법조인 선발제도별 비용분석과 진입유인 분석

천도정 ( Do Jeong Cheon ),황인태 ( In Tae Hwang ) 한국회계학회 2016 회계저널 Vol.25 No.4

본 연구의 목적은 기존 사법시험이 갖는 소위 ‘고시낭인’이 되어 역기능으로서 사회가 부담하고 있는 사회적비용을 감소시키고 법조인의 다양성과 전문적 지식을 법에 도입하기 위한 제도로서 법학전문대학원(law school; 로스쿨: 이하 ‘법전원’)이 갖는 장점에도불구하고 법전원의 고비용구조가 우리 국민 모두가 진입할 수 있는 법조영역에 대한 진입장벽이 되어 특정 소득계층이 진입하지 못하는 문제가 과연 존재할 수 있는지의 여부를 분석하고자 하는데 있다. 법전원이 출범했음에도 불구하고 지금까지 구체적인 분석이 이루어지지 않고 막연한 추측과 여론에 의하여 고비용구조이기 때문에 법조인이 되는데 진입장벽이 되고, 오히려 기존의 사법시험을 존치하여 문제를 해결하여야 한다는 주장이 많이 제기되고 있는 실정이다. 현재 국회에는 김용남 의원 등이 발의한 사시 존치 관련 법안 4건이 계류되어있다. 여기에 오신환 의원이 대표발의한 사시 존치 법안이 지난 6월 제출되어 법안소위 회부를 기다리고있는 상태다. 그러나 기존의 사법시험과 비교하여 얼마나 많은 비용차이가 발생하는지 구체적인 분석은 이루어진 적이 없다. 본 분석의 목적은 기존 사법시험제도와 법전원체제에 대한 가치판단의 문제에 대한 접근은 제외하고, 순수한 비용분석에 의하여 국민소득계층에서 법조계에 진입하지 못하는 소득계층이 존재하는지 여부를 비교분석하는데 있으며, 만일 존재한다면 어떠한 계층이 진입할가능성이 적은지를 분석하였다. 이러한 분석은 국민의 교육과 직업기회에 대한 형평성과 법조분야의 발전에 매우 중요한 의미를 갖는다고 할 수 있다. 따라서 본 비용분석은 법전원 출신의 변호사시험과 기존 사법시험과의 분석에서 측정 불가능한 요인은 배제하고, 측정 가능한 범위 내에서 비용의 총액과 차액분석을 통하여 비교하고, 법조인이 되기 위한 기회비용을 이용하여 비용의 차이를 비교 분석하여 소득계층의 진입가능여부의 판단기준을 제시한다는 것은 원가(비용)분석의 사례로서 큰 의미가 있다고 생각한다. The goal of this cost analysis is to explore and analyze, despite the advantages the new ``law school`` system, which reduces the social costs of the ‘entrance exam vagabond’ problem by solving this social issue the previous judicial bar entrance exam had, and allows the for the diversification of the pool of applicants and encourages professional knowledge in the law industry, if in fact there is a possibility that the cost structure of law school serving as an entrance barrier for certain socio-economic groups to apply to be a Judicial Officer is a problem that exists. Even though the law school system was established, there has not yet been a detailed analysis, and the reality is that through vague guesswork and media spin, the system is blamed as being of high cost and therefore the cause for being a high barrier of entry to certain socioeconomic classes to become a Judicial Officer, and that it also retains the problems of the previous judicial bar examination, so there are many opinions that these problems of the new law school system need to be solved. However, there has yet to have been a detailed cost comparison analysis to explore how much the cost difference is with the old judicial bar examination system. The goal of this analysis is in the case where the previous judicial bar examination has been abolished and the law school system goes into full effect, excluding the qualitative comparison of which selection process is more practical in turning out Judicial Officers, to evaluate from a strictly cost analysis point of view whether the law school system serves as a barrier of entry to any socioeconomic group. And if in fact this barrier exists, to analyze which socioeconomic group has the least chance of being able to enter. Such analysis can be seen as having significant meaning in supporting the fairness of Korea’s education system and job opportunity system and also the advancement of the Judicial Officer selection and law industry. Therefore, this study excludes any elements in the current law school entrance exam system and the previous judicial bar examination system that cannot be accurately quantified, and compares the two systems within the bounds of quantifiable ranges, such as the analysis of the total and differential costs, and also the opportunity cost of becoming a Judicial Officer. All these factors are used for comparative analysis, and to present an official set of criterion that can be used to predict the chance of a certain socioeconomic group being successfully selected as a Judicial Officer has significant meaning as a case study of cost analysis. If the law school system continues, a phenomenon in which the entry of individuals into legal circles is determined according to their economic income quantiles will set in. Therefore, various reviews on the lawyers training system should be performed. In relation to the costs of training lawyers, critics about the national judicial examination point out the seriousness of the problem of social opportunity costs due to numerous “unemployed individuals produced after failing in the examination” because the acceptance ratio remains at 3%. The costs borne by examinees who prepare for the existing national judicial examination are explicit costs that are borne by the examinees themselves. As they are willing to pay the costs, these costs can be viewed as avoidable costs. However, the costs borne by examinees for law schools are imputed costs under a system, and therefore, are more of unavoidable costs. Operating costs borne by universities to operate law schools, and scholarships and other costs borne by universities to meet the conditions required to operate law schools are indirect costs, and thus, these may be categorized as indirect opportunity costs borne by society. In addition, we should be aware that if the bar examination following the law school system continues to be operated for a long time, opportunity costs incurred by declines in the acceptance ratio should be borne. This study conducted an analysis that is limited to the analysis of costs that will actually be incurred or are projected to be incurred while excluding overall axiological judgements on the lawyers training system or discussions on the appropriateness of the system. Therefore, it should be noted that there can be a number of variations according to circumstantial changes. However, there was a limitation in the cost analysis. For example, the operating costs of law schools borne by universities and implicit social indirect costs were excluded from the analysis because it was actually impossible to obtain data on these costs or measure them.

