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Kong MG, Suh J, Lee B, Park HW, Park SY, Moon I, Choi HO, Seo HS, Cho YH, Lee NH, Jang HJ, Kim TH, Kwon SW, Park SD, Oh PC, Moon J, Lee K, Kang WC. Hemo-metabolic impairment in patients with ST-segment elevation myocardial infarction: Data from the INTERSTELLAR registry. Cardiol J 2023:VM/OJS/J/93926. [PMID: 37964646 DOI: 10.5603/cj.93926] [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] [Received: 01/30/2023] [Revised: 08/16/2023] [Accepted: 09/22/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Not only hemo-dynamic (HD) factors but also hemo-metabolic (HM) risk factors reflecting multi-organ injuries are considered as important prognostic factors in ST-segment elevation myocardial infarction (STEMI). However, studies regarding HM risk factors in STEMI patients are currently limited. METHOD Under analysis were 1,524 patients with STEMI who underwent primary percutaneous coronary intervention in the INTERSTELLAR registry. Patients were divided into HM (≥ 2 risk factors) and non-HM impairment groups. The primary outcome was in-hospital all-cause mortality, and the secondary outcome was 1-year all-cause mortality. RESULTS Of 1,524 patients, 214 (14.0%) and 1,310 (86.0%) patients were in the HM and non-HM impairment groups, respectively. Patients with HM impairment had a higher incidence of in-hospital mortality than those without (24.3% vs. 2.7%, p < 0.001). After adjusting for confounders, HM impairment was independently associated with in-hospital mortality (inverse probability of treatment weighting [IPTW]-adjusted odds ratio: 1.81, 95% confidence interval: 1.08-3.14). In the third door-to-balloon (DTB) time tertile (≥ 82 min), HM impairment was strongly associated with in-hospital mortality. In the first DTB time tertile ( < 62 min), indicating relatively rapid revascularization, HM impairment was consistently associated with increased in-hospital mortality. CONCLUSIONS Hemo-metabolic impairment is significantly associated with increased risk of in-hospital and 1-year mortality in patients with STEMI. It remains a significant prognostic factor, regardless of DTB time.
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Affiliation(s)
- Min Gyu Kong
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jon Suh
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
| | - Bora Lee
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Hyun Woo Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Su Yeong Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Inki Moon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hyung Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hye-Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yoon Haeng Cho
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Nae-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Ho-Jun Jang
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Hanil General Hospital, Seoul, Republic of Korea
| | - Sung Woo Kwon
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Division of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jeonggeun Moon
- Division of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyounghoon Lee
- Division of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woong Chol Kang
- Division of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Park SY, Kong MG, Moon I, Park HW, Choi HO, Seo HS, Cho YH, Lee NH, Lee KY, Jang HJ, Kim JS, Choi IJ, Suh J. Clinical efficacy of angiotensin receptor-neprilysin inhibitor in de novo heart failure with reduced ejection fraction. Korean J Intern Med 2023; 38:692-703. [PMID: 37648226 PMCID: PMC10493438 DOI: 10.3904/kjim.2023.065] [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: 02/08/2023] [Revised: 04/22/2023] [Accepted: 06/09/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND/AIMS We aimed to analyze the efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) by the disease course of heart failure (HF). METHODS We evaluated 227 patients with HF in a multi-center retrospective cohort that included those with left ventricular ejection fraction (LVEF) ≤ 40% undergoing ARNI treatment. The patients were divided into patients with newly diagnosed HF with ARNI treatment initiated within 6 months of diagnosis (de novo HF group) and those who were diagnosed or admitted for HF exacerbation for more than 6 months prior to initiation of ARNI treatment (prior HF group). The primary outcome was a composite of cardiovascular death and worsening HF, including hospitalization or an emergency visit for HF aggravation within 12 months. RESULTS No significant differences in baseline characteristics were reported between the de novo and prior HF groups. The prior HF group was significantly associated with a higher primary outcome (23.9 vs. 9.4%) than the de novo HF group (adjusted hazard ratio 2.52, 95% confidence interval 1.06-5.96, p = 0.036), although on a higher initial dose. The de novo HF group showed better LVEF improvement after 1 year (12.0% vs 7.4%, p = 0.010). Further, the discontinuation rate of diuretics after 1 year was numerically higher in the de novo group than the prior HF group (34.4 vs 18.5%, p = 0.064). CONCLUSION The de novo HF group had a lower risk of the primary composite outcome than the prior HF group in patients with reduced ejection fraction who were treated with ARNI.
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Affiliation(s)
- Su Yeong Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Min Gyu Kong
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Inki Moon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyun Woo Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyung-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hye Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yoon Haeng Cho
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Nae-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho-Jun Jang
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Je Sang Kim
- Division of Cardiology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea
| | - Jon Suh
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Park KW, Kang J, Koo BK, Rhee TM, Yang HM, Won KB, Rha SW, Bae JW, Lee NH, Hur SH, Han JK, Shin ES, Kim HS. Aspirin vs. Clopidogrel as a Chronic maintenance monotherapy after PCI in patients with high ischemic risk and high bleeding risk: Subgroup analysis of the HOST-EXAM trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.074] [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.
OnBehalf
on behalf of the HOST-EXAM investigators
Background
The HOST-EXAM randomized clinical trial recently performed a comparison of clopidogrel monotherapy vs. aspirin monotherapy in patients requiring indefinite antiplatelet monotherapy after percutaneous coronary intervention (PCI). This study randomized 5,438 patients who maintained dual antiplatelet therapy without clinical events for 6–18 months after PCI with drug-eluting stents (DES) to receive a monotherapy agent of clopidogrel 75 mg once daily or aspirin 100 mg once daily for 24 months. During the 24-month follow-up, the primary outcome (a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater) rate was significantly lower in the clopidogrel group (hazard ratio [HR] 0.73 [95% CI 0.59–0.90]; p = 0.0035). However, it is uncertain whether the beneficial effect of clopidogrel will be consistent in patients with high ischemic risk or those with high bleeding risk.
Methods
This is a post-hoc analysis of the HOST-EXAM trial. A high ischemic risk was defined as those who had at least 1 of the following procedural features: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI, total stent length >60 mm, or left main PCI. Patients with high bleeding risk were defined according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. The co-primary outcome were thrombotic endpoints (a composite of cardiac death, non-fatal myocardial infarction, ischemic stroke, readmission due to acute coronary syndrome, and definite or probable stent thrombosis) and bleeding endpoints (BARC type ≥2 bleeding events) at 24-month follow-up.
Results
Among the total population, 22.1% had high ischemic risk and 21.4% had high bleeding risk. Complex PCI was not associated with a higher risk of thrombotic endpoints, nor bleeding endpoints. For patients with a high bleeding risk, these patients had a higher risk of both thrombotic endpoints (HR 1.545, 95% CI 0.141-2.092, p = 0.005) and bleeding endpoints (HR 3.418, 95% CI 2.413-4.840, p < 0.001). The primary results focusing on the interaction between high ischemic risk, high bleeding and the antiplatelet regimen will be presented.
Conclusion
The current post-hoc analysis of the HOST-EXAM trial will evaluate the efficacy of clopidogrel monotherapy vs. aspirin monotherapy during the chronic maintenance period after PCI, in patients with high ischemic risk or those with high bleeding risk.
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Affiliation(s)
- K W Park
- Chungbuk National University Hospital, Cheongju, Korea (Republic of)
| | - J Kang
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - B K Koo
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - T M Rhee
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - H M Yang
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - K B Won
- Ulsan University Hospital, Ulsan, Korea (Republic of)
| | - S W Rha
- Korea University Guro Hospital, Seoul, Korea (Democratic People"s Republic of)
| | - J W Bae
- Chungbuk National University Hospital, Cheongju, Korea (Republic of)
| | - N H Lee
- Hangang Sacred Hospital, Seoul, Korea (Republic of)
| | - S H Hur
- Keimyung University Hospital, Daegu, Korea (Republic of)
| | - J K Han
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - E S Shin
- Ulsan University Hospital, Ulsan, Korea (Republic of)
| | - H S Kim
- Seoul National University Hospital, Seoul, Korea (Republic of)
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Cha JJ, Bae S, Park DW, Park JH, Hong SJ, Park SM, Yu CW, Rha SW, Lim DS, Suh SY, Han SH, Woo SI, Lee NH, Choi D, Chae IH, Kim HS, Hong YJ, Ahn Y, Jeong MH, Ahn TH. Clinical Outcomes in Patients With Delayed Hospitalization for Non–ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2022; 79:311-323. [DOI: 10.1016/j.jacc.2021.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023]
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Moon I, Kong M, Park H, Choi H, Seo H, Suh J, Lee NH, Cho Y. Huge Mycotic Aneurysm at the Celiac Trunk in a Patient With Severe Aortic Regurgitation Due to Infective Endocarditis. Circ J 2021; 85:694. [PMID: 33790145 DOI: 10.1253/circj.cj-20-1226] [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: 11/09/2022]
Affiliation(s)
- Inki Moon
- Division of Cardiology, Soonchunhyang University Bucheon Hospital
| | - MinGyu Kong
- Division of Cardiology, Soonchunhyang University Bucheon Hospital
| | - HyunWoo Park
- Division of Cardiology, Soonchunhyang University Bucheon Hospital
| | - HyungOh Choi
- Division of Cardiology, Soonchunhyang University Bucheon Hospital
| | - HyeSun Seo
- Division of Cardiology, Soonchunhyang University Bucheon Hospital
| | - Jon Suh
- Division of Cardiology, Soonchunhyang University Bucheon Hospital
| | - Nae-Hee Lee
- Division of Cardiology, Soonchunhyang University Bucheon Hospital
| | - YoonHaeng Cho
- Division of Cardiology, Soonchunhyang University Bucheon Hospital
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Kong MG, Park HW, Choi HO, Seo HS, Suh J, Cho YH, Lee NH. P6445Stress hyperglycemia and in-hospital mortality in patients with ST-segment elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1039] [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
Introduction
Stress hyperglycemia is common in acute ill patients and associated with poor clinical outcomes. Some studies demonstrated the association of stress hyperglycemia and poor outcomes in acute MI. However, current results for the impact of stress hyperglycemia on mortality in acute MI who underwent PCI are insufficient.
Purpose
We aimed to evaluate the impact of stress hyperglycemia on clinical outcomes of patients with STEMI underwent primary PCI in large scale multi-center registry.
Methods
From 2007 to 2014, in 1,538 patients of the INTERSTELLAR (Incheon-Bucheon Cohort of Patients Undergoing Primary PCI for Acute ST-Elevation Myocardial Infarction) cohort, 997 patients without diabetes who underwent primary PCI for STEMI were retrospectively analyzed. We defined random glucose more than 200mg/dl at admission without diabetic history or results of HbA1C more than 6.5% as stress hyperglycemia. The primary endpoint was in-hospital all-cause death and the secondary endpoint was all-cause death within 1 year after index PCI.
