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other Korea Acute Myocardial Infarction Registry Investigators,Kang, W.Y.,Jeong, M.H.,Ahn, Y.K.,Kim, J.H.,Chae, S.C.,Kim, Y.J.,Hur, S.H.,Seong, I.W.,Hong, T.J.,Choi, D.H.,Cho, M.C.,Kim, C.J.,Seung, K. Elsevier/North-Holland Biomedical Press 2011 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.146 No.2
Background: There is a paucity of data concerning the clinical outcome of patients presenting with acute myocardial infarction (AMI) and near-normal coronary angiograms. The purpose of this study was to evaluate the clinical outcome and the prognosis of the patients with near-normal coronary angiograms who were registered in the Korean Acute Myocardial Infarction Registry (KAMIR). Methods: The subjects were divided into three groups according to findings from coronary angiograms performed between September 2005 and November 2006. Among 8510 consecutive AMI patients, 372 patients (Group I) had near-normal coronary arteries, 6136 patients (Group II) had one- or two-vessel disease, and 2002 patients (Group III) had three-vessel or left main disease. Results: Clinical characteristics, in-hospital mortality, and major cardiac adverse events (MACE) were analyzed. Group I was younger, had the lower prevalence of DM, and showed the higher percentage of previous angina history compared to the other two groups. Group III showed a higher incidence of in-hospital mortality, but there was no significant difference between Group I and Group II (2.6% in Group II and 2.2% in Group I, p=0.952). Furthermore, MACE at 1month, 6months and 12months revealed no significant difference between Groups I and II (12month MACE: 7.8% in Group I and 12.2% in Group II, p=0.359). Conclusions: Patients with near-normal coronary angiograms had similar clinical outcomes and prognosis compared with one- or two-vessel diseased patients presenting with an acute myocardial infarction.
Benefit of statin therapy in patients with coronary spasm-induced acute myocardial infarction
Other Korea Acute Myocardial Infarction Registry Investigators,Piao, Z.H.,Jeong, M.H.,Li, Y.,Jin, L.,Kim, H.K.,Park, K.H.,Sim, D.S.,Kim, K.H.,Hong, Y.J.,Park, H.,Kim, J.H.,Ahn, Y.,Cho, J.G.,Park, J.C. Japanese College of Cardiology 2016 Journal of cardiology Vol.68 No.1
<P>Background: Coronary artery spasm is associated with vascular smooth muscle hyper-reactivity. Statins suppress coronary spasm by inhibiting the vascular smooth muscle contraction. However, it is unclear whether statin therapy benefits patients with coronary spasm-induced acute myocardial infarction (AMI). Methods and results: We analyzed 501 (median age 57 years; male/female, 346/155) patients with coronary spasm-induced AMI with nonobstructive coronary arteries (stenosis severity <50%) from the Korea AMI Registry between November 2005 and October 2013. They were divided into two groups according to statin prescription at discharge (statin group n = 292; nonstatin group n = 209). The primary endpoint was the composite of 12-month major adverse cardiac events, including all causes of death, non-fatal myocardial infarction, and target vessel revascularization. The primary endpoint occurred in 17 patients during 12 months of follow-up. Statin therapy significantly reduced the risk of the composite primary endpoint [adjusted hazard ratio (HR): 0.30; 95% confidence interval (CI): 0.09-0.97; p = 0.045]. Statin therapy reduced the risk of myocardial infarction (HR: 0.19; 95% CI: 0.04-0.93; p = 0.040). However, we found no significant difference in the risk of the composite of all-cause death. Conclusion: Statin therapy in patients with coronary spasm-induced AMI with nonobstructive coronary arteries was associated with improved clinical outcome, which was predominantly accounted for by reducing the incidence of myocardial infarction. (C) 2016 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.</P>
The Korea Acute Myocardial Infarction Registry Investigators,Jeong, H.C.,Jeong, M.H.,Ahn, Y.,Chae, S.C.,Hur, S.H.,Hong, T.J.,Kim, Y.J.,Seong, I.W.,Chae, J.K.,Rhew, J.Y.,Chae, I.H.,Cho, M.C.,Bae, J.H. Elsevier/North-Holland Biomedical Press 2014 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.170 No.3
Background: The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). Methods: We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. Results: In the overall population, the MACEs rate in 1year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p=0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p=0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p=0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function. Conclusions: In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI.