Recombinant canstatin inhibits angiopoietin‐1‐induced angiogenesis and lymphangiogenesis

Hwang‐,Bo, Jeon,Yoo, Ki Hyun,Park, Jong‐,Hwa,Jeong, Han‐,Sin,Chung, In Sik Wiley Subscription Services, Inc., A Wiley Company 2012 International journal of cancer: Journal internati Vol.131 No.2

<P><B>Abstract</B></P><P>We describe the effect of recombinant canstatin, the NC1 domain of the α2 chain of Type IV collagen, on suppression of angiogenesis and lymphangiogenesis both <I>in vitro</I> and <I>in vivo</I>. Recombinant canstatin produced from stably transformed <I>Drosophila</I> S2 cells reduced the expression of angiopoietin‐1 in hypoxia mimetic agent, CoCl<SUB>2</SUB>‐treated CT‐26 cells. Recombinant canstatin inhibited proliferation, tube formation and migration of human angiopoietin‐1 (rhAngpt‐1)‐treated human umbilical vein endothelial cells (HUVEC) and lymphatic endothelial cells (LEC). Recombinant canstatin suppressed the expression of Tie‐2 and vascular endothelial growth factor‐3 (VEGFR‐3) transcripts in rhAngpt‐1‐treated HUVEC and LEC, respectively. The inhibitory effect of recombinant canstatin on tumor growth was also investigated using a heterotopic CT‐26 colon carcinoma animal (BALB/c mice) model. Recombinant canstatin reduced the final volume and weight of tumors, and blood and lymphatic vessel densities of tumors, which were evaluated by CD‐31 and LYVE‐1 immunostaining. Immunohistochemical analysis showed that recombinant canstatin dramatically reduced the expression of angiopoietin‐1 in CT‐26 colon carcinoma‐induced tumor, but not the expression of VEGF‐C. Tie‐2 and VEGFR‐3 expressions were also reduced in recombinant canstatin‐treated tumors. These results indicate that recombinant canstatin has anti‐tumoral activities against CT‐26 colon carcinoma cells. Recombinant canstatin reduces the expression of angiopoietin‐1 in hypoxia‐induced CT‐26 cells and inhibits the angiogenic and lymphangiogenic signaling induced by angiopoietin‐1. Recombinant canstatin probably inhibits angiogenesis and lymphangiogenesis <I>via</I> suppression of the integrin‐dependent FAK signaling induced by angiopoietin‐1/Tie‐2 and/or VEGFR‐3.</P>

