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Shin Y, Jang JH, Ko RE, Na SJ, Chung CR, Choi KH, Park TK, Lee JM, Yang JH. The association of the Sequential Organ Failure Assessment score at intensive care unit discharge with intensive care unit readmission in the cardiac intensive care unit. Eur Heart J Acute Cardiovasc Care 2024; 13:354-361. [PMID: 38381945 DOI: 10.1093/ehjacc/zuae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/16/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
AIMS Unplanned intensive care unit (ICU) readmissions contribute to increased morbidity, mortality, and healthcare costs. The severity of patient illness at ICU discharge may predict early ICU readmission. Thus, in this study, we investigated the association of cardiac ICU (CICU) discharge Sequential Organ Failure Assessment (SOFA) score with unplanned CICU readmission in patients admitted to the CICU. METHODS AND RESULTS We retrospectively reviewed the hospital medical records of 4659 patients who were admitted to the CICU from 2012 to 18. Sequential Organ Failure Assessment scores at CICU admission and discharge were obtained. The predictive performance of organ failure scoring was evaluated by using area under the receiver operating characteristic (AUROC) curves. The primary outcome was unplanned CICU readmission. Of the 3949 patients successfully discharged from the CICU, 184 (4.7%) had an unplanned CICU readmission or they experienced a deteriorated condition but died without being readmitted to the CICU (readmission group). The readmission group had significantly higher rates of organ failure in all organ systems at both CICU admission and discharge than the non-readmission group. The AUROC of the discharge SOFA score for CICU readmission was 0.731, showing good predictive performance. The AUROC of the discharge SOFA score was significantly greater than that of either the initial SOFA score (P = 0.020) or the Acute Physiology and Chronic Health Evaluation II score (P < 0.001). In the multivariable regression analysis, SOFA score, overweight or obese status, history of heart failure, and acute heart failure as reasons for ICU admission were independent predictors of unplanned ICU readmission during the same hospital stay. CONCLUSION The discharge SOFA score may identify patients at a higher risk of unplanned CICU readmission, enabling targeted interventions to reduce readmission rates and improve patient outcomes.
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Affiliation(s)
- Yonghoon Shin
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Ji Hoon Jang
- Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, 875, Haeun-daero, Haeundae-gu, Busan 48108, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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Hong D, Choi KH, Ahn CM, Yu CW, Park IH, Jang WJ, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Gwon HC, Yang JH. Clinical Significance of Residual Ischemia in Acute Myocardial Infarction Complicated by Cardiogenic Shock Undergoing VA-ECMO. Eur Heart J Acute Cardiovasc Care 2024:zuae058. [PMID: 38701179 DOI: 10.1093/ehjacc/zuae058] [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] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2023] [Accepted: 05/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Although culprit-only revascularization during the index procedure has been recommended in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS), the reduction of residual ischemia is also emphasized to improve clinical outcomes. However, few data are available about the significance of residual ischemia in patients undergoing mechanical circulatory supports. This study aimed to evaluate the effects of residual ischemia on clinical outcomes in AMI patients undergoing venoarterial-extracorporeal membrane oxygenation (VA-ECMO). METHODS AMI patients with multivessel disease who underwent VA-ECMO due to refractory CS were pooled from the RESCUE and SMC-ECMO registries. The included patients were classified into three groups according to residual ischemia evaluated using the residual SYNTAX score (rSS): rSS = 0, 0 < rSS ≤ 8, and rSS > 8. The primary outcome was 1-year all-cause death. RESULTS A total of 408 patients were classified into the rSS = 0 (N = 100, 24.5%), 0 < rSS ≤ 8 (N = 136, 33.3%), and rSS > 8 (N = 172, 42.2%) groups. The cumulative incidence of the primary outcome differed significantly according to rSS (33.9% vs. 55.4% vs. 66.1% for rSS = 0, 0 < rSS ≤ 8, and rSS > 8, respectively, overall P < 0.001). In a multivariable model, rSS was independently associated with the risk of 1-year all-cause death (HRadj 1.03, 95% CI 1.01-1.05, P = 0.003). Conversely, the baseline SYNTAX score was not associated with the risk of the primary outcome. Furthermore, when patients were stratified by rSS, the primary outcome did not differ significantly between the high and low delta SYNTAX score groups. CONCLUSIONS In AMI patients with refractory CS who underwent VA-ECMO, residual ischemia was associated with an increased risk of 1-year mortality. Future studies are needed to evaluate the efficacy and safety of revascularization strategies to minimize residual ischemia in patients with CS supported with VA ECMO. CLINICAL TRIAL REGISTRATION REtrospective and Prospective Observational Study to Investigate Clinical oUtcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With Cardiogenic Shock (RESCUE), NCT02985008.
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Affiliation(s)
- David Hong
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ik Hyun Park
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Woo Jin Jang
- Department of Cardiology, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Medicine, Sejong General Hospital, Bucheon, Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Medicine, Inha University Hospital, Incheon, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cha JH, Lee JM, Choi KH, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Lee WS, Song YB. Intravascular Imaging-Guided Optimization of Complex Percutaneous Coronary Intervention by Sex: A Subgroup Analysis of the RENOVATE-COMPLEX-PCI Trial. JAMA Cardiol 2024; 9:466-474. [PMID: 38568686 PMCID: PMC10993152 DOI: 10.1001/jamacardio.2024.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/02/2024] [Indexed: 04/06/2024]
Abstract
Importance There have been heterogeneous results related to sex differences in prognosis after percutaneous coronary artery intervention (PCI) for complex coronary artery lesions. Objective To evaluate potential differences in outcomes with intravascular imaging-guided PCI of complex coronary artery lesions between women and men. Design, Setting, and Participants This prespecified substudy evaluates the interaction of sex in the investigator-initiated, open-label, multicenter RENOVATE-COMPLEX-PCI randomized clinical trial, which demonstrated the superiority of intravascular imaging-guided PCI compared with angiography-guided PCI in patients with complex coronary artery lesions. The trial was conducted at 20 sites in Korea. Patients with complex coronary artery lesions undergoing PCI were enrolled between May 2018 and May 2021, and the median (IQR) follow-up period was 2.1 (1.4-3.0) years. Data were analyzed from December 2022 to December 2023. Interventions After diagnostic coronary angiography, eligible patients were randomly assigned in a 2:1 ratio to receive intravascular imaging-guided PCI or angiography-guided PCI. The choice and timing of the intravascular imaging device were left to the operators' discretion. Main Outcomes and Measures The primary end point was target vessel failure, defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization. Secondary end points included individual components of the primary end point. Results Of 1639 included patients, 339 (20.7%) were women, and the mean (SD) age was 65.6 (10.2) years. There was no difference in the risk of the primary end point between women and men (9.4% vs 8.3%; adjusted hazard ratio [HR], 1.39; 95% CI, 0.89-2.18; P = .15). Intravascular imaging-guided PCI tended to have lower incidence of the primary end point than angiography-guided PCI in both women (5.2% vs 14.5%; adjusted HR, 0.34; 95% CI, 0.15-0.78; P = .01) and men (8.3% vs 11.7%; adjusted HR, 0.72; 95% CI, 0.49-1.05; P = .09) without significant interaction (P for interaction = .86). Conclusions and Relevance In patients undergoing complex PCI, compared with angiographic guidance, intravascular imaging guidance was associated with similar reduction in the risk of target vessel failure among women and men. The treatment benefit of intravascular imaging-guided PCI showed no significant interaction between treatment strategy and sex. Trial Registration ClinicalTrials.gov Identifier: NCT03381872.
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Affiliation(s)
- Ji Hyun Cha
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | | | | | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Seoul, Korea
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Seoul, Korea
| | | | | | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Pil Sang Song
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | | | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | | | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Kwan Yong Lee
- The Catholic University of Korea, Incheon St Mary’s Hospital, Seoul, Korea
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea
| | | | - Jin-Man Cho
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Woo Jin Jang
- Ewha Womans University College of Medicine, Seoul, Korea
| | - Kook-Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Korea
| | - David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kwon W, Choi KH, Lee SH, Hong D, Shin D, Kim HK, Park KH, Choo EH, Kim CJ, Kim MC, Hong YJ, Ahn SG, Doh JH, Lee SY, Park SD, Lee HJ, Kang MG, Koh JS, Cho YK, Nam CW, Joh HS, Kyu Park T, Yang JH, Song YB, Choi SH, Jeong MH, Gwon HC, Hahn JY, Lee JM. Clinical Value of Single-Projection Angiography-Derived FFR in Noninfarct-Related Artery. Circ Cardiovasc Interv 2024; 17:e013844. [PMID: 38771911 DOI: 10.1161/circinterventions.123.013844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/14/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The Murray law-based quantitative flow ratio (μFR) is an emerging technique that requires only 1 projection of coronary angiography with similar accuracy to quantitative flow ratio (QFR). However, it has not been validated for the evaluation of noninfarct-related artery (non-IRA) in acute myocardial infarction (AMI) settings. Therefore, our study aimed to evaluate the diagnostic accuracy of μFR and the safety of deferring non-IRA lesions with μFR >0.80 in the setting of AMI. METHODS μFR and QFR were analyzed for non-IRA lesions of patients with AMI enrolled in the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infarction Related Artery Stenosis in Patients With Acute Myocardial Infarction), consisting of fractional flow reserve (FFR)-guided percutaneous coronary intervention and angiography-guided percutaneous coronary intervention groups. The diagnostic accuracy of μFR was compared with QFR and FFR. Patients were classified by the non-IRA μFR value of 0.80 as a cutoff value. The primary outcome was a vessel-oriented composite outcome, a composite of cardiac death, non-IRA-related myocardial infarction, and non-IRA-related repeat revascularization. RESULTS μFR and QFR analyses were feasible in 443 patients (552 lesions). μFR showed acceptable correlation with FFR (R=0.777; P<0.001), comparable C-index with QFR to predict FFR ≤0.80 (μFR versus QFR: 0.926 versus 0.961, P=0.070), and shorter total analysis time (mean, 32.7 versus 186.9 s; P<0.001). Non-IRA with μFR >0.80 and deferred percutaneous coronary intervention had a significantly lower risk of vessel-oriented composite outcome than non-IRA with performed percutaneous coronary intervention (3.4% versus 10.5%; hazard ratio, 0.37 [95% CI, 0.14-0.99]; P=0.048). CONCLUSIONS In patients with multivessel AMI, μFR of non-IRA showed acceptable diagnostic accuracy comparable to that of QFR to predict FFR ≤0.80. Deferred non-IRA with μFR >0.80 showed a lower risk of vessel-oriented composite outcome than revascularized non-IRA. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02715518.
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Affiliation(s)
- Woochan Kwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Ki Hong Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (S.H.L., M.C.K., Y.J.H., M.H.J.)
| | - David Hong
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC (D.S.)
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea (H.K.K., K.H.P.)
| | - Keun Ho Park
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea (H.K.K., K.H.P.)
| | - Eun Ho Choo
- Seoul St. Mary's Hospital, The Catholic University of Korea, South Korea (E.H.C.)
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, South Korea (C.J.K.)
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (S.H.L., M.C.K., Y.J.H., M.H.J.)
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (S.H.L., M.C.K., Y.J.H., M.H.J.)
| | - Sung Gyun Ahn
- Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, South Korea (S.G.A.)
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.)
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, South Korea (S.Y.L.)
| | - Sang Don Park
- Inha University Hospital, Incheon, South Korea (S.D.P.)
| | - Hyun-Jong Lee
- Sejong General Hospital, Bucheon, South Korea (H.-J.L.)
| | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, South Korea (M.G.K., J.-S.K.)
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, South Korea (M.G.K., J.-S.K.)
| | - Yun-Kyeong Cho
- Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., C.-W.N.)
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., C.-W.N.)
| | - Hyun Sung Joh
- Seoul National University Boramae Medical Center, Seoul National University College of Medicine, South Korea (H.S.J.)
| | - Taek Kyu Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Jeong Hoon Yang
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Seung-Hyuk Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (S.H.L., M.C.K., Y.J.H., M.H.J.)
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.K., K.H.C., D.H., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
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5
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Boerhout CKM, Vink CEM, Lee JM, de Waard GA, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Appelman Y, Beijk MAM, van Royen N, Chamuleau SAJ, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Impact of sex on the assessment of the microvascular resistance reserve. Int J Cardiol 2024; 402:131832. [PMID: 38316189 DOI: 10.1016/j.ijcard.2024.131832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The microvascular resistance reserve (MRR) is an innovative index to assess the vasodilatory capacity of the coronary circulation while accounting for the presence of concomitant epicardial disease. The MRR has shown to be a valuable diagnostic and prognostic tool in the general coronary artery disease (CAD) population. However, considering the fundamental aspects of its assessment and the unique hemodynamic characteristics of women, it is crucial to provide additional considerations for evaluating the MRR specifically in women. AIM The aim of this study was to assess the diagnostic and prognostic applicability of the MRR in women and assess the potential differences across different sexes. METHODS From the ILIAS Registry, we enrolled all patients with a stable indication for invasive coronary angiography, ensuring complete physiological and follow-up data. We analyzed the diagnostic value by comparing differences between sexes and evaluated the prognostic value of the MRR specifically in women, comparing it to that in men. RESULTS A total of 1494 patients were included of which 26% were women. The correlation between MRR and CFR was good and similar between women (r = 0.80, p < 0.005) and men (r = 0.81, p < 0.005). The MRR was an independent and important predictor of MACE in both women (HR 0.67, 0.47-0.96, p = 0.027) and men (HR 0.84, 0.74-0.95, p = 0.007). The optimal cut-off value for MRR in women was 2.8 and 3.2 in men. An abnormal MRR similarly predicted MACE at 5-year follow-up in both women and men. CONCLUSION The MRR seems to be equally applicable in both women and men with stable coronary artery disease.
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Affiliation(s)
| | - C E M Vink
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea
| | | | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Koen Marques
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati Cincinnati, OH, USA; Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University, Daegu, South Korea
| | - Giampaolo Niccoli
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan; Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Paul Knaapen
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Bon Kwon Koo
- Seoul National University Hospital, Department of Internal Medicine, Cardiovascular Center, Seoul, Republic of Korea
| | - Jan J Piek
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, University Medical Centre Utrecht, the Netherlands.
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Kim CH, Lee SH, Kim HK, Kim MC, Kim JH, Hong YJ, Ahn YK, Jeong MH, Hur SH, Kim DI, Chang K, Park HS, Bae JW, Jeong JO, Park YH, Yun KH, Yoon CH, Kim Y, Hwang JY, Kim HS, Choi KH, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Lee JM. Prognostic Implications of N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Non-ST-Elevation Myocardial Infarction. Circ J 2024:CJ-24-0129. [PMID: 38599833 DOI: 10.1253/circj.cj-24-0129] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Limited data exist regarding the prognostic implications of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with non-ST-elevation myocardial infarction (NSTEMI) who undergo percutaneous coronary intervention (PCI).Methods and Results: Of 13,104 patients in the nationwide Korea Acute Myocardial Infarction Registry-National Institutes of Health, 3,083 patients with NSTEMI who underwent PCI were included in the present study. The primary endpoint was major adverse cardiovascular events (MACE) at 3 years, a composite of all-cause death, recurrent myocardial infarction, unplanned repeat revascularization, and admission for heart failure. NT-proBNP was measured at the time of initial presentation for the management of NSTEMI, and patients were divided into a low (<700 pg/mL; n=1,813) and high (≥700 pg/mL; n=1,270) NT-proBNP group. The high NT-proBNP group had a significantly higher risk of MACE, driven primarily by a higher risk of cardiac death or admission for heart failure. These results were consistent after confounder adjustment by propensity score matching and inverse probability weighting analysis. CONCLUSIONS In patients with NSTEMI who underwent PCI, an initial elevated NT-proBNP concentration was associated with higher risk of MACE at 3 years, driven primarily by higher risks of cardiac death or admission for heart failure. These results suggest that the initial NT-proBNP concentration may have a clinically significant prognostic value in NSTEMI patients undergoing PCI.