Results
From 997 nondiabetic cohort population, 117 patients with stress hyperglycemia and 880 patients without stress hyperglycemia were enrolled. Baseline characteristics including age, sex, hypertension, hyperlipidemia, atrial fibrillation, left main disease, and multivessel disease were not significantly different between two groups. However, systolic blood pressure was lower (111.2±39.2 vs. 125.5±28.1, p<0.001) and hypoxic liver injury was frequent (31.0% vs. 20.1%, p=0.007) in stress hyperglycemia. In-hospital and 1-year all-cause mortality were higher in stress hyperglycemia (13.7% vs. 2.7%, p<0.001; 15.4% vs. 3.8%, p<0.001, respectively). However, there is no significant difference in post-discharge mortality rate. Stress hyperglycemia was a significant independent predictor of in-hospital death (adjusted OR: 5.67, 95% CI: 2.40–13.39; p<0.001). Hypotension (defined less than 90mmHg) and left ventricular dysfunction (defined less than 40% of LVEF on echocardiography) were significantly associated with stress hyperglycemia (adjusted OR: 5.72, 95% CI: 3.33–9.82; p<0.001; adjusted OR: 2.38, 95% CI: 1.49–3.82; p<0.001, respectively).
Landmark analysis of all-cause death
Conclusions
In nondiabetic patients who underwent primary PCI for STEMI, stress hyperglycemia is significantly associated with an increased in-hospital all-cause mortality but did not increase post-discharge mortality within 1 year.
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Affiliation(s)
- M G Kong
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - H W Park
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - H O Choi
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - H S Seo
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - J Suh
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - Y H Cho
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - N H Lee
- Soonchunhyang University Hospital, Bucheon, 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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Ahn Y, Kim Y, Chang K, Kim W, Rhee MY, Cha KS, Hyon MS, Shim CY, Lee SY, Kim DI, Kim SW, Lim SW, Han KR, Jo SH, Lee NH, Kwan J, Ahn T. A multicenter, randomized, and double-blind phase IV clinical trial to compare the efficacy and safety of fixed-dose combinations of amlodipine orotate/valsartan 5/160 mg versus valsartan/hydrochlorothiazide 160/12.5 mg in patients with essential hypertension uncontrolled by valsartan 160 mg monotherapy. Medicine (Baltimore) 2018; 97:e12329. [PMID: 30212981 PMCID: PMC6156014 DOI: 10.1097/md.0000000000012329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine whether the effectiveness and safety of fixed-dose combinations (FDCs) of amlodipine orotate/valsartan (AML/VAL) 5/160 mg are noninferior to those of valsartan/hydrochlorothiazide (VAL/HCTZ) 160/12.5 mg in hypertensive patients with inadequate response to valsartan 160 mg monotherapy. METHODS This 8-week, active-controlled, parallel-group, fixed-dose, multicenter, double-blind randomized controlled, and noninferiority trial was conducted at 17 cardiovascular centers in the Republic of Korea. Eligible patients had mean sitting diastolic blood pressure (msDBP) ≥90 mm Hg despite monotherapy with valsartan 160 mg for 4 weeks. Patients were randomly assigned to treatment with AML/VAL 5/160 mg FDC (AML/VAL) group or VAL/HCTZ 160/12.5 mg FDC (VAL/HCTZ) group once daily for 8 weeks. A total of 238 patients were enrolled (AML/VAL group, n = 121; VAL/HCTZ group, n = 117), of whom 228 completed the study. RESULTS At 8 weeks after randomization, msDBP was significantly decreased in both groups (-9.44 ± 0.69 mm Hg in the AML/VAL group and -7.47 ± 0.71 mm Hg in the VAL/HCTZ group, both P < .001 vs baseline). Between group difference was -1.96 ± 1.00 mm Hg, indicating that AML/VAL 5/160 mg FDC was not inferior to VAL/HCTZ 160/12.5 mg FDC at primary efficacy endpoint. Control rate of BP defined as the percentage of patients achieving mean sitting SBP (msSBP) <140 mm Hg or msDBP <90 mm Hg (target BP) from baseline to week 8 was significantly higher in the AML/VAL group than that in the VAL/HCTZ group (84.3% [n = 102] in the AML/VAL group vs 71.3% [n = 82] in the VAL/HCTZ group, P = .016). At 8 weeks after randomization, mean uric acid level was significantly increased in the VAL/HCTZ group compared to that at baseline (0.64 ± 0.08 mg/dL; P < .001). However, it was slightly decreased from baseline in the AML/VAL group (-0.12 ± 0.08 mg/dL; P = .085). The intergroup difference was significant (P < .001). CONCLUSION The effectiveness and safety AML/VAL 5/160 mg FDC are noninferior to those of VAL/HCTZ 160/12.5 mg FDC in patients with hypertension inadequately controlled by valsartan 160 mg monotherapy.
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Affiliation(s)
- Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju
| | - Yongcheol Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju
| | - Kiyuk Chang
- The Catholic University of Korea, Seoul St. Mary's Hospital
| | - Weon Kim
- Kyung Hee University Hospital, Seoul
| | | | | | - Min Su Hyon
- Soonchunhyang University Seoul Hospital, Seoul
| | - Chi Young Shim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul
| | | | - Doo Il Kim
- Inje University Haeundae Paik Hostpital, Busan
| | | | - Sang-Wook Lim
- CHA Bundang Medical Center, CHA University, Seongnam
| | - Kyoo-Rok Han
- Hallym University Kangdong Sacred Heart Hospital, Seoul
| | - Sang-Ho Jo
- Hanllym University Sacred Heart Hospital, Anyang
| | - Nae-Hee Lee
- Soonchunhyang University Bucheon Hospital, Bucheon
| | | | - Taehoon Ahn
- Heart Center, Gachon University Gil Hospital, Incheon, Republic of Korea
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9
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Kim MJ, Kim SS, Park KJ, An HJ, Choi YH, Lee NH, Hyun CG. Methyl jasmonate inhibits lipopolysaccharide-induced inflammatory cytokine production via mitogen-activated protein kinase and nuclear factor-κB pathways in RAW 264.7 cells. Pharmazie 2018; 71:540-543. [PMID: 29441852 DOI: 10.1691/ph.2016.6647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Methyl jasmonate is an important signaling molecule involved in plant defense as well as in the regulation of plant growth and development. Despite its various functions in plants, its effects on animal cells have not been widely studied and no report has been issued on the molecular aspects of its anti-inflammatory effect. In the present study, we investigated the in vitro anti-inflammatory properties of methyl jasmonate in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells. Methyl jasmonate treatment effectively inhibited LPS-induced production of pro-inflammatory mediators (nitric oxide and prostaglandin E2) and cytokines (tumor necrosis factor-α, interleukin (IL)-1β, and IL-6) in a concentration-dependent manner. Furthermore, it attenuated the LPS-induced activation of nuclear factor-κB (NF-κB) by suppressing the degradation of the inhibitor of κB-α (IκB-α). Additionally, methyl jasmonate dose-dependently blocked the phosphorylation of mitogen-activated protein kinases (MAPKs), i.e., p38 kinase, extracellular signal-regulated kinase (ERK) 1/2, and c-Jun N-terminal kinase (JNK), in these cells. These results suggest that methyl jasmonate attenuated the LPS-induced release of pro-inflammatory mediators and cytokines by suppressing the activation of MAPK (JNK, ERK and p38) and NF-κB signaling. This study not only demonstrated that methyl jasmonate exerts anti-inflammatory activities in macrophages but also revealed its potential as a candidate for the treatment of various inflammation-associated diseases.
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Park HS, Kim YJ, Bae YK, Lee NH, Lee YJ, Hah JO, Park TI, Lee KS, Park JB, Kim HS. Differential Expression Patterns of Irf3 and Irf7 in Pediatric Lymphoid Disorders. Int J Biol Markers 2018; 22:34-8. [PMID: 17393359 DOI: 10.1177/172460080702200105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Interferon regulatory factors (IRFs) are multifunctional transcriptional factors. To define the role of IRFs in lymphoid disorders, we determined the expression patterns of IRF3 and IRF7 by immunohistochemistry in 5 normal lymph nodes, 12 reactive hyperplastic lymph nodes, and 27 pediatric lymphomas. IRF3 was prominently expressed in the nuclei of the histiocytes, and was expressed very weakly in the cytoplasm of most of the lymphocytes of the normal lymph nodes. However, IRF7 was expressed strongly in the nuclei of over 50% of the lymphocytes throughout the normal lymph nodes, but the histiocytes and fibroblasts were spared. In the reactive hyperplastic lymph nodes, the number of IRF3- and IRF7-positive cells in the nuclei was elevated. In the lymphomas, the number of IRF3-positive cells in the nucleus appeared to have decreased, and the cells were scattered throughout the lymphoma tissue in no specific pattern. However, in most cases the number of IRF7-positive cells was elevated. These results suggested that IRF3 was activated principally in the histiocytes and T cells under inflammatory conditions, but IRF3 activation was attenuated in cases of lymphoma. However, the number of IRF7-positive cells was found to be elevated in the reactive hyperplastic lymph nodes and pediatric lymphoma.
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Affiliation(s)
- H S Park
- Department of Microbiology, College of Medicine, Yeungnam University, Daegu, Korea
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11
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Yu CW, Lee HJ, Suh J, Lee NH, Park SM, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Lee SH, Choe YH, Kim SM, Choi JH. Coronary Computed Tomography Angiography Predicts Guidewire Crossing and Success of Percutaneous Intervention for Chronic Total Occlusion. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005800. [DOI: 10.1161/circimaging.116.005800] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 10/15/2016] [Accepted: 02/24/2017] [Indexed: 11/16/2022]
Abstract
Background—
We developed a model that predicts difficulty of percutaneous coronary intervention for coronary chronic total occlusion (CTO) using coronary computed tomographic angiography.
Methods and Results—
A total of 684 CTO lesions with preprocedural computed tomographic angiography were enrolled from 4 centers. Data were randomly divided into derivation and validation datasets at 2:1 ratio. The end point was successful guidewire crossing ≤30 minutes, which was met in 50%. The KCCT (Korean Multicenter CTO CT Registry) score was developed based on independent predictors identified by multivariable analysis, which were proximal blunt entry, proximal side branch, bending, occlusion length ≥15 mm, severe calcification, whole luminal calcification, reattempt, and ≥12 months or unknown duration of occlusion. The KCCT score was compared with the other prediction scores, including angiography-based J-CTO, PROGRESS-CTO, CL-score, and CT-based CT-RECTOR. The probability of guidewire crossing ≤30 minutes declined consistently from 100% to 0% according to the KCCT score (
P
<0.01, all). The KCCT score showed higher discriminative performance compared with the other scoring systems (c-statistics=0.78 versus 0.65–0.72,
P
<0.001, all). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a KCCT score of <4 for guidewire crossing ≤30 minutes was 70%, 68%, 72%, 73%, and 70%, respectively. The KCCT score also showed consistent results with procedural success (
P
<0.05, all). These results could be reproduced in validation data set (
P
<0.05, all).
Conclusions—
KCCT scoring could predict successful guidewire crossing ≤30 minutes and also procedural success. KCCT scoring may enable noninvasive grading difficulty of CTO percutaneous coronary intervention.
