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Park SJ, Ahn JM, Kang DY, Yun SC, Ahn YK, Kim WJ, Nam CW, Jeong JO, Chae IH, Shiomi H, Kao HL, Hahn JY, Her SH, Lee BK, Ahn TH, Chang KY, Chae JK, Smyth D, Mintz GS, Stone GW, Park DW. Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial. Lancet 2024; 403:1753-1765. [PMID: 38604213 DOI: 10.1016/s0140-6736(24)00413-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Acute coronary syndrome and sudden cardiac death are often caused by rupture and thrombosis of lipid-rich atherosclerotic coronary plaques (known as vulnerable plaques), many of which are non-flow-limiting. The safety and effectiveness of focal preventive therapy with percutaneous coronary intervention of vulnerable plaques in reducing adverse cardiac events are unknown. We aimed to assess whether preventive percutaneous coronary intervention of non-flow-limiting vulnerable plaques improves clinical outcomes compared with optimal medical therapy alone. METHODS PREVENT was a multicentre, open-label, randomised controlled trial done at 15 research hospitals in four countries (South Korea, Japan, Taiwan, and New Zealand). Patients aged 18 years or older with non-flow-limiting (fractional flow reserve >0·80) vulnerable coronary plaques identified by intracoronary imaging were randomly assigned (1:1) to either percutaneous coronary intervention plus optimal medical therapy or optimal medical therapy alone, in block sizes of 4 or 6, stratified by diabetes status and the performance of percutaneous coronary intervention in a non-study target vessel. Follow-up continued annually in all enrolled patients until the last enrolled patient reached 2 years after randomisation. The primary outcome was a composite of death from cardiac causes, target-vessel myocardial infarction, ischaemia-driven target-vessel revascularisation, or hospitalisation for unstable or progressive angina, assessed in the intention-to-treat population at 2 years. Time-to-first-event estimates were calculated with the Kaplan-Meier method and were compared with the log-rank test. This report is the principal analysis from the trial and includes all long-term analysed data. The trial is registered at ClinicalTrials.gov, NCT02316886, and is complete. FINDINGS Between Sept 23, 2015, and Sept 29, 2021, 5627 patients were screened for eligibility, 1606 of whom were enrolled and randomly assigned to percutaneous coronary intervention (n=803) or optimal medical therapy alone (n=803). 1177 (73%) patients were men and 429 (27%) were women. 2-year follow-up for the primary outcome assessment was completed in 1556 (97%) patients (percutaneous coronary intervention group n=780; optimal medical therapy group n=776). At 2 years, the primary outcome occurred in three (0·4%) patients in the percutaneous coronary intervention group and in 27 (3·4%) patients in the medical therapy group (absolute difference -3·0 percentage points [95% CI -4·4 to -1·8]; p=0·0003). The effect of preventive percutaneous coronary intervention was directionally consistent for each component of the primary composite outcome. Serious clinical or adverse events did not differ between the percutaneous coronary intervention group and the medical therapy group: at 2 years, four (0·5%) versus ten (1·3%) patients died (absolute difference -0·8 percentage points [95% CI -1·7 to 0·2]) and nine (1·1%) versus 13 (1·7%) patients had myocardial infarction (absolute difference -0·5 percentage points [-1·7 to 0·6]). INTERPRETATION In patients with non-flow-limiting vulnerable coronary plaques, preventive percutaneous coronary intervention reduced major adverse cardiac events arising from high-risk vulnerable plaques, compared with optimal medical therapy alone. Given that PREVENT is the first large trial to show the potential effect of the focal treatment for vulnerable plaques, these findings support consideration to expand indications for percutaneous coronary intervention to include non-flow-limiting, high-risk vulnerable plaques. FUNDING The CardioVascular Research Foundation, Abbott, Yuhan Corp, CAH-Cordis, Philips, and Infraredx, a Nipro company.
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Affiliation(s)
- Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Keun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA University School of Medicine, CHA Ilsan Medical Center, Goyang, South Korea
| | - Chang-Wook Nam
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, South Korea
| | - In-Ho Chae
- Division of Cardiology, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Hiroki Shiomi
- Division of Cardiology, Kyoto University Hospital, Kyoto, Japan
| | - Hsien-Li Kao
- Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Ho Her
- Department of Cardiology, Saint Vincent's Hospital, Suwon, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Tae Hoon Ahn
- Cardiovascular Center, Na-Eun Hospital, Incheon, South Korea
| | - Ki-Yuk Chang
- Division of Cardiology, Seoul Saint Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Jei Keon Chae
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju, South Korea
| | - David Smyth
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Kim WJ, Lim HJ, Moon JY, Kim SH, Sung JH, Kim IJ, Lim SW, Cha DH, Kang SH. Sex differences in the impact of body mass index on outcomes of coronary artery disease in Koreans. Coron Artery Dis 2024; 35:193-200. [PMID: 38411167 DOI: 10.1097/mca.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Obesity is often considered a risk factor for cardiovascular disease, but recent studies have shown conflicting results regarding the effect of BMI on the prognosis of coronary artery disease (CAD). This study aimed to evaluate the relationship between BMI and clinical outcomes of CAD according to sex in a Korean population. METHODS A total of 3476 patients with a significant CAD who underwent percutaneous coronary intervention (PCI) were enrolled. Patients were classified as follows according to BMI using the Asia-Pacific cutoff points: underweight (<18.5 kg/m 2 ), normal weight (18.5-22.9 kg/m 2 ), overweight (23.0-24.9 kg/m 2 ) and obese (≥25 kg/m 2 ) patients. Underweight and normal weight patients were further categorized into the lower BMI group, whereas overweight and obese patients were categorized into the higher BMI group. The primary endpoint was all-cause mortality. RESULTS Among women, the higher BMI group showed poor clinical features in the prevalence of hypertension and chest pain presentation, and among men, the higher BMI group had a significantly lower rate of chronic renal failure. At the end of the follow-up period (median 53.5 months), the all-cause mortality rate was lower in the higher BMI group in men, and cardiovascular death and stroke rates were significantly lower in the higher BMI group in women. CONCLUSION In Korean CAD patients treated with PCI, inverse correlations were observed between the clinical outcomes and BMI, but there were differences between men and women.
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Affiliation(s)
- Won-Jang Kim
- Department of Cardiology, CHA Ilsan Medical Center, CHA University, Goyang-si
| | - Ha Jeong Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae Youn Moon
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang-Hoon Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - In Jai Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang-Wook Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dong-Hun Cha
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Lee JM, Kim H, Park YS, Jo HH, Lim SM, Lee J, Choi Y, Kang DY, Ahn JM, Kim S, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Choi JW, Kim KS, Lee SN, Park SJ, Park DW. Surveillance Stress Testing After Percutaneous Intervention for Patients With Multivessel or Left Main Coronary Disease. J Am Coll Cardiol 2024; 83:890-900. [PMID: 38418002 DOI: 10.1016/j.jacc.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND The optimal surveillance strategy after percutaneous coronary intervention (PCI) for high-risk patients with multivessel or left main coronary artery disease (CAD) remains uncertain. OBJECTIVES This study aims to determine the prognostic role of routine functional testing in patients with multivessel or left main CAD who underwent PCI. METHODS The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) trial randomized high-risk PCI patients to routine functional testing at 1 year or standard care alone during follow-up. This analysis focused on participants with multivessel or left main CAD. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. RESULTS Among 1,706 initially randomized patients, 1,192 patients with multivessel (n = 833) or left main (n = 359) were identified, with 589 in the functional testing group and 603 in the standard care group. Two-year incidences of primary outcome were similar between the functional testing group and the standard care group (6.2% vs 5.7%, respectively; HR: 1.09; 95% CI: 0.68-1.74; P = 0.73). This trend persisted in both groups of multivessel (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.62-1.89; P = 0.78) and left main disease (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.46-2.56; P = 0.85) (P for interaction = 0.90). Routine surveillance functional testing was associated with increased rates of invasive angiography and repeat revascularization beyond 1 year. CONCLUSIONS In high-risk patients with multivessel or left main CAD who underwent PCI, there was no incremental clinical benefit from routine surveillance functional-testing compared with standard care alone during follow-up. (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention [POST-PCI]; NCT03217877).
