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Lee HY, Min KW, Han KA, Kim JS, Ahn JC, Kim MH, Lee JB, Shin SH, Kim CJ, Kim KH, Cho DK, Choi J, Rhee MY, Her SH, Kim W, Na JO, Cho GY, Kim SY, Park GM, Lee BK, Jo SH, Lee BW, Sohn IS, Kim DI, Ihm SH, Lee SH, Chung JW, Cho EJ, Son JW, Oh SJ, Hwang JY, Jeong JO, Han KR, Yoon HJ, Seo SM, Chung WJ, Bae JW, Choi JH, Hyun BJ, Cha JE, Yoo SJ, Shin J. The Efficacy and Tolerability of Irbesartan/Amlodipine Combination Therapy in Patients With Essential Hypertension Whose Blood Pressure Were not Controlled by Irbesartan Monotherapy. Clin Ther 2024:S0149-2918(24)00084-5. [PMID: 38704294 DOI: 10.1016/j.clinthera.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/05/2024] [Accepted: 04/10/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE This study aimed to evaluate the efficacy and tolerability of irbesartan (IRB) and amlodipine (AML) combination therapy in patients with essential hypertension whose blood pressure (BP) was not controlled by IRB monotherapy. METHODS Two multicenter, randomized, double-blind, placebo-controlled, phase III studies were conducted in Korea (the I-DUO 301 study and the I-DUO 302 study). After a 4-week run-in period with either 150 mg IRB (I-DUO 301 study) or 300 mg IRB (I-DUO 302 study), patients with uncontrolled BP (ie, mean sitting systolic BP [MSSBP] ≥140 mmHg to <180 mmHg and mean sitting diastolic BP <110 mmHg) were randomized to the placebo, AML 5 mg, or AML 10 mg group. A total of 428 participants were enrolled in the 2 I-DUO studies. In the I-DUO 301 study, 271 participants were randomized in a 1:1:1 ratio to receive either IRB/AML 150/5 mg, IRB/AML 150/10 mg, or IRB 150 mg/placebo. In the I-DUO 302 study, 157 participants were randomized in a 1:1 ratio to receive IRB/AML 300/5 mg or IRB 300 mg/placebo. The primary endpoint was the change in MSSBP from baseline to week 8. Tolerability was assessed according to the development of treatment-emergent adverse events (TEAEs) and clinically significant changes in physical examination, laboratory tests, pulse, and 12-lead electrocardiography. FINDINGS In I-DUO 301, the mean (SD) changes of MSSBP at week 8 from baseline were -14.78 (12.35) mmHg, -21.47 (12.78) mmHg, and -8.61 (12.19) mmHg in the IRB/AML 150/5 mg, IRB/AML 150/10 mg, and IRB 150 mg/placebo groups, respectively. In I-DUO 302, the mean (SD) changes of MSSBP at week 8 from baseline were -13.30 (12.47) mmHg and -7.19 (15.37) mmHg in the IRB/AML 300/5 mg and IRB 300 mg/placebo groups, respectively. In both studies, all combination groups showed a significantly higher reduction in MSSBP than the IRB monotherapy groups (P < 0.001 for both). TEAEs occurred in 10.00%, 10.99%, and 12.22% of participants in the IRB/AML 150/5 mg, IRB/AML 150/10 mg, and IRB 150 mg/placebo groups, respectively, in I-DUO 301 and in 6.33% and 10.67% of participants in the IRB/AML 300/5 mg and IRB 300 mg/placebo groups, respectively, in I-DUO 302, with no significant between-group differences. Overall, there was one serious adverse event throughout I-DUO study. IMPLICATIONS The combination of IRB and AML has superior antihypertensive effects compared with IRB alone over an 8-week treatment period, with placebo-like tolerability. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05476354 (I-DUO 301), NCT05475665 (I-DUO 302).
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Affiliation(s)
- Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Wan Min
- Department of Endocrinology and Metabolism, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Kyung Ah Han
- Department of Endocrinology and Metabolism, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Jeong Su Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jeong Cheon Ahn
- Department of Cardiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Jin Bae Lee
- Department of Cardiology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Sung-Hee Shin
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Chong-Jin Kim
- Department of Cardiology, CHA Gangnam Medical Center, Seoul, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School /Hospital, Gwangju, Republic of Korea
| | - Deok-Kyu Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Junghyun Choi
- Department of Cardiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Moo-Yong Rhee
- Division of Cardiology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Sung-Ho Her
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jin Oh Na
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Seok Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Sang-Ho Jo
- Department of Internal Medicine, Division of Cardiology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Il-Suk Sohn
- Department of Cardiology, KyungHee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - Joong-Wha Chung
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jang Won Son
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Seung-Jin Oh
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kyoo-Rok Han
- Department of Cardiology, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Suk Min Seo
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jin-Ho Choi
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | | | | | | | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea..
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Won KB, Hur SH, Cho YK, Yoon HJ, Nam CW, Kim KB, Bae JH, Choi DJ, Ahn YK, Park JS, Kim HS, Choi RK, Choi D, Kim JH, Han KR, Park HS, Choi SY, Yoon JH, Kwon HC, Rha SW, Hwang KK, Lim DS, Jung KT, Oh SK, Lee JH, Shin ES, Kim KS. Correction: Comparison of 2‑year mortality according to obesity in stabilized patients with type 2 diabetes mellitus after acute myocardial infarction: results from the DIAMOND prospective cohort registry. Cardiovasc Diabetol 2023; 22:159. [PMID: 37386407 DOI: 10.1186/s12933-023-01889-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Affiliation(s)
- Ki-Bum Won
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Chang-Wook Nam
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Kwon-Bae Kim
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jang-Ho Bae
- Division of Cardiology, Konyang University Hospital, Daejeon, South Korea
| | - Dong-Ju Choi
- Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Keun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jong-Seon Park
- Division of Cardiology, Yeungnam University Hospital, Daegu, South Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Seoul National University Hospital, 28 Yeongeon-Dong, Chongno-Gu, Seoul, 110-744, South Korea.
| | - Rak-Kyeong Choi
- Division of Cardiology, Sejong General Hospital, Bucheon, South Korea
| | - Donghoon Choi
- Division of Cardiology, Yonsei University Severance Hospital, Seoul, South Korea
| | - Joon-Hong Kim
- Division of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Hun-Sik Park
- Division of Cardiology, Kyungpook National University Hospital, Daegu, South Korea
| | - So-Yeon Choi
- Division of Cardiology, Ajou University Hospital, Suwon, South Korea
| | - Jung-Han Yoon
- Division of Cardiology, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Hyeon-Cheol Kwon
- Division of Cardiology, Samsung Medical Center, Seoul, South Korea
| | - Seung-Woon Rha
- Division of Cardiology, Korea University Guro Hospital, Seoul, South Korea
| | - Kyung-Kuk Hwang
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Do-Sun Lim
- Division of Cardiology, Korea University Anam Hospital, Seoul, South Korea
| | - Kyung-Tae Jung
- Division of Cardiology, Eulji University Hospital, Daejeon, South Korea
| | - Seok-Kyu Oh
- Division of Cardiology, Wonkwang University Hospital, Iksan, South Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Chungnam National University Hospital, Daejeon, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, Ulsan, South Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
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Yun JP, Kang J, Park KW, Park K, Hwang D, Han JK, Yang HM, Kang HJ, Koo BK, Chae IH, Moon KW, Park HW, Won KB, Jeon DW, Han KR, Choi SW, Ryu JK, Jeong MH, Kim HS. Prasugrel-Based De-Escalation in Patients With Acute Coronary Syndrome According to Renal Function. JACC Asia 2023; 3:51-61. [PMID: 36873753 PMCID: PMC9982221 DOI: 10.1016/j.jacasi.2022.09.013] [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: 06/06/2022] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 01/12/2023]
Abstract
Background Patients with coronary artery disease and impaired renal function are at higher risk for both bleeding and ischemic adverse events after percutaneous coronary intervention (PCI). Objectives This study assessed the efficacy and safety of a prasugrel-based de-escalation strategy in patients with impaired renal function. Methods We conducted a post hoc analysis of the HOST-REDUCE-POLYTECH-ACS study. Patients with available estimated glomerular filtration rate (eGFR) (n = 2,311) were categorized into 3 groups. (high eGFR: >90 mL/min; intermediate eGFR: 60 to 90 mL/min; and low eGFR: <60 mL/min). The end points were bleeding outcomes (Bleeding Academic Research Consortium type 2 or higher), ischemic outcomes (cardiovascular death, myocardial infarction, stent thrombosis, repeated revascularization, and ischemic stroke), and net adverse clinical event (including any clinical event) at 1-year follow-up. Results Prasugrel de-escalation was beneficial regardless of baseline renal function (P for interaction = 0.508). The relative reduction in bleeding risk from prasugrel de-escalation was higher in the low eGFR group than in both the intermediate and high eGFR groups (relative reductions, respectively: 64% (HR: 0.36; 95% CI: 0.15-0.83) vs 50% (HR: 0.50; 95% CI: 0.28-0.90) and 52% (HR: 0.48; 95% CI: 0.21-1.13) (P for interaction = 0.646). Ischemic risk from prasgurel de-escalation was not significant in all eGFR groups (HR: 1.18 [95% CI: 0.47-2.98], HR: 0.95 [95% CI: 0.53-1.69], and HR: 0.61 [95% CI: 0.26-1.39]) (P for interaction = 0.119). Conclusions In patients with acute coronary syndrome receiving PCI, prasugrel dose de-escalation was beneficial regardless of the baseline renal function.
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Affiliation(s)
- Jun Pil Yun
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeehoon Kang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Woo Park
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungil Park
- Dong-A University Hospital, Busan, Republic of Korea
| | - Doyeon Hwang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Han-Mo Yang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jae Kang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | - Hyun Woong Park
- Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Ki-Bum Won
- Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea
| | - Dong Woon Jeon
- National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Kyoo-Rok Han
- Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Si Wan Choi
- Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jae Kean Ryu
- Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Myung Ho Jeong
- Cheonnam University Hospital, Gwangju, Republic of Korea
| | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, Republic of Korea
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Won KB, Shin ES, Kang J, Yang HM, Park KW, Han KR, Moon KW, Oh SK, Kim U, Rhee MY, Kim DI, Kim SY, Lee SY, Han JK, Koo BK, Kim HS. Body Mass Index and Major Adverse Events During Chronic Antiplatelet Monotherapy After Percutaneous Coronary Intervention With Drug-Eluting Stents - Results From the HOST-EXAM Trial. Circ J 2023; 87:268-276. [PMID: 36123011 DOI: 10.1253/circj.cj-22-0344] [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: 01/28/2023]
Abstract
BACKGROUND This study evaluated the association of body mass index (BMI) with adverse clinical outcomes during chronic maintenance antiplatelet monotherapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods and Results: Overall, 5,112 patients were stratified (in kg/m2) into underweight (BMI ≤18.4), normal weight (18.5-22.9), overweight (23.0-24.9), obesity (25.0-29.9) and severe obesity (≥30.0) categories with randomized antiplatelet monotherapy of aspirin 100 mg or clopidogrel 75 mg once daily for 24 months. The primary endpoint was the composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome and major bleeding of Bleeding Academic Research Consortium type ≥3. Compared with normal weight, the risk of primary composite outcomes was higher in the underweight (hazard ratio [HR] 2.183 [1.199-3.974]), but lower in the obesity (HR 0.730 [0.558-0.954]) and severe obesity (HR 0.518 [0.278-0.966]) categories, which is partly driven by the difference in all-cause death. The risk of major bleeding was significantly higher in the underweight (HR 4.140 [1.704-10.059]) than in the normal weight category. A decrease in categorical BMI was independently associated with the increased risk of primary composite outcomes. CONCLUSIONS Lower BMI is associated with a higher risk of primary composite outcomes, which is primarily related to the events of all-cause death or major bleeding during chronic maintenance antiplatelet monotherapy after PCI with DES.
