심방세동에서의 항응고요법

고점석 ( Jum Suk Ko ),김남호 ( Nam Ho Kim ) 대한내과학회 2011 대한내과학회지 Vol.81 No.4

Atrial fibrillation (AF) is the most commonly occurring arrhythmia. An antithrombotic agent is considered mandatory as part of the management in most patients with AF. It has been conclusively demonstrated that long-term anticoagulation therapy can significantly reduce the risk of stroke in patients with non-valvular AF. While vitamin K antagonists (VKAs) such as warfarin are highly effective, they possess numerous limitations that curtail their use, or make their use challenging for clinicians and patients. A new generation of anticoagulants are being investigated in clinical trials in patients with AF. One or more of these agents have the potential to either replace or act as alternatives to VKA therapy in AF. This review summarizes the recent accumulated evidence on anticoagulation to prevent the thromboembolism in patients with non-valvular AF. (Korean J Med 2011;81:434-443)

Increased prevalence of cerebral infarction in patients with atopic dermatitis and low economic status: DATA from KNHANES IV

( Jong Hyun Yoo ),( Jum Suk Ko ),( Nam Ho Kim ),( Seong Nam Shin ),( Sang Jae Rhee ),( Kyung Ho Yun ),( Nam Jin Yoo ),( Eun Mi Lee ),( Seokkyu Oh ),( Jin Won Jeong ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

Introduction: The Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) data revealed high prevalence of end organ damage in Korean hypertensive population. We aimed to identify predictors for cerebral infarction in patients with hypertension from nationwide registry data. Methods: We analyzed 1,564 patients (male 44.8%, Age 63.6±12.1yrs) with diagnosed hypertension from KNHANES IV. We checked baseline demographic data and various clinical risk factors for cerebrovascular disease. Cross sectional analysis was performed to indentify predictors of cerebral infarction in selected patient cohort. Results: Diagnosis of cerebral infarction was confirmed in 102 patients (6.5%). In univariate analysis, old age, lower economic status, presence of hyperlipidemia, major depression, atopic dermatitis and proteinuria had statistically significant correlation with cerebral infarction. After multivariate analysis, low economic status (p=0.001, HR=3.088), atopic dermatitis(p=0.015, HR=3.294) and old age (0=0.001, HR=1.035) remained independent predictors of cerebral infarction. Conclusion: In addition to classical risk factors for cerebral infarction, presence of atopic dermatitis and low economic status were independent risk factors of cerebral infarction in Korean hypertensive population.

Can documented coronary vasospasm be the smoking gun in settling the etiology of sudden cardiac death?

( Nam-ho Kim ),( Jum Suk Ko ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.5

Increased prevalence of cerebral infarction in patients with atopic dermatitis and Low economic status : DATA from KNHANES IV

( Jong-hyun Yoo ),( Jum-suk Ko ),( Nam-ho Kim ),( Seong-nam Shin ),( Sang-jae Rhee ),( Kyung-ho Yun ),( Nam-jin Yoo ),( Eun-mi Lee ),( Seok-kyu Oh ),( Jin-won Jeong ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

Differences in intravascular ultrasound findings in culprit lesions in infarct-related arteries between ST segment elevation myocardial infarction and non-ST segment elevation myocardial infarction

Hong, Young Joon,Jeong, Myung Ho,Choi, Yun Ha,Ma, Eun Hae,Ko, Jum Suk,Lee, Min Goo,Park, Keun Ho,Sim, Doo Sun,Yoon, Nam Sik,Youn, Hyun Ju,Kim, Kye Hun,Park, Hyung Wook,Kim, Ju Han,Ahn, Youngkeun,Cho, Elsevier 2010 Journal of cardiology Vol.56 No.1

