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other Korea Acute Myocardial Infarction Registry Investigators,Kang, W.Y.,Jeong, M.H.,Ahn, Y.K.,Kim, J.H.,Chae, S.C.,Kim, Y.J.,Hur, S.H.,Seong, I.W.,Hong, T.J.,Choi, D.H.,Cho, M.C.,Kim, C.J.,Seung, K. Elsevier/North-Holland Biomedical Press 2011 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.146 No.2
Background: There is a paucity of data concerning the clinical outcome of patients presenting with acute myocardial infarction (AMI) and near-normal coronary angiograms. The purpose of this study was to evaluate the clinical outcome and the prognosis of the patients with near-normal coronary angiograms who were registered in the Korean Acute Myocardial Infarction Registry (KAMIR). Methods: The subjects were divided into three groups according to findings from coronary angiograms performed between September 2005 and November 2006. Among 8510 consecutive AMI patients, 372 patients (Group I) had near-normal coronary arteries, 6136 patients (Group II) had one- or two-vessel disease, and 2002 patients (Group III) had three-vessel or left main disease. Results: Clinical characteristics, in-hospital mortality, and major cardiac adverse events (MACE) were analyzed. Group I was younger, had the lower prevalence of DM, and showed the higher percentage of previous angina history compared to the other two groups. Group III showed a higher incidence of in-hospital mortality, but there was no significant difference between Group I and Group II (2.6% in Group II and 2.2% in Group I, p=0.952). Furthermore, MACE at 1month, 6months and 12months revealed no significant difference between Groups I and II (12month MACE: 7.8% in Group I and 12.2% in Group II, p=0.359). Conclusions: Patients with near-normal coronary angiograms had similar clinical outcomes and prognosis compared with one- or two-vessel diseased patients presenting with an acute myocardial infarction.
Other Korean Working Group in Myocardial Infarction Registry Investigators,Kim, K.H.,Kim, W.,Hwang, S.H.,Kang, W.Y.,Cho, S.C.,Kim, W.,Jeong, M.H. Japanese College of Cardiology 2015 Journal of cardiology Vol.65 No.2
Background: The CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc score has been used to evaluate the risk of thromboembolic events in atrial fibrillation. However, because all the components of CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc are important cardiovascular risk factors, we decided to evaluate the effectiveness of CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc score as a long-term predictor for prognosis in acute myocardial infarction (AMI) patients. Methods: We enrolled 15,681 AMI patients for the Korean Working Group in Acute Myocardial Infarction (KORMI) consecutively and analyzed retrospectively. We divided the all the patients into four groups according to CHADS<SUB>2</SUB>VASc score (Group I: 0-1, n=3317; Group II: 2-3, n=6794; Group III: 4-5, n=4457; Group IV: 6-9, n=1113). The cardiac event was defined as the sum of all-cause mortality and recurrence of myocardial infarction. Results: As the risk score increased, the incidence of cardiac events was higher at 1, 6, 12, and 24 months. The cardiac event-free survival rate was lower as the risk score increased (Group I vs Group II, p<0.001; Group II vs Group III, p<0.001; Group III vs Group IV, p=0.037). After adjusting confounding variables, the Cox-regression multivariate analysis showed that the CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc score was an independent predictor for the long-term prognosis in total AMI patients (p<0.001, hazard ratio=1.414 per scale). Conclusion: The AMI patients with higher CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc score had worse cardiovascular outcome. Therefore, CHADS<SUB>2</SUB>VASc score can be used to stratify AMI patients according to long-term prognosis irrespective of presence of atrial fibrillation.
other Korea Acute Myocardial Infarction Registry Investigators,Chen, K.Y.,Rha, S.W.,Wang, L.,Li, Y.J.,Li, G.P.,Choi, C.U.,Park, C.G.,Seo, H.S.,Oh, D.J.,Jeong, M.H.,Ahn, Y.K.,Hong, T.J.,Kim, Y.J.,Chae, Elsevier/North-Holland Biomedical Press 2014 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.176 No.3
Background: In contrast to many studies comparing everolimus-eluting stent (EES) with paclitaxel-eluting stent (PES), data directly comparing EES with sirolimus-eluting stent (SES) are limited, especially in patients with acute myocardial infarction (AMI). Methods: This study includes 2911 AMI patients treated with SES (n=1264) or EES (n=1701) in Korea Acute Myocardial Infarction Registry (KAMIR). Propensity score matching was applied to adjust for baseline imbalance in clinical and angiographic characteristics, yielding a total of 2400 well-matched patients (1200 receiving SES and 1200 receiving EES). One-year clinical outcomes were compared between the two propensity score matched groups. Results: Baseline clinical and angiographic characteristics were similar between the two propensity score matched groups. One-year clinical outcomes of the propensity score matched cohort were comparable between the EES versus the SES groups including the rates of cardiac death (4.8% vs. 4.8%, P=1.000), recurrent myocardial infarction (1.4% vs. 1.7%, P=0.619), target lesion revascularization (1.4% vs. 1.6%, P=0.737), target lesion failure (7.0% vs. 7.3%, P=0.752), and probable or definite stent thrombosis (0.5% vs. 0.9%, P=0.224) except for a trend toward lower incidence of target vessel revascularization (1.9% vs. 3.0%, P=0.087) and a lower rate of total major adverse cardiac events (9.3% vs. 11.9%, P=0.034) in the EES group. Conclusions: The present propensity score matched analysis performed in a large-scale, prospective, multicenter registry suggests that the second-generation drug-eluting stent EES has at least comparable or even better safety and efficacy profiles as compared with SES in the setting of AMI.
