A Randomized Study Assessing the Effects of Pretreatment with Cilostazol on Periprocedural Myonecrosis after Percutaneous Coronary Intervention

Byeong-Keuk Kim,Joo Young Yang,오승진,윤세정,전동운,고영국 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.5

Purpose: It is unknown whether cilostazol pretreatment reduces postprocedural myonecrosis (PPMN). Cilostazol pretreatment reduces PPMN after percutaneous coronary intervention (PCI). Materials and Methods: A total of 120 patients with stable angina scheduled for elective PCI were randomly assigned to a 7-day pretreatment with Cilostazol (200 mg/day) or to a control group. Creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) levels were measured at baseline and at 6 and 24 hours after PCI. The primary end-point was the occurrence of PPMN, defined as any CK-MB elevation above the upper normal limit (UNL). Aspirin and clopidogrel were co-administered for 7 days before PCI, and resistance to these agents was then assayed using the VerifyNow System. Results: There was no difference in baseline characteristics between the final analyzable cilostazol (n=54) and the control group (n=56). Despite a significantly greater % inhibition of clopidogrel in the cilostazol group (39±23% versus 25±22%, p=0.003), the incidence of PPMN was similar between the cilostazol group (24%) and the control group (25%, p=1.000). The rate of CK-MB elevation at ≥3 times UNL was also similar between the two groups (6% versus 5%, p=0.583). The incidence of cTnI increase over the UNL or to 3 times the UNL was not different between the two groups. There was no significant difference in terms of the rate of adverse events during follow-up, although the cilostazol group showed a tendency to have a slightly higher incidence of entry site hematoma. Conclusion: This trial demonstrated that adjunctive cilostazol pretreatment might not significantly reduce PPMN after elective PCI in patients with stable angina.

Serial Plasma Levels of Angiogenic Factors in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Kim, Bo Hyun,Ko, Young-Guk,Her, Ae-Young,Kim, Jung-Sun,Hwang, Ki-Chul,Shin, Dong-Ho,Kim, Byeong-Keuk,Choi, Donghoon,Ha, Jong-Won,Hong, Myeong-Ki,Jang, Yangsoo The Korean Society of Cardiology 2012 Korean Circulation Journal Vol.42 No.7

<P><B>Background and Objectives</B></P><P>Patients with acute myocardial infarction show varying degrees of collateral development. However, the relationships between angiogenic factors and degree of collaterals are not well known.</P><P><B>Subjects and Methods</B></P><P>Fifty-nine patients (mean age, 59±10 years) with ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI). Patients were divided into one of 2 groups: group I (Rentrop collateral grade 0/1, n=34) or group II (grade 2/3, n=25). Plasma levels of vascular endothelial growth factor (VEGF), soluble VEGF receptor (sFlt-1), angiopoietin (Ang)-2, and soluble Tie-2 at baseline, 24 and 48 hours after PCI were measured.</P><P><B>Results</B></P><P>There were fewer diabetic patients and higher incidence of previous angina and multi-vessel disease in group II. Group II had a lower left ventricular ejection fraction and a trend toward longer pain-to-balloon time. Plasma levels of Ang-2, sFlt-1 were elevated prior to primary PCI and decreased after PCI, whereas plasma level of VEGF was relatively low initially, however rose after PCI. sTie-2 levels showed no significant interval change in group I, but decreased over time in group II. VEGF, sFlt-1, and Tie-2 levels did not differ between the groups at each time point. However, plasma levels of Ang-2 were higher in group I than in group II at baseline and at 48 hours.</P><P><B>Conclusion</B></P><P>Presence of collaterals in STEMI patients undergoing primary PCI was associated with lesser rise in Ang-2 plasma level. VEGF showed a delayed response to acute ischemia compared to Ang-2. Clinical implications of our findings need to be investigated in further studies.</P>

Predictors of poor clinical outcomes after successful chronic total occlusion intervention with drug-eluting stents