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Affiliation(s)
- Joong Min Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hoyun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Sun Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha Hye Jo
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Min Lim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeonwoo Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seonok Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Se Hun Kang
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Chul Soo Park
- Cardiovascular Center and Cardiology Division, Yeouido St Mary's Hospital, Seoul, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Seoul, Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Su Nam Lee
- Division of Cardiology, St Vincent's Hospital, Suwon, Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kim M, Ahn JM, Kang DY, Kim MJ, Kim KW, Koo HJ, Yang DH, Jung SC, Kim B, Wong YTA, Lam CCS, Yin WH, Wei J, Lee YT, Kao HL, Lin MS, Yu Ko T, Kim WJ, Kang SH, Lee SA, Ko E, Kim DH, Kang JW, Lee JH, Lee J, Park J, Kim H, Choi Y, Park SJ, Park DW. Low- or standard-dose edoxaban versus antiplatelet therapy for leaflet thrombus and cerebral thromboembolism after TAVR: A prespecified analysis of randomized ADAPT-TAVR trial. Am Heart J 2024; 269:167-178. [PMID: 38123045 DOI: 10.1016/j.ahj.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The risks of leaflet thrombosis and the associated cerebral thromboembolism are unknown according to different anticoagulation dosing after transcatheter aortic valve replacement (TAVR). The aim was to evaluate the incidence of leaflet thrombosis and cerebral thromboembolism between low-dose (30 mg) or standard-dose (60 mg) edoxaban and dual antiplatelet therapy (DAPT) after TAVR. METHODS In this prespecified subgroup analysis of the ADAPT-TAVR trial, the primary endpoint was the incidence of leaflet thrombosis on 4-dimensional computed tomography at 6-months. Key secondary endpoints were new cerebral lesions on brain magnetic resonance imaging and neurological and neurocognitive dysfunction. RESULTS Of 229 patients enrolled in this study, 118 patients were DAPT group and 111 were edoxaban group (43 [39.1%] 60 mg vs 68 [61.3%] 30 mg). There was a significantly lower incidence of leaflet thrombosis in the standard-dose edoxaban group than in the DAPT group (2.4% vs 18.3%; odds ratio [OR] 0.11; 95% confidence interval [CI], 0.01-0.55; P = .03). However, no significant difference was observed between low-dose edoxaban and DAPT (15.0% vs 18.3%; OR 0.79; 95% CI, 0.32-1.81; P = .58). Irrespective of different antithrombotic regiments, the percentages of patients with new cerebral lesions on brain MRI and worsening neurological or neurocognitive function were not significantly different. CONCLUSIONS In patients without an indication for anticoagulation after TAVR, the incidence of leaflet thrombosis was significantly lower with standard-dose edoxaban but not with low-dose edoxaban, as compared with DAPT. However, this differential effect of edoxaban on leaflet thrombosis was not associated with a reduction of new cerebral thromboembolism and neurological dysfunction.
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Affiliation(s)
- Mijin Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Ju Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Kim
- Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Hyun Jung Koo
- Department of Radiology Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byungjun Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yiu Tung Anthony Wong
- Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Cheung Chi Simon Lam
- Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung Yu Ko
- Division of Cardiology, Department of Internal Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Seung-Ah Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Euihong Ko
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinho Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinsun Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hoyun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeonwoo Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Kim H, Kang DY, Lee J, Choi Y, Ahn JM, Kim S, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Choi JW, Kim KS, Lee SN, Park SJ, Park DW. Routine stress testing in diabetic patients after percutaneous coronary intervention: the POST-PCI trial. Eur Heart J 2024; 45:653-665. [PMID: 37933514 DOI: 10.1093/eurheartj/ehad722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND AND AIMS The optimal follow-up surveillance strategy for high-risk diabetic patients with had undergone percutaneous coronary intervention (PCI) remains unknown. METHODS The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) study was a randomized trial comparing a follow-up strategy of routine functional testing at 1 year vs. standard care alone after high-risk PCI. Randomization was stratified according to diabetes status. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. RESULTS Among 1706 randomized patients, participants with diabetes (n = 660, 38.7%) had more frequent comorbidities and a higher prevalence of complex anatomical or procedural characteristics than those without diabetes (n = 1046, 61.3%). Patients with diabetes had a 52% greater risk of primary composite events [hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.02-2.27; P = .039]. The 2-year incidences of the primary composite outcome were similar between strategies of routine functional testing or standard care alone in diabetic patients (7.1% vs. 7.5%; HR 0.94; 95% CI 0.53-1.66; P = .82) and non-diabetic patients (4.6% vs. 5.1%; HR 0.89; 95% CI 0.51-1.55; P = .68) (interaction term for diabetes: P = .91). The incidences of invasive coronary angiography and repeat revascularization after 1 year were higher in the routine functional-testing group than the standard-care group irrespective of diabetes status. CONCLUSIONS Despite being at higher risk for adverse clinical events, patients with diabetes who had undergone high-risk PCI did not derive incremental benefit from routine surveillance stress testing compared with standard care alone during follow-up.
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Affiliation(s)
- Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Seonok Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Se Hun Kang
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Chul Soo Park
- Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Seoul, South Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Su Nam Lee
- Division of Cardiology, St. Vincent's Hospital, Suwon, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
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Choi Y, Ahn JM, Kang DY, Kim HJ, Kim H, Lee J, Kim M, Park J, Kim KW, Koo HJ, Yang DH, Jung SC, Kim B, Anthony Wong YT, Simon Lam CC, Yin WH, Wei J, Lee YT, Kao HL, Lin MS, Ko TY, Kim WJ, Kang SH, Lee SA, Kim DH, Lee JH, Park SJ, Park DW. Frequency, Predictors, and Clinical Impact of Valvular and Perivalvular Thrombus After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2023; 16:2967-2981. [PMID: 38151311 DOI: 10.1016/j.jcin.2023.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Subclinical aortic valve complex (valvular and perivalvular) thrombus is not rare after transcatheter aortic valve replacement (TAVR). The risk factors and clinical implications of these findings remain uncertain. OBJECTIVES This study sought to evaluate the frequency, predictors, and clinical outcome of aortic valve complex thrombus after TAVR. METHODS In the ADAPT-TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) trial comparing edoxaban vs dual antiplatelet therapy in TAVR patients without an indication for chronic anticoagulation, the frequency of valvular (subclinical leaflet thrombus) and perivalvular (supravalvular, subvalvular, and sinus of Valsalva) thrombus was evaluated by 4-dimensional computed tomography at 6 months. The association of these phenomena with new cerebral thromboembolism on brain magnetic resonance imaging, neurologic and neurocognitive dysfunction, and clinical outcomes was assessed. RESULTS Among 211 patients with 6-month computed tomography evaluations, 91 patients (43.1%) had thrombus at any aortic valve complex, 30 (14.2%) patients had leaflet thrombus, and 78 (37.0%) patients had perivalvular thrombus. A small maximum diameter of the stent at the valve level and low body surface area were independent predictors of aortic valve complex and perivalvular thrombus, and decreased renal function was an independent predictor of leaflet thrombus. No significant differences were observed in new cerebral lesions, neurologic or neurocognitive functions, or clinical outcomes among patients with or without valvular or perivalvular thrombus. CONCLUSIONS Subclinical aortic valve complex (valvular and perivalvular) thrombus was common in patients who had undergone successful TAVR. However, these imaging phenomena were not associated with new cerebral thromboembolism, neurologic or neurocognitive dysfunction, or adverse clinical outcomes. (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement [ADAPT-TAVR]; NCT03284827).