<P><B>Summary</B></P><P><B>Background</B></P><P>Previous studies have reported diffuse destabilization of atherosclerotic plaques in acute myocardial infarction (AMI). We used intravascular ultrasound (IVUS) to assess coronary culprit lesions in ST segment elevation MI (STEMI) vs. in non-ST segment elevation MI (NSTEMI).</P><P><B>Methods</B></P><P>Patient population comprised 125 STEMI and 185 NSTEMI patients. IVUS findings included ruptured plaque (a cavity that communicated with the lumen with an overlying residual fibrous cap fragment), lipid-pool like image (a pooling of hypoechoic or echolucent material covered with a hyperechoic layer), thrombus (discrete intraluminal filling defects), and plaque prolapse (tissue extrusion through the stent strut at post-stenting).</P><P><B>Results</B></P><P>Culprit lesions had larger external elastic membrane area (13.5±4.9mm<SUP>2</SUP> vs. 11.9±4.3mm<SUP>2</SUP>, <I>p</I>=0.002), larger plaque plus media area (10.8±4.4mm<SUP>2</SUP> vs. 9.1±4.1mm<SUP>2</SUP>, <I>p</I>=0.001), and greater plaque burden (78.7±10.1% vs. 74.8±12.0%, <I>p</I>=0.002), and smaller culprit lesion site calcium arc (96±90° vs. 153±114°, <I>p</I>=0.002) in patients with STEMI than in those with NSTEMI. Culprit lesion plaque ruptures, lipid-pool like images, and thrombus were observed more frequently in patients with STEMI than in those with NSTEMI (46% vs. 29%, <I>p</I>=0.002; 39% vs. 25%, <I>p</I>=0.010; and 34% vs. 21%, <I>p</I>=0.006, respectively). Culprit lesions were more predominantly hypoechoic in patients with STEMI than in those with NSTEMI (62% vs. 40%, <I>p</I><0.001). There was a trend that post-stenting plaque prolapse was observed more frequently in patients with STEMI than in those with NSTEMI (33% vs. 24%, <I>p</I>=0.081).</P><P><B>Conclusions</B></P><P>Culprit lesions in STEMI have more markers of plaque instability (more plaque rupture and thrombus, and larger plaque mass) compared with lesions in NSTEMI.</P>

Usual Dose of Simvastatin Does Not Inhibit Plaque Progression and Lumen Loss at the Peri-Stent Reference Segments after Bare-Metal Stent Implantation: A Serial Intravascular Ultrasound Analysis

( Young Joon Hong ),( Myung Ho Jeong ),( Yun Ha Choi ),( Eun Hye Ma ),( Jum Suk Ko ),( Min Goo Lee ),( Keun Ho Park ),( Doo Sun Sim ),( Nam Sik Yoon ),( Hyun Ju Youn ),( Kye Hun Kim ),( Hyung Wook Par 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.4

Background/Aims: The aim of this study was to assess the effects of a usual dose of simvastatin (20 mg/day) on plaque regression and vascular remodeling at the peri-stent reference segments after bare-metal stent implantation. Methods: We retrospectively investigated serial intravascular ultrasound (IVUS) findings in 380 peri-stent reference segments (184 proximal and 196 distal to the stent) in 196 patients (simvastatin group, n = 132 vs. nonstatin group, n = 64). Quantitative volumetric IVUS analysis was performed in 5-mm vessel segments proximal and distal to the stent. Results: IVUS follow-up was performed at a mean of 9.4 months after stenting (range, 5 to 19 months). No significant differences were observed in the changes in mean plaque plus media (P&M) area, mean lumen area, and mean external elastic membrane (EEM) area from post-stenting to follow-up at both proximal and distal edges between the simvastatin and non-statin group. Although lumen loss within the first 3 mm from each stent edge was primarily due to an increase in P&M area rather than a change in EEM area, and lumen loss beyond 3 mm from each stent edge was due to a combination of increased P&M area and decreased EEM area, no significant differences in changes were observed in P&M, EEM, and lumen area at every 1-mm subsegment between the simvastatin and non-statin group. Conclusions: A usual dose of simvastatin does not inhibit plaque progression and lumen loss and does not affect vascular remodeling in peri-stent reference segments in patients undergoing bare-metal stent implantation. (Korean J Intern Med 2010;25:356-363)

Positive remodeling is associated with more plaque vulnerability and higher frequency of plaque prolapse accompanied with post-procedural cardiac enzyme elevation compared with intermediate/negative remodeling in patients with acute myocardial infarction

