Temporal trends and in-hospital outcomes of primary percutaneous coronary intervention in nonagenarians with ST-segment elevation myocardial infarction

( Joon Young Kim ),( Myung Ho Jeong ),( Yong Woo Choi ),( Yong Keun Ahn ),( Shung Chull Chae ),( Seung Ho Hur ),( Taek Jong Hong ),( Young Jo Kim ),( In Whan Seong ),( In Ho Chae ),( Myeong Chan Cho ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6

Background/Aims: Data regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in nonagenarians are very limited. The aim of the present study was to evaluate the temporal trends and in-hospital outcomes of primary PCI in nonagenarian STEMI patients. Methods: We retrospectively reviewed data from the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008, and from the Korea Working Group on Myocardial Infarction (KorMI) from February 2008 to May 2010. Results: During this period, the proportion of nonagenarians among STEMI patients more than doubled (0.59% in KAMIR vs. 1.35% in KorMI), and the rate of use of primary PCI also increased (from 62.5% in KAMIR to 81.0% in KorMI). We identified 84 eligible study patients for which the overall in-hospital mortality rate was 21.4% (25.0% in KAMIR vs. 20.3% in KorMI, p = 0.919). Multivariate analysis identified two independent predictors of in-hospital mortality, namely a final Thrombolysis in Myocardial Infarction (TIMI) flow < 3 (odds ratio [OR], 13.7; 95% confidence interval [CI], 3.2 to 59.0; p < 0.001) and cardiogenic shock during hospitalization (OR, 6.7; 95% CI, 1.5 to 30.3; p = 0.013). Conclusions: The number of nonagenarian STEMI patients who have undergone primary PCI has increased. Although a final TIMI flow < 3 and cardiogenic shock are independent predictors of in-hospital mortality, primary PCI can be performed with a high success rate and an acceptable in-hospital mortality rate.

내원시 저혈당이 당뇨병을 동반한 심근경색증 환자의 예후에 미치는 영향

김은정 ( Eun Jung Kim ),정명호 ( Myung Ho Jeong ),정인석 ( In Seok Jeong ),오상기 ( Sang Gi Oh ),김상형 ( Sang Hyung Kim ),안영근 ( Young Keun Ahn ),김주한 ( Ju Han Kim ),김영조 ( Young Jo Kim ),채성철 ( Shung Chull Chae ),홍택종 대한내과학회 2014 대한내과학회지 Vol.87 No.5

