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Choi, Jah Yeon,Choi, Cheol Ung,Hwang, Soon-Young,Choi, Byoung Geol,Jang, Won Young,Kim, Do Young,Kim, Woohyeun,Park, Eun Jin,Lee, Sunki,Na, Jin Oh,Kim, Jin Won,Kim, Eung Ju,Rha, Seung-Woon,Park, Chang Elsevier 2018 The American Journal of Cardiology Vol.122 No.6
<P>Although statin use in patients with acute myocardial infarction (AMI) is mandatory, it has been suggested to be associated with new-onset diabetes mellitus (NODM). In real world practice, moderate-intensity statin therapy is more commonly used than high-intensity statin therapy. In this study, we investigated the impact of moderate-intensity pitavastatin (2 to 4 mg) compared with moderate-intensity atorvastatin (10 to 20 mg) and rosuvastatin (5 to 10 mg) on the development of NODM during a follow-up period of up to 3years. Between November 2011 and May 2015, 2001 patients with AMI who did not have diabetes mellitus were investigated. The cumulative incidence of NODM was evaluated in all groups. To adjust for potential confounders, multinomial propensity scores were used. Cox proportional hazard models were used to assess the hazard ratio of NODM in the atorvastatin and rosuvastatin groups compared with pitavastatin group. The cumulative incidence of NODM was significantly lower in pitavastatin group compared with the atorvastatin and rosuvastatin groups (3.0% vs 8.4% vs 10.4%, respectively; Log-rank p value = 0.001). After weighting the baseline characteristics of the 3 statin groups by multinomial propensity scores, atorvastatin (hazard ratio: 2.615, 95% confidence interval: 1.163 to 5.879) and rosuvastatin (hazard ratio: 3.906, 95% confidence interval: 1.756 to 8.688) were found to be associated with a higher incidence of NODM compared with pitavastatin therapy on multivariable analysis. Moderate-intensity pitavastatin therapy is associated with a lower incidence of NODM in patients with AMI andhas similar clinical outcomes to moderate-intensity atorvastatin and rosuvastatin therapy.</P>
( Jah Yeon Choi ),( Eun Jin Park ),( Ji Young Song ),( Sung Hun Park ),( Hee Dong Kim ),( Dong Oh Kang ),( Jae Joong Lee ),( Kwang No Lee ),( Ji Bak Kim ),( Sun Ki Lee ),( Jin Oh Na ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Hepatitis A infection with cardiac involvement, especially that needs Extra-Corporeal Membrane Oxygenation (ECMO), had been rarely reported. Here, we report a case of severe acute myocarditis that might be due to acute viral hepatitis A infection. A 35- year old women suffered from dyspnea, nausea, vomiting. Initial Electrocardiogram (ECG) showed sinus tachycardia, but soon it became wide QRS tachycardia and RBBB pattern and hypotension was shown. Liver transaminase and cardiac enzyme was elevated and serologic studies for viral infection showed positive in IgM anti-HAV antibodies with negative in anti-HAV IgG. Echocardiography revealed a decreased ejection fraction of 18% with global hypokinesia of left ventricle. Despite of fi uid loading and inotropics application, hypotension was not corrected and Extra-Corporeal Membrane Oxygenation (ECMO) started. After conservative management for several days, ECMO was removed the patient recovered without any serious sequelae.
Nam, Purumeh,Choi, Byoung Geol,Choi, Se Yeon,Byun, Jae Kyeong,Mashaly, Ahmed,Park, Yoonjee,Jang, Won Young,Kim, Woohyeun,Choi, Jah Yeon,Park, Eun Jin,Na, Jin Oh,Choi, Cheol Ung,Lim, Hong Euy,Kim, Eung Elsevier 2018 Atherosclerosis Vol.270 No.-
<P><B>Abstract</B></P> <P><B>Background and aims</B></P> <P>Myocardial bridge (MB) and coronary artery spasm (CAS) can induce a sustained chest pain, acute coronary syndrome (ACS) and even sudden cardiac death. The aim of this study is to evaluate the relationship between MB and CAS and its impact on long-term clinical outcomes.</P> <P><B>Methods</B></P> <P>A total of 812 patients with MB without significant coronary artery disease (CAD), who underwent acetylcholine (ACH) provocation test, were enrolled. Significant CAS was defined as ≥70% temporary narrowing by ACH test, and MB was defined as the characteristic phasic systolic compression of the coronary artery with a decrease of more than 30% in diameter on the angiogram after intracoronary nitroglycerin infusion. To adjust baseline confounders, logistic regression analysis was performed. The primary endpoint was incidence of CAS, and secondary endpoints were major adverse cardiac events (MACE) and recurrent angina requiring repeat coronary angiography (CAG) at 5 years.</P> <P><B>Results</B></P> <P>MB is closely implicated in a high incidence of CAS, spontaneous spasm, ischemic ECG change and chest pain during ACH provocation test. In addition, MB of various severity and reference vessel size was substantially implicated in CAS incidence, and severe MB was a strong risk factor of CAS. MB patients with CAS were shown to have a higher rate of recurrent angina compared with MB patients without CAS, up to a 5-year follow-up. However, there were no differences regarding the incidence of MACE.