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Affiliation(s)
- Cheol-Woong Yu
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Hyun-Jong Lee
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Jon Suh
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Nae-Hee Lee
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Sang-Min Park
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Taek Kyu Park
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Jeong Hoon Yang
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Young Bin Song
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Joo-Yong Hahn
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Seung Hyuk Choi
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Hyeon-Cheol Gwon
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Sang-Hoon Lee
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Yeon Hyeon Choe
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Sung Mok Kim
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
| | - Jin-Ho Choi
- From the Department of Medicine, Korea University Anam Hospital, Seoul (C.-W.Y.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (H.-J.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Korea (J.S., N.-H.L.); Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital (S-M.P.); and Department of Emergency Medicine (J.-H.C.), Department of Medicine (J.-H.C., T.-K.P., J.-H.Y., Y.-B.S., J.-Y.H., S.-H.C., H.-C.G., S.-H.L.),
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12
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Ihm SH, Jeon HK, Cha TJ, Hong TJ, Kim SH, Lee NH, Yoon JH, Yoon N, Hwang KK, Jo SH, Youn HJ. Efficacy and safety of two fixed-dose combinations of S-amlodipine and telmisartan (CKD-828) versus S-amlodipine monotherapy in patients with hypertension inadequately controlled using S-amlodipine monotherapy: an 8-week, multicenter, randomized, double-blind, Phase III clinical study. Drug Des Devel Ther 2016; 10:3817-3826. [PMID: 27920497 PMCID: PMC5125808 DOI: 10.2147/dddt.s116847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose To evaluate the blood pressure (BP) lowering efficacy and safety of CKD-828, a fixed-dose combination of S-amlodipine (the more active isomer of amlodipine besylate, which is calcium channel blocker) and telmisartan (long acting angiotensin receptor blocker), in patients with hypertension inadequately controlled with S-amlodipine monotherapy. Patients and methods Eligible patients (N=187) who failed to respond after 4-week S-amlodipine 2.5 mg monotherapy (sitting diastolic blood pressure [sitDBP] ≥90 mmHg) to receive CKD-828 2.5/40 mg (n=63), CKD-828 2.5/80 mg (n=63), or S-amlodipine 2.5 mg (n=61) for 8 weeks. The primary efficacy endpoint, mean sitDBP change from baseline to Week 8, was compared between the combination (CKD-828 2.5/40 mg and CKD-828 2.5/80 mg) and S-amlodipine monotherapy groups. The safety was assessed based on adverse events, vital signs, and physical examination findings. Results After the 8-week treatment, changes in sitDBP/systolic BP (SBP) were −9.67±6.50/−12.89±11.78, −10.72±6.19/−13.79±9.41, and −4.93±7.26/−4.55±11.27 mmHg in the CKD-828 2.5/40 mg (P<0.0001/P<0.0001), CKD-828 2.5/80 mg (P<0.0001/P<0.0001), and S-amlodipine 2.5 mg (P<0.0001/P=0.0027) groups, respectively, which were all significant BP reductions. At Week 8, the CKD-828 2.5/40 mg (sitDBP/SBP: P=0.0002/P<0.0001) and CKD-828 2.5/80 mg (sitDBP/SBP: P=0.0001/P<0.0001) showed superior BP-lowering effects to S-amlodipine 2.5 mg (P<0.001). At Week 4, all groups showed significant antihypertensive effects but both CKD-828 combinations (CKD-828 2.5/40 mg and CKD-828 2.5/80 mg) exhibited superior BP-lowering effects to that of S-amlodipine 2.5 mg (sitDBP/SBP: P=0.0028/P=0.0001 and P<0.0001/P=0.0012, respectively). The adverse event incidence was significantly lower in the CKD-828 2.5/40 mg (9.52%, P=0.0086) than in the S-amlodipine 2.5 mg group (27.87%) and increasing the telmisartan dose induced no unexpected adverse events, suggesting the safety of CKD-828. Conclusion CKD-828 is an effective and safe option for patients with inadequate responses to S-amlodipine monotherapy.
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Affiliation(s)
- Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul
| | - Hui-Kyung Jeon
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul
| | - Tae-Joon Cha
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine
| | - Taek-Jong Hong
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul
| | - Nae-Hee Lee
- Department of Cardiology, Soonchunhyang University Hospital, Bucheon
| | - Jung Han Yoon
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju
| | - Namsik Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University, College of Medicine, Cheongju
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul
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13
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Kim SH, Jo SH, Lee SC, Lee SY, Yoon MH, Lee HL, Lee NH, Ha JW, Lee NH, Kim DW, Han GR, Hyon MS, Cho DG, Park CG, Kim YD, Ryu GH, Kim CH, Kim KS, Chung MH, Chae SC, Seung KB, Oh BH. Blood Pressure and Cholesterol-lowering Efficacy of a Fixed-dose Combination With Irbesartan and Atorvastatin in Patients With Hypertension and Hypercholesterolemia: A Randomized, Double-blind, Factorial, Multicenter Phase III Study. Clin Ther 2016; 38:2171-2184. [DOI: 10.1016/j.clinthera.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/10/2016] [Accepted: 04/24/2016] [Indexed: 10/20/2022]
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14
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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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Zheng J, Hewage SRKM, Piao MJ, Kang KA, Han X, Kang HK, Yoo ES, Koh YS, Lee NH, Ko CS, Lee JC, Ko MH, Hyuna JW. Photoprotective Effect of Carpomitra costata Extract against Ultraviolet B-Induced Oxidative Damage in Human Keratinocytes. J Environ Pathol Toxicol Oncol 2016; 35:11-28. [PMID: 27279581 DOI: 10.1615/jenvironpatholtoxicoloncol.2016014003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Natural marine products show various biological properties such as antiphotoaging, antioxidant, anticancer, and anti-inflammation. This study evaluated the protective effects of the brown alga Carpomitra costata (Stackhouse) Batters (Sporochnaceae) against ultraviolet B (UVB)-provoked damage in human HaCaT keratinocytes. C. costata extract (CCE) effectively reduced superoxide anion, hydroxyl radical, and UVB-stimulated intracellular reactive oxygen species (ROS) levels. CCE also restored the expression and activity of UVB-suppressed antioxidant enzymes. Furthermore, CCE decreased UVB-triggered oxidative damage to cellular components including DNA, protein, and lipid and defended the cells against mitochondrial membrane depolarization-medicated apoptosis. The results of this study indicate that CCE can safeguard human keratinocytes against UVB-induced cellular damage via a potent antioxidant mechanism. CCE may find utility as part of a therapeutic arsenal against the damaging effects of UVB radiation on the skin.
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Affiliation(s)
- J Zheng
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | | | - Mei Jing Piao
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Kyoung Ah Kang
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - X Han
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - H K Kang
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - E S Yoo
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Y S Koh
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - N H Lee
- Department of Chemistry, College of Natural Sciences, Jeju National University, Jeju, Republic of Korea
| | - C S Ko
- Jeju Biodiversity Research Institute, Jeju Technopark, Jeju, Republic of Korea
| | - J C Lee
- Jeju Biodiversity Research Institute, Jeju Technopark, Jeju, Republic of Korea
| | - Mi Hee Ko
- Jeju Biodiversity Research Institute, Jeju Technopark, Jeju, Republic of Korea
| | - Jin Won Hyuna
- School of Medicine, Jeju National University, Jeju, Republic of Korea
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Jang JY, Lee SH, Kim BS, Seo HS, Kim WS, Ahn Y, Lee NH, Koh KK, Kang TS, Jo SH, Hong BK, Bae JH, Yang HM, Cha KS, Kim BS, Kwak CH, Cho DK, Kim U, Zo JH, Kang DH, Pyun WB, Chun KJ, Namgung J, Cha TJ, Juhn JH, Jung Y, Jang Y. Erratum to: Additive Beneficial Effects of Valsartan Combined with Rosuvastatin in the Treatment of Hypercholesterolemic Hypertensive Patients. Korean Circ J 2015; 45:349. [PMID: 26240593 PMCID: PMC4521117 DOI: 10.4070/kcj.2015.45.4.349] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ji-Yong Jang
- Division of Cardiology and Cardiovascular Research Institute, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hak Lee
- Division of Cardiology and Cardiovascular Research Institute, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soo Kim
- Division of Cardiology, Department of Internal Medicine, Daedong Hospital, Busan, Korea
| | - Hong Seog Seo
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo-Shik Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Nae-Hee Lee
- Department of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Kwang Kon Koh
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Tae-Soo Kang
- Division of Cardiology, Dankook University College of Medicine, Cheonan, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Bum-Kee Hong
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jang-Ho Bae
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Hyoung-Mo Yang
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Bum Soo Kim
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choong Hwan Kwak
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Deok-Kyu Cho
- Department of Cardiology, Myongji Hospital Cardiovascular Center, Goyang, Korea
| | - Ung Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Kook Jin Chun
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - June Namgung
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Tae-Joon Cha
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Jae-Hyeon Juhn
- Clinical Development Department, LG Life Sciences Ltd., Seoul, Korea
| | - YeiLi Jung
- Clinical Development Department, LG Life Sciences Ltd., Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology and Cardiovascular Research Institute, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Lee K, Yoo SY, Suh J, Park KH, Park Y, Tantry US, Park KS, Han SH, Kang WC, Shin DH, Lee C, Choi SW, Lee JH, Cho YH, Lee NH, Jeong MH, Ahn Y, Kubica J, Gurbel PA, Park JH, Jeong YH. Efficacy of cilostazol on inhibition of platelet aggregation, inflammation and myonecrosis in acute coronary syndrome patients undergoing percutaneous coronary intervention: The ACCEL-LOADING-ACS (ACCELerated Inhibition of Platelet Aggregation, Inflammation and Myonecrosis by Adjunctive Cilostazol Loading in Patients With Acute Coronary Syndrome) study. Int J Cardiol 2015; 190:370-5. [DOI: 10.1016/j.ijcard.2015.04.180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
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Jang JY, Lee SH, Kim BS, Seo HS, Kim WS, Ahn Y, Lee NH, Koh KK, Kang TS, Jo SH, Hong BK, Bae JH, Yang HM, Cha KS, Kim BS, Kwak CH, Cho DK, Kim U, Zo JH, Kang DH, Pyun WB, Chun KJ, Namgung J, Cha TJ, Juhn JH, Jung Y, Jang Y. Additive beneficial effects of valsartan combined with rosuvastatin in the treatment of hypercholesterolemic hypertensive patients. Korean Circ J 2015; 45:225-33. [PMID: 26023311 PMCID: PMC4446817 DOI: 10.4070/kcj.2015.45.3.225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 12/10/2014] [Revised: 02/11/2015] [Accepted: 03/09/2015] [Indexed: 01/09/2023] Open
Abstract
Background and Objectives We compared the efficacy and safety of valsartan and rosuvastatin combination therapy with each treatment alone in hypercholesterolemic hypertensive patients. Subjects and Methods Patients who met inclusion criteria were randomized to receive 1 of the following 2-month drug regimens: valsartan 160 mg plus rosuvastatin 20 mg, valsartan 160 mg plus placebo, or rosuvastatin 20 mg plus placebo. The primary efficacy variables were change in sitting diastolic blood pressure (sitDBP) and sitting systolic blood pressure (sitSBP), and percentage change in low-density lipoprotein-cholesterol (LDL-C) in the combination, valsartan, and rosuvastatin groups. Adverse events (AEs) during the study were analyzed. Results A total of 354 patients were screened and 123 of them were finally randomized. Changes of sitDBP by least squares mean (LSM) were -11.1, -7.2, and -3.6 mm Hg, respectively, and was greater in the combination, as compared to both valsartan (p=0.02) and rosuvastatin (p<0.001). Changes of sitSBP by LSM were -13.2, -10.8, and -4.9 mm Hg, and was greater in the combination, as compared to rosuvastatin (p=0.006) and not valsartan (p=0.42). Percentage changes of LDL-C by LSM were -52, -4, and -47% in each group, and was greater in the combination, as compared to valsartan (p<0.001), similar to rosuvastatin (p=0.16). Most AEs were mild and resolved by the end of the study. Conclusion Combination treatment with valsartan and rosuvastatin exhibited an additive blood pressure-lowering effect with acceptable tolerability, as compared to valsartan monotherapy. Its lipid lowering effect was similar to rosuvatatin monotherapy.
