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Korean Transradial Coronary Intervention Registry Investigators,Lee, S.H.,Jeong, M.H.,Han, K.R.,Sim, D.S.,Yoon, J.,Youn, Y.J.,Cho, B.R.,Cha, K.S.,Hyon, M.S.,Rha, S.W.,Kim, B.O.,Shin, W.Y.,Park, K.S.,C Cahners Pub. Co., etc.] ; Elsevier Science Ltd 2016 The American Journal of Cardiology Vol.117 No.10
Anemia is an independent predictor of bleeding complications and poor clinical outcomes after percutaneous coronary intervention. Percutaneous coronary transradial intervention (TRI) is better than percutaneous coronary transfemoral intervention (TFI) in terms of reducing bleeding complications that can affect the prognosis. This study aims to investigate the clinical outcomes between TRI and TFI for patients with anemia. We analyzed periprocedure complications, in-hospital mortality, and major adverse cardiac events for one year in the Korean TRI registry from January 2013 to April 2014. Patients with chronic kidney disease for whom TFI is preferred were excluded. Anemia was defined as hemoglobin <13 g/dl for men and <12 g/dl for women. A total of 1,279 patients were finally enrolled. Of these, 348 patients had anemia. Among them, 253 patients (72.7%) underwent TRI and 95 patients (27.3%) underwent TFI. There were no significant differences of baseline demographic characteristics between the TRI and TFI groups, except for the incidence of dyslipidemia (TRI 23.7% vs TFI 12.6%, p = 0.023). Multivariate logistic regression analysis revealed lower incidence of composite severe bleeding complications (hazard ratio 0.34, 95% CI 0.12 to 0.99, p = 0.049) and lower incidence of in-hospital mortality than TFI group (hazard ratio 0.74, 95% CI 0.62 to 0.88, p = 0.042). In conclusion, this study suggests that the TRI for patients with anemia may be translated into better prognosis in terms of lower rates of bleeding complications and in-hospital mortality.
Risk of New Native-Vessel Occlusion After Coronary Artery Bypass Grafting
Yoon, S.H.,Kim, Y.H.,Yang, D.H.,Roh, J.H.,Lee, E.Y.,Lee, P.H.,Sugiyama, D.,Chang, M.,Ahn, J.M.,Choi, W.J.,Kang, J.W.,Lim, T.H.,Kim, J.B.,Jung, S.H.,Chung, C.H.,Choo, S.J.,Lee, J.W.,Kang, S.J.,Park, D. Cahners Pub. Co., etc.] ; Elsevier Science Ltd 2017 The American journal of cardiology Vol.119 No.1
<P>Coronary computed tomography angiography is widely used to evaluate the graft patency, but information on the progression of native-vessel disease remains limited. We sought to evaluate the impact of bypass grafting on native-vessel progression after. coronary artery bypass grafting. We evaluated new native-vessel occlusion defined as occlusion length >= 15 mm as a surrogate marker of native-vessel progression. We evaluated 911 patients with 2,271 nonoccluded vessels who underwent coronary artery bypass grafting and received follow-up coronary computed tomography angiography. Over a mean follow-up period of 4.7 years, the new occlusion rates were 9.2% for left anterior descending artery (LAD), and 13.9% for non-LAD, respectively. For non-LAD, new occlusion rate of vessels with bypass grafts was higher compared to those without bypass graft regardless of baseline native vessel stenosis (intermediate stenosis: 8.6% vs 1.7%, p <0.001; severe stenosis: 20.5% vs 9.9%, p = 0.003). Furthermore, new occlusion rate of vessels with venous graft was the highest, followed by vessels with arterial graft and vessels without bypass graft, regardless of baseline stenosis (intermediate stenosis: 11.1% vs 5.2% vs 1.7%, p <0.001; severe stenosis: 23.7% vs 15.9% vs 9.9%, p <0.001). By multivariate analysis, bypass grafting was associated with new native-vessel occlusion for non-LAD (odds ratio 3.04, 95% confidence interval 1.79 to 5.14; p <0.001). Bypass graft was associated with new native-vessel disease progression regardless of baseline stenosis. In conclusion, the decision to bypass or leave a native vessel with intermediate stenosis should cautiously be considered. (C) 2016 Elsevier Inc. All rights reserved.</P>
