Comparative Effects of Statin Therapy versus Renin-Angiotensin System Blocking Therapy in Patients with Ischemic Heart Failure Who Underwent Percutaneous Coronary Intervention

원주민,홍영준,정명호,박현진,김민철,김우진,김현국,심두선,김주한,안영근,조정관,박종춘 전남대학교 의과학연구소 2016 전남의대학술지 Vol.52 No.2

Statins and renin-angiotensin system (RAS) blockers are key drugs for treating patientswith an acute myocardial infarction (AMI). This study was designed to show theassociation between treatment with statins or RAS blockers and clinical outcomes andthe efficacy of two drug combination therapies in patients with ischemic heart failure(IHF) who underwent revascularization for an AMI. A total of 804 AMI patients witha left ventricular ejection fraction <40% who undertook percutaneous coronary interventions(PCI) were analyzed using the Korea Acute Myocardial Infarction Registry(KAMIR). They were divided into four groups according to the use of medications [GroupI: combination of statin and RAS blocker (n=611), Group II: statin alone (n=112), GroupIII: RAS blocker alone (n=53), Group IV: neither treatment (n=28)]. The cumulativeincidence of major adverse cardiac and cerebrovascular events (MACCEs) and independentpredictors of MACCEs were investigated. Over a median follow-up studyof nearly 1 year, MACCEs had occurred in 48 patients (7.9%) in Group I, 16 patients(14.3%) in Group II, 3 patients (5.7%) in Group III, 7 patients (21.4%) in Group IV(p=0.013). Groups using RAS blocker (Group I and III) showed better clinical outcomescompared with the other groups. By multivariate analysis, use of RAS blockers wasthe most powerful independent predictor of MACCEs in patients with IHF who underwentPCI (odds ratio 0.469, 95% confidence interval 0.285-0.772; p=0.003), but statintherapy was not found to be an independent predictor. The use of RAS blockers, butnot statins, was associated with better clinical outcomes in patients with IHF who underwent PCI.

Predictors of Clinical Outcome in Patients with Angiographically Intermediate Lesions with Minimum Lumen Area Less than 4 mm2 Using Intravascular Ultrasound in Non-Proximal Epicardial Coronary Artery

원주민,홍영준,현대용,정형기,오성식,Hyung Yoon Kim,김용철,박혁진,김민철,조재영,이기홍,심두선,윤남식,윤현주,김계훈,박형욱,김주한,안영근,정명호,조정관,박종춘 전남대학교 의과학연구소 2018 전남의대학술지 Vol.54 No.3

We investigated predictors of major adverse cardiac events (MACE) with two years after medical treatment for lesions with angiographically intermediate lesions with intravascular ultrasound (IVUS) minimum lumen area (MLA) <4 mm2 in non-proximal epicardial coronary artery. We retrospectively enrolled 104 patients (57 males, 62±10 years) with angiographically intermediate lesions (diameter stenosis 30-70%) with IVUS MLA <4 mm2 in the non-proximal epicardial coronary artery with a reference lumen diameter between 2.25 and 3.0 mm. We evaluated the incidences of major adverse cardiovascular events (MACE including death, myocardial infarction, target lesion and target vessel revascularizations, and cerebrovascular accident) two years after medical therapy. During the two-year follow-up, 15 MACEs (14.4%) (including 1 death, 2 myocardial infarctions, 10 target vessel revascularizations, and 2 cerebrovascular accidents) occurred. Diabetes mellitus was more prevalent (46.7% vs. 18.0%, p=0.013) and statins were used less frequently in patients with MACE compared with those without MACE (40.0% vs. 71.9%, p=0.015). Independent predictors of MACEs with two years included diabetes mellitus (odds ratio [OR]=3.41; 95% CI=1.43-8.39, p=0.020) and non-statin therapy (OR=3.11; 95% CI=1.14-6.50, p=0.027). Long-term event rates are relatively low with only medical therapy without any intervention, so the cut-off of IVUS MLA 4 mm2 might be too large to be applied for defining significant stenosis. The predictors of long-term MACE were diabetes mellitus and statin therapy in patients with angiographically intermediate lesions in non-proximal epicardial coronary artery.