Hong, Young Joon,Jeong, Myung Ho,Choi, Yun Ha,Ko, Jum Suk,Lee, Min Goo,Kang, Won Yu,Lee, Shin Eun,Kim, Soo Hyun,Park, Keun Ho,Sim, Doo Sun,Yoon, Nam Sik,Youn, Hyun Ju,Kim, Kye Hun,Park, Hyung Wook,Kim Elsevier 2009 Journal of cardiology Vol.53 No.2

<P><B>Summary</B></P><P><B>Background</B></P><P>We assessed the impact of remodeling patterns on pre- and post-procedural intravascular ultrasound (IVUS) findings and cardiac enzyme elevation after stenting in 310 acute myocardial infarction (AMI) patients.</P><P><B>Methods</B></P><P>The positive remodeling (PR) (PR group, <I>n</I>=<I>113</I>) was defined as remodeling index (lesion/reference external elastic membrane cross-sectional area) >1.05, intermediate remodeling (IR) as between 0.95 and 1.05, and negative remodeling (NR) as<0.95 (IR/NR group, <I>n</I>=<I>197</I>). IVUS findings included ruptured plaque (a cavity that communicated with the lumen with an overlying residual fibrous cap fragment), multiple ruptured plaques (different plaque ruptures separated by a >5-mm length of artery containing smooth lumen contours), thrombus (discrete intraluminal filling defects), and plaque prolapse (tissue extrusion through the stent strut at post-stenting). We compared pre- and post-procedural IVUS findings and cardiac-specific troponin I (cTnI) elevation after stenting according to the remodeling pattern.</P><P><B>Results</B></P><P>The plaque rupture (60% vs. 42%, <I>p</I>=0.004), multiple plaque ruptures (22% vs. 14%, <I>p</I>=0.014), and IVUS-detected thrombus (42% vs. 28%, <I>p</I>=0.012) were more common in the PR group compared with the IR/NR group. Post-stenting plaque prolapse was observed more frequently (36% vs. 22%, <I>p</I>=0.008), and cTnI was elevated more significantly after stenting in the PR group compared with the IR/NR group (ΔcTnI; +7.8±51.1ng/ml vs. +0.9±41.1ng/ml, <I>p</I>=0.008). Multivariate analysis showed that PR [odds ratio (OR)=1.92; 95% CI 1.04–2.98, <I>p</I>=0.028], plaque rupture (OR 1.98; 95% CI 1.16–3.45, <I>p</I>=0.025), IVUS-detected thrombus (OR 2.30; 95% CI 1.22–3.98, <I>p</I>=0.008), and plaque prolapse (OR 8.40; 95% CI 4.19–16.84, <I>p</I><0.001) were independently associated with post-stenting cTnI elevation.</P><P><B>Conclusions</B></P><P>AMI patients with PR have more plaque vulnerability and higher frequency of plaque prolapse accompanied by post-procedural cardiac enzyme elevation compared with AMI patients with IR/NR.</P>

Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis

Hong, Young Joon,Jeong, Myung Ho,Choi, Yun Ha,Ko, Jum Suk,Lee, Min Goo,Kang, Won Yu,Lee, Shin Eun,Kim, Soo Hyun,Park, Keun Ho,Sim, Doo Sun,Yoon, Nam Sik,Youn, Hyun Ju,Kim, Kye Hun,Park, Hyung Wook,Kim Oxford University Press 2011 European heart journal Vol.32 No.16

<P><B>Aims</B></P><P>We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary plaque characteristics and no-reflow in acute coronary syndrome (ACS) patients.</P><P><B>Methods and results</B></P><P>A total of 190 consecutive ACS patients were imaged using VH-IVUS and analysed retrospectively. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after stenting. Virtual histology-intravascular ultrasound classified the colour-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden ≥40%. Of the 190 patients studied at pre-stenting, no-reflow was observed in 24 patients (12.6%) at post-stenting. The absolute and %NC areas at the minimum lumen sites (1.6 ± 1.2 vs. 0.9 ± 0.8 mm<SUP>2</SUP>, <I>P</I> < 0.001, and 24.5 ± 14.3 vs. 16.1 ± 10.6%, <I>P</I> = 0.001, respectively) and the absolute and %NC volumes (30 ± 24 vs. 16 ± 17 mm<SUP>3</SUP>, <I>P</I> = 0.001, and 22 ± 11 vs. 14 ± 8%, <I>P</I> < 0.001, respectively) were significantly greater, and the presence of at least one TCFA and multiple TCFAs within culprit lesions (71 vs. 36%, <I>P</I> = 0.001, and 38 vs. 15%, <I>P</I> = 0.005, respectively) was significantly more common in the no-reflow group compared with the normal-reflow group. In the multivariable analysis, %NC volume was the only independent predictor of no-reflow (odds ratio = 1.126; 95% CI 1.045–1.214, <I>P</I> = 0.002).</P><P><B>Conclusion</B></P><P>In ACS patients, post-stenting no-reflow is associated with plaque components defined by VH-IVUS analysis with larger NC and more TCFAs.</P>