안정기 양극성 장애환자의 얼굴자극에 대한 주의력 유지과제에서의 결핍 특성

황성식,전덕인,조현상,김세주,박진영,전재영,석정호 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.3

Objectives : Euthymic patients with bipolar disorder have been reported to show deficits in sustained attention. This study aimed to compare the attention capacities of euthymic bipolar patients with those of control subjects using the sustained att-ention to response task (SART) and to examine the differences in the performance of SART related to the type of the stimulus. Methods : The four SART tasks were performed to measure attention capacities in 42 euthymic patients with bipolar dis-order and 28 control subjects. Happy, neutral, fearful faces and digit '3' were used as target stimuli in happy, neutral, fear and digit task conditions, respectively. The seventy of mood symptoms was assessed with 17-item Hamilton Rating Scale for De-pressive symptoms and Young Mania Rating Scale for manic symptoms. The efficiency estimate which reflects both the res-ponse accuracy and speed was used as the main outcome variable. Results : Bipolar patients showed significantly lower correct response rate than control group in all task conditions. Effi-ciency estimates of the bipolar patient group were significantly lower than those of the control group in the SART using facial stimuli, but not in the digit task condition. There was no significant difference in task performances related to the emotional categories of facial stimuli. Conclusion : Bipolar patients showed deficits in sustained attention even in the euthymic state. The attention deficits shownin the euthymic bipolar patients may be prominent in a more complex task condition with stimuli such as facial stimuli.

백서에서 Depulpin®과 Formocresol에 대한 치수와 치근단 조직의 반응

문형인,김선호,황윤찬,오병주,황인남,김선헌,정선와,윤창,오원만 大韓齒科保存學會 2002 Restorative Dentistry & Endodontics Vol.27 No.4

One fifth dilution of formocresol is usually for pulpotomy of the primary teeth and emergency pulpotomy of the permanent teeth. However, the use of formaldehyde has been subjected to criticism because it may be absorbed into the blood stream and become distributed systemically, it may also alter the pulp tissue rendering it immumologically active, and have carcinogenic potential. Recently Depulpin®(VoCo., Germany) gains popularity as a devitalizing agent during root canal therapy in spite of high concentration of 49% paraformaldehyde because it facilitate devitalization of pulp and make root canal therapy easier. But there have been not enough publications about the reaction of pulp and periapical tissue caused by Depulpin. This study was performed to evaluate the histological changes in pulp and periapical tissue of rats after pulpotomy using formocresol and Depulpin and to elucidate the toxic effects of these agents. Thirty six Sprague-Dawley rats were anesthetized by intraperitoneal injection of ketamine. Maxillary first molar teeth were used for pulpotomy with formocresol and Depulpin. Rats were sacrificed after 2 days, 4 days, 1 week, 2 weeks, 3 weeks and 4 weeks respectively. Specimens were histologically observed by light microscope changes in pulp and periapical tissue. The obtained results were as follows. 1. Formocresol group A zone of fixed tissue, in which odontoblasts could clearly be defined, was present directly underneath the pulpotomy dressing in almost all teeth of this group. This was followed by an area of necrotic tissue which resembled dried out fibrous tissue with no cellular detail except some pyknotic nuclei. In the specimens of after 2 days, 4 days, 1 week, 2 weeks in which vital tissue was present. it was separated from the fibrous area by a zone of inflammation. In the specimens of after 3 weeks and after 4 weeks, inflammatory infiltrate was in the periodontal ligament adjacent to the apical foramina of the teeth. 2. Depulpin® group The area of necrotic tissue which had no cells and fibers , was present adjacent to the dressing. This was followed by dried out fibrous tissue with no cellular details except some pyknotic nucleli. A short stump of vital pulp with odontoblasts was present at the end of the canal after 2 days. Inflammatory infiltrate was in the periodontal ligament after 4 days and after 1week. Severe root resorption and necrosis of periapical tissue opposite the root resorption site were defined after 2 weeks and after 3 weeks. Periapical lesion which consist of necrotic tissue surrounded by a fibrous connective wall. was found after 4 weeks. The results indicated that Depulpin can cause more adverse reaction to the dental pulp and periapical tissue than formocresol, and further studies are needed for its clinical use with safety.

