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Park SJ, Ahn JM, Kang DY, Yun SC, Ahn YK, Kim WJ, Nam CW, Jeong JO, Chae IH, Shiomi H, Kao HL, Hahn JY, Her SH, Lee BK, Ahn TH, Chang KY, Chae JK, Smyth D, Mintz GS, Stone GW, Park DW. Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial. Lancet 2024:S0140-6736(24)00413-6. [PMID: 38604213 DOI: 10.1016/s0140-6736(24)00413-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Acute coronary syndrome and sudden cardiac death are often caused by rupture and thrombosis of lipid-rich atherosclerotic coronary plaques (known as vulnerable plaques), many of which are non-flow-limiting. The safety and effectiveness of focal preventive therapy with percutaneous coronary intervention of vulnerable plaques in reducing adverse cardiac events are unknown. We aimed to assess whether preventive percutaneous coronary intervention of non-flow-limiting vulnerable plaques improves clinical outcomes compared with optimal medical therapy alone. METHODS PREVENT was a multicentre, open-label, randomised controlled trial done at 15 research hospitals in four countries (South Korea, Japan, Taiwan, and New Zealand). Patients aged 18 years or older with non-flow-limiting (fractional flow reserve >0·80) vulnerable coronary plaques identified by intracoronary imaging were randomly assigned (1:1) to either percutaneous coronary intervention plus optimal medical therapy or optimal medical therapy alone, in block sizes of 4 or 6, stratified by diabetes status and the performance of percutaneous coronary intervention in a non-study target vessel. Follow-up continued annually in all enrolled patients until the last enrolled patient reached 2 years after randomisation. The primary outcome was a composite of death from cardiac causes, target-vessel myocardial infarction, ischaemia-driven target-vessel revascularisation, or hospitalisation for unstable or progressive angina, assessed in the intention-to-treat population at 2 years. Time-to-first-event estimates were calculated with the Kaplan-Meier method and were compared with the log-rank test. This report is the principal analysis from the trial and includes all long-term analysed data. The trial is registered at ClinicalTrials.gov, NCT02316886, and is complete. FINDINGS Between Sept 23, 2015, and Sept 29, 2021, 5627 patients were screened for eligibility, 1606 of whom were enrolled and randomly assigned to percutaneous coronary intervention (n=803) or optimal medical therapy alone (n=803). 1177 (73%) patients were men and 429 (27%) were women. 2-year follow-up for the primary outcome assessment was completed in 1556 (97%) patients (percutaneous coronary intervention group n=780; optimal medical therapy group n=776). At 2 years, the primary outcome occurred in three (0·4%) patients in the percutaneous coronary intervention group and in 27 (3·4%) patients in the medical therapy group (absolute difference -3·0 percentage points [95% CI -4·4 to -1·8]; p=0·0003). The effect of preventive percutaneous coronary intervention was directionally consistent for each component of the primary composite outcome. Serious clinical or adverse events did not differ between the percutaneous coronary intervention group and the medical therapy group: at 2 years, four (0·5%) versus ten (1·3%) patients died (absolute difference -0·8 percentage points [95% CI -1·7 to 0·2]) and nine (1·1%) versus 13 (1·7%) patients had myocardial infarction (absolute difference -0·5 percentage points [-1·7 to 0·6]). INTERPRETATION In patients with non-flow-limiting vulnerable coronary plaques, preventive percutaneous coronary intervention reduced major adverse cardiac events arising from high-risk vulnerable plaques, compared with optimal medical therapy alone. Given that PREVENT is the first large trial to show the potential effect of the focal treatment for vulnerable plaques, these findings support consideration to expand indications for percutaneous coronary intervention to include non-flow-limiting, high-risk vulnerable plaques. FUNDING The CardioVascular Research Foundation, Abbott, Yuhan Corp, CAH-Cordis, Philips, and Infraredx, a Nipro company.
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Affiliation(s)
- Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Keun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA University School of Medicine, CHA Ilsan Medical Center, Goyang, South Korea
| | - Chang-Wook Nam
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, South Korea
| | - In-Ho Chae
- Division of Cardiology, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Hiroki Shiomi
- Division of Cardiology, Kyoto University Hospital, Kyoto, Japan
| | - Hsien-Li Kao
- Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Ho Her
- Department of Cardiology, Saint Vincent's Hospital, Suwon, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Tae Hoon Ahn
- Cardiovascular Center, Na-Eun Hospital, Incheon, South Korea
| | - Ki-Yuk Chang
- Division of Cardiology, Seoul Saint Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Jei Keon Chae
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju, South Korea
| | - David Smyth
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Lee JM, Kim H, Park YS, Jo HH, Lim SM, Lee J, Choi Y, Kang DY, Ahn JM, Kim S, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Choi JW, Kim KS, Lee SN, Park SJ, Park DW. Surveillance Stress Testing After Percutaneous Intervention for Patients With Multivessel or Left Main Coronary Disease. J Am Coll Cardiol 2024; 83:890-900. [PMID: 38418002 DOI: 10.1016/j.jacc.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND The optimal surveillance strategy after percutaneous coronary intervention (PCI) for high-risk patients with multivessel or left main coronary artery disease (CAD) remains uncertain. OBJECTIVES This study aims to determine the prognostic role of routine functional testing in patients with multivessel or left main CAD who underwent PCI. METHODS The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) trial randomized high-risk PCI patients to routine functional testing at 1 year or standard care alone during follow-up. This analysis focused on participants with multivessel or left main CAD. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. RESULTS Among 1,706 initially randomized patients, 1,192 patients with multivessel (n = 833) or left main (n = 359) were identified, with 589 in the functional testing group and 603 in the standard care group. Two-year incidences of primary outcome were similar between the functional testing group and the standard care group (6.2% vs 5.7%, respectively; HR: 1.09; 95% CI: 0.68-1.74; P = 0.73). This trend persisted in both groups of multivessel (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.62-1.89; P = 0.78) and left main disease (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.46-2.56; P = 0.85) (P for interaction = 0.90). Routine surveillance functional testing was associated with increased rates of invasive angiography and repeat revascularization beyond 1 year. CONCLUSIONS In high-risk patients with multivessel or left main CAD who underwent PCI, there was no incremental clinical benefit from routine surveillance functional-testing compared with standard care alone during follow-up. (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention [POST-PCI]; NCT03217877).
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Affiliation(s)
- Joong Min Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hoyun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Sun Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha Hye Jo
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Min Lim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeonwoo Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seonok Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Se Hun Kang
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Chul Soo Park
- Cardiovascular Center and Cardiology Division, Yeouido St Mary's Hospital, Seoul, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Seoul, Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Su Nam Lee
- Division of Cardiology, St Vincent's Hospital, Suwon, Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Lee BK. Prasugrel Only May Be Enough After Percutaneous Coronary Intervention for Chronic Coronary Syndrome Patients. JACC Asia 2024; 4:183-184. [PMID: 38463681 PMCID: PMC10920041 DOI: 10.1016/j.jacasi.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
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Kim H, Kang DY, Lee J, Choi Y, Ahn JM, Kim S, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Choi JW, Kim KS, Lee SN, Park SJ, Park DW. Routine stress testing in diabetic patients after percutaneous coronary intervention: the POST-PCI trial. Eur Heart J 2024; 45:653-665. [PMID: 37933514 DOI: 10.1093/eurheartj/ehad722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND AND AIMS The optimal follow-up surveillance strategy for high-risk diabetic patients with had undergone percutaneous coronary intervention (PCI) remains unknown. METHODS The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) study was a randomized trial comparing a follow-up strategy of routine functional testing at 1 year vs. standard care alone after high-risk PCI. Randomization was stratified according to diabetes status. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. RESULTS Among 1706 randomized patients, participants with diabetes (n = 660, 38.7%) had more frequent comorbidities and a higher prevalence of complex anatomical or procedural characteristics than those without diabetes (n = 1046, 61.3%). Patients with diabetes had a 52% greater risk of primary composite events [hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.02-2.27; P = .039]. The 2-year incidences of the primary composite outcome were similar between strategies of routine functional testing or standard care alone in diabetic patients (7.1% vs. 7.5%; HR 0.94; 95% CI 0.53-1.66; P = .82) and non-diabetic patients (4.6% vs. 5.1%; HR 0.89; 95% CI 0.51-1.55; P = .68) (interaction term for diabetes: P = .91). The incidences of invasive coronary angiography and repeat revascularization after 1 year were higher in the routine functional-testing group than the standard-care group irrespective of diabetes status. CONCLUSIONS Despite being at higher risk for adverse clinical events, patients with diabetes who had undergone high-risk PCI did not derive incremental benefit from routine surveillance stress testing compared with standard care alone during follow-up.
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Affiliation(s)
- Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Seonok Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Se Hun Kang
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Chul Soo Park
- Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Seoul, South Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Su Nam Lee
- Division of Cardiology, St. Vincent's Hospital, Suwon, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
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Ki YJ, Kang J, Zhang J, Hu X, Jiang J, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Ahn SG, Yoon MH, Kim U, Hwang D, Shin ES, Kim HS, Tahk SJ, Wang J, Koo BK. Prognostic Implications of Quantitative Flow Ratio and Plaque Characteristics in Intravascular Ultrasound-Guided Treatment Strategy. JACC Cardiovasc Interv 2024; 17:461-470. [PMID: 38340104 DOI: 10.1016/j.jcin.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a method for evaluating fractional flow reserve without the use of an invasive coronary pressure wire or pharmacological hyperemic agent. OBJECTIVES The aim of this study was to investigate the prognostic implications of QFR and plaque characteristics in patients who underwent intravascular ultrasound (IVUS)-guided treatment for intermediate lesions. METHODS Among the IVUS-guided strategy group in the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial, vessels suitable for QFR analysis were included in this study. High-risk features were defined as low QFR (≤0.90), quantitative high-risk plaque characteristics (qn-HRPCs) (minimal lumen area ≤3.5 mm2, or plaque burden ≥70%), and qualitative high-risk plaque characteristics (ql-HRPCs) (attenuated plaque, positive remodeling, or plaque rupture) assessed using IVUS. The primary clinical endpoint was target vessel failure (TVF), defined as a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization. RESULTS A total of 415 (46.1%) vessels could be analyzable for QFR. The numbers of qn-HRPCs and ql-HRPCs increased with decreasing QFR. Among deferred vessels, those with 3 high-risk features exhibits a significantly higher risk of TVF compared with those with ≤2 high-risk features (12.0% vs 2.7%; HR: 4.54; 95% CI: 1.02-20.29). CONCLUSIONS Among the IVUS-guided deferred group, vessels with qn-HRPC and ql-HRPC with low QFR (≤0.90) exhibited a significantly higher risk for TVF compared with those with ≤2 features. Integrative assessment of angiography-derived fractional flow reserve and anatomical and morphological plaque characteristics is recommended to improve clinical outcomes in patients undergoing IVUS-guided deferred treatment.
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Affiliation(s)
- You-Jeong Ki
- Uijeongbu Eulji Medical Center, Gyeonggi-do, Republic of Korea
| | - Jeehoon Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinlong Zhang
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyang Hu
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Jiang
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Weon Kim
- Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jinyu Huang
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Jiang
- Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Hao Zhou
- 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Chen
- 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Wenbing Jiang
- Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, China
| | | | - Wenming He
- Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Sung-Gyun Ahn
- Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | | | - Ung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Doyeon Hwang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Jian'an Wang
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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Lee JW, Kim Y, Lee BK, Yoo SY, Lee SY, Kim CJ, Jin HY, Park JS, Heo JH, Kim DH, Lee JB, Kim DK, Bae JH, Lee SY, Lee SH. Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry: The KODRA Trial. JACC Cardiovasc Interv 2024; 17:329-340. [PMID: 38355261 DOI: 10.1016/j.jcin.2023.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Distal radial access (DRA) as an alternative access route lacks evidence, despite its recent reputation. OBJECTIVES The aim of this study was to evaluate the safety and feasibility of DRA on the basis of daily practice. METHODS The KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) trial was a prospective multicenter registry conducted at 14 hospitals between September 2019 and September 2021. The primary endpoints were the success rates of coronary angiography (CAG) and percutaneous coronary intervention (PCI). The secondary endpoints included successful distal radial artery puncture, access-site crossover, access site-related complications, bleeding events, and predictors of puncture failure. RESULTS A total of 4,977 among 5,712 screened patients were recruited after the exclusion of 735 patients. The primary endpoints, the success rates of CAG and PCI via DRA, were 100% and 98.8%, respectively, among successful punctures of the distal radial artery (94.4%). Access-site crossover occurred in 333 patients (6.7%). The rates of distal radial artery occlusion and radial artery occlusion by palpation were 0.8% (36 of 4,340) and 0.8% (33 of 4,340) at 1-month follow-up. DRA-related bleeding events were observed in 3.3% of patients, without serious hematoma. Multilevel logistic regression analysis identified weak pulse (OR: 9.994; 95% CI: 7.252-13.774) and DRA experience <100 cases (OR: 2.187; 95% CI: 1.383-3.456) as predictors of puncture failure. CONCLUSIONS In this large-scale prospective multicenter registry, DRA demonstrated high success rates of CAG and PCI, with a high rate of puncture success but low rates of distal radial artery occlusion, radial artery occlusion, bleeding events, and procedure-related complications. Weak pulse and DRA experience <100 cases were predictors of puncture failure. (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach [KODRA]; NCT04080700).