Kim, Gwang-Sil,Kim, Byeong-Keuk,Shin, Dong-Ho,Kim, Jung-Sun,Hong, Myeong-Ki,Gwon, Hyeon-Cheol,Kim, Hyo-Soo,Yu, Cheol Woong,Park, Hun Sik,Chae, In-Ho,Rha, Seung-Woon,Jang, Yangsoo Wolters Kluwer Health, Inc. All rights reserved. 2017 Coronary artery disease Vol.28 No.5

<P>Conclusion Clinical parameters such as age, diabetes, and heart failure were independent predictors of the composite of cardiac death, myocardial infarction, and stent thrombosis, whereas angiographic or procedural parameters such as lesion length and number of implanted stents were predictors of target-vessel revascularization. Clinical outcomes after CTO intervention were worse in patients with multiple risk factors. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.</P>

Impact of peripheral artery disease on early and late outcomes of transcatheter aortic valve implantation in patients with severe aortic valve stenosis

Kim, Byung Gyu,Ko, Young-Guk,Hong, Sung-Jin,Ahn, Chul-Min,Kim, Jung-Sun,Kim, Byeong-Keuk,Choi, Donghoon,Jang, Yangsoo,Hong, Myeong-Ki,Lee, Seung Hyun,Lee, Sak,Chang, Byung-Chul Elsevier 2018 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.255 No.-

<P><B>Abstract</B></P> <P><B>Aims</B></P> <P>Peripheral artery disease (PAD) is frequently present in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. This study assessed the impact of PAD on clinical outcome after TAVI.</P> <P><B>Methods</B></P> <P>A total of 115 patients who underwent TAVI were evaluated retrospectively. Patients were divided into PAD and non-PAD groups, with PAD defined as stenosis≥50% in lower extremity arteries. Immediate and late clinical outcomes were compared between the two groups.</P> <P><B>Results</B></P> <P>PAD was present in 31.3% (36/115) of the patients undergoing TAVI. Compared to the non-PAD group, the PAD group had higher Society of Thoracic Surgeons' (STS) risk scores (8.83%±6.20% vs 6.23%±4.15%, p=0.039) and more frequent diagnoses of diabetes (52.8% vs 30.4%, p=0.021) and multi-vessel coronary artery disease (55.6% vs 29.1%, p=0.007). The PAD group also had higher incidence of major vascular complication (11.1% vs 1.3%, p=0.033), 30-day mortality (13.9% vs 1.3%, p<0.001), and subsequent 1-year (30.6% vs 3.8%, p<0.001) and 2-year (47.2% vs. 10.1%, p<0.001) all-cause mortality. PAD was identified as an independent predictor of increased 1-year mortality (hazard ratio [HR] 8.65; 95% confidence interval [CI], 1.05–71.14, p=0.045) after TAVI along with high STS score (HR 11.18, 95% CI 1.36–92.04, p=0.025).</P> <P><B>Conclusions</B></P> <P>Presence of PAD was significantly associated with increased rates of major vascular complications as well as immediate and late mortality in patients undergoing TAVI. Assessment of PAD before TAVI is essential to choose an access strategy and to predict clinical results.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Peripheral Artery Disease is common in transcatheter aortic valve implant patients. </LI> <LI> PAD was associated with major vascular complications in TAVI patients (p=0.033). </LI> <LI> PAD was associated with immediate and late mortality in TAVI patients (p<0.001). </LI> <LI> PAD was an independent predictor of 1-year mortality after TAVI (p=0.025). </LI> <LI> Assessment of PAD before TAVI is essential to determine procedure and clinical outcome. </LI> </UL> </P>

Randomised comparison of strut coverage between Nobori biolimus-eluting and sirolimus-eluting stents: an optical coherence tomography analysis

Kim, Byeong-Keuk,Ha, Jinyong,Mintz, Gary S.,Kim, Jung-Sun,Shin, Dong-Ho,Ko, Young-Guk,Choi, Donghoon,Jang, Yangsoo,Hong, Myeong-Ki Europa Digital and Publishing 2014 EuroIntervention Vol.9 No.12

Minimization of Tool-Path in NC Milling Operation

Kim, Byeong Keuk,Park, Joon Young,Wee, Nam Sook 동국대학교 산업기술연구원 1997 산업기술논문집 Vol.10 No.-

This paper describes new methods to minimize the cutting time in zigzag milling operation of two dimensional polygonal surfaces. Previous works have been focused mainly on experimental approaches by considering some machining parameters such as, spindle speed, depth of cut, cutter traverse rate, cutter diameter, number of teeth, and so on. However, in this study, we considered a geometrical factor, which is the length of cut. In an N-sided concave or convex polygon, an algorithm has been developed which minimize the total length of cut.