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Affiliation(s)
- Ki-Bum Won
- Division of Cardiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine
| | - Jeehoon Kang
- Division of Cardiology, Seoul National University Hospital
| | - Han-Mo Yang
- Division of Cardiology, Seoul National University Hospital
| | - Kyung Woo Park
- Division of Cardiology, Seoul National University Hospital
| | - Kyoo-Rok Han
- Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University
| | - Keon-Woong Moon
- Division of Cardiology, St. Vincent's Hospital, The Catholic University of Korea
| | - Seok Kyu Oh
- Division of Cardiology, Wonkwang University Hospital
| | - Ung Kim
- Division of Cardiology, Yeungnam University Hospital
| | - Moo-Yong Rhee
- Division of Cardiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine
| | - Doo-Il Kim
- Division of Cardiology, Haeundae Paik Hospital, Inje University
| | - Song-Yi Kim
- Division of Cardiology, College of Medicine, Jeju National University
| | - Sung-Yun Lee
- Division of Cardiology, Ilsan Paik Hospital, Inje University
| | - Jung-Kyu Han
- Division of Cardiology, Seoul National University Hospital
| | - Bon-Kwon Koo
- Division of Cardiology, Seoul National University Hospital
| | - Hyo-Soo Kim
- Division of Cardiology, Seoul National University Hospital
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Jeong HS, Hong SJ, Cho JM, Han KH, Cha DH, Jo SH, Kang HJ, Choi SY, Choi CU, Cho EJ, Jeong YH, Gwon HC, Kim BK, Lee SY, Kim SH, Ahn JC, Hong YJ, Kim WS, Woo SI, Park TH, Han KR. A Multicenter, Randomized, Double-Blind, Active-Controlled, Factorial Design, Phase III Clinical Trial to Evaluate the Efficacy and Safety of Combination Therapy of Pitavastatin and Ezetimibe Versus Monotherapy of Pitavastatin in Patients With Primary Hypercholesterolemia. Clin Ther 2022; 44:1310-1325. [DOI: 10.1016/j.clinthera.2022.09.001] [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] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
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Ki YJ, Lee BK, Park KW, Bae JW, Hwang D, Kang J, Han JK, Yang HM, Kang HJ, Koo BK, Kim DB, Chae IH, Moon KW, Park HW, Won KB, Jeon DW, Han KR, Choi SW, Ryu JK, Jeong MH, Cha KS, Kim HS. Prasugrel-based De-Escalation of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With STEMI. Korean Circ J 2022; 52:304-319. [PMID: 35129316 PMCID: PMC8989793 DOI: 10.4070/kcj.2021.0293] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
There is a fundamental trade-off that exists between ischemic and bleeding risk that must be considered in deciding the optimal strategy of dual antiplatelet therapy. Prasugrel-based de-escalation decreased the risk of net adverse clinical event (NACE) due to a reduction in bleeding in the HOST-REDUCE-POLYTECH-ACS trial. In non-ST-segment elevation acute coronary syndromes patients, prasugrel-based dose de-escalation from one-month post-percutaneous coronary intervention reduced the risk of NACE. In ST-elevation myocardial infarction (STEMI), de-escalation showed no benefit for NACE and a statistically insignificant but numerically higher rate of ischemic events. Our data raises caution about prasugrel dose reduction in higher thrombotic conditions. Background and Objectives De-escalation of dual-antiplatelet therapy through dose reduction of prasugrel improved net adverse clinical events (NACEs) after acute coronary syndrome (ACS), mainly through the reduction of bleeding without an increase in ischemic outcomes. Whether the benefits of de-escalation are sustained in highly thrombotic conditions such as ST-elevation myocardial infarction (STEMI) is unknown. We aimed to assess the efficacy and safety of de-escalation therapy in patients with STEMI or non-ST-segment elevation ACS (NSTE-ACS). Methods This is a pre-specified subgroup analysis of the HOST-REDUCE-POLYTECH-ACS trial. ACS patients were randomized to prasugrel de-escalation (5 mg daily) or conventional dose (10 mg daily) at 1-month post-percutaneous coronary intervention. The primary endpoint was a NACE, defined as a composite of all-cause death, non-fatal myocardial infarction, stent thrombosis, clinically driven revascularization, stroke, and bleeding events of grade ≥2 Bleeding Academic Research Consortium (BARC) criteria at 1 year. Results Among 2,338 patients included in the randomization, 326 patients were diagnosed with STEMI. In patients with NSTE-ACS, the risk of the primary endpoint was significantly reduced with de-escalation (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.48–0.89; p=0.006 for de-escalation vs. conventional), mainly driven by a reduced bleeding. However, in those with STEMI, there was no difference in the occurrence of the primary outcome (HR, 1.04; 95% CI, 0.48–2.26; p=0.915; p for interaction=0.271). Conclusions Prasugrel dose de-escalation reduced the rate of NACE and bleeding, without increasing the rate of ischemic events in NSTE-ACS patients but not in STEMI patients.
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Affiliation(s)
- You-Jeong Ki
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bong Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University, Chuncheon, Korea
| | - Kyung Woo Park
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Doyeon Hwang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeehoon Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung-Kyu Han
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han-Mo Yang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, Bucheon, Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keon-Woong Moon
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, Suwon, Korea
| | - Hyun Woong Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Ki-Bum Won
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Dong Woon Jeon
- Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Si Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Kean Ryu
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam University Hospital, Gwangju, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Ki YJ, Lee BK, Park KW, Bae JW, Hwang D, Kang J, Han JK, Yang HM, Kang HJ, Koo BK, Kim DB, Chae IH, Moon KW, Park HW, Won KB, Jeon DW, Han KR, Choi SW, Ryu JK, Jeong MH, Cha KS, Kim HS. Erratum: Correction of Text in the Article “Prasugrel-based De-Escalation of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With STEMI”. Korean Circ J 2022; 52:483-484. [PMID: 35656907 PMCID: PMC9160639 DOI: 10.4070/kcj.2022.0999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- You-Jeong Ki
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bong Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University, Chuncheon, Korea
| | - Kyung Woo Park
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Doyeon Hwang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeehoon Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung-Kyu Han
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han-Mo Yang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, Bucheon, Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keon-Woong Moon
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, Suwon, Korea
| | - Hyun Woong Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Ki-Bum Won
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Dong Woon Jeon
- Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Si Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Kean Ryu
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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8
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Rhee TM, Kang J, Woo (KW) Park K, Yang HM, Won KB, Rha SW, Bae JW, Lee NH, Hur SH, Yoon J, Park TH, Kim BS, Lim SW, Cho YH, Jeon DW, Kim SH, Han KR, Moon KW, Oh SK, Kim U, Rhee MY, Kim DI, Kim SY, Lee S, Lee SU, Kim SW, Kim SY, Jeon HK, Cha KS, Jo SH, Ryu JK, Suh IW, Choi HH, Woo SI, Chae IH, Shin WY, Kim DK, Oh JH, Jeong MH, Kim YH, Han JK, Shin ES, Koo BK, Kim HS. TCT-6 Impact of Diabetes Mellitus on the Effectiveness of Aspirin Versus Clopidogrel as a Chronic Maintenance Antiplatelet Monotherapy After Percutaneous Coronary Intervention: Results From the HOST-EXAM Trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Seo WW, Park MS, Kim SE, Lee JH, Park DG, Han KR, Oh DJ, Hyon MS. Neutrophil-Lymphocyte Ratio as a Predictor of Venous Thromboembolism after Total Knee Replacement. J Knee Surg 2021; 34:171-177. [PMID: 31394586 DOI: 10.1055/s-0039-1694043] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is a potentially serious complication after total knee replacement (TKR), and recent guideline recommends thromboprophylaxis for VTE after TKR. The neutrophil-lymphocyte ratio (NLR) has emerged as a simple and new prognostic biomarker for several cardiovascular diseases. This study was performed to investigate the precise incidence of postoperative VTE and the role of NLR for predicting VTE in patients receiving thromboprophylaxis after TKR. We retrospectively enrolled 264 patients undergoing TKR who underwent routine screening enhanced pulmonary artery and lower extremity venography computed tomography (CT) scan within 7 postoperative days. Biochemical tests were performed within 2 weeks prior to surgery, and the NLR was defined as the absolute neutrophil count in peripheral blood divided by lymphocyte count. All patients received thromboprophylaxis with enoxaparin postoperatively. Of 264 patients, 102 (38.6%) were diagnosed with deep vein thrombosis (DVT) or pulmonary embolism on CT scan. Preoperative NLR was significantly higher in patients with postoperative VTE compared with that in patients without VTE (2.57 ± 1.59 vs. 2.11 ± 1.10, p = 0.011). Receiver operating characteristic curve analysis showed that a preoperative NLR of 1.90 was the best cutoff value for the prediction of postoperative VTE (sensitivity 57.8%, specificity 55.6%, and area under curve 0.589). In the multivariate analysis, a preoperative NLR ≥1.90 was a sole independent predictor of postoperative VTE (odds ratio: 1.95, 95% computed tomography: 1.16-3.31, p = 0.013). The present study shows a higher incidence of VTE (38.6%) after TKR in patients receiving thromboprophylaxis than that reported in previous studies. Furthermore, preoperative NLR was significantly higher in patients with postoperative VTE, and a high preoperative NLR (≥1.90) was an independent predictor of VTE after TKR. NLR measurement may be a simple and useful method for the prediction of VTE in patients undergoing TKR.
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Affiliation(s)
- Won-Woo Seo
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea.,Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Myung-Soo Park
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea.,Division of Cardiology, Dongtan Sacred Heart Hospital, Dongtan, South Korea
| | - Sung Eun Kim
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Jun-Hee Lee
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Dae-Gyun Park
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Dong-Jin Oh
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Min-Su Hyon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea.,Division of Cardiology, Soonchunhyang University Hospital, Seoul, South Korea
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10
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Lee HY, Han KH, Chung WB, Her SH, Park TH, Rha SW, Choi SY, Jung KT, Park JS, Kim PJ, Lee JM, Jeong MH, Shin ES, Gwon HC, Han KR, Chae JK, Kim WS, Choi DJ, Hong BK, Choi SW, Chung N. Safety and Efficacy of Pitavastatin in Patients With Impaired Fasting Glucose and Hyperlipidemia: A Randomized, Open-labeled, Multicentered, Phase IV Study. Clin Ther 2020; 42:2036-2048. [PMID: 32921501 DOI: 10.1016/j.clinthera.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/01/2020] [Accepted: 07/25/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Although the role of high-intensity lipid-lowering therapy in cardiovascular protection has broadened, concerns still exist about new-onset diabetes mellitus (NODM), especially in vulnerable patients. This study aimed to compare the effect of high-dose (4 mg/d) and usual dose (2 mg/d) pitavastatin on glucose metabolism in patients with hyperlipidemia and impaired fasting glucose (IFG). METHODS In this 12-month study, glucose tolerance and lipid-lowering efficacy of high-dose pitavastatin (4 mg [study group]) was compared with that of usual dose pitavastatin (2 mg [control group]) in patients with hyperlipidemia and IFG. The primary end point was the change of glycosylated hemoglobin (HbA1c) after 24 weeks of treatment. The secondary end points were as follows: (1) NODM within 1 year after treatment, (2) change of lipid parameters, (3) changes of adiponectin, and (4) change of blood glucose and insulin levels. FINDINGS Of the total 417 patients screened, 313 patients with hypercholesterolemia and IFG were randomly assigned into groups. The mean (SD) change in HbA1c was 0.06% (0.20%) in the study group and 0.03% (0.22%) in the control group (P = 0.27). Within 1 year, 27 patients (12.3%) developed NODM, including 12 (10.6%) of 113 patients in the study group and 15 (14.2%) of 106 in the control group (P = 0.43). The study group had a significantly higher reduction of total cholesterol and LDL-C levels and a higher increase in apolipoprotein A1/apolipoprotein B ratio (0.68 [0.40] vs 0.51 [0.35], P < 0.01). IMPLICATIONS The high-dose pitavastatin therapy did not aggravate glucose metabolism compared with the usual dose therapy. Moreover, it had a better effect on cholesterol-lowering and apolipoprotein distribution in the patients with hyperlipidemia and IFG.
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Affiliation(s)
- Hae-Young Lee
- Seoul National University Hospital, Seoul, South Korea
| | | | | | - Sung-Ho Her
- Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Tae-Ho Park
- Dong-A University Hospital, Busan, South Korea
| | | | | | | | | | - Pum-Joon Kim
- St. Mary's Hospital Eunpyeong, Seoul, South Korea
| | - Jong-Min Lee
- St. Mary's Hospital Uijeongbu, Seoul, South Korea
| | - Myung-Ho Jeong
- Chonnam National University Hospital, Gwangju, South Korea
| | | | | | - Kyoo-Rok Han
- Kangdong Sacred Heart Hospital, Gangdong-gu, South Korea
| | - Jei-Keon Chae
- Chonbuk National University Hospital, Jeollabuk-do, South Korea
| | - Woo-Shik Kim
- Kyung Hee University Hospital, Gangdong, South Korea
| | - Dong-Ju Choi
- Seoul National University Bundang Hospital, Seoul, South Korea
| | | | - Si-Wan Choi
- Chungnam National University Hospital, Daejeon, South Korea
| | - Namsik Chung
- Yonsei University Severance Hospital, Seoul, South Korea.
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11
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Youn YJ, Lee JW, Ahn SG, Lee SH, Yoon J, Park KS, Lee JB, Yoo SY, Lim DS, Cho JH, Choi CU, Jeong MH, Han KR, Cha KS, Lee SY, Choi HH, Choi JW, Hyon MS, Kim MH. Randomized Comparison of Everolimus- and Zotarolimus-Eluting Coronary Stents With Biolimus-Eluting Stents in All-Comer Patients. Circ Cardiovasc Interv 2020; 13:e008525. [DOI: 10.1161/circinterventions.119.008525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
There is limited data comparing the Xience everolimus-eluting stent (EES) and the Resolute zotarolimus-eluting stent (ZES) with the BioMatrix biolimus-eluting stent (BES).
Methods:
This open-label, randomized, noninferiority trial enrolled all-comer patients to be randomly treated with either BES, EES, or ZES in a 1:1:1 ratio in 15 centers across South Korea. The primary end point was a device-oriented composite outcome consisting of cardiac death, target-vessel myocardial infarction, and clinically indicated target lesion revascularization at 24 months. The BES was compared with the EES and the ZES by intention-to-treat analyses with a noninferiority margin of 3.8%, respectively.
Results:
Because of slow recruitment and low event rates, this trial was prematurely terminated after enrollment of 1935 (75%) of the intended 2580 patients. Of the 1911 patients randomized to either EES (n=638), BES (n=634), or ZES (n =639), the rate of device-oriented composite outcome was 3.6%, 2.2%, and 3.9%, respectively, at 24 months (BES versus EES: absolute risk difference −1.4% [upper limit of 1-sided 95% CI: −3.2%];
P
for noninferiority
<0.001; BES versus ZES: absolute risk difference −1.7% [upper limit of 1-sided 95% CI: −3.6%];
P
for noninferiority
<0.001).
Conclusions:
The BES was noninferior to either the EES or the ZES in all-comer patients for device-oriented composite outcome at the 24-month follow-up. However, caution is advised regarding interpretation of these results due to the premature termination of this study.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01397175.
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Affiliation(s)
- Young Jin Youn
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Jun-Won Lee
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Sung Gyun Ahn
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Seung-Hwan Lee
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Junghan Yoon
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Keum Soo Park
- Division of Cardiology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea (K.S.P.)
| | - Jin Bae Lee
- Division of Cardiology, Daegu Catholic University Medical Center, Catholic University, South Korea (J.-B.L.)
| | - Sang-Yong Yoo
- Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, South Korea (S.-Y.Y.)
| | - Do-Sun Lim
- Division of Cardiology, Korea University Anam Hospital (D.-S.L.), Korea University, Seoul, South Korea
| | - Jang Hyun Cho
- Division of Cardiology, St. Carollo General Hospital, Suncheon, South Korea (J.H.C.)
| | - Cheol Ung Choi
- Division of Cardiology, Korea University Guro Hospital (C.U.C.), Korea University, Seoul, South Korea
| | - Myung Ho Jeong
- The Heart Center, Chonnam National University Hospital, Chonnam National University, Gwangju, South Korea (M.H.J.)
| | - Kyoo-Rok Han
- Division of Cardiology, Kangdong Sacred Heart Hospital Hallym University, Seoul (K.-R.H.)
| | - Kwang Soo Cha
- Division of Cardiology, Pusan National University Hospital, Pusan National University, Busan, South Korea (K.S.C.)
| | - Sung Yun Lee
- Division of Cardiology, Inje University Ilsan-Paik Hospital, Inje University, Goyang, South Korea (S.Y.L.)
| | - Hyun-Hee Choi
- Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University, South Korea (H.-H.C.)