복합레진의 조건등색에 관한 연구 : D_(65), A, C, FCW and TL84

박기정,황윤찬,김선호,오원만,황인남 전남대학교 치의학연구소 2003 구강과학 Vol.15 No.2

There were problems in selecting exact colors of composite resins currently used in clinic by examining with naked eyes. This study was done to present a criterion in selection of the most proper light sources and materials by measuring metamerism index of the light curing composite resins with spectrocolorimeter. Metamerism is present when two objects appear to be the same color in one illuminant but different in another. This is due to the fact that they have different spectral curves that fail to match under the second illuminant. In this study, five light polymerized composite resins; Esthet-X, Filteck Z250, Filteck A110, Charisma, Vitalescence which are currently used in clinic were chosen based on Vita shade. Five samples were made for shade of each product with Teflon mold(diameter: 15mm, thickness: 2mm). Compressed resins with glass slab were light polymerized with a visible light curing unit(Optilux 500, 13mm tip diameter, Demetron, USA) for 60 seconds. Polymerized samples were removed and those were grinded to 2.0mm in thickness with sand papers(#600 & #1000). Samples were carefully prepared without fingerprints and impurities in grinding procedure and kept in distilled water for a week at room temperature. Metamerism index of each samples on a Barium sulfate plate(L^(*)=96.54, a^(*)=0.19, b^(*)=0.01) prepared for sample fixation were measured with spectrocolorimeter(Miniscan XE plus. Model 4000s. Hunter Lab, USA) by applying standard light source D65, C, Fcw, TL84' and A. Standardization was done with Reference standard(X=80.8, Y=85.7, Z=90.8) and Light trap. Samples were kept in distilled water at room temperature in all procedures. The results are as follows. 1. Different resins using same Vita shade showed recognizable color difference(ΔE^(*)>2). 2. All composites had Ml below accepted value 0.5 between standard illuminant(D65, C, & A) and below 1.5 under fluorescent condition (Fcw & TL84). 3. Ml value between D65 and A showed higher value than Ml value between other source of light(p<0.01). 4. All resins except Z25O showed Ml value that A3 is higher than Al between D65 and A(p<0.05).

셀레콕시브 및 그 합성유도체들의 항암활성 스크리닝

박정란,강진형,구효정,노지영,류형철,박상욱,고동현,조일환,이주영,황다니엘,김인경 한국약제학회 2003 Journal of Pharmaceutical Investigation Vol.33 No.2

Selective COX (cyclooxygenase)-2 inhibitors including celecoxib have been shown to induce apoptosis and cell cycle changes in various tumor cells. New inhibitors are recently being developed as chemomodulating agents. We evaluated celecoxib and screened 150 synthetic compounds for anti-proliferative activities in vitro. Effects of celecoxib on COX activity, cell growth, cell cycle distribution, and apoptosis induction were determined in A549 COX-2 overexpressing human non-small cell lung cancer (NSCLC) cells. The COX inhibition of celecoxib increased with concentration up to 82% at 1μM after 24 hr exposure. Forty μM and 50μM of celecoxib induce G_1 arrest, and TUNEL-positive apoptotic cells, respectively. Among 150 compounds, several compounds were selected for having greater COX-2 inhibitory activity and higher selectivity than celecoxib with growth inhibitory activity. Celecoxib showed concentration-dependent COX inhibitory activity, and ability to induce cell cycle arrest and apoptosis in human NSCLC cells in vitro. Among synthetic analogues screened, several compounds showed promising in vitro activity as COX-2 inhibitory anticancer agents, which warrant further evaluation in vitro and in vivo.