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Affiliation(s)
- Ji-Yong Jang
- Division of Cardiology and Cardiovascular Research Institute, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hak Lee
- Division of Cardiology and Cardiovascular Research Institute, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soo Kim
- Division of Cardiology, Department of Internal Medicine, Daedong Hospital, Busan, Korea
| | - Hong Seog Seo
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo-Shik Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Nae-Hee Lee
- Department of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Kwang Kon Koh
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Tae-Soo Kang
- Division of Cardiology, Dankook University College of Medicine, Cheonan, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Bum-Kee Hong
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jang-Ho Bae
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Hyoung-Mo Yang
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Bum Soo Kim
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choong Hwan Kwak
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
| | - Deok-Kyu Cho
- Department of Cardiology, Myongji Hospital Cardiovascular Center, Goyang, Korea
| | - Ung Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Kook Jin Chun
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - June Namgung
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Tae-Joon Cha
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Jae-Hyeon Juhn
- Clinical Development Department, LG Life Sciences Ltd., Seoul, Korea
| | - YeiLi Jung
- Clinical Development Department, LG Life Sciences Ltd., Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology and Cardiovascular Research Institute, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Devaney JM, Wang S, Furbert-Harris P, Apprey V, Ittmann M, Wang BD, Olender J, Lee NH, Kwabi-Addo B. Genome-wide differentially methylated genes in prostate cancer tissues from African-American and Caucasian men. Epigenetics 2015; 10:319-28. [PMID: 25864488 DOI: 10.1080/15592294.2015.1022019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Increasing evidence suggests that aberrant DNA methylation changes may contribute to prostate cancer (PCa) ethnic disparity. To comprehensively identify DNA methylation alterations in PCa disparity, we used the Illumina 450K methylation platform to interrogate the methylation status of 485,577 CpG sites focusing on gene-associated regions of the human genome. Genomic DNA from African-American (AA; 7 normal and 3 cancers) and Caucasian (Cau; 8 normal and 3 cancers) was used in the analysis. Hierarchical clustering analysis identified probe-sets unique to AA and Cau samples, as well as common to both. We selected 25 promoter-associated novel CpG sites most differentially methylated by race (fold change > 1.5-fold; adjusted P < 0.05) and compared the β-value of these sites provided by the Illumina, Inc. array with quantitative methylation obtained by pyrosequencing in 7 prostate cell lines. We found very good concordance of the methylation levels between β-value and pyrosequencing. Gene expression analysis using qRT-PCR in a subset of 8 genes after treatment with 5-aza-2'-deoxycytidine and/or trichostatin showed up-regulation of gene expression in PCa cells. Quantitative analysis of 4 genes, SNRPN, SHANK2, MST1R, and ABCG5, in matched normal and PCa tissues derived from AA and Cau PCa patients demonstrated differential promoter methylation and concomitant differences in mRNA expression in prostate tissues from AA vs. Cau. Regression analysis in normal and PCa tissues as a function of race showed significantly higher methylation prevalence for SNRPN (P = 0.012), MST1R (P = 0.038), and ABCG5 (P < 0.0002) for AA vs. Cau samples. We selected the ABCG5 and SNRPN genes and verified their biological functions by Western blot analysis and siRNA gene knockout effects on cell proliferation and invasion in 4 PCa cell lines (2 AA and 2 Cau patients-derived lines). Knockdown of either ABCG5 or SNRPN resulted in a significant decrease in both invasion and proliferation in Cau PCa cell lines but we did not observe these remarkable loss-of-function effects in AA PCa cell lines. Our study demonstrates how differential genome-wide DNA methylation levels influence gene expression and biological functions in AA and Cau PCa.
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Affiliation(s)
- J M Devaney
- a Children's National Medical Center ; Center for Genetic Medicine Research ; Washington, DC USA
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Seo HS, Cho YH, Her K, Lim JW, Lee NH. The image of submitral aneurysm with multiple fistulas. Eur Heart J Cardiovasc Imaging 2015; 16:870. [PMID: 25851316 DOI: 10.1093/ehjci/jev081] [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)
- Hye-Sun Seo
- Division of Cardiology, Soonchunhyang University Hospital, Bucheon, South Korea
| | - Youn-Haeng Cho
- Division of Cardiology, Soonchunhyang University Hospital, Bucheon, South Korea
| | - Keun Her
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Bucheon, South Korea
| | - Jae Woong Lim
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Bucheon, South Korea
| | - Nae-Hee Lee
- Division of Cardiology, Soonchunhyang University Hospital, Bucheon, South Korea
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Park SJ, Lee CW, Ahn JM, Park DW, Kang SJ, Lee SW, Kim YH, Park SW, Han S, Lee SG, Seong IW, Rha SW, Jeong MH, Lim DS, Yoon JH, Hur SH, Choi YS, Yang JY, Lee NH, Kim HS, Lee BK, Kim KS, Lee SU, Chae JK, Cheong SS, Suh IW, Park HS, Nah DY, Jeon DS, Seung KB, Lee K, Jang JS. Response to letter regarding article, "optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: a randomized, controlled trial". Circulation 2014; 130:e161-2. [PMID: 25462828 DOI: 10.1161/circulationaha.114.011890] [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: 11/16/2022]
Affiliation(s)
- Seung-Jung Park
- The Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Cheol Whan Lee
- The Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jung-Min Ahn
- The Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Duk-Woo Park
- The Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Soo-Jin Kang
- The Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seung-Whan Lee
- The Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Young-Hak Kim
- The Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seong-Wook Park
- The Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seungbong Han
- Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | | | - In-Whan Seong
- Chungnam National University Hospital, Daejeon, South Korea
| | | | - Myung-Ho Jeong
- Chonnam National University Hospital, Gwangju, South Korea
| | - Do-Sun Lim
- Korea University Anam Hospital, Seoul, South Korea
| | - Jung-Han Yoon
- Yonsei University Wonju College of Medicine, Wonju Christian Hospital, Wonju, South Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Yun-Seok Choi
- The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Joo-Young Yang
- National Health Insurance Corporation, Ilsan Hospital, Ilsan, South Korea
| | - Nae-Hee Lee
- Soon Chun Hyang University Hospital Bucheon, Bucheon, South Korea
| | - Hyun-Sook Kim
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, South Korea
| | - Kee-Sik Kim
- Daegu Catholic University Medical Center, Daegu, South Korea
| | - Seung-Uk Lee
- Kwangju Christian Hospital, Kwangju, South Korea
| | - Jei-Keon Chae
- Chonbuk National University Hospital, Jeonju, South Korea
| | | | - Il-Woo Suh
- Sam Anyang Hospital, Anyang, South Korea
| | - Hun-Sik Park
- Kyungpook National University Hospital, Daegu, South Korea
| | - Deuk-Young Nah
- Dongguk University Gyeongju Hospital Gyeongju, South Korea
| | - Doo-Soo Jeon
- The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, South Korea
| | - Ki-Bae Seung
- The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Keun Lee
- Veterans Hospital Service Medical Center, Seoul, South Korea
| | - Jae-Sik Jang
- Inje University College of Medicine, Busan Paik Hospital, Busan, South Korea
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Hyun YJ, Piao MJ, Kim KC, Zheng J, Yao CW, Cha JW, Kang HK, Yoo ES, Koh YS, Lee NH, Ko MH, Hyun JW. Photoprotective Effect of a <i>Polyopes affinis</i> (Harvey) Kawaguchi and Wang (<i>Halymeniaceae</i>)-Derived Ethanol Extract on Human Keratinocytes. TROP J PHARM RES 2014. [DOI: 10.4314/tjpr.v13i6.6] [Citation(s) in RCA: 5] [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] [Indexed: 11/17/2022] Open
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Lee JY, Park DW, Kim YH, Ahn JM, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, Yun SC, Yang TH, Lee BK, Lee NH, Yang JY, Shin WY, Park HS, Kim KS, Hur SH, Lee SY, Park JS, Choi YS, Lee SU, Her SH, Park SJ. Comparison of biolimus A9-eluting (Nobori) and everolimus-eluting (Promus Element) stents in patients with de novo native long coronary artery lesions: a randomized Long Drug-Eluting Stent V trial. Circ Cardiovasc Interv 2014; 7:322-9. [PMID: 24823426 DOI: 10.1161/circinterventions.113.000841] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 12/16/2022]
Abstract
BACKGROUND Procedural and clinical outcomes still remain unfavorable for patients with long coronary lesions who undergo percutaneous coronary intervention. The current study, therefore, evaluated 2 innovative drug-eluting stents for the management of long-lesion coronary artery disease. METHODS AND RESULTS This randomized, multicenter, prospective trial, called the Long Drug-Eluting Stent (LONG-DES) V trial, compared the biodegradable polymer-based biolimus A9-eluting stent (BES) and the durable polymer-based platinum chromium everolimus-eluting stent (PtCr-EES) in 500 patients with long (≥ 25 mm) coronary lesions. The primary end point of the trial was in-segment late luminal loss at the 9-month angiographic follow-up. The BES and PtCr-EES groups had similar baseline characteristics, with a slightly shorter lesion length in the BES group versus the PtCr-EES group (29.24 ± 12.17 versus 32.27 ± 13.84 mm; P = 0.016). In-segment late luminal loss was comparable between the 2 groups at the 9-month angiographic follow-up (BES, 0.14 ± 0.38 versus PtCr-EES, 0.11 ± 0.37 mm; difference, 0.031; 95% confidence interval, -0.053 to 0.091; P = 0.03 for a noninferiority margin of 0.11, P = 0.45 for superiority), as was in-stent late luminal loss (0.20 ± 0.41 versus 0.24 ± 0.38 mm; P = 0.29). The incidence of in-segment (6.1% versus 4.9%; P = 0.63) and in-stent (3.7% versus 4.9%; P = 0.59) binary restenosis was also similar between the groups. There was no significant between-group difference in the rate of composite outcome of death, myocardial infarction, and target vessel revascularization (41, 16.7% in BES versus 42, 16.5% in PtCr-EES; P=0.94). CONCLUSIONS BES and PtCr-EES implantation showed analogous angiographic and clinical outcomes for patients with de novo long coronary lesions. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01186120.
