Comparison of Paclitaxel-Versus Sirolimus-Eluting Stents for the Treatment of Acute ST-Elevation Myocardial lnfarction

김현숙 ( Hyun Sook Kim ),이재환 ( Jae Hwan Lee ),성인환 ( In Whan Seong ),이승환 ( Seung Whan Lee ),이경석 ( Kyoung Suk Rhee ),김원호 ( Won Ho Kim ),고재기 ( Jae Ki Ko ) 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.1

Objectives: Paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) are more effective than bare-metal stent for reducing restenosis. However, it is not known whether there are differences between PES and SES in terms of safety and efficacy in the setting of ST-elecation myocardial infarction (STEMI). Methods and Results: Acute STEMI patients (n=231) undergoing primary stenting were randomly assigned to PES (n=115) or SES (n=116) treatment. Primary end point was in-segment late loss at 6 months. Secondary end points were 6-month angiographic restenosis and major adverse cardiac events (MACE) at 9 months. At 6 months, in-segment late loss was higher in the PES than the SES group (0.33±0.70 vs. 0.05±0.40mm, respectively, p<0.001). During 9-month follow-up, 14 (6.1%) patients were died (9 in PES, 5 in SES group). Nine-month TLR (7.8% vs. 2.6%, p=0.09) and MACE (15.7% vs. 6.9%, p= NS) tended to be lower in SES group than PES group. Conclusions: Both PES and SES implantation was safe, and both showed favorable clinical outcomes in STEMI patients undergoing primary angioplasty. SES appeared to be superior to PES in preventing neointimal hyperplasia.

승모판 협착증 환자에서의 경피적 풍선판막성형술 및 판막대치술의 치료 효과

성인환(In Whan Seong),박승정(Seung Jung Park),박성욱(Seong Wook Park),김재중(Jae Joong Kim),이종구(Jong Koo Lee) 대한내과학회 1991 대한내과학회지 Vol.40 No.4

N/A To assess the efficacy of mitral balloon valvuloplasty (PMV) and mitral valve replacement (MVR) in patients with mitral stenosis, PMV or MVR was performed in 73 patients (male 28, female 44, mean age 42±12 yrs) between September 1989 and August 1990. Atrial fibrillation was found in 33. PMV could be performed in 68 (93%) out of 73 patients and MVR in only 5 (7%). PMV using the Inoue balloon technique was in 35 and double balloon technique in 33, and 63(93%) out of 68 PMV were be technically successful. After PMV, the mitral valve area MVA increased from 0.9±0.2 to 1.9±0.3 ㎠(p<0.0001). The mean mitral diastolic gradient decreased from 16. 6±28.0 to 5.6±3.1 mmHg (p<0.0001), the mean left atrial pressure and mean pulmonary artery pressure significantly decreased from 25±8, 32±13 to 14±5, 25±10 mmHg, respectively (p <0.001), and pulmonary vascular resistance decreased from 299±318 to 271±217 dynes sec/cm5. The cardiac output increased from 3.5±0.9 to 4.0±1.1L/min (p<0 01). Technical failures included inability to cross the mitral valve in 2, Inoue balloon deflation failure in the left atrium in 2, inability to fix the guide wire into the left ventricle in 1, and 1 death due to hemorrhagic myocardial infarction after surgical removal of the undeflated Inoue balloon. Complications included severe mitral regurgitation Grade 4/4 in 1, creation of left-to right shunt (Qp/Qs>1.2) in 12(19%), cerebral embolism in I, bleeding requiring transfusion in 1, but no cardiac tamponade in our series. MVR was performed in only 5 patients, and the reason of MVR was heavily thickened and/or calcified mitral valvular or subvalvular structure (echo-score>12) in 3, visible thrombus in the left artium in 1, and mitral valve vegetation in 1. MVA after MVR by Doppler echocardiogram increased from 0.6±0.1 to 2±0.5㎠ (p<0. 001), which was significantly greater than that of post- PMV (p<0.01).