other Korea Acute Myocardial Infarction Registry Investigators,Li, Y.J.,Rha, S.W.,Chen, K.Y.,Jin, Z.,Wang, L.,Ramasamy, S.,Poddar, K.L.,Minami, Y.,Park, J.Y.,Choi, C.U.,Oh, D.J.,Jeong, M.H. Japanese College of Cardiology 2012 Journal of cardiology Vol.59 No.1
Background: Whether low molecular weight heparin (LMWH) enoxaparin is equivalent to unfractionated heparin (UFH) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains unclear. Methods: A total of 2397 NSTEMI patients who underwent PCI with DES received either LMWH [n=1178, subcutaneous enoxaparin 1mg/kg, b.i.d., initiated after the patient's arrival and continued until 3-5 days after PCI plus reduced dose of UFH (50-70U/kg) during PCI] or UFH (n=1219, 24,000U/day infusion, initiated after the patient's arrival and continued until at least 48h after PCI). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared. Results: Enoxaparin group had similar incidences of cardiac death, total death, and total major adverse cardiac events (MACE) at 8 months compared with UFH group. The incidences of major and minor bleeding events were also similar between the two groups. Multivariable Cox regression analysis showed that enoxaparin group had similar incidences of cardiac death [adjusted odds ratio (OR) 1.16, 95% confidence interval (CI) 0.64-2.10, p=0.620], total death (adjusted OR 1.08, 95% CI 0.66-1.76, p=0.760), and total MACE (adjusted OR 0.94, 95% CI 0.69-1.28, p=0.692) at 8 months as compared with UFH group. Conclusions: Enoxaparin with reduced dose of UFH only during PCI as an adjunctive antithrombotic therapy in NSTEMI patients undergoing PCI with DES was safe and showed comparable 8-month clinical outcomes as compared with UFH alone.
Other KAMIR Investigators,Jeong, H.C.,Ahn, Y.,Hong, Y.J.,Kim, J.H.,Jeong, M.H.,Kim, Y.J.,Chae, S.C.,Cho, M.C. Elsevier/North-Holland Biomedical Press 2013 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.167 No.5
Objective: We investigated whether statin therapy and high-sensitivity C-reactive protein (hs-CRP) levels were associated with the risk of stent thrombosis (ST) in acute myocardial infarction (AMI) patients. Methods: A total of 9,162 AMI patients who underwent coronary stent implantation were analyzed in the Korean Acute Myocardial Infarction Registry. The study population was divided into four groups according to level of hs-CRP and peri-procedural statin treatment: low hs-CRP (@?2.0mg/L) and high hs-CRP (>2mg/L) with or without statin therapy. We compared the incidence of early ST among the groups. Results: Statin therapy did not significantly affect the development of early ST in the low hs-CRP group. In the high hs-CRP group, however, the incidence of early ST was significantly decreased with statin treatment. In a subgroup analysis of the high hs-CRP group, patients aged less than 65years, without diabetes, with a high body mass index, and with a high Killip class seemed to benefit more from statin therapy. In a multivariable Cox regression analysis of the high hs-CRP group, lack of statin therapy was a significant predictor of ST incidence. Conclusions: Peri-procedural statin treatment had an effect on reduced incidence of early ST in AMI patients with high levels of hs-CRP.
other Korea Acute Myocardial Infarction Registry Investigators,Ahmed, K.,Jeong, M.H.,Chakraborty, R.,Ahmed, S.,Hong, Y.J.,Sim, D.S.,Park, K.H.,Kim, J.H.,Ahn, Y.,Kang, J.C.,Cho, M.C.,Kim, C.J.,Kim, Y.J Japanese College of Cardiology 2014 Journal of cardiology Vol.64 No.4
Background: Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). The aim of the study was to compare zotarolimus- and everolimus-eluting stents used during primary PCI in patients with acute myocardial infarction (AMI) and CKD. Methods: We selected 854 consecutive ST-elevation MI patients with CKD (estimated glomerular filtration rate <60mL/min/1.73m<SUP>2</SUP>) undergoing primary PCI who were followed up for 12 months. They were divided into two groups based on type of stents implanted: (1) zotarolimus-eluting stent (ZES) and (2) everolimus-eluting stent (EES). The study end point was the 12-month major adverse cardiac events (MACE) which included all-cause death, non-fatal MI, target lesion revascularization (TLR), and target vessel revascularization (TVR). Results: The average number of stents used per vessel was 1.4+/-0.7. A total of 433 patients received ZES and 421 patients received EES. There was no significant difference in the incidence of 12-month MI, TLR, or TVR. All-cause death was found to be borderline significant between two groups (2.8% in ZES vs 0.9% in EES, p=0.05). The incidence of 12-month MACE in ZES and EES was 5.7% and 2.6% respectively, p=0.022. Stent thrombosis did not differ between groups (p=0.677). Kaplan-Meier analysis did not show significant difference for 12-month MACE-free survival between groups (log-rank p=0.158). It remained the same even after propensity adjustment for multiple confounders in Cox model (p=0.326). Conclusions: Implantation of ZES or EES provided comparable clinical outcomes with similar risk of 12-month MACE and death in STEMI patients with CKD undergoing primary PCI.
