Higher Long-Term Mortality in Patients with Non-ST-Elevation Myocardial Infarction than ST-Elevation Myocardial Infarction after Discharge

Xiongyi Han,Liyan Bai,정명호,안준호,현대용,조경훈,김민철,심두선,홍영준,김주한,안영근 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.5

Purpose: This study aimed to compare mortality rates after discharge between the patients with non-ST-elevation myocardial infarction(NSTEMI) and those with ST-elevation myocardial infarction (STEMI), and identify each mortality risk factors in these twotypes of myocardial infarction. Materials and Methods: Between 2011 and 2015, 13105 consecutive patients were enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry (KAMIR-NIH); 12271 patients with acute myocardial infarction met the inclusion criteriaand were further stratified into the STEMI (n=5828) and NSTEMI (n=6443) groups. The occurrence of mortality and cardiac mortalityat 3 years were compared between groups, and the factors associated with mortality for NSTEMI and STEMI were evaluated. Results: The comparison between these two groups and long-term follow-up outcomes showed that the cumulative rates of allcauseand cardiac mortality were higher in the NSTEMI group than in the STEMI group [all-cause mortality: 10.9% vs. 5.8%; hazardsratio (HR), 0.464; 95% confidence interval (CI), 0.359–0.600, p<0.001; cardiac mortality: 6.6% vs. 3.5%, HR, 0.474; 95% CI,0.344–0.654, p<0.001, respectively). In the NSTEMI group, low left ventricular ejection fraction (LVEF; <40%), no percutaneous coronaryintervention (PCI), old age (≥65 years), and low hemoglobin level (<12 g/dL) were identified as risk factors for 3-year mortality. In the STEMI group, old age, low glomerular filtration rate (<60 mL/min/1.73 m2), low LVEF, high heart rate (>100 beats/min),no PCI, and low hemoglobin level were identified as the risk factors for 3-year mortality. Conclusion: The NSTEMI group had higher mortality compared to the STEMI group during the 3-year clinical follow-up after discharge. Low LVEF and no PCI were the main risk factors for mortality in the NSTEMI group. In contrast, old age and renal dysfunctionwere the risk factors for long-term mortality in the STEMI group.

Spontaneous huge subdural spine hematoma in a patient receiving dual anti-platelet therapy after drug-eluting coronary stent implantation

Xiongyi Han,원주민,심두선,김민철,김용철,홍영준,김주한,안영근,정명호 전남대학교 의과학연구소 2018 전남의대학술지 Vol.54 No.2

Successful Treatment of Coronary Spasm with Atherosclerosis Rapidly Progressing to Acute Myocardial Infarction in a Young Woman

Xiongyi Han,정명호,심두선,김민철,김용철,김주한,홍영준,안영근 한국지질동맥경화학회 2018 지질·동맥경화학회지 Vol.7 No.1

Variant angina pectoris (VAP) is a special type of unstable angina with coronary artery spasm as the main pathogenesis, characterized by resting chest pain, and transient ST segment dynamic changes. The development of acute myocardial infarction is not uncommon. We report a case of a 49-year-old female patient diagnosed with VAP at 2 years before who suddenly suffered severe chest pain. Troponin-I was elevated. Immediate coronary angiography showed near-total occlusion in the proximal left anterior descending artery, which was not fully dilated despite use of intracoronary nitroglycerin. Intravascular ultrasound showed focal significant stenosis with a large amount of plaque at the site of spasm and the lesion was successfully treated with drug-eluting stent placement. Intravascular imaging may be instrumental in high-risk patients with VAP who suffer recurrent chest pain despite intensive anti-spasm medications.

Long-Term Clinical Outcome according to Changes of Glomerular Filtration Rate in AMI Patients with Multivessel Disease after Percutaneous Coronary Intervention

Xiongyi Han,Liyan Bai,정명호,현대영,조경훈,김용철,김민철,심두선,홍영준,김주한,안영근 전남대학교 의과학연구소 2020 전남의대학술지 Vol.56 No.2

