종설: 심혈관 질환에서 저 고밀도지단백 (HDL) 콜레스테롤혈증 치료의 중요성

서재빈,정우영 한국지질동맥경화학회 2008 韓國脂質學會誌 Vol.18 No.2

Comparison of Angiographic Outcomes of Side Branch Ostium at Bifurcation Coronary Lesion between Two-stent and One-stent Techniques

서재빈,박경우,이해영,강현재,구본권,김상현,김효수 대한의학회 2015 Journal of Korean medical science Vol.30 No.7

Although the favored strategy for coronary bifurcation intervention is stenting main vessel with provisional side branch (SB) stenting, we occasionally use two-stent strategy. The objective of this study was to investigate the angiographic outcome of SB ostium in twostent group, compared with one-stent group. We analyzed 199 patients with bifurcation lesion who underwent percutaneous coronary intervention (PCI) with drug-eluting stent and follow up angiography. The patients were divided into one-stent group (167 lesions, 158 patients) and two-stent group (41 lesions, 41 patients). Prior to intervention, SB ostium minimal luminal diameter (MLD) was smaller in two-stent group than in one-stent group (1.08 ± 0.55 mm vs. 1.39 ± 0.60 mm; P = 0.01). But, immediately after PCI, SB MLD of two-stent group became greater than that of one-stent group (2.41 ± 0.40 mm vs. 1.18 ± 0.68 mm; P < 0.01). Six to nine months after PCI, this angiographic superiority in SB MLD of two-stent group persisted (1.56 ± 0.71 mm vs. 1.13 ± 0.53 mm; P < 0.01), although there was larger late loss in two-stent group (0.85 ± 0.74 mm vs. 0.05 ± 0.57 mm; P < 0.01). In terms of target lesion revascularization and target vessel revascularization rates, one-stent group showed better results than two-stent group. We could attain wider long term SB ostium after two-stent strategy than after one-stent strategy.

A Case of Left Atrial Metastasis From Hepatocellular Carcinoma: Life-Saving Palliative Resection Using Cardiopulmonary Bypass

서재빈,김준성,정동섭,정우영,김상현,김명아,조주희 대한심장학회 2011 Korean Circulation Journal Vol.41 No.9

Hepatocellular carcinoma (HCC) with metastasis to the heart is uncommon. We report a rare case of left atrial metastasis of HCC which was resected palliatively as a live-saving procedure with the use of cardiopulmonary bypass. Despite chemoembolization, which was undertaken 11 times, cardiac metastasis occurred. Moreover, the right and left atria and left ventricle were involved simultaneously. The severe dyspnea improved dramatically after surgery. Following this, the patient underwent systemic chemotherapy and lived a life without recurrence of symptoms associated with mitral valve obstruction.

A Patient with Prior History of Open Heart Surgery, who Survived from a Traumatic Ventricular Free Wall and Coronary Artery Rupture, without Surgical Repair

서재빈,조상호,윤창환,박승정,정우영,손대원,박영배,최윤식 대한심장학회 2004 Korean Circulation Journal Vol.34 No.1

A case of a 23 year-old man who, thanks to his parietal pericardium, scarred by previous open heart surgery,survived traumatic ventricular free wall and coronary artery rupture, without surgical repair, is reported. He wasinjured in a traffic accident and transferred to our hospital immediately. On arrival, he was hypotensive, withblood pressure of 53/25 mmHg. Because hemoperitoneum was suspected, an emergency exploratory laparotomywas performed. After surgery, his blood pressure stabilized, but electrocardiography showed abnormal findingsthat had not existed before the traffic accident. To find the probable cause of the electrocardiographic changes,echocardiography was performed, which showed a right ventricular free wall and right coronary artery ruptures.Nevertheless, he survived, without surgery, due to the thickened and adhered pericardium around the rupture site,which presumably resulted from the prior open heart surgery. Since discharged, he has remained well for ninemonths, with no further events. (Korean Circulation J 2004;34 (1):104-106)

Comparison of Two Different Strategies of Intravascular Ultrasound Guidance during Percutaneous Coronary Intervention; Routine versus Selective

서재빈,Kyung-WooPark,Hae-Young Lee,Hyun-Jae Kang,Bon-Kwon Koo,Sang-Hyun Kim,Hyo-SooKim 대한심장학회 2013 Korean Circulation Journal Vol.43 No.5