other Korea Acute Myocardial Infarction Registry Investigators,Hachinohe, D.,Jeong, M.H.,Saito, S.,Kim, M.C.,Cho, K.H.,Ahmed, K.,Hwang, S.H.,Lee, M.G.,Sim, D.S.,Park, K.H.,Kim, J.H.,Hong, Y.J.,Ahn, Y. Japanese College of Cardiology 2012 Journal of cardiology Vol.59 No.3
Background: The role of thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PPCI) remains a matter of controversy. Methods and results: A total of 2105 patients enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry, a cohort of 745 (35.4%) patients who underwent TA during PPCI was compared with 1360 (64.6%) patients who underwent conventional PCI without TA. Clinical outcomes at 12-months of overall enrolled patients and subgroups according to key variables were assessed using Cox regression models adjusted by propensity score. Although there was no significant difference among overall patients, in subgroup analyses, administration of glycoprotein (GP) IIb/IIIa inhibitor during PPCI [adjusted hazard ratio (HR) 0.329, 95% confidence interval (CI) 0.126-0.860, p=0.023] and left anterior descending (LAD) as a culprit lesion (adjusted HR 0.516, 95% CI 0.275-0.971, p=0.040) were the settings, in which TA was associated with a lower major adverse cardiac events (MACE) rate compared with non-TA. Conclusions: Although TA does not improve clinical outcomes in overall patients who underwent PPCI, TA for LAD occlusion improves 12-month MACE. Furthermore, use of GP IIb/IIIa inhibitor with TA has a synergistic effect on clinical outcomes.
other Korea Acute Myocardial Infarction Registry Investigators,Sim, D.S.,Jeong, M.H.,Ahn, Y.,Kim, Y.J.,Chae, S.C.,Hong, T.J.,Seong, I.W.,Chae, J.K.,Kim, C.J.,Cho, M.C.,Rha, S.W.,Bae, J.H.,Seung, K.B. Elsevier/North-Holland Biomedical Press 2016 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.221 No.-
<P>Background: Immediate invasive approach for non-ST-segment elevation myocardial infarction (NSTEMI) may permit treatment of the underlying plaque rupture as early as possible with subsequent reduction of death and myocardial infarction (MI). We sought to assess clinical impact of immediate percutaneous coronary intervention (PCI) for NSTEMI. Methods: A total of 6134 NSTEMI patients undergoing PCI from the Korea Acute Myocardial Infarction Registry were divided into group 1 (immediate PCI within 4 h, n = 1132) and group 2 (non-immediate PCI after 4 h, n = 5002). Propensity-matched 12-month clinical outcome was compared. Results: In all patients and propensity-matched cohort (n = 1131 in each group), group 1 had higher peak troponin level, higher rate of pre-PCI Thrombolysis In Myocardial Infarction (TIMI) grade 0 or 1, higher use of glycoprotein IIb/IIIa inhibitor, and lower use of unfractionated heparin and nitrates. In all patients, 12-month rates of MI and death/MI were higher in group 1. No differences were observed in 12-month death and major adverse cardiac events (MACE: composite of death, MI, target-vessel revascularization, and coronary artery bypass graft surgery). In propensity-matched cohort, no significant differences were observed in 12-month rates of death, MI, death/MI or MACE. However, group 1 had less major bleeding (0.8% vs. 3.0%, p = 0.024) and shorter hospital stay. Conclusions: Immediate PCI for patients with NSTEMI was associated with lower pre-PCI culprit vessel patency and not with improved 12-month clinical outcome. (C) 2016 Elsevier Ireland Ltd. All rights reserved.</P>
other Korea Acute Myocardial Infarction Registry Investigators,Kim, H.K.,Jeong, M.H.,Ahn, Y.,Chae, S.C.,Kim, Y.J.,Hur, S.H.,Seong, I.W.,Hong, T.J.,Choi, D.H.,Cho, M.C.,Kim, C.J.,Seung, K.B.,Jang, Y.S. Japanese College of Cardiology 2017 Journal of cardiology Vol.69 No.1
<P>Conclusion: Despite improvements in door-to-balloon time, no parallel reductions in mortality rate and total ischemic time were observed. Total ischemic time was associated with mortality. The present study suggests that additional efforts are needed to shorten total ischemic time including patient and pre hospital systemic delay for better prognosis after primary PCI. (C) 2016 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.</P>