</P> <P><B>Conclusions</B></P> <P>Severe MB was associated with high incidence of CAS, and MB patients with CAS were likely to have a higher incidence of recurrent angina. Intensive medical therapy and close clinical follow-up are needed for better clinical outcomes in MB patients with CAS.</P> <P><B>Highlights</B></P> <P> <UL> <LI> The aim of this study is to evaluate the relationship between myocardial bridge (MB) and coronary artery spasm (CAS). </LI> <LI> A total of 812 patients with MB without significant coronary artery disease who underwent acetylcholine test were enrolled. </LI> <LI> Severe MB was associated with high incidence of CAS, and MB patients with CAS had a higher incidence of recurrent angina. </LI> </UL> </P>
Impact of alcohol drinking on acetylcholine-induced coronary artery spasm in Korean populations
Sohn, Sung Min,Choi, Byoung Geol,Choi, Se Yeon,Byun, Jae Kyeong,Mashaly, Ahmed,Park, Yoonjee,Jang, Won Young,Kim, Woohyeun,Choi, Jah Yeon,Park, Eun Jin,Na, Jin Oh,Choi, Cheol Ung,Lim, Hong Euy,Kim, Eu Elsevier 2018 Atherosclerosis Vol.268 No.-
<P><B>Abstracts</B></P> <P><B>Background and aims</B></P> <P>Generally, immoderate alcohol consumption is associated with variant angina and accepted as one of the risk factors for coronary artery spasm (CAS), but evidence is lacking in this regard. The aim of this study is to evaluate the impact of alcohol consumption and drinking pattern on CAS by acetylcholine (ACH) provocation test and long-term clinical outcomes.</P> <P><B>Methods</B></P> <P>A total of 5491 patients with typical or atypical chest pain, without significant coronary artery disease, who underwent intracoronary ACH provocation test, were enrolled prospectively, and retrospectively analyzed in this study. They were divided into two groups according to their alcohol drinking status; the current alcohol (CA) drinking group (n = 1792), and non-CA group (n = 3699). To adjust for potential confounders, a propensity score matching (PSM) analysis was performed. The primary endpoint was incidence of CAS, and secondary endpoints were major adverse cardiac events (MACE) and recurrent angina requiring repeat coronary angiography (CAG) at 5 years.</P> <P><B>Results</B></P> <P>After PSM analysis, alcohol consumption was a strong risk factor for CAS. Furthermore, excessive alcohol consumption was correlated with a higher risk for CAS. As compared with the non-CA group, the CA group showed worse angiographic and clinical findings, including higher incidence of CAS (58% <I>vs.</I> 62%, <I>p</I> = 0.016), spontaneous spasm (17% <I>vs.</I> 22%, <I>p</I> = 0.004), multi-vessel spasm (31% <I>vs.</I> 37%, <I>p</I> = 0.009), proximal epicardial spasm (39% <I>vs.</I> 46%, <I>p</I> = 0.002), ischemic electrocardiography changes such as T-inversion (0.4% <I>vs.</I> 1.2%, <I>p</I> < 0.001) and chest pain (42% <I>vs.</I> 46%, <I>p</I> = 0.047) during ACH provocation test. However, the status and pattern of alcohol drinking had no influence on long-term clinical outcomes such as MACE or recurrent angina.</P> <P><B>Conclusions</B></P> <P>Alcohol consumption is a strong risk factor for CAS, and excessive alcohol consumption was correlated with a higher risk for CAS. Further well-designed studies are needed to confirm the results.</P> <P><B>Highlights</B></P> <P> <UL> <LI> The aim of study is to evaluate the impact of alcohol consumption on coronary spasm (CAS) and long-term clinical outcomes. </LI> <LI> Alcohol consumption is a strong risk factor for CAS. </LI> <LI> Furthermore, excessive alcohol consumption was correlated with a higher risk for CAS. </LI> </UL> </P>
Rha, Seung-Woon,Choi, Byoung Geol,Baek, Man Jong,Ryu, Yang gi,Li, Hu,Choi, Se Yeon,Byun, Jae Kyeong,Mashaly, Ahmed,Park, Yoonjee,Jang, Won Young,Kim, Woohyeun,Choi, Jah Yeon,Park, Eun Jin,Na, Jin Oh,C Yonsei University, College of Medicine 2018 Yonsei medical journal Vol.59 No.5
<P><B>Purpose</B></P><P>Many recent studies have reported that successful percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) for chronic total occlusion (CTO) has more beneficial effects than failed CTO-PCI; however, there are only limited data available from comparisons of successful CTO-PCI with medical therapy (MT) in the Korean population.</P><P><B>Materials and Methods</B></P><P>A total of 840 consecutive CTO patients who underwent diagnostic coronary angiography, receiving either PCI with DESs or MT, were enrolled. Patients were divided into two groups according to the treatment assigned. To adjust for potential confounders, propensity score matching (PSM) analysis was performed using logistic regression. Individual major clinical outcomes and major adverse cardiac events, a composite of total death, myocardial infarction (MI), stroke, and revascularization, were compared between the two groups up to 5 years.