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Affiliation(s)
- Chang Hoon Kim
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School
| | - Young Keun Ahn
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School
| | | | - Doo Il Kim
- Department of Cardiology, Inje University Haeundae Baek Hospital, Inje University College of Medicine
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital
| | - Jang-Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine
| | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | | | | | - Yisik Kim
- Chonbuk National University Hospital and Chonbuk National University Medical School
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Ki Hong Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Taek Kyu Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Hoon Yang
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
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7
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Joh HS, Lee SH, Jo J, Kim HK, Lim WH, Kim HL, Seo JB, Chung WY, Kim SH, Zo JH, Kim MA, Kim MC, Kim JH, Hong YJ, Ahn YK, Jeong MH, Hur SH, Kim DI, Chang K, Park HS, Bae JW, Jeong JO, Park YH, Yun KH, Yoon CH, Kim Y, Hwang JY, Kim HS, Hong D, Kwon W, Choi KH, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Lee JM. Intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00125-7. [PMID: 38609042 DOI: 10.1016/j.rec.2024.03.009] [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] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION AND OBJECTIVES There are no clinical data on the efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI in patients with acute myocardial infarction (AMI) and cardiogenic shock. The current study sought to evaluate the impact of intravascular imaging-guided PCI in patients with AMI and cardiogenic shock. METHODS Among a total of 28 732 patients from the nationwide pooled registry of KAMIR-NIH (November, 2011 to December, 2015) and KAMIR-V (January, 2016 to June, 2020), we selected a total of 1833 patients (6.4%) with AMI and cardiogenic shock who underwent PCI of the culprit vessel. The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of cardiac death, myocardial infarction, repeat revascularization, and definite or probable stent thrombosis. RESULTS Among the study population, 375 patients (20.5%) underwent intravascular imaging-guided PCI and 1458 patients (79.5%) underwent angiography-guided PCI. Intravascular imaging-guided PCI was associated with a significantly lower risk of 1-year MACE than angiography-guided PCI (19.5% vs 28.2%; HR, 0.59; 95%CI, 0.45-0.77; P<.001), mainly driven by a lower risk of cardiac death (13.7% vs 24.0%; adjusted HR, 0.53; 95%CI, 0.39-0.72; P<.001). These results were consistent in propensity score matching (HR, 0.68; 95%CI, 0.46-0.99), inverse probability weighting (HR, 0.61; 95%CI, 0.45-0.83), and Bayesian analysis (Odds ratio, 0.66, 95% credible interval, 0.49-0.88). CONCLUSIONS In AMI patients with cardiogenic shock, intravascular imaging-guided PCI was associated with a lower risk of MACE at 1-year than angiography-guided PCI, mainly driven by the lower risk of cardiac death.
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Affiliation(s)
- Hyun Sung Joh
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Jinhwan Jo
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hack-Lyoung Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Bin Seo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Young Chung
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Hee Zo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-A Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Keun Ahn
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Seung Ho Hur
- Department of Internal Medicine and Cardiovascular Center, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Doo Il Kim
- Department of Cardiology, Inje University Haeundae Baek Hospital, Inje University College of Medicine, Busan, Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyeong Ho Yun
- Department of Internal Medicine and Cardiovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Chang-Hwan Yoon
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Yisik Kim
- Department of Internal Medicine and Cardiovascular Center, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - David Hong
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woochan Kwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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8
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Choi KH, Kang D, Lee J, Park H, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Gwon HC, Cho J, Yang JH. Association between intensive care unit nursing grade and mortality in patients with cardiogenic shock and its cost-effectiveness. Crit Care 2024; 28:99. [PMID: 38523296 PMCID: PMC10962168 DOI: 10.1186/s13054-024-04880-9] [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] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Despite the high workload of cardiac intensive care unit (ICU), there is a paucity of evidence on the association between nurse workforce and mortality in patients with cardiogenic shock (CS). This study aimed to evaluate the prognostic impact of the ICU nursing grade on mortality and cost-effectiveness in CS. METHODS A nationwide analysis was performed using the K-NHIS database. Patients diagnosed with CS and admitted to the ICU at tertiary hospitals were enrolled. ICU nursing grade was defined according to the bed-to-nurse ratio: grade1 (bed-to-nurse ratio < 0.5), grade2 (0.5 ≤ bed-to-nurse ratio < 0.63), and grade3 (0.63 ≤ bed-to-nurse ratio < 0.77) or above. The primary endpoint was in-hospital mortality. Cost-effective analysis was also performed. RESULTS Of the 72,950 patients with CS, 27,216 (37.3%) were in ICU nursing grade 1, 29,710 (40.7%) in grade 2, and 16,024 (22.0%) in grade ≥ 3. The adjusted-OR for in-hospital mortality was significantly higher in patients with grade 2 (grade 1 vs. grade 2, 30.6% vs. 37.5%, adjusted-OR 1.14, 95% CI1.09-1.19) and grade ≥ 3 (40.6%) with an adjusted-OR of 1.29 (95% CI 1.23-1.36) than those with grade 1. The incremental cost-effectiveness ratio of grade1 compared with grade 2 and ≥ 3 was $25,047/year and $42,888/year for hospitalization and $5151/year and $5269/year for 1-year follow-up, suggesting that grade 1 was cost-effective. In subgroup analysis, the beneficial effects of the high-intensity nursing grade on mortality were more prominent in patients who received CPR or multiple vasopressors usage. CONCLUSIONS For patients with CS, ICU grade 1 with a high-intensity nursing staff was associated with reduced mortality and more cost-effectiveness during hospitalization compared to grade 2 and grade ≥ 3, and its beneficial effects were more pronounced in subjects at high risk of CS.
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jin Lee
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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9
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Han M, Hwang S, Agusbudiman A, Lee JM, Lee KB, Kim BC, Heo DH, Kim TH. Digital coincidence counting with 4πβ(PPC)-γ for the standardization of 60Co. Appl Radiat Isot 2024; 205:111173. [PMID: 38211394 DOI: 10.1016/j.apradiso.2024.111173] [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: 09/30/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
A 4πβ(PPC)-γ coincidence system has been made at KRISS based on a digital DAQ. 60Co sources were measured to verify the system. The maximum detection efficiency for beta particles was estimated to be 96.7 %. Massic activities for sample sources had 0.005 % of the sample variability error, which was well within the expanded standard uncertainty of 0.54 % (k = 2).
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Affiliation(s)
- Minji Han
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - Sanghoon Hwang
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea.
| | - Agung Agusbudiman
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - J M Lee
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - K B Lee
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - B C Kim
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea
| | - D H Heo
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea
| | - T H Kim
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea
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10
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Hong D, Lee J, Lee H, Cho J, Guallar E, Choi KH, Lee SH, Shin D, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Kang D, Lee JM. Cost-Effectiveness of Intravascular Imaging-Guided Complex PCI: Prespecified Analysis of RENOVATE-COMPLEX-PCI Trial. Circ Cardiovasc Qual Outcomes 2024; 17:e010230. [PMID: 38477162 DOI: 10.1161/circoutcomes.123.010230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/30/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND Although clinical benefits of intravascular imaging-guided percutaneous coronary intervention (PCI) in patients with complex coronary artery lesions have been observed in previous trials, the cost-effectiveness of this strategy is uncertain. METHODS RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance vs Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) was conducted in Korea between May 2018 and May 2021. This prespecified cost-effectiveness substudy was conducted using Markov model that simulated 3 states: (1) post-PCI, (2) spontaneous myocardial infarction, and (3) death. A simulated cohort was derived from the intention-to-treat population, and input parameters were extracted from either the trial data or previous publications. Cost-effectiveness was evaluated using time horizon of 3 years (within trial) and lifetime. The primary outcome was incremental cost-effectiveness ratio (ICER), an indicator of incremental cost on additional quality-adjusted life years (QALYs) gained, in intravascular imaging-guided PCI compared with angiography-guided PCI. The current analysis was performed using the Korean health care sector perspective with reporting the results in US dollar (1200 Korean Won, ₩=1 dollar, $). Willingness to pay threshold was $35 000 per QALY gained. RESULTS A total of 1639 patients were included in the trial. During 3-year follow-up, medical costs ($8661 versus $7236; incremental cost, $1426) and QALY (2.34 versus 2.31; incremental QALY, 0.025) were both higher in intravascular imaging-guided PCI than angiography-guided PCI, resulting incremental cost-effectiveness ratio of $57 040 per QALY gained within trial data. Conversely, lifetime simulation showed total cumulative medical cost was reversed between the 2 groups ($40 455 versus $49 519; incremental cost, -$9063) with consistently higher QALY (8.24 versus 7.89; incremental QALY, 0.910) in intravascular imaging-guided PCI than angiography-guided PCI, resulting in a dominant incremental cost-effectiveness ratio. Consistently, 70% of probabilistic iterations showed cost-effectiveness of intravascular imaging-guided PCI in probabilistic sensitivity analysis. CONCLUSIONS The current cost-effectiveness analysis suggests that imaging-guided PCI is more cost-effective than angiography-guided PCI by reducing medical cost and increasing quality-of-life in complex coronary artery lesions in long-term follow-up. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.
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Affiliation(s)
- David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.)
| | - Jin Lee
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.)
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.)
| | - Hankil Lee
- College of Pharmacy, Ajou University, Suwon, South Korea (H.L.)
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.)
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.)
| | - Eliseo Guallar
- Department of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD (E.G.)
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.)
| | - Seung Hun Lee
- Chonnam National University Hospital, Gwangju, Korea (S.H.L.)
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC (D.S.)
| | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-Y.L., S.-J.L.)
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-Y.L., S.-J.L.)
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.)
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Korea (S.Y.L.)
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.)
| | - Kyeong Ho Yun
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Jae Young Cho
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea (C.J.K., H.-S.A.)
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea (C.J.K., H.-S.A.)
| | - Chang-Wook Nam
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Hyuck-Jun Yoon
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Korea (Y.H.P.)
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (W.S.L.)
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.)
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.)
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.)
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.)
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.)
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.)
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.)
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (J.L., J.C., D.K.)
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H., J.M.L.)
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11
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Choi KH, Kwon W, Shin D, Lee SH, Hwang D, Zhang J, Nam CW, Shin ES, Doh JH, Chen SL, Kakuta T, Toth GG, Piroth Z, Hakeem A, Uretsky BF, Hokama Y, Tanaka N, Lim HS, Ito T, Matsuo A, Azzalini L, Leesar MA, Daemen J, Collison D, Collet C, De Bruyne B, Koo BK, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Lee JM. Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction. JACC Asia 2024; 4:229-240. [PMID: 38463680 PMCID: PMC10920040 DOI: 10.1016/j.jacasi.2023.10.009] [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] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 03/12/2024]
Abstract
Background Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified. Objectives This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF). Methods A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR. Results Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HRadj: 1.029; 95% CI: 1.009-1.049; P = 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HRadj: 1.145; 95% CI: 1.025-1.280; P = 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HRadj: 1.028; 95% CI: 1.005-1.052; P = 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF (Pinteraction = 0.019). Conclusions Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%. (Prognostic Implications of Physiologic Investigation After Revascularization with Stent [POST-PCI FLOW]; NCT04684043).
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woochan Kwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Seung-Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Gabor G. Toth
- University Heart Centre Graz, Medical University Graz, Austria
| | - Zsolt Piroth
- Gottsegen National Cardiovascular Centre, Budapest, Hungary
| | - Abdul Hakeem
- Division of Cardiovascular Diseases and Hypertension, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Barry F. Uretsky
- Central Arkansas VA Health System/University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Hong-Seok Lim
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Akiko Matsuo
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lorenzo Azzalini
- Division of Cardiovascular Diseases, University of Alabama, Birmingham, Alabama, USA
| | - Massoud A. Leesar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joost Daemen
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Carlos Collet
- Department of Cardiology, University of Lausanne, Switzerland
| | | | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Lee JM, Kim H, Lee JY, Choi KH, Song YB, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY. Optical Coherence Tomography Compared With Intravascular Ultrasound and Angiography in Complex Coronary Artery Lesions. JACC Cardiovasc Imaging 2024; 17:336-338. [PMID: 37943231 DOI: 10.1016/j.jcmg.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/22/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023]
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13
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Hong D, Kim SE, Lee SH, Lee SJ, Lee JY, Kim SM, Lee SY, Kwon W, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Gwon HC, Hahn JY, Lee JM. Current evidence for prognostic benefit of intravascular imaging-guided percutaneous coronary intervention in chronic total occlusion intervention. Korean J Intern Med 2024:kjim.2023.420. [PMID: 38419334 DOI: 10.3904/kjim.2023.420] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 03/02/2024] Open
Abstract
Although percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has been increasing in recent years, CTO PCI is still one of the most challenging procedures with relatively higher rates of procedural complications and adverse clinical events after PCI. Due to the innate limitations of invasive coronary angiography, intravascular imaging (IVI) has been used as an adjunctive tool to complement PCI, especially in complex coronary artery disease. Considering the complexity of CTO lesions, the role of IVI is particularly important in CTO intervention. IVI has been a useful adjunctive tool in every step of CTO PCI including assisted wire crossing, confirmation of wire location within CTO segment, and stent optimization. The meticulous use of IVI has been one of the greatest contributors to recent progress of CTO PCI. Nevertheless, studies evaluating the role of IVI during CTO PCI are limited. The current review provides a comprehensive overview of the mechanistic advantages of IVI in CTO PCI, summarizes previous studies and trials, and presents future perspective of IVI in CTO PCI.
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Affiliation(s)
- David Hong
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Seung Hun Lee
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung-Jae Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang Yeub Lee
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Woochan Kwon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shin D, Lee SH, Hong D, Choi KH, Lee JM. Physiologic Assessment After Percutaneous Coronary Interventions and Functionally Optimized Revascularization. Cardiol Clin 2024; 42:55-76. [PMID: 37949540 DOI: 10.1016/j.ccl.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Coronary physiologic assessment has become a standard of care for patients with coronary atherosclerotic disease. While most attention has focused on pre-interventional physiologic assessment to aid in revascularization decision-making, post-interventional physiologic assessment has not been as widely used, despite evidence supporting its role in assessment and optimization of the revascularization procedure. A thorough understanding of such evidence and ongoing studies would be crucial to incorporate post-interventional physiologic assessment into daily practice. Thus, this review provides a comprehensive overview of current evidence regarding the evolving role of physiologic assessment as a functional optimization tool for the entire revascularization process.
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Affiliation(s)
- Doosup Shin
- Division of Cardiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - David Hong
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
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15
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Kwon W, Hong D, Choi KH, Lee SH, Shin D, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Park TK, Yang JH, Choi SH, Gwon HC, Song YB, Hahn JY, Lee JM. Intravascular Imaging-Guided Percutaneous Coronary Intervention Before and After Standardized Optimization Protocols. JACC Cardiovasc Interv 2024; 17:292-303. [PMID: 38267144 DOI: 10.1016/j.jcin.2023.10.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Although benefits of intravascular imaging (IVI) in percutaneous coronary intervention (PCI) have been observed in previous studies, it is not known whether changes in contemporary practice, especially with application of standardized optimization protocols, have improved clinical outcomes. OBJECTIVES The authors sought to investigate whether clinical outcomes of IVI-guided PCI are different before and after the application of standardized optimization protocols in using IVI. METHODS 2,972 patients from an institutional registry (2008-2015, before application of standardized optimization protocols, the past group) and 1,639 patients from a recently published trial (2018-2021 after application of standardized optimization protocols, the present group) were divided into 2 groups according to use of IVI. The primary outcome was 3-year target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization. RESULTS Significant reduction of TVF was observed in the IVI-guided PCI group compared with the angiography-guided PCI group (10.0% vs 6.7%; HR: 0.77; 95% CI: 0.61-0.97; P = 0.027), mainly driven by reduced cardiac death or myocardial infarction in both past and present IVI-guided PCI groups. When comparing past IVI and present IVI groups, TVF was significantly lower in the present IVI group (8.5% vs 5.1%; HR: 0.63; 95% CI: 0.42-0.94; P = 0.025), with the difference being driven by reduced target vessel revascularization in the present IVI group. Consistent results were observed in inverse-probability-weighting adjusted analysis. CONCLUSIONS IVI-guided PCI improved clinical outcomes more than angiography-guided PCI. In addition, application of standardized optimization protocols when using IVI further improved clinical outcomes after PCI. (Intravascular Imaging- Versus Angiography-Guided Percutaneous Coronary Intervention For Complex Coronary Artery Disease [RENOVATE-COMPLEX-PCI]; NCT03381872; and the institutional cardiovascular catheterization database of Samsung Medical Center: Long-Term Outcomes and Prognostic Factors in Patient Undergoing CABG or PCI; NCT03870815).