관동맥 조영상 정상소견을 보인 환자에서 관동맥내 아세틸콜린 주사에 의한 관동맥 조영 소견의 변화

박성욱(Seong Wook Park),박승정(Seung Jung Park),김재중(Jae Joong Kim),성인환(In Whan Seong),김상위(Sang We Kim),이종구(Jong Koo Lee) 대한내과학회 1991 대한내과학회지 Vol.40 No.5

N/A The effect of an intracoronary injection of acetylcholine (A1, 20 ug; A2, 50 ug; A3, 100 ug) on the coronary artrial diameter was examined by coronary arteriography in 29 adult patients (16 men, 13 women), aged 19 to 70 years (mean 49), with normal or near normal coronary arteriographic findings. The Luminal diameter of each coronary arterial segment after each dose of acetylcholine (Ach) was compared with the diameters before Ach injection. After injection of 20 to 100 ug of Ach into the left and right coronary arteries, a significant diffuse narrowing occurred in all segments of the left and right coronary artery except for the left main stem, with more narrowing to increased doses of Ach (A1:-1.39%, A2: -7.2%, A3:-9.6% compared with control). The change in the luminal diameter after injection of 100 μg of Ach was an initial constrictive response followed by gradual dilatation, and the peak constriction occurred in 1 min after injection of Ach (1 min, -15%.2 min., -9. 6%: 3min., -2.8%: 4 min., -2.8%: 5min., 3%). These results indicate that Ach invariably induces coronary vasoconstriction in adult patients with normal or near normal coronary arteries, and the peak constrictive response occurs in 1 minute after injection of Ach. The vosoconstrictive response to Ach may reflect the endothelial dysfunction associated with early atherosclerosis, which is not evident by coronary arteriography.

개흉술을 받는 한국 성인 판막 환자의 유의한 관상동맥

최웅림 ( Uhng Lim Choi ),이선화 ( Sun Hwa Lee ),박재형 ( Jae Hyeong Park ),성석우 ( Seok Woo Seong ),김준형 ( Jun Hyung Kim ),이재환 ( Jae Hwan Lee ),최시완 ( Si Wan Choi ),정진옥 ( Jin Ok Jeong ),성인환 ( In Whan Seong ),이경석 ( 대한내과학회 2012 대한내과학회지 Vol.83 No.1

목적: 판막 질환으로 수술적 치료를 시행받는 환자들에서 유의한 관상동맥 질환의 유무를 확인하는 것은 동시에 관상 동맥우회술을 시행함으로써 향후의 재개흉술 및 이로 인한 합병증의 예방에 중요하다. 국내의 허혈성 심질환의 빈도는 서구에 비해 낮으나 어떤 환자군에서 관상동맥 조영술을 시행하여야 하는지에 대한 기초 통계자료는 없는 실정이다. 이에 저자들은 국내에서 판막 질환으로 개흉 술을 시행 받는 환자들을 대상으로 하여 관상동맥 조영술의 시행유무 및 유의한 관상동맥 질환의 유병률에 대해 연구하였다. 방법: 2005년 1월부터 2011년 6월까지 충남대학교 병원 및 전북대학교 병원 심장내과와 흉부외과에서 유의한 판막 질환으로 개흉 술을 시행 받은 성인 환자들을 대상으로 후향적 분석을 하였다. 급성 대동맥 박리 증이나 외상으로 인해 응급수술을 시행 받은 경우 및 관상동맥 협착증으로 관상동맥 우회로 술을 시행 받으면서 동시에 판막 질환을 수술한 경우는 제외하였다. 결과: 연구 기간 동안 총 431명의 환자(평균나이 58 ± 13세, 남자 204명)가 연구에 등록되었다. 질환 별로 보면 승모 판막 질환은 241명에서 관찰되었고, 대동맥판 질환은 230명에서 관찰되었다. 관상동맥 조영 술을 시행 받은 환자는 297명(68.9%)으로 이 중 36명(12.1%)에서 유의한 협착증이 관찰되었고, 32명에서 관상동맥 우회로 술이 판막 수술과 동시에 시행되었다. 다변 량 분석결과 관상동맥의 유의한 협착은 65세 이상의 고령 [Odd ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], 심혈관계 위험인자가 많은 경우(≥3) (OR =3.002, 95% CI = 1.386-6.503, p = 0.005) 및 대동맥협착증(OR= 2.763, 95% CI = 1.269-6.013, p = 0.010)과 유의하게 연관되었다. 결론: 한국에서 판막 질환으로 수술적 치료를 시행 받는 성인 환자에서 유의한 관상동맥 질환의 빈도는 12.1%로 주로 고령, 대동맥판막 협착증 및 많은 수의 심혈관계 위험인자를 가진 환자에서 높게 나타났다. Background/Aims: The identification of significant coronary arterial disease (CAD) is important to reduce perioperative ischemic insult and the possibility of repeated open-chest surgery in patients scheduled to undergo valvular surgery. However, there are no published data on the incidence of significant CAD in these patients. Thus, we examined the prevalence of significant CAD in patients scheduled to undergo valvular surgery. Methods: From January 2005 to June 2011, all consecutive adult patients diagnosed with significant valvular disease and scheduled for an elective open valvular operation were retrospectively investigated at Chungnam National University Hospital and Chonbuk National University Hospital. Patients who underwent emergent valvular operations due to acute aortic dissection or trauma and concomitant valvular operations at the time of coronary artery bypass graft (CABG) surgery were excluded. Results: During the study period, a total of 431 patients (58 ± 13 years old, 204 males) were included. The distributions of mitral (241 patients) and aortic valvular disease (230 patients) were similar. Coronary angiography was performed in 297 patients (68.9%). Of these, 36 (12.1%) showed significant CAD and 32 underwent concomitant CABG operations. Based on a multivariate analysis, the presence of CAD was significantly associated with old age (≥ 65 years old) [odds ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], more cardiovascular risk factors (≥ 3) (OR = 3.002, 95% CI = 1.386-6.503, p = 0.005), and the presence of aortic stenosis (OR = 2.763, 95% CI = 1.269-6.013, p = 0.010). Conclusions: The incidence of significant CAD was 12.1% in adult patients who underwent valvular operations in Korea. CAD was more common in patients with old age, aortic stenosis, and multiple cardiovascular risk factors.