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Affiliation(s)
- Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwa Jung Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mijin Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Chai Jung
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byungjun Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yiu Tung Anthony Wong
- Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Cheung Chi Simon Lam
- Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Yu Ko
- Division of Cardiology, Department of Internal Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Won-Jang Kim
- Department of Cardiology, CHA Medical Center, Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Medical Center, Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Jang MH, Ahn JM, Kang DY, Kim KW, Koo HJ, Yang DH, Jung SC, Kim B, Wong YTA, Lam CCS, Yin WH, Wei J, Lee YT, Kao HL, Lin MS, Ko TY, Kim WJ, Kang SH, Ko E, Lee SA, Kim DH, Kim H, Choi Y, Lee J, Park SJ, Park DW. Impact of leaflet thrombosis on valve haemodynamic status after transcatheter aortic valve replacement. Heart 2023; 110:140-147. [PMID: 37586823 DOI: 10.1136/heartjnl-2023-322946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES The effect of subclinical leaflet thrombosis, characterised by hypoattenuated leaflet thickening (HALT), on the valve haemodynamic function and durability of the bioprosthetic valve, is not yet determined. We determined the impact of HALT on valve haemodynamics after transcatheter aortic valve replacement (TAVR) and the predictors of haemodynamic structural valve deterioration (SVD). METHODS The Anticoagulation vs Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization after Transcatheter Aortic Valve Replacement(ADAPT-TAVR) trial is a multicenter, randomised trial that compared edoxaban and dual antiplatelet therapy in patients who had undergone successful TAVR. The presence of HALT was evaluated by four-dimensional CT at 6 months and serial echocardiography performed at baseline, immediately post-TAVR and after 6 months. SVD was defined as at least one of the following: (1) mean transprosthetic gradient ≥20 mm Hg, (2) change in the mean gradient ≥10 mm Hg from baseline, or (3) new or increase in intraprosthetic aortic regurgitation of at least ≥1 grade, resulting in moderate or greater regurgitation. RESULTS At 6 months, HALT was found in 30 of 211 (14.2%) patients. The presence of HALT did not significantly affect aortic valve mean gradients (with vs without HALT; 14.0±4.8 mm Hg vs 13.7±5.5 mm Hg; p=0.74) at 6 months. SVD was reported in 30 of 206 patients (14.6%) at 6-month follow-up echocardiography. Older age (OR: 1.138; 95% CI: 1.019 to 1.293; p=0.033), use of aortic valve size ≤23 mm (OR: 6.254; 95% CI: 2.230 to 20.569; p=0.001) and mean post-TAVR pressure gradient (OR: 1.233; 95% CI: 1.123 to 1.371; p<0.001) were independent predictors of haemodynamic SVD; however, the presence of HALT was not identified as a predictor of SVD. CONCLUSIONS In patients who had undergone successful TAVR, aortic valve haemodynamic status was not influenced by the presence of HALT. Although HALT was not a predictor of haemodynamic SVD at 6 months, it warrants further longer-term follow-up to evaluate the effect on long-term valve durability. TRIAL REGISTRATION NUMBER NCT03284827 (https://www. CLINICALTRIALS gov).
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Affiliation(s)
| | | | | | - Kyung Won Kim
- Asan Image Metrics, Clinical Trial Center, Asan Institue for Life Sciences, Asan Medical Center, Seoul, South Korea
| | | | | | | | - Byungjun Kim
- Radiology, Korea University Anam Hospital, Seoul, Korea
| | | | | | - Wei-Hsian Yin
- Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yung-Tsai Lee
- Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Yu Ko
- Cardiology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Won-Jang Kim
- Cardiology, CHA Ilsan Medical Center, Goyang-si, Gyeonggi-do, Korea
| | - Se Hun Kang
- Cardiology, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, Korea
| | - Euihong Ko
- Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | | | - Dae-Hee Kim
- Cardiology, Asan Medical Center, Seoul, Korea
| | - Hoyun Kim
- Cardiology, Asan Medical Center, Seoul, Korea
| | | | - Jinho Lee
- Cardiology, Asan Medical Center, Seoul, Korea
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8
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Ahn JM, Kang DY, Lee PH, Ahn YK, Kim WJ, Nam CW, Jeong JO, Chae IH, Shiomi H, Kao PHL, Hahn JY, Her SH, Lee BK, Ahn TH, Chang K, Chae JK, Smyth D, Stone GW, Park DW, Park SJ. Preventive PCI or medical therapy alone for vulnerable atherosclerotic coronary plaque: Rationale and design of the randomized, controlled PREVENT trial. Am Heart J 2023; 264:83-96. [PMID: 37271356 DOI: 10.1016/j.ahj.2023.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Acute coronary syndromes are commonly caused by the rupture of vulnerable plaque, which often appear angiographically not severe. Although pharmacologic management is considered standard therapy for stabilizing plaque vulnerability, the potential role of preventive local treatment for vulnerable plaque has not yet been determined. The PREVENT trial was designed to compare preventive percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) with OMT alone in patients with functionally nonsignificant high-risk vulnerable plaques. METHODS The PREVENT trial is a multinational, multicenter, prospective, open-label, active-treatment-controlled randomized trial. Eligible patients have at least 1 angiographically significant stenosis (diameter stenosis >50% by visual estimation) without functional significance (fractional flow reserve [FFR] >0.80). Target lesions are assessed by intracoronary imaging and must meet at least 2 imaging criteria for vulnerable plaque; (1) minimal lumen area <4.0 mm2; (2) plaque burden >70%; (3) maximal lipid core burden index in a 4 mm segment >315 by near infrared spectroscopy; and (4) thin cap fibroatheroma as determined by virtual histology or optical coherence tomography. Enrolled patients are randomly assigned in a 1:1 ratio to either preventive PCI with either bioabsorbable vascular scaffolds or metallic everolimus-eluting stents plus OMT or OMT alone. The primary endpoint is target-vessel failure, defined as the composite of death from cardiac causes, target-vessel myocardial infarction, ischemic-driven target-vessel revascularization, or hospitalization for unstable or progressive angina, at 2 years after randomization. RESULTS Enrollment of a total of 1,608 patients has been completed. Follow-up of the last enrolled patient will be completed in September 2023 and primary results are expected to be available in early 2024. CONCLUSIONS The PREVENT trial is the first large-scale, randomized trial to evaluate the effect of preventive PCI on non-flow-limiting vulnerable plaques containing multiple high-risk features that is appropriately powered for clinical outcomes. PREVENT will provide compelling evidence as to whether preventive PCI of vulnerable plaques plus OMT improves patient outcomes compared with OMT alone. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT02316886. KEY POINTS The PREVENT trial is the first, large-scale randomized clinical trial to evaluate the effect of preventive PCI on non-flow-limiting vulnerable plaque with high-risk features. It will provide compelling evidence to determine whether PCI of focal vulnerable plaques on top of OMT improves patient outcomes.