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Affiliation(s)
- Jong-Young Lee
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Duk-Woo Park
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Young-Hak Kim
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Jung-Min Ahn
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Won-Jang Kim
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Soo-Jin Kang
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Seung-Whan Lee
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Cheol Whan Lee
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Seong-Wook Park
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Sung-Cheol Yun
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Tae-Hyun Yang
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Bong-Ki Lee
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Nae-Hee Lee
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Joo-Young Yang
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Won-Yong Shin
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Hun Sik Park
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Kee-Sik Kim
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Seung Ho Hur
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Sung Yun Lee
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Jong-Seon Park
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Yun Seok Choi
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Seung Uk Lee
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Sung-Ho Her
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.)
| | - Seung-Jung Park
- From the Department of Cardiology (J.-Y. L., D.-W.P., Y.-H.K., J.-M.A., W.-J.K., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.-J.P.) and Division of Biostatistics, Center for Medical Research and Information (S.-C.Y.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Internal Medicine, Inje University Pusan Paik Hospital, Pusan, Korea (T.-H.Y.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (N.-H.L.); Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea (J.-Y.Y.); Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea (W.-Y.S.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea (H.S.P.); Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea (K.-S.K.); Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (S.Y.L.); Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea (J.-S.P.); Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea (Y.S.C.); Department of Internal Medicine, Kwangju Christian Hospital, Kwangju, Korea (S.U.L.); and Department of Internal Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.-H.H.).
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24
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Lee CW, Ahn JM, Park DW, Kang SJ, Lee SW, Kim YH, Park SW, Han S, Lee SG, Seong IW, Rha SW, Jeong MH, Lim DS, Yoon JH, Hur SH, Choi YS, Yang JY, Lee NH, Kim HS, Lee BK, Kim KS, Lee SU, Chae JK, Cheong SS, Suh IW, Park HS, Nah DY, Jeon DS, Seung KB, Lee K, Jang JS, Park SJ. Optimal Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation. Circulation 2014; 129:304-12. [DOI: 10.1161/circulationaha.113.003303] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [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: 01/18/2023]
Abstract
Background—
The risks and benefits of long-term dual antiplatelet therapy remain unclear.
Methods and Results—
This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4%) and 61 dual-therapy group patients (2.6%; hazard ratio, 0.94; 95% confidence interval, 0.66–1.35;
P
=0.75). The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1%) and 34 (1.4%) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95% confidence interval, 0.42–1.20;
P
=0.20).
Conclusions—
Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01186146.
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Affiliation(s)
- Cheol Whan Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Jung-Min Ahn
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Duk-Woo Park
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Soo-Jin Kang
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Whan Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Young-Hak Kim
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seong-Wook Park
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seungbong Han
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Sang-Gon Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - In-Whan Seong
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Woon Rha
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Myung-Ho Jeong
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Do-Sun Lim
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Jung-Han Yoon
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Ho Hur
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Yun-Seok Choi
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Joo-Young Yang
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Nae-Hee Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Hyun-Sook Kim
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Bong-Ki Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Kee-Sik Kim
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Uk Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Jei-Keon Chae
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Sang-Sig Cheong
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Il-woo Suh
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Hun-Sik Park
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Deuk-Young Nah
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Doo-Soo Jeon
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Ki-Bae Seung
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Keun Lee
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Jae-Sik Jang
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
| | - Seung-Jung Park
- From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University
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25
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Park GM, Lee SW, Park SW, Kim YH, Yun SC, Cho YR, Ahn JM, Lee JY, Kim WJ, Park DW, Kang SJ, Lee CW, Lee BK, Lee NH, Cho YH, Suh J, Shin WY, Lee SJ, Lee SW, Park WJ, Kim HS, Lee SG, Cheong SS, Her SH, Park MW, Kim CJ, Park SJ. Comparison of Zotarolimus-Eluting stent versus Sirolimus-Eluting stent for de novo coronary artery disease in patients with diabetes mellitus from the ESSENCE-DIABETES II trial. Am J Cardiol 2013; 112:1565-70. [PMID: 24063840 DOI: 10.1016/j.amjcard.2013.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 11/26/2022]
Abstract
Angiographic and clinical outcomes remain relatively unfavorable for diabetic patients even after the use of drug-eluting stent. This prospective, multicenter, randomized study compared the relative efficacy and safety of resolute zotarolimus-eluting stent (R-ZES) and sirolimus-eluting stent (SES) implantation in diabetic patients with coronary artery disease. The primary end point was noninferiority of angiographic in-segment late loss at 9 months. Clinical events were also monitored for at least 12 months. Patient recruitment was prematurely stopped after enrollment of 256 patients (127 in R-ZES group and 129 in SES) because of discontinuing production of SES. The R-ZES was noninferior to the SES for 9-month in-segment late loss (0.34 ± 0.30 vs 0.39 ± 0.43 mm; difference -0.048; 95% confidence interval -0.157 to 0.061; upper 1-sided 95% confidence interval 0.044; p <0.001 for noninferiority). In addition, in-stent late loss (0.22 ± 0.29 vs 0.21 ± 0.40 mm, p = 0.849) and the rates of in-segment (1.2% vs 6.7%, p = 0.119) and in-stent (1.2% vs 3.3%, p = 0.621) binary restenoses were similar between the 2 groups. At 12 months, there were no statistical differences between the 2 groups in the incidence of any clinical outcomes (death, myocardial infarction, stent thrombosis, ischemia-driven target lesion revascularization, ischemia-driven target vessel revascularization, and composite outcomes). In conclusion, despite having reduced power because of early study termination, our study suggests that the R-ZES has noninferior angiographic outcomes at 9 months to the SES in diabetic patients with coronary artery disease.
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26
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Seo HS, Cho YH, Choi JH, Suh J, Lee NH, Lim OK. The Association of Left Ventricular Hypertrophy with Intraventricular Dyssynchrony at Rest and during Exercise in Hypertensive Patients. J Cardiovasc Ultrasound 2012; 20:174-80. [PMID: 23346286 PMCID: PMC3542510 DOI: 10.4250/jcu.2012.20.4.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 10/02/2012] [Revised: 12/17/2012] [Accepted: 12/17/2012] [Indexed: 11/24/2022] Open
Abstract
Background Impaired exercise tolerance with dyspnea is common in hypertensive patients and this may be due to the exaggeration of nonuniform ventricular activation during exercise. So we want to evaluate the effect of left ventricular hypertrophy (LVH) on systolic intraventricular dyssynchrony during exercise. Methods A total of 85 patients with hypertension who having exertional dyspnea and 30 control individuals were enrolled. Exercise stress echocardiography was performed using a symptom limited, multistage supine bicycle test. To evaluate the dyssynchrony of left ventricular (LV), we calculated the standard deviation (SD) of the averaged time-to-peak systolic velocity (TPs-SD, ms) of 12 middle and basal LV segments obtained from the three standard apical views at rest and peak exercise. Results There was no significant difference in systolic blood pressure (BP) and heart rate between the two groups. TPs-SD was significantly higher in patients with LVH at rest (31.5 ± 12.1 vs. 22.0 ± 12.6 ms, p = 0.002) with exaggeration of the degree at peak exercise (39.0 ± 11.9 vs. 24.6 ± 13.3 ms, p < 0.001). Multiple regression analysis showed LV mass index was independently associated with LV dyssynchrony at peak exercise (β = 0.515, p = 0.001) when controlled for age, sex, and systolic BP at peak exercise. Conclusion Intraventricular systolic dyssynchrony during exercise is significantly associated with the degree of LVH in hypertensive patients.
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Affiliation(s)
- Hye-Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Korea
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27
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Ahn JM, Park DW, Kim YH, Song H, Cho YR, Kim WJ, Lee JY, Kang SJ, Lee SW, Lee CW, Park SW, Yun SC, Han S, Lee SY, Lee BK, Cho JH, Yang TH, Lee NH, Yang JY, Park JS, Shin WY, Kim MH, Bae JH, Kim MK, Yoon J, Park SJ. Comparison of resolute zotarolimus-eluting stents and sirolimus-eluting stents in patients with de novo long coronary artery lesions: a randomized LONG-DES IV trial. Circ Cardiovasc Interv 2012; 5:633-40. [PMID: 23048051 DOI: 10.1161/circinterventions.111.965673] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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: 11/16/2022]
Abstract
BACKGROUND Procedural and clinical outcomes still remain unfavorable for patients with long coronary lesions who undergo stent-based coronary interventions. Therefore, we compared the relative efficacy and safety of resolute zotarolimus-eluting stents (R-ZES) and sirolimus-eluting stents (SES) for patients with de novo long coronary lesions. METHODS AND RESULTS This randomized, multicenter, prospective trial, called the Percutaneous Treatment of LONG Native Coronary Lesions With Drug-Eluting Stent-IV (LONG-DES IV) trial, compared long R-ZES and SES in 500 patients with long (≥25 mm) native coronary lesions. The primary end point of the trial was in-segment late luminal loss at 9-month angiographic follow-up. The baseline characteristics were not different between R-ZES and SES groups, including lesion lengths (32.4±13.5 mm versus 31.0±13.5 mm, P=0.27). At 9-month angiographic follow-up, the R-ZES was noninferior to the SES with respect to in-segment late luminal loss, the primary study end point (0.14±0.38 mm versus 0.12±0.43 mm, P for noninferiority=0.03, P for superiority=0.68). In addition, in-stent late luminal loss (0.26±0.36 mm versus 0.24±0.42 mm, P=0.78) and the rates of in-segment (5.2% versus 7.2%, P=0.44) and in-stent (4.0% versus 6.0%, P=0.41) binary restenosis were not significantly different between the 2 groups. There were no significant between-group differences in the rate of adverse clinical events (death, myocardial infarction, stent thrombosis, target-lesion revascularization, and composite outcomes). CONCLUSIONS For patients with de novo long coronary artery disease, R-ZES implantation showed noninferior angiographic outcomes as compared with SES implantation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01186094.
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Affiliation(s)
- Jung-Min Ahn
- Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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28
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Abstract
BACKGROUND The strength of each heart beat and the stiffness of large arteries contribute to blood pressure (BP). When the large arteries are stiff and their resistance greater, the afterload increases and this may change the function of the heart. However, the relation between common carotid artery stiffness and heart function in hypertensive patients has not been clarified. METHODS Two hundred and twenty hypertensive patients underwent transthoracic and carotid echocardiography. Measurements of local arterial stiffness were taken at the right common carotid artery level and stiffness parameter (β), pressure-strain elasticity modulus and intima-media thickness were calculated. Brachial cuff BP was measured just before starting the carotid study. The patients with any cardiovascular disease, diabetes mellitus, stroke, transient ischemic attack, or carotid stenosis were excluded. RESULTS Carotid artery stiffness parameter (β) was correlated with age and left ventricular mass index (p < 0.005). Even though β was not correlated with LV systolic function, it was inversely correlated with diastolic function as measured by early mitral annular velocity. When the artery was stiffer, early mitral annular velocity (e') decreased (p < 0.001) and the index of left atrial (LA) pressure (early diastolic mitral inflow E velocity/e') increased (p = 0.001). In logistic regression, diastolic dysfunction was affected by age (beta -0.385, p = 0.001), LA volume index (beta 0.175, p = 0.013) and β (beta -0.273, p = 0.019). CONCLUSION In hypertensive patients, changes in carotid artery stiffness can affect the diastolic function, independent of age and LA volume index. Therefore, measurements and control of carotid stiffness can play an important role in the prevention of diastolic heart failure.