좌심실 보조장치를 이용한 전격성 심근염의 치료 - 1례 보고 -

강신광,박상순,나명훈,유재현,임승평,이영,성인환,Kang, Shin-Kwang,Park, Sang-Soon,Na, Myung-Hoon,Yu, Jae-Hyeon,Lim, Seung-Pyung,Lee, Young,Seong, In-Whan 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.6

17세 여자 고등학교 학생이 전흉부 동통을 주소로 입원하였다. 약물 치료와 대동맥내 풍선 펌프에도 불구하고 폐부종과 순환 허탈이 악화되었다. 급성 전격성 심근염 추정 진단 하에 좌심실 보조장치를 설치하였다. 유입구 도관은 유방하 좌전개흉술로 좌심이를 통하여 좌심방에 삽입하였고, 좌심이의 일부를 조직검사를 위해 떼어냈다. 유출구 도관은 좌측 대퇴 동맥에 PTFE도관을 간치시켜 삽입하였다. 체외순환 158시간 후 심초음파에서 좌심실의 운동성이 거의 정상으로 회복되었고, 좌심실 보조장치를 성공적으로 이탈할 수 있었다. 면역화학 검사와 중화 항체 검사에서 콕사키바이러스가 확인되었다. 환자는 입원 23일 째 아무런 심부전 증상없이 퇴원하였다. A 17 year-old high school girl was admitted for anterior chest pain. Pulmonary edema and circulatory collapse progressed in spite of the medical treatment and intra-aortic balloon pump. Left ventricular assist device(LVAD, Bio-Pump, Medtronic Bio-Med, USA) was instituted under the impression of acute fulminant myocarditis. The inlet cannula was inserted in the left atrium(LA) via left submammary anterior thoracotomy. Biopsy was taken from left atrial appendage. The outlet cannula inserted to the left femoral artery using PTFE cuff. After 158 hours of extracorporeal circulation, LVAD was able to be weaned successfully with nearly normalized LV motion on echocardiogram, Coxsakievirus was identified with immunochemistry and serum neutralization test. She was discharged without any heart failure symptoms after 23 days of hopitalization.

관상동맥질환자를 위한 타이치 적용 심장재활 프로그램이 심혈관 위험요소, 심혈관질환 재발 위험도 및 건강 관련 삶의 질에 미치는 효과

송라윤(Song, Rha Yun),박문경(Park, Moon Kyoung),정진옥(Cheong, Jin-Ok),박재형(Park, Jae-Hyeong),성인환(Seong, In-Whan) 한국성인간호학회 2013 성인간호학회지 Vol.25 No.5

증례 : Thiamine 결핍에 의해 발생한 가역적인 중증 폐동맥 고혈압증 1예

박형서 ( Hyung Seo Park ),박재형 ( Jae Hyeong Park ),정재욱 ( Chae Uk Chung ),장원일 ( Won Il Jang ),김은미 ( Eun Mi Kim ),최시완 ( Si Wan Choi ),성인환 ( In Whan Seong ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1S