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Eulji University, Seoul, South Korea (J.W.C.)
| | - Min Su Hyon
- Division of Cardiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University, South Korea (M.S.H.)
| | - Moo-Hyun Kim
- Division of Cardiology, Dong-A University Hospital, Dong-A University, Busan, South Korea (M.-H.K.)
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12
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Park DG, Seo WW, Kim SE, Lee JH, Han KR, Oh DJ. P1478 Evaluation of reversibility of alcoholic cardiomyopathy using doubaimine stress echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Alcoholic cardiomyopathy (CM) is known as a reversible CM. Appropriate medications with cessation of alcohol may lead to full recovery of chamber size and contractility. But there is not much information about morphologic and hemodynamic changes over the course of treatment, and predictors of reversibility. We experienced the patient with alcoholic CM who was admitted with heart failure and recovered over 1 year and 5 months. He consumed daily 180g alcohol for 6 months before admission. On initial echocardiography, left atrial (LA) dimension, left ventricular (LV) systolic dimension (SD) and diastolic dimension (DD), inferior vena cava (IVC) size, and ejection fraction (EF) were 50 mm, 69 mm, 78 mm, 27 mm and 22%, respectively. Doppler examination revealed a restrictive pattern in tansmitral flow, and a systolic peak velocity/diastolic peak velocity (S/D) ratio of less than 1 in pulmonary vein flow (PVF). Pressure gradient through tricuspid regurgitation was 29 mmHg. Coronary angiogram confirmed no significant stenosis. Within 1 week after medications, LVEF increased mainly by decrease of enlarged LVSD which might be partly caused by volume overload, evidenced by respiratory variation of transmitral flow. On 8th day, we performed dobutamine stress echocardiography (DSE) to evaluate reversibility because LVEF slightly decreased despite decrease of LVDD. During dobutamine infusion, both LVDD and LVSD decreased along with increase of LVEF according to dose escalation. From 1 to 2 months, LVEF slightly increased with decrease of LVDD and LVSD. Afterwards, LVEF was normalized mainly with decrease of LVSD, and LVEF was completely normalized at 1 year and 5 month after initiation of treatment. Initial increase of LVEF might reflect decrease of LVSD by relief of volume overload rather than improving LV contractility. Based on this observation of serial change of chambers and LVEF, we speculate that increased LV wall tension, which is induced by increase of preload as a compensating mechanism for increasing stroke volume, might aggravate LVEF in later stage of heart failure with reduced EF. The sequence of normalization in chamber size was IVC, and then LA, and then LVDD. Transmitral flow as an indicator of diastolic dysfunction changed from restrictive (transiently existed only for 1 week) to abnormal relaxation pattern (no change since that time). PVF pattern showed S/D ratio < 1 until 1 week, and then triphasic pattern at 1 month, finally biphasic pattern at 8 month after initiation of medications. We observed a serial change of echocardiographic findings in patient with alcoholic CM, which might provide an insightful information to understand reverse of LV or LA remodeling associated with hemodynamic parameters, and DSE might be helpful to evaluate reversibility of LV systolic function and convince patients who are reluctant to medications.
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Affiliation(s)
- D G Park
- Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - W W Seo
- Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - S E Kim
- Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - J H Lee
- Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - K R Han
- Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - D J Oh
- Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea (Republic of)
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13
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Lee MH, Bang DW, Park BW, Cho BR, Rha SW, Jeong MH, Yoon J, Suh J, Han KR, Hyon MS. Transradial versus transfemoral intervention in non-ST-segment elevation acute coronary syndrome patients undergoing percutaneous coronary intervention: the Korean transradial intervention registry of 1 285 patients. Cardiovasc J Afr 2018; 29:374-380. [PMID: 30398512 DOI: 10.5830/cvja-2018-047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/30/2018] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Although the implementation of transradial intervention (TRI) has increased over the last few years, there are limited data on the impact of TRI on efficacy and safety in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). We sought to compare one-year clinical outcomes and bleeding complications of TRI with those of transfemoral intervention (TFI) in patients with NSTE-ACS. METHODS The Korean TRI registry was a cohort of 20 centres from 2012 to 2015. The primary efficacy endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death (CD), non-fatal myocardial infarction (MI) and repeat revascularisation (RR). Among the 1 319 patients with NSTE-ACS, 1 285 were finally analysed after excluding 34 due to lack of follow-up data. The patients were divided into TRI and TFI groups according to the final access site. RESULTS At one-year follow up, the TRI group showed a significantly lower rate of MACE, and a marginally significantly lower rate of CD than the TFI group in the crude population. However, in propensity-score matched analysis, the rate of MACE did not differ between the TRI and TFI groups. Regarding bleeding complications, the TRI group was associated with significantly lower rates of major bleeding in both the crude and matched populations. Independent predictors of MACE were chronic kidney disease (CKD) and multi-vessel disease (MVD). CONCLUSIONS In patients with NSTE-ACS, TRI was associated with favourable one-year clinical outcomes and lower bleeding complications compared to TFI. Independent predictors of MACE were clinical and angiographic profiles (CKD, MVD) rather than vascular access sites.
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Affiliation(s)
- Min-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.
| | - Duk Won Bang
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Byung Won Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Seung-Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Jon Suh
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea.
| | - Min Su Hyon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
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14
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Ahn Y, Kim Y, Chang K, Kim W, Rhee MY, Cha KS, Hyon MS, Shim CY, Lee SY, Kim DI, Kim SW, Lim SW, Han KR, Jo SH, Lee NH, Kwan J, Ahn T. A multicenter, randomized, and double-blind phase IV clinical trial to compare the efficacy and safety of fixed-dose combinations of amlodipine orotate/valsartan 5/160 mg versus valsartan/hydrochlorothiazide 160/12.5 mg in patients with essential hypertension uncontrolled by valsartan 160 mg monotherapy. Medicine (Baltimore) 2018; 97:e12329. [PMID: 30212981 PMCID: PMC6156014 DOI: 10.1097/md.0000000000012329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine whether the effectiveness and safety of fixed-dose combinations (FDCs) of amlodipine orotate/valsartan (AML/VAL) 5/160 mg are noninferior to those of valsartan/hydrochlorothiazide (VAL/HCTZ) 160/12.5 mg in hypertensive patients with inadequate response to valsartan 160 mg monotherapy. METHODS This 8-week, active-controlled, parallel-group, fixed-dose, multicenter, double-blind randomized controlled, and noninferiority trial was conducted at 17 cardiovascular centers in the Republic of Korea. Eligible patients had mean sitting diastolic blood pressure (msDBP) ≥90 mm Hg despite monotherapy with valsartan 160 mg for 4 weeks. Patients were randomly assigned to treatment with AML/VAL 5/160 mg FDC (AML/VAL) group or VAL/HCTZ 160/12.5 mg FDC (VAL/HCTZ) group once daily for 8 weeks. A total of 238 patients were enrolled (AML/VAL group, n = 121; VAL/HCTZ group, n = 117), of whom 228 completed the study. RESULTS At 8 weeks after randomization, msDBP was significantly decreased in both groups (-9.44 ± 0.69 mm Hg in the AML/VAL group and -7.47 ± 0.71 mm Hg in the VAL/HCTZ group, both P < .001 vs baseline). Between group difference was -1.96 ± 1.00 mm Hg, indicating that AML/VAL 5/160 mg FDC was not inferior to VAL/HCTZ 160/12.5 mg FDC at primary efficacy endpoint. Control rate of BP defined as the percentage of patients achieving mean sitting SBP (msSBP) <140 mm Hg or msDBP <90 mm Hg (target BP) from baseline to week 8 was significantly higher in the AML/VAL group than that in the VAL/HCTZ group (84.3% [n = 102] in the AML/VAL group vs 71.3% [n = 82] in the VAL/HCTZ group, P = .016). At 8 weeks after randomization, mean uric acid level was significantly increased in the VAL/HCTZ group compared to that at baseline (0.64 ± 0.08 mg/dL; P < .001). However, it was slightly decreased from baseline in the AML/VAL group (-0.12 ± 0.08 mg/dL; P = .085). The intergroup difference was significant (P < .001). CONCLUSION The effectiveness and safety AML/VAL 5/160 mg FDC are noninferior to those of VAL/HCTZ 160/12.5 mg FDC in patients with hypertension inadequately controlled by valsartan 160 mg monotherapy.
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Affiliation(s)
- Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju
| | - Yongcheol Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju
| | - Kiyuk Chang
- The Catholic University of Korea, Seoul St. Mary's Hospital
| | - Weon Kim
- Kyung Hee University Hospital, Seoul
| | | | | | - Min Su Hyon
- Soonchunhyang University Seoul Hospital, Seoul
| | - Chi Young Shim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul
| | | | - Doo Il Kim
- Inje University Haeundae Paik Hostpital, Busan
| | | | - Sang-Wook Lim
- CHA Bundang Medical Center, CHA University, Seongnam
| | - Kyoo-Rok Han
- Hallym University Kangdong Sacred Heart Hospital, Seoul
| | - Sang-Ho Jo
- Hanllym University Sacred Heart Hospital, Anyang
| | - Nae-Hee Lee
- Soonchunhyang University Bucheon Hospital, Bucheon
| | | | - Taehoon Ahn
- Heart Center, Gachon University Gil Hospital, Incheon, Republic of Korea
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15
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Jo SH, Park SJ, Kim EJ, Kim SJ, Cho HJ, Song JM, Shin J, Park JJ, Shin JH, Han KR, Choi DJ. S-amlodipine plus chlorthalidone vs. S-amlodipine plus telmisartan in hypertensive patients unresponsive to amlodipine monotherapy: study protocol for a randomized controlled trial. Trials 2018; 19:324. [PMID: 29925421 PMCID: PMC6011241 DOI: 10.1186/s13063-018-2636-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/10/2018] [Indexed: 11/20/2022] Open
Abstract
Background The efficacy of a combination of a calcium channel blocker (CCB) plus chlorthalidone (diuretic) versus a CCB plus an angiotensin receptor blocker (ARB) in patients not responding to CCB monotherapy has not been evaluated previously. We plan to compare the efficacy and safety of S-amlodipine (CCB) plus chlorthalidone versus S-amlodipine plus telmisartan (ARB) combinations among hypertension patients unresponsive to amlodipine monotherapy. Methods/design This study is a prospective, randomized, double-blind, multicenter, parallel, non-inferiority phase 4 study. Hypertension patients who have been treated with amlodipine (5 mg) or S-amlodipine (2.5 mg) monotherapy for ≥2 weeks and whose mean diastolic blood pressure (DBP) is greater than 90 mmHg will be randomized to either S-amlodipine (2.5 mg) plus chlorthalidone (25 mg) or S-amlodipine (2.5 mg) plus telmisartan (40 mg) therapy. The primary efficacy endpoint is mean sitting DBP change after 12 weeks of treatment. The study objective is to prove the non-inferiority of the former combination (test drug) as compared to the latter one (control) with a non-inferiority margin of 3 mmHg in mean DBP change. The secondary endpoints are 6-week DBP change, 6- and 12-week sitting systolic BP (SBP) change, and the attainment of the target BP (SBP < 140 mmHg or DBP < 90 mmHg). Urine albumin, albumin/creatinine ratio (ACR), pulse wave velocity, central BP, 24-h ambulatory BP monitoring, and body fluid composition analysis will be performed at each hospital’s discretion. The sample size was estimated as 170 in total with 1:1 randomization. Discussion This is the first study comparing the efficacy of a CCB plus chlorthalidone versus a CCB plus an ARB in patients who are not responding to CCB single therapy. The study result will help clinicians to choose between chlorthalidone and telmisartan in CCB-unresponsive patients. Trial registration ClinicalTrials.gov, NCT03226340. Registered on 2 December 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2636-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sang-Ho Jo
- Division of Cardiology, Hallym University Sacred Heart Hospital/Hallym University College of Medicine, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea
| | - Sung-Ji Park
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center/Sungkyunkwan University School of Medicine, #50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Soo-Joong Kim
- Division of Cardiology, KyungHee University Hospital, Seoul, South Korea
| | - Hyun-Jae Cho
- Division of Cardiology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, University of Ulsan College of Medicine/Asan Medical Center, Seoul, South Korea
| | - Jinho Shin
- Division of Cardiology, Hanyang University Hospital, Seoul, South Korea
| | - Jin Joo Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University School of Medicine, Suwon, South Korea
| | - Kyoo-Rok Han
- Department of Internal Medicine, Kangdong Sacred Heart Hospital/Hallym University Medical Center, Seoul, South Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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Park KW, Rhee TM, Kang HJ, Koo BK, Gwon HC, Yoon JH, Lim DS, Chae IH, Han KR, Ahn T, Jeong MH, Jeon DW, Jang YS, Kim HS. Randomized Prospective Comparison of Everolimus-Eluting vs. Sirolimus-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention ― 3-Year Clinical Outcomes of the EXCELLENT Randomized Trial ―. Circ J 2018; 82:1566-1574. [DOI: 10.1253/circj.cj-17-0677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Tae-Min Rhee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | | | | | | | - In-Ho Chae
- Seoul National University Bundang Hospital
| | | | | | | | | | | | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
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17
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Rhee TM, Park KW, Lee JM, Lee MS, Jeon KH, Kang HJ, Koo BK, Rhew JY, Cha KS, Bae JH, Han KR, Park SH, Park WJ, Rha SW, Oh SK, Kwon HM, Seung KB, Ahn T, Kim SH, Kim HS. Predictors and Long-Term Clinical Outcome of Longitudinal Stent Deformation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005518. [DOI: 10.1161/circinterventions.117.005518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Tae-Min Rhee
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Kyung Woo Park
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Joo Myung Lee
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Michael S. Lee
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Ki-Hyun Jeon
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Hyun-Jae Kang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Bon-Kwon Koo
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Jay Young Rhew
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Kwang Soo Cha
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Jang-Ho Bae
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Kyoo-Rok Han
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Si-Hoon Park
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Woo-Jung Park
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Seung-Woon Rha
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Seok-Kyu Oh
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Hyuck Moon Kwon
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Ki-Bae Seung
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Taehoon Ahn
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Sang-Hyun Kim
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Hyo-Soo Kim
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
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18
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Seo WW, Kim SE, Park MS, Lee JH, Park DG, Han KR, Oh DJ. Systematic Review of Treatment for Trapped Thrombus in Patent Foramen Ovale. Korean Circ J 2017; 47:776-785. [PMID: 28955396 PMCID: PMC5614954 DOI: 10.4070/kcj.2016.0295] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/22/2016] [Accepted: 01/12/2017] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives Trapped thrombus in patent foramen ovale (PFO) is a rare complication of pulmonary embolism that may lead to tragic clinical events. The aim of this study was to identify the optimal treatment for different clinical situations in patients with trapped thrombus in a PFO by conducting a literature review. Subjects and Methods A PubMed database search was conducted from 1991 through 2015, and 194 patients (185 articles) with trapped thrombus in a PFO were identified. Patient characteristics, paradoxical embolic events, and factors affecting 60-day mortality were analyzed retrospectively. Results Among all patients, 112 (57.7%) were treated with surgery, 28 with thrombolysis, and 54 with anticoagulation alone. Dyspnea (79.4%), chest pain (33.0%), and syncope (17.5%) were the most common presenting symptoms. Pretreatment embolism was found in 37.6% of cases, and stroke (24.7%) was the most common event. Surgery was associated with fewer post-treatment embolic events than were other treatment options (p=0.044). In the multivariate analysis, initial shock or arrest, and thrombolysis were independent predictors of 60-day mortality. Thrombolysis was related with higher 60-day mortality compared with surgery in patients who had no initial shock or arrest. Conclusion This systematic review showed that surgery was associated with a lower overall incidence of post-treatment embolic events and a lower 60-day mortality in patients with trapped thrombus in a PFO. In patients without initial shock or arrest, thrombolysis was related with a higher 60-day mortality compared with surgery.
