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Seizure-Like Activities during Head-Up Tilt Test- Induced Syncope
송필상,박정외,임혜란,허준,김준형,온영근,김준수 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.1
Purpose: Some patients with neurally mediated reflex syncope may be misdiagnosed as epilepsy because myoclonic jerky movements are observed during syncope. The seizure-like activities during the head-up tilt test (HUT) have been rarely reported. The purpose of this study was to assess the characteristics of these seizure-like activities and evaluate whether there are differences in the clinical characteristics and hemodynamic parameters of patients with neurally mediated reflex syncope with and without seizure-like activities during HUT-induced syncope. Materials and Methods: The medical records of 1,383 consecutive patients with a positive HUT were retrospectively reviewed, and 226 patients were included in this study. Results: Of 226 patients, 13 (5.75%) showed seizure-like activities, with 5 of these (2.21%) having multifocal myoclonic jerky movements, 5 (2.21%) having focal seizurelike activity involving one extremity, and 3 (1.33%) having upward deviation of eye ball. Comparison of patients with and without seizure-like activities revealed no significant differences in terms of clinical variables and hemodynamic parameters during HUT. Conclusion: Seizure-like activities occurred occasionally during HUTinduced syncope in patients with neurally mediated reflex syncope. The seizure-like activities during HUT might not be related to the severity of the syncopal episodes or hemodynamic changes during HUT.
송필상,박규태,김민정,전기현,박진식,최락경,송영빈,최승혁,최진호,이상훈,권현철,정진옥,임을순,김상욱,천우정,오주현,한주용 대한심장학회 2019 Korean Circulation Journal Vol.49 No.1
Background and Objectives: There are no data comparing clinical outcomes of complex percutaneous coronary intervention (PCI) between biodegradable polymer-biolimus-eluting stents (BP-BES) and durable polymer-everolimus-eluting stents (DP-EES). We sought to evaluate the safety and efficacy of BP-BES compared with DP-EES in patients undergoing complex PCI. Methods: Patients enrolled in the SMART-DESK registry were stratified into 2 categories based on the complexity of PCI. Complex PCI was defined as having at least one of the following features: unprotected left main lesion, ≥2 lesions treated, total stent length >40 mm, minimal stent diameter ≤2.5 mm, or bifurcation as target lesion. The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target vessel-related myocardial infarction (TV-MI), or target lesion revascularization (TLR) at 2 years of follow-up. Results: Of 1,999 patients, 1,145 (57.3%) underwent complex PCI: 521 patients were treated with BP-BES and 624 with DP-EES. In propensity-score matching analysis (481 pairs), the risks of TLF (3.8% vs. 5.2%, adjusted hazard ratio [HR], 0.578; 95% confidence interval [CI], 0.246–1.359; p=0.209), cardiac death (2.5% vs. 2.5%, adjusted HR, 0.787; 95% CI, 0.244–2.539; p=0.689), TV-MI (0.5% vs. 0.4%, adjusted HR, 1.128; 95% CI, 0.157–8.093; p=0.905), and TLR (1.1% vs. 2.9%, adjusted HR, 0.390; 95% CI, 0.139–1.095; p=0.074) did not differ between 2 stent groups after complex PCI. Conclusions: Clinical outcomes of BP-BES were comparable to those of DP-EES at 2 years after complex PCI. Our data suggest that use of BP-BES is acceptable, even for complex PCI.
송필상,한주용,송영빈,최진호,최승혁,강구현,안계택,임우현,박경우,김효수,권현철 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.5
Purpose: The optimum loading dose of clopidogrel has not been established in Asian patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Our aim was to evaluate the impact of different clopidogrel loading doses on short- and long-term clinical outcomes in Asian STEMI patients undergoing primary PCI. Materials and Methods: We studied 691 STEMI patients undergoing primary PCI, loaded with 600 mg (n=381) or 300 mg (n=310) of clopidogrel. The primary outcome was major adverse cardiac events (MACEs), defined as a composite of all-cause death, reinfarction,or target vessel revascularization (TVR). Results: Baseline clinical and peri-procedural characteristics were mostly comparable between the 600 mg and 300 mg groups. There were no differences in 1 month MACEs as well as all-cause death, reinfarction, TVR, and stent thrombosis between the two groups. After a median follow-up of 921 days, MACEs [adjusted hazard ratio (HR) for the 600 mg group 1.79, 95% confidence interval (CI): 0.80-3.97, p=0.153], all-cause death (adjusted HR for the 600 mg group 0.97, 95% CI: 0.50-1.88, p=0.928), reinfarction (adjusted HR for the 600 mg group 1.03, 95% CI: 0.55-1.91, p=0.937), and TVR (adjusted HR for the 600 mg group 1.36, 95% CI: 0.68-2.69, p=0.388) did not differ between the two groups. These results were reliable even after analysis of propensity score-matched population, and were also constant among various subgroups. Conclusion: A 600 mg loading dose of clopidogrel did not result in better short- and long-term clinical outcomes in Asian STEMI patients undergoing primary PCI.
송필상 ( Pil Sang Song ),고광철 ( Kwang Cheol Koh ),유병철 ( Byung Chul Yoo ),백승운 ( Seung Woon Paik ),이준혁 ( Joon Hyoek Lee ),최문석 ( Moon Suk Choi ),류동열 ( Dong Ryeol Ryu ),이진영 ( Jin Young Lee ) 대한소화기학회 2005 대한소화기학회지 Vol.45 No.6
Hepatocellular carcinoma (HCC) is one of the most common malignancies. Many factors are considered to be etiology associated with HCC; the important factors are hepatitis B and C viruses and alcohol. Cirrhosis is present in the majority of patients with H
김은경,송필상,양정훈,송영빈,한주용,최진호,이상훈,홍경표,박정의,김덕경,최승혁,권현철 대한의학회 2013 Journal of Korean medical science Vol.28 No.1
Peripheral artery disease (PAD) is an important marker for the risk stratification of patients with coronary artery disease (CAD). We investigated the prevalence of PAD in patients undergoing percutaneous coronary intervention (PCI) with CAD and the relationship between ankle-brachial pressure index (ABPI) and CAD severity. A total of 711 patients undergoing PCI for CAD from August 2009 to August 2011 were enrolled. PAD diagnosis was made using the ABPI. The prevalence of PAD was 12.8%. In PAD patients, mean values of right and left ABPI were 0.71 ± 0.15 and 0.73 ± 0.15. Patients with PAD had a higher prevalence of left main coronary disease (14.3% vs 5.8%, P = 0.003), more frequently had multivessel lesions (74.9% vs 52.1%, P < 0.001) and had higher SYNTAX score (18.2 ± 12.3 vs 13.1 ± 8.26, P = 0.002). Using multivariate analysis, we determined that left main CAD (OR, 2.954; 95% CI, 1.418-6.152, P = 0.004) and multivessel CAD (OR, 2.321; 95% CI, 1.363-3.953, P = 0.002) were both independently associated with PAD. We recommend that ABPI-based PAD screening should be implemented in all patients undergoing PCI with CAD, especially in severe cases.