the Korea Acute Myocardial Infarction Registry Investigators,Lee, H.W.,Cha, K.S.,Ahn, J.,Choi, J.C.,Oh, J.H.,Choi, J.H.,Lee, H.C.,Yun, E.,Jang, H.Y.,Choi, J.H.,Hong, T.J.,Jeong, M.H.,Ahn, Y.,Chae, S.C Elsevier/North-Holland Biomedical Press 2016 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.202 No.-
<P>Background: The transradial (TR) approach for percutaneous coronary intervention (PCI) is challenging and associated with failure in elderly patients. We compared the TR and transfemoral (TF) approaches in patients >80 years with acute myocardial infarction (MI) undergoing PCI. Methods: A total of 1945 (7.2%) octogenarians were enrolled from among 27,129 patients in the Korea Acute Myocardial Infarction Registry. The TR group (n = 336, 17.3%) was compared with the TF group (n = 1609, 82.7%) in the overall and propensity-matched cohorts with respect to procedural success, complications, in-hospital mortality, and one-year mortality and total major adverse cardiac event (MACE; death, MI, and revascularization) rate. Results: In the overall cohort, the TR group had lower incidence of Killip class III or IV compared to the TF group. The disease extent and lesion severity were similar between groups, as was the procedural success rate (97.7% vs. 98.3%); however, in-hospital complications were significantly lower in the TR group (8.1% vs. 20.3%). In-hospital mortality was significantly lower in the TR group than the TF group (3.4% vs. 11.4%), as were the one-year mortality and total MACE (9.8% vs. 18.4% and 13% vs. 21.9%, respectively). These outcomes were consistent in the propensity-matched cohort. The TR approach was found to be a significant predictor of low in-hospital mortality (OR 0.355, 95% CI 0.139-0.907), but not of one-year mortality (OR 0.644, 95% CI 0.334-1.240). Conclusions: In octogenarians with acute MI undergoing PCI, the TR approach was more effective than the TF approach as it had lower complication rate and better clinical outcomes with comparable procedural success. (C) 2015 Elsevier Ireland Ltd. All rights reserved.</P>
성석우,안계택,김미주,진선아,이상엽,정명호,정진옥,Korea Acute Myocardial Infarction Registry Investigators 전남대학교 의과학연구소 2020 전남의대학술지 Vol.56 No.1
We evaluated whether thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) reduces adverse clinical outcomes within 30-days and 1-year periods. There is no well-designed, Korean data about the clinical impact of intracoronary TA during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI). From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3749 patients with STEMI undergoing primary PCI within 12 hours (60.8±12.9 years, 18.7% women) with pre-procedural Thrombolysis in Myocardial Infarction (TIMI) flow 0, 1 in coronary angiography were enrolled between November 2011 and December 2015. The patients were divided into two groups: PCI with TA (n=1630) and PCI alone (n=2119). The primary end-point was major adverse cardiac event (MACE), defined as the composite of cardiovascular death (CVD), recurrent MI and stroke for 30-days and 1-year. TA did not diminish the risk of MACE, all-cause mortality and CVD in all patients during 30-days or 1-year. After performing the propensity score matching, TA also did not reduce the risk of MACE (Hazard ratio (HR) with 95% Confidence Interval (CI):1.187 [0.863-1.633], p value=0.291), all-cause mortality (HR with 95% CI: 1.130 [0.776-1.647], p value=0.523) and CVD (HR with 95% CI: 1.222 [0.778-1.920], p value=0.384) during the 1-year period. In subgroup analysis, there was no benefit of clinical outcomes favoring PCI with TA. In conclusion, primary PCI with TA did not reduce MACE, all-cause mortality or CVD among the Korean patients with STEMI and pre-procedural TIMI flow 0, 1 during the 30-day and 1-year follow ups.