수리된 복합레진 수복물의 전달결합강도 연구

최수영,정선와,황윤찬,김선호,윤창,오원만,황인남 大韓齒科保存學會 2002 Restorative Dentistry & Endodontics Vol.27 No.6

This study was performed to evaluate the interfacial shear bond strength of base (direct and indirect) and repair composites with aging and surface treatment methods. Direct composites resin specimens (Charisma®, Heraeus Kulzer, Germany) were aged for 5 min, 1 hour, 24 hours, and 1 week in 37℃ distilled water before surface treatment, and then divided into five groups: Group 1, grinding; Group 2, grinding and application of bonding agent; Group 3, grinding, etching with 37% phosphoric acid for 30sec, and application of bonding agent; Group 4, grinding, etching with 37% phosphoric acid for 30sec, silane treatment, and application of bonding agent; Group 5, grinding, etching with 4% hydrofluoric acid for 30sec, silane treatment, and application of bonding agent. Indirect composite resin specimens (Artglass®, Heraeus Kulzer, Germany) were aged for 1 week in 37℃ distilled water and divided into seven groups: Group 1 - Group 5, equal to Charisma specimens; Group 6, grinding, etching 37% phosphoric acid for 60sec, silane treatment, and application of bonding agent; Group 7, grinding, etching with 4% hydrofluoric acid for 60 sec, silane treatment, and application of bonding agent. The repair material(Charisma®) was then added on the center of the surface (5mm in diameter, 5mm in height). The shear bond strength was tested and the data was analyzed using one-way ANOVA and the Student-Newman-Keuls test. The following conclusions were drawn. 1. The shear bond strength of Charisma® specimens aged for 1 hour was significantly higher in Group 2 and Group 5 than in Group 1 (p<0.05), and that of Charisma® specimens aged for 1 week was significantly higher in Group 3 and Group 5 than in Group 1 (p<0.05). No significant difference was found in the bond strength of specimens aged for 5 min and 24 hours. 2. In Group 2 of the Charisma® specimens, there was significant difference between the bond strength of 24 hours and that of 1 week (p<0.05). 3. In Group 4 of the Charisma® specimens, the shear bond strength of specimens aged for 24 hours was significantly higher than the others(p<0.05). 4. There was no significant diiference between the shear bond strength of the Artglass® specimens. 5. Most of the Charisma® specimens showed cohesive fractures. Artglass® specimens that were etched with acid(phosphoric or hydrofluoric) for 30 sec showed more cohesive fractures.