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Affiliation(s)
- Woochan Kwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea; Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | | | | | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea
| | | | | | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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16
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Hong D, Lee SH, Lee J, Lee H, Shin D, Kim HK, Park KH, Choo EH, Kim CJ, Kim MC, Hong YJ, Jeong MH, Ahn SG, Doh JH, Lee SY, Don Park S, Lee HJ, Kang MG, Koh JS, Cho YK, Nam CW, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Gwon HC, Guallar E, Cho J, Hahn JY, Kang D, Lee JM. Cost-Effectiveness of Fractional Flow Reserve-Guided Treatment for Acute Myocardial Infarction and Multivessel Disease: A Prespecified Analysis of the FRAME-AMI Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2352427. [PMID: 38270954 PMCID: PMC10811558 DOI: 10.1001/jamanetworkopen.2023.52427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/14/2023] [Indexed: 01/26/2024] Open
Abstract
Importance Complete revascularization by non-infarct-related artery (IRA) percutaneous coronary intervention (PCI) in patients with acute myocardial infarction is standard practice to improve patient prognosis. However, it is unclear whether a fractional flow reserve (FFR)-guided or angiography-guided treatment strategy for non-IRA PCI would be more cost-effective. Objective To evaluate the cost-effectiveness of FFR-guided compared with angiography-guided PCI in patients with acute myocardial infarction and multivessel disease. Design, Setting, and Participants In this prespecified cost-effectiveness analysis of the FRAME-AMI randomized clinical trial, patients were randomly allocated to either FFR-guided or angiography-guided PCI for non-IRA lesions between August 19, 2016, and December 24, 2020. Patients were aged 19 years or older, had ST-segment elevation myocardial infarction (STEMI) or non-STEMI and underwent successful primary or urgent PCI, and had at least 1 non-IRA lesion (diameter stenosis >50% in a major epicardial coronary artery or major side branch with a vessel diameter of ≥2.0 mm). Data analysis was performed on August 27, 2023. Intervention Fractional flow reserve-guided vs angiography-guided PCI for non-IRA lesions. Main Outcomes and Measures The model simulated death, myocardial infarction, and repeat revascularization. Future medical costs and benefits were discounted by 4.5% per year. The main outcomes were quality-adjusted life-years (QALYs), direct medical costs, incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INB) of FFR-guided PCI compared with angiography-guided PCI. State-transition Markov models were applied to the Korean, US, and European health care systems using medical cost (presented in US dollars), utilities data, and transition probabilities from meta-analysis of previous trials. Results The FRAME-AMI trial randomized 562 patients, with a mean (SD) age of 63.3 (11.4) years. Most patients were men (474 [84.3%]). Fractional flow reserve-guided PCI increased QALYs by 0.06 compared with angiography-guided PCI. The total cumulative cost per patient was estimated as $1208 less for FFR-guided compared with angiography-guided PCI. The ICER was -$19 484 and the INB was $3378, indicating that FFR-guided PCI was more cost-effective for patients with acute myocardial infarction and multivessel disease. Probabilistic sensitivity analysis showed consistent results and the likelihood iteration of cost-effectiveness in FFR-guided PCI was 97%. When transition probabilities from the pairwise meta-analysis of the FLOWER-MI and FRAME-AMI trials were used, FFR-guided PCI was more cost-effective than angiography-guided PCI in the Korean, US, and European health care systems, with an INB of $3910, $8557, and $2210, respectively. In probabilistic sensitivity analysis, the likelihood iteration of cost-effectiveness with FFR-guided PCI was 85%, 82%, and 31% for the Korean, US, and European health care systems, respectively. Conclusions and Relevance This cost-effectiveness analysis suggests that FFR-guided PCI for non-IRA lesions saved medical costs and increased quality of life better than angiography-guided PCI for patients with acute myocardial infarction and multivessel disease. Fractional flow reserve-guided PCI should be considered in determining the treatment strategy for non-IRA stenoses in these patients. Trial Registration ClinicalTrials.gov Identifier: NCT02715518.
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Affiliation(s)
- David Hong
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Chonnam National University Hospital, Gwangju, Korea
| | - Jin Lee
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Hankil Lee
- College of Pharmacy, Ajou University, Suwon, South Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Keun Ho Park
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Eun Ho Choo
- Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chan Joon Kim
- Uijeongbu St Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min Chul Kim
- Chonnam National University Hospital, Gwangju, Korea
| | | | | | - Sung Gyun Ahn
- Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | | | | | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Yun-Kyeong Cho
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Ki Hong Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eliseo Guallar
- Department of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Yang S, Kang J, Hwang D, Zhang J, Jiang J, Hu X, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Ahn SG, Yoon MH, Kim U, Lee JM, Ki YJ, Shin ES, Kim HS, Tahk SJ, Wang J, Koo BK. Physiology- or Imaging-Guided Strategies for Intermediate Coronary Stenosis. JAMA Netw Open 2024; 7:e2350036. [PMID: 38170524 PMCID: PMC10765263 DOI: 10.1001/jamanetworkopen.2023.50036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Importance Treatment strategies for intermediate coronary lesions guided by fractional flow reserve (FFR) and intravascular ultrasonography (IVUS) have shown comparable outcomes. Identifying low-risk deferred vessels to ensure the safe deferral of percutaneous coronary intervention (PCI) and high-risk revascularized vessels that necessitate thorough follow-up can help determine optimal treatment strategies. Objectives To investigate outcomes according to treatment types and FFR and IVUS parameters after FFR- or IVUS-guided treatment. Design, Setting, and Participants This cohort study included patients with intermediate coronary stenosis from the Fractional Flow Reserve and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients With Intermediate Stenosis (FLAVOUR) trial, an investigator-initiated, prospective, open-label, multicenter randomized clinical trial that assigned patients into an IVUS-guided strategy (which recommended PCI for minimum lumen area [MLA] ≤3 mm2 or 3 mm2 to 4 mm2 with plaque burden [PB] ≥70%) or an FFR-guided strategy (which recommended PCI for FFR ≤0.80). Data were analyzed from November to December 2022. Exposures FFR or IVUS parameters within the deferred and revascularized vessels. Main Outcomes and Measures The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, and revascularization at 2 years. Results A total of 1619 patients (mean [SD] age, 65.1 [9.6] years; 1137 [70.2%] male) with 1753 vessels were included in analysis. In 950 vessels for which revascularization was deferred, incidence of TVF was comparable between IVUS and FFR groups (3.8% vs 4.1%; P = .72). Vessels with FFR greater than 0.92 in the FFR group and MLA greater than 4.5 mm2 or PB of 58% or less in the IVUS group were identified as low-risk deferred vessels, with a decreased risk of TVF (hazard ratio [HR], 0.25 [95% CI, 0.09-0.71]; P = .009). In 803 revascularized vessels, the incidence of TVF was comparable between IVUS and FFR groups (3.6% vs 3.7%; P = .95), which was similar in the revascularized vessels undergoing PCI optimization (4.2% vs 2.5%; P = .31). Vessels with post-PCI FFR of 0.80 or less in the FFR group or minimum stent area of 6.0 mm2 or less or with PB at stent edge greater than 58% in the IVUS group had an increased risk for TVF (HR, 7.20 [95% CI, 3.20-16.21]; P < .001). Conclusions and Relevance In this cohort study of patients with intermediate coronary stenosis, FFR- and IVUS-guided strategies showed comparable outcomes in both deferred and revascularized vessels. Binary FFR and IVUS parameters could further define low-risk deferred vessels and high-risk revascularized vessels.
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Affiliation(s)
- Seokhun Yang
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeehoon Kang
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Doyeon Hwang
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jinlong Zhang
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Jiang
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyang Hu
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | | | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Gangwon-Do, Republic of Korea
| | - Weon Kim
- Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jinyu Huang
- Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Jiang
- Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Hao Zhou
- The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Chen
- The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Wenbing Jiang
- The Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou, China
| | | | - Wenming He
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Sung Gyun Ahn
- Wonju Severance Christian Hospital, Wonju, Gangwon-Do, Republic of Korea
| | | | - Ung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | | | - You-Jeong Ki
- Uijeongbu Eulji Medical Center, Uijeongbu, Gyeonggi-Do, Republic of Korea
| | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Jian’an Wang
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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18
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Seung J, Choo EH, Kim CJ, Kim HK, Park KH, Lee SH, Kim MC, Hong YJ, Ahn SG, Doh JH, Lee SY, Park SD, Lee HJ, Kang MG, Koh JS, Cho YK, Nam CW, Koo BK, Lee BK, Yun KH, Hong D, Joh HS, Choi KH, Park TK, Lee JM, Yang JH, Song YB, Choi SH, Gwon HC, Hahn JY. Angiographic Severity of the Nonculprit Lesion and the Efficacy of Fractional Flow Reserve-Guided Complete Revascularization in Patients With AMI: FRAME-AMI Substudy. Circ Cardiovasc Interv 2024; 17:e013611. [PMID: 37929584 DOI: 10.1161/circinterventions.123.013611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The benefit of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for noninfarct-related artery (IRA) lesions with angiographically severe stenosis in patients with acute myocardial infarction is unclear. METHODS Among 562 patients from the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infraction Related Artery Stenosis in Patients With Acute Myocardial Infarction) who were randomly allocated into either FFR-guided or angiography-guided PCI for non-IRA lesions, the current study evaluated the relationship between non-IRA stenosis measured by quantitative coronary angiography (QCA) and the efficacy of FFR-guided PCI. The incidence of the primary end point (death, myocardial infarction, or repeat revascularization) was compared between FFR- and angiography-guided PCI according to non-IRA stenosis severity (QCA stenosis ≥70% or <70%). RESULTS A total of 562 patients were assigned to FFR-guided (n=284) versus angiography-guided PCI (n=278). At a median follow-up of 3.5 years, the primary end point occurred in 14 of 181 patients with FFR-guided PCI and 31 of 197 patients with angiography-guided PCI among patients with QCA stenosis ≥70% (8.5% versus 19.2%; hazard ratio, 0.41 [95% CI, 0.22-0.80]; P=0.008), while occurred in 4 of 103 patients with FFR-guided PCI and 9 of 81 patients with angiography-guided PCI among those with QCA stenosis <70% (3.9% versus 11.1%; P=0.315). There was no significant interaction between treatment strategy and non-IRA stenosis severity (P for interaction=0.636). FFR-guided PCI was associated with the reduction of death and myocardial infarction in both patients with QCA stenosis ≥70% (6.7% versus 15.1%; P=0.008) and those with QCA stenosis <70% (1.0% versus 9.6%; P=0.042) compared with angiography-guided PCI. CONCLUSIONS In patients with acute myocardial infarction and multivessel disease, FFR-guided PCI tended to have a lower risk of primary end point than angiography-guided PCI regardless of non-IRA stenosis severity without significant interaction. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02715518.
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Affiliation(s)
- Jaeho Seung
- Seoul St. Mary's Hospital (J.S., E.H.C.), The Catholic University of Korea, Seoul
| | - Eun Ho Choo
- Seoul St. Mary's Hospital (J.S., E.H.C.), The Catholic University of Korea, Seoul
| | - Chan Joon Kim
- Uijeongbu St. Mary's Hospital (C.J.K.), The Catholic University of Korea, Seoul
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea (H.K.K., K.H.P.)
| | - Keun Ho Park
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea (H.K.K., K.H.P.)
| | - Seung Hun Lee
- Chonnam National University Hospital, Gwangju, Korea (S.H.L., M.C.K., Y.J.H.)
| | - Min Chul Kim
- Chonnam National University Hospital, Gwangju, Korea (S.H.L., M.C.K., Y.J.H.)
| | - Young Joon Hong
- Chonnam National University Hospital, Gwangju, Korea (S.H.L., M.C.K., Y.J.H.)
| | - Sung Gyun Ahn
- Wonju College of Medicine, Wonju Severance Christian Hospital, Yonsei University, Korea (S.G.A.)
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.)
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L.)
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Korea (S.Y.L.)
| | | | | | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.H.)
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.H.)
| | - Yun-Kyeong Cho
- Dongsan Medical Center, Keimyung University, Daegu, Korea (Y.-K.C., C.-W.N.)
| | - Chang-Wook Nam
- Dongsan Medical Center, Keimyung University, Daegu, Korea (Y.-K.C., C.-W.N.)
| | - Bon-Kwon Koo
- Seoul National University Hospital, Korea (B.-K.K.)
| | - Bong-Ki Lee
- Kangwon National University School of Medicine, Chuncheon, Korea (B.-K.L.)
| | | | - David Hong
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Hyun Sung Joh
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Ki Hong Choi
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Taek Kyu Park
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Jeong Hoon Yang
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Young Bin Song
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Seung-Hyuk Choi
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Joo-Yong Hahn
- Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., H.S.J., K.H.C., T.K.P., J.M.L., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
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19
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Eftekhari A, van de Hoef TP, Hoshino M, Lee JM, Boerhout CKM, de Waard GA, Jung JH, Lee SH, Mejia-Renteria H, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Effat MA, Marques K, Doh JH, Banerjee R, Nam CW, Niccoli G, Murai T, Nakayama M, Tanaka N, Shin ES, Knaapen P, van Royen N, Escaned J, Koo BK, Chamuleau SAJ, Kakuta T, Piek JJ, Christiansen EH. Changes in microvascular resistance following percutaneous coronary intervention - From the ILIAS global registry. Int J Cardiol 2023; 392:131296. [PMID: 37633364 DOI: 10.1016/j.ijcard.2023.131296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/08/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Microvascular resistance (MR) has prognostic value in acute and chronic coronary syndromes following percutaneous coronary intervention (PCI), however anatomic and physiologic determinants of the relative changes of MR and its association to target vessel failure (TVF) has not been investigated previously. This study aims to evaluate the association between changes in MR and TVF. METHODS This is a sub-study of the Inclusive Invasive Physiological Assessment in Angina Syndromes (ILIAS) registry which is a global multi-centre initiative pooling lesion-level coronary pressure and flow data. RESULTS Paired pre-post PCI haemodynamic data were available in n = 295 vessels out of n = 828 PCI treated patients and of these paired data on MR was present in n = 155 vessels. Vessels were divided according to increase vs. decrease % in microvascular resistance following PCI (ΔMR % ≤ 0 vs. ΔMR > 0%). Decreased microvascular resistance ΔMR % ≤ 0 occurred in vessels with lower pre-PCI fractional flow reserve (0.67 ± 0.15 vs. 0.72 ± 0.09 p = 0.051), coronary flow reserve (1.9 ± 0.8 vs. 2.6 ± 1.8 p < 0.0001) and higher hyperemic microvascular resistance (2.76 ± 1.3 vs. 1.62 ± 0.74 p = 0.001) and index of microvascular resistance (24.4 IQ (13.8) vs. 15. 8 IQ (13.2) p = 0.004). There was no difference in angiographic parameters between ΔMR % ≤ 0 vs. ΔMR > 0%. In a cox regression model ΔMR % > 0 was associated with increased rate of TVF (hazard ratio 95% CI 3.6 [1.2; 10.3] p = 0.018). CONCLUSION Increased MR post-PCI was associated with lesions of less severe hemodynamic influence at baseline and higher rates of TVF at follow-up.
