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Kiyuk Chang,Youngkeun Ahn,Sungmin Lim,Jeong Hoon Yang,Kwan Yong Lee,Eun Ho Choo,Hyun Kuk Kim,Chang-Wook Nam,김원,Jin-Yong Hwang,Seung-Woon Rha,Hyo-Soo Kim,Myeong-Chan Cho,Yangsoo Jang,Myung Ho Jeong 대한심장학회 2021 Korean Circulation Journal Vol.51 No.4
Acute myocardial infarction (AMI) is a fatal manifestation of ischemic heart disease and remains a major public health concern worldwide despite advances in its diagnosis and management. The characteristics of patients with AMI, as well as its disease patterns, have gradually changed over time in Korea, and the outcomes of revascularization have improved dramatically. Several characteristics associated with the revascularization of Korean patients differ from those of patients in other countries. The sophisticated state of AMI revascularization in Korea has led to the need for a Korean expert consensus. The Task Force on Expert Consensus Document of the Korean Society of Myocardial Infarction has comprehensively reviewed the outcomes of large clinical trials and current practical guidelines, as well as studies on Korean patients with AMI. Based on these comprehensive reviews, the members of the task force summarize the major guidelines and recent publications, and propose an expert consensus for revascularization in patients with AMI.
Chang-Hwan Yoon,Jihong Jang,Seung Ho Hur,Jun-Hee Lee,Seung Hwan Han,Soon-Jun Hong,Kiyuk Chang,In-Ho Chae 대한심장학회 2022 Korean Circulation Journal Vol.52 No.5
Background and objectives: To compare the safety and efficacy of a new everolimus-eluting stent with an abluminal-coated biodegradable polymer (Osstem Cardiotec Centum) with those of the Xience Alpine stent (Xience). Methods: This randomized, prospective, multicenter, parallel-designed, single-blind trial was conducted among patients with myocardial ischemia undergoing percutaneous coronary intervention (PCI) from 21st September 2018 until 3rd July 2020. The primary efficacy endpoint was in-segment late lumen loss (LLL) at 270 days after the procedure and the primary safety endpoints were major adverse cardiac events (MACE), composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: We enrolled 121 patients and analyzed 113 patients who finished 270 days of follow-up for the primary efficacy endpoint. The mean age of the participants was 66.8 years. As for the primary efficacy endpoint, LLL of the Osstem Cardiotec Centum group was 0.09±0.13 mm and that of the Xience group was 0.12±0.14 mm (upper limit of 1-sided 95% confidence interval, 0.02; p for non-inferiority, 0.0084). This result demonstrates the non-inferiority of the Osstem Cardiotec Centum. As for the primary safety endpoint, MACE occurred in one patient (1.59% of the Xience group). Meanwhile, no MACE occurred in the Osstem Cardiotec Centum group. Conclusions: The Osstem Cardiotec Centum is non-inferior to the Xience Alpine® stent and is confirmed to be safe. It could be safely and effectively applied to patients with coronary artery disease undergoing PCI.
김찬준,Kiyuk Chang,Byeong-Keuk Kim,Chang Gyu Park,Yangsoo Jang 대한심장학회 2021 Korean Circulation Journal Vol.51 No.1
Background and Objectives: DENEX™ is a novel renal sympathetic denervation (RDN) system that is equipped with 3 electrodes that deliver radiofrequency energy to the renal nerves along renal arteries. The purpose of this study was to evaluate the safety and efficacy of RDN with DENEX™ in resistant hypertension. Methods: This was an open-label, single-arm, multicenter, first-in-man pilot study. Between November 2016 and May 2018, a total of 16 patients were enrolled at 4 centers in South Korea. The inclusion criteria were systolic blood pressure (SBP) ≥150 mmHg and use of 3 or more antihypertensive medications, including diuretics. The primary objective was the safety outcome of RDN with the DENEX™ system. The secondary objective was efficacy outcome based on changes of office, and 24-hour ambulatory SBP from baseline to 3 months. The patients underwent abdominal computed tomography (CT) or duplex ultrasonogram before and 6 months after RDN. Results: No major adverse events occurred after RDN for 6 month of follow-up period. There was no vascular complication either by CT or duplex ultrasonogram. The office SBP was significantly reduced from 164.6±11.6 mmHg at baseline to 142.0±20.4 mmHg (−24.4±24.4 mmHg, p=0.003) at 3 months. The ambulatory SBP was reduced from 151.44±12.85 mmHg at baseline to 140.0±16.5 mmHg (−13.1±18.9 mmHg, p=0.056) at 3 months. Conclusion: RDN with the DENEX™ system showed a favorable safety profile in resistant hypertension. A significant reduction in office SBP and a borderline reduction in ambulatory SBP were observed.
