking moderate-intensity statin for primary prevention.?Methods: Pts without HF(N-terminal pro-B-type natriuretic peptide (NT-proBNP) > 400 pg/ml) were enrolled and divided into 4 quartiles according to hsCRP levels. New-onset HF as primary endpoint and other cardiovascular events as secondary endpoints were evaluated up to 9 years.?Results: Compared to the lowest quartile (<0.46 mg/L, n=1224), the highest quartile (>1.86 mg/L, n=1194) of hsCRP was associated with a higher incidence of new-onset HF [OR= 2.28, (95% CI 1.63-3.20), p<0.001]. Even after proportional hazard cox-regression adjusted by age, gender, cardiovascular comorbidities including arrhythmia, hypertension, diabetes, chronic kidney disease, laboratory parameters and medications including types of statins, there was a weaker but still significant relationship between higher levels of hsCRP and the development of new-onset HF [HR= 1.74, (95% CI 1.23-2.46), p=0.002, figure]. Conclusions: In our study, hsCRP levels remaining high even after moderate-intensity statin treatment significantly predicted the development of new-onset HF during long-term follow-up. Risk stratification according to the level of hsCRP may help identify pts who need additional attention for future deterioration of cardiac function.

S-210 Impact of Hypertension on Insulin Resistance in Asian Population

( Myung Han Hyun ),( Byoung Geol Choi ),( Seung-woon Rha ),( Jin Oh Na ),( Cheol Ung Choi ),( Hong Euy Lim ),( Jin Won Kim ),( Eung Ju Kim ),( Chang Gyu Park ),( Hong Seog Seo ),( Dong Joo Oh ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Background: Hypertension is a well-known risk factor for cardiovascular and metabolic diseases. However, it is not clear that whether hypertension is associated with increased insulin resistance, especially in Asian population. Methods: We investigated the relationship between hypertension and insulin resistance of 4,983 consecutive patients during a mean follow-up of 2 years. To adjust potential confounders including age, gender, body mass index, diabetes mellitus, hyperlipidemia, chronic kidney disease, lipid profile, and medications, a propensity score matching (PSM) analysis was performed using the logistic regression model. Insulin resistance index based on the homeostatic model assessment-insulin resistance (HOMA-IR). We also compared fasting blood glucose (FBS), glycated hemobglobin (HbA1c), fasting serum insulin (Insulin) between the subset of hypertension and normotension group. Results: After PSM analysis, 1,590 patients (795 hypertension vs 795 normotension) with the mean follow-up duration of 594±266 days were analyzed. Baseline characteristics were similar between the two groups. In paired t-test, hypertension group increased HOMA-IR by 15% significantly (p<0.001). However, normotension group increased HOMA-IR by 3% without significance. In contrast to HOMA-IR, Insulin level was significantly increased in both groups and no significant change in FBS were observed in two groups (Table). Conclusions: In the present study, hypertension is associated with increased insulin resistance in Asian population.

Chronic total occlusion intervention of the non-infarct-related artery in acute myocardial infarction patients: the Korean multicenter chronic total occlusion registry

Park, Ji Young,Choi, Byoung Geol,Rha, Seung-Woon,Kang, Tae Soo,Choi, Cheol Ung,Yu, Cheol Woong,Gwon, Hyeon-Cheol,Chae, In-Ho,Kim, Hyo-Soo,Park, Hun Sik,Lee, Seung-Hwan,Kim, Moo-Hyun,Hur, Seung-Ho,Jang Wolters Kluwer Health, Inc. All rights reserved. 2018 Coronary artery disease Vol.29 No.6

<P>BackgroundThe Korean chronic total occlusion (CTO) registry was collected prospectively from 26 cardiovascular centers since May 2007. The aim of this study is to investigate the impact of a successful staged percutaneous coronary intervention (PCI) of CTO lesions in acute myocardial infarction (AMI) patients on clinical outcomes.Patients and methodsAmong 2813 patients who underwent a staged PCI because of CTO lesions, 422 (15%) patients underwent primary PCI because of AMI. Among 422 patients, successful staged CTO-PCI was performed in 76%. The clinical outcomes were compared between the successful CTO-PCI group (n=321) and the failed CTO-PCI group (n=101). To adjust for potential confounders, a propensity score matching (PSM) analysis was carried out using the logistic regression model.ResultsAfter the PSM analysis, two propensity-matched groups (85 pairs, n=170) were generated and the baseline characteristics were balanced. The incidence of total death (P=0.029) and non-ST-segment elevation myocardial infarction (NSTEMI, P=0.043) at 1 year was higher in the failed CTO-PCI group. Multivariate regression showed that successful CTO-PCI was an independent predictor of preventing mortality (hazard ratio, 0.21, P=0.048). In the subgroup analysis, the Kaplan-Meier curve showed that successful CTO-PCI had a lower incidence of total death (log-rank=0.004) and cardiac death (log-rank=0.005) up to 1 year in NSTEMI patients. Cox-proportional analysis showed that successful CTO-PCI was beneficial in patients with NSTEMI, hypertension, and non-left-anterior descending artery lesion for preventing mortality.ConclusionIn this study, a staged successful CTO-PCI in AMI patients was associated with improved 1-year survival in the Korean population.</P>

A single institutional experience of surgically resected thymic epithelial tumors over 10 years: clinical outcomes and clinicopathologic features.