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Affiliation(s)
- Yusik Myung
- Division of Cardiology, Cardiovascular Center, Soonchunhyang University Hospital, Bucheon, Korea
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29
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Park DW, Kim YH, Song HG, Ahn JM, Kim WJ, Lee JY, Kang SJ, Lee SW, Lee CW, Park SW, Yun SC, Her SH, Hur SH, Park JS, Kim MK, Choi YS, Kim HS, Cho JH, Lee SG, Park YW, Jeong MH, Lee BK, Lee NH, Lim DS, Yoon J, Seung KB, Shin WY, Rha SW, Kim KS, Tahk SJ, Park BE, Ahn T, Yang JY, Jeong YS, Rhew JH, Park SJ. Outcomes After Unrestricted Use of Everolimus-Eluting and Sirolimus-Eluting Stents in Routine Clinical Practice. Circ Cardiovasc Interv 2012; 5:365-71. [PMID: 22693347 DOI: 10.1161/circinterventions.111.966549] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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: 01/29/2023]
Abstract
Background—
It remains unclear whether there are differences in the safety and efficacy outcomes between everolimus-eluting stents (EES) and sirolimus-eluting stents (SES) in contemporary practice.
Methods and Results—
We prospectively enrolled 6166 consecutive patients who received EES (3081 patients) and SES (3085 patients) between April 2008 and June 2010, using data from the Interventional Cardiology Research In-Cooperation Society-Drug-Eluting Stents Registry. The primary end point was a composite of death, nonfatal myocardial infarction (MI), or target-vessel revascularization (TVR). At 2 years of follow-up, the 2 study groups did not differ significantly in crude risk of the primary end point (12.1% for EES versus 12.4% for SES; HR, 0.97; 95% CI, 0.84–1.12,
P
=0.66). After adjustment for differences in baseline risk factors, the adjusted risk for the primary end point remained similar for the 2 stent types (HR, 0.96; 95% CI, 0.82–1.12,
P
=0.60). There were also no differences between the stent groups in the adjusted risks of the individual component of death (HR, 0.93; 95% CI, 0.67–1.30,
P
=0.68), MI (HR, 0.97; 95% CI, 0.79–1.18,
P
=0.74), and TVR (HR, 1.10; 95% CI, 0.82–1.49,
P
=0.51). The adjusted risk of stent thrombosis also was similar (HR, 1.16; 95% CI, 0.47–2.84,
P
=0.75).
Conclusions—
In contemporary practice of percutaneous coronary intervention procedures, the unrestricted use of EES and SES showed similar rates of safety and efficacy outcomes with regard to death, MI, sent thrombosis, and TVR. Future longer-term follow-up is needed to better define the relative benefits of these drug-eluting stents.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01070420.
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Affiliation(s)
- Duk-Woo Park
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Young-Hak Kim
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Hae-Geun Song
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Jung-Min Ahn
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Won-Jang Kim
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Jong-Young Lee
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Soo-Jin Kang
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Seung-Whan Lee
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Cheol Whan Lee
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Seong-Wook Park
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Sung-Cheol Yun
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Sung Ho Her
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Seung Ho Hur
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Jin Sik Park
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Myeong-Kon Kim
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Yun Seok Choi
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Hyun Sook Kim
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Jang-Hyun Cho
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Sang Gon Lee
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Yong Whi Park
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Myung-Ho Jeong
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Bong Ki Lee
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Nae-Hee Lee
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Do-Sun Lim
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Junghan Yoon
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Ki Bae Seung
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Won-Yong Shin
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Seung-Woon Rha
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Kee-Sik Kim
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Seung-Jea Tahk
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Byoung Eun Park
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Taehoon Ahn
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Joo-Young Yang
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Yong Seok Jeong
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Jay-Hyun Rhew
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
| | - Seung-Jung Park
- From the Departments of Cardiology (S.J.P., D.W.P., Y.H.K., S.J.K., S.W.L., C.W.L., S.W.P.) and Division of Biostatistics (S.C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea (S.H.H.); Keimyung University Dongsan Medical Center, Daegu, Korea (S.H.H.); Sejong General Hospital, Bucheon, Korea (J.S.P.); Kyunghee University Medical Center, Seoul,
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Kim HS, Park SJ, Park DW, Park SW, Cheong SS, Lee SG, Cho BR, Lee SW, Lee NH, Lee K. Comparison of the efficacy and safety of paclitaxel-eluting coroflex please stents and paclitaxel-eluting stents in patients with coronary artery disease: a randomized PIPA trial. Catheter Cardiovasc Interv 2012; 80:799-806. [PMID: 22120995 DOI: 10.1002/ccd.23440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/07/2011] [Accepted: 10/17/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare the safety and efficacy of the new Coroflex™ Please stents with conventional Taxus™ Liberte stents in patients with coronary artery lesions. BACKGROUND The Coroflex™ Please stent is a new version of paclitaxel-eluting stent, and observational cohort studies have reported similar angiographic and clinical outcomes as with the first-generation stents. However, it has not been directly compared with the early generation paclitaxel-eluting stents in a multicenter, prospective, and randomized study. METHODS We randomly assigned 319 patients to receive Coroflex™ Please stents (159 patients; 198 lesions) or Taxus™ Liberte stents (160 patients; 232 lesions). The primary end point was angiographic in-segment late luminal loss at 9 months. RESULTS Most baseline clinical and angiographic characteristics were similar between these two groups. The Coroflex™ Please and Taxus™ Liberte stents showed similar in-segment late loss (0.40 ± 0.53 mm vs. 0.39 ± 0.52 mm, P = 0.98) and rates of in-segment binary restenosis (22.2% vs. 18.8%, P = 0.48) at 9 months. After clinical follow-up for 12 months, the two groups had similar rates of death (1.3% vs. 1.3%, P > 0.99), myocardial infarction (3.8% vs. 7.5%, P = 0.22), stent thrombosis (2.5% vs. 1.9%, P = 0.72), and target-lesion revascularization (7.5% vs. 7.5%, P = 0.99). CONCLUSIONS The Coroflex™ Please stent resulted in similar angiographic and clinical outcomes as the Taxus™ Liberte stent in patients with coronary artery lesions.
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Affiliation(s)
- Hyun-Sook Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Ha TH, Seo HS, Choo WJ, Choi J, Suh J, Cho YH, Lee NH. The Effect of Metabolic Syndrome on Myocardial Contractile Reserve during Exercise in Non-Diabetic Hypertensive Subjects. J Cardiovasc Ultrasound 2011; 19:176-82. [PMID: 22259660 PMCID: PMC3259541 DOI: 10.4250/jcu.2011.19.4.176] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 04/20/2011] [Revised: 11/07/2011] [Accepted: 11/30/2011] [Indexed: 01/09/2023] Open
Abstract
Background Metabolic syndrome (MS) is associated with increased left ventricular (LV) mass and diastolic dysfunction. This study uses relatively load-independent Doppler tissue echocardiography to examine whether MS is associated with decreased longitudinal contractile reserve during dynamic exercise. Methods A total of 112 patients with relatively well-controlled, treated hypertension who complained of exertional dyspnea were enrolled (average age: 56.7 ± 10.5 years). Fifty-six were non-diabetic patients with MS (Group 1), and 56 were age-sex matched hypertensive patients without MS (Group 2). Exercise stress echo was performed using a symptom-limited, multistage, supine bicycle exercise test. Multiple Doppler parameters were obtained at baseline, at each stage of exercise, and during recovery. Results There was no significant difference between the two groups in terms of age, gender, and hemodynamic variables. E/E', an index of LV filling pressure, was significantly higher in the MS group at rest and during exercise. The longitudinal contractile reserve, the change in S' (longitudinal tissue velocity) from baseline to peak exercise, was significantly lower in the MS group (2.00 ± 1.65 vs. 2.90 ± 1.66, p = 0.015). Multiple regression analysis showed independent association of MS with longitudinal contractile reserve when controlled for confounding factors, such as LV mass index, gender, blood pressure, and age (β = -0.235, p = 0.035). Conclusion Longitudinal contractile reserve was reduced in MS patients compared to others, although both groups demonstrated similar longitudinal contractile function at rest. We present the first demonstration that metabolic syndrome is independently associated with LV systolic dysfunction during exercise in hypertensive patients.
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Affiliation(s)
- Tae Hoon Ha
- Cardiology Division, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
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Park DW, Kim YH, Song HG, Ahn JM, Kim WJ, Lee JY, Kang SJ, Lee SW, Lee CW, Park SW, Yun SC, Seung KB, Yang TH, Lee SG, Lee JH, Seong IW, Cheong SS, Lee BK, Lee NH, Lee SW, Lee SW, Lee K, Kim HS, Jeon DS, Kim MK, Nah DY, Tahk SJ, Park SJ. Comparison of Everolimus- and Sirolimus-Eluting Stents in Patients With Long Coronary Artery Lesions. JACC Cardiovasc Interv 2011; 4:1096-103. [PMID: 22017935 DOI: 10.1016/j.jcin.2011.05.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 05/31/2011] [Indexed: 10/16/2022]
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Kim WJ, Lee SW, Park SW, Kim YH, Yun SC, Lee JY, Park DW, Kang SJ, Lee CW, Lee JH, Choi SW, Seong IW, Lee BK, Lee NH, Cho YH, Shin WY, Lee SJ, Lee SW, Hyon MS, Bang DW, Park WJ, Kim HS, Chae JK, Lee K, Park HK, Park CB, Lee SG, Kim MK, Park KH, Choi YJ, Cheong SS, Yang TH, Jang JS, Her SH, Park SJ. Randomized comparison of everolimus-eluting stent versus sirolimus-eluting stent implantation for de novo coronary artery disease in patients with diabetes mellitus (ESSENCE-DIABETES): results from the ESSENCE-DIABETES trial. Circulation 2011; 124:886-92. [PMID: 21810659 DOI: 10.1161/circulationaha.110.015453] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [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: 01/18/2023]
Abstract
BACKGROUND Drug-eluting stents significantly improved angiographic and clinical outcomes compared with bare metal stents in diabetic patients. However, a comparison of everolimus-eluting stents and sirolimus-eluting stents in diabetic patients has not been evaluated. Therefore we compared effectiveness of everolimus-eluting stents and sirolimus-eluting stents in patients with diabetes mellitus. METHODS AND RESULTS This prospective, multicenter, randomized study compared everolimus-eluting stent (n=149) and sirolimus-eluting stent (n=151) implantation in diabetic patients. The primary end point was noninferiority of angiographic in-segment late loss at 8 months. Clinical events were also monitored for at least 12 months. Everolimus-eluting stents were noninferior to sirolimus-eluting stents for 8-month in-segment late loss (0.23 ± 0.27 versus 0.37 ± 0.52 mm; difference, -0.13 mm; 95% confidence interval, -0.25 to -0.02; upper 1-sided 95% confidence interval, -0.04; P<0.001 for noninferiority), with reductions in in-stent restenosis (0% versus 4.7%; P=0.029) and in-segment restenosis (0.9% versus 6.5%; P=0.035). However, in-stent late loss (0.11 ± 0.26 versus 0.20 ± 0.49 mm; P=0.114) was not statistically different between the 2 groups. At 12 months, ischemia-driven target lesion revascularization (0.7% versus 2.6%; P=0.317), death (1.3% versus 3.3%; P=0.448), and myocardial infarction (0% versus 1.3%; P=0.498) were not statistically different between the 2 groups. Major adverse cardiac events, including death, myocardial infarction, and ischemia-driven target lesion revascularization (2.0% versus 5.3%; P=0.218), were also not statistically different between the 2 groups. CONCLUSION Everolimus-eluting stents were noninferior to sirolimus-eluting stents in reducing in-segment late loss and reduced angiographic restenosis at 8 months in patients with diabetes mellitus and coronary artery disease.