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Affiliation(s)
- Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital and Cardiovascular Center, Yonsei University College of Medicine, Yongin, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Sang-Yong Yoo
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea; Division of Cardiology, Department of Internal Medicine, Good Morning Hospital, Pyeongtaek, South Korea
| | - Sang Yeub Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea; Division of Cardiology, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
| | - Han-Young Jin
- Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jin Sup Park
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Do Hoi Kim
- Division of Cardiology, Department of Internal Medicine, Hyundai Uvis Hospital, Incheon, South Korea; Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital Gumi, Gumi, South Korea
| | - Jin Bae Lee
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Dong-Kie Kim
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jun Ho Bae
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Sung-Yun Lee
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea; Division of Cardiology, Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea; Division of Cardiology, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, South Korea.
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Yang S, Kang J, Hwang D, Zhang J, Jiang J, Hu X, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Ahn SG, Yoon MH, Kim U, Lee JM, Ki YJ, Shin ES, Kim HS, Tahk SJ, Wang J, Koo BK. Physiology- or Imaging-Guided Strategies for Intermediate Coronary Stenosis. JAMA Netw Open 2024; 7:e2350036. [PMID: 38170524 PMCID: PMC10765263 DOI: 10.1001/jamanetworkopen.2023.50036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Importance Treatment strategies for intermediate coronary lesions guided by fractional flow reserve (FFR) and intravascular ultrasonography (IVUS) have shown comparable outcomes. Identifying low-risk deferred vessels to ensure the safe deferral of percutaneous coronary intervention (PCI) and high-risk revascularized vessels that necessitate thorough follow-up can help determine optimal treatment strategies. Objectives To investigate outcomes according to treatment types and FFR and IVUS parameters after FFR- or IVUS-guided treatment. Design, Setting, and Participants This cohort study included patients with intermediate coronary stenosis from the Fractional Flow Reserve and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients With Intermediate Stenosis (FLAVOUR) trial, an investigator-initiated, prospective, open-label, multicenter randomized clinical trial that assigned patients into an IVUS-guided strategy (which recommended PCI for minimum lumen area [MLA] ≤3 mm2 or 3 mm2 to 4 mm2 with plaque burden [PB] ≥70%) or an FFR-guided strategy (which recommended PCI for FFR ≤0.80). Data were analyzed from November to December 2022. Exposures FFR or IVUS parameters within the deferred and revascularized vessels. Main Outcomes and Measures The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, and revascularization at 2 years. Results A total of 1619 patients (mean [SD] age, 65.1 [9.6] years; 1137 [70.2%] male) with 1753 vessels were included in analysis. In 950 vessels for which revascularization was deferred, incidence of TVF was comparable between IVUS and FFR groups (3.8% vs 4.1%; P = .72). Vessels with FFR greater than 0.92 in the FFR group and MLA greater than 4.5 mm2 or PB of 58% or less in the IVUS group were identified as low-risk deferred vessels, with a decreased risk of TVF (hazard ratio [HR], 0.25 [95% CI, 0.09-0.71]; P = .009). In 803 revascularized vessels, the incidence of TVF was comparable between IVUS and FFR groups (3.6% vs 3.7%; P = .95), which was similar in the revascularized vessels undergoing PCI optimization (4.2% vs 2.5%; P = .31). Vessels with post-PCI FFR of 0.80 or less in the FFR group or minimum stent area of 6.0 mm2 or less or with PB at stent edge greater than 58% in the IVUS group had an increased risk for TVF (HR, 7.20 [95% CI, 3.20-16.21]; P < .001). Conclusions and Relevance In this cohort study of patients with intermediate coronary stenosis, FFR- and IVUS-guided strategies showed comparable outcomes in both deferred and revascularized vessels. Binary FFR and IVUS parameters could further define low-risk deferred vessels and high-risk revascularized vessels.
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Affiliation(s)
- Seokhun Yang
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeehoon Kang
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Doyeon Hwang
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jinlong Zhang
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Jiang
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyang Hu
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | | | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Gangwon-Do, Republic of Korea
| | - Weon Kim
- Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jinyu Huang
- Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Jiang
- Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Hao Zhou
- The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Chen
- The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Wenbing Jiang
- The Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou, China
| | | | - Wenming He
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Sung Gyun Ahn
- Wonju Severance Christian Hospital, Wonju, Gangwon-Do, Republic of Korea
| | | | - Ung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | | | - You-Jeong Ki
- Uijeongbu Eulji Medical Center, Uijeongbu, Gyeonggi-Do, Republic of Korea
| | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Jian’an Wang
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Seung J, Choo EH, Kim CJ, Kim HK, Park KH, Lee SH, Kim MC, Hong YJ, Ahn SG, Doh JH, Lee SY, Park SD, Lee HJ, Kang MG, Koh JS, Cho YK, Nam CW, Koo BK, Lee BK, Yun KH, Hong D, Joh HS, Choi KH, Park TK, Lee JM, Yang JH, Song YB, Choi SH, Gwon HC, Hahn JY. Angiographic Severity of the Nonculprit Lesion and the Efficacy of Fractional Flow Reserve-Guided Complete Revascularization in Patients With AMI: FRAME-AMI Substudy. Circ Cardiovasc Interv 2024; 17:e013611. [PMID: 37929584 DOI: 10.1161/circinterventions.123.013611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The benefit of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for noninfarct-related artery (IRA) lesions with angiographically severe stenosis in patients with acute myocardial infarction is unclear. METHODS Among 562 patients from the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infraction Related Artery Stenosis in Patients With Acute Myocardial Infarction) who were randomly allocated into either FFR-guided or angiography-guided PCI for non-IRA lesions, the current study evaluated the relationship between non-IRA stenosis measured by quantitative coronary angiography (QCA) and the efficacy of FFR-guided PCI. The incidence of the primary end point (death, myocardial infarction, or repeat revascularization) was compared between FFR- and angiography-guided PCI according to non-IRA stenosis severity (QCA stenosis ≥70% or <70%). RESULTS A total of 562 patients were assigned to FFR-guided (n=284) versus angiography-guided PCI (n=278). At a median follow-up of 3.5 years, the primary end point occurred in 14 of 181 patients with FFR-guided PCI and 31 of 197 patients with angiography-guided PCI among patients with QCA stenosis ≥70% (8.5% versus 19.2%; hazard ratio, 0.41 [95% CI, 0.22-0.80]; P=0.008), while occurred in 4 of 103 patients with FFR-guided PCI and 9 of 81 patients with angiography-guided PCI among those with QCA stenosis <70% (3.9% versus 11.1%; P=0.315). There was no significant interaction between treatment strategy and non-IRA stenosis severity (P for interaction=0.636). FFR-guided PCI was associated with the reduction of death and myocardial infarction in both patients with QCA stenosis ≥70% (6.7% versus 15.1%; P=0.008) and those with QCA stenosis <70% (1.0% versus 9.6%; P=0.042) compared with angiography-guided PCI. CONCLUSIONS In patients with acute myocardial infarction and multivessel disease, FFR-guided PCI tended to have a lower risk of primary end point than angiography-guided PCI regardless of non-IRA stenosis severity without significant interaction. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02715518.
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Affiliation(s)
- Jaeho Seung
- Seoul St. Mary's Hospital (J.S., E.H.C.), The Catholic University of Korea, Seoul
| | - Eun Ho Choo
- Seoul St. Mary's Hospital (J.S., E.H.C.), The Catholic University of Korea, Seoul
| | - Chan Joon Kim
- Uijeongbu St. Mary's Hospital (C.J.K.), The Catholic University of Korea, Seoul
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea (H.K.K., K.H.P.)
| | - Keun Ho Park
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea (H.K.K., K.H.P.)
| | - Seung Hun Lee
- Chonnam National University Hospital, Gwangju, Korea (S.H.L., M.C.K., Y.J.H.)
| | - Min Chul Kim
- Chonnam National University Hospital, Gwangju, Korea (S.H.L., M.C.K., Y.J.H.)
| | - Young Joon Hong
- Chonnam National University Hospital, Gwangju, Korea (S.H.L., M.C.K., Y.J.H.)
| | - Sung Gyun Ahn
- Wonju College of Medicine, Wonju Severance Christian Hospital, Yonsei University, Korea (S.G.A.)
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.)
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L.)
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Korea (S.Y.L.)
| | | | | | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.H.)
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.H.)
| | - Yun-Kyeong Cho
- Dongsan Medical Center, Keimyung University, Daegu, Korea (Y.-K.C., C.-W.N.)
| | - Chang-Wook Nam
- Dongsan Medical Center, Keimyung University, Daegu, Korea (Y.-K.C., C.-W.N.)
| | - Bon-Kwon Koo
- Seoul National University Hospital, Korea (B.-K.K.)
| | - Bong-Ki Lee
- Kangwon National University School of Medicine, Chuncheon, Korea (B.-K.L.)
| | | | - David Hong
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Hyun Sung Joh
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Ki Hong Choi
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Taek Kyu Park
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Jeong Hoon Yang
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Young Bin Song
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Seung-Hyuk Choi
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Joo-Yong Hahn
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
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Kim KH, Lee BK, Seo JH, Chun KJ, Cho BR. Successful coronary angiography via distal radial access in an 82-year-old male patient with polydactyly. Korean J Intern Med 2024; 39:196-197. [PMID: 37750033 PMCID: PMC10790034 DOI: 10.3904/kjim.2023.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/05/2023] [Accepted: 05/18/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- Kang Hee Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jeong Hun Seo
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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10
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Lee JM, Kim H, Hong D, Hwang D, Zhang J, Hu X, Jiang J, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Kang J, Ahn SG, Yoon MH, Kim U, Ki YJ, Shin ES, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Gwon HC, Koo BK, Kim HS, Tahk SJ, Wang J, Hahn JY. Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision. Circ Cardiovasc Interv 2023; 16:e013308. [PMID: 38018840 DOI: 10.1161/circinterventions.123.013308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND There are limited data regarding the safety of deferral of percutaneous coronary intervention based on intravascular ultrasound (IVUS) findings. The current study sought to compare the prognosis between deferred lesions based on IVUS and fractional flow reserve (FFR)-guided treatment decision. METHODS This study is a post hoc analysis of the FLAVOUR randomized trial (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients With Intermediate Stenosis) that compared 2-year clinical outcomes between IVUS- and FFR-guided treatment decision on intermediate coronary artery lesions using predefined criteria. In both IVUS and FFR groups, vessels were classified into deferred or revascularized vessels, and patients were classified as those with or without deferred lesions. Vessel-oriented composite outcomes (cardiac death, target vessel myocardial infarction, or target vessel revascularization) in deferred vessels and patient-oriented composite outcomes (death, myocardial infarction, or any revascularization) in patients with deferred lesions were compared between the IVUS and FFR groups. RESULTS A total of 1682 patients and 1820 vessels were analyzed, of which 922 patients and 989 vessels were deferred. At 2 years, there was no difference in the cumulative incidence of vessel-oriented composite outcomes in deferred vessels between IVUS (n=375) and FFR (n=614) groups (3.8% versus 4.1%; hazard ratio, 0.91 [95% CI, 0.47-1.75]; P=0.77). The risk of vessel-oriented composite outcomes was comparable between deferred and revascularized vessels following treatment decision by IVUS (3.8% versus 3.5%; hazard ratio, 1.09 [95% CI, 0.54-2.19]; P=0.81) and FFR (4.1% versus 3.6%; hazard ratio, 1.14 [95% CI, 0.56-2.32]; P=0.72). In comparison of patient-oriented composite outcomes in patients with deferred lesions, there was no significant difference between the IVUS (n=357) and FFR (n=565) groups (6.2% versus 5.9%; hazard ratio, 1.05 [95% CI, 0.61-1.80]; P=0.86). CONCLUSIONS In patients with intermediate coronary artery stenosis, deferral of percutaneous coronary intervention based on IVUS-guided treatment decision showed comparable risk of clinical events with FFR-guided treatment decision. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02673424.
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Affiliation(s)
- Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Hangyul Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Doyeon Hwang
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
| | - Jinlong Zhang
- The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China
| | - Xinyang Hu
- The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China
| | - Jun Jiang
- The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (C.-W.N.)
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (J.-H.D.)
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Republic of Korea (B.-K.L.)
| | - Weon Kim
- Kyung Hee University Hospital, Seoul, Republic of Korea (W.K.)
| | - Jinyu Huang
- Affiliated Hangzhou First People's Hospital (J.H.), Zhejiang University School of Medicine, China
| | - Fan Jiang
- Hangzhou Normal University Affiliated Hospital, China (F.J.)
| | - Hao Zhou
- The First Affiliated Hospital of Wenzhou Medical University, China (H.Z.)
| | - Peng Chen
- The Second Affiliated Hospital of Wenzhou Medical University, China (P.C.)
| | | | - Wenbing Jiang
- The Third Clinical Institute Affiliated to Wenzhou Medical University, China (W.J.)
| | | | - Wenming He
- The Affiliated Hospital of Medical School of Ningbo University, China (W.H.)
| | - Jeehoon Kang
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
| | - Sung-Gyun Ahn
- Wonju Severance Christian Hospital, Republic of Korea (S.-G.A.)
| | - Myeong-Ho Yoon
- Ajou University Hospital, Suwon, Republic of Korea (M.-H.Y., S.-J.T.)
| | - Ung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea (U.K.)
| | - You-Jeong Ki
- Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Republic of Korea (Y.-J.K.)
| | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (E.-S.S.)