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Affiliation(s)
- Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil Hyung Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Keun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA University Ilsan Medical Center, Goyang, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Korea
| | - In-Ho Chae
- Division of Cardiology, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Hiroki Shiomi
- Division of Cardiology, Kyoto University Hospital, Kyoto, Japan
| | - Paul Hsien Li Kao
- Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Joo-Yong Hahn
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Sung-Ho Her
- Department of Cardiology, St. Vincent's Hospital, Suwon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Tae Hoon Ahn
- Department of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Kiyuk Chang
- Division of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jei Keon Chae
- Division of Cardiology, Chonbuk National University Medical School, Jeonju, Korea
| | - David Smyth
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, Zena and Michael A. Wiener Cardiovascular Institute, New York, NY
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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9
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Lee JH, Ahn JM, Kang DY, Kim KW, Koo HJ, Yang DH, Jung SC, Kim B, Wong YTA, Lam CCS, Yin WH, Wei J, Lee YT, Kao HL, Lin MS, Ko TY, Kim WJ, Kang SH, Yun SC, Ko E, Park H, Lee SA, Kim DH, Park SJ, Park DW. Effect of Edoxaban Versus Antiplatelet Therapy on Leaflet Thrombosis and Cerebral Thromboembolism After TAVI According to Major Clinical and Anatomic Factors in Prespecified Subgroup Analysis from the ADAPT-TAVR Trial. Am J Cardiol 2023; 203:352-361. [PMID: 37517131 DOI: 10.1016/j.amjcard.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 08/01/2023]
Abstract
It is unknown whether edoxaban versus dual antiplatelet therapy (DAPT) has differential treatment effects on leaflet thrombosis, cerebral thromboembolism, and neurologic or neurocognitive dysfunction according to clinical and anatomic factors after transcatheter aortic valve implantation. To investigate the relative effects of edoxaban and DAPT on leaflet and cerebral thromboembolism in patients with major risk factors. The primary end point of this study was the incidence of leaflet thrombosis on computed tomography at 6 months. The secondary end points were new cerebral lesions on brain magnetic resonance imaging and neurologic and neurocognitive dysfunction between baseline and 6-month follow-up. Cox regression models assessed the consistency of the treatment effects in the prespecified subgroups. The favorable effect of edoxaban versus DAPT on the leaflet thrombosis was consistent across multiple clinical or anatomic subgroups, without significant interaction between the drug effect and each subgroup (p for interaction for age = 0.597, gender = 0.557, body mass index = 0.866, Society of Thoracic Surgeons score = 0.307, valve type = 0.702, edoxaban reduction criteria = 0.604, and valve morphology = 0.688). However, the incidence of new cerebral lesions on brain magnetic resonance imaging and worsening of neurologic and neurocognitive function were not significantly different between the groups among the various key subgroups. The relative effects of edoxaban and DAPT on the risk of leaflet thrombosis, cerebral thromboembolism, and neurologic dysfunction were consistent across a diverse spectrum of clinical or anatomical factors. Further studies are required to define tailored antithrombotic therapy for high-risk groups with specific clinical or anatomic characteristics.
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Affiliation(s)
| | | | | | - Kyung Won Kim
- Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences
| | - Hyun Jung Koo
- Department of Radiology Research Institute of Radiology, and
| | - Dong Hyun Yang
- Department of Radiology Research Institute of Radiology, and
| | - Seung Chai Jung
- Department of Radiology Research Institute of Radiology, and
| | - Byungjun Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yiu Tung Anthony Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Cheung Chi Simon Lam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Yu Ko
- Division of Cardiology, Department of Internal Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Won-Jang Kim
- Department of Cardiology, CHA Ilsan Medical Center, Goyang, Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Euihong Ko
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu-city, Fukuoka, Japan
| | - Hanbit Park
- Department of Cardiology, GangNeung Asan Hospital, GangNeung, Korea
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10
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Lee SY, Choi KH, Park TK, Kim J, Kim EK, Park SJ, Park SW, Gwon HC, Chang K, Yu CW, Kim J, Choi YJ, Chae IH, Lee JH, Kim JH, Park JS, Kim WJ, Yoon YW, Ahn TH, Lee SR, Choi BJ, Yang TH, Choi CU, Hur SH, Oh SJ, Lee HC, Park H, Kim HS, Choi SH. Impact of Atrial Fibrillation on Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI): The K-TAVI Registry. Yonsei Med J 2023; 64:413-422. [PMID: 37365735 DOI: 10.3349/ymj.2022.0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of antithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients undergoing TAVI and demonstrate the status of antithrombotic therapy for these patients. MATERIALS AND METHODS A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year. RESULTS AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% confidence interval (CI): 1.182-4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621-6.071, p=0.001). Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%). CONCLUSION AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.
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Affiliation(s)
- Sang Yoon Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - JuHan Kim
- Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Jin Choi
- Cardiology, Cardiovascular Center, Sejong General Hospital, Bucheon, Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Hwan Lee
- Department of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jun-Hong Kim
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Korea
| | - Jong Seon Park
- Department of Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Young Won Yoon
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Ahn
- Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang Rok Lee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Byoung Joo Choi
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - Tae-Hyun Yang
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seong-Jin Oh
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Han Cheol Lee
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - HunSik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Cardiology Centre, Seoul National University Hospital, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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11
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Kang SH, Moon JY, Kim SH, Sung JH, Kim IJ, Lim SW, Cha DH, Kim WJ. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes in Koreans. Medicine (Baltimore) 2022; 101:e32579. [PMID: 36596077 PMCID: PMC9803465 DOI: 10.1097/md.0000000000032579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Anemia is a well-known risk factor for cardiovascular disease. However, there are limited data on whether anemia on admission is a long-term prognostic factor in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention. We sought to evaluate the prevalence and prognostic consequences of anemia in patients with ACS treated with percutaneous coronary intervention in Korea. We retrospectively enrolled 1930 consecutive patients. Among the anemic population (hemoglobin [Hb] < 13 g/dL in men, and < 12 g/dL in women), we classified patients with Hb ≥ 7 g/dL, <10 d/dL as moderate anemia, other cases classified as mild anemia. Among patients with normal hemoglobin levels, we classified those with Hb > 16.5 g/dL in men, and > 16.0 g/dL in women, as having high hemoglobin. We examined the relationship between anemia with all-cause mortality and secondary outcomes - including cardiovascular mortality, myocardial infarction, stroke, and repeat revascularization. We classified 3.3%, 21.5%, and 5.3% of patients as moderate anemia, mild anemia, and high hemoglobin, respectively. During a median follow-up of 67.2 (interquartile range; 46.8-88.5) months, 74 (3.8%) patients died. Compared with patients with normal hemoglobin, we detected a significantly increased risk for all-cause mortality in patients with anemia (adjusted hazard ratios for moderate and mild anemia, respectively: 8.26 [95% confidence interval: 3.98-17.15], P < .001 and 2.60 [1.54-4.40], P < .001). Among patients with ACS, anemia is prevalent and is strongly associated with increased mortality and cardiovascular events. Clinical trials will prospectively evaluate the efficacy of treatment for anemia on the outcomes of patients with ACS.