( Hae Chang Jeong ),( Joon Ho Ahn ),( Min Chul Kim ),( Doo Sun Sim ),( Keun Ho Park ),( Young Joon Hong ),( Ju Han Kim ),( Myung Ho Jeong ),( Ki-bae Seung ),( Kiyuk Chang ),( Youngkeun Ahn ) 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.2
Background/Aims: The optimal percutaneous coronary intervention (PCI) strategy in patients with acute myocardial infarction (AMI) with multivessel disease (MVD) is uncertain. This study was designed to develop a novel and simple tool for assessing an individualized and optimized PCI strategy in AMI patients with MVD. Methods: In total, 5,025 patients with AMI from nine centers at two universities were enrolled in the prospective Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction (COREA-AMI) registry from January 2004 through December 2009. From among them, we selected 2,630 patients with MVD who were treated by culprit-only or multivessel (MV) PCI. We investigated major adverse cardiac events (MACEs) during a 1-year clinical follow-up. Using a subgroup analysis, we extracted variables for use in the culprit only versus multivessel revascularization (CONVERSE) score, which showed a preference for MV PCI rather than culprit-only PCI for treating MVD. Results: The CONVERSE score was constructed using eight independent variables (1 point for each variable): age > 65 years, hypertension, diabetes mellitus, high Killip class (III or IV), low left ventricular ejection fraction (≤ 50%), low creatinine clearance (≤ 60 mL/min), high level of high-sensitivity C-reactive protein (≥ 2.0 mg/L), and left anterior descending artery or left main as the nonculprit vessel. The incidence of MACEs increased linearly with the CONVERSE score. The receiver operating characteristic curve showed that the cutoff value was 3 points. Conclusions: The results suggest that patients with a CONVERSE score of 3 or more should undergo MV PCI.
Worsening renal function, association with long-term mortality in stable post-MI 1-year survivors
( Seung Won Ahn ),( Kwan Yong Lee ),( Sungmin Lim ),( Tae Hoon Kim ),( Yoon Seok Koh ),( Hun Jun Park ),( Pumjoon Kim ),( Kiyuk Chang ),( Wook Sung Chung ),( Doo Sun Sim ),( Keun Ho Park ),( Ju Han Ki 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1
Background: Impaired renal function is associated with adverse clinical outcome in patient with acute Myocardial infarction. However, few data exist on the association of worsening renal function and long-term mortality in patients who survived at 1 year after index AMI. Methods: We consecutively enrolled AMI patients who underwent percutaneous coronary intervention (PCI) between January 2004-December 2009 from 9 universityhospitals in S.Korea. Patients who were alive and did not experience a recurrent MI or stroke during the first 365 days post-index MI were analyzed. We excluded 169 patients with estimated glomerular filtration rate (eGFR) below 15 mL/min/m2. We divided patients to quintiles according to the degree of changes in the eGFR value between index AMI and 1 year later. The primary endpoint was all-cause mortality from Day 366 to study completion. Results: of 4.748 AMI patients, 1,929 patients were alive and their GFR values were available for the assessment of all-cause mortality. The median change of eGFR was -0.7 mL/min/m2. All-cause mortality from 1 to 4 year of index AMI was 10.6% in the 1st quintile (≥ 20% decline in eGFR values) and 4.5% in the remained quintiles [Unadjusted HR (95% CI) 2.38 (1.61-3.50), p <0.001]. In multivariable Cox proportional regression analysis, older age [Adjusted HR (95% CI) 4.40 (2.69-7.21), p<0.001], not taking dual antiplatelet agent at 1 year [2.09 (1.40-3.10), p<0.001], non-ST-segment elevation myocardial infarction at index events [1.83 (1.24-2.69), p=0.002], and worsening eGFR within the first year [1.51 (1.01-2.26), p=0.04] were the predictors of long-term mortality. Conclusions: Worsening renal function within the first year after index AMI was associated with long-term mortality in stable post-MI 1-year survivors.