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Affiliation(s)
- Won-Woo Seo
- Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung Eun Kim
- Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Myung-Soo Park
- Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun-Hee Lee
- Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong-Jin Oh
- Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Gwon HC, Jeon DW, Kang HJ, Jang JS, Park DW, Shin DH, Moon KW, Kim JS, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Han KR, Kim HS. The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:320-327. [PMID: 28567082 PMCID: PMC5449526 DOI: 10.4070/kcj.2017.0070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Appropriate use criteria (AUC) was developed to improve the quality of percutaneous coronary intervention (PCI). However, these criteria should consider the current practice pattern in the country where they are being applied. Materials and Methods The algorithm for the Korean PCI practice pattern (KP3) was developed by modifying the United States-derived AUC in expert consensus meetings. KP3 class A was defined as any strategy with evidence from randomized trials that was more conservative for PCI than medical therapy or coronary artery bypass graft (CABG). Class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or CABG. Class B was defined as a strategy that was partly class A and partly class C. We applied the KP3 classification system to the Korean PCI registry. Results The KP3 class A was noted in 67.7% of patients, class B in 28.8%, and class C in 3.5%. The median proportion of class C cases per center was 2.0%. The distribution of KP3 classes varied significantly depending on clinical and angiographic characteristics. The proportion of KP3 class C cases per center was not significantly dependent on PCI volume, but rather on the percentage of ACS cases in each center. Conclusion We report the current PCI practice pattern by applying the new KP3 classification in a nationwide PCI registry. The results should be interpreted carefully with due regard for the complex relationships between the determining variables and the healthcare system in Korea.
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Affiliation(s)
- Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Woon Jeon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Sik Jang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keon-Woong Moon
- Division of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Juhan Kim
- Division of Cardiology, Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Ok Kim
- Division of Cardiology, Sanggye-Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo-Rok Han
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Jang JS, Han KR, Moon KW, Jeon DW, Shin DH, Kim JS, Park DW, Kang HJ, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Gwon HC, Kim HS. The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:328-340. [PMID: 28567083 PMCID: PMC5449527 DOI: 10.4070/kcj.2017.0071] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country. MATERIALS AND METHODS Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data. RESULTS A total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively. CONCLUSION These data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research.
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Affiliation(s)
- Jae-Sik Jang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Kyoo-Rok Han
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Keon-Woong Moon
- Division of Cardiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Dong Woon Jeon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Juhan Kim
- Division of Cardiology, Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Ok Kim
- Division of Cardiology, Sanggye-Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Gwon HC, Jeon DW, Kang HJ, Jang JS, Park DW, Shin DH, Moon KW, Kim JS, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Han KR, Kim HS. Erratum: The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:541. [PMID: 28765752 PMCID: PMC5537162 DOI: 10.4070/kcj.2016.0446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Woon Jeon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Sik Jang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keon-Woong Moon
- Division of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Juhan Kim
- Division of Cardiology, Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Ok Kim
- Division of Cardiology, Sanggye-Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo-Rok Han
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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22
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Joo HJ, Cho SA, Hong SJ, Hur SH, Bae JH, Choi DJ, Ahn YK, Park JS, Choi RK, Choi D, Kim JH, Han KR, Park HS, Choi SY, Yoon JH, Kwon HC, Rha SW, Hwang KK, Jung KT, Oh SK, Lee JH, Shin ES, Kim KS, Kim HS, Lim DS. Impact of low high-density lipoprotein-cholesterol level on 2-year clinical outcomes after acute myocardial infarction in patients with diabetes mellitus. Lipids Health Dis 2016; 15:197. [PMID: 27863493 PMCID: PMC5116186 DOI: 10.1186/s12944-016-0374-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/11/2016] [Indexed: 11/25/2022] Open
Abstract
Background It is still unclear whether low high-density lipoprotein cholesterol (HDL-C) affects cardiovascular outcomes after acute myocardial infarction (AMI), especially in patients with diabetes mellitus. Methods A total of 984 AMI patients with diabetes mellitus from the DIabetic Acute Myocardial InfarctiON Disease (DIAMOND) Korean multicenter registry were divided into two groups based on HDL-C level on admission: normal HDL-C group (HDL-C ≥ 40 mg/dL, n = 519) and low HDL-C group (HDL-C < 40 mg/dL, n = 465). The primary endpoint was 2-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), and target vessel revascularization (TVR). Results The median follow-up duration was 730 days. The 2-year MACE rates were significantly higher in the low HDL-C group than in the normal HDL-C group (MACE, 7.44% vs. 3.49%, p = 0.006; cardiac death, 3.72% vs. 0.97%, p = 0.004; non-fatal MI, 1.75% vs. 1.55%, p = 0.806; TVR, 3.50% vs. 0.97%, p = 0.007). Kaplan-Meier analysis revealed that the low HDL-C group had a significantly higher incidence of MACE compared to the normal HDL-C group (log-rank p = 0.013). After adjusting for conventional risk factors, Cox proportional hazards analysis suggested that low HDL-C was an independent risk predictor for MACE (hazard ratio [HR] 3.075, 95% confidence interval [CI] 1.034-9.144, p = 0.043). Conclusions In patients with diabetes mellitus, low HDL-C remained an independent risk predictor for MACE after adjusting for multiple risk factors during 2-year follow-up of AMI. Trial registration This study was the sub-analysis of the prospective multi-center registry of DIAMOND (Diabetic acute myocardial infarction Disease) in Korea. This is the observational study supported by Bayer HealthCare, Korea. Study number is 15614. First patient first visit was 02 April 2010 and last patient last visit was 09 December 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12944-016-0374-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hyung Joon Joo
- Division of Cardiology, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Sang-A Cho
- Division of Cardiology, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Soon Jun Hong
- Division of Cardiology, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jang-Ho Bae
- Division of Cardiology, Konyang University Hospital, Daejeon, South Korea
| | - Dong-Ju Choi
- Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Keun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jong-Seon Park
- Division of Cardiology, Yeungnam University Hospital, Daegu, South Korea
| | - Rak-Kyeong Choi
- Division of Cardiology, Sejong General Hospital, Bucheon, South Korea
| | - Donghoon Choi
- Division of Cardiology, Yonsei University Severance Hospital, Seoul, South Korea
| | - Joon-Hong Kim
- Division of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Hun-Sik Park
- Division of Cardiology, Kyungpook National University Hospital, Daegu, South Korea
| | - So-Yeon Choi
- Division of Cardiology, Ajou University Hospital, Suwon, South Korea
| | - Jung-Han Yoon
- Division of Cardiology, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Hyeon-Cheol Kwon
- Division of Cardiology, Samsung Medical Center, Seoul, South Korea
| | - Seung-Woon Rha
- Division of Cardiology, Korea University Guro Hospital, Seoul, South Korea
| | - Kyung-Kuk Hwang
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Kyung-Tae Jung
- Division of Cardiology, Eulji University Hospital, Daejeon, South Korea
| | - Seok-Kyu Oh
- Division of Cardiology, Wonkwang University Hospital, Iksan, South Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Chungnam National University Hospital, Daejeon, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, Ulsan, South Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Seoul National University Hospital, 101, DaeHak-ro, JongRo-gu, Seoul, 110-744, Republic of Korea.
| | - Do-Sun Lim
- Division of Cardiology, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea.
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23
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Kim KJ, Kim SH, Yoon YW, Rha SW, Hong SJ, Kwak CH, Kim W, Nam CW, Rhee MY, Park TH, Hong TJ, Park S, Ahn Y, Lee N, Jeon HK, Jeon DW, Han KR, Moon KW, Chae IH, Kim HS. Effect of fixed-dose combinations of ezetimibe plus rosuvastatin in patients with primary hypercholesterolemia: MRS-ROZE (Multicenter Randomized Study of ROsuvastatin and eZEtimibe). Cardiovasc Ther 2016; 34:371-82. [PMID: 27506635 PMCID: PMC5108468 DOI: 10.1111/1755-5922.12213] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM We aimed to compare the effects of fixed-dose combinations of ezetimibe plus rosuvastatin to rosuvastatin alone in patients with primary hypercholesterolemia, including a subgroup analysis of patients with diabetes mellitus (DM) or metabolic syndrome (MetS). METHOD This multicenter eight-week randomized double-blind phase III study evaluated the safety and efficacy of fixed-dose combinations of ezetimibe 10 mg plus rosuvastatin, compared with rosuvastatin alone in patients with primary hypercholesterolemia. Four hundred and seven patients with primary hypercholesterolemia who required lipid-lowering treatment according to the ATP III guideline were randomized to one of the following six treatments for 8 weeks: fixed-dose combinations with ezetimibe 10 mg daily plus rosuvastatin (5, 10, or 20 mg daily) or rosuvastatin alone (5, 10, or 20 mg daily). RESULTS Fixed-dose combination of ezetimibe plus rosuvastatin significantly reduced LDL cholesterol, total cholesterol, and triglyceride levels compared with rosuvastatin alone. Depending on the rosuvastatin dose, these fixed-dose combinations of ezetimibe plus rosuvastatin provided LDL cholesterol, total cholesterol, and triglyceride reductions of 56%-63%, 37%-43%, and 19%-24%, respectively. Moreover, the effect of combination treatment on cholesterol levels was more pronounced in patients with DM or MetS than in non-DM or non-MetS patients, respectively, whereas the effect of rosuvastatin alone did not differ between DM vs non-DM or MetS vs non-MetS patients. CONCLUSION Fixed-dose combinations of ezetimibe and rosuvastatin provided significantly superior efficacy to rosuvastatin alone in lowering LDL cholesterol, total cholesterol, and triglyceride levels. Moreover, the reduction rate was greater in patients with DM or MetS.