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Affiliation(s)
- Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Tim P van de Hoef
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Medicine Hearth Vascular Stroke Institute Seoul, Republic of Korea
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Mauro Echavarria-Pinto
- Hospital General Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estad Querétaro, Facultad de Medicina Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Hearth Center, Gifu, Japan
| | | | - Mohamed A Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | | | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
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20
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Lee JM, Kim H, Hong D, Hwang D, Zhang J, Hu X, Jiang J, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Kang J, Ahn SG, Yoon MH, Kim U, Ki YJ, Shin ES, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Gwon HC, Koo BK, Kim HS, Tahk SJ, Wang J, Hahn JY. Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision. Circ Cardiovasc Interv 2023; 16:e013308. [PMID: 38018840 DOI: 10.1161/circinterventions.123.013308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND There are limited data regarding the safety of deferral of percutaneous coronary intervention based on intravascular ultrasound (IVUS) findings. The current study sought to compare the prognosis between deferred lesions based on IVUS and fractional flow reserve (FFR)-guided treatment decision. METHODS This study is a post hoc analysis of the FLAVOUR randomized trial (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients With Intermediate Stenosis) that compared 2-year clinical outcomes between IVUS- and FFR-guided treatment decision on intermediate coronary artery lesions using predefined criteria. In both IVUS and FFR groups, vessels were classified into deferred or revascularized vessels, and patients were classified as those with or without deferred lesions. Vessel-oriented composite outcomes (cardiac death, target vessel myocardial infarction, or target vessel revascularization) in deferred vessels and patient-oriented composite outcomes (death, myocardial infarction, or any revascularization) in patients with deferred lesions were compared between the IVUS and FFR groups. RESULTS A total of 1682 patients and 1820 vessels were analyzed, of which 922 patients and 989 vessels were deferred. At 2 years, there was no difference in the cumulative incidence of vessel-oriented composite outcomes in deferred vessels between IVUS (n=375) and FFR (n=614) groups (3.8% versus 4.1%; hazard ratio, 0.91 [95% CI, 0.47-1.75]; P=0.77). The risk of vessel-oriented composite outcomes was comparable between deferred and revascularized vessels following treatment decision by IVUS (3.8% versus 3.5%; hazard ratio, 1.09 [95% CI, 0.54-2.19]; P=0.81) and FFR (4.1% versus 3.6%; hazard ratio, 1.14 [95% CI, 0.56-2.32]; P=0.72). In comparison of patient-oriented composite outcomes in patients with deferred lesions, there was no significant difference between the IVUS (n=357) and FFR (n=565) groups (6.2% versus 5.9%; hazard ratio, 1.05 [95% CI, 0.61-1.80]; P=0.86). CONCLUSIONS In patients with intermediate coronary artery stenosis, deferral of percutaneous coronary intervention based on IVUS-guided treatment decision showed comparable risk of clinical events with FFR-guided treatment decision. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02673424.
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Affiliation(s)
- Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Hangyul Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Doyeon Hwang
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
| | - Jinlong Zhang
- The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China
| | - Xinyang Hu
- The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China
| | - Jun Jiang
- The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (C.-W.N.)
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (J.-H.D.)
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Republic of Korea (B.-K.L.)
| | - Weon Kim
- Kyung Hee University Hospital, Seoul, Republic of Korea (W.K.)
| | - Jinyu Huang
- Affiliated Hangzhou First People's Hospital (J.H.), Zhejiang University School of Medicine, China
| | - Fan Jiang
- Hangzhou Normal University Affiliated Hospital, China (F.J.)
| | - Hao Zhou
- The First Affiliated Hospital of Wenzhou Medical University, China (H.Z.)
| | - Peng Chen
- The Second Affiliated Hospital of Wenzhou Medical University, China (P.C.)
| | | | - Wenbing Jiang
- The Third Clinical Institute Affiliated to Wenzhou Medical University, China (W.J.)
| | | | - Wenming He
- The Affiliated Hospital of Medical School of Ningbo University, China (W.H.)
| | - Jeehoon Kang
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
| | - Sung-Gyun Ahn
- Wonju Severance Christian Hospital, Republic of Korea (S.-G.A.)
| | - Myeong-Ho Yoon
- Ajou University Hospital, Suwon, Republic of Korea (M.-H.Y., S.-J.T.)
| | - Ung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea (U.K.)
| | - You-Jeong Ki
- Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Republic of Korea (Y.-J.K.)
| | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (E.-S.S.)
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
| | - Bon-Kwon Koo
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
| | - Hyo-Soo Kim
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
| | - Seung-Jea Tahk
- Ajou University Hospital, Suwon, Republic of Korea (M.-H.Y., S.-J.T.)
| | - Jian'an Wang
- Seoul National University Hospital, Republic of Korea (D. Hwang, J.K., B.-K.K., H.-S.K., J.W.)
- The Second Affiliated Hospital (J.Z., X.H., J.J., J.W.), Zhejiang University School of Medicine, China
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L., H.K., D. Hong, K.H.C., T.K.P., J.H.Y., Y.B.S., S.-H.C., H.-C.G., J.-Y.H.)
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Koo BK, Hwang D, Park S, Kuramitsu S, Yonetsu T, Kim CH, Zhang J, Yang S, Doh JH, Jeong YH, Choi KH, Lee JM, Ahn JM, Matsuo H, Shin ES, Hu X, Low AF, Kubo T, Nam CW, Yong AS, Harding SA, Xu B, Hur SH, Choo GH, Tan HC, Mullasari A, Hsieh IC, Kakuta T, Akasaka T, Wang J, Tahk SJ, Fearon WF, Escaned J, Park SJ. Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 2. JACC Asia 2023; 3:825-842. [PMID: 38155788 PMCID: PMC10751650 DOI: 10.1016/j.jacasi.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/08/2023] [Indexed: 12/30/2023]
Abstract
Coronary physiologic assessment is performed to measure coronary pressure, flow, and resistance or their surrogates to enable the selection of appropriate management strategy and its optimization for patients with coronary artery disease. The value of physiologic assessment is supported by a large body of clinical data that has led to major recommendations in all practice guidelines. This expert consensus document aims to convey practical and balanced recommendations and future perspectives for coronary physiologic assessment for physicians and patients in the Asia-Pacific region, based on updated information in the field that includes both wire- and image-based physiologic assessment. This is Part 2 of the whole consensus document, which provides theoretical and practical information on physiologic indexes for specific clinical conditions and patient statuses.
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Affiliation(s)
- Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sungjoon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Shoichi Kuramitsu
- Department of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chee Hae Kim
- Department of Internal Medicine and Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea and Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Adrian F. Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Takashi Kubo
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Chang-Wook Nam
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Andy S.C. Yong
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Scott A. Harding
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Bo Xu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Seung-Ho Hur
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gim Hooi Choo
- Department of Cardiology, Cardiac Vascular Sentral KL (CVSKL), Kuala Lumpur, Malaysia
| | - Huay Cheem Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Ajit Mullasari
- Department of Cardiology, Madras Medical Mission, Chennai, India
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - William F. Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Kwon W, Lee JM, Yun KH, Choi KH, Lee SJ, Lee JY, Lee SY, Kim SM, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Song YB. Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention. Circ Cardiovasc Interv 2023; 16:e013359. [PMID: 38018841 DOI: 10.1161/circinterventions.123.013359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/12/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) demonstrated that intravascular imaging-guided percutaneous coronary intervention (PCI) improved clinical outcome compared with angiography-guided PCI for patients with complex coronary artery lesions. This study aims to assess whether the prognostic benefit of intravascular imaging-guided procedural optimization persists in patients undergoing PCI for left main coronary artery disease. METHODS Of 1639 patients enrolled in the RENOVATE-COMPLEX-PCI, 192 patients with left main coronary artery disease were selected for the current prespecified substudy. Selected patients were randomly assigned to either the intravascular imaging-guided PCI group (n=138) or the angiography-guided PCI group (n=54). The primary end point was target vessel failure defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization. RESULTS At a median follow-up of 2.1 years (interquartile range 1.1 to 3.0 years), intravascular imaging-guided PCI was associated with lower incidence of primary end point compared with angiography-guided PCI (6.8% versus 25.1%; hazard ratio, 0.31 [95% CI, 0.13-0.76]; P=0.010). This significant reduction in primary end point was mainly driven by a lower risk of cardiac death or spontaneous target vessel-related myocardial infarction (1.6% versus 12.7%; hazard ratio, 0.16 [95% CI, 0.03-0.82]; P=0.028). Intravascular imaging-guided PCI was independently associated with a lower risk of primary end point, even after adjusting for various clinical factors (hazard ratio, 0.29 [95% CI, 0.12-0.72]; P=0.007). CONCLUSIONS Intravascular imaging-guided PCI showed clinical benefit over angiography-guided PCI for left main coronary artery disease in reducing the risk of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.
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Affiliation(s)
- Woochan Kwon
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Ho Yun
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Ki Hong Choi
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital (S.-J.L., J.-Y.L.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Kangbuk Samsung Hospital (S.-J.L., J.-Y.L.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.)
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea (S.Y.L.)
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.)
| | - Jae Young Cho
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul (C.J.K., H.-S.A.)
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul (C.J.K., H.-S.A.)
| | - Chang-Wook Nam
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Hyuck-Jun Yoon
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Yong Hwan Park
- Samsung Changwon Hospital (Y.H.P.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (W.S.L.)
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.K., P.S.S.)
| | - Pil Sang Song
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.K., P.S.S.)
| | - Joon-Hyung Doh
- Inje University Ilsan-Paik hospital, Goyang, Korea (J.-H.D.)
| | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea (S.-H.J.)
| | - Chang-Hwan Yoon
- Seoul National University Bundang Hospital, Seongnam, Korea (C.-H.Y.)
| | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Kwan Yong Lee
- The Catholic University of Korea, Incheon St Mary's Hospital, Seoul (K.Y.L.)
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea (Y.-H.L.)
| | - Yun-Hyeong Cho
- Hanyang University Myongji Hospital, Goyang, Korea (Y.-H.C.)
| | - Jin-Man Cho
- Kyung Hee University Hospital at Gangdong, Seoul, Korea (J.-M.C.)
| | - Woo Jin Jang
- Ewha Womans University College of Medicine, Seoul, Korea (W.J.J.)
| | - Kook-Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Korea (K.-J.C.)
| | - David Hong
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
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23
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Yang S, Hwang D, Lee JM, Lee SH, Boerhout CK, Woudstra J, Vink CE, de Waard GA, Jung JH, Renteria HM, Hoshino M, Pinto ME, Meuwissen M, Matsuo H, Cambero MM, Eftekhari A, Effat MA, Murai T, Marques K, Appelman Y, Doh JH, Christiansen EH, Banerjee R, Kim HK, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Beijk MA, Chamuleau SA, van Royen N, Knaapen P, Kakuta T, Escaned J, Piek JJ, van de Hoef TP, Koo BK. Prognostic Implications of Individual and Combinations of Resting and Hyperemic Coronary Pressure and Flow Parameters. JACC Asia 2023; 3:865-877. [PMID: 38155797 PMCID: PMC10751649 DOI: 10.1016/j.jacasi.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 12/30/2023]
Abstract
Background Coronary pressure- and flow-derived parameters have prognostic value. Objectives This study aims to investigate the individual and combined prognostic relevance of pressure and flow parameters reflecting resting and hyperemic conditions. Methods A total of 1,971 vessels deferred from revascularization after invasive pressure and flow assessment were included from the international multicenter registry. Abnormal resting pressure and flow were defined as distal coronary pressure/aortic pressure ≤0.92 and high resting flow (1/resting mean transit time >2.4 or resting average peak flow >22.7 cm/s), and abnormal hyperemic pressure and flow as fractional flow reserve ≤0.80 and low hyperemic flow (1/hyperemic mean transit time <2.2 or hyperemic average peak flow <25.0 cm/s), respectively. The clinical endpoint was target vessel failure (TVF), myocardial infarction (MI), or cardiac death at 5 years. Results The mean % diameter stenosis was 46.8% ± 16.5%. Abnormal pressure and flow were independent predictors of TVF and cardiac death/MI (all P < 0.05). The risk of 5-year TVF or MI/cardiac death increased proportionally with neither, either, and both abnormal resting pressure and flow, and abnormal hyperemic pressure and flow (all P for trend < 0.001). Abnormal resting pressure and flow were associated with a higher rate of TVF or MI/cardiac death in vessels with normal fractional flow reserve; this association was similar for abnormal hyperemic pressure and flow in vessels with normal resting distal coronary pressure/aortic pressure (all P < 0.05). Conclusions Abnormal resting and hyperemic pressure and flow were independent prognostic predictors. The abnormal flow had an additive prognostic value for pressure in both resting and hyperemic conditions with complementary prognostic between resting and hyperemic parameters.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Coen K.M. Boerhout
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Caitlin E.M. Vink
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Guus A. de Waard
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Ji Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
| | - Hernan Mejia Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Masahiro Hoshino
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Mauro Echavarria Pinto
- Hospital General ISSSTE Querétaro Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, México
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A. Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Joon Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | | | - Rupak Banerjee
- Department of Mechanical and Materials Engineering, University of Cincinnati, Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Chang Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
- Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Marcel A.M. Beijk
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Steven A.J. Chamuleau
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Jan J. Piek
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Tim P. van de Hoef
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands
| | - Bon-Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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24
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Shin ES, Her AY, Kim B, Hahn JY, Song YB, Lee JM, Park TK, Yang JH, Choi JH, Choi SH, Lee SH, Gwon HC. Sex-Based Outcomes of P2Y12 Inhibitor Monotherapy After Three Months of Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention. J Korean Med Sci 2023; 38:e383. [PMID: 37987108 PMCID: PMC10659928 DOI: 10.3346/jkms.2023.38.e383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/22/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND In patients undergoing percutaneous coronary intervention (PCI) in the SMART-CHOICE trial, P2Y12 inhibitor monotherapy after three months of dual antiplatelet therapy (DAPT) achieved clinical outcomes comparable to those of 12 months of DAPT. Nonetheless, the effects of sex on these outcomes remain unknown. METHODS This open-label, non-inferiority, randomized study, conducted in 33 hospitals in South Korea, included 2,993 patients undergoing PCI with drug-eluting stents. Patients were randomly assigned to receive DAPT (aspirin plus a P2Y12 inhibitor) for three months then P2Y12 inhibitor alone for nine months, or DAPT for the entire 12 months. The primary endpoints were major adverse cardiac and cerebrovascular events (a composite of all-cause death, myocardial infarction, or stroke) 12 months after the index procedure. The bleeding endpoints were Bleeding Academic Research Consortium (BARC) bleeding types 2 to 5. RESULTS Of the patients, 795 (26.6%) were women, who were older and had a higher prevalence of hypertension, diabetes, and dyslipidemia than men. The sexes exhibited comparable primary endpoints (adjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.55-1.55; P = 0.770) and bleeding endpoints (adjusted HR, 1.07; 95% CI, 0.63-1.81; P = 0.811). P2Y12 inhibitor monotherapy vs DAPT was associated with lower risk of BARC type 2 to 5 bleeding in women (adjusted HR, 0.40; 95% CI, 0.16-0.98; P = 0.045) but the difference was not statistically significant when using the Bonferroni correction. The primary endpoints were similar between treatment groups in both sexes. CONCLUSION In both sexes undergoing PCI, P2Y12 inhibitor monotherapy after three months of DAPT achieved similar risks of the primary endpoints and the bleeding events compared with prolonged DAPT. Therefore, the benefits of early aspirin withdrawal with ongoing P2Y12 inhibitors may be comparable in women and men. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02079194.
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Affiliation(s)
- Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bitna Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Vink CEM, Woudstra J, Lee JM, Boerhout CKM, Cook CM, Hoshino M, Mejia-Renteria H, Lee SH, Jung JH, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Beijk MAM, Doh JH, Piek JJ, van de Hoef TP, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, van Royen N, Chamuleau SAJ, Knaapen P, Escaned J, Kakuta T, Koo BK, Appelman Y, de Waard GA. Sex differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome in symptomatic patients undergoing invasive coronary angiography: Insights from the global ILIAS invasive coronary physiology registry. Atherosclerosis 2023; 384:117167. [PMID: 37558604 DOI: 10.1016/j.atherosclerosis.2023.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND AIMS The management of chronic coronary syndrome (CCS) is informed by studies predominantly including men. This study investigated the relationship between patients sex and different endotypes of CCS, including sex-specific clinical outcomes. METHODS In patients with CCS undergoing coronary angiography, invasive Fractional Flow Reserve (FFR) and Coronary Flow Reserve (CFR) were measured. Patients were stratified into groups: 1) obstructive coronary artery disease (oCAD) (FFR≤0.80, no revascularization), 2) undergoing revascularization, 3) non-obstructive coronary artery disease with coronary microvascular dysfunction (CMD) (FFR>0.80, CFR≤2.5), and 4) non-obstructive coronary artery disease without CMD (FFR>0.80 and CFR>2.5). RESULTS 1836 patients (2335 vessels) were included, comprising 1359 (74.0%) men and 477 (26.0%) women. oCAD was present in 14.1% and was significantly less prevalent in women than in men (10.3% vs 15.5%, respectively p < 0.01). Revascularization was present in 30.9% and was similarly prevalent in women and men (28.2% vs. 31.9%, respectively p = 0.13). CMD was present in 24.2% and was significantly more prevalent in women than men (28.6% vs 22.6%, respectively p < 0.01). Normal invasive measurements were found in 564 patients (33.0% women vs 30.0% men, p = 0.23). Male sex was associated with an increased risk of target vessel failure compared to women (HR.1.89, 95% CI 1.12-3.18, p = 0.018), regardless of CCS-endotype. CONCLUSIONS Sex differences exist in the prevalence and outcomes of different endotypes of CCS in symptomatic patients undergoing invasive coronary angiography. In particular, oCAD (and subsequent revascularization) were more prevalent in men. Conversely, CMD was more prevalent in women. Overall, men experienced a worse cardiovascular outcome compared to women, independent of any specific CCS endotype.