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Affiliation(s)
- Won-Jang Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Suh J, Cho YH, Lee NH. Antegrade ballooning with retrograde approach for the treatment of long restenotic total occlusion. J Invasive Cardiol 2011; 23:E164-E167. [PMID: 21725132] [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: 05/31/2023]
Abstract
A retrograde approach through collateral channels is thought to improve the success rate of percutaneous coronary intervention for chronic total coronary occlusion (CTO). Among CTO lesions, the in-stent chronic total reocclusion (ISR-CTO) is a subset with an unsatisfactory outcome despite repeated procedures. Various strategies and techniques are required to improve the success rate of this novel approach. We describe a case in which a long ISR-CTO was successfully recanalized by a drug-eluting balloon after antegrade ballooning of the proximal part of the lesion with retrograde wire crossing, and discuss the availability of this approach for the treatment of long ISR-CTO.
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Affiliation(s)
- Jon Suh
- Division of Cardiology, Department of Internal Medicine, SoonChunHyang University Bucheon Hospital, Bucheon, South Korea
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Kim JY, Lee NH, Cho YH, Suh J, Seo HS, Kim DH, Jeon YW. Recanalization of an accidentally crushed coronary stent by intravascular ultrasonography catheter entrapment. Korean Circ J 2011; 41:327-30. [PMID: 21779286 PMCID: PMC3132695 DOI: 10.4070/kcj.2011.41.6.327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 05/13/2010] [Revised: 10/27/2010] [Accepted: 11/16/2010] [Indexed: 11/30/2022] Open
Abstract
Intravascular ultrasonography (IVUS) imaging is a user-friendly technique widely used during coronary interventions. An 80-year-old man was admitted with chest pain, and successful percutaneous coronary intervention was performed with stent implantation. One week later, the patient complained of further chest pain. Urgent coronary angiography showed total occlusion of the middle left anterior descending artery and the aspiration of thrombi was high. IVUS imaging showed inadequate stent strut apposition and distal dissection. We attempted another stent implantation but the IVUS catheter was stuck on the 0.014 inch wire. Therefore, we tried to pass the wire across the lateral side. After the wire was successfully passaged, the sprinter balloon was passed through the crushed stent to expand it. After 4 days later, the patient was discharged with no symptoms or electrocardiographic change.
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Affiliation(s)
- Jae Yun Kim
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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Ahn JM, Kim YH, Kim HS, Park DW, Cheong SS, Lee BK, Lee SW, Lee K, Lee NH, Lee SG, Lee CH, Park GM, Kim YG, Hwang KW, Lee SW, Lee CW, Park SW, Park SJ. AS-051 Comparison of the Efficacy and Safety of Paclitaxel-Eluting CoroflexTM Please Stent versus Paclitaxel-Eluting Stent in Patients with Coronary Artery Disease: The PIPA Randomized Controlled Trial. Am J Cardiol 2011. [DOI: 10.1016/j.amjcard.2011.02.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kim YH, Kim HS, Park DW, Cheong SS, Lee BK, Lee SW, Lee K, Lee NH, Lee SG, Lee CH, Hwang KW, Park GM, Kim YG, Ahn JM, Song HG, Kim WJ, Lee JY, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ. COMPARISON OF THE EFFICACY AND SAFETY OF PACLITAXEL-ELUTING COROFLEXTM PLEASE STENT VERSUS PACLITAXEL-ELUTING STENT IN PATIENTS WITH CORONARY ARTERY DISEASE: THE PIPA RANDOMIZED CONTROLLED TRIAL. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61837-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lee SW, Lee JY, Park DW, Kim YH, Yun SC, Kim WJ, Suh J, Cho YH, Lee NH, Kang SJ, Lee CW, Park SW, Park SJ. Long-term clinical outcomes of successful versus unsuccessful revascularization with drug-eluting stents for true chronic total occlusion. Catheter Cardiovasc Interv 2011; 78:346-53. [PMID: 21452248 DOI: 10.1002/ccd.23019] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 01/22/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aims of this study were to investigate the long-term clinical outcomes of patients with successful versus unsuccessful revascularization with drug-eluting stents (DES) for chronic total occlusion (CTO). BACKGROUND The benefits of successful revascularization of CTO remain unclear. METHODS Consecutive patients (n = 333) with "true" CTO, defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 on angiography and duration ≥3 months, were divided into two groups, those with successful (CTO success group, n = 251) and unsuccessful (CTO failure group, n = 82) revascularization with DES for CTO lesions. The primary endpoint was defined as major adverse cardiac events (MACE) the composite of death, Q-wave myocardial infarction (MI), or target vessel revascularization (TVR). RESULTS The CTO success group was significantly younger, with a higher involvement of LAD, and lower incidences of renal failure, previous myocardial infarction, and previous coronary intervention than the CTO failure group. After a median follow up of 1,317 days (interquartile range, 1,059-1,590 days), there were no significant between-group differences in rate of MACE, both after crude analysis (9.4% vs. 11.8%, log-rank P = 0.16) and after adjustment (HR 1.17; 95% CI 0.47-2.88, P = 0.53). On multivariate analysis, major predictors of MACE were left ventricle ejection fraction (LVEF) <40% (HR 3.14; 95% CI 1.39-7.09, P = 0.005) and multiple CTO (HR 2.38; 95% CI 1.01-5.71, P = 0.049). CONCLUSIONS Long-term clinical outcomes were similar in the CTO success and failure groups. Multiple CTOs and LVEF <40% in CTO patients were independent predictors of MACE.
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Affiliation(s)
- Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lee SW, Park SW, Kim YH, Yun SC, Park DW, Lee CW, Kang SJ, Park SJ, Lee JH, Choi SW, Seong IW, Lee NH, Cho YH, Shin WY, Lee SJ, Lee SW, Hyon MS, Bang DW, Choi YJ, Kim HS, Lee BK, Lee K, Park HK, Park CB, Lee SG, Kim MK, Park KH, Park WJ. A Randomized, Double-Blind, Multicenter Comparison Study of Triple Antiplatelet Therapy With Dual Antiplatelet Therapy to Reduce Restenosis After Drug-Eluting Stent Implantation in Long Coronary Lesions. J Am Coll Cardiol 2011; 57:1264-70. [DOI: 10.1016/j.jacc.2010.10.035] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 10/04/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
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Lee SW, Park SW, Kim YH, Yun SC, Park DW, Lee CW, Kang SJ, Rhee KS, Chae JK, Ko JK, Park JH, Lee JH, Choi SW, Jeong JO, Seong IW, Cho YH, Lee NH, Kim JH, Chun KJ, Kim HS, Park SJ. A Randomized Comparison of Sirolimus- Versus Paclitaxel-Eluting Stent Implantation in Patients With Diabetes Mellitus. JACC Cardiovasc Interv 2011; 4:310-6. [DOI: 10.1016/j.jcin.2010.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/09/2010] [Indexed: 11/28/2022]
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Park JH, Seo HS, Park SK, Suh J, Kim DH, Cho YH, Lee NH. Spontaneous systemic tumor embolism caused by tumor invasion of pulmonary vein in a patient with advanced lung cancer. J Cardiovasc Ultrasound 2010; 18:148-50. [PMID: 21253365 PMCID: PMC3021894 DOI: 10.4250/jcu.2010.18.4.148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 05/04/2010] [Revised: 09/29/2010] [Accepted: 09/29/2010] [Indexed: 11/22/2022] Open
Abstract
We describe a 72-year-old man who presented with left hemiparesis due to acute cerebral infarction in the right fronto-temporal lobe. Three months prior to admission, he was hospitalized for right hemiparesis due to the acute cerebral infarction in the left anterior cerebral artery territory. To investigate the cause of his recurrent embolic event, a chest computed tomography scan and echocardiography were performed, which revealed advanced lung cancer invading contiguously through the pulmonary veins to the right main pulmonary artery and left atrium. Tumor embolism is a rare cause of stroke, occurring with primary or metastatic neoplasms of the lung. Echocardiography is a useful tool in patients with cerebral embolic episodes.
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Affiliation(s)
- Jung Hwan Park
- Department of internal medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Park DW, Kim YH, Yun SC, Kang SJ, Lee SW, Lee CW, Park SW, Seong IW, Lee JH, Tahk SJ, Jeong MH, Jang Y, Cheong SS, Yang JY, Lim DS, Seung KB, Chae JK, Hur SH, Lee SG, Yoon J, Lee NH, Choi YJ, Kim HS, Kim KS, Kim HS, Hong TJ, Park HS, Park SJ. Comparison of zotarolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for coronary revascularization: the ZEST (comparison of the efficacy and safety of zotarolimus-eluting stent with sirolimus-eluting and paclitaxel-eluting stent for coronary lesions) randomized trial. J Am Coll Cardiol 2010; 56:1187-95. [PMID: 20883925 DOI: 10.1016/j.jacc.2010.03.086] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [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: 10/08/2009] [Revised: 01/13/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the relative efficacy and safety of zotarolimus-eluting stents (ZES) in comparison with the established and widely used sirolimus- (SES) and paclitaxel-eluting stents (PES) in routine clinical practice. BACKGROUND Whether ZES might provide similar clinical and angiographic outcomes in a broad spectrum of patients compared with SES or PES is undetermined. METHODS We performed a single-blind, multicenter, prospectively randomized trial to compare ZES with SES and PES in 2,645 patients undergoing percutaneous coronary intervention. The primary end point was a composite of major adverse cardiac events (MACE) (death, myocardial infarction, and ischemia-driven target vessel revascularization) at 12 months. A noninferiority comparison (ZES vs. SES) and a superiority comparison (ZES vs. PES) were performed for the primary end point. RESULTS Baseline clinical and angiographic characteristics were similar in the 3 groups. At 12 months, the ZES group showed noninferior rates of MACE compared with the SES group (10.2% vs. 8.3%, p for noninferiority = 0.01, p for superiority = 0.17) and significantly fewer MACE than the PES group (10.2% vs. 14.1%, p for superiority = 0.01). The incidence of death or myocardial infarction was similar among the groups (ZES vs. SES vs. PES, 5.8% vs. 6.9% vs. 7.6%, respectively, p = 0.31). The incidence of stent thrombosis was significantly lower in the SES group (ZES vs. SES vs. PES, 0.7% vs. 0% vs. 0.8%, respectively, p = 0.02). CONCLUSIONS In this large-scale, practical randomized trial, the use of ZES resulted in similar rates of MACE compared with SES and in fewer MACE compared with PES at 12 months. (Comparison of the Efficacy and the Safety of Zotarolimus-Eluting Stent Versus Sirolimus-Eluting Stent and PacliTaxel-Eluting Stent for Coronary Lesions; NCT00418067).