Kim, Beom Kyung,Cho, Byoung Chul,Choi, Hye Jin,Sohn, Joo Hyuk,Park, Moo Suk,Chang, Joon,Kim, Se Kyu,Kim, Dae Joon,Chung, Kyung Young,Lee, Chang Geol,Kim, Joo Hang,Yoo, Nae Choon National Hellenic Research Foundation 2008 ONCOLOGY REPORTS Vol.19 No.6

<P>Thymic epithelial tumors (TETs) consist of a series of neoplasm that differ morphologically and biologically. Due to its rarity and indolent natural history, large-scale prospective trials have been lacking. This study aimed to evaluate long-term clinical outcomes and clinicopathologic features for TET after surgical resection and adjuvant treatments. One hundred patients who received surgery plus adjuvant radiotherapy +/- chemotherapy for TET (Masaoka stage II-IVa) from 1995 to 2005 were retrospectively reviewed. Masaoka staging systems were adopted, and pathologic results were classified according to World health organization (WHO) histologic classification. After surgery, 55 patients were treated with radiotherapy alone, while 45 with radiotherapy and chemotherapy. The median radiation dose was 50.4 Gy (45-63 Gy) and six cycles of chemotherapy, consisting of doxorubicin, cisplatin, vincristine and cyclophosphamide, were applied every 3-4 weeks. Distributions according to Masaoka stage were as follows; stage II (58 patients), III (21) and IVa (21). According to WHO histology, there were A (3), AB (7), B1 (7), B2 (31), B3 (31) and C (21). With a median follow-up duration of 65 months (8-143 months), the 5-year overall survival (OS) and disease-free survival (DFS) rates were 75.7% (89.2, 67.9 and 52.1% in stage II, III and IVa, respectively) and 70.3% (83, 62.4 and 33.6% in stage II, III and IVa, respectively). In multivariate analysis, prognostic factors for OS were age, WHO histology, Masaoka stage, and recurrence, while pleural involvement, WHO histology, and Masaoka stage had significant impacts on DFS. Adjuvant chemotherapy did not alter survival outcomes and recurrence patterns. Pleura was the most common recurrence site (15 patients, 53.6%), and significantly associated with pleural recurrence-free survival. In conclusion, pleural involvement at diagnosis was the important prognostic factor, in addition to WHO histology and Masaoka stage. To prevent pleural recurrence and prolong survival, innovative therapeutic approaches warrant further investigations.</P>

Comparison of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with diabetes mellitus and non-ST-segment elevation myocardial infarction who underwent successful percutaneous coronary intervention

Byun, Jae Kyeong,Choi, Byoung Geol,Rha, Seung-Woon,Choi, Se Yeon,Jeong, Myung Ho Elsevier 2018 Atherosclerosis Vol.277 No.-

<P><B>Abstract</B></P> <P><B>Background and aims</B></P> <P>Angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are known to be beneficial for either non-ST-segment elevation myocardial infarction (NSTEMI) patients or diabetes mellitus (DM) patients. However, the comparative efficacy of ACEI <I>versus</I> ARB in patients with NSTEMI and DM is unclear. The aim of this study was to compare the protective efficacy of ACEI <I>versus</I> ARB in patients with NSTEMI and DM, who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES).</P> <P><B>Methods</B></P> <P>Among 53,281 patients enrolled in the nationwide Korea Acute Myocardial Infarction Registry, 3426 patients with NSTEMI and DM, who were treated with renin-angiotensin system (RAS) inhibitors, had undergone successful PCI with DESs. They were classified into two groups: ACEI group (<I>N</I> = 2076), and ARB group (<I>N</I> = 1350). Individual major clinical outcomes and major adverse cardiac events (MACE), the composite of total death, myocardial infarction (MI), and revascularization were compared between the two groups for up to two years.</P> <P><B>Results</B></P> <P>After propensity score-matching analysis, two propensity-matched groups (1103 pairs, total = 2206) were generated, and the baseline characteristics were balanced. Although all causes of death and recurrent MI were not different between the two groups, the incidence of revascularization (4.0% <I>vs.</I> 7.1%; <I>p</I> = 0.002), including target vessel (2.3% <I>vs.</I> 5.0; <I>p</I> = 0.002), and MACE (8.7% <I>vs.</I> 12.5%, <I>p</I> = 0.008), were lower in the ACEI group than the ARB group at two-year follow-up.</P> <P><B>Conclusions</B></P> <P>Compared with ARB, no beneficial effects of ACEI on all causes of death, cardiac death, or recurrence of MI were observed, but ACEI reduced the incidence of revascularization and MACE in this population. Thus, well-designed trials with a larger population are needed to confirm these results.</P> <P><B>Highlights</B></P> <P> <UL> <LI> No beneficial effects of ACEI on total deaths, cardiac deaths, or recurrence of MI were observed. </LI> <LI> ACEI reduced the incidence of revascularization and MACE. </LI> <LI> In subgroup analysis, ACEI had a beneficial effect on MACE. </LI> </UL> </P>