Impact of the attainment of current recommended low-density lipoprotein cholesterol goal of less than 70 mg/dl on clinical outcomes in very high-risk patients treated with drug-eluting stents

Kim, Byeong-Keuk,Kim, Dong Whan,Oh, Seungjin,Yoon, Se-Jung,Park, Sungha,Jeon, Dong Woon,Yang, Joo Young Lippincott Williams Wilkins, Inc. 2010 Coronary artery disease Vol.21 No.3

OBJECTIVE: We sought to evaluate whether the attainment of low-density lipoprotein cholesterol (LDL-C) goal of less than 70 mg/dl would affect clinical outcomes in Korean patients treated with drug-eluting stents (DES). BACKGROUND: The current cholesterol guideline has strongly recommended reducing LDL-C to less than 70 mg/dl as the goal of therapy for very high-risk patients. METHODS: From 2003 to 2006, a total of 1347 very high-risk patients were treated with DES. Among them, we identified 578 eligible patients with follow-up LDL-C within 6–8 months after DES and divided these patients into two groups based on the level of follow-up LDL-C: group A, follow-up LDL less than 70 mg/dl (n=234) and group B, LDL of at least 70 mg/dl (n=344). Then we analyzed the incidence of major adverse cardiac and cerebrovascular events [MACCE: death, myocardial infarction, target-vessel revascularization (TVR), non-TVR, cerebrovascular accidents] of both the groups. RESULTS: During the follow-up (mean duration=30±10 months), group A showed a significantly lower TVR (6%) and MACCE rate (14%), compared with group B (TVR: 12%, P=0.032; MACCE: 24%, P=0.002). However, there was no difference in the rate of death, myocardial infarction, or cerebrovascular accidents between the two groups. By multivariate analysis, follow-up LDL-C level of less than 70 mg/dl was one of the significant predictors for the occurrence of MACCE (odds ratio=0.39, 95% confidence interval: 0.21–0.72, P=0.003) or TVR (odds ratio=0.39, 95% confidence interval: 0.20–0.76, P=0.005). CONCLUSION: This study showed that the attainment of LDL-C goal of less than 70 mg/dl was significantly associated with a lower MACCE or TVR rate in very high-risk Korean patients treated with DES.

Limitations of coronary computed tomographic angiography for delineating the lumen and vessel contours of coronary arteries in patients with stable angina

Kim, Choongki,Hong, Sung-Jin,Shin, Dong-Ho,Kim, Jung-Sun,Kim, Byeong-Keuk,Ko, Young-Guk,Choi, Donghoon,Jang, Yangsoo,Hong, Myeong-Ki Oxford University Press 2015 European heart journal cardiovascular Imaging Vol.16 No.12

<P><B>Aims</B></P><P>We sought to evaluate whether coronary computed tomographic angiography (CCTA) could accurately and reproducibly delineate the lumen and vessel contours of coronary arteries.</P><P><B>Methods and results</B></P><P>One hundred coronary stenotic lesions representing 91 patients with stable angina who received both CCTA and intravascular ultrasound (IVUS) were analysed. Three segments with minimal lumen cross-sectional area (CSA), proximal reference, and distal reference on IVUS images were selected for each lesion. Five observers measured lumen and vessel CSAs at three matching segments on CCTA images. These CSAs were compared with the IVUS-measured CSAs as a reference standard. All five observers underestimated lumen CSA at the three selected segments by CCTA. The minimal lumen CSA assessed by CCTA exhibited very weak correlations with those obtained by IVUS (<I>r</I> =0.23, 0.24, 0.15, 0.25, and 0.28, respectively). In contrast to the lumen CSA, the vessel CSA at the three segments was overestimated by all observers when assessed by CCTA. At the segment with minimal lumen CSA, the vessel CSA obtained by CCTA showed weak correlations with those assessed by IVUS (<I>r</I> = 0.43, 0.33, 0.44, 0.37, and 0.42, respectively). Moreover, intra-class correlation coefficients ranged from 0.44 to 0.73 among the five observers for lumen or vessel CSA measurements by CCTA at the segment with minimal lumen CSA.</P><P><B>Conclusion</B></P><P>CCTA has potential limitations in the accurate delineation of lumen and vessel contours in patients with angina, as there was a high level of discordance with the IVUS-measured lumen and vessel CSAs and high inter-observer variability.</P>