심방세동 환자에서 혈전색전성 합병증의 새로운 위험인자

조천영 ( Cheon Yeong Cho ),정대호 ( Dae Ho Jung ),고점석 ( Jum Suk Ko ),윤남식 ( Nam Sik Yoon ),이상록 ( Sang Rok Lee ),임상엽 ( Sang Yup Lim ),박형욱 ( Hyung Wook Park ),손일석 ( Il Suk Sohn ),김계훈 ( Kye Hun Kim ),홍영준 ( Youn 대한내과학회 2006 대한내과학회지 Vol.71 No.4

목적: 심방세동은 가장 흔한 지속성 부정맥이며 전신 혈전색전증의 가장 흔한 원인이다. 심방세동에서 혈전색전증은 사망률이 높고 심각한 불구를 초래하므로 예방이 무엇보다도 중요하며 이를 위해서는 위험인자의 정확한 규명이 필수적이다. 본 연구는 심혈관 질환 치료에 안지오텐신 전환효소 억제제, 안지오텐신-II 수용체 차단제, 스타틴 등이 활발히 사용된 이후에 심방세동의 혈전색전 위험인자에 새로운 변화가 있는지 조사하고 심방세동에서 혈전색전 위험의 증가 기전을 규명하기 위해 시행되었다. 방법: 혈전색전의 위험인자를 파악하기 위해 심방세동으로 치료받고 있는 환자 192명(61±11세, 남자 137)을 색전성 뇌경색증이 합병한 색전군(n=95명)과 합병하지 않은 비색전군(n=97명)으로 나누어 인구학적 특성, 동반 질환, 심전도 소견, 심초음파도 소견 및 치료 약제 등을 비교하였다. 혈전색전의 위험을 증가시키는 기전을 규명하기 위해서는 심장 율동이 정상인 25명과 심방세동 환자 71명[발작성: 21명(46±18세), 지속성: 19명(59±10세), 영속성: 31명(51±12세)]을 대상으로 내피세포기능을 반영하는 von Willebrand factor (vWF; factor 8 related antigen), 전신 염증 상태를 나타내는 백혈구 수, 적혈구 침강속도, 고예민성 C-reactive protein (hsCRP), 혈액 응고계 상태를 반영하는 fibrinogen, fibrinogen degradation product, fibrin d-dimer 등을 측정하여 비교하였다. 결과: 1. 심방세동에서 혈전색전의 위험인자 심방세동 환자 중 색전군이 비색전군에 비해 의미있게 나이가 많았고(p<0.05), 동반 질환으로 고혈압, 당뇨병, 이상지질혈증, 흡연이 색전군에서 의미있게 더 많았다(각각 p<0.05). 심전도에서는 심방세동파의 크기가 1mm 미만인 경우가 색전군에서 의미있게 많았고(p<0.05), 심초음파도에서는 좌심실기능부전(좌심실 구혈률 <40%), 판막질환, 심근증의 빈도가 색전군에서 의미있게 높았고(각각, p<0.05), 좌심방 직경도 색전군에서 의미있게 컸다(p<0.05). 색전군에서 비색전군에 비해 항응고제(p<0.01), 안지오텐신-II 수용체 차단제(p<0.05), 스타틴(p<0.05)을 복용한 경우가 의미게 적었다. 2. 심방세동에서 혈전색전 위험 증가의 기전 심방세동 환자에서 vWF-factor 8 related antigen의 농도는 좌심실부전(EF<40%), 고혈압, 고령(>65세), 당뇨병, 승모판협착증이 동반된 경우에 의미있게 증가하였다(각각, 165±53% vs. 116±49%, p<0.05; 135±22% vs. 119±24%, p<0.05; 136±55% vs. 113±51%, p<0.05; 138±59% vs. 120±52%, p<0.05; 151±34% vs. 120±33%, p<0.05). 또한 vWF-factor 8 related antigen의 농도는 나이(r=0.392, p<0.001), 좌심방 크기(r=0.375, p<0.01), 좌심실 수축기말 직경(r=0.283, p<0.05), 좌심실 확장기말 직경(r=0.234, p<0.05), 좌심실구혈률(r=0.255, p<0.05), 심방세동의 유병 기간(r=0.341, p<0.01) 등과 의미있는 상관관계가 있었다. 전신 염증 표지자는 혈전색전 위험인자 동반 유무에 따른 차이가 없었다. 혈중 fibrinogen 농도는 나이(r=0.368, p<0.001), NYHA class (r=0.314, p<0.01)와 의미있는 상관관계가 있었고 d-dimer는 NYHA class와 의미있는 상관관계가 있었다(r=0.505, p<0.001). 결론: 본 연구 결과로 기존의 혈전색전 위험인자에 더하여 흡연, 심전도에서 미세 심방세동파(<1 mm), 안지오텐신-II 수용체 차단제나 스타틴의 무복용 등이 심방세동의 새로운 혈전색전 위험인자가 될 수 있음을 알 수 있었다. 