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Affiliation(s)
- Kyung-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Won Yoon
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Department of Internal Medicine, Medical College, Korea University, Seoul, Korea
| | - Soon-Jun Hong
- Division of Cardiology, Department of Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Choong-Hwan Kwak
- Division of Cardiology, Department of Cardiovascular Center, Gyeongsang National University Hospital, Jinju, Korea
| | - Weon Kim
- Cardiovascular Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University, Gyeongju, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Tae-Ho Park
- Department of Internal Medicine, Cardiology Division, Dong-A University Hospital, Busan, Korea
| | | | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Namho Lee
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hui-Kyung Jeon
- Department of Cardiovascular, Uijeongbu, Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong-Woon Jeon
- Division of Cardiology, Department of Internal Medicine, NHIC Ilsan Hospital, Goyang, Korea
| | - Kyoo-Rok Han
- Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Keon-Woong Moon
- Cardiology Division, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Lim WH, Chae IH, Yoon CH, Choi DJ, Lim SW, Park WJ, Doh JH, Kim SH, Kim MA, Lee SH, Yoon JH, Ahn YK, Hyon MS, Kim KS, Kim YK, Lee HC, Seol SH, Hwang KK, Choi SW, Han KR, Shin ES, Kim SW, Lee BK, Kim HS. Comparison of dual antiplatelet therapy prescribed as one-pill versus two-pill regimen. A pooled analysis of individual patient data from the three MR-CAPCIS trials. Thromb Haemost 2016; 116:78-86. [PMID: 27029284 DOI: 10.1160/th15-12-0931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/15/2016] [Indexed: 12/10/2022]
Abstract
Fixed-dose combination (FDC) drugs can simplify the medication regimen and potentially improve adherence. However, evidence is lacking about the efficacy and safety of FDC drugs of clopidogrel plus aspirin. Individual data from the three independent MR-CAPCIS trials were pooled and analysed. In those trials, subjects who had been treated with either dual antiplatelet therapy (DAPT) or aspirin alone after drug-eluting stent (DES) implantation were randomly assigned to one-pill or to two-pill DAPT group. Platelet reactivity was measured with VerifyNow-P2Y12 and aspirin point-of-care assays at baseline and eight weeks after treatment. In the present study, primary efficacy endpoint was changes in platelet reactivity unit (PRU) between baseline and eight weeks. A total of 965 subjects were analysed. In prior clopidogrel and aspirin users, PRU was well maintained regardless of switching to either one-pill or two-pill DAPT (ΔPRU=0.4 vs 0.0, p=0.939). In prior aspirin users, PRU was decreased by 73.7 in one-pill DAPT and 77.5 in two-pill DAPT group, with no differences between them (p=0.499). The incidence of high on-treatment platelet reactivity at eight weeks, defined as PRU≥235 in Western people, was 34.8 % in one-pill DAPT group and 37.6 % in two-pill DAPT group (p=0.380), and that defined as PRU ≥275 in Oriental people was 17.7 vs 21.7 % (p=0.129). Independent predictors of high platelet reactivity on clopidogrel were female gender, increasing age, and diabetes. Study drugs were well tolerated. In conclusion, FDC one-pill DAPT showed similar efficacy to two-pill DAPT in terms of platelet reactivity in patients receiving DES in Korea.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hyo-Soo Kim
- Hyo-Soo Kim, MD, PhD, Professor, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Korea, Tel.: +82 2 2072 2226, Fax: +82 2 766 8904, E-mail : ,
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25
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Hur SH, Won KB, Kim IC, Bae JH, Choi DJ, Ahn YK, Park JS, Kim HS, Choi RK, Choi D, Kim JH, Han KR, Park HS, Choi SY, Yoon JH, Gwon HC, Rha SW, Jang W, Bae JW, Hwang KK, Lim DS, Jung KT, Oh SK, Lee JH, Shin ES, Kim KS. Comparison of 2-year clinical outcomes between diabetic versus nondiabetic patients with acute myocardial infarction after 1-month stabilization: Analysis of the prospective registry of DIAMOND (DIabetic acute myocardial infarctiON Disease) in Korea: an observational registry study. Medicine (Baltimore) 2016; 95:e3882. [PMID: 27336875 PMCID: PMC4998313 DOI: 10.1097/md.0000000000003882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study assessed the 2-year clinical outcomes of patients with diabetes mellitus (DM) after acute myocardial infarction (AMI) in a cohort of the DIAMOND (DIabetic Acute Myocardial infarctiON Disease) registry. Clinical outcomes were compared between 1088 diabetic AMI patients in the DIAMOND registry after stabilization of MI and 1088 nondiabetic AMI patients from the KORMI (Korean AMI) registry after 1 : 1 propensity score matching using traditional cardiovascular risk factors. Stabilized patients were defined as patients who did not have any clinical events within 1 month after AMI. Primary outcomes were the 2-year rate of major adverse cardiac events (MACEs), a composite of all-cause death, recurrent MI (re-MI), and target vessel revascularization (TVR). Matched comparisons revealed that diabetic patients exhibited significantly lower left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate and smaller stent size. Diabetic patients exhibited significantly higher 2-year rates of MACE (8.0% vs 3.7%), all-cause death (3.9% vs 1.4%), re-MI (2.8% vs 1.2%), and TVR (3.5% vs 1.3%) than nondiabetic patients (all P < 0.01), and higher cumulative rates in Kaplan-Meier analyses of MACE, all-cause death, and TVR (all P < 0.05). A multivariate Cox regression analysis revealed that chronic kidney disease, LVEF < 35%, and long stent were independent predictors of MACE, and large stent diameter and the use of drug-eluting stents were protective factors against MACE. The 2-year MACE rate beyond 1 month after AMI was significantly higher in DM patients than non-DM patients, and this rate was associated with higher comorbidities, coronary lesions, and procedural characteristics in DM.
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Affiliation(s)
- Seung-Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Ki-Bum Won
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - In-Cheol Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Jang-Ho Bae
- Department of Internal Medicine, Konyang University Hospital, Daejeon
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Young-Keun Ahn
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju
| | - Jong-Seon Park
- Department of Internal Medicine, Yeungnam University Hospital, Daegu
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - Rak-Kyeong Choi
- Department of Internal Medicine, Sejong General Hospital, Bucheon
| | - Donghoon Choi
- Department of Internal Medicine, Yonsei University Severance Hospital, Seoul
| | - Joon-Hong Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan
| | - Kyoo-Rok Han
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul
| | - Hun-Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu
| | - So-Yeon Choi
- Department of Internal Medicine, Ajou University Hospital, Suwon
| | - Jung-Han Yoon
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju
| | | | - Seung-Woon Rha
- Department of Internal Medicine, Korea University Guro Hospital, Seoul
| | | | | | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National UniversityHospital, Cheongju
| | - Do-Sun Lim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul
| | - Kyung-Tae Jung
- Department of Internal Medicine, Eulji University Hospital, Daejeon
| | - Seok-Kyu Oh
- Department of Internal Medicine, Wonkwang University Hospital, Iksan
| | - Jae-Hwan Lee
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon
| | - Eun-Seok Shin
- Department of Internal Medicine, Ulsan University Hospital, Ulsan
| | - Kee-Sik Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
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26
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Lee HC, Lee SR, Han KR, Yu CW, Park CG, Ahn YK, Jin HY, Kim DW, Cho DK, Choi S, Kim SH, Chang KY, Lee S, Pyun W, Lee NH, Kang W, Hong BK, Cho BR, Chae IH, Shin JH, Chun K, Kim DI, Lee JW, Kim YJ, Choi D. Efficacy and Safety of DP-R202 in Patients with Chronic Artery Occlusive Disease: Multicenter Randomized Double-blind Active-controlled Parallel Group Phase III Clinical Study. Clin Ther 2016; 38:557-73. [PMID: 26856926 DOI: 10.1016/j.clinthera.2016.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 01/08/2016] [Accepted: 01/09/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Sarpogrelate hydrochloride, a selective 5-hydroxytryptamine 2A antagonist, is a widely used antiplatelet agent for the treatment of peripheral arterial disease (PAD). DP-R202 is a new sarpogrelate hydrochloride product with an improved dosage regimen compared with the agent in current use. The aim of this study was to compare the efficacy and safety profile of DP-R202 and Anplag(⁎) Tab in patients with PAD. METHODS This study was a 12-week, multicenter, randomized, double-blinded, active-controlled, parallel group comparative Phase III clinical trial. One hundred fifty-one volunteer patients with PAD were randomized to receive DP-R202 300 mg once daily or Anplag Table 100 mg TID for 12 weeks. The primary end point was a change in patient assessment of lower leg pain intensity with the use of a visual analog scale (VAS) after 12 weeks of treatment. Results after 4, 8, and 12 weeks of treatment were compared with baseline and between treatment groups, and all patients were assessed for adverse events (AEs), clinical laboratory data, and vital signs. FINDINGS Two hundred thirty-one patients from 25 medical centers were assessed, and 151 were enrolled and randomly assigned to 1 of 2 treatment groups. Seventy-five patients received DP-R202 300 mg once daily and 76 patients received Anplag Table 100 mg TID for 12 weeks. Analysis of the change in lower leg pain intensity as determined by VAS score between baseline and week 12 (mean [SD], 20.72 [20.06] mm vs 15.55 [21.44] mm) suggested that DP-R202 was not inferior to Anplag Tab, and no significant differences were found in the secondary end points. No significant between-group differences were observed in the prevalence of drug-related clinical- or laboratory-determined AEs. For tolerability, no specific issue was found during the treatment period. IMPLICATION The results of this study suggest that DP-R202 was not inferior to Anplag Tab for efficacy in patients with PAD and indicated a good safety profile.
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Affiliation(s)
- Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Medical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
| | - Sang-Rok Lee
- Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Kyoo-Rok Han
- Hallym University, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Cheol-Woong Yu
- Cardiovascular Center (Interventional Cardiology), Anam Hospital, Seoul, Republic of Korea
| | - Chang-Gyu Park
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Young-Keun Ahn
- Chonnam National University Hospital, GwangJu, Republic of Korea
| | - Han-Young Jin
- Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Dong-Woon Kim
- Chungbuk National University, Cheongju, Republic of Korea
| | - Deok-Kyu Cho
- Myongji Hospital Cardiovascular Center, Goyang, Republic of Korea
| | - SeungHyuk Choi
- Sungkyunkwan University Samsung Medical Center, Seoul, Republic of Korea
| | | | - Ki-yuk Chang
- The Catholic University of Korea Seoul St. Mary׳s Hospital, Seoul, Republic of Korea
| | - Seunghwan Lee
- Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Wookbum Pyun
- Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Nam-Ho Lee
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Woongchol Kang
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Bum-Kee Hong
- Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Byung-Ryul Cho
- Kangwon National University Hospital, ChunCheon, Republic of Korea
| | - In-Ho Chae
- Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea
| | - Joon-Han Shin
- Ajou University Medical Center, Suwon, Republic of Korea
| | - Kookjin Chun
- Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Doo-il Kim
- Inje University Haeundae Paik Hospital, Pusan, Republic of Korea
| | - Jae-Won Lee
- Research and Development division, Alvogen Korea Co., Ltd., Seoul, Republic of Korea
| | - Young-Jae Kim
- Research and Development division, Alvogen Korea Co., Ltd., Seoul, Republic of Korea
| | - Donghoon Choi
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea.
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27
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Youn YJ, Lee JW, Ahn SG, Lee SH, Yoon J, Cho BR, Cheong SS, Kim HY, Lee JH, Bae JH, Lee JB, Suh J, Park KS, Han KR, Jeong MH, Rha SW, Her SH, Cho YH, Kim SW. Current Practice of Transradial Coronary Angiography and Intervention: Results from the Korean Transradial Intervention Prospective Registry. Korean Circ J 2015; 45:457-68. [PMID: 26617647 PMCID: PMC4661360 DOI: 10.4070/kcj.2015.45.6.457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 03/23/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives Although increasing evidence has indicated that radial access is a beneficial technique, few studies have focused on Korean subjects. The aim of this study was to evaluate current practice of coronary angiography (CAG) and percutaneous coronary intervention (PCI) using radial access in South Korea. Subjects and Methods A total of 6338 subjects were analyzed from Korean Transradial Intervention prospective registry that was conducted at 20 centers in Korea. After evaluating the initial access, subjects intended for radial access were assessed for their baseline, procedure-related, and complication data. Subjects were categorized into three groups: group of overall subjects (n=5554); group of subjects who underwent PCI (n=1780); and group of subjects who underwent primary percutaneous coronary intervention (PPCI) (n=167). Results The rate of radial artery as an initial access and the rate of access site crossover was 87.6% and 4.4%, respectively, in overall subjects. Those rates were 82.4% and 8.1%, respectively, in subjects who underwent PCI, and 60.1% and 4.8%, respectively, in subjects who underwent PPCI. For subjects who underwent CAG, a 6-F introducer sheath and a 5-F angiographic catheter was the most commonly used. During PCI, a 6-F introducer sheath (90.6%) and a 6-F guiding catheter were standardly used. Conclusion The large prospective registry allowed us to present the current practice of CAG and PCI using radial access. These data provides evidence to achieve consensus on radial access in CAG and PCI in the Korean population.
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Affiliation(s)
| | - Jun-Won Lee
- Wonju Severance Christian Hospital, Wonju, Korea
| | | | | | - Junghan Yoon
- Wonju Severance Christian Hospital, Wonju, Korea
| | | | | | - Hee-Yeol Kim
- Catholic University Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Jae-Hwan Lee
- Chungnam National University Hospital, Daejeon, Korea
| | | | - Jin-Bae Lee
- Daegu Catholic University Medical Center, Daegu, Korea
| | - Jon Suh
- Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | | | - Kyoo-Rok Han
- Hallym University Kandgong Sacred Heart Hospital, Seoul, Korea
| | | | | | - Sung-Ho Her
- Catholic University Daejeon St. Mary's Hospital, Daejeon, Korea
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Lee HY, Kim YJ, Ahn T, Youn HJ, Chull Chae S, Seog Seo H, Kim KS, Rhee MY, Choi DJ, Kim JJ, Chun KJ, Yoo BS, Park JS, Oh SK, Kim DS, Kwan J, Ahn Y, Bae Park J, Jeong JO, Hyon MS, Cho EJ, Han KR, Kim DI, Joo SJ, Shin JH, Sung KC, Jeon ES. A Randomized, Multicenter, Double-blind, Placebo-controlled, 3 × 3 Factorial Design, Phase II Study to Evaluate the Efficacy and Safety of the Combination of Fimasartan/Amlodipine in Patients With Essential Hypertension. Clin Ther 2015; 37:2581-2596.e3. [PMID: 25850881 DOI: 10.1016/j.clinthera.2015.02.019] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/16/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The objective of this study was to evaluate the efficacy and safety of a fimasartan/amlodipine combination in patients with hypertension and to determine the optimal composition for a future single-pill combination formulation. METHODS This Phase II study was conducted by using a randomized, multicenter, double-blind, placebo-controlled, 3 × 3 factorial design. After a 2-week placebo run-in period, eligible hypertensive patients (with a sitting diastolic blood pressure [SiDBP] between 90 and 114 mm Hg) were randomized to treatment. They received single or combined administration of fimasartan at 3 doses (0, 30, and 60 mg) and amlodipine at 3 doses (0, 5, and 10 mg) for 8 weeks. The primary efficacy end point was the change in SiDBP from baseline and at week 8; secondary end points included the change in SiDBP from baseline and at week 4 and the changes in sitting systolic blood pressure from baseline and at weeks 4 and 8. Treatment-emergent adverse events (AEs) were also assessed. FINDINGS 420 Korean patients with mild to moderate hypertension were randomly allocated to the 9 groups. Mean (SD) SiDBP changes in each group after 8 weeks were as follows: placebo, -6.0 (8.5) mm Hg; amlodipine 5 mg, -10.6 (9.2) mm Hg; amlodipine 10 mg, -15.9 (7.2) mm Hg; fimasartan 30 mg, -10.1 (9.1) mm Hg; fimasartan 60 mg, -13.0 (10.0) mm Hg; fimasartan 30 mg/amlodipine 5 mg, -16.2 (8.5) mm Hg; fimasartan 30 mg/amlodipine 10 mg, -19.5 (7.5) mm Hg; fimasartan 60 mg/amlodipine 5 mg, -16.6 (6.9) mm Hg; and fimasartan 60 mg/amlodipine 10 mg, -21.5 (8.3) mm Hg. All treatment groups produced significantly greater reductions in blood pressure compared with the placebo group. In addition, all combination treatment groups had superior reductions in blood pressure compared with the monotherapy groups. In the combination treatment groups, doubling fimasartan dose in the given dose of amlodipine did not show further BP reduction, whereas doubling amlodipine dose showed significantly further BP reduction in the given dose of fimasartan. During the study period, 75 (17.9%) of 419 patients experienced 110 AEs. Ninety-five AEs were mild, 9 were moderate, and 6 were severe in intensity. Eight patients discontinued the study due to AEs. There was no significant difference in incidence of AEs among groups (P = 0.0884). The most common AE was headache (12 patients [2.9%]), followed by dizziness (11 patients [2.6%]) and elevated blood creatine phosphokinase levels (6 patients [1.4%]). IMPLICATIONS Fimasartan combined with amlodipine produced superior blood pressure reductions and low levels of AEs compared with either monotherapy. Therefore, a single-pill combination with fimasartan 60 mg/amlodipine 10 mg will be developed. ClinicalTrials.gov: NCT01518998.