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Bon-Kwon Koo
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
| | - Hyo-Soo Kim
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
| | - Seung-Jea Tahk
- Ajou University Hospital, Suwon, Republic of Korea (M.-H.Y., S.-J.T.)
| | - Jian'an Wang
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
- The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
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Kim H, Kang DY, Ahn JM, Lee J, Choi Y, Hur SH, Park HJ, Tresukosol D, Kang WC, Kwon HM, Rha SW, Lim DS, Jeong MH, Lee BK, Huang H, Lim YH, Bae JH, Kim BO, Ong TK, Ahn SG, Chung CH, Park DW, Park SJ. Everolimus-Eluting Stents or Bypass Surgery for Multivessel Disease in Diabetics: The BEST Extended Follow-Up Study. JACC Cardiovasc Interv 2023; 16:2412-2422. [PMID: 37821187 DOI: 10.1016/j.jcin.2023.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Diabetes mellitus is associated with more complex coronary artery diseases. Coronary artery bypass grafting (CABG) is a preferred revascularization strategy over percutaneous coronary intervention (PCI) in diabetics with multivessel coronary artery disease (MVD). OBJECTIVES This study sought to examine the different prognostic effects of revascularization strategies according to the diabetes status from the randomized BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease) trial. METHODS Patients (n = 880) with MVD were randomly assigned to undergo PCI with an everolimus-eluting stent vs CABG stratified by diabetics (n = 363) and nondiabetics (n = 517). The primary endpoint was the composite of death, myocardial infarction, or target vessel revascularization during a median follow-up of 11.8 years (IQR: 10.6-12.5 years). RESULTS In diabetics, the primary endpoint rate was significantly higher in the PCI group than in the CABG group (43% and 32%; HR: 1.53; 95% CI: 1.12-2.08; P = 0.008). However, in nondiabetics, no significant difference was found between the groups (PCI group, 29%; CABG group, 29%; HR: 0.97; 95% CI: 0.67-1.39; P = 0.86; Pinteraction= 0.009). Irrespective of the presence of diabetes, no significant between-group differences were found in the rate of a safety composite of death, myocardial infarction, or stroke and mortality rate. However, the rate of any repeat revascularization was significantly higher in the PCI group than in the CABG group. CONCLUSIONS In diabetics with MVD, CABG was associated with better clinical outcomes than PCI. However, the mortality rate was similar between PCI and CABG irrespective of diabetes status during an extended follow-up. (Ten-Year Outcomes of Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST Extended], NCT05125367; Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST], NCT00997828).
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Affiliation(s)
- Hoyun Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jinho Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeonwoo Choi
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hun-Jun Park
- Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | | | | | | | | | | | | | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Korea
| | - He Huang
- Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | | | | | - Byung Ok Kim
- Inje University Sanggye Paik Hospital, Seoul, Korea
| | | | - Sung Gyun Ahn
- Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Cheol-Hyun Chung
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Zhang J, Jiang J, Hu X, Sun Y, Li C, Zhu L, Gao F, Dong L, Liu Y, Shen J, Ni C, Wang K, Chen Z, Chen H, Li S, Yang S, Kang J, Hwang D, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Ahn SG, Yoon MH, Kim U, Lee JM, Ki YJ, Shin ES, Kim CH, Tahk SJ, Koo BK, Wang J. Sex Differences in Fractional Flow Reserve- or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2426-2435. [PMID: 37638768 DOI: 10.1016/j.jcin.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND A recent randomized trial reported fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy was noninferior to the intracoronary ultrasound (IVUS)-guided PCI strategy with respect to clinical outcomes with fewer revascularizations. OBJECTIVES This study sought to investigate the sex differences in treatment and clinical outcomes according to physiology- or imaging-guided PCI strategies. METHODS In this secondary analysis of the FLAVOUR (Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI) trial, the impact of sex on procedural characteristics, PCI rate, and outcomes according to different strategies and treatment types (PCI vs deferral of PCI) was analyzed. The primary outcome was target vessel failure (TVF) at 24 months, defined as a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization. RESULTS Of 1,619 patients, 30% were women. Compared with men, women had a smaller minimal lumen area, smaller plaque burden, and higher FFR. They had a lower PCI rate (40.8% vs 47.9%; P = 0.008), which was mainly contributed by FFR guidance. Overall, women showed a lower TVF rate (2.4% vs 4.5%). According to the treatment type, the cumulative incidence of TVF was lower in women than in men among those with the deferral of PCI (1.7% vs 5.2%). However, this trend was not observed in patients who underwent PCI. In both women and men, there were no differences in clinical outcomes between the FFR- and IVUS-guided strategies. CONCLUSIONS In cases of intermediate stenosis, despite receiving fewer interventions, women had more favorable outcomes than men. The use of FFR led to a lower PCI rate but had a similar prognostic value compared with IVUS in both women and men.
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Affiliation(s)
- Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, China
| | - Jun Jiang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, China
| | - Yong Sun
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Changling Li
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Lingjun Zhu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Feng Gao
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Liang Dong
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Yabin Liu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Jian Shen
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Cheng Ni
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Kan Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Zexin Chen
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Haibo Chen
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Shiqiang Li
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Seokhun Yang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeehoon Kang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Doyeon Hwang
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Gangwon-Do, Republic of Korea
| | - Weon Kim
- Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jinyu Huang
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Jiang
- Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Hao Zhou
- The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Chen
- The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Wenbing Jiang
- The Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou, China
| | | | - Wenming He
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Sung Gyun Ahn
- Wonju Severance Christian Hospital, Wonju, Gangwon-Do, Republic of Korea
| | | | - Ung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | | | - You-Jeong Ki
- Uijeongbu Eulji Medical Center, Uijeongbu, Gyeonggi-Do, Republic of Korea
| | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Chee Hae Kim
- Veterans Health Service Medical Center, Seoul, Republic of Korea
| | | | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China.
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13
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Ahn JM, Kang DY, Lee PH, Ahn YK, Kim WJ, Nam CW, Jeong JO, Chae IH, Shiomi H, Kao PHL, Hahn JY, Her SH, Lee BK, Ahn TH, Chang K, Chae JK, Smyth D, Stone GW, Park DW, Park SJ. Preventive PCI or medical therapy alone for vulnerable atherosclerotic coronary plaque: Rationale and design of the randomized, controlled PREVENT trial. Am Heart J 2023; 264:83-96. [PMID: 37271356 DOI: 10.1016/j.ahj.2023.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Acute coronary syndromes are commonly caused by the rupture of vulnerable plaque, which often appear angiographically not severe. Although pharmacologic management is considered standard therapy for stabilizing plaque vulnerability, the potential role of preventive local treatment for vulnerable plaque has not yet been determined. The PREVENT trial was designed to compare preventive percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) with OMT alone in patients with functionally nonsignificant high-risk vulnerable plaques. METHODS The PREVENT trial is a multinational, multicenter, prospective, open-label, active-treatment-controlled randomized trial. Eligible patients have at least 1 angiographically significant stenosis (diameter stenosis >50% by visual estimation) without functional significance (fractional flow reserve [FFR] >0.80). Target lesions are assessed by intracoronary imaging and must meet at least 2 imaging criteria for vulnerable plaque; (1) minimal lumen area <4.0 mm2; (2) plaque burden >70%; (3) maximal lipid core burden index in a 4 mm segment >315 by near infrared spectroscopy; and (4) thin cap fibroatheroma as determined by virtual histology or optical coherence tomography. Enrolled patients are randomly assigned in a 1:1 ratio to either preventive PCI with either bioabsorbable vascular scaffolds or metallic everolimus-eluting stents plus OMT or OMT alone. The primary endpoint is target-vessel failure, defined as the composite of death from cardiac causes, target-vessel myocardial infarction, ischemic-driven target-vessel revascularization, or hospitalization for unstable or progressive angina, at 2 years after randomization. RESULTS Enrollment of a total of 1,608 patients has been completed. Follow-up of the last enrolled patient will be completed in September 2023 and primary results are expected to be available in early 2024. CONCLUSIONS The PREVENT trial is the first large-scale, randomized trial to evaluate the effect of preventive PCI on non-flow-limiting vulnerable plaques containing multiple high-risk features that is appropriately powered for clinical outcomes. PREVENT will provide compelling evidence as to whether preventive PCI of vulnerable plaques plus OMT improves patient outcomes compared with OMT alone. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT02316886. KEY POINTS The PREVENT trial is the first, large-scale randomized clinical trial to evaluate the effect of preventive PCI on non-flow-limiting vulnerable plaque with high-risk features. It will provide compelling evidence to determine whether PCI of focal vulnerable plaques on top of OMT improves patient outcomes.
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Affiliation(s)
- Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil Hyung Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Keun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA University Ilsan Medical Center, Goyang, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Korea
| | - In-Ho Chae
- Division of Cardiology, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Hiroki Shiomi
- Division of Cardiology, Kyoto University Hospital, Kyoto, Japan
| | - Paul Hsien Li Kao
- Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Joo-Yong Hahn
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Sung-Ho Her
- Department of Cardiology, St. Vincent's Hospital, Suwon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Tae Hoon Ahn
- Department of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Kiyuk Chang
- Division of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jei Keon Chae
- Division of Cardiology, Chonbuk National University Medical School, Jeonju, Korea
| | - David Smyth
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, Zena and Michael A. Wiener Cardiovascular Institute, New York, NY
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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14
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Youn YJ, Lee JW, Ahn SG, Lee SH, Yoon J, Park JH, Yoo SY, Kang WC, Lee NH, Kwon KH, Doh JH, Lim SW, Jang YS, Jeon DW, Heo JH, Choi WG, Cho S, Lee BK, Jeong H, Hong BK, Choi HH. Clinical safety and effectiveness of the Genoss drug-eluting stent in real-world clinical practice. Korean J Intern Med 2023; 38:683-691. [PMID: 37423255 PMCID: PMC10493452 DOI: 10.3904/kjim.2023.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND/AIMS The Genoss DES™ is a novel, biodegradable, polymer-coated, sirolimus-eluting stent with a cobalt- chromium stent platform and thin strut. Although the safety and effectiveness of this stent have been previously investigated, real-world clinical outcomes data are lacking. Therefore, the aim of this prospective, multicenter trial was to evaluate the clinical safety and effectiveness of the Genoss DES™ in all-comer patients undergoing percutaneous coronary intervention. METHODS The Genoss DES registry is a prospective, single-arm, observational trial for evaluation of clinical outcomes after Genoss DES™ implantation in all-comer patients undergoing percutaneous coronary intervention from 17 sites in South Korea. The primary endpoint was a device-oriented composite outcome of cardiac death, target vessel-related myocardial infarction (MI), and clinically driven target lesion revascularization (TLR) at 12 months. RESULTS A total of 1,999 patients (66.4 ± 11.1 years of age; 72.8% male) were analyzed. At baseline, 62.8% and 36.7% of patients had hypertension and diabetes, respectively. The implanted stent number, diameter, and length per patient were 1.5 ± 0.8, 3.1 ± 0.5 mm, and 37.0 ± 25.0 mm, respectively. The primary endpoint occurred in 1.8% patients, with a cardiac death rate of 1.1%, target vessel-related MI rate of 0.2%, and clinically driven TLR rate of 0.8%. CONCLUSION In this real-world registry, the Genoss DES™ demonstrated excellent safety and effectiveness at 12 months among all-comer patients undergoing percutaneous coronary intervention. These findings suggest that the Genoss DES™ may be a viable treatment option for patients with coronary artery disease.
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Affiliation(s)
- Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Sang-Yong Yoo
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung,
Korea
| | - Woong Chol Kang
- Department of Cardiology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
| | - Nam Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul,
Korea
| | - Ki Hwan Kwon
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul,
Korea
| | - Joon Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang,
Korea
| | - Sang-Wook Lim
- Division of Cardiology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam,
Korea
| | - Yang Soo Jang
- Division of Cardiology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam,
Korea
| | - Dong Woon Jeon
- Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan,
Korea
| | - Woong Gil Choi
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Sungsoo Cho
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong,
Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon,
Korea
| | - Hyonju Jeong
- Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University Medical Center, Goyang,
Korea
| | - Bum-Kee Hong
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Hyun-Hee Choi
- Division of Cardiology, Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon,
Korea
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15
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Seo JH, Kim KH, Chun KJ, Lee BK, Cho BR, Ryu DR. How can progression be predicted in patients with mild to moderate aortic valve stenosis? Eur Heart J Cardiovasc Imaging 2023; 24:1146-1153. [PMID: 37159331 DOI: 10.1093/ehjci/jead099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 05/11/2023] Open
Abstract
AIMS The pressure increase per time unit (dP/dt) in aortic stenosis (AS) jet velocity is assumed to have inter-individual variability in the progressive AS stage. We sought to examine the association of aortic valve (AoV) Doppler-derived dP/dt in patients with mild to moderate AS with risk of progression to severe disease. METHODS AND RESULTS A total of 481 patients diagnosed with mild or moderate AS [peak aortic jet velocity (Vmax) between 2 and 4 m/s] according to echocardiographic criteria were included. AoV Doppler-derived dP/dt was determined by measuring the time needed for the pressure to increase at a velocity of the AoV jet from 1 m/s to 2 m/s. During a median follow-up period of 2.7 years, 12 of 404 (3%) patients progressed from mild to severe AS and 31 of 77 (40%) patients progressed from moderate to severe AS. AoV Doppler-derived dP/dt had a good ability to predict risk of progression to severe AS (area under the curve = 0.868) and the cut-off value was 600 mmHg/s. In multivariable logistic regression, initial AoV calcium score (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.18-2.73; P = 0.006) and AoV Doppler-derived dP/dt (aOR, 1.52/100 mmHg/s higher dP/dt; 95% CI, 1.10-2.05; P = 0.012) were associated with progression to severe AS. CONCLUSION AoV Doppler-derived dP/dt above 600 mmHg/s was associated with risk of AS progression to the severe stage in patients with mild to moderate AS. This may be useful in individualized surveillance strategies for AS progression.