Glomerular filtration rate (GFR) is an important indicator of renal failure. However, regarding delta GFR in acute myocardial infarction (AMI) is rare. In this study, it was examined whether the delta GFR had an adverse effect on outcomes in patients with AMI and multivessel disease (MVD). Among 13,105 consecutive patients enrolled in the Korea Acute Myocardial Infarction–National Institute of Health registry, 2619 with AMI and MVD who underwent percutaneous cardiac intervention (PCI) were assigned to the better delta GFR (group I, n=1432 [54.7%]) or worse delta GFR (group II, n=1187 [45.3%]) groups and followed for 3 or more years. The mean age of group I was lower than that of group II (62.64±11.52 years vs. 64.29±11.64 years; p<0.001). On multivariate analysis, delta GFR (hazard ratio, 1.50; 95% confidence interval, 1.05-2.13; p=0.024) was a negative risk factor for adverse cardiac events. Age over 65 years (p< 0.001), history of MI (p=0.008), low hemoglobin (p<0.001), high triglyceride (p=0.008), low high-density lipoprotein cholesterol (p=0.002), and low left ventricular ejection fraction (LVEF) (p<0.001) were prognostic factors for major adverse cardiac events (MACE). In patients with a GFR <60 mL/min/1.73 m2, mortality was increased by 0.9% in the multivessel PCI group and 0.7% in the IRA-only PCI group at the 1-year follow-up. According to the 3-year clinical follow-up analysis, prognosis was better in better delta GFR patients with AMI and MVD who underwent PCI than in worse delta GFR patients.

Impact of Previous Angina on Clinical Outcomes in ST-Elevation Myocardial Infarction Underwent Percutaneous Coronary Intervention

Xiongyi Han,정명호,원주민,김용철,김민철,심두선,홍영준,김주한,안영근 전남대학교 의과학연구소 2020 전남의대학술지 Vol.56 No.2

The present study sought to assess the impact of previous angina symptoms on real world clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) who had undergone successful percutaneous coronary interventions using drug-eluting stents (DES). Patients were selected from 13,650 consecutive patients enrolled in the Korea Acute Myocardial Infarction-National Institute of Health (KAMIR-NIH) registry. A total of 5167 STEMI patients were divided into a previous-angina group (n= 1129) and a control group (n=4038). Major adverse cardiac and cerebrovascular events (MACCEs) that included all-cause death, recurrent myocardial infarction (re-MI), repeat PCI, coronary artery bypass graft (CABG), cerebrovascular accident (CVA). Among the 5167 patients with STEMI, MACCEs had occurred in 168 patients in the previous- angina group (14.9%) and 726 patients in the control group (18.0%) (HR, 0.76, 95% CI, 0.60-0.96, p=0.019) at the two-year (800-day) for clinical outcomes. Previous angina was associated with better clinical outcomes with respect to all-cause death (HR, 0.65, 95% CI, 0.44-0.96, p=0.029) and cardiac death (HR, 0.52, 95% CI, 0.31-0.84, p=0.008). Previous angina was a negative risk factor for adverse cardiac events. A previous history of angina predisposes a patient to a favorable outcome after acute myocardial infarction (AMI) in patients with DES implantation.

Clinical characteristics of spontaneous coronary artery dissection in young female patients with acute myocardial infarction in Korea

( Yongcheol Kim ),( Xiongyi Han ),( Youngkeun Ahn ),( Min Chul Kim ),( Doo Sun Sim ),( Young Joon Hong ),( Ju Han Kim ),( Myung Ho Jeong ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.1

Background/Aims: We aimed to evaluate the prevalence, characteristics, and clinical outcomes of spontaneous coronary artery dissection (SCAD) in young female patients with acute myocardial infarction (AMI). Methods: We identified 8,250 patients diagnosed with AMI who underwent coronary angiogram from the Chonnam National University Hospital database, Gwangju, Korea, between November 2005 and September 2017. A total of 148 female patients aged less than 60 years with a history of AMI were retrospectively studied and the characteristics and clinical outcomes were evaluated for all SCAD patients. Results: Among female patients with AMI aged less than 60 years, the prevalence of SCAD was 8.78% (13 of 148). Based on the angiographic classification, type 2 SCAD was most commonly observed on angiograms in 69.2% of the cases (nine of 13), followed by type 3 in 23.1% (three of 13), and type 1 in 7.7% (one of 13). Furthermore, the left anterior descending (LAD) artery was the most commonly affected coronary artery (76.9%, 10 of 13 cases) and the distal segments of the coronary arteries were the most common sites of SCAD (92.3%, 12 of 13). Regarding the clinical outcomes, one of 13 patients experienced repeat revascularization during the following 31 months. Conclusions: The prevalence of SCAD was 8.7%, indicating that SCAD is not rare, among female patients aged less than 60 years with AMI in Korea. Type 2 SCAD was most commonly observed on angiogram. Moreover, the distal portion of the LAD was the segment most commonly affected by SCAD. The long-term clinical outcomes were favorable in patients surviving SCAD.