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Affiliation(s)
- Hae-Young Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Taehoon Ahn
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Ho-Joong Youn
- Catholic University of Korea, Seoul St. Mary׳s Hospital, Seoul, Republic of Korea
| | - Shung Chull Chae
- Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hong Seog Seo
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Ki-Sik Kim
- Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Moo-Yong Rhee
- Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Dong-Ju Choi
- Seoul National University Bundang Hospital, Sungnam, Busan, Republic of Korea
| | | | - Kook-Jin Chun
- Pusan University Yangsan Hospital, Busan, Republic of Korea
| | - Byung-Su Yoo
- Wonju Christian Hospital, Wonju, Republic of Korea
| | - Jong-Seon Park
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Seok-Kyu Oh
- Wonkwang University School of Medicine and Hospital, Iksan, Republic of Korea
| | - Dong-Soo Kim
- Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jun Kwan
- Inha University Hospital, Incheon, Republic of Korea
| | - Youngkeun Ahn
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | | | - Jin-Ok Jeong
- Chungnam National University Hospital, Daegu, Republic of Korea
| | - Min-Soo Hyon
- Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Eun-Joo Cho
- Catholic University of Korea, St. Paul׳s Hospital, Seoul, Republic of Korea
| | - Kyoo-Rok Han
- Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Doo-Il Kim
- Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | | | - Jin-Ho Shin
- Hanyang University Hospital, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Kangbuk Samsung Hospital, Seoul, Republic of Korea
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Kim SH, Kim MK, Seo HS, Hyun MS, Han KR, Cho SW, Kim YK, Hoon Park S. Efficacy and safety of morning versus evening dose of controlled-release simvastatin tablets in patients with hyperlipidemia: a randomized, double-blind, multicenter phase III trial. Clin Ther 2013; 35:1350-60.e1. [PMID: 23998970 DOI: 10.1016/j.clinthera.2013.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 03/11/2013] [Revised: 06/17/2013] [Accepted: 06/26/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Flexibility in the recommended dosing time for a statin may improve patient compliance. OBJECTIVE This study was designed to compare the efficacy and tolerability of morning and evening doses of controlled-release simvastatin in Korean adults with dyslipidemia. It was carried out as a requirement to obtain authorization from the Korean regulatory agency to market the product. METHODS In this prospective, randomized, double-blind, multicenter, placebo-controlled Phase III study, we randomly assigned 132 patients with hypercholesterolemia to a morning-dose group or an evening-dose group. Patients in the morning-dose group received 20 mg controlled-release simvastatin in the morning and a placebo in the evening, and those in the evening-dose group received a placebo in the morning and 20 mg controlled-release simvastatin in the evening. RESULTS After 8 weeks of the treatment, the difference in the mean change of LDL-C between the morning-dose and evening-dose groups was -2.78% (95% confidence interval, -7.65 to 2.10). The changes in total cholesterol, triglycerides, HDL-C, apolipoprotein A1, apolipoprotein B, and lipoprotein (a) after treatment did not differ between groups. Also, the achievement rates of the target LDL-C goal suggested by the dyslipidemia treatment guideline of the Korean Society of Lipidology and Atherosclerosis were not different. No serious adverse event was observed in either group. Mild and moderate adverse events were observed similarly in both groups. CONCLUSIONS Although controlled-release simvastatin significantly reduces LDL-C levels with good tolerability in Korean adults with dyslipidemia, the time of administration does not affect its efficacy.
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Affiliation(s)
- Sang-Hyun Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul Metropolitan Boramae Hospital, Seoul, Republic of Korea
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Choi YJ, Park JS, Kim U, Lee SH, Son JW, Shin DG, Kim YJ, Jeong MH, Ahn YK, Cho MC, Bae JW, Kim CJ, Cho JM, Han KR, Lee JH. Changes in smoking behavior and adherence to preventive guidelines among smokers after a heart attack. J Geriatr Cardiol 2013; 10:146-150. [PMID: 23888174 PMCID: PMC3708054 DOI: 10.3969/j.issn.1671-5411.2013.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 03/28/2013] [Accepted: 04/27/2013] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE Risk factor modification is key to preventing subsequent cardiac events after a heart attack. This study was designed to investigate the disparity between preventive guidelines and clinical practice among smoking patients. METHODS The study was carried out in smokers admitted with myocardial infarction (MI). A total of 275 patients who had been regularly followed for over one year after MI were randomly selected and enrolled in this study. We investigated changes in smoking behavior and the adherence rate to ACC/AHA Guidelines for secondary prevention in patients with coronary artery disease at the time of, and one year after, the index event. RESULTS The study population consisted of 275 patients (97.1% males) with a mean age of 57.0 ± 11.2 years. Achievement of target goals at one year was as follows: smoking cessation, 52.3%; blood pressure, 83.9%; HbA1c, 32.7%; lipid profile, 65.5%; and body mass index (BMI), 50.6%. Over one year, 80% of the patients attempted to quit smoking; 27% of them re-started smoking within one month after discharge while 65% succeeded in cessation of smoking. At one year, only 52% of the patients overall had stopped smoking. From the multivariate logistic analysis including smoking patterns and clinical characteristics, the severity of coronary artery disease was the only independent predictor for smoking cessation (Relative risk (RR): 1.230; P = 0.022). CONCLUSIONS Only a small percentage of MI patients adhere to guidelines for secondary prevention and a sizable proportion fail to stop smoking. These findings underscore the need for an effective patient education system.
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Affiliation(s)
- Yoon-Jung Choi
- Divison of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, South Korea
| | - Jong-Seon Park
- Divison of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, South Korea
| | - Ung Kim
- Divison of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, South Korea
| | - Sang-Hee Lee
- Divison of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, South Korea
| | - Jang-Won Son
- Divison of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, South Korea
| | - Dong-Gu Shin
- Divison of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, South Korea
| | - Young-Jo Kim
- Divison of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, South Korea
| | - Myung-Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Kwangju 501-757, South Korea
| | - Young-Keun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Kwangju 501-757, South Korea
| | - Myeong-Chan Cho
- Divison of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 410, Sungbong-ro, Heungdeok-gu, Cheongju, Chungcheongbuk-do 361-711, South Korea
| | - Jang-Whan Bae
- Divison of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 410, Sungbong-ro, Heungdeok-gu, Cheongju, Chungcheongbuk-do 361-711, South Korea
| | - Chong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kyunghee University Hospital, 892, Dongnam-ro, Gandong-gu, Seoul 134-727, South Korea
| | - Jin-Man Cho
- Division of Cardiology, Department of Internal Medicine, Kyunghee University Hospital, 892, Dongnam-ro, Gandong-gu, Seoul 134-727, South Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Department of Internal Medicine, Hanrim University Hospital, 94-195, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul 150-030, South Korea
| | - Jun-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Hanrim University Hospital, 94-195, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul 150-030, South Korea
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Park KW, Lee JM, Kang SH, Ahn HS, Yang HM, Lee HY, Kang HJ, Koo BK, Cho J, Gwon HC, Lee SY, Chae IH, Youn TJ, Chae JK, Han KR, Yu CW, Kim HS. Safety and efficacy of second-generation everolimus-eluting Xience V stents versus zotarolimus-eluting resolute stents in real-world practice: patient-related and stent-related outcomes from the multicenter prospective EXCELLENT and RESOLUTE-Korea registries. J Am Coll Cardiol 2012; 61:536-44. [PMID: 23273394 DOI: 10.1016/j.jacc.2012.11.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [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: 06/25/2012] [Revised: 10/21/2012] [Accepted: 11/07/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to compare the safety and efficacy of the Xience V/Promus everolimus-eluting stent (EES) (Abbott Vascular, Temecula, California) with the Endeavor Resolute zotarolimus-eluting stent (ZES-R) (Medtronic Cardiovascular, Santa Rosa, California) in "all-comer" cohorts. BACKGROUND Only 2 randomized controlled trials have compared these stents. METHODS The EXCELLENT (Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting) and RESOLUTE-Korea registries prospectively enrolled 3,056 patients treated with the EES and 1,998 patients treated with the ZES-R, respectively, without exclusions. Stent-related composite outcomes (target lesion failure [TLF]) and patient-related composite outcomes were compared in crude and propensity score-matched analyses. RESULTS Of 5,054 patients, 3,830 (75.8%) had off-label indication (2,217 treated with EES and 1,613 treated with ZES-R). The stent-related outcome (82 [2.7%] vs. 58 [2.9%], p = 0.662) and the patient-related outcome (225 [7.4%] vs. 153 [7.7%], p = 0.702) did not differ between EES and ZES-R, respectively, at 1 year, which was corroborated by similar results from the propensity score-matched cohort. The rate of definite or probable stent thrombosis (18 [0.6%] vs. 7 [0.4%], p = 0.306) also was similar. In multivariate analysis, off-label indication was the strongest predictor of TLF (adjusted hazard ratio: 2.882; 95% confidence interval: 1.226 to 6.779; p = 0.015). CONCLUSIONS In this robust real-world registry with unrestricted use of EES and ZES-R, both stents showed comparable safety and efficacy at 1-year follow-up. Overall incidences of TLF and definite stent thrombosis were low, even in the patients with off-label indication, suggesting excellent safety and efficacy of both types of second-generation drug-eluting stents.
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Affiliation(s)
- Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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Park DG, Kim SE, Lee JH, Han KR, Oh DJ. Echocardiographic serial changes of hypertensive cardiomyopathy with severely reduced ejection fraction: comparison with idiopathic dilated cardiomyopathy. Clin Cardiol 2012; 35:554-8. [PMID: 22707118 DOI: 10.1002/clc.22012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 04/18/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hypertensive cardiomyopathy with reduced ejection fraction (HTCMREF) is known as an important cause of reversible cardiomyopathy, but its serial changes on echocardiography is yet to be elucidated. HYPOTHESIS HTCMREF on serial echocardiography has distinctive points as compared to idiopathic dilated cardiomyopathy (idDCM). METHODS We retrospectively studied 18 hypertensive patients (mean age, 63 ± 13 years, 56% women) admitted with severe left ventricular (LV) systolic dysfunction and heart failure. We compared clinical characteristics and echocardiographic parameters at admission and follow-up between the patients with HTCMREF and 18 age-matched patients with idDCM. Left ventricular mass (LVM) and left atrial volume (LAV) were calculated by a formula using echocardiographic measurement. RESULTS In HTCMREF, left ventricular ejection fraction improved to 52.3 ± 8.8% during a mean follow-up of 574 days. In HTCMREF, initial left atrial diameter was greater than in idDCM (43.6 ± 5.8 mm vs 38.9 ± 6.3, p = 0.027). At follow-up, LAV index decreased in HTCMREF (from 31.9 ± 8.3 mL/m(2) to 21.0 ± 8.9, P < 0.001), as opposed to a significant increase in idDCM (from 28.5 ± 10.9 mL/m(2) to 31.9 ± 8.3, P < 0.001). There was no significant difference in initial LVM index between the 2 groups, but only in HTCMREF did LVM index decrease significantly (151.4 ± 42.1 g/m(2) from 192.2 ± 43.7, P < 0.01) at follow-up. In HTCMREF, LV wall on M-mode was thicker than in idDCM. CONCLUSIONS Hypertensive cardiomyopathy with severe LV systolic dysfunction might be characterized by eccentric left ventricular hypertrophy and enlarged left atrium in comparison with idDCM.
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Affiliation(s)
- Dae-Gyun Park
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, South Korea.
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Kang SH, Suh JW, Yoon CH, Cho MC, Kim YJ, Chae SC, Yoon JH, Gwon HC, Han KR, Kim JH, Ahn YK, Jeong MH, Kim HS, Choi DJ. Sex differences in management and mortality of patients with ST-elevation myocardial infarction (from the Korean Acute Myocardial Infarction National Registry). Am J Cardiol 2012; 109:787-93. [PMID: 22196789 DOI: 10.1016/j.amjcard.2011.11.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/07/2011] [Accepted: 11/07/2011] [Indexed: 12/22/2022]
Abstract
There has been controversy over the disparity between men and women with regard to the management and prognosis of acute myocardial infarction. Analyzing nationwide multicenter prospective registries in Korea, the aim of this study was to determine whether female gender independently imposes a risk for mortality. Data from 14,253 patients who were hospitalized for ST-segment elevation myocardial infarction from November 2005 to September 2010 were extracted from registries. Compared to men, women were older (mean age 56 ± 12 vs 67 ± 10 years, p < 0.001), and female gender was associated with a higher frequency of co-morbidities, including hypertension, diabetes, and dyslipidemia. Women had longer pain-to-door time and more severe hemodynamic status than men. All-cause mortality rates were 13.6% in women and 7.0% in men at 1 year after the index admission (hazard ratio for women 2.01, 95% confidence interval 1.80 to 2.25, p < 0.001). The risk for death after ST-segment elevation myocardial infarction corresponded highly with age. Although the risk remained high after adjusting for age, further analyses adjusting for medical history, clinical performance, and hemodynamic status diminished the gender effect (hazard ratio 1.00, 95% confidence interval 0.86 to 1.17, p = 0.821). Propensity score matching, as a sensitivity analysis, corroborated the results. In conclusion, this study shows that women have a comparable risk for death after ST-segment elevation myocardial infarction as men. The gender effect was accounted for mostly by the women's older age, complex co-morbidities, and severe hemodynamic conditions at presentation.