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Affiliation(s)
- Jeong Hun Seo
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, 24289, Republic of Korea
| | - Kang Hee Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, 24289, Republic of Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, 24289, Republic of Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, 24289, Republic of Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, 24289, Republic of Korea
| | - Dong Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, 24289, Republic of Korea
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16
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Bang CY, Jeong C, Lee SH, Sung K, Lee BK, Lee SY. Salvage percutaneous transluminal angioplasty of the superficial femoral artery in the diabetic foot with deteriorating limb ischemia. Wounds 2023; 35:E261-E264. [PMID: 37643452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
INTRODUCTION PAD frequently co-occurs with diabetes, often leading to chronic nonhealing wounds. Foot gangrene and amputation are common outcomes of untreated CLI. CASE REPORT A 67-year-old male with diabetes and deteriorating limb ischemia following surgical stress underwent successful surgical repair after emergency PTA of the SFA for extensive heel necrosis. After surgical debridement of necrotic heel tissue, the ABI on the affected side suddenly reduced to 0.36, but it improved to 1.06 at 4 weeks following stenting angioplasty, allowing the subsequent flap surgery to repair the heel defect. At the 1-year follow-up visit, the patient exhibited durable heel coverage and the restoration of weightbearing function. No signs or symptoms indicative of restenosis were evident in the blood vessel treated with stent angioplasty. CONCLUSION This case highlights the importance of proper evaluation of critical ischemic conditions and the need for prompt endovascular interventions in preserving the at-risk diabetic foot.
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Affiliation(s)
- Chi Young Bang
- Department of Plastic and Reconstructive Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Chanho Jeong
- Department of Plastic and Reconstructive Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Seung Ho Lee
- Department of Plastic and Reconstructive Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Kunyong Sung
- Department of Plastic and Reconstructive Surgery, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sang-Yeul Lee
- Department of Plastic and Reconstructive Surgery, Kangwon National University Hospital, Chuncheon, Korea
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Seo JH, Kim KH, Chun KJ, Lee BK, Cho BR, Ryu DR. Impact of low-density lipoprotein cholesterol on progression of aortic valve sclerosis and stenosis. Front Cardiovasc Med 2023; 10:1171703. [PMID: 37529711 PMCID: PMC10390070 DOI: 10.3389/fcvm.2023.1171703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/08/2023] [Indexed: 08/03/2023] Open
Abstract
Background Little research has been assessed atherosclerotic risk factors at various stages of calcific aortic valve disease. This study sought to determine risk factors of patients with aortic valve sclerosis (AVS) and mild to moderate aortic stenosis (AS). Methods The study included 1,007 patients diagnosed with AVS or mild to moderate AS according to echocardiographic criteria. Patients were identified as a rapid progression group if the annualized difference in peak aortic jet velocity (Vmax) between two echocardiographic examinations was >0.08 m/s/yr in AVS and >0.3 m/s/yr in AS, respectively. We used multivariable logistic regression analyses to assess the factors associated with rapid disease progression or progression to severe AS. Results Among 526 AVS patients, higher LDL-C level (odds ratio [OR] 1.22/per 25 mg/dl higher LDL-C, 95% confidence interval [CI] 1.05-1.43) was significantly associated with rapid disease progression. Compared to patients with LDL-C level <70 mg/dl, the adjusted OR for rapid progression were 1.32, 2.15, and 2.98 for those with LDL-C level of 70-95 mg/dl, 95-120 mg/dl, and ≥120 mg/dl, respectively. Among 481 mild to moderate AS patients, the baseline Vmax (OR 1.79/per 0.5 m/s higher Vmax, 95% CI 1.18-2.70) was associated with rapid progression. Compared to patients with Vmax 2.0-2.5 m/s, the adjusted OR for rapid progression were 2.47, 2.78, and 3.49 for those with Vmax of 2.5-3.0 m/s, 3.0-3.5 m/s, and 3.5-4.0 m/s, respectively. LDL-C and baseline Vmax values were independently associated with progression to severe AS. Conclusion Atherosclerotic risk factors such as LDL-C were significantly associated with the rapid progression in AVS and baseline Vmax was important in the stage of mild to moderate AS.
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18
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Lee JM, Kim HK, Park KH, Choo EH, Kim CJ, Lee SH, Kim MC, Hong YJ, Ahn SG, Doh JH, Lee SY, Park SD, Lee HJ, Kang MG, Koh JS, Cho YK, Nam CW, Koo BK, Lee BK, Yun KH, Hong D, Joh HS, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Gwon HC, Hahn JY. Fractional flow reserve versus angiography-guided strategy in acute myocardial infarction with multivessel disease: a randomized trial. Eur Heart J 2023; 44:473-484. [PMID: 36540034 DOI: 10.1093/eurheartj/ehac763] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/09/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS In patients with acute myocardial infarction (MI) and multivessel coronary artery disease, percutaneous coronary intervention (PCI) of non-infarct-related artery reduces death or MI. However, whether selective PCI guided by fractional flow reserve (FFR) is superior to routine PCI guided by angiography alone is unclear. The current trial sought to compare FFR-guided PCI with angiography-guided PCI for non-infarct-related artery lesions among patients with acute MI and multivessel disease. METHODS AND RESULTS Patients with acute MI and multivessel coronary artery disease who had undergone successful PCI of the infarct-related artery were randomly assigned to either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis of >50%) for non-infarct-related artery lesions. The primary end point was a composite of time to death, MI, or repeat revascularization. A total of 562 patients underwent randomization. Among them, 60.0% underwent immediate PCI for non-infarct-related artery lesions and 40.0% were treated by a staged procedure during the same hospitalization. PCI was performed for non-infarct-related artery in 64.1% in the FFR-guided PCI group and 97.1% in the angiography-guided PCI group, and resulted in significantly fewer stent used in the FFR-guided PCI group (2.2 ± 1.1 vs. 2.5 ± 0.9, P < 0.001). At a median follow-up of 3.5 years (interquartile range: 2.7-4.1 years), the primary end point occurred in 18 patients of 284 patients in the FFR-guided PCI group and in 40 of 278 patients in the angiography-guided PCI group (7.4% vs. 19.7%; hazard ratio, 0.43; 95% confidence interval, 0.25-0.75; P = 0.003). The death occurred in five patients (2.1%) in the FFR-guided PCI group and in 16 patients (8.5%) in the angiography-guided PCI group; MI in seven (2.5%) and 21 (8.9%), respectively; and unplanned revascularization in 10 (4.3%) and 16 (9.0%), respectively. CONCLUSION In patients with acute MI and multivessel coronary artery disease, a strategy of selective PCI using FFR-guided decision-making was superior to a strategy of routine PCI based on angiographic diameter stenosis for treatment of non-infarct-related artery lesions regarding the risk of death, MI, or repeat revascularization.
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Affiliation(s)
- Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea
| | - Keun Ho Park
- Chosun University Hospital, University of Chosun College of Medicine, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea
| | - Eun Ho Choo
- Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Chan Joon Kim
- Uijeongbu St. Mary's Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu, Gyeonggi-do 11765, Korea
| | - Seung Hun Lee
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea
| | - Min Chul Kim
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea
| | - Young Joon Hong
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea
| | - Sung Gyun Ahn
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon-do 26426, Korea
| | - Joon-Hyung Doh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang, Gyeonggi-do 10380, Korea
| | - Sang Yeub Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776 Sunhawn-ro, Cheongju, Chungcheongbuk-do 28644, Korea.,Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 501 Iljik-dong, Gwangmyeong, Gyeonggi-do 14353, Korea
| | - Sang Don Park
- Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea
| | - Hyun-Jong Lee
- Department of Internal Medicine, Sejong General Hospital, 20 Gyeyangmunhwa-ro, Gyeyang-gu, Incheon 21080, Korea
| | - Min Gyu Kang
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 501 Jinju-daero, Jinju, Gyeongsangnam-do 52727, Korea
| | - Jin-Sin Koh
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 501 Jinju-daero, Jinju, Gyeongsangnam-do 52727, Korea
| | - Yun-Kyeong Cho
- Keimyung University Dongsan Medical Center, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Bong-Ki Lee
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Baengnyeong-ro 156, Chuncheon, Gangwon-do 24289, Korea
| | - Kyeong Ho Yun
- Department of Internal Medicine, Wonkwang University Hospital, 895 Muwang-ro, Iksan, Jeollabuk-do 54538, Korea
| | - David Hong
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-guw, Seoul 06351, Korea
| | - Hyun Sung Joh
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ki Hong Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Taek Kyu Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Jeong Hoon Yang
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Seung-Hyuk Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea
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Ahn JM, Kang DY, Yun SC, Ho Hur S, Park HJ, Tresukosol D, Chol Kang W, Moon Kwon H, Rha SW, Lim DS, Jeong MH, Lee BK, Huang H, Hyo Lim Y, Ho Bae J, Ok Kim B, Kiam Ong T, Gyun Ahn S, Chung CH, Park DW, Park SJ. Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Artery Disease: Extended Follow-Up Outcomes of Multicenter Randomized Controlled BEST Trial. Circulation 2022; 146:1581-1590. [PMID: 36121700 DOI: 10.1161/circulationaha.122.062188] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents and coronary artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease. METHODS This prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stents or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early because of slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target vessel revascularization. RESULTS During a median follow-up of 11.8 years (interquartile range, 10.6-12.5 years; maximum, 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI, 0.88-1.56]; P=0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75-1.53]; P=0.70), as well as the occurrence of death from any cause (20.5% and 19.9%; HR, 1.04 [95% CI, 0.65-1.67]; P=0.86). However, spontaneous myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06-3.27]; P=0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95% CI, 1.58-2.32]; P<0.001) were more frequent after PCI than after CABG. CONCLUSIONS In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT05125367 and NCT00997828.
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Affiliation(s)
- Jung-Min Ahn
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, South Korea (S.H.H.)
| | - Hun-Jun Park
- Catholic University of Korea, Seoul St. Mary's Hospital (H.-J.P.)
| | | | - Woong Chol Kang
- Gachon University Gil Hospital, Incheon, South Korea (W.C.K.)
| | | | | | - Do-Sun Lim
- Korea University Anam Hospital, Seoul (D.-S.L.)
| | - Myung-Ho Jeong
- Chonnam National University Hospital, Gwangju, South Korea (M.-H.J.)
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, South Korea (B.-K.L.)
| | - He Huang
- Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China (H.H.)
| | - Young Hyo Lim
- Hanyang University Hospital, Seoul, South Korea (Y.H.L.)
| | - Jang Ho Bae
- Konyang University Hospital, Daejeon, South Korea (J.H.B.)
| | - Byung Ok Kim
- Inje University Sanggye Paik Hospital, Seoul, South Korea (B.O.K.)
| | - Tiong Kiam Ong
- Sarawak General Hospital, Kuching, Sarawak, Malaysia (T.K.O.)
| | - Sung Gyun Ahn
- Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea (S.G.A.)
| | - Cheol-Hyun Chung
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Heart Institute (J.-M.A., D.-Y.K., C.-H.C., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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20
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Lee S, Kim C, Kim H, Ahn SG, Cho S, Park JK, Moon JY, Won H, Suh Y, Cho JR, Cho YH, Oh SJ, Lee BK, Kime JS. Perioperative risk and benefit of antiplatelet therapy in patients undergoing non-cardiac surgery within 1 year after percutaneous coronary intervention with second-generation drug-eluting stents. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Antiplatelet therapy (APT) in patients undergoing non-cardiac surgery (NCS) after percutaneous coronary intervention (PCI) is still on debate due to its opposite effects which are to prevent from cardiovascular events and to cause bleeding. There is no apparent consensus on how to determine perioperative APT strategy within 1 year after PCI. Therefore, we investigated the risk and benefit of APT in NCS within 1 year after PCI.
Methods
Patients undergoing NCS after PCI with second-generation drug-eluting stents are retrospectively included from multicenter cohort of 8 medical centers in Korea. Perioperative clinical event within 30 days after NCS was recorded. Net adverse clinical event (NACE) including all cause death, major adverse cardiac event (MACE, a composite of cardiac death, myocardial infarction, and stent thrombosis) and major bleeding were evaluated. To overcome bias, propensity score covariate adjustment was performed using logistic regression analysis to generate propensity scores for patients of both APT strategies.
Results
Total 1130 patients (median age 69 years, female 30.5%) undergoing NCS within 1 year after PCI were eligible in the cohort. Study population included 55.1% patients suffered from ACS and 22.5% underwent complex PCI. NCS included 45.8% intermediate-to-high risk surgery and 10.7% urgent or emergent surgery. APT was continued during NCS in 62.7% of the patients. More patients continued DAPT (48% vs. 32%, p<0.001) among the patients who underwent NCS within 6 months after PCI than those who underwent NCS after 6 months. There were 49 NACE (4.3%), 16 MACE (1.4%) and 23 major bleeding events (2.0%), respectively. Continuing APT was associated with a lower risk of NACE (Adjusted hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.27–0.89; p=0.020)) and MACE (Adjusted HR, 0.35; 95 CI, 0.12–0.96; p=0.042). Subgroup analysis showed a tendency that continuing APT might be favorable than discontinuing APT in terms of MACE in patients who were diagnosed with ACS, underwent complex PCI, or underwent NCS within 6 months after PCI.