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Affiliation(s)
- Caitlin E M Vink
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Christopher M Cook
- The Essex Cardiothoracic Centre, Essex, United Kingdom; Anglia Ruskin University, Essex, United Kingdom
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Marcel A M Beijk
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, Cincinnati, OH, USA; Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea; Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Cardiovascular Center, Seoul, Republic of Korea
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands.
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26
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Kwon W, Choi KH, Song YB, Park YH, Lee JM, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY. Intravascular Imaging in Patients With Complex Coronary Lesions and Chronic Kidney Disease. JAMA Netw Open 2023; 6:e2345554. [PMID: 38019512 PMCID: PMC10687657 DOI: 10.1001/jamanetworkopen.2023.45554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/14/2023] [Indexed: 11/30/2023] Open
Abstract
Importance As patients with chronic kidney disease (CKD) are more likely to have complex coronary lesions, intravascular imaging guidance in percutaneous coronary intervention (PCI) for this population could be potentially beneficial. Objectives To investigate whether the outcomes of intravascular imaging-guided procedural optimization would be different according to the presence of CKD. Design, Setting, and Participants This was a prespecified substudy of RENOVATE-COMPLEX-PCI, a recently published multicenter randomized clinical trial in Korea studying the benefits of intravascular imaging for complex coronary lesions. Patients with complex coronary lesions, with or without CKD, were enrolled between May 2018 and May 2021. Data were analyzed from January to June 2023. Interventions PCI in each group was done either under the guidance of intravascular imaging or angiography alone. Main Outcomes and Measures The primary end point was target vessel failure (TVF) at the 3-year point, defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization. Results A total of 1639 patients (1300 male [79.3%]) treated with PCI for complex coronary lesions were stratified into CKD (296 participants) and non-CKD (1343 participants) groups. The mean (SD) age of each group was 70.3 (9.4) and 64.5 (10.1) years, and mean (SD) estimated serum creatinine was 2.9 (5.3) and 0.8 (0.2) mg/dL for CKD and non-CKD groups, respectively. Intravascular imaging-guided revascularization was associated with significantly lower incidence of the primary end point compared with angiography-guided revascularization in both CKD (13.3% vs 23.3%; hazard ratio [HR], 0.51; 95% CI, 0.27-0.93; P = .03) and non-CKD (6.4% vs 9.9%; HR, 0.66; 95% CI, 0.44-0.99; P = .05) groups. The significantly lower incidence of the primary end point was mainly associated with the lower risk of cardiac death or target vessel-related myocardial infarction (9.4% vs 22.2%; HR, 0.39; 95% CI, 0.20-0.76; P = .006) in the CKD group and by target vessel revascularization (3.0% vs 5.5%; HR, 0.55; 95% CI, 0.30-0.99; P = .05) in the non-CKD group. Those with a glomerular filtration rate of at least 30 mL/min/1.73m2 and less than 60 ml/kg/1.73m2 showed the greatest benefit from imaging-guided complex PCI (8.8% vs 21.2%; HR, 0.28; 95% CI, 0.11-0.68; P = .02). Conclusions and Relevance In this prespecified cohort substudy of the Randomized Controlled Trial of Intravascular Imaging Guidance versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention trial, intravascular imaging guidance showed clinical benefit over angiography guidance in reducing the risk of TVF, regardless of the presence of CKD. The greatest benefits of imaging-guided complex PCI were observed in stage 3 CKD. Trial Registration ClinicalTrials.gov Identifier: NCT03381872.
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Affiliation(s)
- Woochan Kwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | | | | | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St Mary’s Hospital, Seoul, Korea
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St Mary’s Hospital, Seoul, Korea
| | | | | | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Pil Sang Song
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | | | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chang-Hwan Yoon
- Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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27
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Shin D, Dai N, Wilburn P, Choi KH, Lee SH, Kim HK, Maehara A, Stone GW, Myung Lee J. Effect of Supersaturated Oxygen Therapy on Coronary Microcirculatory Function in Patients With Anterior STEMI. JACC Cardiovasc Interv 2023; 16:2469-2471. [PMID: 37676228 DOI: 10.1016/j.jcin.2023.08.001] [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] [Received: 05/22/2023] [Revised: 07/13/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023]
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28
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Lee SH, Hong D, Shin D, Kim HK, Park KH, Choo EH, Kim CJ, Kim MC, Hong YJ, Ahn SG, Doh JH, Lee SY, Park SD, Lee HJ, Kang MG, Koh JS, Cho YK, Nam CW, Joh HS, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Jeong MH, Gwon HC, Hahn JY, Lee JM. QFR Assessment and Prognosis After Nonculprit PCI in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv 2023; 16:2365-2379. [PMID: 37821181 DOI: 10.1016/j.jcin.2023.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/13/2023] [Accepted: 08/01/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Complete revascularization using either angiography-guided or fractional flow reserve (FFR)-guided strategy can improve clinical outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, there is concern that angiography-guided percutaneous coronary intervention (PCI) may result in un-necessary PCI of the non-infarct-related artery (non-IRA), and its long-term prognosis is still unclear. OBJECTIVES This study sought to evaluate clinical outcomes after non-IRA PCI according to the quantitative flow ratio (QFR). METHODS We performed post hoc QFR analysis of non-IRA lesions of AMI patients enrolled in the FRAME-AMI (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease) trial, which randomly allocated 562 patients into either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis >50%) for non-IRA lesions. Patients were classified by non-IRA QFR values into the QFR ≤0.80 and QFR >0.80 groups. The primary outcome was a major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction, and repeat revascularization. RESULTS A total of 443 patients (552 lesions) were eligible for QFR analysis. Of 209 patients in the angiography-guided PCI group, 30.0% (n = 60) underwent non-IRA PCI despite having QFR >0.80 in the non-IRA. Conversely, only 2.7% (n = 4) among 209 patients in the FFR-guided PCI group had QFR >0.80 in the non-IRA. At a median follow-up of 3.5 years, the rate of MACEs was significantly higher among patients with non-IRA PCI despite QFR >0.80 than in patients with deferred PCI for non-IRA lesions (12.9% vs 3.1%; HR: 4.13; 95% CI: 1.10-15.57; P = 0.036). Non-IRA PCI despite QFR >0.80 was associated with a higher risk of non-IRA MACEs than patients with deferred PCI for non-IRA lesions (12.9% vs 2.1%; HR: 5.44; 95% CI: 1.13-26.19; P = 0.035). CONCLUSIONS In AMI patients with multivessel disease, 30.0% of angiography-guided PCI resulted in un-necessary PCI for the non-IRA with QFR >0.80, which was significantly associated with an increased risk of MACEs than in those with deferred PCI for non-IRA lesions. (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease [FRAME-AMI] ClinicalTrials.gov number; NCT02715518).
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Affiliation(s)
- Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - David Hong
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Keun Ho Park
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Eun Ho Choo
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung Gyun Ahn
- Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | | | | | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Yun-Kyeong Cho
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyun Sung Joh
- Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taek Kyu Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Hoon Yang
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Hyuk Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Zhang J, Jiang J, Hu X, Sun Y, Li C, Zhu L, Gao F, Dong L, Liu Y, Shen J, Ni C, Wang K, Chen Z, Chen H, Li S, Yang S, Kang J, Hwang D, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Ahn SG, Yoon MH, Kim U, Lee JM, Ki YJ, Shin ES, Kim CH, Tahk SJ, Koo BK, Wang J. Sex Differences in Fractional Flow Reserve- or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2426-2435. [PMID: 37638768 DOI: 10.1016/j.jcin.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND A recent randomized trial reported fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy was noninferior to the intracoronary ultrasound (IVUS)-guided PCI strategy with respect to clinical outcomes with fewer revascularizations. OBJECTIVES This study sought to investigate the sex differences in treatment and clinical outcomes according to physiology- or imaging-guided PCI strategies. METHODS In this secondary analysis of the FLAVOUR (Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI) trial, the impact of sex on procedural characteristics, PCI rate, and outcomes according to different strategies and treatment types (PCI vs deferral of PCI) was analyzed. The primary outcome was target vessel failure (TVF) at 24 months, defined as a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization. RESULTS Of 1,619 patients, 30% were women. Compared with men, women had a smaller minimal lumen area, smaller plaque burden, and higher FFR. They had a lower PCI rate (40.8% vs 47.9%; P = 0.008), which was mainly contributed by FFR guidance. Overall, women showed a lower TVF rate (2.4% vs 4.5%). According to the treatment type, the cumulative incidence of TVF was lower in women than in men among those with the deferral of PCI (1.7% vs 5.2%). However, this trend was not observed in patients who underwent PCI. In both women and men, there were no differences in clinical outcomes between the FFR- and IVUS-guided strategies. CONCLUSIONS In cases of intermediate stenosis, despite receiving fewer interventions, women had more favorable outcomes than men. The use of FFR led to a lower PCI rate but had a similar prognostic value compared with IVUS in both women and men.
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Affiliation(s)
- Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, China
| | - Jun Jiang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, China
| | - Yong Sun
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Changling Li
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Lingjun Zhu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Feng Gao
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Liang Dong
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Yabin Liu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Jian Shen
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Cheng Ni
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Kan Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Zexin Chen
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Haibo Chen
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Shiqiang Li
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Seokhun Yang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeehoon Kang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Doyeon Hwang
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Gangwon-Do, Republic of Korea
| | - Weon Kim
- Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jinyu Huang
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Jiang
- Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Hao Zhou
- The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Chen
- The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Wenbing Jiang
- The Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou, China
| | | | - Wenming He
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Sung Gyun Ahn
- Wonju Severance Christian Hospital, Wonju, Gangwon-Do, Republic of Korea
| | | | - Ung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | | | - You-Jeong Ki
- Uijeongbu Eulji Medical Center, Uijeongbu, Gyeonggi-Do, Republic of Korea
| | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Chee Hae Kim
- Veterans Health Service Medical Center, Seoul, Republic of Korea
| | | | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China.
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Hsu FM, Huang TC, Guo JC, Hsu CH, Lee JM, Huang PM, Chang YL, Cheng JCH. A Prospective Study of Bevacizumab and Neoadjuvant Concurrent Chemoradiation in Locally Advanced Esophageal Squamous Cell Carcinoma: Paradoxical Increase in Circulating Vascular Endothelial Growth Factor-A and Effect on Outcome. Int J Radiat Oncol Biol Phys 2023; 117:e302-e303. [PMID: 37785104 DOI: 10.1016/j.ijrobp.2023.06.2320] [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] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the prior prospective biomarker study, high serum vascular endothelial growth factor-A (VEGF-A) was associated with a poor prognosis. We conducted a prospective phase II trial of adding Bevacizumab, an anti-VEGF-A monoclonal antibody, to neoadjuvant concurrent chemoradiation (neoCCRT) for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). This prospective biomarker study aims to evaluate the expressions of angiogenesis-associated circulating biomarkers before and after neoCCRT and compare clinical outcomes for patients receiving platinum/5-fluorouracil (PF) with or without Bevacizumab. MATERIALS/METHODS Patients with biopsy-proven resectable non-T4 LA-ESCC were enrolled for the prospective phase II trial investigating PF-neoCCRT plus Bevacizumab (BPF group). A parallel patient cohort enrolled in a prospective biomarker study receiving PF-neoCCRT was included in the present analysis as the control group (PF group). Radiotherapy was delivered with 40 Gy in 20 fractions. All patients had restaging workups after enoCCRT and underwent radical esophagectomy if the disease remained resectable. Serums were collected before and after neoCCRT. The serum concentrations of angiogenesis-associated biomarkers were determined by the multiplex enzyme-linked immunosorbent assay. Survival analyses were performed by the Kaplan-Meier method. The t-test and log-rank test were used to compare differences in biomarker expression and survival between groups. RESULTS From 2016 to 2019, 43 patients (BPF/PF group: 21/22) were enrolled in the study. Twenty patients in each group had serum samples available for biomarker analysis. 15 out of 21 patients in the BPF group and 20 out of 22 patients in the PF group underwent radical esophagectomy. Six patients in the BPF group and nine patients in the PF group achieved pathological complete responses. The median overall survival for the BPF and PF group was 20.8 months and not-reached, respectively (hazard ratio = 1.33, long rank p = 0.58). In the BPF group, the serum VEGF-A level was significantly increased from an average value of 446 pg/mL to 723 pg/mL after neoCCRT (p = 0.037), while its level was decreased from 815 ng/mL to 380 pg/mL in the PF group (p = 0.104). In addition, the expression value of circulating Angiopoietin-1 was not changed in the BPF group (before neoCCRT, mean value = 828 pg/mL; after neoCCRT, mean value 762 pg/mL, p = 0.67). In contrast, serum Angiopoietin-1 level was reduced from an average value of 659 pg/mL before neoCCRT to 271 pg/mL after neoCCRT (p = 0.002) in the PF group. CONCLUSION The addition of Bevacizumab to PF-neoCCRT did not improve pathological or survival outcomes in patients with resectable LA-ESCC. Adding a single dose of Bevacizumab paradoxically increases circulating VEGF-A while maintaining the Angiopoietin-1 serum level after neoCCRT. Further investigation by using additional VEGF-A inhibition may be required to achieve sustained angiogenesis blocked for tumor control.
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Affiliation(s)
- F M Hsu
- Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - T C Huang
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - J C Guo
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - C H Hsu
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - J M Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - P M Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Y L Chang
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - J C H Cheng
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
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31
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Koo BK, Lee JM, Hwang D, Park S, Shiono Y, Yonetsu T, Lee SH, Kawase Y, Ahn JM, Matsuo H, Shin ES, Hu X, Ding D, Fezzi S, Tu S, Low AF, Kubo T, Nam CW, Yong AS, Harding SA, Xu B, Hur SH, Choo GH, Tan HC, Mullasari A, Hsieh IC, Kakuta T, Akasaka T, Wang J, Tahk SJ, Fearon WF, Escaned J, Park SJ. Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 1. JACC Asia 2023; 3:689-706. [PMID: 38095005 PMCID: PMC10715899 DOI: 10.1016/j.jacasi.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 12/30/2023]
Abstract
Coronary physiologic assessment is performed to measure coronary pressure, flow, and resistance or their surrogates to enable the selection of appropriate management strategy and its optimization for patients with coronary artery disease. The value of physiologic assessment is supported by a large body of evidence that has led to major recommendations in clinical practice guidelines. This expert consensus document aims to convey practical and balanced recommendations and future perspectives for coronary physiologic assessment for physicians and patients in the Asia-Pacific region based on updated information in the field that including both wire- and image-based physiologic assessment. This is Part 1 of the whole consensus document, which describes the general concept of coronary physiology, as well as practical information on the clinical application of physiologic indices and novel image-based physiologic assessment.