경피적 경혈관 관상동맥 확장술의 초기결과 및 재협착

성인환 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

To evaluate the success rate, complication and restenosis rate of percutaneous transluminal coronary angioplasty (PTCA), we analized the result of PTCA for 153 lesions in 109 patients admitted to TaeJeon Eul Ji hospital between March 1993 and December 1994. The results were as follows ; 1) The PTCA was successful in 147 of 153 lesions, the success rate was 96%. The success rate was significantly higher in subgroups with type A (98%) than type B lesion (87%). 2) The PTCA was failed in 6 of 153 lesions (4%). The causes of PTCA failure included guidewire passage failure in 4, balloon passage failure in 1 and acute closure in 1 lesion. 3) The PTCA complications were death in 1 (0.9%), acute myocardial infarction in 1, ventricular tarchycardia in 2, cardiac tamponade in 1 and bleeding in 2 patients. 4) The follow up coronary angiography was performed in 83 of 153 (54%) for a mean follow up duration 7.1 months. The restenosis was observed 37 of 83 lesions, the restenosis rate was 45%. The angiographically restenosis rate was significantly higher in subgroup with over 60 years old (60%), male (50%), diabetes (67%), type B leion (59%), and over 10% residual stenosis (57%). I conclude that the PTCA is an effective and safe revascularization therapy that has a high success rate and low incidence of complications in selected patients with the coronary artery disease. The limitation of PTCA is the restenosis, so I should make a study of reducing the restenosis after PTCA.

이형성 협심증의 위험인자에 관한 연구

성인환 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

To determine the risk factors in variant angina, 62 patients with variant angina compared with 50 normal control subjects and 109 patients with fixed angina(over 75% stenosis). The results are as follows: l. The mean age is significantly(P<0.05) lower in variant angina group(53.3±9.7) than fixed angina group(60.6±10.3 years). 2. The proportion of male is significantly higher in variant angina group(85) than normal control group(42%). Only in male, the risk factors were compared with 53 patients with variant angina and 21 normal control subjects and 79 patients with fixed angina. 3. The smoking amount is significantly higher in variant angina group(29.6±13.5) than normal control group(19.4±12.5 pack. years). The proportion of obesity is significantly lower in variant angina group(3.7) than normal control group(28.9%). The age, serum lipid level (cholesterol, triglyceride and HDL) and the proportion of hypertension and diabetes mellitus are no significant differences beween variant angina and normal control group. 4. The mean age and the proportion of obesity and hypertension is significantly lower in variant angina group(53.4±9.7, 3.7, 24.5) than fixed angina group(59.8 ± 10.Oyears, 25.3%, 44.3%). The HDL level is significantly higher in variant angina group(50.3±12.3) than fixed angina group (35.7±12.3mg/dl). 5. The smoking amount is significantly higher in patients with variant angina than normal control group by multivariate logistic regression analysis. Thus we concluded that smoking is the most significant risk factor in variant angina.

한국인에서 혈소판 당단백 Ⅱb/Ⅲa 유전자 다형성과 관동맥 성형술 후 재 협착과의 관계

이민수,이정우,김보영,임대승,강정아,김정희,김윤철,성보영,최성준,성인환,전은석 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.2

Platelet aggregation is the final pathway of acute coronary syndrome such as acute myocardial infarction and unstable angina. Platelet glycoprotein IIb/IIIa is a membrane receptor for fibrinogen and yon Willebrand factor and it plays an important role in platelet aggregation and in the pathogenesis of acute coronary syndrome. It is known that polymorphism of the gene that encoding platelet glycoprotein IIb/IIIa(PI^A1/A2) is strongly related to acute coronary syndrome in Caucasian, but not in Koreans. We investigated relationship between platelet glycoprotein llb/Illa gene polymorphism and restenosis of coronary artery after angioplasty in Koreans. Total 371 patients(M=251. F=120) were enrolled. Angioplasty group comprised 143 patients who underwent coronary angioplasty, and in the angioplasty group, restenosis group comprised with the 65 patients who had restenotic lesion over 50% of luminal diameter in follow-up coronary angiography. Normal group comprised 153 patients who had no significant angiographic lesion and variant angina group comprised 75 patients who were positive in ergonovine test. Genomic DNA was extracted from peripheral arterial blood. To determine the frequency of P1^A1/A2 genotype, polymerase chain reaction(PCR) was done and the product was restricted with Mspl. 3%. agarrose gel electrophoresis showed restriction fragment length polymorphism. Clinical profile and risk factor were also reviewed. Among all 371 patients of study group, genotype of only one patients in restenosis group if is proven to be PI^A1/A2 heterozygote. All patients of normal study group, no restenosis group, and the other patients in restenosis group have an PI^A1 homozygote genotype. In our study, platelet glycoprotein IIb/Illa polymorphism has no relationship with restenosis of the coronary artery after angioplasty in Koreans. But the genotypic frequency of platelet glycoprotein IIb/IIIa gene polymorphism in Koreans is concordant with that of previous studies.