Conclusions
About two thirds of the patients were continuing APT during NCS. Our findings may support a careful consideration of APT continuation for some of the patients who are undergoing NCS within 1 year after PCI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Lee
- Yonsei University, Division of Cardiology , Seoul , Korea (Republic of)
| | - C Kim
- Ewha Womans University Seoul Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - H Kim
- NHIS Ilsan Hospital, Division of Cardiology , Goyang , Korea (Republic of)
| | - S G Ahn
- Wonju Severance Christian Hospital, Division of Cardiology , Wonju , Korea (Republic of)
| | - S Cho
- Dankook University, Division of Cardiovascular Medicine , Cheonan-si , Korea (Republic of)
| | - J K Park
- NHIS Ilsan Hospital, Division of Cardiology , Goyang , Korea (Republic of)
| | - J Y Moon
- Cha Bundang Medical Center, Department of Cardiology , Seongnam , Korea (Republic of)
| | - H Won
- Chung-Ang University Hospital, Cardiovascular & Arrhythmia Center , Seoul , Korea (Republic of)
| | - Y Suh
- Myongji Hospital, Department of Cardiology , Goyang , Korea (Republic of)
| | - J R Cho
- Kangnam Sacred Heart Hospital, Division of Cardiology , Seoul , Korea (Republic of)
| | - Y H Cho
- Myongji Hospital, Department of Cardiology , Goyang , Korea (Republic of)
| | - S J Oh
- NHIS Ilsan Hospital, Division of Cardiology , Goyang , Korea (Republic of)
| | - B K Lee
- Gangnam Severance Hospital, Division of Cardiology , Seoul , Korea (Republic of)
| | - J S Kime
- Yonsei University, Division of Cardiology , Seoul , Korea (Republic of)
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21
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Park DW, Kang DY, Ahn JM, Yun SC, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ. Routine Functional Testing or Standard Care in High-Risk Patients after PCI. N Engl J Med 2022; 387:905-915. [PMID: 36036496 DOI: 10.1056/nejmoa2208335] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-risk patients who have undergone percutaneous coronary intervention (PCI) is uncertain. METHODS We randomly assigned 1706 patients with high-risk anatomical or clinical characteristics who had undergone PCI to a follow-up strategy of routine functional testing (nuclear stress testing, exercise electrocardiography, or stress echocardiography) at 1 year after PCI or to standard care alone. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Key secondary outcomes included invasive coronary angiography and repeat revascularization. RESULTS The mean age of the patients was 64.7 years, 21.0% had left main disease, 43.5% had bifurcation disease, 69.8% had multivessel disease, 70.1% had diffuse long lesions, 38.7% had diabetes, and 96.4% had been treated with drug-eluting stents. At 2 years, a primary-outcome event had occurred in 46 of 849 patients (Kaplan-Meier estimate, 5.5%) in the functional-testing group and in 51 of 857 (Kaplan-Meier estimate, 6.0%) in the standard-care group (hazard ratio, 0.90; 95% confidence interval [CI], 0.61 to 1.35; P = 0.62). There were no between-group differences with respect to the components of the primary outcome. At 2 years, 12.3% of the patients in the functional-testing group and 9.3% in the standard-care group had undergone invasive coronary angiography (difference, 2.99 percentage points; 95% CI, -0.01 to 5.99), and 8.1% and 5.8% of patients, respectively, had undergone repeat revascularization (difference, 2.23 percentage points; 95% CI, -0.22 to 4.68). CONCLUSIONS Among high-risk patients who had undergone PCI, a follow-up strategy of routine functional testing, as compared with standard care alone, did not improve clinical outcomes at 2 years. (Funded by the CardioVascular Research Foundation and Daewoong Pharmaceutical; POST-PCI ClinicalTrials.gov number, NCT03217877.).
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Affiliation(s)
- Duk-Woo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Do-Yoon Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Min Ahn
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Sung-Cheol Yun
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Yong-Hoon Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Ho Hur
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Cheol Hyun Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Won-Jang Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Se Hun Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Chul Soo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Bong-Ki Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Won Suh
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung Han Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jae Woong Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Kee-Sik Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Si Wan Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Su Nam Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Jung Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
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Park DW, Kang DY, Ahn JM, Yun SC, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ. Routine Functional Testing or Standard Care in High-Risk Patients after PCI. N Engl J Med 2022. [PMID: 36036496 DOI: 10.1056/nejmoa2208335jonesd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-risk patients who have undergone percutaneous coronary intervention (PCI) is uncertain. METHODS We randomly assigned 1706 patients with high-risk anatomical or clinical characteristics who had undergone PCI to a follow-up strategy of routine functional testing (nuclear stress testing, exercise electrocardiography, or stress echocardiography) at 1 year after PCI or to standard care alone. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Key secondary outcomes included invasive coronary angiography and repeat revascularization. RESULTS The mean age of the patients was 64.7 years, 21.0% had left main disease, 43.5% had bifurcation disease, 69.8% had multivessel disease, 70.1% had diffuse long lesions, 38.7% had diabetes, and 96.4% had been treated with drug-eluting stents. At 2 years, a primary-outcome event had occurred in 46 of 849 patients (Kaplan-Meier estimate, 5.5%) in the functional-testing group and in 51 of 857 (Kaplan-Meier estimate, 6.0%) in the standard-care group (hazard ratio, 0.90; 95% confidence interval [CI], 0.61 to 1.35; P = 0.62). There were no between-group differences with respect to the components of the primary outcome. At 2 years, 12.3% of the patients in the functional-testing group and 9.3% in the standard-care group had undergone invasive coronary angiography (difference, 2.99 percentage points; 95% CI, -0.01 to 5.99), and 8.1% and 5.8% of patients, respectively, had undergone repeat revascularization (difference, 2.23 percentage points; 95% CI, -0.22 to 4.68). CONCLUSIONS Among high-risk patients who had undergone PCI, a follow-up strategy of routine functional testing, as compared with standard care alone, did not improve clinical outcomes at 2 years. (Funded by the CardioVascular Research Foundation and Daewoong Pharmaceutical; POST-PCI ClinicalTrials.gov number, NCT03217877.).
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Affiliation(s)
- Duk-Woo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Do-Yoon Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Min Ahn
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Sung-Cheol Yun
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Yong-Hoon Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Ho Hur
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Cheol Hyun Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Won-Jang Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Se Hun Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Chul Soo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Bong-Ki Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Won Suh
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung Han Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jae Woong Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Kee-Sik Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Si Wan Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Su Nam Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Jung Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
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Koo BK, Hu X, Kang J, Zhang J, Jiang J, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Ahn SG, Yoon MH, Kim U, Lee JM, Hwang D, Ki YJ, Shin ES, Kim HS, Tahk SJ, Wang J. Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI. N Engl J Med 2022; 387:779-789. [PMID: 36053504 DOI: 10.1056/nejmoa2201546] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In patients with coronary artery disease who are being evaluated for percutaneous coronary intervention (PCI), procedures can be guided by fractional flow reserve (FFR) or intravascular ultrasonography (IVUS) for decision making regarding revascularization and stent implantation. However, the differences in clinical outcomes when only one method is used for both purposes are unclear. METHODS We randomly assigned 1682 patients who were being evaluated for PCI for the treatment of intermediate stenosis (40 to 70% occlusion by visual estimation on coronary angiography) in a 1:1 ratio to undergo either an FFR-guided or IVUS-guided procedure. FFR or IVUS was to be used to determine whether to perform PCI and to assess PCI success. In the FFR group, PCI was to be performed if the FFR was 0.80 or less. In the IVUS group, the criteria for PCI were a minimal lumen area measuring either 3 mm2 or less or measuring 3 to 4 mm2 with a plaque burden of more than 70%. The primary outcome was a composite of death, myocardial infarction, or revascularization at 24 months after randomization. We tested the noninferiority of the FFR group as compared with the IVUS group (noninferiority margin, 2.5 percentage points). RESULTS The frequency of PCI was 44.4% among patients in the FFR group and 65.3% among those in the IVUS group. At 24 months, a primary-outcome event had occurred in 8.1% of the patients in the FFR group and in 8.5% of those in the IVUS group (absolute difference, -0.4 percentage points; upper boundary of the one-sided 97.5% confidence interval, 2.2 percentage points; P = 0.01 for noninferiority). Patient-reported outcomes as reported on the Seattle Angina Questionnaire were similar in the two groups. CONCLUSIONS In patients with intermediate stenosis who were being evaluated for PCI, FFR guidance was noninferior to IVUS guidance with respect to the composite primary outcome of death, myocardial infarction, or revascularization at 24 months. (Funded by Boston Scientific; FLAVOUR ClinicalTrials.gov number, NCT02673424.).
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Affiliation(s)
- Bon-Kwon Koo
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Xinyang Hu
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jeehoon Kang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jinlong Zhang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jun Jiang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Joo-Yong Hahn
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Chang-Wook Nam
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Joon-Hyung Doh
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Bong-Ki Lee
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Weon Kim
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jinyu Huang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Fan Jiang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Hao Zhou
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Peng Chen
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Lijiang Tang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Wenbing Jiang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Xiaomin Chen
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Wenming He
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Sung-Gyun Ahn
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Myeong-Ho Yoon
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Ung Kim
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Joo-Myung Lee
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Doyeon Hwang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - You-Jeong Ki
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Eun-Seok Shin
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Hyo-Soo Kim
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Seung-Jea Tahk
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jian'an Wang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
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Kim SH, Lim KR, Seo JH, Ryu DR, Lee BK, Cho BR, Chun KJ. Higher heart rate variability as a predictor of atrial fibrillation in patients with hypertension. Sci Rep 2022; 12:3702. [PMID: 35260686 PMCID: PMC8904557 DOI: 10.1038/s41598-022-07783-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/22/2022] [Indexed: 11/09/2022] Open
Abstract
The autonomic nervous system (ANS) plays an important role in the initiation and maintenance of atrial fibrillation (AF). However, the meaning of higher heart rate variability (HRV) in predicting AF remains unclear. Among 2100 patients in the Holter registry, a total of 782 hypertensive patients were included in this study. Baseline HRV was measured by time domain and frequency domain methods using 24-h Holter monitoring. The primary outcome was the development of AF. During an average follow-up of 1.1 years, 44 patients developed AF. Higher HRV parameters including high-frequency (P < 0.001), the square root of the mean squared differences of successive NN intervals (P < 0.001), and the percentage of NN intervals that are more than 50 ms different from the previous interval (P < 0.001) were associated with the occurrence of AF in univariate analysis. Premature atrial contractions burden, lower baseline heart rate, age, hemodialysis, coronary artery disease, and chronic heart failure were also associated with AF. In Cox regression analysis, higher HRV (representing excessive autonomic fluctuation) was an independent risk factor for AF. Excessive autonomic fluctuation represented by higher HRV in patients with hypertension was associated with an increased risk of AF.
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Affiliation(s)
- San Ha Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156, Baekryung-ro, Chuncheon, Gangwon-do, 24289, South Korea
| | - Kyoung Ree Lim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jeong-Hun Seo
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156, Baekryung-ro, Chuncheon, Gangwon-do, 24289, South Korea
| | - Dong Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156, Baekryung-ro, Chuncheon, Gangwon-do, 24289, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156, Baekryung-ro, Chuncheon, Gangwon-do, 24289, South Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156, Baekryung-ro, Chuncheon, Gangwon-do, 24289, South Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156, Baekryung-ro, Chuncheon, Gangwon-do, 24289, South Korea.
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25
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Ofori Dei SM, Christensen DR, Awosoga OA, Lee BK, Jackson AC. Correction to: A Composite Measure of Gambling Exposure: Availability, Accessibility or Both? J Gambl Stud 2021; 37:1311. [PMID: 33835402 DOI: 10.1007/s10899-021-10026-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S M Ofori Dei
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - D R Christensen
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada. .,Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia.
| | - O A Awosoga
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - B K Lee
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - A C Jackson
- Australian Centre for Heart Health, North Melbourne, Australia.,Faculty of Health, Deakin University, North Melbourne, Australia.,Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia.,Centre on Behavioral Health, University of Hong Kong, Hong Kong, China
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26
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Chung H, Park CH, Kim YJ, Kim JY, Min PK, Yoon YW, Lee KA, Lee BK, Hong BK, Kim TH, Rim SJ, Kwon HM, Choi EY. Myocardial extracellular space expansion is related to burden of premature ventricular contractions in patients with hypertrophic cardiomyopathy without non-sustained ventricular tachycardia. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Current guidelines suggest the presence of non-sustained ventricular tachycardia (NSVT) as a risk factor of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, high burden of premature ventricular contraction (PVC) may reflect myocardial fibrosis although the absence of NSVT.
Purpose
We investigated the association between PVC burden and myocardial extracellular space expansion in HCM patients without NSVT.
Methods
Of the 212 patients prospectively enrolled to the HCM registry of genetics, 84 patients were evaluated with both cardiac magnetic resonance and 24hr holter. Among them, 71 patients (58 males, mean age: 71 ± 13 years) have not been diagnosed with NSVT.
Results
Patients with NSVT (n = 13) showed more impaired LA functional indices and higher myocardial fibrosis burden compared with patients without NSVT (n = 71). Among patients who have not been diagnosed with NSVT, patients with late gadolinium enhancement (LGE, n = 46) had a higher total beats (109 ± 332 vs. 7 ± 13 beats per a day, p = 0.003) and burden (0.114 ± 0.225 vs. 0.008 ± 0.014 %, p = 0.003) of PVC during 24-hour compared with patients without LGE (n = 25). %LGE was correlated with total beats of PVC (r = 0.358, p = 0.002) and PVC burden (r = 0.377, p = 0.001). ECV also correlated with total beats of PVC (r = 0.387, p = 0.001) and PVC burden (r = 0.401, p = 0.001). The optimal cutoff value for PVC number was 45 (37.0% of sensitivity and 100% of specificity) with 0.733 of the area under the ROC curve (p < 0.001). Pathogenic or likely pathogenic sarcomere mutation was higher in NSVT group than no NSVT group (p < 0.05), and had a higher tendency in higher PVC burden group (0.05 < p < 0.1) than lower PVC burden group.
Conclusions
Total beats and burden of PVC are significantly related to increase in myocardial fibrosis in HCM patients without NSVT.