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Affiliation(s)
- Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sungjoon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seung Hun Lee
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
| | - Simone Fezzi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Adrian F. Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Takashi Kubo
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Chang-Wook Nam
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Andy S.C. Yong
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Scott A. Harding
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Bo Xu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Seung-Ho Hur
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gim Hooi Choo
- Department of Cardiology, Cardiac Vascular Sentral KL (CVSKL), Kuala Lumpur, Malaysia
| | - Huay Cheem Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Ajit Mullasari
- Department of Cardiology, Madras Medical Mission, Chennai, India
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - William F. Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hamaya R, Goto S, Hwang D, Zhang J, Yang S, Lee JM, Hoshino M, Nam CW, Shin ES, Doh JH, Chen SL, Toth GG, Piroth Z, Hakeem A, Uretsky BF, Hokama Y, Tanaka N, Lim HS, Ito T, Matsuo A, Azzalini L, Leesar MA, Collet C, Koo BK, De Bruyne B, Kakuta T. Machine-learning-based prediction of fractional flow reserve after percutaneous coronary intervention. Atherosclerosis 2023; 383:117310. [PMID: 37797507 DOI: 10.1016/j.atherosclerosis.2023.117310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) reflects residual atherosclerotic burden and is associated with future events. How much post-PCI FFR can be predicted based on baseline basic information and the clinical relevance have not been investigated. METHODS We compiled a multicenter registry of patients undergoing pre- and post-PCI FFR. Machine-learning (ML) algorithms were designed to predict post-PCI FFR levels from baseline demographics, quantitative coronary angiography, and pre-PCI FFR. FFR deviation was defined as actual minus ML-predicted post-PCI FFR levels, and its association with incident target vessel failure (TVF) was evaluated. RESULTS Median (IQR) pre- and post-PCI FFR values were 0.71 (0.61, 0.77) and 0.88 (0.84, 0.93), respectively. The Spearman correlation coefficient of the actual and predicted post-PCI FFR was 0.54 (95% CI: 0.52, 0.57). FFR deviation was non-linearly associated with incident TVF (HR [95% CI] with Q3 as reference: 1.65 [1.14, 2.39] in Q1, 1.42 [0.98, 2.08] in Q2, 0.81 [0.53, 1.26] in Q4, and 1.04 [0.69, 1.56] in Q5). A model with polynomial function of continuous FFR deviation indicated increasing TVF risk for FFR deviation ≤0 but plateau risk with FFR deviation >0. CONCLUSIONS An ML-based algorithm using baseline data moderately predicted post-PCI FFR. The deviation of post-PCI FFR from the predicted value was associated with higher vessel-oriented event.
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Affiliation(s)
- Rikuta Hamaya
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Shinichi Goto
- One Brave Idea and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea
| | - Masahiro Hoshino
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Gabor G Toth
- University Heart Centre Graz, Medical University, Graz, Austria
| | - Zsolt Piroth
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Barry F Uretsky
- Central Arkansas VA Health System/University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, South Korea
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akiko Matsuo
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Massoud A Leesar
- Division of Cardiovascular Diseases, University of Cincinnati, Cincinnati, OH, USA
| | | | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Cardiology, University of Lausanne, Switzerland
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan.
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Lee JM, Shin D, Lee SH, Choi KH, Kim SM, Chun EJ, Lee KY, Hwang D, Ahn SG, Brown AJ, Mejía-Rentería H, Lefieux A, Molony D, Chang K, Kakuta T, Escaned J, Samady H. Differential predictability for high-risk plaque characteristics between fractional flow reserve and instantaneous wave-free ratio. Sci Rep 2023; 13:16005. [PMID: 37749337 PMCID: PMC10520044 DOI: 10.1038/s41598-023-43352-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/22/2023] [Indexed: 09/27/2023] Open
Abstract
To evaluate the differential associations of high-risk plaque characteristics (HRPC) with resting or hyperemic physiologic indexes (instantaneous wave-free ratio [iFR] or fractional flow reserve [FFR]), a total of 214 vessels from 127 patients with stable angina or acute coronary syndrome who underwent coronary computed tomography angiography (CCTA) and invasive physiologic assessment were investigated. HPRC were classified into quantitative (minimal luminal area < 4 mm2 or plaque burden ≥ 70%) and qualitative features (low attenuation plaque, positive remodeling, napkin ring sign, or spotty calcification). Vessels with FFR ≤ 0.80 or iFR ≤ 0.89 had significantly higher proportions of HRPC than those with FFR > 0.80 or iFR > 0.89, respectively. FFR was independently associated with both quantitative and qualitative HRPC, but iFR was only associated with quantitative HRPC. Both FFR and iFR were significantly associated with the presence of ≥ 3 HRPC, and FFR demonstrated higher discrimination ability than iFR (AUC 0.703 vs. 0.648, P = 0.045), which was predominantly driven by greater discriminating ability of FFR for quantitative HRPC (AUC 0.832 vs. 0.744, P = 0.005). In conclusion, both FFR and iFR were significantly associated with CCTA-derived HRPC. Compared with iFR, however, FFR was independently associated with the presence of qualitative HRPC and showed a higher predictive ability for the presence of ≥ 3 HRPC.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
| | - Doosup Shin
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Sung Mok Kim
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia
| | | | | | - David Molony
- Andreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Heart and Vascular Institute, Northeast Georgia Health System, 200 South Enota Drive, Suite 430, Gainesville, GA, 30501, USA
| | - Kiyuk Chang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
- Georgia Heart and Vascular Institute, Northeast Georgia Health System, 200 South Enota Drive, Suite 430, Gainesville, GA, 30501, USA.
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Hong D, Kim SM, Lee SY, Choi KH, Song YB, Lee JY, Lee SJ, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Lee JM. Prognostic Impact of Intravascular Imaging-Guided Percutaneous Coronary Intervention in Chronic Total Occlusion. Circulation 2023; 148:903-905. [PMID: 37695832 DOI: 10.1161/circulationaha.123.065876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.M.K.)
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea (S.Y.L.)
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-Y.L., S.-J.L.)
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-Y.L., S.-J.L.)
| | - Kyeong Ho Yun
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Jae Young Cho
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea (C.J.K., H.-S.A.)
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea (C.J.K., H.-S.A.)
| | - Chang-Wook Nam
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Hyuck-Jun Yoon
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea (Y.H.P.)
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (W.S.L.)
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.J., P.S.S.)
| | - Pil Sang Song
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.J., P.S.S.)
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.)
| | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea (S.-H.J.)
| | - Chang-Hwan Yoon
- Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea (C.-H.Y.)
| | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Kwan Yong Lee
- The Catholic University of Korea, Incheon St Mary's Hospital, Seoul, Korea (K.Y.L.)
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea (Y.-H.L.)
| | - Yun-Hyeong Cho
- Hanyang University Myongji Hospital, Goyang, Korea (Y.-H.C.)
| | - Jin-Man Cho
- Kyung Hee University Hospital at Gangdong, Seoul, Korea (J.-M.C.)
| | - Woo Jin Jang
- Ewha Womans University College of Medicine, Seoul, Korea (W.J.J.)
| | - Kook-Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Korea (K.-J.C.)
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
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35
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Yang S, Hwang D, Zhang J, Park J, Yun JP, Lee JM, Nam C, Shin E, Doh J, Chen S, Kakuta T, Toth GG, Piroth Z, Johnson NP, Hakeem A, Uretsky BF, Hokama Y, Tanaka N, Lim H, Ito T, Matsuo A, Azzalini L, Leesar MA, Neleman T, van Mieghem NM, Diletti R, Daemen J, Collison D, Collet C, De Bruyne B, Koo B. Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications. J Am Heart Assoc 2023; 12:e030572. [PMID: 37642032 PMCID: PMC10547308 DOI: 10.1161/jaha.123.030572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Background Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results From an individual patient data meta-analysis of 17 cohorts of patients who underwent post-PCI fractional flow reserve measurement after drug-eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed. The primary outcome was cardiac death or target-vessel myocardial infarction at 2 years. The mean age of patients was 64.2±10.2 years, and the mean angiographic percent diameter stenosis was 63.9%±14.3%. Among 11 clinical and 8 vessel features, 4 adverse clinical characteristics (age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction <50%) and 2 adverse vessel characteristics (post-PCI fractional flow reserve ≤0.80 and total stent length ≥54 mm) were identified to independently predict the primary outcome (all P<0.05). The number of adverse vessel characteristics had additive predictability for the primary end point to that of adverse clinical characteristics (area under the curve 0.72 versus 0.78; P=0.03) and vice versa (area under the curve 0.68 versus 0.78; P=0.03). The cumulative event rate increased in the order of none, either, and both of adverse clinical characteristics ≥2 and adverse vessel characteristics ≥1 (0.3%, 2.4%, and 5.3%; P for trend <0.01). Conclusions In patients undergoing drug-eluting stent implantation, adverse clinical and vessel characteristics were associated with the risk of cardiac death or target-vessel myocardial infarction. Because these characteristics showed independent and additive prognostic value, their integrative assessment can optimize post-PCI risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04684043. www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42021234748.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jinlong Zhang
- Department of CardiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Jiesuck Park
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jun Pil Yun
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Chang‐Wook Nam
- Department of MedicineKeimyung University Dongsan Medical CenterDaeguSouth Korea
| | - Eun‐Seok Shin
- Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanSouth Korea
| | - Joon‐Hyung Doh
- Department of MedicineInje University Ilsan Paik HospitalGoyangSouth Korea
| | - Shao‐Liang Chen
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Tsunekazu Kakuta
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Gabor G. Toth
- University Heart Centre Graz, Medical University GrazGrazAustria
| | - Zsolt Piroth
- Gottsegen Hungarian Institute of CardiologyBudapestHungary
| | - Nils P. Johnson
- Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing AtherosclerosisUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNJ
| | - Barry F Uretsky
- Central Arkansas VA Health System/University of Arkansas for Medical SciencesLittle RockAR
| | - Yohei Hokama
- Department of CardiologyTokyo Medical University Hachioji Medical CenterTokyoJapan
| | - Nobuhiro Tanaka
- Department of CardiologyTokyo Medical University Hachioji Medical CenterTokyoJapan
| | - Hong‐Seok Lim
- Department of CardiologyAjou University School of MedicineSuwonSouth Korea
| | - Tsuyoshi Ito
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Akiko Matsuo
- Department of CardiologyKyoto Second Red Cross HospitalKyotoJapan
| | - Lorenzo Azzalini
- Division of Cardiology, Department of MedicineUniversity of WashingtonSeattleWA
| | - Massoud A. Leesar
- Division of Cardiovascular DiseasesUniversity of AlabamaBirminghamAL
| | - Tara Neleman
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Nicolas M van Mieghem
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Roberto Diletti
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Joost Daemen
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Damien Collison
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National HospitalGlasgowUnited Kingdom
| | | | - Bernard De Bruyne
- Cardiovascular Center AalstAalstBelgium
- Department of CardiologyUniversity of LausanneSwitzerland
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
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36
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Kwon W, Choi KH, Yang JH, Chung YJ, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Yu CW, Park IH, Jang WJ, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD, Gwon HC. Efficacy of thrombus aspiration in cardiogenic shock complicating acute myocardial infarction and high thrombus burden. Rev Esp Cardiol (Engl Ed) 2023; 76:719-728. [PMID: 36746233 DOI: 10.1016/j.rec.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES Current guidelines do not recommend routine thrombus aspiration in acute myocardial infarction (AMI) because no benefits were observed in previous randomized trials. However, there are limited data in cardiogenic shock (CS) complicating AMI. METHODS We included 575 patients with AMI complicated by CS. The participants were stratified into the TA and no-TA groups based on use of TA. The primary outcome was a composite of 6-month all-cause death or heart failure rehospitalization. The efficacy of TA was additionally assessed based on thrombus burden (grade I-IV vs V). RESULTS No significant difference was found in in-hospital death (28.9% vs 33.5%; P=.28), or 6-month death, or heart failure rehospitalization (32.4% vs 39.4%; HRadj: 0.80; 95%CI, 0.59-1.09; P=.16) between the TA and no-TA groups. However, in 368 patients with a higher thrombus burden (grade V), the TA group had a significantly lower risk of 6-month all-cause death or heart failure rehospitalization than the no-TA group (33.4% vs 46.3%; HRadj: 0.59; 95%CI, 0.41-0.85; P=.004), with significant interaction between thrombus burden and use of TA for primary outcome (adjusted Pint=.03). CONCLUSIONS Routine use of TA did not reduce short- and mid-term adverse clinical outcomes in patients with AMI complicated by CS. However, in select patients with a high thrombus burden, the use of TA might be associated with improved clinical outcomes. The study was registered at ClinicalTrials.gov (Identifier: NCT02985008).
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Affiliation(s)
- Woochan Kwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Yu Jin Chung
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ik Hyun Park
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Woo Jin Jang
- Department of Cardiology, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, University of Inje College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Escaned J, Berry C, De Bruyne B, Shabbir A, Collet C, Lee JM, Appelman Y, Barbato E, Biscaglia S, Buszman PP, Campo G, Chieffo A, Colleran R, Collison D, Davies J, Giacoppo D, Holm NR, Jeremias A, Paradies V, Piróth Z, Raposo L, Roguin A, Rudolph T, Sarno G, Sen S, Toth GG, Van Belle E, Zimmermann FM, Dudek D, Stefanini G, Tarantini G. Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology. EUROINTERVENTION 2023; 19:464-481. [PMID: 37171503 PMCID: PMC10436072 DOI: 10.4244/eij-d-23-00194] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
The clinical value of fractional flow reserve and non-hyperaemic pressure ratios are well established in determining an indication for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). In addition, over the last 5 years we have witnessed a shift towards the use of physiology to enhance procedural planning, assess post-PCI functional results, and guide PCI optimisation. In this regard, clinical studies have reported compelling data supporting the use of longitudinal vessel analysis, obtained with pressure guidewire pullbacks, to better understand how obstructive CAD contributes to myocardial ischaemia, to establish the likelihood of functionally successful PCI, to identify the presence and location of residual flow-limiting stenoses and to predict long-term outcomes. The introduction of new functional coronary angiography tools, which merge angiographic information with fluid dynamic equations to deliver information equivalent to intracoronary pressure measurements, are now available and potentially also applicable to these endeavours. Furthermore, the ability of longitudinal vessel analysis to predict the functional results of stenting has played an integral role in the evolving field of simulated PCI. Nevertheless, it is important to have an awareness of the value and challenges of physiology-guided PCI in specific clinical and anatomical contexts. The main aim of this European Association of Percutaneous Cardiovascular Interventions clinical consensus statement is to offer up-to-date evidence and expert opinion on the use of applied coronary physiology for procedural PCI planning, disease pattern recognition and post-PCI optimisation.
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Affiliation(s)
- Javier Escaned
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Colin Berry
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
| | - Asad Shabbir
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yolande Appelman
- Amsterdam UMC, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Piotr P Buszman
- Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
- American Heart of Poland, Ustroń, Poland
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Róisín Colleran
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Damien Collison
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Justin Davies
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Daniele Giacoppo
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
- ISAResearch, German Heart Centre Munich, Munich, Germany
| | - Niels R. Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Zsolt Piróth
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Luís Raposo
- Unidade de Intervenção Cardiovascular, Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Ariel Roguin
- Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Tanja Rudolph
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Giovanna Sarno
- Cardiology, Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Sayan Sen
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Gabor G Toth
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Lille, France
- Department of Cardiology, Institut Pasteur de Lille, Lille, France
| | | | - Dariusz Dudek
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
- University of Padua Medical School, Padua, Italy
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38
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Boerhout CKM, Lee JM, de Waard GA, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Appelman Y, Beijk MAM, van Royen N, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Microvascular resistance reserve: diagnostic and prognostic performance in the ILIAS registry. Eur Heart J 2023; 44:2862-2869. [PMID: 37350567 PMCID: PMC10406337 DOI: 10.1093/eurheartj/ehad378] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/06/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
AIMS The microvascular resistance reserve (MRR) was introduced as a means to characterize the vasodilator reserve capacity of the coronary microcirculation while accounting for the influence of concomitant epicardial disease and the impact of administration of potent vasodilators on aortic pressure. This study aimed to evaluate the diagnostic and prognostic performance of MRR. METHODS AND RESULTS A total of 1481 patients with stable symptoms and a clinical indication for coronary angiography were included from the global ILIAS Registry. MRR was derived as a function of the coronary flow reserve (CFR) divided by the fractional flow reserve (FFR) and corrected for driving pressure. The median MRR was 2.97 [Q1-Q3: 2.32-3.86] and the overall relationship between MRR and CFR was good [correlation coefficient (Rs) = 0.88, P < 0.005]. The difference between CFR and MRR increased with decreasing FFR [coefficient of determination (R2) = 0.34; Coef.-2.88, 95% confidence interval (CI): -3.05--2.73; P < 0.005]. MRR was independently associated with major adverse cardiac events (MACE) at 5-year follow-up [hazard ratio (HR) 0.78; 95% CI 0.63-0.95; P = 0.024] and with target vessel failure (TVF) at 5-year follow-up (HR 0.83; 95% CI 0.76-0.97; P = 0.047). The optimal cut-off value of MRR was 3.0. Based on this cut-off value, only abnormal MRR was significantly associated with MACE and TVF at 5-year follow-up in vessels with functionally significant epicardial disease (FFR <0.75). CONCLUSION MRR seems a robust indicator of the microvascular vasodilator reserve capacity. Moreover, in line with its theoretical background, this study suggests a diagnostic advantage of MRR over other indices of vasodilatory capacity in patients with hemodynamically significant epicardial coronary artery disease.