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Han KH, Rha SW, Kang HJ, Bae JW, Choi BJ, Choi SY, Gwon HC, Bae JH, Hong BK, Choi DH, Han KR. Evaluation of short-term safety and efficacy of HMG-CoA reductase inhibitors in hypercholesterolemic patients with elevated serum alanine transaminase concentrations: PITCH study (PITavastatin versus atorvastatin to evaluate the effect on patients with hypercholesterolemia and mild to moderate hepatic damage). J Clin Lipidol 2012; 6:340-51. [PMID: 22836071 DOI: 10.1016/j.jacl.2012.01.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/01/2011] [Accepted: 01/30/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND We evaluated the safety and efficacy of the 3-hydroxyl-3-methylglutaryl coenzyme A reductase inhibitors atorvastatin and pitavastatin in patients with mild-to-moderate increased levels of hepatic enzymes. METHODS AND RESULTS In this 12-week, prospective, randomized, open-label, active drug-controlled, and dose-titration study, 189 subjects with elevated low-density lipoprotein cholesterol (≥3.36 mmol/L) and alanine transaminase (ALT; ×1.25≥ and ≤×2.5 ULN; 50-100 IU/L) concentrations, but nonalcoholic and serologically negative for viral hepatitis markers at screening, were randomized to 12 weeks of treatment with pitavastatin 2-4 mg/day (PITA, n = 97) or atorvastatin 10-20 mg/day (ATOR, n = 92). Pitavastatin and atorvastatin equally reduced low-density lipoprotein cholesterol concentrations (-34.6 ± 16.0% and -38.1 ± 16.2%, respectively, P < .0001 each by analysis of variance). Seven (n = 4 PITA, n = 3 ATOR) and 10 (n = 5 PITA, n = 5 ATOR) patients experienced episodes of ALT >100 IU/L at weeks 4 and 12, respectively, with one patient in each group excluded because of severe ALT elevation >3× ULN (>120 IU/L) at week 4. The 135 patients with persistently increased ALT concentrations at screening and randomization showed significant reductions in ALT after 12 weeks of treatment with PITA (n = 68, -8.4%) or ATOR (n = 67, -8.9%; P < .05, analysis of variance). Serial nonenhanced computed tomography in 38 subjects (n = 18 PITA, n = 20 ATOR) showed that both statins reduced the severity of hepatic steatosis, especially in subjects with clear hepatic steatosis at baseline (n = 9 PITA, n = 10 ATOR). Statin treatment of another 38 subjects with spontaneous normalization of ALT at randomization had little effect on ALT levels but did not induce severe ALT elevation (>100 IU/L). CONCLUSIONS Conventional doses of pitavastatin and atorvastatin effectively and safely reduce elevated hepatic enzyme concentrations.
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Affiliation(s)
- Ki Hoon Han
- Asan Medical Center, University of Ulsan, 388-1 Pungnap-2 dong Songpa-gu 138-736, Seoul, Republic of Korea
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Gwon HC, Hahn JY, Park KW, Song YB, Chae IH, Lim DS, Han KR, Choi JH, Choi SH, Kang HJ, Koo BK, Ahn T, Yoon JH, Jeong MH, Hong TJ, Chung WY, Choi YJ, Hur SH, Kwon HM, Jeon DW, Kim BO, Park SH, Lee NH, Jeon HK, Jang Y, Kim HS. Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: the Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting (EXCELLENT) randomized, multicenter study. Circulation 2011; 125:505-13. [PMID: 22179532 DOI: 10.1161/circulationaha.111.059022] [Citation(s) in RCA: 474] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The optimal duration of dual antiplatelet therapy (DAPT) after implantation of drug-eluting coronary stents remains undetermined. We aimed to test whether 6-month DAPT would be noninferior to 12-month DAPT after implantation of drug-eluting stents. METHODS AND RESULTS We randomly assigned 1443 patients undergoing implantation of drug-eluting stents to receive 6- or 12-month DAPT (in a 1:1 ratio). The primary end point was a target vessel failure, defined as the composite of cardiac death, myocardial infarction, or ischemia-driven target vessel revascularization at 12 months. Rates of target vessel failure at 12 months were 4.8% in the 6-month DAPT group and 4.3% in the 12-month DAPT group (the upper limit of 1-sided 95% confidence interval, 2.4%; P=0.001 for noninferiority with a predefined noninferiority margin of 4.0%). Although stent thrombosis tended to occur more frequently in the 6-month DAPT group than in the 12-month group (0.9% versus 0.1%; hazard ratio, 6.02; 95% confidence interval, 0.72-49.96; P=0.10), the risk of death or myocardial infarction did not differ in the 2 groups (2.4% versus 1.9%; hazard ratio, 1.21; 95% confidence interval, 0.60-2.47; P=0.58). In the prespecified subgroup analysis, target vessel failure occurred more frequently in the 6-month DAPT group than in the 12-month group (hazard ratio, 3.16; 95% confidence interval, 1.42-7.03; P=0.005) among diabetic patients. CONCLUSIONS Six-month DAPT did not increase the risk of target vessel failure at 12 months after implantation of drug-eluting stents compared with 12-month DAPT. However, the noninferiority margin was wide, and the study was underpowered for death or myocardial infarction. Our results need to be confirmed in larger trials. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00698607.
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Affiliation(s)
- Hyeon-Cheol Gwon
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 DaeHak-ro, JongRo-gu, Seoul, 110-744, Korea.
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Park KW, Chae IH, Lim DS, Han KR, Yang HM, Lee HY, Kang HJ, Koo BK, Ahn T, Yoon JH, Jeong MH, Hong TJ, Chung WY, Jo SH, Choi YJ, Hur SH, Kwon HM, Jeon DW, Kim BO, Park SH, Lee NH, Jeon HK, Gwon HC, Jang YS, Kim HS. Everolimus-eluting versus sirolimus-eluting stents in patients undergoing percutaneous coronary intervention: the EXCELLENT (Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting) randomized trial. J Am Coll Cardiol 2011; 58:1844-54. [PMID: 22018294 DOI: 10.1016/j.jacc.2011.07.031] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 06/29/2011] [Accepted: 07/05/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVES The goal of this study was to compare the angiographic outcomes of everolimus-eluting stents (EES) and sirolimus-eluting stents (SES) in a head-to-head manner. BACKGROUND EES have been shown to be superior to paclitaxel-eluting stents in inhibiting late loss (LL) and clinical outcome. Whether EES may provide similar angiographic and clinical outcomes compared with SES is undetermined. METHODS This was a prospective, randomized, open-label, multicenter trial to demonstrate the noninferiority of EES compared with SES in preventing LL at 9 months. A total of 1,443 patients undergoing percutaneous coronary intervention were randomized 3:1 to receive EES or SES. Routine follow-up angiography was recommended at 9 months. The primary endpoint was in-segment LL at 9 months, and major secondary endpoints included in-stent LL at 9 months, target lesion failure, cardiac death, nonfatal myocardial infarction, target lesion revascularization, and stent thrombosis at 12 months. Data were managed by an independent management center, and clinical events were adjudicated by an independent adjudication committee. RESULTS Clinical follow-up was available in 1,428 patients and angiographic follow-up in 924 patients (1,215 lesions). The primary endpoint of the study (in-segment LL at 9 months) was 0.11 ± 0.38 mm and 0.06 ± 0.36 mm for EES and SES, respectively (p for noninferiority = 0.0382). The in-stent LL was also noninferior (EES 0.19 ± 0.35 mm; SES 0.15 ± 0.34 mm; p for noninferiority = 0.0121). The incidence of clinical endpoints was not statistically different between the 2 groups, including target lesion failure (3.75% vs. 3.05%; p = 0.53) and stent thrombosis (0.37% vs. 0.83%; p = 0.38). CONCLUSIONS EES were noninferior to SES in inhibition of LL after stenting, which was corroborated by similar rates of clinical outcomes. (Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting [EXCELLENT]; NCT00698607).
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Affiliation(s)
- Kyung Woo Park
- Cardiovascular Center, Seoul National University Main Hospital, Chongno-gu, Seoul, Korea
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Shin DH, Park KW, Koo BK, Oh IY, Seo JB, Gwon HC, Jeong MH, Seong IW, Rha SW, Yang JY, Park SJ, Yoon JH, Han KR, Park JS, Hur SH, Tahk SJ, Kim HS. Comparing two-stent strategies for bifurcation coronary lesions: which vessel should be stented first, the main vessel or the side branch? J Korean Med Sci 2011; 26:1031-40. [PMID: 21860553 PMCID: PMC3154338 DOI: 10.3346/jkms.2011.26.8.1031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 06/21/2011] [Indexed: 12/02/2022] Open
Abstract
This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.
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Affiliation(s)
- Dong-Ho Shin
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jae-Bin Seo
- Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Myung-Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - In-Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Woon Rha
- Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Ju-Young Yang
- Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Seung-Jung Park
- Department of Internal Medicine, University of Ulsan Asan Medical Center, Seoul, Korea
| | - Jung Han Yoon
- Department of Internal Medicine, Wonju Christian Hospital, Wonju, Korea
| | - Kyoo-Rok Han
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jong-Sun Park
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seung-Jea Tahk
- Department of Internal Medicine, Ajou Univeristy Hospital, Suwon, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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Kim SE, Lee JH, Park DG, Han KR, Oh DJ. Acute Myocardial Infarction by Right Coronary Artery Occlusion Presenting as Precordial ST Elevation on Electrocardiography. Korean Circ J 2010; 40:536-8. [PMID: 21088759 PMCID: PMC2978298 DOI: 10.4070/kcj.2010.40.10.536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 03/26/2010] [Indexed: 12/16/2022] Open
Abstract
It is rare to observe ST-segment elevation in only the anterior leads and not the inferior leads during right coronary artery occlusion. We describe a case with acute myocardial infarction (MI) by right coronary artery occlusion who developed ST-segment elevation only in the precordial leads V1 to V3.
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Affiliation(s)
- Sung Eun Kim
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Oh IY, Seo MK, Lee HY, Kim SG, Kim KS, Kim WH, Hyon MS, Han KR, Lim SJ, Kim CH. Beneficial Effect of Efonidipine, an L- and T-Type Dual Calcium Channel Blocker, on Heart Rate and Blood Pressure in Patients With Mild-to-Moderate Essential Hypertension. Korean Circ J 2010; 40:514-9. [PMID: 21088755 PMCID: PMC2978294 DOI: 10.4070/kcj.2010.40.10.514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 04/02/2010] [Accepted: 04/09/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Efonidipine hydrochloride, an L- and T-type dual calcium channel blocker, is suggested to have a heart rate (HR)-slowing action in addition to a blood pressure (BP)-lowering effect. The aim of this study was to determine the effect of efonidipine on HR and BP in patients with mild-to-moderate hypertension. SUBJECTS AND METHODS In a multi-center, prospective, open-labeled, single-armed study, we enrolled 53 patients who had mild-to-moderate hypertension {sitting diastolic BP (SiDBP) 90-110 mmHg}. After a 2-week washout, eligible patients were treated with efonidipine (40 mg once daily for 12 weeks). The primary end point was the change in HR from baseline to week 12. The secondary end-point included the change in trough sitting BP and 24-hour mean BP between baseline and week 12. Laboratory and clinical adverse events were monitored at each study visit (4, 8, and 12 weeks). RESULTS Fifty-two patients were included in the intention-to-treat analysis. After 12 weeks of treatment with efonidipine, the resting HR decreased significantly from baseline to week 12 {from 81.5±5.3 to 71.8±9.9 beats/minute (difference, -9.9±9.0 beats/minute), p<0.0001}. The trough BP {sitting systolic blood pressure (SiSBP) and SiDBP} and 24-hour mean BP also decreased significantly (SiSBP: from 144.6±8.2 to 132.9±13.5 mmHg, p<0.0001; SiDBP: from 96.9±5.4 to 88.3±8.6 mmHg, p<0.0001, 24-hour mean systolic BP: from 140.4±13.5 to 133.8±11.6 mmHg, p<0.0001; 24-hour mean diastolic BP: from 91.7±8.7 to 87.5±9.5 mmHg, p<0.0001). CONCLUSION Efonidipine was effective in controlling both HR and BP in patients with mild-to-moderate hypertension.
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Affiliation(s)
- Il-Young Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea
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Hahn JY, Song YB, Choi JH, Choi SH, Lee SY, Park HS, Hur SH, Lee S, Han KR, Rha SW, Cho BR, Park JS, Yoon J, Lim DS, Lee SH, Gwon HC. Three-month dual antiplatelet therapy after implantation of zotarolimus-eluting stents: the DATE (Duration of Dual Antiplatelet Therapy AfterImplantation of Endeavor Stent) registry. Circ J 2010; 74:2314-21. [PMID: 20938098 DOI: 10.1253/circj.cj-10-0347] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The optimal duration of dual antiplatelet therapy remains controversial. METHODS AND RESULTS Between December 2006 and March 2008, 823 patients were enrolled in a prospective multicenter registry for 3-month dual antiplatelet therapy (aspirin 100-200mg+clopidogrel 75 mg daily) followed by aspirin mono-therapy after zotarolimus-eluting stents (ZES). Major exclusion criteria were: cardiogenic shock, stent thrombosis (ST)-segment elevation myocardial infarction (MI) within 48h, previous drug-eluting stent implantation, severe left ventricular dysfunction, bifurcation lesions requiring 2-stenting, left main and graft lesions. The primary outcome was a composite of cardiac death, MI, or ST at 1 year. The median duration of dual antiplatelet therapy was 95 days (interquartile range 90-101). At 1 year, 3 patients (0.4%) had cardiac deaths, 3 patients (0.4%) had MI, and 4 patients (0.5%) had definite or probable ST, leading to the primary outcome in 5 patients (0.6%). Death, MI, or any revascularization occurred in 68 patients (8.3%). Among patients who were event-free at 3 months (n=812), clopidogrel was discontinued at 3 months in 661 patients and was continued for longer than 3 months in 151 patients. Discontinuation of clopidogrel at 3 months did not increase the primary outcome (HR 0.90; 95%CI, 0.09-9.02), death, MI, or any revascularization (HR 0.89; 95%CI, 0.48-1.67) after adjustment for the propensity score. CONCLUSIONS Three-month dual antiplatelet therapy seems to be feasible after ZES implantation in relatively low-risk patients.