</P><P><B>Results</B></P><P>After PSM, two propensity-matched groups (265 pairs, n=530) were generated, and the baseline characteristics were balanced. Although the PCI group showed a higher incidence of target lesion and vessel revascularization on CTO, the incidence of MI tended to be lower [hazard ratio (HR): 0.339, 95% confidence interval (CI): 0.110 to 1.043, <I>p</I>=0.059] and the composite of total death or MI was lower (HR: 0.454, 95% CI: 0.224 to 0.919, <I>p</I>=0.028), compared with the MT group up to 5 years.</P><P><B>Conclusion</B></P><P>In this study, successful CTO PCI with DESs was associated with a higher risk of repeat PCI for the target vessel, but showed a reduced incidence of death or MI.</P>
Kim, Yong Hoon,Her, Ae-Young,Choi, Byoung Geol,Choi, Se Yeon,Byun, Jae Kyeong,Baek, Man Jong,Ryu, Yang Gi,Park, Yoonjee,Mashaly, Ahmed,Jang, Won Young,Kim, Woohyeun,Choi, Jah Yeon,Park, Eun Jin,Na, Ji Williams & Wilkins Co 2018 Medicine Vol.97 No.35
<P><B>Abstract</B></P><P>Left ventricular hypertrophy (LVH) is associated with increased risk for vascular events and mortality. This study investigated 8-year clinical outcomes of hypertensive patients with LVH who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) compared with hypertensive patients without LVH.</P><P>A total of 1704 consecutive hypertensive patients who underwent PCI from 2004 to 2014 were enrolled. We classified them into either the LVH group (n = 406) or the control group (without LVH, n = 1298). LVH was defined by LV mass index > 115 g/m<SUP>2</SUP> in men and > 95 g/m<SUP>2</SUP> in women. After propensity score matched (PSM) analysis, 2 PSM groups (366 pairs, n = 732, c-statistic = 0.629) were generated.</P><P>For up to 8 years, the LVH group showed a higher incidence of cardiac death (4.4% vs 1.2%, log-rank <I>P</I> = .023, hazard ratio: 3.371, 95% confidence interval: 1.109–10.25; <I>P</I> = .032) compared with the control group. However, there were no significant differences between the 2 groups in the incidence of total death, myocardial infarction, revascularization, and major adverse cardiac events up to 8 years.</P><P>LVH in hypertensive patients who underwent successful PCI with DES was associated with higher incidence of cardiac death up to 8 years of follow-up. More careful managements and clinical follow-up are needed and treatment strategies should specifically focus to target prevention and reversal of LVH in hypertensive patients.</P>
Kim, Yong Hoon,Her, Ae-Young,Choi, Byoung Geol,Choi, Se Yeon,Byun, Jae Kyeong,Park, Yoonjee,Baek, Man Jong,Ryu, Yang Gi,Mashaly, Ahmed,Jang, Won Young,Kim, Woohyeun,Park, Eun Jin,Choi, Jah Yeon,Na, Ji Elsevier Science Publishers B.V 2018 Diabetes research and clinical practice Vol.138 No.-
<P><B>Abstract</B></P> <P><B>Aims</B></P> <P>The usefulness of routine angiographic follow-up (RAF) and clinical follow-up (CF) after percutaneous coronary intervention (PCI) in patients with diabetes is not well understood. We compare 3-year clinical outcomes of RAF and CF in diabetic patients underwent PCI with drug-eluting stents (DES).</P> <P><B>Methods</B></P> <P>A total of 843 patients with diabetes who underwent PCI with DES were enrolled. RAF was performed at 6–9 months after PCI (n = 426). Rest of patients were medically managed and clinically followed (n = 417); symptom-driven events were captured. After propensity score matched analysis, 2 propensity-matched groups (262 pairs, n = 524, C-statistic = 0.750) were generated. The primary endpoint was major adverse cardiac events (MACE), the composite of total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-target vessel revascularization (Non-TVR).</P> <P><B>Results</B></P> <P>During the 3-year follow-up period, the cumulative incidence of target lesion revascularization [TLR: hazard ratio (HR), 4.07; 95% confidence interval (CI), 1.18–9.34; p = 0.001], target vessel revascularization (TVR: HR, 4.02; 95% CI, 1.93–8.40; p < 0.001), non-TVR (HR, 4.92; 95% CI, 1.68–14.4; p = 0.004) and major adverse cardiac events (MACE: HR, 2.53; 95% CI, 1.60–4.01, p < 0.001) were significantly higher in the RAF group. However, the incidence of total death, non-fatal MI were similar between the two groups.</P> <P><B>Conclusions</B></P> <P>RAF following index PCI with DES in patients with diabetes was associated with increased incidence of revascularization and MACE without changes of death or re-infarction rates and increased TLR and TVR rates in both first- and second-generation DES.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Usefulness of routine angiographic follow-up (RAF) in diabetes is less well known. </LI> <LI> RAF cause increased incidence of revascularization and major adverse cardiac events. </LI> <LI> Target lesion revascularization also higher in second-generation drug-eluting stents. </LI> </UL> </P>