심방세동에서 혈전색전의 증가는 주로 심내막과 동맥의 내피세포 기능 저하에 의해 일어남을 알 수 있었다. Background: Atrial fibrillation (AF) is the most common cause of embolic cerebral infarction. This study was performed to determine new risk factors and the mechanism underlying thromboembolism (TE) in patients with AF. Methods: 192 patients (M:F=137:55, 61±11 years) with AF were randomly selected and divided into a TE (n=95) and non-TE group (n=97). Another 71 patients with AF (M:F=38:33, 55±14) were studied for endothelial function by measuring the level of von Willebrand factor (vWF; factor 8 related antigen), inflammation by WBC, ESR, and high sensitive CRP and coagulation system by fibrinogen, fibrinogen degradation product and fibrin d-dimer; the results were compared with 25 patients with normal sinus rhythm. Results: The TE group was older than non-TE group. Hypertension (HTN), diabetes mellitus (DM), hypercholesterolemia, smoking and fine AF (AF wave amplitude <1 mm) were more frequent in the TE group. Mitral valvular disease, an ejection fraction <40% and dilated cardiomyopathy were more frequent in the TE group and the left atrial (LA) dimension was greater in the TE group. The use of anticoagulants, an angiotensin-II receptor blocker and statins were less frequently observed in the TE group. The vWF-factor 8 related antigen was higher in patients with advanced age, LV dysfunction, HTN, DM, mitral stenosis and positively correlated with age, LA dimension, LV end-diastolic and end-systolic dimension, ejection fraction, NYHA class and AF duration. The fibrinogen level was positively correlated with age, NYHA class, LA dimension and d-dimer with NYHA class. Markers for inflammation or coagulation were not significantly different in the atrial fibrillation and the sinus rhythm group. Conclusions: No use of an angiotensin-II receptor blocker or statin and fine AF may be new risk factors for TE in patients with AF. The TE risk factors are thought to increase TE by impairing endothelial function.(Korean J Med 71:371-380, 2006)

관상동맥 중재술을 받은 급성 심근경색증 환자의 저밀도 지단백 콜레스테롤 수치와 임상경과

조경훈 ( Kyung Hoon Cho ),정명호 ( Myung Ho Jeong ),박근호 ( Keun Ho Park ),이민구 ( Min Goo Lee ),고점석 ( Jum Suk Ko ),이신은 ( Shin Eun Lee ),강원유 ( Won Yu Kang ),김수현 ( Soo Hyun Kim ),심두선 ( Doo Sun Sim ),윤남식 ( Nam Si 대한내과학회 2009 대한내과학회지 Vol.76 No.6