Comparison of Optical Coherence Tomographic Assessment between First- and Second-Generation Drug-Eluting Stents

Kim, Byeong-Keuk,Kim, Jung-Sun,Park, Junbeom,Ko, Young-Guk,Choi, Donghoon,Jang, Yangsoo,Hong, Myeong-Ki Yonsei University College of Medicine 2012 Yonsei medical journal Vol.53 No.3

<P><B>Purpose</B></P><P>There is a lack of sufficient data in comparison of optical coherence tomographic (OCT) findings between first- and second-generation drug-eluting stents (DES). Compared to first-generation (i.e., sirolimus- or paclitaxel-eluting stents), second-generation DESs (i.e., everolimus- or biolinx-based zotarolimus-eluting stents) might have more favorable neointimal coverage.</P><P><B>Materials and Methods</B></P><P>Follow-up OCT findings of 103 patients (119 lesions) treated with second-generation DESs were compared with those of 139 patients (149 lesions) treated with first-generation DESs. The percentage of uncovered or malapposed struts, calculated as the ratio of uncovered or malapposed struts to total struts in all OCT cross-sections, respectively, was compared between the two groups.</P><P><B>Results</B></P><P>Both DES groups showed similar suppression of neointimal hyperplasia (NIH) on OCT (mean NIH cross-sectional area; second- vs. first-generation=1.1±0.5 versus 1.2±1.0 mm<SUP>2</SUP>, respectively, <I>p</I>=0.547). However, the percentage of uncovered struts of second-generation DESs was significantly smaller than that of first-generation DESs (3.8±4.8% vs.7.5±11.1%, respectively, <I>p</I><0.001). The percentage of malapposed struts was also significantly smaller in second-generation DESs than in first-generation DESs (0.4±1.6% vs.1.4±3.7%, respectively, <I>p</I>=0.005). In addition, intra-stent thrombi were less frequently detected in second-generations DESs than in first-generation DESs (8% vs. 20%, respectively, <I>p</I>=0.004).</P><P><B>Conclusion</B></P><P>This follow-up OCT study showed that second-generation DESs characteristically had greater neointimal coverage than first-generation DESs.</P>

Increased Risk of Cardiovascular Events in Stroke Patients Who had Not Undergone Evaluation for Coronary Artery Disease

Kim, Young Dae,Song, Dongbeom,Nam, Hyo Suk,Choi, Donghoon,Kim, Jung-Sun,Kim, Byeong-Keuk,Chang, Hyuk-Jae,Choi, Hye-Yeon,Lee, Kijeong,Yoo, Joonsang,Lee, Hye Sun,Nam, Chung Mo,Heo, Ji Hoe Yonsei University, College of Medicine 2017 Yonsei medical journal Vol.58 No.1

<P><B>Purpose</B></P><P>Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoing evaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not.</P><P><B>Materials and Methods</B></P><P>This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (−) group]. Occurrences of death, cardiovascular events, and recurrent stroke were compared between the groups using Cox proportional hazards models and propensity score analyses.</P><P><B>Results</B></P><P>During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (−) group than in the MDCT (+) group. The Cox proportional hazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (−) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172–8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (−) group seemed to also have a higher risk of recurrent stroke.</P><P><B>Conclusion</B></P><P>Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.</P>