항생제 혼합 시멘트 정을 이용한 장관골 감염성 불유합의 이단계 치료

조세현,정순택,박형빈,황선철,하용찬,황인환 대한골절학회 2004 대한골절학회지 Vol.17 No.4

목적: 장관골 감염성 불유합의 치료 시 항생제 혼합 시멘트 정을 이용한 이단계 재건술의 결과를 분석하고자 한다. 대상 및 방법: 1998년 1월부터 2002년 9월까지 장관골 감염성 불유합으로 이단계 재건 수술을 받은 41예 (대퇴골 26예, 경골 15예)를 대상으로 하였다. 일단계 수술에서는 광범위한 변연 절제술, 부골 제거 및 세척술과 기존 고정 장치의 제거 또는 외고정 장치로의 교환을 시행한 후 시공 (dead space)과 불유합 주변 연부조직 내 항생제 혼합 시멘트 정을 삽입하였다. 임상적 감염 증상이 호전된 평균 8.7주 (3주~32주) 후 이단계 재건술로서 Ⅰ군은 내고정 장치 (금속판 5예, 골수강내 금속정 8예), Ⅱ군은 외고정 장치 (Ilizarov 25예, Monofixator 3예)로 각각 고정하고 17예에서는 골내 이동술이나 골 연장술을 시행하였다. 양군 모두 필요한 경우 골 이식과 시멘트 정의 교환을 추가하였다. 추시 기간은 16개월에서 최장 71개월로 평균 45개월 이었다. 치료 결과는 골유합 기간 및 Paley 방법에 의한 방사선상 골유합 상태와 하지 기능으로 평가하였다. 결과: Ⅰ군 13예 전부와 Ⅱ군 28예 중 26예에서 감염의 치료와 골유합을 얻었다. 이단계 재건술 후 골 이식술, 골 소파술, 외고정 핀 교환과 각변형 교정술, 피부 이식 또는 근육 피판 회전술 등의 보조적 시술이 Ⅰ군은 평균 2회, Ⅱ군은 평균 6.2회 추가되었다. 평균 골유합 기간은 Ⅰ군이 19.3주이고 Ⅱ군이 23.1주로 내고정군이 더 빨랐다. 방사선상 Paley 골유합 상태는 Ⅰ군이 우수 8예, 양호 5예이었고, Ⅱ군이 우수 18예, 양호 7예, 보통 1예, 불량 2예 이었다 (p=0.492). 기능적 결과는 Ⅰ군에서 우수 6예, 양호 6예, 보통 1예 이었고, Ⅱ군에서는 우수 10예, 양호 13예, 보통 3예, 불량 2예 이었다 (p=0.267). 결론: 항생제 혼합 시멘트 정의 골수염 치료 효과가 관찰되었으며, 감염이 호전된 후 내고정 장치로 교환해 준 군이 외고정을 유지한 군에 비하여 추가 수술 횟수가 적고, 골유합 기간도 빨랐다. Purpose: To evaluate treatment results between internal na external fixation groups in two-stage reconstruction of infected nonunion of long bones using antibiotics-impregnated cement beads. Materials and Methods: In the first stage, preexisting hardwares were removed and radical debridement was done. The dead space was filled with antibiotics -impregnated cement beads and the nonunion sits was immobilized by external fixation, cast or skeletal traction. In the second stage, all cases were divided into two groups; the nonunion was fixed by internal fixation in group Ⅰ versus external fixation in group Ⅱ. The intervening period between the first and second stage was average 8.7 weeks (range, 3~23 weeks). Results: The follow-up period was average 45 months (range, 16~71 months). Infection control and bone union were achieved in all 13 cases of group Ⅰ. Infection recurred in two of 28 cases in group Ⅱ, one underwent above-knee amputation and the other case was lost in follow-up. The mean number of supportive operations including repeated curettage, augmentation and change of infected pins, angular correction, and soft tissue flap was average 2 and 6.2 times respectively in group Ⅰ and group Ⅱ. Bony union period was average 19.3 and 23.1 weeks in each group. According to Paley's classification, group Ⅰ was similar to group Ⅱ in bony and functional result (p>0.05). Conclusion: Antibiotics-impregnated cement beads provided positive effect on infection control. Internal fixation group showed less number of additional operations and earlier bony union than external fixation group.

Optimal Timing of Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Myocardial Infarction Complicated by Acute Decompensated Heart Failure (from the Korea Acute Myocardial Infarction Registry-National Institutes of Healt

Kim, Min Chul,Jeong, Myung Ho,Sim, Doo Sun,Hong, Young Joon,Kim, Ju Han,Ahn, Youngkeun,Ahn, Tae Hoon,Seung, Ki Bae,Choi, Dong-Joo,Kim, Hyo-Soo,Gwon, Hyeon Cheol,Seong, In Whan,Hwang, Kyung Kuk,Chae, S Elsevier 2018 The American journal of cardiology Vol.121 No.11