Background and Objectives: Intravascular ultrasound (IVUS) is helpful during percutaneous coronary intervention (PCI), because it can be used to confirm good apposition or optimal expansion of stents. In this study, we compared angiographic result as well as clinical out-comes between two different strategies of IVUS-guidance, the selective vs. the routine. Subjects and Methods: The study population consisted of 279 patients undergoing electric and emergency intracoronary implatation of TAXUS stent from August 2003 through September 2006. For this study, we divided physicians into two groups; doctors to perform PCI under ‘routine’ IVUS-guidance vs. PCI under ‘selective’ IVUS-guidance. Among a total of 279 patients (384 lesions) who underwent PCI with TAXUS stent, 87 patients underwent the procedure under the strategy of ‘routine’ IVUS-guidance, whereas 192 patients under ‘se-lective’ IVUS-guidance. Results: The baseline clinical features of the patients are similar between the two groups. The actual rate of IVUS usage was 89.2% in the routine group and 68.2% in the selective group (p<0.01). A high rate of adjunctive ballooning was determined as a remarkable procedure-related parameter which was comparable between the two groups (72.5% vs. 76.1% in routine vs. selective, p=0.57). The minimal lumen diameter at immediate post-PCI was significantly larger in the routine IVUS group than that in the selective group (2.58 mm vs. 2.48 mm,p=0.03). However, the difference disappeared during the follow-up period (1.98 mm vs. 1.98 mm, p=0.94). Clinical outcomes at 1 year were not different between the two groups. Conclusion: PCI under the strategy of ‘selective’ IVUS-guidance was comparable to PCI under ‘routine’ IVUS-guidance in terms of angiographic and clinical outcomes in circumstances with frequent use of adjunctive ballooning after stenting.

두가지 형태의 혈관내피전구세포(Endothelial Progenitor Cell, EPC)의 특성분석

윤창환,서재빈,허진,최진호,김지현,박승정,조상호,이준희,황경국,김상현,조주희,김명아,김효수 대한심장학회 2004 Korean Circulation Journal Vol.34 No.3

Background and Objectives:Endothelial progenitor cells (EPC) in one study group are not the same as those in other investigators, suggesting that EPC is not a single type of cell population. In this study, we tried to demonstrate the heterogeneity of EPC. 배경 및 목적: 이전의 연구를 통하여 혈관내피전구세포(EPC)가 하나의 세포군이 아니라는 것을 추정하였다. 본 연구는 이러한 서로 다른, 혈관내피전구세포를 규명하기 위하여 수행되었다. 방 법: 동일 혈액제공자로부터, 두 가지 종류의 혈관내피 전구세포를 순차적으로 얻기 위하여, 인간 말초혈액으로부터 전체 단핵구를 혈관신생조건하에서 배양하였다. 각 세포들의 발생시간에 따라 초기와 후기 혈관내피전구세포라 명하였다. 결 과: 초기 EPC는 spindle 모양으로 2~3주까지 증식 후 약 4주 이후부터 사라져 가는 반면, 후기 EPC는 cobblestone 모양으로, 2~3주에 처음 나타나서 4~8주까지 폭발적으로 증가하여 약 12주까지 증식한 후, 사라져 간다. 후기 EPC는 VE-cadherin, Flt-1, KDR을 초기 EPC보다 높은 수준으로 발현하였고, CD45는 초기 EPC와 달리 발현하지 않았다. 후기 EPC는 초기 EPC에 비해 뛰어난 Nitric oxide 생산능력과 HUVEC 단층배양으로의 편입, 시험관 내 모세혈관형성능력을 가진다. 결 론: 이전의 EPC에 관한 연구들은 두 가지 세포 중 한 가지씩만을 보고하였으나, 본 연구는 성인 말초혈액으로부터 두 가지 형태의 EPC를 동시에 배양하고, 각 세포의 특성을 분석한 첫 번째 연구이다. 저자들은 서로 다른 형태의 두 가지 혈관내피전구세포를 성인으로부터 분리하였으며, 그것들은 서로 다른 유전적, 기능적 차이로 인하여 성인의 혈관신생에 각각 다른 역할을 할 것으로 추정된다.