목적: 당뇨병 환자에게 철저한 혈당 조절은 논란의 여지가 있으며, 이에 당뇨병을 동반한 급성 심근경색증 환자의 내원 시 저혈당과 병원 내 주요 임상 사건 및 사망률 그리고 추적관찰 1년간 사망률과의 관계를 알아보고자 하였다. 방법: 2005년 11월부터 2012년 3월까지 KAMIR에 등록된 당뇨병이 동반된 급성 심근경색증 환자 5,249명을 혈당 수치에 따라서 저혈당을 보인 환자(≤ 70 mg/dL)를 I군(93명, 72.6± 11.0세, 여성 46.2%), 정상혈당을 보인 환자(> 70 and < 140)를 II군(1,262명, 71.3 ± 10.7, 여성 34.3%), 고혈당을 보인 환자(≥ 140)를 III군(3,894명, 70.3 ± 11.1, 여성 36.0%)으로 분류하여, 병원 내 주요 임상사건 및 1년 후 사망률과의 관계를 비교하였다. 결과: 각 군의 평균 연령은 I군(72.6 ± 11.0세), II군(71.3 ±10.7세), III군(70.3 ± 11.1세)으로 I군에서 연령이 높았다(p =0.006). I군에서 내원 시 비전형적인 증상 양상(p = 0.002), Killip class III-IV (p = 0.003), 심초음파을 이용한 좌심실 구혈률 40% 미만의 환자(p = 0.002), NSTEMI가 많았다(p = 0.001). 전체 대상 환자 5,249명 중 344명(6.6%)이 입원 중 사망하였으며, 이 중에서 I군 12명(12.9%), II군 66명(5.2%), III군 266명(6.8%)으로 I군에서 사망률이 유의하게 높았다(p = 0.006).다변량 회귀분석에서 나이(p = 0.001), Killip class III-IV (p =0.001), 뇌혈관 질환(p = 0.002), 만성 신부전증(p = 0.001), 급성 신부전증(p = 0.001), 심인성 쇼크(p = 0.001), 심실성 빈맥증(p = 0.005), 좌심실 구혈률 40% 미만(p = 0.001), 내원시 혈당 70 mg/dL 미만(p = 0.005)은 추적관찰 한 달간 사망률에 독립적인 예측인자이었다. 정상 혈당군에 비하여 저혈당 군에서 사망률이 유의하게 증가하였고(OR 3.571, 95% CI1.465-8.705, p = 0.005). 고혈당군에 비해 저혈당군에서 사망률이 유의하게 증가하였다(OR 4.088, 95% CI 1.757-9.511, p= 0.001). 그러나 추적관찰 1년간에서 내원시 혈당은 사망률의 유의한 예측인자가 아니었다(p = 0.428). 결론: 당뇨병을 동반한 심근경색증 환자의 내원 시 저혈당은 입원중과 추적관찰 한 달간의 사망률을 예측할 수 있는 예후인자였다. Methods: We analyzed 5,249 diabetic patients who enrolled in the Korean Acute Myocardial Infarction Registry from November 2005 to March 2013. The patients were divided into three groups according to their blood glucose level at admission; Group I:hypoglycemia (≤ 70 mg/dL), Group II: normoglycemia (70-140 mg/dL) and Group III: hyperglycemia (≥ 140 mg/dL). We assessed in-hospital mortality and the major adverse cardiac events based on blood glucose levels at admission. Results: The mean age was older in group I at 72.6 ± 11.0 years compared to 71.3 ± 10.7 in group II and 70.3 ± 11.1 in group III (p < 0.006). A total of 344 patients died during hospitalization. In-hospital mortality was higher in group I at 12.9%, compared to 5.2% in group II and 6.8% in group III (p < 0.006). Multivariable logistic regression analysis determined that the independent predictors of 1-month mortality were age, Killip class III-IV, cerebrovascular disease, chronic renal failure, acute renal failure, cardiogenic shock, ventricular tachycardia, ejection fraction < 40% and hypoglycemia in admission. The mortality rate at 1 month was significantly higher in group I compared to group II (odds ratio [OR] 3.571; 95% confidence interval [CI] 1.465-8.705, p = 0.005) compared to group II and group III (OR 4.088; 95% CI 1.757-9.511, p = 0.001). Conclusions: Hypoglycemia on admission was an important predictor of in-hospital and one-month mortality in AMI patients with diabetes mellitus. (Korean J Med 2014;87:565-573)