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Affiliation(s)
- Coen K M Boerhout
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Joo Myung Lee
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Guus A de Waard
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, South Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, 20 Gyeyangmunhwa-ro, Gyeyang-gu, Incheon, South Korea
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4 Yabutaminami, Gifu, 500-8384, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro—Facultad de Medicina, Universidad Autónoma de Querétaro, Av Tecnológico 101, Las Campanas, 76000 Santiago de Querétaro, México
| | - Martijn Meuwissen
- Department of Cardiology, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4 Yabutaminami, Gifu, 500-8384, Japan
| | - Maribel Madera-Cambero
- Department of Cardiology, Tergooi Hospital, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45229, USA
| | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4 Chome-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028, Tsuchiura city, Japan
| | - Koen Marques
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyangsi, Gyeonggi-do, Goyang, South Korea
| | - Evald H Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45219, USA
- Research Services, Veteran Affairs Medical Center, 3200 Vine St, Cincinnati, OH 45220, USA
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University, 1095 Dalgubeol-daero, Sindang-dong, Dalseo-gu, Daegu, South Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Institute of Cardiology, 296-12 Changgyeonggung-ro, Jongno-gu, Seoul, Rome, Italy
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4 Yabutaminami, Gifu, 500-8384, Japan
- Cardiovascular Center, Toda Central General Hospital, 1 Chome-19-3 Honcho, Toda, Saitama 335-0023, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Zuid-Korea, Ulsan, Dong-gu 25, South Korea
| | - Yolande Appelman
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marcel A M Beijk
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Paul Knaapen
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4 Chome-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028, Tsuchiura city, Japan
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Yeongeon-dong, Jongno-gu, Seoul, South Korea
| | - Jan J Piek
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim P van de Hoef
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Choi KH, Lee SY, Song YB, Park TK, Lee JM, Yang JH, Choi JH, Choi SH, Gwon HC, Hahn JY. Prognostic Impact of Operator Experience and IVUS Guidance on Long-Term Clinical Outcomes After Complex PCI. JACC Cardiovasc Interv 2023; 16:1746-1758. [PMID: 37495350 DOI: 10.1016/j.jcin.2023.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Although consistent clinical data support intravascular ultrasound (IVUS) use during complex percutaneous coronary intervention (PCI), long-term follow-up outcomes on differential effects of IVUS according to operator experience are scarce. OBJECTIVES The current study aimed to evaluate the influence of operator experience on lesion complexity, long-term clinical outcomes, and the interactions of IVUS guidance in patients undergoing complex PCI. METHODS A total of 6,005 patients who underwent PCI with drug-eluting stents for complex lesions were recruited from the institutional registry of Samsung Medical Center. The study population was stratified by the use of IVUS and operator experience (less experienced operator [lifetime independent experience with PCI ≤5 years] vs experienced operator). The primary endpoint was a composite of cardiac death or target vessel myocardial infarction (TVMI) up to 10 years. RESULTS Compared with less experienced operators, experienced operators used IVUS more frequently (29.6% [1,128/3,805] vs 24.8% [546/2,200]; P < 0.001) and achieved a lower risk of cardiac death or TVMI (experienced vs less experienced, adjusted HR: 0.779; 95% CI: 0.663-0.915; P = 0.002). IVUS use was associated with a significantly lower risk of cardiac death or TVMI than angiography alone for less experienced operators (23.5% vs 11.4%; adjusted HR: 0.477; 95% CI: 0.337-0.673; P < 0.001) as well as experienced operators (18.0% vs 13.5%; adjusted HR: 0.747; 95% CI: 0.559-0.998; P = 0.048). There were significant interactions for the risk of cardiac death or TVMI between IVUS use and operator experience (P = 0.037). CONCLUSIONS PCI by experienced operators and the use of IVUS during complex PCI were independently associated with lower long-term risks of cardiac death or TVMI. The beneficial effects of IVUS were more prominent for less experienced operators. (Prospective Percutaneous Coronary Intervention Registry [SMC-PCI]; NCT05624905).
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Kim J, Kang D, Kim SE, Park H, Park TK, Lee JM, Yang JH, Song YB, Choi JH, Choi SH, Gwon HC, Guallar E, Cho J, Hahn JY. Comparison Between Fimasartan Versus Other Angiotensin Receptor Blockers in Patients With Heart Failure After Acute Myocardial Infarction. J Korean Med Sci 2023; 38:e202. [PMID: 37365730 DOI: 10.3346/jkms.2023.38.e202] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUNDS Fimasartan is the most recently developed, potent, and long-acting angiotensin II receptor blocker (ARB). However, data are limited regarding treatment effects of fimasartan in patients with heart failure. METHODS Between 2010 and 2016, patients who underwent coronary revascularization for myocardial infarction (MI) with heart failure and prescription of ARB at hospital discharge were enrolled from the Korean nationwide medical insurance data. Clinical outcomes were compared between patients receiving fimasartan and those receiving other ARBs (candesartan, valsartan, losartan, telmisartan, olmesartan, and irbesartan). The primary outcome was a composite of all-cause death, recurrent MI, hospitalization for heart failure, and stroke. RESULTS Of 2,802 eligible patients, fimasartan was prescribed to 124 patients (4.4%). During a median follow-up of 2.2 years (interquartile range, 1.0-3.9), 613 events of the primary outcome occurred. There was no significant difference in the primary outcome between patients receiving fimasartan and those receiving other ARBs (adjusted hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.46-1.45). Compared with patients receiving other ARBs, those receiving fimasartan had comparable incidence of all-cause death (adjusted HR, 0.70; 95% CI, 0.30-1.63), recurrent MI (adjusted HR, 1.28; 95% CI, 0.49-3.34), hospitalization for heart failure (adjusted HR, 0.70; 95% CI, 0.27-1.84), and stroke (adjusted HR, 0.59; 95% CI, 0.18-1.96). CONCLUSION In this nationwide cohort, fimasartan, compared with other ARBs, had comparable treatment effects for a composite of all-cause death, recurrent MI, hospitalization for heart failure, and stroke in patients with heart failure after MI.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Eun Kim
- Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Faria D, Hennessey B, Shabbir A, Mejía-Rentería H, Wang L, Lee JM, Matsuo H, Biscaglia S, Koo BK, Xu B, Baptista S, Gonzalo N, Escaned J. Functional coronary angiography for the assessment of the epicardial vessels and the microcirculation. EUROINTERVENTION 2023; 19:203-221. [PMID: 37326378 DOI: 10.4244/eij-d-22-00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Over the last decade, steady progress has been made in the ability to assess coronary stenosis relevance by merging computerised analyses of angiograms with fluid dynamic modelling. The new field of functional coronary angiography (FCA) has attracted the attention of both clinical and interventional cardiologists as it anticipates a new era of facilitated physiological assessment of coronary artery disease, without the need for intracoronary instrumentation or vasodilator drug administration, and an increased adoption of ischaemia-driven revascularisation. This state-of-the-art review performs a deep dive into the foundations and rationale behind FCA indices derived from either invasive or computed angiograms. We discuss the currently available FCA systems, the evidence supporting their use, and the specific clinical scenarios in which FCA might facilitate patient management. Finally, the rapidly growing application of FCA to the diagnosis of coronary microvascular dysfunction is discussed. Overall, we aim to provide a state-of-the-art review not only to digest the achievements made so far in FCA, but also to enable the reader to follow the many publications and developments in this field that will likely take place in years to come.
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Affiliation(s)
- Daniel Faria
- Hospital Clínico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
- Interventional Cardiology Unit, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Breda Hennessey
- Hospital Clínico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Asad Shabbir
- Hospital Clínico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | | | - Lin Wang
- Hospital Clínico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea and Institute on Aging, Seoul National University, Seoul, Republic of Korea
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Sérgio Baptista
- Interventional Cardiology Unit, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
- University Clinic of Cardiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Nievez Gonzalo
- Hospital Clínico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Javier Escaned
- Hospital Clínico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
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Choi KH, Yang JH, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Yu CW, Park IH, Jang WJ, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD, Kang TS, Gwon HC. Culprit-Only Versus Immediate Multivessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicating Advanced Cardiogenic Shock Requiring Venoarterial-Extracorporeal Membrane Oxygenation. J Am Heart Assoc 2023; 12:e029792. [PMID: 37158104 DOI: 10.1161/jaha.123.029792] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/10/2023]
Abstract
Background Despite the benefit of culprit-only percutaneous coronary intervention (PCI) in the CULPRIT-SHOCK (Culprit Lesion Only PCI Versus Multi-vessel PCI in Cardiogenic Shock) trial, the optimal revascularization strategy for refractory cardiogenic shock (CS) requiring mechanical circulatory support devices remains controversial. This study aimed to compare clinical outcomes between the culprit-only and immediate multivessel PCI strategies in patients with acute myocardial infarction complicated by CS who underwent venoarterial-extracorporeal membrane oxygenation before revascularization. Methods and Results This study included patient-pooled data from the RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Devices for Korean Patients With Cardiogenic Shock) and SMC-ECMO (Samsung Medical Center-Extracorporeal Membrane Oxygenation) registries. A total of 315 patients with acute myocardial infarction with multivessel disease who underwent venoarterial-extracorporeal membrane oxygenation before revascularization attributable to refractory CS were included in this analysis. The study population was classified into culprit-only versus immediate multivessel PCI according to nonculprit lesion treatment strategies. The primary end point was 30-day mortality or renal-replacement therapy, and the key secondary end point was 12-month follow-up mortality. Among the study population, 175 (55.6%) underwent culprit-only PCI and 140 (44.4%) underwent immediate multivessel PCI. Compared with culprit-only PCI, immediate multivessel PCI was associated with significantly lower risks of 30-day mortality or renal-replacement therapy (68.0% versus 54.3%; P=0.018) and all-cause mortality during 12 months of follow-up (59.5% versus 47.5%; hazard ratio [HR], 0.689 [95% CI, 0.506-0.939]; P=0.018) in patients with acute myocardial infarction and CS who underwent venoarterial-extracorporeal membrane oxygenation before revascularization. These results were also consistent in the 99 pairs of propensity score-matched population (60.6% versus 43.6%; HR, 0.622 [95% CI, 0.420-0.922]; P=0.018). Conclusions Among patients with acute myocardial infarction with multivessel disease complicated by advanced CS requiring venoarterial-extracorporeal membrane oxygenation before revascularization, immediate multivessel PCI was associated with lower incidences of 30-day mortality or renal replacement therapy and 12-month follow-up mortality, compared with culprit-only PCI. Registration Information clinicaltrials.gov. Identifier: NCT02985008.
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital Yonsei University College of Medicine Seoul South Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine Korea University Anam Hospital Seoul Republic of Korea
| | - Ik Hyun Park
- Department of Cardiology Samsung Changwon Hospital, Sungkyunkwan University School of Medicine Changwon South Korea
| | - Woo Jin Jang
- Department of Cardiology Ewha Woman's University Seoul Hospital, Ehwa Woman's University School of Medicine Seoul Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine Konkuk University Medical Center Seoul South Korea
| | - Jang-Whan Bae
- Department of Internal Medicine Chungbuk National University College of Medicine Cheongju South Korea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine Ilsan Paik Hospital, University of Inje College of Medicine Seoul South Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Medicine Sejong General Hospital Bucheon South Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Medicine Chung-Ang University Hospital Seoul South Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine Chungnam National University Hospital Daejeon Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Medicine Inha University Hospital Incheon South Korea
| | - Tae-Soo Kang
- Division of Cardiovascular Medicine, Department of Internal Medicine Dankook University Hospital, Dankook University College of Medicine Cheonan South Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
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Kim J, Kim JY, Jeong DS, Chung TW, Park SJ, Park KM, Kim JS, Lee JM, On YK. Long-term outcome of thoracoscopic ablation and radiofrequency catheter ablation for persistent atrial fibrillation as a de novo procedure. Europace 2023:7152740. [PMID: 37144277 DOI: 10.1093/europace/euad096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/21/2023] [Indexed: 05/06/2023] Open
Abstract
AIMS Limited data are available regarding the efficacy of thoracoscopic ablation as the first procedure for persistent atrial fibrillation (AF). We sought to compare the long-term efficacy of thoracoscopic ablation vs. radiofrequency (RF) catheter ablation as the first procedure for persistent AF. METHODS AND RESULTS Between February 2011 and December 2020, 575 patients who underwent ablation for persistent AF were studied. Among them, thoracoscopic ablation was performed in 281 patients, RF catheter ablation in 228, and hybrid ablation in 66. Rhythm, clinical, and safety outcomes during 7-year follow-up were compared. The patients who underwent thoracoscopic ablation were older, had a higher prevalence of stroke, and had a larger left atrial volume than those who underwent RF catheter ablation. In the propensity score-matched population (n = 306), incidences of atrial tachyarrhythmia recurrence were 51.4% in the thoracoscopic ablation group and 62.5% in the RF catheter ablation group [adjusted hazard ratio (HR) 0.869, 95% confidence interval (CI) 0.618-1.223, P = 0.420]. Stroke and total procedural adverse events were not significantly different between thoracoscopic and RF catheter ablation (2.7 vs. 2.5%, P = 0.603, and 7.1 vs. 4.8%, P = 0.374, respectively). The hybrid ablation group showed similar rhythm outcomes compared with both the thoracoscopic and the RF catheter ablation groups. At the redo procedure, pulmonary vein gaps were more frequently observed in the RF catheter ablation group (32.6%) than in the thoracoscopic ablation group (7.9%) and in the hybrid ablation group (8.8%) (P < 0.001). CONCLUSION As a first procedure in persistent AF, thoracoscopic ablation and RF catheter ablation showed comparable efficacy, clinical, and safety outcomes during long-term follow-up.
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Affiliation(s)
- Juwon Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ju Youn Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Wan Chung
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - June Soo Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
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Kumar S, Molony D, Khawaja S, Crawford K, Thompson EW, Hung O, Shah I, Navas-Simbana J, Ho A, Kumar A, Ko YA, Hosseini H, Lefieux A, Lee JM, Hahn JY, Chen SL, Otake H, Akasaka T, Shin ES, Koo BK, Stankovic G, Milasinovic D, Nam CW, Won KB, Escaned J, Erglis A, Murasato Y, Veneziani A, Samady H. Stent underexpansion is associated with high wall shear stress: a biomechanical analysis of the shear stent study. Int J Cardiovasc Imaging 2023:10.1007/s10554-023-02838-6. [PMID: 37119348 DOI: 10.1007/s10554-023-02838-6] [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] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 03/15/2023] [Indexed: 05/01/2023]
Abstract
Coronary stent underexpansion is associated with restenosis and stent thrombosis. In clinical studies of atherosclerosis, high wall shear stress (WSS) has been associated with activation of prothrombotic pathways, upregulation of matrix metalloproteinases, and future myocardial infarction. We hypothesized that stent underexpansion is predictive of high WSS. WSS distribution was investigated in patients enrolled in the prospective randomized controlled study of angulated coronary arteries randomized to undergo percutaneous coronary intervention with R-ZES or X-EES. WSS was calculated from 3D reconstructions of arteries from intravascular ultrasound (IVUS) and angiography using computational fluid dynamics. A logistic regression model investigated the relationship between WSS and underexpansion and the relationship between underexpansion and stent platform. Mean age was 63±11, 78% were male, 35% had diabetes, mean pre-stent angulation was 36.7°±14.7°. Underexpansion was assessed in 83 patients (6,181 IVUS frames). Frames with stent underexpansion were significantly more likely to exhibit high WSS (> 2.5 Pa) compared to those without underexpansion with an OR of 2.197 (95% CI = [1.233-3.913], p = 0.008). There was no significant association between underexpansion and low WSS (< 1.0 Pa) and no significant differences in underexpansion between R-ZES and X-EES. In the Shear Stent randomized controlled study, underexpanded IVUS frames were more than twice as likely to be associated with high WSS than frames without underexpansion.