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Affiliation(s)
- Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae Youn Moon
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Hoon Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jung Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - In Jai Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Wook Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dong Hun Cha
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
- * Correspondence: Won-Jang Kim, Department of cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundgang-gu, Seongnam-si, Gyeonggi-do 13496, Korea (e-mail: )
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Park DW, Kang DY, Ahn JM, Yun SC, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ. Routine Functional Testing or Standard Care in High-Risk Patients after PCI. N Engl J Med 2022; 387:905-915. [PMID: 36036496 DOI: 10.1056/nejmoa2208335] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-risk patients who have undergone percutaneous coronary intervention (PCI) is uncertain. METHODS We randomly assigned 1706 patients with high-risk anatomical or clinical characteristics who had undergone PCI to a follow-up strategy of routine functional testing (nuclear stress testing, exercise electrocardiography, or stress echocardiography) at 1 year after PCI or to standard care alone. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Key secondary outcomes included invasive coronary angiography and repeat revascularization. RESULTS The mean age of the patients was 64.7 years, 21.0% had left main disease, 43.5% had bifurcation disease, 69.8% had multivessel disease, 70.1% had diffuse long lesions, 38.7% had diabetes, and 96.4% had been treated with drug-eluting stents. At 2 years, a primary-outcome event had occurred in 46 of 849 patients (Kaplan-Meier estimate, 5.5%) in the functional-testing group and in 51 of 857 (Kaplan-Meier estimate, 6.0%) in the standard-care group (hazard ratio, 0.90; 95% confidence interval [CI], 0.61 to 1.35; P = 0.62). There were no between-group differences with respect to the components of the primary outcome. At 2 years, 12.3% of the patients in the functional-testing group and 9.3% in the standard-care group had undergone invasive coronary angiography (difference, 2.99 percentage points; 95% CI, -0.01 to 5.99), and 8.1% and 5.8% of patients, respectively, had undergone repeat revascularization (difference, 2.23 percentage points; 95% CI, -0.22 to 4.68). CONCLUSIONS Among high-risk patients who had undergone PCI, a follow-up strategy of routine functional testing, as compared with standard care alone, did not improve clinical outcomes at 2 years. (Funded by the CardioVascular Research Foundation and Daewoong Pharmaceutical; POST-PCI ClinicalTrials.gov number, NCT03217877.).
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Affiliation(s)
- Duk-Woo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Do-Yoon Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Min Ahn
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Sung-Cheol Yun
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Yong-Hoon Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Ho Hur
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Cheol Hyun Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Won-Jang Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Se Hun Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Chul Soo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Bong-Ki Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Won Suh
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung Han Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jae Woong Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Kee-Sik Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Si Wan Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Su Nam Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Jung Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
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Park DW, Kang DY, Ahn JM, Yun SC, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ. Routine Functional Testing or Standard Care in High-Risk Patients after PCI. N Engl J Med 2022. [PMID: 36036496 DOI: 10.1056/nejmoa2208335jonesd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-risk patients who have undergone percutaneous coronary intervention (PCI) is uncertain. METHODS We randomly assigned 1706 patients with high-risk anatomical or clinical characteristics who had undergone PCI to a follow-up strategy of routine functional testing (nuclear stress testing, exercise electrocardiography, or stress echocardiography) at 1 year after PCI or to standard care alone. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Key secondary outcomes included invasive coronary angiography and repeat revascularization. RESULTS The mean age of the patients was 64.7 years, 21.0% had left main disease, 43.5% had bifurcation disease, 69.8% had multivessel disease, 70.1% had diffuse long lesions, 38.7% had diabetes, and 96.4% had been treated with drug-eluting stents. At 2 years, a primary-outcome event had occurred in 46 of 849 patients (Kaplan-Meier estimate, 5.5%) in the functional-testing group and in 51 of 857 (Kaplan-Meier estimate, 6.0%) in the standard-care group (hazard ratio, 0.90; 95% confidence interval [CI], 0.61 to 1.35; P = 0.62). There were no between-group differences with respect to the components of the primary outcome. At 2 years, 12.3% of the patients in the functional-testing group and 9.3% in the standard-care group had undergone invasive coronary angiography (difference, 2.99 percentage points; 95% CI, -0.01 to 5.99), and 8.1% and 5.8% of patients, respectively, had undergone repeat revascularization (difference, 2.23 percentage points; 95% CI, -0.22 to 4.68). CONCLUSIONS Among high-risk patients who had undergone PCI, a follow-up strategy of routine functional testing, as compared with standard care alone, did not improve clinical outcomes at 2 years. (Funded by the CardioVascular Research Foundation and Daewoong Pharmaceutical; POST-PCI ClinicalTrials.gov number, NCT03217877.).
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Affiliation(s)
- Duk-Woo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Do-Yoon Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Min Ahn
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Sung-Cheol Yun
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Yong-Hoon Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Ho Hur
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Cheol Hyun Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Won-Jang Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Se Hun Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Chul Soo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Bong-Ki Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Won Suh
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung Han Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jae Woong Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Kee-Sik Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Si Wan Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Su Nam Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Jung Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
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Kang SH, Song HN, Moon JY, Kim SH, Sung JH, Kim IJ, Lim SW, Cha DH, Kim WJ. Prevalence and prognostic significance of malnutrition in patients with acute coronary syndrome treated with percutaneous coronary intervention. Medicine (Baltimore) 2022; 101:e30100. [PMID: 36042595 PMCID: PMC9410591 DOI: 10.1097/md.0000000000030100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The incidence and impact of malnutrition on acute coronary syndrome (ACS) remain unclear. This study aimed to evaluate the prevalence, clinical relevance, and prognostic outcomes of malnutrition in patients with ACS treated with percutaneous coronary intervention. This retrospective study included 1930 consecutive patients with ACS undergoing percutaneous coronary intervention and assessed their nutritional status using 3 scoring systems: Controlling Nutritional Status score, nutritional risk index (NRI), and prognostic nutritional index (PNI). The primary endpoint was all-cause mortality. The Controlling Nutritional Status, NRI, and PNI scores showed that 5.2%, 17.5%, and 3.9% of patients were moderately or severely malnourished, respectively. During a median follow-up of 67.2 months (interquartile range: 46.8-88.5 months), 74 (3.8%) patients died. Malnutrition was associated with a significantly increased risk for all-cause mortality compared with good nutrition (adjusted hazard ratios for moderate and severe malnutrition, respectively: 5.65 [95% confidence interval: 3.27-9.78] and 15.26 [7.50-31.05] for the NRI score, 5.53 [2.10-14.49] and 11.08 [5.69-21.59] for the PNI; P < .001). The current findings demonstrated that malnutrition is prevalent among patients with ACS and is closely associated with increased mortality. Further study is needed to evaluate the effects of nutritional interventions on the outcomes of patients with ACS.