Kim, Ho-Sook,Chang, Kiyuk,Koh, Yoon-Seok,Park, Mahn-Won,Choi, Yun-Seok,Park, Chul-Soo,Oh, Minkyung,Kim, Eun-Young,Shon, Ji-Hong,Shin, Jae-Gook,Seung, Ki-Bae American Heart Association, Inc. 2013 Circulation. Cardiovascular genetics Vol.6 No.5
<P><B>Background—</B></P><P>More intensive platelet suppression is required in patients with acute myocardial infarction (AMI) than in those with stable angina because of differential platelet activation between AMI and stable angina. In this context, CYP2C19 genotype leading to reduced active metabolite formation may profoundly affect the clinical outcome of clopidogrel therapy in patients with AMI compared with those with stable angina.</P><P><B>Methods and Results—</B></P><P>Effects of CYP2C19 genotypes on the clinical outcome of clopidogrel therapy were evaluated in 2188 patients (532 patients with AMI and 1656 patients with stable angina) undergoing percutaneous coronary intervention. The primary clinical outcome was a composite of major adverse cardiac and cerebrovascular events defined as death from any cause, nonfatal myocardial infarction, or stroke during 1 year of clopidogrel therapy. Compared with extensive metabolizer, the CYP2C19 poor metabolizer was significantly associated with higher risk of major adverse cardiac and cerebrovascular events in patients with AMI (hazard ratio, 2.88; 95% confidence interval, 1.27–6.53; <I>P</I>=0.011). However, this finding was not seen in patients with stable angina. A significant interaction between CYP2C19 genotypes and disease subsets of AMI and stable angina was identified with respect to major adverse cardiac and cerebrovascular events (adjusted interaction <I>P</I>=0.045). The patients with AMI showed lower percent inhibition of P2Y12 compared with patients with stable angina in CYP2C19 poor metabolizer or CYP2C19 intermediate metabolizer genotype groups but not in CYP2C19 extensive metabolizer genotype group.</P><P><B>Conclusions—</B></P><P>CYP2C19 poor metabolizer is associated with poor clinical outcome of clopidogrel therapy in Asian patients with AMI but not in those with stable angina possibly because of differential requirement of platelet suppression in patients with AMI and stable angina.</P><P><B>Clinical Trial Registration Information—</B></P><P>URL: clinicaltrials.gov. Identifier: NCTO1239914.</P>
Understanding Vulnerable Plaques: Current Status and Future Directions
Kwan-Yong Lee,Kiyuk Chang 대한심장학회 2019 Korean Circulation Journal Vol.49 No.12
The main cause of acute myocardial infarction is plaque rupture accompanied by superimposed coronary thrombosis. Thin-cap fibroatheromas (TCFAs) have been suggested as a type of lesion with a vulnerability that can cause plaque rupture. However, not only the existence of a TCFA but also the fine and complex interactions of other anatomical and hemodynamic factors, such as microcalcification in the fibrous cap, cholesterol crystal-induced inflammasome activation, the apoptosis of intraplaque macrophages, and endothelial shear stress distribution should precede a clinical event caused by plaque rupture. Recent studies are being conducted to identify these mechanisms through molecular imaging and hemodynamic assessment using computational fluid dynamics, which will result in better clinical results through selective coronary interventions.
Choo, Eun Ho,Chang, Kiyuk,Ahn, Youngkeun,Jeon, Doo Soo,Lee, Jong Min,Kim, Dong Bin,Her, Sung-Ho,Park, Chul Soo,Kim, Hee Yeol,Yoo, Ki-Dong,Jeong, Myung Ho,Seung, Ki-Bae BMJ Publishing Group Ltd 2014 Heart Vol.100 No.6
<P><B>Objective</B></P><P>β-blockers are the standard treatment for myocardial infarction (MI) based on evidence from the pre-thrombolytic era. The aim of this study was to examine the effect of β-blocker treatment in patients with acute MI and preserved systolic function in the era of percutaneous coronary intervention (PCI).</P><P><B>Methods</B></P><P>We analysed a multicentre registry and identified 3019 patients who presented with acute MI between 2004 and 2009. Patients were treated with PCI, had left ventricular EFs ≥50% according to echocardiograms that were performed during the index PCI, and were alive at the time of discharge. The association between β-blocker use after discharge and mortality (all-cause death and cardiac death) within 3 years was examined.</P><P><B>Results</B></P><P>Patients who were not treated with β-blockers (n=595) showed higher rates of all-cause death and cardiac death compared to patients treated with β-blockers (10.8% vs 5.7%, p<0.001, 7.6% vs 2.6%, p<0001). The multivariate Cox proportional hazards model showed that β-blocker treatment was associated with a significant reduction in all-cause death (adjusted HR 0.633, 95% CI 0.464 to 0.863; p=0.004) and cardiac death (adjusted HR 0.47, 95% CI 0.32 to 0.70; p<0.001). Comparable results were obtained after propensity score matching.</P><P><B>Conclusions</B></P><P>β-blocker treatment was associated with reduced long term mortality in patients with acute MI and preserved systolic function who received PCI.</P>