In-hospital mortality in patients with STEMI admitted during off hours

( Sung-Soo Kim ),( Myung Ho Jeong ),( Jeong Gwan Cho ),( Young Keun Ahn ),( Jong Hyun Kim ),( Shung Chull Chae ),( Young Jo Kim ),( Seung Ho Hur ),( In Whan Seong ),( Taek Jong Hong ),( Dong-hoon Choi 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Conflicting results exist on the outcome of off hours PCI in ST elevation myocardial infarction (STEMI). However, there were only a few studies that have focused on the clinical characteristics and outcomes of off hours PCI in STEMI. So, we studied the clinical characteristics and hospital mortality in STEMI patients treated with primary PCI during regular hours (weekdays 9:00 AM to 6:00 PM) versus off hours Weekdays 6:01 PM to 8:59 AM, weekends, and holidays) in Korea Acute Myocardial Infarction Registry. We analyzed in hospital and one year mortality among 5,665 consecutive ST segment elevation myocardial infarction patients treated with primary PCI between November 2005 to January 2008. Total 2,848 (50.2%) patients were treated during off hours. Baseline finding were similar, although regular hours patients were older. Median symptom to balloon time (304 min, IQR 175 to 750 vs. 270 min, IQR 145 to 551, p=0.001) were longer for regular hours primary PCI. Median door to balloon time (71min, IQR: 48 to 132 vs. 59 min, IQR 39 to 110 min, p=0.001) were longer for off hours pPCI. Also, Cardiac enzyme such as Max CK-MB (212.1±299.3 vs 194.7±303.4, p=0.031) and max TnI (72.6±239.5 vs. 58.9±94.4, p=0.013) were increased in off hours pPCI. However, unadjusted in hospital (6.0% off hours vs. 6.0% regular hours, p=0.946) and one year cardiac mortality (11.3% off hours vs. 11.7% regular hours, p=0.661) were comparable. In multivariate analysis, off hours primary PCI did not predict an adverse outcome. In conclusion, when primary PCI was performed within an appropriate reperfusion strategy, the clinical effectiveness of either off hours or regular hours pPCI is comparable.

Decreased Glomerular Filtration Rate is an Independent Predictor of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Kim, Joon Young,Jeong, Myung Ho,Ahn, Yong Keun,Moon, Jae Hyun,Chae, Shung Chull,Hur, Seung Ho,Hong, Taek Jong,Kim, Young Jo,Seong, In Whan,Chae, In Ho,Cho, Myeong Chan,Kim, Chong Jin,Jang, Yang Soo,Yo The Korean Society of Cardiology 2011 Korean Circulation Journal Vol.41 No.4

<P><B>Background and Objectives</B></P><P>Patients with renal dysfunction (RD) experience worse prognosis after myocardial infarction (MI). The aim of the present study was to investigate the impact of admission estimated glomerular filtration rate (eGFR) on clinical outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation MI (STEMI).</P><P><B>Subjects and Methods</B></P><P>We retrospectively evaluated 4,542 eligible patients from the Korea Acute Myocardial Infarction Registry (KAMIR). Patients were divided into three groups according to eGFR (mL/min/1.73 m<SUP>2</SUP>): normal renal function (RF) group (eGFR ≥60, n=3,515), moderate RD group (eGFR between 30 to 59, n=894) and severe RD group (eGFR <30, n=133). Baseline characteristics, angiographic and procedural results, and in-hospital outcomes between the three groups were compared.</P><P><B>Results</B></P><P>Age, gender, Killip class ≥3, hypertension, diabetes, congestive heart failure, peak creatine kinase-MB, high sensitivity C-reactive protein, B-type natriuretic peptide, left ventricle ejection fraction, multivessel disease, infarct-related artery and rate of successful PCI were significantly different between the 3 groups (p<0.05). With decline in RF, in-hospital complications developed with an increasing frequency (14.1% vs. 31.8% vs. 45.5%, p<0.0001). In-hospital mortality rate was significantly higher in the moderate and severe RD groups as compared to the normal RF group (2.3% vs. 13.9% vs. 25.6%, p<0.0001). Using multivariate logistic regression analysis, adjusted odds ratio for in-hospital mortality was 2.67 {95% confidence interval (CI) 1.44-4.93, p=0.002} in the moderate RD group, and 4.09 (95% CI 1.48-11.28, p=0.006) in the severe RD group as compared to the normal RF group.</P><P><B>Conclusion</B></P><P>Decreased admission eGFR was associated with worse clinical courses and it was an independent predictor of in-hospital mortality in STEMI patients undergoing primary PCI.</P>

