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박훈준,승기배,김범준,박찬석,길욱현,백상홍,최규보 대한심장학회 2007 Korean Circulation Journal Vol.37 No.3
Deciding on the appropriate antiplatelet therapy is a challenge when treating patients with idiopathic thrombocytopenicpurpura (ITP) and who are undergoing percutaneous coronary intervention (PCI). We describe here acase of PCI in a patient with chronic, refractory ITP. A 61-year-old woman presented with exertional chest painand a low platelet count (4×109/L) at admission. Coronary angiography revealed 99% stenosis of the mid leftanterior descending artery and 95% stenosis of the mid left circumflex artery. Antiplatelet agents couldn’t beadministered because of the risk of bleeding. After transfusion of platelets and administering intravenous immunoglobulin,we deployed baremetal stents in both lesions without administering any antiplatelet agents. Althoughfocal in-stent restenosis developed 5 months later, there was no episode of stent thrombosis despite not usingantiplatelet agents. The present case suggests that the rate of stent thrombosis may be lower was previously thoughtand antiplatelet therapy may be considered on a case by case for patient suffering with thrombocytopenia.(Korean Circulation J 2007;37:87-90)
New Therapeutic Approaches to the Treatment of Dyslipidemia 2: LDL-C and Lp(a)
김경안,박훈준 한국지질동맥경화학회 2023 지질·동맥경화학회지 Vol.12 No.1
Dyslipidemia is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). There are abundant and unequivocal data to indicate that low-density lipoproteins (LDL) are a cause of ASCVD. Reduction of plasma low-density lipoprotein cholesterol (LDL-C) by medical therapy such as statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have proven to significantly reduce the risk of cardiovascular events. However, for many reasons, many patients are not able to achieve LDL-C levels recommended by guidelines on currently available therapies. This has led to the development of new drugs lowering LDL-C, such as inclisiran, bempedoic acid, and evinacumab, in the hope of reducing cardiovascular (CV) risk. Drugs targeting lipoprotein (a) (Lp[a]) also have a role in the prevention of atherosclerosis, with genetic studies having established that 20%–30% of the human population inherits plasma Lp(a) levels in the atherogenic range. In this paper, we will review the recent progress made in the approaches to LDL-C and Lp(a) therapeutic modulation.
박찬석,김희열,박훈준,임상현,김동빈,이종민,김범준,박철수,문건웅,유기동,전두수,정욱성,승기배,김재형 대한심장학회 2009 Korean Circulation Journal Vol.39 No.3
difficult despite equipment advances. Changes in electrocardiographic patterns, such as Q and T waves, during chronic total occlusion can provide information about procedural success and myocardial viability. In this study, we investigated clinical, electrocardiographic, and procedural characteristics of chronic total occlusions. Subjects and Methods: Patients (2,635) who underwent coronary angiography between January 2006 and July 2007 at six Catholic University Hospitals were identified using a dedicated Internet database. Results: A total of 195 patients had total occlusion lesions (7.4%). Percutaneous coronary interventions were attempted in 136 total occlusion lesions (66.0%) in 134 patients. Successful recanalization with stent implantation was accomplished in 89 lesions, with a procedural success rate of 66.4%. One procedure-related death occurred because of no-reflow phenomenon. After excluding 8 patients with bundle branch block, Q and T wave inversions were observed in 60 (32.1%) and 78 patients (41.7%), respectively. The presence of Q waves was associated with severe angina, decreased left ventricular ejection fraction, regional wall motion abnormality, and T wave inversion, but was not related to procedural success. Conclusion: Percutaneous coronary intervention is a safe and useful procedure for the revascularization of coronary chronic total occlusion lesions. The procedural success rate was not related to the presence of pathologic Q waves, which were associated with severe angina and decreased left ventricular function. difficult despite equipment advances. Changes in electrocardiographic patterns, such as Q and T waves, during chronic total occlusion can provide information about procedural success and myocardial viability. In this study, we investigated clinical, electrocardiographic, and procedural characteristics of chronic total occlusions. Subjects and Methods: Patients (2,635) who underwent coronary angiography between January 2006 and July 2007 at six Catholic University Hospitals were identified using a dedicated Internet database. Results: A total of 195 patients had total occlusion lesions (7.4%). Percutaneous coronary interventions were attempted in 136 total occlusion lesions (66.0%) in 134 patients. Successful recanalization with stent implantation was accomplished in 89 lesions, with a procedural success rate of 66.4%. One procedure-related death occurred because of no-reflow phenomenon. After excluding 8 patients with bundle branch block, Q and T wave inversions were observed in 60 (32.1%) and 78 patients (41.7%), respectively. The presence of Q waves was associated with severe angina, decreased left ventricular ejection fraction, regional wall motion abnormality, and T wave inversion, but was not related to procedural success. Conclusion: Percutaneous coronary intervention is a safe and useful procedure for the revascularization of coronary chronic total occlusion lesions. The procedural success rate was not related to the presence of pathologic Q waves, which were associated with severe angina and decreased left ventricular function.
장성원,승기배,박훈준,박찬석,김동빈,김승훈,김범준,정해억,백상홍,최규보 대한심장학회 2008 Korean Circulation Journal Vol.38 No.1
Background and Objectives: The presence of elevated troponin after percutaneous coronary intervention (PCI) is considered to reflect irreversible myocardial injury. However, its prognostic value remains unclear. The purpose of this study was to investigate the incidence, risk factors, and clinical outcomes of troponin I (TnI) elevation after the implantation of drug-eluting stent (DES). Subjects and Methods: We performed a retrospective analysis of 335 patients who had undergone PCI with DES. Patients who had acute coronary syndrome with elevated TnI levels before PCI were excluded. TnI levels were measured 6 and 24 hours after PCI. Results: Baseline clinical characteristics were similar in the elevated TnI and normal TnI groups. Elevated postprocedural TnI (>1.5 ng/mL) occurred in 52 patients (15.5%). Univariate analysis revealed that the clinically significant variables were multi-vessel disease (p<0.001), multiple stent implantation (p=0.003), total stent length (p=0.001), side-branch occlusion (p<0.001), and bifurcation lesion (p=0.003). Multivariate analysis indicated that the independent predictors of elevated TnI after DES implantation were multi-vessel disease (p=0.019), side-branch occlusion (p=0.001), and bifurcation (p=0.011). There were no significant differences in major adverse cardiovascular events between the elevated TnI and normal TnI groups (p=0.461). Conclusion: Multi-vessel disease, side-branch occlusion, and bifurcation were independent predictors of elevated TnI following DES implantation. The elevation of TnI after successful PCI with DES was not associated with worse 400-day clinical outcomes. (Korean Circ J 2008;38:12-16)