<P>The optimal timing of percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation myocardial infarction (NSTEMI), complicated by acute decompensated heart failure (ADHF), is unclear. A total of 1,027 patients with NSTEMI complicated by ADHF who underwent successful PCI were analyzed using a Korean multicenter registry. All patients were divided into 4 groups by the timing of PCI: group 1 (PCI < 2 hour after admission, n = 149), group 2 (2 to 24 hours, n = 577), group 3 (24 to 72 hours, n = 189), and group 4 (≥72 hours, n = 112). We analyzed the incidences of 12-month mortality, nonfatal myocardial infarction (MI), target-vessel revascularization, and rehospitalization because of HF. The prevalence of ADHF in patients with NSTEMI was 15.2% at initial presentation, and in-hospital mortality was higher in group 1 than in the other groups. There were no significant differences in mortality, nonfatal MI, target-vessel revascularization, or rehospitalization for HF during the 12-month follow-up between groups, regardless of initial PCI timing, except for a higher 12-month mortality in patients who received PCI within 24 hours (vs ≥24 hours) (hazard ratio 1.52, 95% confidence interval 1.09 to 2.29, p = 0.046). Early PCI did not reduce adverse clinical outcomes in patients with NSTEMI complicated by ADHF. Delayed PCI after stabilization may be reasonable in such high-risk patients.</P>

Comparison of prasugrel versus clopidogrel in Korean patients with acute myocardial infarction undergoing successful revascularization

Park, Keun-Ho,Jeong, Myung Ho,Kim, Hyun Kuk,Ahn, Tae Hoon,Seung, Ki Bae,Oh, Dong Joo,Choi, Dong-Joo,Kim, Hyo-Soo,Gwon, Hyeon Cheol,Seong, In Whan,Hwang, Kyung Kuk,Chae, Shung Chull,Kim, Kwon-Bae,Kim, Elsevier 2018 Journal of cardiology Vol.71 No.1

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Although there have been several reports that prasugrel can improve clinical outcomes, the efficacy and safety of prasugrel is unknown in Korean patients with acute myocardial infarction (AMI) undergoing successful revascularization.</P> <P><B>Methods</B></P> <P>A total of 4421 patients [637 patients were prescribed prasugrel (60/10 or 5mg, loading/maintenance dose) and 3784 patients clopidogrel (600 or 300/75mg)] with AMI undergoing successful revascularization were enrolled from the core clinical cohort of Korea Acute Myocardial Infarction Registry-National Institute of Health.</P> <P><B>Results</B></P> <P>After propensity score matching (637 pairs), there were no significant differences in baseline clinical and procedural characteristics and in-hospital medications between the two groups. The primary efficacy endpoint, defined as the composite of cardiac death, MI, stroke, or target vessel revascularization at 6 months showed no significant difference between prasugrel and clopidogrel (2.4% vs. 2.9%, <I>p</I> =0.593). Also, no difference was observed in the composite of cardiac death, MI, or stroke during hospitalization between two groups (0.8% vs. 0.9%, <I>p</I> =0.762). However, the incidence of in-hospital Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding was significantly higher in prasugrel compared with clopidogrel (5.3% vs. 2.7%, <I>p</I> =0.015). In multivariate linear regression analysis, trans-femoral intervention, use of glycoprotein IIb/IIIa inhibitors, use of calcium channel blocker, and use of prasugrel were independent predictors of in-hospital TIMI major or minor bleeding [odds ratio (OR)=6.918; 95% confidence interval (CI)=2.453–19.510, OR=2.577; 95% CI=1.406–4.724, OR=4.016; 95% CI=1.382–11.668, OR=2.022; 95% CI=1.101–3.714].</P> <P><B>Conclusions</B></P> <P>Our study shows that the recommended dose of prasugrel had significantly higher in-hospital bleeding complications without reducing ischemic events compared with clopidogrel. However, further large-scale, long-term, randomized clinical trials are required to accurately assess the efficacy and safety of prasgurel and to find out the optimal dose for Korean AMI patients.</P>