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Affiliation(s)
- Duk-Woo Park
- Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lee NH, Seo HS, Choi JH, Suh J, Cho YH. Recanalization strategy of retrograde angioplasty in patients with coronary chronic total occlusion —Analysis of 24 cases, focusing on technical aspects and complications. Int J Cardiol 2010; 144:219-29. [DOI: 10.1016/j.ijcard.2009.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 01/04/2009] [Accepted: 04/12/2009] [Indexed: 10/20/2022]
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Park SJ, Park DW, Kim YH, Kang SJ, Lee SW, Lee CW, Han KH, Park SW, Yun SC, Lee SG, Rha SW, Seong IW, Jeong MH, Hur SH, Lee NH, Yoon J, Yang JY, Lee BK, Choi YJ, Chung WS, Lim DS, Cheong SS, Kim KS, Chae JK, Nah DY, Jeon DS, Seung KB, Jang JS, Park HS, Lee K. Duration of dual antiplatelet therapy after implantation of drug-eluting stents. N Engl J Med 2010; 362:1374-82. [PMID: 20231231 DOI: 10.1056/nejmoa1001266] [Citation(s) in RCA: 375] [Impact Index Per Article: 26.8] [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: 12/22/2022]
Abstract
BACKGROUND The potential benefits and risks of the use of dual antiplatelet therapy beyond a 12-month period in patients receiving drug-eluting stents have not been clearly established. METHODS In two trials, we randomly assigned a total of 2701 patients who had received drug-eluting stents and had been free of major adverse cardiac or cerebrovascular events and major bleeding for a period of at least 12 months to receive clopidogrel plus aspirin or aspirin alone. The primary end point was a composite of myocardial infarction or death from cardiac causes. Data from the two trials were merged for analysis. RESULTS The median duration of follow-up was 19.2 months. The cumulative risk of the primary outcome at 2 years was 1.8% with dual antiplatelet therapy, as compared with 1.2% with aspirin monotherapy (hazard ratio, 1.65; 95% confidence interval [CI], 0.80 to 3.36; P=0.17). The individual risks of myocardial infarction, stroke, stent thrombosis, need for repeat revascularization, major bleeding, and death from any cause did not differ significantly between the two groups. However, in the dual-therapy group as compared with the aspirin-alone group, there was a nonsignificant increase in the composite risk of myocardial infarction, stroke, or death from any cause (hazard ratio, 1.73; 95% CI, 0.99 to 3.00; P=0.051) and in the composite risk of myocardial infarction, stroke, or death from cardiac causes (hazard ratio, 1.84; 95% CI, 0.99 to 3.45; P=0.06). CONCLUSIONS The use of dual antiplatelet therapy for a period longer than 12 months in patients who had received drug-eluting stents was not significantly more effective than aspirin monotherapy in reducing the rate of myocardial infarction or death from cardiac causes. These findings should be confirmed or refuted through larger, randomized clinical trials with longer-term follow-up. (ClinicalTrials.gov numbers, NCT00484926 and NCT00590174.)
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Affiliation(s)
- Seung-Jung Park
- Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, South Korea
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Park SJ, Park DW, Kim YH, Yun SC, Kang SJ, Lee SW, Park SW, Seong IW, Lee JH, Tahk SJ, Jeong MH, Jang Y, Cheong SS, Yang JY, Lim DS, Seung KB, Chae JK, Hur SH, Lee SG, Yoon J, Lee NH, Choi YJ, Kim KS, Kim HS, Kim HS, Hong TJ, Park HS. AS-152: Comparison of Zotarolimus-Eluting Stents with Sirolimus-Eluting and Paclitaxel-Eluting Stents for Coronary Revascularization in a Real-World Setting. Am J Cardiol 2010. [DOI: 10.1016/j.amjcard.2010.01.199] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Park JS, Park DW, Kim YH, Yun SC, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ, Seong IW, Lee JH, Tahk SJ, Jeong MH, Jang Y, Cheong SS, Yang JY, Lim DS, Seung KB, Chae JK, Hur SH, Lee SG, Yoon J, Lee NH, Choi YJ, Kim HS, Kim KS, Kim HS, Hong TJ, Park HS. AS-157: Comparison of Zotarolimus-Eluting Stents with Sirolimus-Eluting and Paclitaxel-Eluting Stents for Patients with Diabetes Mellitus in the ZEST Trial: A Subanalysis of a Randomized Trial. Am J Cardiol 2010. [DOI: 10.1016/j.amjcard.2010.01.204] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yoon WJ, Moon JY, Song G, Lee YK, Han MS, Lee JS, Ihm BS, Lee WJ, Lee NH, Hyun CG. Artemisia fukudo essential oil attenuates LPS-induced inflammation by suppressing NF-kappaB and MAPK activation in RAW 264.7 macrophages. Food Chem Toxicol 2010; 48:1222-9. [PMID: 20156520 DOI: 10.1016/j.fct.2010.02.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 02/06/2010] [Accepted: 02/08/2010] [Indexed: 01/21/2023]
Abstract
In the present study, the chemical constituents of Artemisia fukudo essential oil (AFE) were investigated using GC-MS. The major constituents were alpha-thujone (48.28%), beta-thujone (12.69%), camphor (6.95%) and caryophyllene (6.01%). We also examined the effects of AFE on the production of nitric oxide (NO), prostaglandin E(2) (PGE(2)), tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6, in lipopolysaccharide (LPS)-activated RAW 264.7 macrophages. Western blotting and RT-PCR tests indicated that AFE has potent dose-dependent inhibitory effects on pro-inflammatory cytokines and mediators. We investigated the mechanism by which AFE inhibits NO and PGE(2) by examining the level of nuclear factor-kappaB (NF-kappaB) activation within the mitogen-activated protein kinase (MAPK) pathway, which is an inflammation-induced signal pathway in RAW 264.7 cells. AFE inhibited LPS-induced ERK, JNK, and p38 phosphorylation. Furthermore, AFE inhibited the LPS-induced phosphorylation and degradation of Ikappa-B-alpha, which is required for the nuclear translocations of the p50 and p65 NF-kappaB subunits in RAW 264.7 cells. Our results suggest that AFE might exert an anti-inflammatory effect by inhibiting the expression of pro-inflammatory cytokines. Such an effect is mediated by a blocking of NF-kappaB activation which consequently inhibits the generation of inflammatory mediators in RAW264.7 cells. AFE may be useful for treating inflammatory diseases.
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Affiliation(s)
- W J Yoon
- Jeju Biodiversity Research Institute, Jeju High-Tech Development Institute, Jeju, Republic of Korea
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Lee SW, Chun KJ, Park SW, Kim HS, Kim YH, Yun SC, Kim WJ, Lee JY, Park DW, Lee CW, Hong MK, Rhee KS, Chae JK, Ko JK, Park JH, Lee JH, Choi SW, Jeong JO, Seong IW, Jon S, Cho YH, Lee NH, Kim JH, Park SJ. Comparison of Triple antiplatelet therapy and dual antiplatelet therapy in patients at high risk of restenosis after drug-eluting stent implantation (from the DECLARE-DIABETES and -LONG Trials). Am J Cardiol 2010; 105:168-73. [PMID: 20102913 DOI: 10.1016/j.amjcard.2009.08.667] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/25/2009] [Accepted: 08/25/2009] [Indexed: 10/20/2022]
Abstract
Although cilostazol has decreased restenosis and target lesion revascularization (TLR) after drug-eluting stent implantation, it is not known if this effect is durable at 2 years. We analyzed 2 randomized studies (Drug-Eluting stenting followed by Cilostazol treatment reduces LAte REstenosis in patients with DIABETES mellitus and Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte REstenosis in patients with LONG native coronary lesions trials) in which 900 patients were randomly assigned to triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol; triple group, n = 450) and dual antiplatelet therapy (aspirin and clopidogrel; standard group, n = 450) for 6 months in patients with diabetes or long lesions receiving drug-eluting stents. We evaluated 2-year major adverse cardiac events (MACEs) including death, myocardial infarction (MI), and TLR. Nine-month TLRs and MACEs were significantly decreased in the triple versus standard group. At 2 years, the triple group sowed significantly decreased TLRs (4.2% vs 9.1%, hazard ratio 0.45, 95% confidence interval 0.26 to 0.78, p = 0.004) and MACEs (5.6% vs 10.4%, hazard ratio 0.52, 95% confidence interval 0.32 to 0.84, p = 0.008) compared to the standard group with no differences in death and MI. In subgroup analysis, triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with paclitaxel-eluting stents, diabetes mellitus, small vessels, long lesions, and left anterior descending coronary artery lesions. In conclusion, compared to the standard group, initial benefit in decreases of 9-month TLRs and MACEs in the triple group was sustained at 2 years with no differences in death or MI. Triple antiplatelet therapy decrease of 2-year TLR was favorable in all subgroups, especially in patients with high-risk profiles.
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Seo HS, Kim DH, Kim EJ, Yoo HY, Kim C, Lee CH, Kim BY, Chung CH, Suh J, Cho YH, Lee NH. An unusual type of hypertrophic cardiomyopathy. Korean Circ J 2009; 39:213-6. [PMID: 19949582 PMCID: PMC2771784 DOI: 10.4070/kcj.2009.39.5.213] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/16/2009] [Accepted: 01/19/2009] [Indexed: 11/13/2022] Open
Abstract
An unusual type of hypertrophic cardiomyopathy was diagnosed in a 17-year-old girl who presented with dyspnea on exertion. The hypertrophied myocardium was localized to the anterior portion of the left ventricle from the base to the apex without left ventricular outflow tract obstruction. On cardiac magnetic resonance imaging (MRI), patchy and linear delayed hyperenhancement was shown in the anterior and inferior mid-wall, which is not concordant
with the coronary artery territory.
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Affiliation(s)
- Hye-Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Korea
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Lee SW, Park SW, Kim YH, Yun SC, Park DW, Lee CW, Hong MK, Rhee KS, Chae JK, Ko JK, Park JH, Lee JH, Choi SW, Jeong JO, Seong IW, Cho YH, Lee NH, Kim JH, Chun KJ, Kim HS, Park SJ. AS-42: A Randomized Comparison of Triple Antiplatelet Therapy with Dual Antiplatelet Therapy in Patients at High-Risk of Restenosis after Drug-Eluting Stent Implantation: 2-year Clinical Outcomes of DECLARE-DIABETES and LONG Trials. Am J Cardiol 2009. [DOI: 10.1016/j.amjcard.2009.01.085] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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