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Affiliation(s)
- Sonali Kumar
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - David Molony
- Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA, USA
| | - Sameer Khawaja
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kaylyn Crawford
- Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA, USA
| | - Elizabeth W Thompson
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Hung
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Imran Shah
- Department of Mathematics and Computer Science, Emory University, Atlanta, GA, USA
| | - Jessica Navas-Simbana
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Arlen Ho
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Arnav Kumar
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yi-An Ko
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Hossein Hosseini
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Adrien Lefieux
- Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA, USA
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan Medical Center, Ulsan, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Chang-Wook Nam
- Department of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Republic of Korea
| | - Ki-Bum Won
- Department of Cardiology, Ulsan Medical Center, Ulsan, Republic of Korea
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos Madrid, Madrid, Spain
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Alessandro Veneziani
- Department of Mathematics and Computer Science, Emory University, Atlanta, GA, USA
| | - Habib Samady
- Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA, USA.
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Choi KH, Yang JH, Seo JH, Hong D, Youn T, Joh HS, Lee SH, Kim D, Park TK, Lee JM, Song YB, Choi JO, Hahn JY, Choi SH, Gwon HC, Jeon ES. Discriminative Role of Invasive Left Heart Catheterization in Patients Suspected of Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2023; 12:e027581. [PMID: 36892042 PMCID: PMC10111528 DOI: 10.1161/jaha.122.027581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Background Recently, diastolic stress testing and invasive hemodynamic measurements have been emphasized for diagnosis of heart failure with preserved ejection fraction (HFpEF) because when determined using noninvasive parameters it can fall into a nondiagnostic intermediate range. The current study evaluated the discriminative and prognostic roles of invasive measured left ventricular end-diastolic pressure in the population with suspected HFpEF, particularly for patients with intermediate Heart Failure Association Pre-test Assessment, Echocardiography & Natriuretic Peptide, Functional Testing, Final Etiology (HFA-PEFF) score. Methods and Results A total of 404 patients with symptoms or signs of HF and preserved left ventricular systolic function were enrolled. All subjects underwent left heart catheterization with left ventricular end-diastolic pressure measurement for confirmation of HFpEF (≥16 mm Hg). The primary outcome was all-cause death or readmission due to HF within 10 years. Among the study population, 324 patients (80.2%) were diagnosed as invasively confirmed HFpEF, and 80 patients (19.8%) were as noncardiac dyspnea. The patients with HFpEF showed a significantly higher HFA-PEFF score than the patients with noncardiac dyspnea (3.8±1.8 versus 2.6±1.5, P<0.001). The discriminative ability of the HFA-PEFF score for diagnosing HFpEF was modest (area under the curve, 0.70 [95% CI, 0.64-0.75], P<0.001). The HFA-PEFF score was associated with a significantly higher 10-year risk of death or HF readmission (per-1 increase, hazard ratio [HR], 1.603 [95% CI, 1.376-1.868], P<0.001). Among the 226 patients with an intermediate HFA-PEFF score (2-4), those with invasively confirmed HFpEF had a significantly higher risk of death or HF readmission within 10 years than the patients with noncardiac dyspnea (24.0% versus 6.9%, HR, 3.327 [95% CI, 1.109-16.280], P=0.030). Conclusions The HFA-PEFF score is a moderately useful tool for predicting future adverse events in suspected HFpEF, and invasively measured left ventricular end-diastolic pressure can provide additional information to discriminate patient prognosis, particularly in those with intermediate HFA-PEFF scores. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04505449.
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Critical Care Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jeong Hun Seo
- Division of Cardiology, Department of Medicine Kangwon National University Hospital Chuncheon, Gangwon-Do Republic of Korea
| | - David Hong
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Taeho Youn
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hyun Sung Joh
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center Chonnam National University Hospital Gwangju Republic of Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
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Brier LM, Chen S, Sherafati A, Bice AR, Lee JM, Culver JP. Transient disruption of functional connectivity and depression of neural fluctuations in a mouse model of acute septic encephalopathy. Cereb Cortex 2023; 33:3548-3561. [PMID: 35972424 PMCID: PMC10068285 DOI: 10.1093/cercor/bhac291] [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] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Septic encephalopathy leads to major and costly burdens for a large percentage of admitted hospital patients. Elderly patients are at an increased risk, especially those with dementia. Current treatments are aimed at sedation to combat mental status changes and are not aimed at the underlying cause of encephalopathy. Indeed, the underlying pathology linking together peripheral infection and altered neural function has not been established, largely because good, acutely accessible readouts of encephalopathy in animal models do not exist. Behavioral testing in animals lasts multiple days, outlasting the time frame of acute encephalopathy. Here, we propose optical fluorescent imaging of neural functional connectivity (FC) as a readout of encephalopathy in a mouse model of acute sepsis. Imaging and basic behavioral assessment were performed at baseline, Hr8, Hr24, and Hr72 following injection of either lipopolysaccharide or phosphate buffered saline. Neural FC strength decreased at Hr8 and returned to baseline by Hr72 in motor, somatosensory, parietal, and visual cortical regions. Additionally, neural fluctuations transiently declined at Hr8 and returned to baseline by Hr72. Both FC strength and fluctuation tone correlated with neuroscore indicating this imaging methodology is a sensitive and acute readout of encephalopathy.
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Affiliation(s)
- L M Brier
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - S Chen
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - A Sherafati
- Department of Physics, Washington University School of Arts and Science, St. Louis, MO 63110, USA
| | - A R Bice
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - J M Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - J P Culver
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Physics, Washington University School of Arts and Science, St. Louis, MO 63110, USA
- Department of Biomedical Engineering, Washington University School of Engineering, St. Louis, MO 63110, USA
- Department of Electrical and Systems Engineering, Washington University School of Engineering, St. Louis, MO 63110, USA
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Lee JM, Lee YS, Lee YJ, Lee JH, Han TY, Choi JE. Generalized painful papulovesicular eruption following the COVID-19 BNT162b2 mRNA vaccine. J Eur Acad Dermatol Venereol 2023. [PMID: 36914917 DOI: 10.1111/jdv.19043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Affiliation(s)
- J M Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Y S Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Y J Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - J H Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - T Y Han
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - J E Choi
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
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Lee JM, Choi KH, Song YB, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY. Intravascular Imaging-Guided or Angiography-Guided Complex PCI. N Engl J Med 2023; 388:1668-1679. [PMID: 36876735 DOI: 10.1056/nejmoa2216607] [Citation(s) in RCA: 88] [Impact Index Per Article: 88.0] [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: 03/07/2023]
Abstract
BACKGROUND Data regarding clinical outcomes after intravascular imaging-guided percutaneous coronary intervention (PCI) for complex coronary-artery lesions, as compared with outcomes after angiography-guided PCI, are limited. METHODS In this prospective, multicenter, open-label trial in South Korea, we randomly assigned patients with complex coronary-artery lesions in a 2:1 ratio to undergo either intravascular imaging-guided PCI or angiography-guided PCI. In the intravascular imaging group, the choice between intravascular ultrasonography and optical coherence tomography was at the operators' discretion. The primary end point was a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization. Safety was also assessed. RESULTS A total of 1639 patients underwent randomization, with 1092 assigned to undergo intravascular imaging-guided PCI and 547 assigned to undergo angiography-guided PCI. At a median follow-up of 2.1 years (interquartile range, 1.4 to 3.0), a primary end-point event had occurred in 76 patients (cumulative incidence, 7.7%) in the intravascular imaging group and in 60 patients (cumulative incidence, 12.3%) in the angiography group (hazard ratio, 0.64; 95% confidence interval, 0.45 to 0.89; P = 0.008). Death from cardiac causes occurred in 16 patients (cumulative incidence, 1.7%) in the intravascular imaging group and in 17 patients (cumulative incidence, 3.8%) in the angiography group; target-vessel-related myocardial infarction occurred in 38 (cumulative incidence, 3.7%) and 30 (cumulative incidence, 5.6%), respectively; and clinically driven target-vessel revascularization in 32 (cumulative incidence, 3.4%) and 25 (cumulative incidence, 5.5%), respectively. There were no apparent between-group differences in the incidence of procedure-related safety events. CONCLUSIONS Among patients with complex coronary-artery lesions, intravascular imaging-guided PCI led to a lower risk of a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization than angiography-guided PCI. (Supported by Abbott Vascular and Boston Scientific; RENOVATE-COMPLEX-PCI ClinicalTrials.gov number, NCT03381872).
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Affiliation(s)
- Joo Myung Lee
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Ki Hong Choi
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Young Bin Song
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Jong-Young Lee
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Seung-Jae Lee
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Sang Yeub Lee
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Sang Min Kim
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Kyeong Ho Yun
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Jae Young Cho
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Chan Joon Kim
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Hyo-Suk Ahn
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Chang-Wook Nam
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Hyuck-Jun Yoon
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Yong Hwan Park
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Wang Soo Lee
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Jin-Ok Jeong
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Pil Sang Song
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Joon-Hyung Doh
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Sang-Ho Jo
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Chang-Hwan Yoon
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Min Gyu Kang
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Jin-Sin Koh
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Kwan Yong Lee
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Young-Hyo Lim
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Yun-Hyeong Cho
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Jin-Man Cho
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Woo Jin Jang
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Kook-Jin Chun
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - David Hong
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Taek Kyu Park
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Jeong Hoon Yang
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Seung-Hyuk Choi
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Hyeon-Cheol Gwon
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
| | - Joo-Yong Hahn
- From Samsung Medical Center (J.M.L., K.H.C., Y.B.S., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H.) and Kangbuk Samsung Hospital (J.-Y.L., S.-J.L.), Sungkyunkwan University School of Medicine, the Catholic University of Korea, Uijeongbu St. Mary's Hospital (C.J.K., H.-S.A.), Chung-Ang University College of Medicine, Chung-Ang University Hospital (W.S.L.), the Catholic University of Korea, Incheon St. Mary's Hospital (K.Y.L.), Hanyang University Seoul Hospital, College of Medicine, Hanyang University (Y.-H.L.), Kyung Hee University Hospital at Gangdong (J.-M.C.), and Ewha Womans University College of Medicine (W.J.J.), Seoul, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (S.Y.L., S.M.K.), Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong (S.Y.L.), Wonkwang University Hospital, Iksan (K.H.Y., J.Y.C.), Keimyung University Dongsan Hospital, Daegu (C.-W.N., H.-J.Y.), Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Y.H.P.), Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (J.-O.J., P.S.S.), Inje University Ilsan-Paik hospital, Goyang (J.-H.D.), the Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang (S.-H.J.), Seoul National University Bundang Hospital, Seongnam-si (C.-H.Y.), Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju (M.G.K., J.-S.K.), Hanyang University Myongji Hospital, Goyang (Y.-H.C.), and Pusan National University Yangsan Hospital, Yangsan (K.-J.C.) - all in South Korea
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Lee SH, Rhee TM, Shin D, Hong D, Choi KH, Kim HK, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Chae SC, Cho MC, Kim CJ, Kim JH, Kim HS, Gwon HC, Jeong MH, Lee JM. Prognosis after discontinuing renin angiotensin aldosterone system inhibitor for heart failure with restored ejection fraction after acute myocardial infarction. Sci Rep 2023; 13:3539. [PMID: 36864119 PMCID: PMC9981744 DOI: 10.1038/s41598-023-30700-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
Abstract
Prognostic effect of discontinuing renin-angiotensin-aldosterone-system-inhibitor (RAASi) for patients with heart failure (HF) after acute myocardial infarction (AMI) whose left ventricular (LV) systolic function was restored during follow-up is unknown. To investigate the outcome after discontinuing RAASi in post-AMI HF patients with restored LV ejection fraction (EF). Of 13,104 consecutive patients from the nationwide, multicenter, and prospective Korea Acute Myocardial Infarction-National Institutes of Health (KAMIR-NIH) registry, HF patients with baseline LVEF < 50% that was restored to ≥ 50% at 12-month follow-up were selected. Primary outcome was a composite of all-cause death, spontaneous MI, or rehospitalization for HF at 36-month after index procedure. Of 726 post-AMI HF patients with restored LVEF, 544 maintained RAASi (Maintain-RAASi) beyond 12-month, 108 stopped RAASi (Stop-RAASi), and 74 did not use RAASi (RAASi-Not-Used) at baseline and follow-up. Systemic hemodynamics and cardiac workloads were similar among groups at baseline and during follow-up. Stop-RAASi group showed elevated NT-proBNP than Maintain-RAASi group at 36-month. Stop-RAASi group showed significantly higher risk of primary outcome than Maintain-RAASi group (11.4% vs. 5.4%; adjusted hazard ratio [HRadjust] 2.20, 95% confidence interval [CI] 1.09-4.46, P = 0.028), mainly driven by increased risk of all-cause death. The rate of primary outcome was similar between Stop-RAASi and RAASi-Not-Used group (11.4% vs. 12.1%; HRadjust 1.18 [0.47-2.99], P = 0.725). In post-AMI HF patients with restored LV systolic function, RAASi discontinuation was associated with significantly increased risk of all-cause death, MI, or rehospitalization for HF. Maintaining RAASi will be necessary for post-AMI HF patients, even after LVEF is restored.
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Affiliation(s)
- Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Min Rhee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - David Hong
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Seung-Hyuck Choi
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Myeong-Chan Cho
- Cardiology Division, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea.
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Lee SH, Jeong YH, Hong D, Choi KH, Lee JM, Park TK, Yang JH, Hahn JY, Choi SH, Gwon HC, Jeong MH, Kim BK, Joo HJ, Chang K, Park Y, Ahn SG, Suh JW, Lee SY, Cho JR, Her AY, Kim HS, Kim MH, Lim DS, Shin ES, Song YB. Clinical Impact of CYP2C19 Genotype on Clopidogrel-Based Antiplatelet Therapy After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:829-843. [PMID: 37045504 DOI: 10.1016/j.jcin.2023.01.363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Although there is a growing body of evidence that CYP2C19 genotyping can be beneficial when considering treatment with clopidogrel after percutaneous coronary intervention (PCI), whether a genotype-guided strategy can be generally adopted in routine practice remains unclear among East Asians. OBJECTIVES This study sought to investigate long-term outcomes of patients undergoing clopidogrel-based antiplatelet therapy after drug-eluting stent (DES) implantation according to CYP2C19 genotypes. METHODS From the nationwide multicenter PTRG-DES (Platelet function and genoType-Related long-term proGnosis in DES-treated patients) consortium, patients who underwent CYP2C19 genotyping were selected and classified according to CYP2C19 loss-of-function allele: rapid metabolizers (RMs) or normal metabolizers (NMs) vs intermediate metabolizers (IMs) or poor metabolizers (PMs). The primary outcome was a composite of cardiac death, myocardial infarction, and stent thrombosis at 5 years after the index procedure. RESULTS Of 8,163 patients with CYP2C19 genotyping, 56.7% presented with acute coronary syndrome. There were 3,098 (37.9%) in the RM or NM group, 3,906 (47.9%) in the IM group, and 1,159 (14.2%) in the PM group. IMs or PMs were associated with an increased risk of 5-year primary outcome compared with RMs or NMs (HRadj: 1.42; 95% CI: 1.01-1.98; P = 0.041), and the effect was more pronounced in the first year (HRadj: 1.67; 95% CI: 1.10-2.55; P = 0.016). The prognostic implication of being an IM and PM was significant in acute coronary syndrome patients (HRadj: 1.88; 95% CI: 1.20-2.93; P = 0.005) but not in those with stable angina (HRadj: 0.92; 95% CI: 0.54-1.55; P = 0.751) (interaction P = 0.028). CONCLUSIONS Among East Asians with clopidogrel-based antiplatelet therapy after DES implantation, CYP2C19 genotyping could stratify patients who were likely to have an increased risk of atherothrombotic events. (Platelet Function and genoType-Related Long-term progGosis in DES-treated Patients: A Consortium From Multi-centered Registries [PTRG-DES]; NCT04734028).
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