Jang, J.Y.,Heo, R.,Lee, S.,Kim, J.B.,Kim, D.H.,Yun, S.C.,Song, J.M.,Song, J.K.,Lee, J.W.,Kang, D.H. Cahners Pub. Co., etc.] ; Elsevier Science Ltd 2017 The American journal of cardiology Vol.119 No.6
<P>The optimal decision regarding whether to repair or replace the tricuspid valve (TV) remains controversial in patients with very severe functional tricuspid regurgitation (TR). We sought to compare clinical outcomes of TV repair versus replacement for very severe TR associated with severe TV tethering. We included 96 consecutive patients (20 men, 58 11 years of age) who had both severe tethering of TV and very severe functional TR and consequently underwent TV surgery during left-sided valve surgery. TV repair was performed on 79 patients (repair group), whereas 17 patients underwent TV replacement (replacement group). The primary end point of the study was defined as the composite of operative mortality, cardiac death, repeat TV surgery, and hospitalization due to congestive heart failure during follow-up. The 2 groups had similar baseline clinical, echocardiographic, and operative characteristics, but operative mortality was significantly higher in the replacement group than in the repair group (p = 0.008). During a median follow-up of 87 months, 19 patients (24%) in the repair group and 8 (47%) in the replacement group attained the composite end point, and TV replacement was independently associated with end points in the Cox proportional hazards analysis after adjustment with propensity score (hazard ratio 4.033, 95% CI 1.470 to 11.071; p = 0.007). In conclusion, compared with TV repair, replacement was associated with higher operative mortality and worse long-term clinical outcomes in patients with very severe functional TR. Repair should be the preferred surgical option even for severe TR associated with more advanced tethering and right ventricular dilatation. (C) 2017 Elsevier Inc. All rights reserved.</P>
Incidence, Implications, and Predictors of Stent Thrombosis in Acute Myocardial Infarction
Lim, S.,Koh, Y.S.,Kim, P.J.,Kim, H.Y.,Park, C.S.,Lee, J.M.,Kim, D.B.,Yoo, K.D.,Jeon, D.S.,Her, S.H.,Yim, H.W.,Chang, K.,Ahn, Y.,Jeong, M.H.,Seung, K.B. Cahners Pub. Co., etc.] ; Elsevier Science Ltd 2016 The American Journal of Cardiology Vol.117 No.10
Stent thrombosis (ST) remains a catastrophic problem in patients undergoing percutaneous coronary intervention (PCI). However, a paucity of data exist regarding the incidence, implications, and predictors of ST in patients with acute myocardial infarction (AMI). We consecutively enrolled patients with AMI in the CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI registry who underwent PCI from January 2004 to December 2009 and analyzed definite or probable ST according to Academic Research Consortium definitions. The median follow-up duration was 41.9 months. Definite or probable ST occurred in 136 patients (3.7%), including 44 with early ST (1.0%), 38 with late ST (0.9%), and 54 with very late ST (2.0%). The annual incidence of very late ST ranged from 0.5% to 0.6%. The all-cause mortality rate after ST was 29%, which was higher than that for patients without ST (17%; p <0.001). The independent predictors of ST were no-reflow phenomenon (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.28 to 3.03), decreased left ventricular ejection fraction (HR 1.70, 95% CI 1.21 to 2.40), anemia (HR 1.54, 95% CI 1.09 to 2.18), and a mean stent diameter <3.0 mm (HR 1.53, 95% CI 1.04 to 2.27). ST is not uncommon in patients with AMI and continues to occur beyond 1 year after PCI, irrespective of the stent type or clinical presentation. Patients with ST are associated with higher mortality than patients without ST. No reflow, decreased left ventricular ejection fraction, anemia, and a mean stent diameter <3.0 mm are independent predictors of ST.