도시지역 일부 고등학생들의 우울과 불안에 관한 조사 연구

곽은주,송인순,정용준,조영채 韓國保健敎育.健康增進學會 2003 보건교육건강증진학회지 Vol.20 No.2

This study has examined the degree of depression and anxiety among high school students in an urban area and then explored the factors influencing their depression and/or anxiety status. Self-administered questionnaires were offered to 2,381 students from ten high schools in Daejon Metropolitan City. The items for investigation included such factors as various characteristics of school and family life, daily life style, and the degree of depression and anxiety. Based on the study results, the following conclusions were made; 1. The distribution according to the depression degree has shown that 61.9% of students were normal, 32.9% of students had mild depression, 5.0% moderate depression, and 0.3% severe depression. As for anxiety, 40.2% of students were normal, while 19.1% were classified as having anxiety and 40.7% borderline anxiety. 2. As regards to the degree of depression and anxiety, it was greater in girls than boys, in 3rd graders than 1st and 2nd graders, and in the groups who have recieved lower grades in studies, who had poor relations with their friends and a low feeling of satisfaction with school life. In particular, concerning various characteristics of family life, the scores of depression and anxiety were higher in the groups whose financial conditions were poor, whose parents' interests were lower, whose degree of satisfaction with their family and school life was lower, than their counterparts. 3. According to their life styles higher scores of depression and anxiety were found in the groups whose sleeping time was inappropriate, whose breakfasts were skipped, who ate daily snacks, who didn't take regular exercises, and who had poor health habits, compared to their counterparts, respectively. 4. As for the correlation between the degree of depression and its associated variables, the higher scores of depression were in positive correlation with the groups who had lower grades in studies, poor relation with their friends, low feeling of satisfaction with school and home life, low parents' interest, poor subjective condition of health, breakfast skipping, lack of regular exercises, and lower indices of health habits. 5. As for anxiety, the higher scores of anxiety were in the positive correlation with the groups with poor relation with their friends, low feeling of satisfaction with school and family life, poor subjective condition of health, lack of regular exercises, and poor health habits. 6. The influential factors on the depression of students were selected such as subjective condition of health, sex, feeling of satisfaction with family and school life, grades in studies, relation with their friends, presence of regular exercises, degree of interest of parents, sleeping time, cigarette smoking and eating breakfast. 7. The influential factors on the anxiety state of students were selected such as subjective condition of health, feeling of satisfaction with family and school life, sex, sleeping time, regular exercises, cigarette smoking, snacking and relations with their friends. The present study results suggest that girls rather than boys, higher graders than lower ones are more vulnerable to anxiety and depression state, and besides, various characteristics of school and family life, and daily life style can be influential on students' emotional states. Therefore, better management of psychological status of students is thought to require a wide variety of measures to modify the influencing factors and to encourage social support.

Impact of the Metabolic Syndrome on the Clinical Outcome of Patients with Acute ST-Elevation Myocardial Infarction

Lee, Min Goo,Jeong, Myung Ho,Ahn, Youngkeun,Chae, Shung Chull,Hur, Seung Ho,Hong, Taek Jong,Kim, Young Jo,Seong, In Whan,Chae, Jei Keon,Rhew, Jay Young,Chae, In Ho,Cho, Myeong Chan,Bae, Jang Ho,Rha, S The Korean Academy of Medical Sciences 2010 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.25 No.10

<P>We sought to determine the prevalence of metabolic syndrome (MS) in patients with acute myocardial infarction and its effect on clinical outcomes. Employing data from the Korea Acute Myocardial Infarction Registry, a total of 1,990 patients suffered from acute ST-elevation myocardial infarction (STEMI) between November 2005 and December 2006 were categorized according to the National Cholesterol Education Program-Adult Treatment Panel III criteria of MS. Primary study outcomes included major adverse cardiac events (MACE) during one-year follow-up. Patients were grouped based on existence of MS: group I: MS (n=1,182, 777 men, 62.8±12.3 yr); group II: Non-MS (n=808, 675 men, 64.2±13.1 yr). Group I showed lower left ventricular ejection fraction (LVEF) (<I>P</I>=0.005). There were no differences between two groups in the coronary angiographic findings except for multivessel involvement (<I>P</I>=0.01). The incidence of in-hospital death was higher in group I than in group II (<I>P</I>=0.047), but the rates of composite MACE during one-year clinical follow-up showed no significant differences. Multivariate analysis showed that low LVEF, old age, MS, low high density lipoprotein cholesterol and multivessel involvement were associated with high in-hospital death rate. In conclusion, MS is an important predictor for in-hospital death in patients with STEMI.</P>

Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients

Kim, Eun Jung,Jeong, Myung Ho,Kim, Ju Han,Ahn, Tae Hoon,Seung, Ki Bae,Oh, Dong Joo,Kim, Hyo-Soo,Gwon, Hyeon Cheol,Seong, In Whan,Hwang, Kyung Kuk,Chae, Shung Chull,Kim, Kwon-Bae,Kim, Young Jo,Cha, Kwa Elsevier 2017 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.236 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Acute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate.</P> <P><B>Methods</B></P> <P>A total of 12,625 AMI patients (64.0±12.6years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4±11.6years, 30.4% female) and 8228 non-diabetes (63.3±13years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status.</P> <P><B>Results</B></P> <P>In diabetic patients, independent predictors of in-hospital mortality were old age, high HbA<SUB>1</SUB>C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction<40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (≥200mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction<40%, cardiogenic shock, stent thrombosis and decreased Hb≥5g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, <I>p</I> <0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, <I>p</I> <0.001). Comorbidity including cardiogenic shock (<I>p</I> <0.001), cerebral hemorrhage (<I>p</I> =0.012), decreased Hb≥5g/dL (<I>p</I> =0.013), atrioventricular block (<I>p</I> <0.001) and ventricular tachycardia (<I>p</I> =0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients.</P> <P><B>Conclusions</B></P> <P>These findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients.</P>

일부 고등학생들의 일상생활특성에 따른 스트레스와 피로자각증상의 평가

이주영,송인순,정용준,조영채 韓國學校保健學會 2003 韓國學校保健學會誌 Vol.16 No.1

The present study was designed to evaluate the factors influential on stress and subjective fatigue symptoms based on school life environments and daily life style among high school students. The self-administered questionnaires were delivered to 2,381 high school students of both sexes in Taejon metropolitan city during the period from Mar. 1st to Jun. 30th, 2000. The analysis of study results revealed the following findings: 1. According to the magnitude of stress, the normal subjects were 3.1%, the groups with potential stress were 64.7%, and the groups at high risk for stress were 32.2%. Higher level of stress existed in the female than the male students, and in the third grader than the 1st and 2nd graders. According to the classification of typical constitutional symptoms of fatigue, categoryⅢ (group with difficulty in concentration) and categoryⅠ(group with dullness and sleepiness) in a decreasing order of frequency, which showed that the predominant pattern of fatigue arose from the body parts. 2. With regard to the school life characteristics and stress scores, the higher cores of stress were shown in the groups with the lower grades, with worse friend's relation and with the lower satisfaction with the school life. the scores for the subjective fatigue symptoms were higher in the male, in the low graders, in the better friend's relation, and in the satisfactory group than the respective counterparts. 3. Concerning home life characteristics, the higher scores of stress were associated with the students characterized by the recognized poor economic conditions, lower interests of parents, lack of satisfaction with the home life, the poor subjective health status. On the other hand, the scores for the subjective fatigue symptoms were higher in the student groups with good economic conditions, higher interests of parents, presence of satisfaction with the home life, and good subjective health status. 4. Concerning daily life style, the higher scores of stress were in the students who had inappropriate sleep hours, skipped breakfasts, daily consumption of intermeal snacks, lack of exercise, daily smoking, normal indices of obesity, and lower indices of health habit. conversely, the scores of subjective fatigue symptoms were higher in the groups who had daily breakfasts, no intermeal snacks, daily exercise, no smoking than their counterparts. 5. The factors exerting influence upon the stress included the satisfaction with life, friend's relation, satisfaction with the home life, exercise, school grades, interests of parents, school year, sex, scores of health habit, degree of obesity, economic conditions of home. Those influencing on the degree os stress included stress, intermeal snacks, smoking, friend's relation and satisfaction with the home life.