Abstract Figure. Mechanism of ventricular arrhythmia
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Affiliation(s)
- H Chung
- Kyung Hee Medical Center, Seoul, Korea (Republic of)
| | - CH Park
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - YJ Kim
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - JY Kim
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - PK Min
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - YW Yoon
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - KA Lee
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - BK Lee
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - BK Hong
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - TH Kim
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - SJ Rim
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - HM Kwon
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - EY Choi
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
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27
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Ofori Dei SM, Christensen DR, Awosoga OA, Lee BK, Jackson AC. The Relative and Interactive Effects of Actual and Perceived Gambling Exposure on Gambling Behaviour. J Gambl Stud 2021; 37:853-874. [PMID: 33481142 DOI: 10.1007/s10899-020-09991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
Actual and perceptual measures of gambling exposure are important predictors of problem gambling. This study used Zero-Inflated Poisson regression analyses to assess the relative and interactive effects of actual and perceived exposure on problem gambling risk and severity. Data from the 2008 and 2009 Social and Economic Impacts of Gambling in Alberta surveys indicated actual exposure was significantly associated with problem gambling risk while perceived exposure was significantly associated with problem gambling severity. These associations differ for gamblers from emerging and mature areas. Further, actual and perceived exposure had significant interaction effects on problem gambling severity but not on risk. Implications from these findings suggest that the prevalence of problem gambling could be reduced by restrictions on gambling opportunities.
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Affiliation(s)
- S M Ofori Dei
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - D R Christensen
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada. .,Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia.
| | - O A Awosoga
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - B K Lee
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - A C Jackson
- Australian Centre for Heart Health, North Melbourne, Australia.,Faculty of Health, Deakin University, Melbourne, Australia.,Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia.,Centre on Behavioural Health, University of Hong Kong, Pok Fu Lam, Hong Kong
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28
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Roh Y, Nam S, Lee BK, Ryu DR, Chun K, Lee KS, Cho N, Yoon Y, Park H, Cho BR, Kim JS. Radiation exposure of interventional cardiologists during coronary angiography: evaluation by phantom measurement and computer simulation. Phys Eng Sci Med 2020; 43:1279-1287. [DOI: 10.1007/s13246-020-00931-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
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29
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Lee KY, Lee BK, Kim WJ, Kang SH, Park TK, Kim SY, Suh JW, Yoon CH, Yang DH, Ryu SK, Kim SH, Lee SY, Chae IH. Consensus statement on coronary intervention during the coronavirus disease 19 pandemic: from the Korean Society of Interventional Cardiology. Korean J Intern Med 2020; 35:749-757. [PMID: 32668513 PMCID: PMC7373961 DOI: 10.3904/kjim.2020.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus 2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities; the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.
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Affiliation(s)
- Kwan Yong Lee
- Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Song-Yi Kim
- Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Heon Yang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sung Yun Lee
- Cardiac and Vascular Center, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to In-Ho Chae, M.D. Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7012 Fax: +82-31-787-4290 E-mail:
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30
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Yoon YH, Ahn JM, Kang DY, Park H, Cho SC, Lee PH, Hur SH, Kim WJ, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ, Park DW. Pragmatic trial comparing routine versus no routine functional testing in high-risk patients who underwent percutaneous coronary intervention: Rationale and design of POST-PCI trial. Am Heart J 2020; 224:156-165. [PMID: 32402702 DOI: 10.1016/j.ahj.2020.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/20/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although the need to detect restenosis has diminished in the contemporary practice of percutaneous coronary intervention (PCI) with drug-eluting stents (DES), the surveillance of ischemia owing to restenosis or disease progression deserves attention in high-risk PCI settings. It is unknown whether follow-up strategy of routine noninvasive functional testing potentially reduces the risk of major cardiovascular events in high-risk PCI patients. METHODS The POST-PCI study is an investigator-initiated, multicenter, prospective randomized trial comparing the effectiveness of two follow-up strategies in patients with high-risk anatomic or clinical characteristics who underwent PCI. Study participants were randomly assigned to either (1) the routine noninvasive stress testing (exercise electrocardiography, nuclear stress imaging, or stress echocardiography) at 12 months post-PCI or (2) the standard-care without routine testing. In the routine stress testing group, depending on the testing results, all clinical decisions regarding subsequent diagnostic or therapeutic procedures were at the treating physician's discretion. The primary endpoint was a composite outcome of death from any causes, myocardial infarction, or hospitalization for unstable angina at 2 years post-PCI. RESULTS More than 1700 high-risk PCI patients have been randomized over 2.0 years at 11 major cardiac centers in Korea. CONCLUSION This pragmatic POST-PCI trial will provide valuable clinical evidence on the effectiveness of follow-up strategy of routine noninvasive stress testing in high-risk PCI patients.
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31
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Kim JS, Lee BK, Ryu DR, Chun K, Kwon HS, Nam SR, Kim DI, Lee SY, Jeong JO, Bae JW, Park JS, Ahn Y, Chae JK, Yoon MH, Lee SH, Yoon J, Gwon HC, Choi D, Kwon SM, Roh YH, Cho BR. Occupational radiation exposure in femoral artery approach is higher than radial artery approach during coronary angiography or percutaneous coronary intervention. Sci Rep 2020; 10:7104. [PMID: 32346022 PMCID: PMC7188817 DOI: 10.1038/s41598-020-62794-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
Medical radiation exposure is a significant concern for interventional cardiologists (IC). This study was aimed at estimating the radiation exposure of IC operators and assistants in real clinical practice. The radiation exposure of the operator and assistant was evaluated by conducting two types of procedures via coronary angiography (CAG) and percutaneous coronary intervention (PCI) on 1090 patients in 11-cardiovascular centers in Korea. Radiation exposure was measured using an electronic personal dosimeter (EPD). EPD were attached at 3 points on each participant: on the apron on the left anterior chest (A1), under the apron on the sternum (A2), and on the thyroid shield (T). Average radiation exposure (ARE) of operators at A1, A2, and T was 19.219 uSv, 4.398 uSv, and 16.949 uSv during CAG and 68.618 uSv, 15.213 uSv, and 51.197 uSv during PCI, respectively. ARE of assistants at A1, A2, and T was 4.941 uSv, 0.860 uSv, and 5.232 uSv during CAG and 20.517 uSv, 4.455 uSv, and 16.109 uSv during PCI, respectively. AED of operator was 3.4 times greater during PCI than during CAG.
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Affiliation(s)
- Jung-Su Kim
- Department of Radiologic technology, Daegu Health College, Daegu, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Dong-Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Kwangjin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - Ho-Seok Kwon
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea
| | - So-Ra Nam
- Department of Health and Safety Convergence Science, College of Health Science, Korea University, Seoul, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Korea
| | - Sung-Yun Lee
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Inje University, College of Medicine, Goyang, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University, School of Medicine, Daegu, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University, School of Medicine, Chonnam, Korea
| | - Je-Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospita, Chonbuk National University, School of Medicine, Chonbuk, Korea
| | - Myeong-Ho Yoon
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Ajou University, School of Medicine, Kyeonggi, Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju, College of Medicine, Wonju, Korea
| | - Jeonghan Yoon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju, College of Medicine, Wonju, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon-Mu Kwon
- Department of Radiologic technology, Daegu Health College, Daegu, Korea
| | - Young-Hoon Roh
- Department of Health and Safety Convergence Science, College of Health Science, Korea University, Seoul, Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, School of Medicine, Chuncheon, Korea.
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32
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Kim JS, Lee BK, Ryu DR, Chun KJ, Choi HH, Roh Y, Kwon SM, Cho BR. A MULTICENTRE SURVEY OF LOCAL DIAGNOSTIC REFERENCE LEVELS AND ACHIEVABLE DOSE FOR CORONARY ANGIOGRAPHY AND PERCUTANEOUS TRANSLUMINAL CORONARY INTERVENTION PROCEDURES IN KOREA. Radiat Prot Dosimetry 2019; 187:378-382. [PMID: 31605144 DOI: 10.1093/rpd/ncz178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 06/24/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
Interventional cardiology procedures can involve relatively high radiation doses compared to general radiography. During coronary angiography (CAG) and percutaneous transluminal coronary intervention (PCI), the same area is exposed to radiation for a long period. In this study, radiation exposure data of 1071 examinations in Korean hospitals were collected, and the achievable dose (AD) and diagnostic reference levels (DRLs) in actual medical practice for two types of interventional cardiology procedures in Korea were established. In CAG, 75th percentile DRLs and AD of the total kerma-area product were 47.0 and 33.1 Gy·cm 2, respectively. In PCI, those values were 171.3 and 102.6 Gy·cm2, respectively. This is the first study to introduce the DRLs for cardiovascular interventional procedures in Korea. These results will help optimise the interventional cardiology procedures for Korean cardiac centres.
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Affiliation(s)
- Jung Su Kim
- Department of Radiologic Technology, Daegu Health College, Daegu 41453, Republic of Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
| | - Dong Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
| | - Hyun-Hee Choi
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Chunchoen Sacred Heart Hospital, Hallym University, Chuncheon 24253, Republic of Korea
| | - Younghoon Roh
- Department of Research & Development Integrated Medical Technology Team, Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju 28160, Republic of Korea
| | - Soon-Mu Kwon
- Department of Radiologic Technology, Daegu Health College, Daegu 41453, Republic of Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
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33
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Kim JS, Lee BK, Ryu DR, Chun KJ, Choi HH, Roh Y, Kwon SM, Cho BR. A MULTICENTRE SURVEY OF LOCAL DIAGNOSTIC REFERENCE LEVELS AND ACHIEVABLE DOSE FOR CORONARY ANGIOGRAPHY AND PERCUTANEOUS TRANSLUMINAL CORONARY INTERVENTION PROCEDURES IN KOREA. Radiat Prot Dosimetry 2019; 187:407. [PMID: 32032425 DOI: 10.1093/rpd/ncaa016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Jung Su Kim
- Department of Radiologic Technology, Daegu Health College, Daegu 41453, Republic of Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
| | - Dong Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
| | - Hyun-Hee Choi
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Chunchoen Sacred Heart Hospital, Hallym University, Chuncheon 24253, Republic of Korea
| | - Younghoon Roh
- Department of Research & Development Integrated Medical Technology Team, Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju 28160, Republic of Korea
| | - Soon-Mu Kwon
- Department of Radiologic Technology, Daegu Health College, Daegu 41453, Republic of Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
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Kim IS, Lee BK, Yang PS, Yu HT, Kim TH, Uhm JS, Pak HN, Lee MH, Kim JY, Joung B. P5660Clinical impact of polycythemia on cardiovascular outcome from the general population: a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although adverse effect of anemia had been reported, effect of polycythemia on cardiovascular outcome from the general population had not been revealed yet.
Methods
We included 451,107 subjects who received national health examinations from the Korean National Health Insurance Service-based National Sample Cohort from 2009–2013. Medical records were screened from January 2002 to investigate the subjects' disease-free baseline period. They were followed until December 2013. We divided male and female subjects into four categories each based on hemoglobin level (normal, moderate to severe and mild anemia, polycythemia) to assess each outcome.
Results
During 1,735,964 person·years, 12,107 major adverse cardiovascular and cerebrovascular events (MACCE), 862 incident acute myocardial infarction (MI), 5,850 incident ischemic stroke, and 2,430 incident atrial fibrillation (AF) were observed. Compared to normal hemoglobin range group, polycythemia group showed higher MACCE (HR=1.23 [1.12–1.35] in male, HR=1.79 [1.20–2.67] in female, each p<0.001), incident MI (HR=1.37 [1.05–1.79] in male, HR=3.46 [1.06–14.00] in female, each p<0.001), incident ischemic stroke (HR=1.27 [1.10–1.46] in male, HR=1.72 [1.02–2.91] in female, each p<0.001), and incident AF (HR=1.46 [1.21–1.74] in male, HR=2.13 [1.03–4.77] in female, each p<0.001). Each outcome was linearly increased with the increase of hemoglobin among subjects with polycythemia (p<0.001), and with the decrease of hemoglobin among subjects with anemia (each p<0.001, U-shaped relationship). These relationship was more profound in obese female younger than 60-year-old.
Conclusion
Not only anemia but also polycythemia were significantly associated with higher rate of MACCE including death, incident MI, ischemic stroke, and AF among the general population.
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Affiliation(s)
- I.-S Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - B K Lee
- Gangnam Severance Hospital, Cardiology Division, Seoul, Korea (Republic of)
| | - P S Yang
- Bundang CHA General Hospital, Cardiology Division, Seongnam, Korea (Republic of)
| | - H T Yu
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J Y Kim
- Gangnam Severance Hospital, Cardiology Division, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
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Won KB, Lee BK, Rizvi A, Hadamitzky M, Budoff MJ, Leipsic JA, Berman DS, Min JK, Chang HJ. P3380Longitudinal assessment of coronary atherosclerosis according to baseline and changes of serum hemoglobin level. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Little is known regarding the impact of serum hemoglobin level changes (Δ hemoglobin) on coronary plaque volume. This study evaluated the association between Δ hemoglobin and coronary plaque volume change (PVC) using serial coronary computed tomographic angiography (CCTA).
Methods
A total of 830 subjects (61±10 years, 51.9% male) who underwent serial CCTA with available hemoglobin levels were analyzed from the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. The median inter-scan period was 3.2 (2.5 to 4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were stratified into four groups based on the quartile of baseline hemoglobin levels. Annualized PVC was defined as total PVC divided by inter-scan period. Plaque progression (PP) was defined as plaque volume at follow-up minus plaque volume at index >0.
Results
Baseline total plaque volume (mm3) was not different among all groups (group I [lowest]: 34.1 (0.0–127.4) vs. group II: 28.8 (0.0–123.0) vs. group III: 49.9 (5.6–135.0) vs. group IV [highest]: 34.3 (0.0–130.7); p=0.235). During follow-up, Δ hemoglobin was related to annualized PVC (β:−0.114; p=0.001) and PP (odds ratio: 0.868; 95% confidence interval: 0.770–0.978; p=0.020). Multiple linear regression models showed that Δ hemoglobin significantly impacted on annualized PVC in only the composite of I and II groups.