Spontaneous huge subdural spine hematoma in a patient receiving dual anti-platelet therapy after drug-eluting coronary stent implantation

Xiongyi Han,원주민,심두선,김민철,김용철,홍영준,김주한,안영근,정명호 전남대학교 의과학연구소 2018 전남의대학술지 Vol.54 No.2

Usefulness of House Dust Mite Nasal Provocation Test in Asthma

최인선,김수정,원주민,박명수 대한천식알레르기학회 2017 Allergy, Asthma & Immunology Research Vol.9 No.2

Purpose: We previously reported that the skin prick test was sensitive and the serum specific immunoglobulin E test was specific for predicting positive airway responses to house dust mites (HDMs) in patients with asthma. Because the nose and bronchus are one airway, the nasal provocation test would be more specific for predicting the bronchial responses to HDM than the skin test. Methods: The allergy skin prick test and nasal and bronchial provocation tests using HDM (Dermatophagoides farinae) were performed in 41 young men (age, 19-28 years) who wanted military certification for asthma. The nasal responses to HDM was scored according to the severity of rhinorrhea, sneezing, and nose itching. Results: The prevalence of a positive skin prick test to HDM did not significantly differ between patients with (n=24) and without (n=17) an early airway reaction (EAR; 79.2% vs 70.6%, P=0.534). However, the prevalence of a positive nasal test was significantly higher in the airway responders than in the others (37.5% vs 0%, P=0.005). The concordance of a positive response to the nasal test (κ=0.332, P=0.004) but not to the skin prick test (κ=0.091, P=0.529) was significant with an EAR. The diagnostic sensitivity of the nasal test (37.5%) was lower than that of the skin prick test (79.2%), but the specificity was higher (100% vs 29.4%). Conclusions: The skin prick test is more sensitive, whereas the nasal test is more specific and accurate, for predicting an EAR to HDM in patients with asthma.

Impact of Previous Angina on Clinical Outcomes in ST-Elevation Myocardial Infarction Underwent Percutaneous Coronary Intervention

Xiongyi Han,정명호,원주민,김용철,김민철,심두선,홍영준,김주한,안영근 전남대학교 의과학연구소 2020 전남의대학술지 Vol.56 No.2

The present study sought to assess the impact of previous angina symptoms on real world clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) who had undergone successful percutaneous coronary interventions using drug-eluting stents (DES). Patients were selected from 13,650 consecutive patients enrolled in the Korea Acute Myocardial Infarction-National Institute of Health (KAMIR-NIH) registry. A total of 5167 STEMI patients were divided into a previous-angina group (n= 1129) and a control group (n=4038). Major adverse cardiac and cerebrovascular events (MACCEs) that included all-cause death, recurrent myocardial infarction (re-MI), repeat PCI, coronary artery bypass graft (CABG), cerebrovascular accident (CVA). Among the 5167 patients with STEMI, MACCEs had occurred in 168 patients in the previous- angina group (14.9%) and 726 patients in the control group (18.0%) (HR, 0.76, 95% CI, 0.60-0.96, p=0.019) at the two-year (800-day) for clinical outcomes. Previous angina was associated with better clinical outcomes with respect to all-cause death (HR, 0.65, 95% CI, 0.44-0.96, p=0.029) and cardiac death (HR, 0.52, 95% CI, 0.31-0.84, p=0.008). Previous angina was a negative risk factor for adverse cardiac events. A previous history of angina predisposes a patient to a favorable outcome after acute myocardial infarction (AMI) in patients with DES implantation.

우리나라 노인에서 심방세동의 유병률

은정남,조정관,김성수,박형욱,이기홍,윤남식,김종윤,원주민,신민호,신준호 대한노인병학회 2016 Annals of geriatric medicine and research Vol.20 No.1

Background: Atrial fibrillation (AF) is the most common arrhythmia particularly in the elderly and a potent risk factor for ischemic stroke. Screening for AF in asymptomatic individuals might prevent strokes by earlier detection and anticoagulation therapy. We investigated the prevalence of AF in the Korean elderly and its clinical characteristics. Methods: This study included 1,483 participants (839 males, 644 females) ≥60 years (72.9±5.4 years) who had undergone electrocardiogram (ECG) screening at the senior health promotion center, Gwangju, from March 2014 to June 2014. Their assessments included 12 lead electrocardiograms, questionnaires and physical examinations. Results: AF was detected in 46 individuals (3.1%), and newly detected in 20 of these 46 (43.4%). The prevalence of AF increased sharply with age-1.0% in 60-69 years group, 3.3% in 70-79 years group, and 7.2% in ≥80 years group. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.05-1.17; p<0.001), male gender (OR 5.28, 95% CI 2.04-13.66; p=0.001), obesity (body mass index>25kg/m2) (OR, 2.17; 95% CI, 1.14-4.11; p=0.017), and heart failure (OR, 8.74; 95% CI, 1.45-52.46, p=0.018) were associated with increased risk for AF. Conclusion: The prevalence of AF in the Korean elderly was 3.1% and increased steeply with age from 1.0% to 7.2%. Screening with ECG may be considered as nearly half (43.4%) of AF cases were newly detected.