Predictors of In-Hospital Mortality in Korean Patients with Acute Myocardial Infarction
Hae Young Yang,Min-Joo Ahn,,정명호,안영근,김영조,조명찬,김종진,Korea Acute Myocardial Infarction Registry Investigators 전남대학교 의과학연구소 2019 전남의대학술지 Vol.55 No.1
Acute myocardial infarction (AMI) is a fatal cardiovascular disease, and mortality is relatively high; therefore, integrated assessment is necessary for its management. There are several risk predictive models, but treatment trends have changed due to newly introduced medications and the universal use of percutaneous coronary intervention (PCI). The author aimed to find out predictive factors of in-hospital mortality in Korean patients with AMI. A group of 13,104 patients with AMI enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) registry were divided into two groups. One was a derivation group for evaluating mortality prediction; the other was a validation group for the application of risk prediction. In-hospital mortality was 4.2% (n=552). With hierarchical and stepwise multivariate analyses, nine factors were shown to predict in-hospital mortality for Korean patients with AMI. These were 1) being over 65 years of age, 2) high Killip class over II, 3) hyperglycemia over 180 mg/dl, 4) tachycardia over 100/min, 5) serum creatinine over 1.5 mg/dl, 6) atypical chest pain, 7) low systolic blood pressure under 90 mmHg, 8) low Thrombolysis In Myocardial Infarction (TIMI) flow (TIMI 0-II) before PCI and 9) low TIMI flow (TIMI 0-II) after PCI. The validation group showed a predictive power of 88.3%. Old age, high Killip class, hyperglycemia, tachycardia, renal dysfunction, atypical chest pain, low systolic blood pressure, and low TIMI flow are important risk factors of in-hospital mortality in Korean patients with AMI.
김경환,김철환,정명호,안영근,김영조,조명찬,김완,김종진,Other Korea Acute Myocardial Infarction Registry Investigators 대한심장학회 2016 Korean Circulation Journal Vol.46 No.3
Background and Objectives: The differential benefit of statin according to the state of dyslipidemia has been sparsely investigated. Wesought to address the efficacy of statin in secondary prevention of myocardial infarction (MI) according to the level of triglyceride andhigh density lipoprotein cholesterol (HDL-C) on admission. Subjects and Methods: Acute MI patients (24653) were enrolled and the total patients were divided according to level of triglyceride andHDL-C on admission: group A (HDL-C≥40 mg/dL and triglyceride<150 mg/dL; n=11819), group B (HDL-C≥40 mg/dL and triglyceride≥150mg/dL; n=3329), group C (HDL-C<40 mg/dL and triglyceride<150 mg/dL; n=6062), and group D (HDL-C<40 mg/dL & triglyceride≥150mg/dL; n=3443). We evaluated the differential efficacy of statin according to the presence or absence of component of dyslipidemia. Theprimary end points were major adverse cardiac events (MACE) for 2 years. Results: Statin therapy significantly reduced the risk of MACE in group A (hazard ratio =0.676; 95% confidence interval: 0.582-0.785;p<0.001). However, the efficacy of statin was not prominent in groups B, C, or D. In a propensity-matched population, the result wassimilar. In particular, the benefit of statin in group A was different compared with group D (interaction p=0.042)Conclusion: The benefit of statin in patients with MI was different according to the presence or absence of dyslipidemia. In particular,because of the insufficient benefit of statin in patients with MI and dyslipidemia, a different lipid-lowering strategy is necessary in thesepatients.