Different Impact of Diabetes Mellitus on In-hospital and 1-Year Mortality in Patients with Acute Myocardial Infarction Who Underwent Successful Percutaneous Coronary Intervention: Results from the Korean Acute Myocardial Infarction Registry

( Keun Ho Park ),( Young Keun Ahn ),( Myung Ho Jeong ),( Shung Chull Chae ),( Seung Ho Hur ),( Young Jo Kim ),( In Whan Seong ),( Jei Keon Chae ),( Taek Jong Hong ),( Myeong Chan Cho ),( Jang Ho Bae ) 대한내과학회 2012 The Korean Journal of Internal Medicine Vol.27 No.2

Background/Aims: The aim of this study was to evaluate the impact of diabetes mellitus (DM) on in-hospital and 1-year mortality in patients who suffered acute myocardial infarction (AMI) and underwent successful percutaneous coronary intervention (PCI). Methods: Among 5,074 consecutive patients from the Korea AMI Registry with successful revascularization between November 2005 and June 2007, 1,412 patients had a history of DM. Results: The DM group had a higher mean age prevalence of history of hypertension, dyslipidemia, ischemic heart disease, high Killip class, and diagnoses as non-ST elevation MI than the non-DM group. Left ventricular ejection fraction (LVEF) and creatinine clearance were lower in the DM group, which also had a significantly higher incidence of in-hospital and 1-year mortality of hospital survivors (4.6% vs. 2.8%, p = 0.002; 5.0% vs. 2.5%, p < 0.001). A multivariate analysis revealed that independent predictors of in-hospital mortality were Killip class IV or III at admission, use of angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers, LVEF, creatinine clearance, and a diagnosis of ST-elevated MI but not DM. However, a multivariate Cox regression analysis showed that DM was an independent predictor of 1-year mortality (hazard ratio, 1.504; 95% confidence interval, 1.032 to 2.191). Conclusions: DM has a higher association with 1-year mortality than in-hospital mortality in patients with AMI who underwent successful PCI. Therefore, even when patients with AMI and DM undergo successful PCI, they may require further intensive treatment and continuous attention.

Impact of total occlusion of an infarct-related artery on long-term mortality in acute non-ST-elevation myocardial infarction patients who underwent early percutaneous coronary intervention.

Kim, Min Chul,Ahn, Youngkeun,Rhew, Shi Hyun,Jeong, Myung Ho,Kim, Ju Han,Hong, Young Joon,Chae, Shung Chull,Kim, Young Jo,Hur, Seung Ho,Seong, In Whan,Chae, Jei Keon International Heart Journal Association 2012 International heart journal Vol.53 No.3

<P>Some patients with non-ST-elevation myocardial infarction (NSTEMI) have a total occlusive infarct-related artery. However, the long-term prognosis of these patients is uncertain, particularly for those who underwent an early invasive strategy. The aim of this study was to determine the clinical impact of total occlusion (TO) of an infarct-related artery (IRA) in these patients. A total of 2,094 patients with NSTEMI who underwent an early invasive strategy with percutaneous coronary intervention (PCI) in the Korea Acute MI Registry (KAMIR) were analyzed (TO group; 665 patients, and non-TO group; 1,429 patients).In-hospital and one-year clinical outcomes were compared between the two groups. The left circumflex (42.9%) and right coronary artery (31.9%) were the major IRA in the TO group, while the left anterior descending artery was more common as an IRA in the non-TO group (44.1%). In-hospital complications including death and cardiogenic shock occurred frequently in the TO group. Also, the rates of one-month and 12-month adverse cardiac outcomes were higher in the TO group. In the Cox-proportional hazard model, TO in IRA predicted 12-month all-cause death. In conclusion, NSTEMI patients with TO in IRA showed worse short- and long-term clinical outcomes compared with those of non-TO patients.</P>