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Affiliation(s)
- Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Han Na Song
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae Youn Moon
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang-Hoon Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - In Jai Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang-Wook Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dong-Hun Cha
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
- *Correspondence: Won-Jang Kim, Department of Cardiology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundgang-gu, Seongnam-si, Gyeonggi-do 13496, Korea (e-mail: )
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15
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Park DW, Ahn JM, Kang DY, Kim KW, Koo HJ, Yang DH, Jung SC, Kim B, Wong YTA, Lam CCS, Yin WH, Wei J, Lee YT, Kao HL, Lin MS, Ko TY, Kim WJ, Kang SH, Yun SC, Lee SA, Ko E, Park H, Kim DH, Kang JW, Lee JH, Park SJ. Edoxaban Versus Dual Antiplatelet Therapy for Leaflet Thrombosis and Cerebral Thromboembolism After TAVR: The ADAPT-TAVR Randomized Clinical Trial. Circulation 2022; 146:466-479. [PMID: 35373583 DOI: 10.1161/circulationaha.122.059512] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is unknown whether the direct oral anticoagulant edoxaban can reduce leaflet thrombosis and the accompanying cerebral thromboembolic risk after transcatheter aortic valve replacement. In addition, the causal relationship of subclinical leaflet thrombosis with cerebral thromboembolism and neurological or neurocognitive dysfunction remains unclear. METHODS We conducted a multicenter, open-label randomized trial comparing edoxaban with dual antiplatelet therapy (aspirin plus clopidogrel) in patients who had undergone successful transcatheter aortic valve replacement and did not have an indication for anticoagulation. The primary end point was an incidence of leaflet thrombosis on 4-dimensional computed tomography at 6 months. Key secondary end points were the number and volume of new cerebral lesions on brain magnetic resonance imaging and the serial changes of neurological and neurocognitive function between 6 months and immediately after transcatheter aortic valve replacement. RESULTS A total of 229 patients were included in the final intention-to-treat population. There was a trend toward a lower incidence of leaflet thrombosis in the edoxaban group compared with the dual antiplatelet therapy group (9.8% versus 18.4%; absolute difference, -8.5% [95% CI, -17.8% to 0.8%]; P=0.076). The percentage of patients with new cerebral lesions on brain magnetic resonance imaging (edoxaban versus dual antiplatelet therapy, 25.0% versus 20.2%; difference, 4.8%; 95% CI, -6.4% to 16.0%) and median total new lesion number and volume were not different between the 2 groups. In addition, the percentages of patients with worsening of neurological and neurocognitive function were not different between the groups. The incidence of any or major bleeding events was not different between the 2 groups. We found no significant association between the presence or extent of leaflet thrombosis with new cerebral lesions and a change of neurological or neurocognitive function. CONCLUSIONS In patients without an indication for long-term anticoagulation after successful transcatheter aortic valve replacement, the incidence of leaflet thrombosis was numerically lower with edoxaban than with dual antiplatelet therapy, but this was not statistically significant. The effects on new cerebral thromboembolism and neurological or neurocognitive function were also not different between the 2 groups. Because the study was underpowered, the results should be considered hypothesis generating, highlighting the need for further research. REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT03284827.
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Affiliation(s)
- Duk-Woo Park
- Division of Cardiology (D.-W.P., J.-M.A., D.-Y.K., S.-A.L., E.K., D.-H.K., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology (D.-W.P., J.-M.A., D.-Y.K., S.-A.L., E.K., D.-H.K., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Division of Cardiology (D.-W.P., J.-M.A., D.-Y.K., S.-A.L., E.K., D.-H.K., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Hyun Jung Koo
- Department of Radiology Research Institute of Radiology (H.J.K., D.H.Y., S.C.J., J.-W.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology Research Institute of Radiology (H.J.K., D.H.Y., S.C.J., J.-W.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Chai Jung
- Department of Radiology Research Institute of Radiology (H.J.K., D.H.Y., S.C.J., J.-W.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byungjun Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul (B.K.)
| | - Yiu Tung Anthony Wong
- Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital (Y.T.A.W., C.C.S.L.)
| | - Cheung Chi Simon Lam
- Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital (Y.T.A.W., C.C.S.L.)
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan (W.-H.Y., J.W., Y.-T.L.)
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan (W.-H.Y., J.W., Y.-T.L.)
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan (W.-H.Y., J.W., Y.-T.L.)
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (H.-L.K., M.-S.L.)
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (H.-L.K., M.-S.L.)
| | - Tsung-Yu Ko
- Division of Cardiology, Department of Internal Medicine, Hsin-Chu Branch, National Taiwan University Hospital (T.-Y.K.)
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Korea (W.-J.K., S.H.K.)
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Korea (W.-J.K., S.H.K.)
| | - Sung-Cheol Yun
- Division of Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ah Lee
- Division of Cardiology (D.-W.P., J.-M.A., D.-Y.K., S.-A.L., E.K., D.-H.K., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Euihong Ko
- Division of Cardiology (D.-W.P., J.-M.A., D.-Y.K., S.-A.L., E.K., D.-H.K., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanbit Park
- Division of Cardiology, GangNeung Asan Hospital (H.P.), University of Ulsan College of Medicine, Korea
| | - Dae-Hee Kim
- Division of Cardiology (D.-W.P., J.-M.A., D.-Y.K., S.-A.L., E.K., D.-H.K., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology Research Institute of Radiology (H.J.K., D.H.Y., S.C.J., J.-W.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology (J.-H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology (D.-W.P., J.-M.A., D.-Y.K., S.-A.L., E.K., D.-H.K., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chang SA, Lee SH, Choi JH, Chung WJ, Choi JY, Kim HK, Jung HO, Park SM, Kim WJ, Jung SY, Chang HJ. Real-world practice patterns and characteristics of adverse events with selexipag in Korean patients with pulmonary arterial hypertension. Expert Opin Drug Saf 2022; 21:1423-1432. [PMID: 35451909 DOI: 10.1080/14740338.2022.2069750] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND Optimizing an individual dose with careful management of adverse events (AEs) is essential in the treatment with selexipag approved for pulmonary arterial hypertension (PAH). This study aims to identify real-world practice patterns and AE characteristics of selexipag. RESEARCH DESIGN AND METHODS This multicenter, longitudinal, observational study included Korean patients with PAH who initiated with selexipag and followed up to the earliest timepoint of 24-week post-treatment. The dose-titration pattern, AE incidences by dosing and time course, recovery pattern from AEs, and relationship between doses and AE incidences were evaluated. RESULTS Data for 113 patients were included in the analysis. The individual maintenance dose ranged between 200 and 3,200 µg/day. More often AEs were occurred in the titration phase than maintenance phase. There was no significant difference in AE incidences according to the distribution of titration and maintenance doses. The four most common AEs were diarrhea, headache, nausea/vomiting, and myalgia without showing a dose-dependent trend in either frequency or severity. The recovery rates were between 65.0% and 76.9% with a median time to recovery of 15-70 days (range, 2-233). CONCLUSION Our finding that AE incidence did not increase with increasing dose of selexipag would provide supportive real-world evidence on the management of optimal dose and safety.