Comparison of Prognosis According to the Use of Emergency Medical Services in Patients with ST-Segment Elevation Myocardial Infarction

김유리,정명호,안민정,Xiongyi Han,조경훈,심두선,홍영준,김주한,안영근,KAMIR-NIH Registry Investigators 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.2

Purpose: This study aimed to compare long-term clinical outcomes according to the use of emergency medical services (EMS) inpatients with ST-segment elevation myocardial infarction (STEMI) who arrived at the hospital within 12 hr of symptom onset. Materials and Methods: A total of 13104 patients with acute myocardial infarction were enrolled in the Korea Acute MyocardialInfarction Registry–National Institutes of Health from October 2011 to December 2015. Of them, 2416 patients with STEMI whoarrived at the hospital within 12 hr were divided into two groups: 987 patients in the EMS group and 1429 in the non-EMS group. Propensity score matching (PSM) was performed to reduce bias from confounding variables. After PSM, 796 patients in the EMSgroup and 796 patients in the non-EMS group were analyzed. The clinical outcomes during 3 years of clinical follow-up werecompared between the two groups according to the use of EMS. Results: The symptom-to-door time was significantly shorter in the EMS group than in the non-EMS group. The EMS group hadmore patients with high Killip class compared to the non-EMS group. The rates of all-cause death and major adverse cardiac events(MACE) were not significantly different between the two groups. After PSM, the rate of all-cause death and MACE were still notsignificantly different between the EMS and non-EMS groups. The predictors of mortality were high Killip class, renal dysfunction,old age, long door-to-balloon time, long symptom-to-door time, and heart failure. Conclusion: EMS utilization was more frequent in high-risk patients. The use of EMS shortened the symptom-to-door time, butdid not improve the prognosis in this cohort.

Preclinical Evaluation of a Novel Polymer-free Everolimus-eluting Stent in a Mid-term Porcine Coronary Restenosis Model

조경훈,Jeong Myung Ho,Park Dae Sung,Kim Moonki,Kim JungHa,Park Jun-Kyu,Han Xiongyi,Hyun Dae Young,Kim Min Chul,Sim Doo Sun,Hong Young Joon,Kim Ju Han,Ahn Youngkeun 대한의학회 2021 Journal of Korean medical science Vol.36 No.40

Background: Titanium dioxide films exhibit good biocompatibility and may be effective as drug-binding matrices for drug-eluting stents. We conducted a mid-term evaluation of a novel polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film deposition (TIGEREVOLUTION®) in comparison with a commercial durable polymer everolimus-eluting stent (XIENCE Alpine®) in a porcine coronary restenosis model. Methods: Twenty-eight coronary arteries from 14 mini-pigs were randomly allocated to TIGEREVOLUTION® stent and XIENCE Alpine® stent groups. The stents were implanted in the coronary artery at a 1.1–1.2:1 stent-to-artery ratio. Eleven stented coronary arteries in each group were finally analyzed using coronary angiography, optical coherence tomography, and histopathologic evaluation 6 months after stenting. Results: Quantitative coronary analysis showed no significant differences in the preprocedural, post-procedural, and 6-month lumen diameters between the groups. In the volumetric analysis of optical coherence tomography at 6 months, no significant differences were observed in stent volume, lumen volume, and percent area stenosis between the groups. There were no significant differences in injury score, inflammation score, or fibrin score between the groups, although the fibrin score was zero in the TIGEREVOLUTION® stent group (0 vs. 0.07 ± 0.11, P = 0.180). Conclusion: Preclinical evaluation, including optical coherence tomographic findings 6 months after stenting, demonstrated that the TIGEREVOLUTION® stent exhibited efficacy and safety comparable with the XIENCE Alpine® stent, supporting the need for further clinical studies on the TIGEREVOLUTION® stent.