목적: 최근에 인구의 고령화 및 생활습관의 변화로 심근경색증, 협심증 등의 관상동맥 질환은 최근 10여 년간 한국성인에서 급증하여 주요 사망원인이 되고 있다. 관상동맥 질환의 위험인자로는 흡연, 고혈압, 당뇨병, 고지혈증 등이 잘 알려져 있으며, 이러한 위험인자를 조절하는 것이 관상동맥질환의 예방과 치료에 필수적이다. 또한, 관상동맥 질환의 치료로써 경피적 관상동맥 풍선 확장술과 스텐트 삽입술과 같은 경피적 관상동맥 중재술(percutaneous coronary intervention: PCI)이 많이 시행되고 있다. 그러므로 이러한 위험인자들과 PCI 후 임상경과에 대한 연구는 급성심근 경색증환자의 예방 및 치료에 중요하다. 본 연구에서는 LDL-C이 높을수록 관상동맥 중재술 후 임상경과에 어떠한 영향을 미치는지 파악하고자 하였다. 방법: 2006년 1월부터 2007년 12월까지 전남대학교병원에 내원하여 급성 심근경색증으로 PCI 후 1년간 추적관찰 하였던 867명(62.6±12.0세, 남자; 70%)을 LDL-C 수치에 따라 다섯 군으로 나누어서 각 군 간에 관상동맥 중재술 후 임상경과와 그에 대해 영향을 끼칠 수 있는 요인들을 분석 검토하였다. 결과: 대상 환자의 위험인자는 흡연(63%), 고혈압(46%), 당뇨병(28%) 순이었다. LDL-C 수치가 높을수록 허혈성 심장질환의 과거력이 적었고(p=0.036), 크레아티닌 청소율은 증가하는 추세(p=0.039)였으며, hsCRP는 감소추세(p=0.000)였다. 160 mg/dL 미만에서 LDL-C이 증가할수록 NT-proBNP는 감소하였으며(p=0.002), LDL-C이 70 mg/dL 미만에서 관상동맥 중재술 시술 후 TIMI flow grade III가 유의하게 적었다(p=0.001). LDL-C 수치가 160 mg/dL 이상인 그룹을 제외하면, LDL-C이 높아질수록 PCI 후 병원 내 합병증 발생이 적었다(linear p=0.010). 1개월간 추적관찰하였을 때 LDL-C각 군 간에 임상경과에 차이는 없었다. 1년 동안 추적관찰하였을 때 LDL-C이 100~129 mg/dL인 군에 비해 130~159 mg/dL인 군에서 주요 심장 사건 발생률은 낮았으나(p=0.033), 사망률에는 유의한 차이는 없었다. 1년 간 사망률에 독립적인 예측인자로는 좌심실 구혈률(p<0.000), hsCRP (p=0.011), 나이(p=0.047), 크레아티닌 청소율(p=0.039) 등이었다. 결론: 관상동맥 중재술 시술을 받은 급성 심근경색증 환자에서 낮은 저밀도 지단백 콜레스테롤 수치를 보인 환자에서 병원 내 합병증 발생률이 높았으며, 장기적 임상경과와 무관하였다. Background/Aims: This study examined the relationship between the low-density lipoprotein cholesterol (LDL-C) level and clinical outcome after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods: Between January 2006 and December 2007, 867 patients (age, 62.6±12.5 years; males, 71%) undergoing a 1-year follow-up after PCI for AMI were divided into five groups according to the LDL-C level: <70, 70-100, 100-130, 130-160, and ≥160 mg/dL. Results: Smoking (63%), hypertension (46%), and diabetes mellitus (28%) were common risk factors. The history of ischemic heart disease decreased as the LDL-C level increased (p=0.036). Patients with lower LDL-C levels had lower creatinine clearance and higher high-sensitivity C-reactive protein (hsCRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. The rate of in-hospital complications after PCI declined with increases in the LDL-C level, except in patients with LDL-C >160 mg/dL (linear p=0.010). There was no correlation between the LDL-C level and the 30-day or 1-year clinical outcome after PCI. After multivariate adjustment, independent predictors of the 1-year mortality after PCI were left ventricular ejection fraction, hsCRP, age, and creatinine clearance. Conclusions: Higher LDL-C levels were related to fewer in-hospital complications, but there was no correlation between the LDL-C level and long-term clinical outcome after PCI in Korean patients with AMI. (Korean J Med 76:692-700, 2009)