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Affiliation(s)
- Sung-A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan, Republic of Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan, Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine Seoul National University College of Medicine, Section of Cardiovascular Imaging, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hae-Ok Jung
- Division of Cardiology, Department of Medicine, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Korea University Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Won-Jang Kim
- Division of Cardiology, Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Republic of Korea
| | - Su Young Jung
- Medical Affairs, Janssen Korea Ltd, Seoul, Republic of Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei College of Medicine, Seoul, Republic of Korea
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17
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Kang SH, Kim WJ, Park JP, Kim DH, Park SM, Song J, Ko J. PREVALENCE AND PROGNOSTIC SIGNIFICANCE OF MALNUTRITION IN PATIENTS WITH CORONARY ARTERY DISEASE TREATED WITH PERCUTANEOUS CORONARY INTERVENTION: A RETROSPECTIVE COHORT STUDY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02458-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Kang SH, Kim IJ, Kim WJ. Adult Presentation of Subaortic Stenosis with Subaortic Membrane Treated with Surgical Removal. J Cardiovasc Dev Dis 2022; 9:jcdd9020036. [PMID: 35200689 PMCID: PMC8876706 DOI: 10.3390/jcdd9020036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Subaortic stenosis (SAS) is a rare heart disease in adults with an unclear etiology and variable clinical presentation. In some cases, SAS appears as hypertrophic cardiomyopathy with obstruction due to the accompanying systolic anterior motion of the mitral valve. A 46-year-old male with dizziness for several months presented in the outpatient department. Two-dimensional transthoracic echocardiography demonstrated a slightly hypertrophic left ventricle with normal systolic function without wall-motion abnormalities. Just below the aortic valve, a linear structure protruding from the septum side and the left-ventricular outflow tract (LVOT) side of the mitral valve was confirmed, which was causing a significant pressure gradient (mean and maximum of 91 mmHg and 138 mmHg, respectively). A diagnosis of SAS with subaortic membrane was made, and surgical myomectomy and subaortic membrane removal surgery were performed. Postoperative transthoracic echocardiography did not show flow acceleration through the LVOT, nor a significant pressure gradient across the aortic valve. This case report highlights the clinical significance of SAS with subaortic membrane, which can be confused with aortic stenosis of other etiology.
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Affiliation(s)
| | | | - Won-Jang Kim
- Correspondence: ; Tel.: +82-31-780-5000 (ext. 3449)
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19
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Abstract
Subaortic stenosis (SAS) is a rare heart disease in adults with an unclear etiology and variable clinical presentation. In some cases, SAS appears as hypertrophic cardiomyopathy with obstruction due to the accompanying systolic anterior motion of the mitral valve. A 46-year-old male with dizziness for several months presented in the outpatient department. Two-dimensional transthoracic echocardiography demonstrated a slightly hypertrophic left ventricle with normal systolic function without wall-motion abnormalities. Just below the aortic valve, a linear structure protruding from the septum side and the left-ventricular outflow tract (LVOT) side of the mitral valve was confirmed, which was causing a significant pressure gradient (mean and maximum of 91 mmHg and 138 mmHg, respectively). A diagnosis of SAS with subaortic membrane was made, and surgical myomectomy and subaortic membrane removal surgery were performed. Postoperative transthoracic echocardiography did not show flow acceleration through the LVOT, nor a significant pressure gradient across the aortic valve. This case report highlights the clinical significance of SAS with subaortic membrane, which can be confused with aortic stenosis of other etiology.
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Affiliation(s)
- Se Hun Kang
- CHA Bundang Medical Center, Department of Cardiology, CHA University, Seongnam 13496, Korea
| | - In Jai Kim
- CHA Bundang Medical Center, Department of Cardiology, CHA University, Seongnam 13496, Korea
| | - Won-Jang Kim
- CHA Bundang Medical Center, Department of Cardiology, CHA University, Seongnam 13496, Korea
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Kang J, Oh YM, Lee JH, Kim EK, Lim SY, Kim WJ, Yoon HI, Kim TH, Park TS, Kim SO, Lee SW, Lee SD, Lee JS. Distinctive patterns of pulmonary function change according to baseline lung volume and diffusing capacity. Int J Tuberc Lung Dis 2021; 24:597-605. [PMID: 32553011 DOI: 10.5588/ijtld.19.0401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Multicentre retrospective study in South Korea.OBJECTIVE: To longitudinally evaluate changes in lung volume and diffusing capacity for carbon monoxide (DLCO) with forced expiratory volume in 1 sec (FEV1).DESIGN: A total of 155 patients with chronic obstructive pulmonary disease (COPD), whose pulmonary function parameters were measured annually for 5 years, were selected from a prospective cohort in South Korea. A random coefficients model was used to estimate mean annual FEV1, lung volume parameter and DLCO change rates.RESULTS: Patients were classified into four groups based on baseline DLCO and residual volume/total lung capacity (RV/TLC) measurements. The annual FEV1 decline rate was greater in patients with low DLCO than in those with normal DLCO, with the greatest decline occurring in patients with low DLCO and normal RV/TLC. RV and RV/TLC declined in patients with high RV/TLC, whereas these increased in patients with normal RV/TLC. DLCO decreased longitudinally in all four groups, with the greatest decline occurring in patients with normal DLCO and normal RV/TLC.CONCLUSIONS: Different subgroups of patients with COPD exhibited distinctive pulmonary function change patterns. Baseline DLCO and RV/TLC may be used as physiological markers to predict long-term changes in pulmonary function.
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Affiliation(s)
- J Kang
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Y-M Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - J-H Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, CHA University, Seongnam
| | - E K Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, CHA University, Seongnam
| | - S Y Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul
| | - W J Kim
- Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon
| | - H I Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - T-H Kim
- Division of Pulmonology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri
| | - T S Park
- Division of Pulmonology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri
| | - S O Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea
| | - S W Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - S-D Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - J S Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Park H, Kang DY, Ahn JM, Kim KW, Wong AYT, Lam SCC, Yin WH, Wei J, Lee YT, Kao HL, Lin MS, Ko TY, Kim WJ, Kang SH, Ko E, Kim DH, Koo HJ, Yang DH, Kang JW, Jung SC, Lee JH, Yun SC, Park SJ, Park DW. Rationale and design of the ADAPT-TAVR trial: a randomised comparison of edoxaban and dual antiplatelet therapy for prevention of leaflet thrombosis and cerebral embolisation after transcatheter aortic valve replacement. BMJ Open 2021; 11:e042587. [PMID: 33402409 PMCID: PMC7786793 DOI: 10.1136/bmjopen-2020-042587] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Optimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) is still unknown. We hypothesised that the direct factor Xa inhibitor edoxaban can potentially prevent subclinical leaflet thrombosis and cerebral embolisation compared with conventional dual antiplatelet therapy (DAPT) in patients undergoing TAVR. METHODS AND ANALYSIS The ADAPT-TAVR trial is an international, multicentre, randomised, open-label, superiority trial comparing edoxaban-based strategy and DAPT strategy in patients without an indication for oral anticoagulation who underwent successful TAVR. A total of 220 patients are randomised (1:1 ratio), 1-7 days after successful TAVR, to receive either edoxaban (60 mg daily or 30 mg daily if patients had dose-reduction criteria) or DAPT using aspirin (100 mg daily) plus clopidogrel (75 mg daily) for 6 months. The primary endpoint was an incidence of leaflet thrombosis on four-dimensional, volume-rendered cardiac CT imaging at 6 months post-TAVR. The key secondary endpoints were the number of new lesions and new lesion volume on brain diffusion-weighted MRI and the changes in neurological and neurocognitive function assessment between immediate post-TAVR and 6 months of study drug administration. Detailed clinical information on thromboembolic and bleeding events were also assessed. ETHICS AND DISSEMINATION Ethic approval has been obtained from the Ethics Committee/Institutional Review Board of Asan Medical Center (approval number: 2017-1317) and this trial is also approved by National Institute of Food and Drug Safety Evaluation of Republic of Korea (approval number: 31511). Results of this study will be disseminated in scientific publication in reputed journals. TRIAL REGISTRATION NUMBER NCT03284827.