Korea Transradial Coronary Intervention Prospective Registry Investigators,Choe, J.C.,Cha, K.S.,Choi, J.H.,Kim, B.W.,Park, J.S.,Lee, H.W.,Oh, J.H.,Choi, J.H.,Lee, H.C.,Hong, T.J.,Youn, Y.J.,Lee, S.H. Cahners Pub. Co., etc.] ; Elsevier Science Ltd 2016 The American Journal of Cardiology Vol.117 No.10
The transradial approach is increasingly used for percutaneous coronary intervention (PCI), and we therefore aimed to compare the clinical outcomes after transradial intervention (TRI) and transfemoral intervention (TFI) in all patients undergoing PCI. Among 6,973 patients enrolled in a nationwide, prospective, multicenter registry (February 2013 to September 2013), 1,860 underwent TRI (n = 1,445, 77.7%) and TFI (n = 415, 22.3%). Bleeding and major adverse cardiac events (MACE; death, myocardial infarction, revascularization, or stent thrombosis) were compared. Bleeding occurred in 42 patients (2.3%) and was significantly less likely in the TRI versus TFI group (overall cohort: 1.5% vs 4.8%, p = 0.001; propensity score-matched: n = 728, 2.7% vs 5.2%, p = 0.048). Multivariate regression revealed that TRI was negatively associated with bleeding (odds ratio 0.42, 95% CI 0.21 to 0.83, p = 0.013). MACE occurred in 152 patients (8.2%). Kaplan-Meier estimates showed higher MACE-free survival rates in the TRI versus TFI group (overall cohort: 93.3% vs 86.7%, log-rank p = 0.026; propensity score-matched: 91.8% vs 86.5%, log-rank p = 0.04). Cox proportional analysis demonstrated that TRI independently predicted improved MACE (hazard ratio 0.64, 95% CI 0.43 to 0.91, p = 0.024). In conclusion, TRI is associated with reduced bleeding rates and better clinical outcomes than TFI in all patients undergoing PCI.
Chung, J.H.,Lee, K.E.,Nam, C.W.,Doh, J.H.,Kim, H.I.,Kwon, S.S.,Shim, E.B.,Shin, E.S. Cahners Pub. Co., etc.] ; Elsevier Science Ltd 2017 The American Journal of Cardiology Vol.120 No.3
Coronary computed tomography angiography (CCTA)-derived fractional flow reserve from computed tomography (CT-FFR) may provide better diagnostic performance over CCTA alone, but the complexity of its method limits the use in clinical environment. The aim of the present study is to validate a newly developed vessel-length based computational fluid dynamics scheme for the computation of FFR based on CCTA data, compare them with invasively measured FFR, and evaluate its diagnostic performance with that of CCTA. One hundred seventeen patients from 4 medical institutions who had clinically indicated invasive coronary angiography for suspected coronary artery disease (CAD) were enrolled. Invasive FFR measurement was performed in 218 vessels and these measurements were regarded as the reference standard. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR on a per-vessel basis were 85.8%, 86.2%, 85.5%, 79.8%, and 90.3%, respectively, for CT-FFR @?0.80, and 66.1%, 75.9%, 59.5%, 55.5%, and 78.8%, respectively, for CCTA ≥50%. A higher area under the receiver operating characteristic curve for CT-FFR was observed compared with CCTA (0.93 vs 0.74, p <0.0001). The CT-FFR and FFR correlated well (r = 0.76, p <0.001) with slight underestimation by CT-FFR (0.014 +/- 0.077, p = 0.007). With a novel method of vessel-length based computational fluid dynamics scheme, CT-FFR can be performed at a personal computer enhancing its applicability in clinical situation. The diagnostic accuracy of CT-FFR for the detection of functionally significant CAD was good and was superior to that of CCTA within a population of suspected CAD.