One-Year Clinical Outcomes among Patients with Metabolic Syndrome and Acute Myocardial Infarction
지미선,정명호,안영근,김영조,채성철,홍택종,성인환,채제건,Chong Jin Kim,조명찬,나승운,배장호,승기배,Seung Jung Park,Korea Acute Myocardial Infarction Registry Investigators 대한심장학회 2013 Korean Circulation Journal Vol.43 No.8
Background and Objectives: Metabolic syndrome (MetS) is an important risk factor for cardiovascular disease. However, the clinical outcome of acute myocardial infarction (AMI) with MetS has not been well examined. The purpose of this study was to evaluate the clini-cal outcomes of AMI patients with MetS. Subjects and Methods: We evaluated a total of 6352 AMI patients who had successful percutaneous coronary interventions and could be identified for MetS between 2005 and 2008 at 51 hospitals participating in the Korea Acute Myocardial Infarction Registry. They were divided into 2 groups according to the presence of MetS: the MetS group (n=2493, 39.2%) versus the Non-MetS group (n=3859, 60.8%). In addition, 4049 AMI patients with high levels of low density lipoprotein-cholesterol (LDL-C) (≥100 mg/dL) among them, were divided into the MetS group (n=1561, 38.6%) versus the Non-MetS group (n=2488, 61.4%). Results: In the overall population, there was no significant difference in 12-month the major adverse cardiac events (MACE) rate be -tween the 2 groups. However, the MetS group showed a significantly higher 12-month MACE rate in the high LDL-C population. Multi-variate analysis showed that MetS was an independent prognostic factor for 12-month MACE {hazard ratio (HR) 1.607, 95% confidence interval (CI) 1.027 to 2.513, adjusted p=0.038} and for 12-month target vessel revascularization (HR 1.564, 95% CI 1.092 to 2.240, ad-justed p=0.015) in the high LDL-C population. Conclusion: MetS patients with AMI in the overall population showed no significant difference in 12-month clinical outcomes. However,in patients with higher LDL-C ≥100 mg/dL, they showed significantly worse clinical outcome than Non-MetS patients. Therefore, it is im -portant to ascertain the presence of MetS in AMI patients, and more aggressive therapy should be strongly considered for AMI patient with MetS.
Korea Acute Myocardial Infarction Registry Investigators,Ji, M.S.,Jeong, M.H.,Ahn, Y.K.,Kim, S.H.,Kim, Y.J.,Chae, S.C.,Hong, T.J.,Seong, I.W.,Chae, J.K.,Kim, C.J.,Cho, M.C.,Rha, S.W.,Bae, J.H.,Seung, Elsevier/North-Holland Biomedical Press 2015 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.199 No.-
<P>Background: Despite common use of second-generation drug-eluting stents in treating patients with coronary artery disease, there is lack of data comparing these stents exclusively in patients with acute myocardial infarction (AMI), especially with metabolic syndrome (MetS), which is highly prevalent in AMI and potential to worsen clinical outcomes. The aim of this study was to compare clinical outcomes of everolimus-eluting stent (EES) and Resolute-zotarolimus-eluting stent (R-ZES) in AMI patients with MetS, in terms of stent-related and patient-related outcomes. Methods: A total of 3942 AMI patients in the KAMIR (Korea Acute Myocardial Infarction Registry) were grouped according to the presence of MetS and stent type: EES (N = 1582) and R-ZES (N = 255) in MetS (1837). Target lesion failure (TLF) and patient-oriented composite events (POCE) at 1 year were evaluated. Results: In MetS patients, TLF (3.7% vs. 2.7%, p = 0.592) and POCE (7.9% vs. 6.7%, p = 0.764) were similar between EES and R-ZES. Also in Non-MetS patients, TLF (3.9% vs. 3.1%, p = 0.307) and POCE (6.4% vs. 7.3%, p = 0.866) were similar between 2 groups. TLF was similar between MetS and Non-MetS patients (3.6% vs. 3.8%), while POCEs ( 7.7% vs. 6.6%) were higher in MetS. Propensity-score matching analysis showed similar results between stent groups in MetS and Non-MetS. In multivariate analysis, left ventricular ejection fraction and symptom-to-door time were independent predictors of TLF and POCE in MetS patients with AMI. Conclusions: In MetS patients with AMI, EES and R-ZES showed excellent performance and safety. However, patient-oriented composite events were relatively high, suggesting more efforts to improve them. (C) 2015 Published by Elsevier Ireland Ltd.</P>