Gender difference in the association between brachial-ankle pulse wave velocity and cardiovascular risk scores

이태민,임학령,오소희,임우현,서재빈,정우영,김상현,김명아,조주희 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.3

Background/Aims: Although brachial-ankle pulse wave velocity (baPWV) has been validated as a novel method to predict the cardiovascular risk in general population, the relevance of baPWV to the traditional risk scores has not been clearly revealed. This study investigated the relationship between baPWV and four different cardiovascular risk-predicting scores in men and women. Methods: A total of 539 subjects (58.1 ± 12.2 years, 50.1% men) without cardiovascular disease (CVD) who underwent health examinations including baPWV measurement were retrospectively analyzed. Four cardiovascular risk scores (Framingham risk score [FRS; 1998], Adult Treatment Panel [ATP] III revised FRS [2002], generalized FRS [2008], and American College of Cardiology/American Heart Association [ACC/AHA] CVD risk [2013]) were calculated in each subject. Results: In a total population, baPWV was moderately correlated with four cardiovascular risk scores (r = 0.577 for FRS; r = 0.594 for ATP III revised FRS; r = 0.589 for generalized FRS; r = 0.571 for ACC/AHA CVD risk; p < 0.001 for each). These correlations were stronger in women than in men (r = 0.649 vs. 0.451 for FRS; r = 0.719 vs. 0.411 for ATP III revised FRS; r = 0.735 vs. 0.540 for generalized FRS; r = 0.699 vs. 0.552 for ACC/AHA CVD risk; p for gender difference ≤ 0.005 for each). Conclusions: In middle-aged and elderly Koreans without CVD, baPWV was identified as having a moderately positive correlation with four different risk scores. The correlation was stronger in women than in men, implying the better performance of baPWV in women for predicting cardiovascular risk of healthy population.

Comparing Two-Stent Strategies for Bifurcation Coronary Lesions: Which Vessel Should be Stented First, the Main Vessel or the Side Branch?

신동호,박경우,구본권,오일영,서재빈,권현철,정명호,성인환,나승운,양주영,박승정,윤정한,한규록,박종선,허승호,탁승제,김효수 대한의학회 2011 Journal of Korean medical science Vol.26 No.8

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, ‘main across side first (A-family)’ vs ‘side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013),but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, ‘A-family’ seems preferable to ‘S-family’ if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in ‘S-family’.

Clinical factors associated with obstructive coronary disease in out-of-hospital cardiac arrest

박지석,신종환,김학령,임우현,서재빈,김상현,조주희,김명아 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.1

The Prevention of Contrast Induced Nephropathy by Sarpogrelate: a Prospective Randomized Controlled Clinical Trial

기유정,권선아,김학령,서재빈,정우영 대한의학회 2019 Journal of Korean medical science Vol.34 No.40

Background: Although some strategies are used for prophylaxis of contrast induced nephropathy, their efficacy is not fully established. Sarpogrelate can relieve vasospasm and have anti-inflammatory action. This study examined whether sarpogrelate reduces the incidence of contrast induced nephropathy (CIN) or subsequent renal impairment during four weeks after coronary angiography compared with a control group. Methods: Seventy-four participants with chronic renal failure were randomly assigned to the sarpogrelate or control group. Patients assigned to the sarpogrelate group received oral saporogelate from 24 hours before contrast exposure up to one month after contrast exposure. The primary outcome of this study was the incidence of CIN within 48 hours after exposure to the contrast agent. Results: Thirty-one subjects in the control group and 35 subjects in the sarpogrelate group were used for the analysis. Cumulative CIN occurred numerically more at 48 hours in the sarpogrelate group and less at one month without statistical significance (11.4% vs. 6.5% at 48 hours and 11.4% vs. 16.1% at one month, respectively). Baseline renal function was similar in both groups, but the estimated glomerular filtration rate (eGFR) was lower in the sarpogrelate group at 12 and 48 hours compared with the control group (45.6 vs. 54.7 mL/min/1.73m2 ; P = 0.023 and 39.9 vs. 50.6 mL/min/1.73m2 ; P = 0.020, respectively). At one month, the eGFR became comparable between the two groups because the eGFR was aggravated in the control group and maintained in the sarpogrelate group. Conclusion: This study failed to demonstrate that sarpogrelate has a renoprotective effect against contrast induced acute kidney injury.