Seo, J.B.,Shin, D.H.,Park, K.W.,Koo, B.K.,Gwon, H.C.,Jeong, M.H.,Seong, I.W.,Rha, S.W.,Yang, J.Y.,Park, S.J.,Yoon, J.H.,Han, K.R.,Park, J.S.,Hur, S.H.,Tahk, S.J.,Kim, H.S. Cahners Pub. Co., etc.] ; Elsevier Science Ltd 2016 The American Journal of Cardiology Vol.118 No.6
The most favored strategy for bifurcation lesion is stenting main vessel with provisional side branch (SB) stenting. This study was performed to elucidate predictors for SB failure during this provisional strategy. The study population was patients from 16 centers in Korea who underwent drug-eluting stent implantation for bifurcation lesions with provisional strategy (1,219 patients and 1,236 lesions). On multivariate analysis, the independent predictors for SB jailing after main vessel stenting were SB calcification, large SB reference diameter, severe stenosis of SB, and not taking clopidogrel. Regarding SB compromise, however, the independent predictors were true bifurcation lesion and small SB reference diameter, whereas possible predictors were parent vessel thrombus and parent vessel total occlusion. In addition, SB predilation helps us to get favorable SB outcome. The diameter of SB ostium after main vessel stenting became similar between severe SB lesions treated with predilation and mild SB lesions not treated with predilation. In conclusion, SB calcification, less clopidogrel use, large SB reference diameter, and high SB diameter stenosis are independent predictors for SB jailing, and true bifurcation and small SB reference diameter are independent predictors for SB compromise after main vessel stenting.
Hwang, J.w.,Park, S.J.,Cho, E.J.,Kim, E.K.,Lee, G.Y.,Chang, S.A.,Choi, J.O.,Lee, S.C.,Park, S.W. Cahners Pub. Co., etc.] ; Elsevier Science Ltd 2017 The American Journal of Cardiology Vol.119 No.11
<P>An association between N-terminal prohormone brain natriuretic peptide (NT-proBNP) and exercise tolerance in patients with valvular heart disease (VHD) has been suggested; however, there are few data available regarding this relation. The aim of this study is to evaluate the correlation between exercise tolerance and NT-proBNP in patients with asymptomatic or mildly symptomatic significant VHD and normal left ventricular ejection fraction (LV EF). A total of 96 patients with asymptomatic or mildly symptomatic VHD and normal LV EF (>= 50%) underwent cardiopulmonary exercise echocardiography. NT-proBNP levels were determined at baseline and after exercise in 3 hours. Patients were divided in 2 groups based on lower (<26 ml/kg/min, n = 47) or higher (>= 26 ml/kg/min, n = 49) peak oxygen consumption (VO2) as a representation of exercise tolerance. In the 2 groups, after adjusting for age and gender, the NT-proBNP level after exercise in 3 hours, left atrial volume index before exercise, right ventricular systolic pressure before exercise, E velocity after exercise, and E/e' ratio after exercise varied significantly. In addition, peak V02 was inversely related to NT-proBNP before (r = 0.352, p <0.001) and after exercise (r = 0.351, p <0.001). The NT-proBNP level before exercise was directly related to the left atrial volume index, E/e' ratio, and right ventricular systolic pressure before and after exercise. NT-proBNP after exercise was also directly related to the same parameters. NTproBNP levels both before and after exercise were higher in the group with lower exercise tolerance. In conclusion, through the correlation among exercise tolerance, NT-proBNP, and parameters of diastolic dysfunction, we demonstrated that diastolic dysfunction and NT-proBNP could predict exercise tolerance in patients with significant VHD and normal LV EF. (C) 2017 Elsevier Inc. All rights reserved.</P>