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Affiliation(s)
- Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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41
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Hong JY, Park DG, Yoo JJ, Lee SM, Kim MK, Kim SE, Lee JH, Han KR, Oh DJ. The correlation between left ventricular failure and right ventricular systolic dysfunction occurring in thyrotoxicosis. Korean Circ J 2010; 40:266-71. [PMID: 20589198 PMCID: PMC2893366 DOI: 10.4070/kcj.2010.40.6.266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/17/2009] [Accepted: 09/30/2009] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Heart failure rarely occurs in patients with thyrotoxicosis (6%), with half of the cases having left ventricular dysfunction (LVD). Although a few studies reported isolated right heart failure in thyrotoxicosis, there has been no evaluation of relationship between LVD and right ventricular dysfunction (RVD). SUBJECTS AND METHODS We enrolled 12 patients (mean age: 51+/-11 years, 9 females) diagnosed as having thyrotoxicosis with heart failure and LVD {left ventricular ejection fraction (LVEF) <40%}, and divided them into two groups {Group I with RVD defined as tricuspid annular plane excursion (TAPSE) less than 15 mm and Group II without RVD}. Clinical features, laboratory variables, and echocardiographic parameters were compared between two groups. RESULTS RVD was found in 6 (50%) patients. On admission, there were no significant differences between the two groups in clinical features, laboratory variables, or echocardiographic parameters including atrial fibrillation {6 vs. 5, not significant (NS)}, heart rate (149+/-38 vs. 148+/-32/min, NS), LVEF (36.7+/-9.5 vs. 35.1+/-6.3%, NS), or the tricuspid regurgitation peak pressure gradient (TRPPG, 30.9+/-2.0 vs. 36.3+/-9.3 mmHg, NS). After antithyroid treatment, all achieved an euthyroid state and both ventricular functions were recovered. All data, including the recovery time of LVEF and the change of heart rate between two groups, displayed no significant differences. CONCLUSION In half of patients, RVD was combined with thyrotoxicosis-associated LVD. There were no differences in clinical factors or hemodynamic parameters between patients with and without RVD. This suggests that RVD is not secondary to thyrotoxicosis-associated LVD.
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Affiliation(s)
- Ji Yeon Hong
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
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42
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Shin DH, Chae IH, Youn TJ, Cho SI, Kwon DA, Suh JW, Chang HJ, Cho YS, Chung WY, Choi YJ, Gwon HC, Han KR, Choi DJ. Reasonable duration of Clopidogrel use after drug-eluting stent implantation in Korean patients. Am J Cardiol 2009; 104:1668-73. [PMID: 19962472 DOI: 10.1016/j.amjcard.2009.07.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 04/23/2009] [Revised: 07/10/2009] [Accepted: 07/10/2009] [Indexed: 01/25/2023]
Abstract
Current guidelines recommend that clopidogrel be given to patients for 12 months after drug-eluting stent (DES) implantation. However, the evidence is insufficient to support the benefit of long-term clopidogrel therapy, especially in Asian patients. The aim of this study was to evaluate whether different durations of clopidogrel use might influence long-term outcomes after DES implantation. A total of 844 patients from 4 medical centers in Korea who had undergone successful DES implantation from November 2004 to April 2006 were enrolled. Patients who were event free at 6-month follow-up were divided into 2 groups by clopidogrel use (575 users, 163 nonusers) and followed. The end point was a composite of death, myocardial infarction, and stent thrombosis. During 1,056.4 patient-years of follow-up (median 2.02), there were 7 deaths, 3 myocardial infarctions, and 2 episodes of stent thrombosis. No significant differences in the primary end point were observed between clopidogrel users and nonusers (cumulative incidence 2.9% vs 2.8%, p = 0.578; adjusted hazard ratio 0.67, 95% confidence interval 0.16 to 2.77). In analysis with time-dependent covariates, the incidence rates of the primary end point during observation periods with and without clopidogrel were similar, although the effect estimates were broad (9.9 with and 10.6 without clopidogrel per 1,000 patient-years; adjusted hazard ratio 0.52, 95% confidence interval 0.09 to 3.17). Interestingly, the effect estimates from propensity score analyses, although they also had wide confidence intervals, were closer to the null than those from conventional Cox analyses. In conclusion, this cohort of Korean patients failed to show an absolute benefit of long-term clopidogrel therapy after DES implantation. The benefit of clopidogrel use beyond 6 months after DES implantation remains uncertain, and hence the decision to use long-term dual-antiplatelet therapy should be based on the risk factors of each patient.
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Affiliation(s)
- Dong-Ho Shin
- Department of Epidemiology, Seoul National University, Seoul, Korea
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Park SY, Park DG, Choi HH, Yoon DH, Kim SE, Lee JH, Han KR, Oh DJ. A Case of Suspected Danon Disease Presenting as a Hypertrophic Cardiomyopathy. J Cardiovasc Ultrasound 2009. [DOI: 10.4250/jcu.2009.17.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- So-Yeon Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Hyun-Hee Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Duck-Hyoung Yoon
- Division of Cardiology, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Sung-Eun Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jun-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Dong-Jin Oh
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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44
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Hong KW, Park DG, Choi HH, Kim SE, Yoon DH, Lee JH, Han KR, Oh DJ. Tako-Tsubo Cardiomyopathy by Transient Dynamic Left Midventricular Obstruction. Korean Circ J 2009. [DOI: 10.4070/kcj.2009.39.1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kyung-Wook Hong
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun-Hee Choi
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Eun Kim
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Duck-Hyoung Yoon
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong-Jin Oh
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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45
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Lee SH, Park JS, Kim W, Shin DG, Kim YJ, Kim DS, Choi DJ, Han KR, Kim CJ, Cho MC, Chae SC, Jeong MH. Impact of body mass index and waist-to-hip ratio on clinical outcomes in patients with ST-segment elevation acute myocardial infarction (from the Korean Acute Myocardial Infarction Registry). Am J Cardiol 2008; 102:957-65. [PMID: 18929693 DOI: 10.1016/j.amjcard.2008.06.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 06/02/2008] [Accepted: 06/02/2008] [Indexed: 12/20/2022]
Abstract
The relation between body mass index (BMI) and waist-to-hip ratio (WHR) to clinical outcomes in patients with ST-segment elevation acute myocardial infarction (MI) has not been well described. As part of the Korean Acute MI Registry, we enrolled 3,734 eligible patients who were diagnosed with ST-segment elevation acute MI. The study population was categorized by BMI (into 4 groups according to the World Health Organization classification for the Asian population) and WHR (into 2 sets of 4 groups, 1 set for men and another for women, based on the INTERHEART study). Baseline characteristics and clinical outcomes were analyzed and compared among the BMI and WHR categories. Mean follow-up duration was 199 +/- 37 days. In the BMI category, underweight versus obese patients were older, were more likely to present with heart failure, and underwent guideline-based treatments less frequently. In the WHR category, the reverse trends were apparent for the latter factors except treatment-use frequencies. The highest mortality rate was observed in patients with the lowest BMI and the highest WHR. In an adjusted model, the highest WHR (hazard ratio 5.57, 95% confidence interval 1.53 to 12.29, p = 0.009) and the underweight (hazard ratio 2.88, 95% confidence interval 1.17 to 6.08, p = 0.021) categories within the 2 anthropometric indexes remained as mortality risk factors. In conclusion, the relation between obesity and prognosis after ST-segment elevation acute MI appears complex and should be further assessed in larger population-based cohort studies to determine the associations apparent in this study.
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Abstract
AIMS Local anaesthetics, which act as neurolytics and Na(+) channel blockers, have been used for disrupting the neural firings in certain neuropathic pain conditions. This study was undertaken to investigate the clinical outcome of trigeminal nerve block with 10% lidocaine in the management of trigeminal neuralgia (TN). METHODS Thirty-five patients with primary TN received trigeminal nerve blocks with 10% lidocaine. Success was defined as complete pain relief or mild pain without medication 1 day after the treatment. We followed the patients up every 2 months assessing for pain recurrence, sensory changes and other complications for a total of 37-45 months (median 43 months). RESULTS Twelve of the 35 patients (34.3%) responded favourably to the treatment and were considered as success. Eleven patients experienced complete pain relief and one could tolerate pain without medication 1 day after the blocks, which lasted for 3-172 weeks. Four patients experienced mildly decreased sensation in the region of the face supplied by the nerve 1 day after the blocks; however, all recovered normal skin sensation in 6 months. There was neither allodynia nor other sensory discomfort. The pain intensity and current pain duration before treatment were significantly different between the two groups. CONCLUSION Trigeminal nerve block with high concentration lidocaine (10%) is capable of achieving an intermediate period of pain relief, particularly in patients with lower pain intensity and shorter pain duration prior to the procedure.
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Affiliation(s)
- K R Han
- Pain Clinic, Department of Anesthesia and Pain Medicine, Ajou University Hospital, Suwon, Korea
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47
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Lee JA, Park DG, Kim SE, Heo GM, Lee JH, Han KR, Oh DJ. A Case of Hypertrophic Cardiomyopathy Complicated by Acute Myocardial Infarction and Ventricular Tachycardia: Slow Coronary Artery Flow. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.5.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jeong-A Lee
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Eun Kim
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Gyeong-Mi Heo
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong-Jin Oh
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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48
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Lee SH, Choi SH, Choi S, Jung JH, Lee N, Choi YJ, Park DG, Hong KS, Han KR, Oh DJ, Rhim CY. Impact of chronotropic effect of cilostazol after acute myocardial infarction: insights from change in left ventricular volume and function. Circ J 2006; 71:106-11. [PMID: 17186987 DOI: 10.1253/circj.71.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cilostazol, a phosphodiesterase inhibitor, is an antiplatelet agent with positive chronotropic effect, the impact of which on left ventricular (LV) volume and function in acute myocardial infarction (AMI) was evaluated in the present study. METHODS AND RESULTS In 56 patients with AMI treated with primary coronary stenting, serial echocardiographic studies within 24 h and at 6 months were performed. Patients received a conventional antiplatelet regimen either without cilostazol (group 1, n=29) or with cilostazol (group 2, n=27). At 6 months, the difference in the change in heart rate between group 1 and group 2 was statistically significant (9.9 beats/min; p=0.04). However, changes in LV end-systolic volume (LVESV) (7.1+/-8.2 vs 10.0+/-21.7 ml, p=0.60), LV ejection fraction (EF) (8.2+/-9.9 vs 9.0+/-12.6%, p=0.85) and the ratio of early mitral inflow velocity to the mitral annular velocity (E/E') (0.6+/-3.7 vs -1.7+/-3.2) were not different between the 2 groups. Cardiac event rate was similar between the 2 groups. On multivariate regression analyses, cilostazol therapy had no significant influence on the changes in LVESV, LVEF or E/E'. CONCLUSIONS In this study, the addition of cilostazol on conventional drug therapy had no adverse influence on LV remodeling or LV function after AMI.
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Affiliation(s)
- Sang Hak Lee
- Cardiology Division, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
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Abstract
OBJECTIVE Although the diagnosis of metachronous colorectal cancer have increased, due primarily to improvements in diagnostic modalities, the potential risk factors for these tumours are not well known. We compared the characteristics of patients with metachronous and sporadic primary colorectal cancer to determine risk factors for its occurrence. PATIENTS AND METHODS We reviewed the records of 5447 patients with colorectal cancer, who had been treated at Asan Medical Centre between July 1989 and January 2004. A metachronous cancer was defined as a secondary colorectal cancer occurring more than 6 months after the index cancer. RESULTS Metachronous colorectal cancer occurred in 39 (0.7%) patients. Their average age was 53 years, somewhat younger than the average age of sporadic colorectal cancer patients (58 years). In patients with metachronous cancer, the cancer was more likely to be located in the right colon (P < 0.03), and the incidence of synchronous polyps or cancer was significantly higher (P < 0.001). The relative distributions of histological grades and clinicopathological characteristics were similar in index and metachronous cancers. Metachronous cancers were diagnosed more frequently at an early stage. The time interval between index and metachronous cancer ranged from 6 to 215 months (mean 39 months), with 13 (33.3%) patients diagnosed with metachronous cancer after 5 years. CONCLUSION We found that in patients aged < 50 years, existence of synchronous polyps or cancer influence on the development of metachronous colorectal cancer. Regular follow-up is necessary for early detection, even after 5 years, for these patients.
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Affiliation(s)
- I J Park
- Colorectal Clinic, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Centre, Seoul, Korea
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Doo YC, Han SJ, Han SW, Park WJ, Choi SH, Cho GY, Hong KS, Han KR, Lee NH, Oh DJ, Ryu KH, Rim CY, Lee KH, Lee Y. Effect of preexisting statin use on expression of C-reactive protein, adhesion molecules, interleukin-6, and antioxidized low-density lipoprotein antibody in patients with unstable angina undergoing coronary stenting. Clin Cardiol 2005; 28:72-6. [PMID: 15757077 PMCID: PMC6654111 DOI: 10.1002/clc.4960280206] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Statins are believed to reduce coronary heart disease by mechanisms in addition to their well-known cholesterol lowering effect. HYPOTHESIS We studied the effect of statins on expression of C-reactive protein (CRP), interleukin-6 (IL-6), adhesion molecules, and antioxidized low-density lipoprotein antibody (anti-oxLDL Ab) in patients with unstable angina (Braunwald class IIb or IIIb) undergoing coronary stenting. METHODS Consecutive 50 patients with unstable angina were included in the study. We classified the study subjects as patients using statins (Group A, n=20, men 10, mean age 62 years) and patients not using statins (Group B, n=30, men 15, mean age 60 years). RESULTS Baseline levels of inflammatory markers were similar in the two groups. However, 24 h after coronary stenting, serum levels of CRP (2.00 vs. 4.63 mg/l, p < 0.05), intercellular adhesion molecule-1 (ICAM-1) (217 vs. 261 ng/ml, p < 0.01), and anti-oxLDL Ab (8.97 vs. 12.96 U/ml, p < 0.05) were significantly higher in Group B than in Group A. Furthermore, 72 h after coronary stenting, serum levels of CRP (3.00 vs. 5.50 mg/l, p < 0.01) and ICAM-1 (222 vs. 277 ng/ml, p < 0.05) were significantly higher in Group B than in Group A. CONCLUSIONS Preexisting statin therapy plays a role in reducing the serum levels of CRP, ICAM-1, and anti-oxLDL Ab after coronary stenting in patients with unstable angina. These data support an anti-inflammatory or plaque-stabilizing effect of statin therapy.
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Affiliation(s)
- Young-Cheoul Doo
- Division of Cardiology, Department of Internal Medicine, Kang-Dong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
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