Conclusion
Based on serial CCTA findings, Δ hemoglobin independently impacted on coronary PVC in individuals with low to normal baseline hemoglobin level.
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Affiliation(s)
- K.-B Won
- Ulsan University Hospital, Cardiology, Ulsan, Korea (Republic of)
| | - B K Lee
- Gangnam Severance Hospital, Cardiology, Seoul, Korea (Republic of)
| | - A Rizvi
- Ulsan University Hospital, Cardiology, Ulsan, Korea (Republic of)
| | | | - M J Budoff
- University of California Los Angeles, Los Angeles, United States of America
| | | | - D S Berman
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - J K Min
- Weill Cornell Medical College, New York, United States of America
| | - H.-J Chang
- Yonsei Cardiovascular Center, Cardiology, Seoul, Korea (Republic of)
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Lee SW, Lee PH, Ahn JM, Park DW, Yun SC, Han S, Kang H, Kang SJ, Kim YH, Lee CW, Park SW, Hur SH, Rha SW, Her SH, Choi SW, Lee BK, Lee NH, Lee JY, Cheong SS, Kim MH, Ahn YK, Lim SW, Lee SG, Hiremath S, Santoso T, Udayachalerm W, Cheng JJ, Cohen DJ, Muramatsu T, Tsuchikane E, Asakura Y, Park SJ. Randomized Trial Evaluating Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion. Circulation 2019; 139:1674-1683. [DOI: 10.1161/circulationaha.118.031313] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Seung-Whan Lee
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Pil Hyung Lee
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Cheol Yun
- Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Korea (S.H.)
| | - Heejun Kang
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Whan Lee
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Ho Hur
- Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.)
| | - Seung-Woon Rha
- Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.)
| | - Sung-Ho Her
- Department of Cardiology, The Catholic University of Korea, Daejeon St. Mary’s Hospital (S.-H.H.)
| | - Si Wan Choi
- Department of Cardiology, Chungnam National University Hospital, Daejeon, Korea (S.W.C.)
| | - Bong-Ki Lee
- Department of Cardiology, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.)
| | - Nae-Hee Lee
- Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Korea (N.-H.L.)
| | - Jong-Young Lee
- Department of Cardiology, Kangbuk Samsung Medical Center, Seoul, Korea (J.-Y.L.)
| | - Sang-Sig Cheong
- Department of Cardiology, Gangneung Asan Hospital, Korea (S.-S.C.)
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea (M.H.K.)
| | - Young-Keun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea (Y.-K.A.)
| | - Sang Wook Lim
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Korea (S.W.L.)
| | - Sang-Gon Lee
- Department of Cardiology, Ulsan University Hospital, Korea (S.-G.L.)
| | | | - Teguh Santoso
- Department of Cardiology, Medistra Hospital, Jakarta, Indonesia (T.S.)
| | - Wasan Udayachalerm
- Department of Cardiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand (W.U.)
| | - Jun Jack Cheng
- Department of Cardiology, Shin Kong Hospital, Taipei, Taiwan (J.J.C.)
| | - David J. Cohen
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | | | | | - Yasushi Asakura
- Department of Cardiology, Hakujikai Memorial Hospital, Tokyo, Japan (Y.A.)
| | - Seung-Jung Park
- Department of Cardiology (S-W.L., P.H.L., J.-M.A., D.-W.P., H.K., S.-J.K., Y.-H.K., C.W.L., S.-W.P., S.-J.P.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lee BK, Chang JH. Online Steepest Descent Optimization of Muting Technique Parameters in ITU-T G.722 Frame Erasure Concealment. ACTA ACUST UNITED AC 2019. [DOI: 10.3813/aaa.919317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Seo JH, Chun KJ, Lee BK, Cho BR, Ryu DR. Statins Have No Role in Preventing the Progression of Aortic Valve Sclerosis. J Cardiovasc Imaging 2018; 26:229-237. [PMID: 30607391 PMCID: PMC6310758 DOI: 10.4250/jcvi.2018.26.e27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/30/2018] [Accepted: 11/20/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Statins are thought to have little effect on the progression of aortic stenosis, but the data on their role in patients with aortic valve sclerosis (AVS) are limited and inconsistent. METHODS We retrospectively analyzed 541 consecutive patients (214 men, age: 70 ± 11 years) with AVS. Each patient underwent two or more electrocardiography examinations at least 6 months apart at Kangwon National University Hospital from August 2010 to August 2015. AVS is defined as irregular thickening of the leaflets, focal increases in echogenicity and minimal elevation of the peak aortic valve velocity (> 1.5 and < 2 m/s). The progression rate of AVS was expressed as the increase in peak velocity per year (m/s/yr). RESULTS The mean follow-up duration was 24.9 ± 13.3 months in the statin-treated group and 24.1 ± 12.4 months in the non-statin-treated group (p = 0.460). There were no differences between the statin-treated and non-statin-treated groups in mean age, gender or smoking status. Relative to the non-statin-treated group, a higher number of patients in the statin-treated group had hypertension, diabetes, ischemic heart disease, and stroke. The progression rate of AVS did not differ between the statin-treated and non-statin-treated groups (0.012 ± 0.340 m/s/yr vs. 0.014 ± 0.245 m/s/yr, p = 0.956). Multivariate analysis showed initial peak aortic jet velocity was significantly associated with AVS progression (β = 0.153, p = 0.009). CONCLUSIONS Our study demonstrated that statins had no effect on the progression of AVS. However, well-designed studies are needed to define the prognosis and management of AVS.
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Affiliation(s)
- Jeong-Hun Seo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Kwang-Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Dong Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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Won KB, Kim HC, Lee BK, Chang HJ. P738Association between insulin resistance estimated by triglyceride glucose index and arterial stiffness. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K B Won
- Ulsan University Hospital, Cardiology, Ulsan, Korea Republic of
| | - H C Kim
- Yonsei University College of Medicine, Preventive Medicine, Seoul, Korea Republic of
| | - B K Lee
- Gangnam Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - H J Chang
- Yonsei Cardiovascular Center, Cardiology, Seoul, Korea Republic of
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40
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Won KB, Lee SE, Lee BK, Sung JM, Park HB, Heo R, Hadamitzky M, Rizvi A, Kim YJ, Conte E, Andreini D, Budoff MJ, Leipsic JA, Min JK, Chang HJ. P2485Longitudinal quantitative assessment of coronary plaque progression related to glycemic status using serial coronary computed tomography angiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K B Won
- Ulsan University Hospital, Cardiology, Ulsan, Korea Republic of
| | - S E Lee
- Yonsei Cardiovascular Center, Cardiology, Seoul, Korea Republic of
| | - B K Lee
- Gangnam Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - J M Sung
- Yonsei Cardiovascular Center, Cardiology, Seoul, Korea Republic of
| | - H B Park
- International St. Mary's Hospital, Cardiology, Incheon, Korea Republic of
| | - R Heo
- Weill Cornell Medical College, Cardiovascular Imaging, New York, United States of America
| | - M Hadamitzky
- German Heart Center of Munich, Radiology, Munich, Germany
| | - A Rizvi
- Weill Cornell Medical College, Cardiovascular Imaging, New York, United States of America
| | - Y J Kim
- Seoul National University Hospital, Cardiology, Seoul, Korea Republic of
| | - E Conte
- Cardiology Center Monzino IRCCS, Medicine, Milan, Italy
| | - D Andreini
- Cardiology Center Monzino IRCCS, Medicine, Milan, Italy
| | - M J Budoff
- Harbor UCLA Medical Center, Medicine, Los Angeles, United States of America
| | - J A Leipsic
- St Paul's Hospital, Radiology, Vancouver, Canada
| | - J K Min
- Weill Cornell Medical College, Cardiovascular Imaging, New York, United States of America
| | - H J Chang
- Yonsei Cardiovascular Center, Cardiology, Seoul, Korea Republic of
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Kang J, Koo BK, Hu X, Lee JM, Hahn JY, Yang HM, Shin ES, Nam CW, Doh JH, Lee BK, Ahn C, Wang J, Tahk SJ. Comparison of Fractional FLow Reserve And Intravascular ultrasound-guided Intervention Strategy for Clinical OUtcomes in Patients with InteRmediate Stenosis (FLAVOUR): Rationale and design of a randomized clinical trial. Am Heart J 2018; 199:7-12. [PMID: 29754669 DOI: 10.1016/j.ahj.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/02/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coronary angiography has limitations in defining the ischemia-causing stenotic lesion, especially in cases with intermediate coronary stenosis. Fractional flow reserve (FFR) is a current standard method to define the presence of ischemia, and intravascular ultrasound (IVUS) is the most commonly used invasive imaging tool that can provide the lesion geometry and can provide the information on plaque vulnerability. The primary aim of this study is to compare the safety and efficacy of FFR-guided and IVUS-guided percutaneous coronary intervention (PCI) strategies in patients with intermediate coronary stenosis. TRIAL DESIGN Comparison of Fractional FLow Reserve And Intravascular ultrasound-guided Intervention Strategy for Clinical OUtcomes in Patients with InteRmediate Stenosis (FLAVOUR) trial is an international, multicenter, prospective, randomized clinical trial. A total of 1,700 consecutive patients with intermediate stenosis (40%-70% by visual estimation) in a major epicardial coronary artery will be randomized 1:1 to receive either FFR-guided or IVUS-guided PCI strategy. Patients will be treated with PCI according to the predefined criteria for revascularization; FFR ≤ 0.80 in the FFR-guided group and Minimal Lumen Area (MLA) ≤3 mm2 (or 3 mm2<MLA ≤4 mm2 and plaque burden >70%) in the IVUS-guided group. The primary end point is the patient-oriented composite outcome, which is a composite of all-cause death, myocardial infarction, and any repeat revascularization at 24months after randomization. We will test noninferiority of current standard FFR-guided PCI strategy compared with IVUS-guided decision for PCI and stent optimization strategy. CONCLUSION The FLAVOUR trial will compare the safety and efficacy of FFR- and IVUS-guided PCI strategies in patients with intermediate coronary stenosis. This study will provide an insight on optimal evaluation and treatment strategy for patients with intermediate coronary stenosis.
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Lee BK, Lee HY, Ryu HH, Jeung KW. Continuous Renal Replacement Therapy in a Patient with Cardiac Arrest after Glyphosate-Surfactant Herbicide Poisoning. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intractable hypotension is a major cause of death after glyphosate-surfactant herbicide poisoning. However, there is no specific treatment besides conservative care. Herein, we report a patient poisoned by glyphosate-surfactant herbicide experiencing cardiac arrest but was successfully resuscitated and treated with continuous venovenous haemodiafiltration (CVVHDF). The 60-year-old patient was brought to our emergency department after ingesting glyphosate-surfactant herbicide. He developed pulmonary oedema, severe metabolic acidosis (pH 6.960), and hyperkalaemia (serum potassium 8.8 mmol/L). Although he experienced cardiac arrest for about 12 minutes, the use of CVVHDF improved the metabolic acidosis and hyperkalaemia, and finally stabilised his vital signs. He regained an alert mental state after therapeutic hypothermia. CVVHDF, which is a better tolerated renal replacement therapy than haemodialysis in haemodynamically unstable patients, should be considered in glyphosate-surfactant poisoned patients of intractable hypotension with severe metabolic acidosis or hyperkalaemia.
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Lee DH, Lee BK. Performance of the simplified acute physiology score III in acute organophosphate poisoning: A retrospective observational study. Hum Exp Toxicol 2017; 37:221-228. [DOI: 10.1177/0960327117698541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The performances of acute physiology and chronic health evaluation (APACHE) II and simplified acute physiology score (SAPS) II have previously been evaluated in acute organophosphate poisoning. We aimed to compare the performance of the SAPS III with those of the APACHE II and SAPS II, as well as to identify the best tool for predicting case fatality using the standardized mortality ratios (SMRs) in acute organophosphate poisoning. A retrospective analysis of organophosphate poisoning was conducted. The APACHE II, SAPS II, and SAPS III were calculated within 24 h of admission. Discrimination was evaluated by calculating the area under the receiver operating characteristic curve (AUROC). The SMRs were calculated as 95% confidence intervals (CIs). In total, 100 cases of organophosphate poisoning were included. The in-hospital case fatality was 19%. The median scores of the APACHE II, SAPS II, and SAPS III were 20.0 (10.0–27.0), 41.0 (28.0–54.8), and 53.0 (36.3–68.8), respectively. The AUROCs were not significantly different among the APACHE II (0.815; 95% CI, 0.712–0.919), SAPS II (0.820; 95% CI, 0.719–0.912), and SAPS III (0.850; 95% CI, 0.763–0.936). Based on these scores and in-hospital case fatality, the SMRs for the APACHE II, SAPS II, and SAPS III were 1.01 (95% CI, 0.50–2.72), 1.01 (95% CI, 0.54 -2.78), and 0.98 (95% CI, 0.33–1.99), respectively. The SAPS III provided a good discrimination and satisfactory calibration in acute organophosphate poisoning. It was therefore a useful tool in predicting case fatality in acute organophosphate poisoning, similar to the APACHE II and SAPS II.
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Affiliation(s)
- DH Lee
- Department of Emergency Medicine, Chonnam University Hospital, Dong-gu, Gwangju, Republic of Korea
| | - BK Lee
- Department of Emergency Medicine, Chonnam University Hospital, Dong-gu, Gwangju, Republic of Korea
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Roh YH, Lee BK, Baek JR, Park MH, Noh JH, Gong HS, Baek GH. Effect of metabolic syndrome on the outcome of corticosteroid injection for carpal tunnel syndrome. J Hand Surg Eur Vol 2016; 41:963-969. [PMID: 27313183 DOI: 10.1177/1753193416654447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Diffuse peripheral nerve impairment is common in metabolic syndrome: in patients with metabolic syndrome and carpal tunnel syndrome this might affect the outcome of treatment by local corticosteroid injection. A total of 55 consecutive patients with carpal tunnel syndrome and metabolic syndrome treated with corticosteroid injection (10 mg triamcinolone acetonide) were age and sex matched with 55 control patients without metabolic syndrome. Grip strength, perception of touch with Semmes-Weinstein monofilaments and Boston Carpal Tunnel Questionnaires were assessed at the baseline and at 6, 12 and 24 weeks follow-up. The two groups had similar pre-operative grip strength and Boston Carpal Tunnel Questionnaire scores. The Boston Carpal Tunnel Questionnaire symptom and function scores of the metabolic syndrome group were significantly greater than the control group at 12 and 24 weeks follow-up. Except for significantly greater grip strength at the 12-week follow-up in the control group, there were no significant differences in grip strength between the groups. Semmes-Weinstein monofilament sensory index for the control group was significantly greater than that of the metabolic syndrome group throughout the 24-week follow-up. After 24 weeks, five patients (13%) in the control group and 13 patients (27%) in the metabolic syndrome group had had carpal tunnel surgery. Patients with metabolic syndrome are at risk for poor functional outcome and failure of treatment after corticosteroid injection for carpal tunnel syndrome. LEVEL OF EVIDENCE Treatment benefits III.
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Affiliation(s)
- Y H Roh
- 1 Department of Orthopaedic Surgery, Gachon University School of Medicine, Incheon, Korea.,Current affiliation: Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - B K Lee
- 1 Department of Orthopaedic Surgery, Gachon University School of Medicine, Incheon, Korea
| | - J R Baek
- 1 Department of Orthopaedic Surgery, Gachon University School of Medicine, Incheon, Korea
| | - M H Park
- 1 Department of Orthopaedic Surgery, Gachon University School of Medicine, Incheon, Korea
| | - J H Noh
- 2 Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, Korea
| | - H S Gong
- 3 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - G H Baek
- 3 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Park SH, Jeon KH, Lee JM, Nam CW, Doh JH, Lee BK, Rha SW, Yoo KD, Jung KT, Cho YS, Lee HY, Youn TJ, Chung WY, Koo BK. Long-Term Clinical Outcomes of Fractional Flow Reserve-Guided Versus Routine Drug-Eluting Stent Implantation in Patients With Intermediate Coronary Stenosis: Five-Year Clinical Outcomes of DEFER-DES Trial. Circ Cardiovasc Interv 2016; 8:e002442. [PMID: 26643736 DOI: 10.1161/circinterventions.115.002442] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to compare the long-term clinical outcomes between fractional flow reserve (FFR)-guided and routine drug-eluting stent (DES) implantation in patients with an intermediate coronary stenosis. METHODS AND RESULTS A total of 229 patients with an angiographically intermediate coronary stenosis were randomly assigned to FFR-guided or Routine-DES implantation group. For FFR-guided group (n=114), treatment strategy was determined according to the target vessel FFR (FFR<0.75: DES implantation [FFR-DES group]; FFR≥0.75: deferral of stenting [FFR-Defer group]). Routine-DES group underwent DES implantation without FFR measurement (n=115). The primary end point was the incidence of major adverse cardiac events, a composite of cardiac death, myocardial infarction, and target lesion revascularization. Of lesions assigned to FFR-guided strategy, only one quarter had functional significance (FFR<0.75). At 2-year follow-up, the cumulative incidence of major adverse cardiac events was 7.9±2.5% in the FFR-guided group and 8.8±2.7% in Routine-DES group (P=0.80). At 5-year follow-up, the cumulative incidence of major adverse cardiac events was 11.6±3.0% and 14.2±3.3% for the FFR-guided group and the Routine-DES group (P=0.55). There was no difference in major adverse cardiac events rates between the 2 groups ≤5-year follow-up (hazard ratio, 1.25; 95% confidence interval, 0.60-2.60). CONCLUSIONS In lesions with angiographically intermediate stenosis, FFR guidance provides a tailored approach, which is at least as good as an angiography-guided routine-DES implantation strategy and avoids unnecessary DES-stenting in a considerable part of the patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00592228.
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Affiliation(s)
- Sang Hyun Park
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Ki-Hyun Jeon
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Joo Myung Lee
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Chang-Wook Nam
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Joon-Hyung Doh
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Bong-Ki Lee
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Seung-Woon Rha
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Ki-dong Yoo
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Kyung Tae Jung
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Young-Seok Cho
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Hae-Young Lee
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Tae-Jin Youn
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Woo-Young Chung
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.)
| | - Bon-Kwon Koo
- From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
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Lee BK, Koo BK, Nam CW, Doh JH, Chung WY, Cho BR, Fearon WF. Does Pre-Treatment with High Dose Atorvastatin Prevent Microvascular Dysfunction after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome? Korean Circ J 2016; 46:472-80. [PMID: 27482255 PMCID: PMC4965425 DOI: 10.4070/kcj.2016.46.4.472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/23/2015] [Accepted: 08/13/2015] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives There is controversy surrounding whether or not high dose statin administration before percutaneous coronary intervention (PCI) decreases peri-procedural microvascular injury. We performed a prospective randomized study to investigate the mechanisms and effects of pre-treatment high dose atorvastatin on myocardial damage in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing PCI. Subjects and Methods Seventy seven patients with NSTE-ACS were randomly assigned to either the high dose group (atorvastatin 80 mg loading 12 to 24 h before PCI with a further 40 mg loading 2 h before PCI, n=39) or low dose group (atorvastatin 10 mg administration 12 to 24 h before PCI, n=38). Index of microcirculatory resistance (IMR) was measured after stent implantation. Creatine kinase-myocardial band (CK-MB) and high sensitivity C-reactive protein (CRP) levels were measured before and after PCI. Results The baseline characteristics were not different between the two patient groups. Compared to the low dose group, the high dose group had lower post PCI IMR (14.1±5.0 vs. 19.2±9.3 U, p=0.003). Post PCI CK-MB was also lower in the high dose group (median: 1.40 ng/mL (interquartile range [IQR: 0.75 to 3.45] vs. 4.00 [IQR: 1.70 to 7.37], p=0.002) as was the post-PCI CRP level (0.09 mg/dL [IQR: 0.04 to 0.16] vs. 0.22 [IQR: 0.08 to 0.60], p=0.001). Conclusion Pre-treatment with high dose atorvastatin reduces peri-PCI microvascular dysfunction verified by post-PCI IMR and exerts an immediate anti-inflammatory effect in patients with NSTE-ACS.
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Affiliation(s)
- Bong-Ki Lee
- Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bon-Kwon Koo
- Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Woo-Young Chung
- Division of Cardiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - William F Fearon
- Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA
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Abstract
Lead (Pb), an occupational and environmental toxicant, is known to induce immunomodulatory effects resulting in lowered resistance to infectious micro-organisms and altered levels of immunoglobulins in humans. Preferential activation of type-2 helper T cells and inhibition of type-1 T-cell activation is considered a cellular mechanism for the Pb-induced immune alteration, which has not been investigated well in humans. Lead's influence on in vivo balance between type-1 and type-2 activities was assessed among workers exposed to Pb through battery manufacturing in Korea. Serum IgE levels were significantly higher in the workers with a blood Pb level (PbB) of ≤30 μg/dL than in the workers with a PbB of <30 μg/dL. Furthermore, the serum IgE concentrations significantly correlated with PbB although no significant relationship between PbB and serum interleukin-4 or interferon gamma levels was observed. The present study indicates that elevation of IgE levels may be an immunologic index for Pb-induced in vivo toxicities, potentially involved with progression of various allergic diseases in humans.
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Affiliation(s)
- Y Heo
- Catholic University of Daegu, Department of Occupational Health, 330 Kumrak 1-ri, Hayang-eup, Kyongsan-si, Kyongbuk, Korea
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48
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Mohd Nasir N, Lee BK, Yap SS, Thong KL, Yap SL. Cold plasma inactivation of chronic wound bacteria. Arch Biochem Biophys 2016; 605:76-85. [PMID: 27046340 DOI: 10.1016/j.abb.2016.03.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/20/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
Abstract
Cold plasma is partly ionized non-thermal plasma generated at atmospheric pressure. It has been recognized as an alternative approach in medicine for sterilization of wounds, promotion of wound healing, topical treatment of skin diseases with microbial involvement and treatment of cancer. Cold plasma used in wound therapy inhibits microbes in chronic wound due to its antiseptic effects, while promoting healing by stimulation of cell proliferation and migration of wound relating skin cells. In this study, two types of plasma systems are employed to generate cold plasma: a parallel plate dielectric barrier discharge and a capillary-guided corona discharge. Parameters such as applied voltage, discharge frequency, treatment time and the flow of the carrier gas influence the cold plasma chemistry and therefore change the composition and concentration of plasma species that react with the target sample. Chronic wound that fails to heal often infected by multidrug resistant organisms makes them recalcitrant to healing. Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (Pseudomonas aeruginosa) are two common bacteria in infected and clinically non-infected wounds. The efficacies of the cold plasma generated by the two designs on the inactivation of three different isolates of MRSA and four isolates of P. aeruginosa are reported here.
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Affiliation(s)
- N Mohd Nasir
- Plasma Research Laboratory, Department of Physics, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - B K Lee
- Plasma Research Laboratory, Department of Physics, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - S S Yap
- Faculty of Engineering, Multimedia University, Cyberjaya, 63100, Selangor, Malaysia
| | - K L Thong
- Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - S L Yap
- Plasma Research Laboratory, Department of Physics, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Kim YH, Lee JH, Roh JH, Ahn JM, Yoon SH, Park DW, Lee JY, Yun SC, Kang SJ, Lee SW, Lee CW, Seung KB, Shin WY, Lee NH, Lee BK, Lee SG, Nam CW, Yoon J, Yang JY, Hyon MS, Lee K, Jang JS, Kim HS, Park SW, Park SJ. Randomized Comparisons Between Different Stenting Approaches for Bifurcation Coronary Lesions With or Without Side Branch Stenosis. JACC Cardiovasc Interv 2016; 8:550-60. [PMID: 25907082 DOI: 10.1016/j.jcin.2015.01.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/29/2014] [Accepted: 01/01/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to evaluate the optimal percutaneous coronary intervention techniques using drug-eluting stents for bifurcation coronary lesions. BACKGROUND The optimal bifurcation stenting technique needs to be evaluated. METHODS The trial included 2 randomization studies separated by the presence of side branch (SB) stenosis for patients having non-left main bifurcation lesions. For 306 patients without SB stenosis, the routine final kissing balloon or leave-alone approaches were compared. Another randomization study compared the crush or single-stent approaches for 419 patients with SB stenosis. RESULTS Between the routine final kissing balloon and leave-alone groups for nondiseased SB lesions, angiographic restenosis occurred in 17.9% versus 9.3% (p=0.064), comprising 15.1% versus 3.7% for the main branch (p=0.004) and 2.8% versus 5.6% for the SB (p=0.50) from 214 patients (69.9%) receiving 8-month angiographic follow-up. Incidence of major adverse cardiac events including death, myocardial infarction, or target vessel revascularization over 1 year was 14.0% versus 11.6% between the routine final kissing balloon and leave-alone groups (p=0.57). In another randomization study for diseased SB lesions, 28.2% in the single-stent group received SB stents. From 300 patients (71.6%) receiving angiographic follow-up, between the crush and single-stent groups, angiographic restenosis rate was 8.4% versus 11.0% (p=0.44), comprising 5.2% versus 4.8% for the main branch (p=0.90) and 3.9% versus 8.3% for the SB (p=0.12). One-year major adverse cardiac events rate between the crush and single-stent groups was 17.9% versus 18.5% (p=0.84). CONCLUSIONS Angiographic and clinical outcomes were excellent after percutaneous coronary intervention using drug-eluting stents with any stent technique for non-left main bifurcation lesions once the procedure was performed successfully.
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Affiliation(s)
- Young-Hak Kim
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Jae-Hwan Lee
- Chungnam National University Hospital, Daejeon, South Korea
| | - Jae-Hyung Roh
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Sung-Han Yoon
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Jong-Young Lee
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Asan Medical Center, Seoul, South Korea
| | - Soo-Jin Kang
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Seung-Whan Lee
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Cheol Whan Lee
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Ki Bae Seung
- Catholic University of Korea, St. Mary's Hospital, Seoul, South Korea
| | | | | | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, South Korea
| | - Sang-Gon Lee
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Junghan Yoon
- Yonsei University, Wonju Severance Christial Hospital, Wonju, South Korea
| | - Joo-Young Yang
- National Health Insurance Corporation, Ilsan Hospital, Ilsan, South Korea
| | - Min-Su Hyon
- Soonchunhyang University Hospital, Seoul, South Korea
| | - Keun Lee
- Veterans Hospital, Seoul, South Korea
| | | | - Hyun-Sook Kim
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Seong-Wook Park
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, Seoul, South Korea.
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50
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Tremmel JA, Fearon WF, Lee BK, Lim HS, Yong AS, Yamada R, Tanaka S, Lee DP, Yeung AC. Response to Letters Regarding Article, "Invasive Evaluation of Patients With Angina in the Absence of Obstructive Coronary Artery Disease". Circulation 2015; 132:e244. [PMID: 26572677 DOI: 10.1161/circulationaha.115.017741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Andy S Yong
- Department of Cardiology, Royal Prince Alfred and Concord Hospitals, University of Sydney, Sydney, Australia
| | - Ryotaro Yamada
- Department of Cardiology, Tokai University Oiso Hospital, Oiso, Japan
| | | | - David P Lee
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
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