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Affiliation(s)
- Hanbit Park
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Kyung Won Kim
- Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Anthony Y T Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Simon C C Lam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yung-Tsai Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Yu Ko
- Division of Cardiology, Department of Internal Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, The Republic of Korea
| | - Euihong Ko
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Sung-Cheol Yun
- Department of Biostatistics, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea
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22
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Abstract
Patients with cleidocranial dysplasia (CCD) caused by mutations in RUNX2 have severe dental anomalies, including delayed or absent eruption of permanent teeth. This requires painful and expensive surgical/orthodontic intervention because of the absence of medicine for this condition. Here, we demonstrate that nicotinamide, a vitamin B3 and class III histone deacetylase inhibitor, significantly improves delayed tooth eruption in Runx2+/- mice, a well-known CCD animal model, through the restoration of decreased osteoclastogenesis. We also found that Csf1 mRNA and protein levels were significantly reduced in Runx2+/- osteoblasts as compared with wild type whereas RANKL and OPG levels had no significant difference between wild type and Runx2+/- osteoblasts. The nicotinamide-induced restoration of osteoclastogenesis of bone marrow-derived macrophages in Runx2+/- mice was due to the increased expression of RUNX2 and CSF1 and increased RANKL/OPG ratio. RUNX2 directly regulated Csf1 mRNA expression via binding to the promoter region of the Csf1 gene. In addition, nicotinamide enhanced the RUNX2 protein level and transacting activity posttranslationally with Sirt2 inhibition. Taken together, our study shows the potential and underlying molecular mechanism of nicotinamide for the treatment of delayed tooth eruption by using the Runx2+/- murine model, suggesting nicotinamide as a candidate therapeutic drug for dental abnormalities in patients with CCD.
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Affiliation(s)
- H Yoon
- Department of Molecular Genetics and Pharmacology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, Republic of Korea
| | - H J Kim
- Department of Molecular Genetics and Pharmacology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, Republic of Korea
| | - H R Shin
- Department of Molecular Genetics and Pharmacology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, Republic of Korea
| | - B S Kim
- Department of Molecular Genetics and Pharmacology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, Republic of Korea
| | - W J Kim
- Department of Molecular Genetics and Pharmacology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, Republic of Korea
| | - Y D Cho
- Department of Periodontology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, Republic of Korea
| | - H M Ryoo
- Department of Molecular Genetics and Pharmacology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, Republic of Korea
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23
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Newall AT, Leong RNF, Nazareno A, Muscatello DJ, Wood JG, Kim WJ. Delay-adjusted age- and sex-specific case fatality rates for COVID-19 in South Korea: Evolution in the estimated risk of mortality throughout the epidemic. Int J Infect Dis 2020; 101:306-311. [PMID: 33011281 PMCID: PMC7529598 DOI: 10.1016/j.ijid.2020.09.1478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives The aim of this study was to estimate delay-adjusted case fatality rates (CFRs) for COVID-19 in South Korea, and evaluate how these estimates have evolved over time throughout the epidemic. Methods Public data from the Korea Centers for Disease Control and Prevention (KCDC) were used to estimate age- and sex-specific CFRs for COVID-19 in South Korea up to June 12, 2020. We applied statistical methods previously developed to adjust for the delay between diagnosis and death, and presented both delay-adjusted and crude (unadjusted) CFRs throughout the epidemic. Results The overall estimated delay-adjusted CFR was 2.39% (3.05% for males and 1.92% for females). Within each age strata where deaths were reported, males were found to have significantly higher CFRs than females. The estimated CFRs increased substantially from age 60 years in males and from 70 years in females. Both the delay-adjusted and crude CFRs were found to have evolved substantially, particularly early in the epidemic, converging only from mid-April 2020. Conclusions The CFRs for South Korea provide an estimate of mortality risk in a setting where case ascertainment is likely to be more complete. The evolution in CFRs throughout the epidemic highlights the need for caution when interpreting CFRs calculated at a given time point.
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Affiliation(s)
- A T Newall
- School of Public Health and Community Medicine, University of NSW, Sydney, NSW, Australia.
| | - R N F Leong
- School of Public Health and Community Medicine, University of NSW, Sydney, NSW, Australia.
| | - A Nazareno
- School of Public Health and Community Medicine, University of NSW, Sydney, NSW, Australia.
| | - D J Muscatello
- School of Public Health and Community Medicine, University of NSW, Sydney, NSW, Australia.
| | - J G Wood
- School of Public Health and Community Medicine, University of NSW, Sydney, NSW, Australia.
| | - W J Kim
- Department of Infectious Diseases, Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
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Lee KY, Lee BK, Kim WJ, Kang SH, Park TK, Kim SY, Suh JW, Yoon CH, Yang DH, Ryu SK, Kim SH, Lee SY, Chae IH. Consensus statement on coronary intervention during the coronavirus disease 19 pandemic: from the Korean Society of Interventional Cardiology. Korean J Intern Med 2020; 35:749-757. [PMID: 32668513 PMCID: PMC7373961 DOI: 10.3904/kjim.2020.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus 2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities; the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.
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Affiliation(s)
- Kwan Yong Lee
- Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Song-Yi Kim
- Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Heon Yang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sung Yun Lee
- Cardiac and Vascular Center, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to In-Ho Chae, M.D. Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7012 Fax: +82-31-787-4290 E-mail:
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Yoon YH, Ahn JM, Kang DY, Park H, Cho SC, Lee PH, Hur SH, Kim WJ, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ, Park DW. Pragmatic trial comparing routine versus no routine functional testing in high-risk patients who underwent percutaneous coronary intervention: Rationale and design of POST-PCI trial. Am Heart J 2020; 224:156-165. [PMID: 32402702 DOI: 10.1016/j.ahj.2020.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/20/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although the need to detect restenosis has diminished in the contemporary practice of percutaneous coronary intervention (PCI) with drug-eluting stents (DES), the surveillance of ischemia owing to restenosis or disease progression deserves attention in high-risk PCI settings. It is unknown whether follow-up strategy of routine noninvasive functional testing potentially reduces the risk of major cardiovascular events in high-risk PCI patients. METHODS The POST-PCI study is an investigator-initiated, multicenter, prospective randomized trial comparing the effectiveness of two follow-up strategies in patients with high-risk anatomic or clinical characteristics who underwent PCI. Study participants were randomly assigned to either (1) the routine noninvasive stress testing (exercise electrocardiography, nuclear stress imaging, or stress echocardiography) at 12 months post-PCI or (2) the standard-care without routine testing. In the routine stress testing group, depending on the testing results, all clinical decisions regarding subsequent diagnostic or therapeutic procedures were at the treating physician's discretion. The primary endpoint was a composite outcome of death from any causes, myocardial infarction, or hospitalization for unstable angina at 2 years post-PCI. RESULTS More than 1700 high-risk PCI patients have been randomized over 2.0 years at 11 major cardiac centers in Korea. CONCLUSION This pragmatic POST-PCI trial will provide valuable clinical evidence on the effectiveness of follow-up strategy of routine noninvasive stress testing in high-risk PCI patients.
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Cho H, Lee JG, Kang SJ, Kim WJ, Choi SY, Ko J, Min HS, Choi GH, Kang DY, Lee PH, Ahn JM, Park DW, Lee SW, Kim YH, Lee CW, Park SW, Park SJ. Angiography-Based Machine Learning for Predicting Fractional Flow Reserve in Intermediate Coronary Artery Lesions. J Am Heart Assoc 2020; 8:e011685. [PMID: 30764731 PMCID: PMC6405668 DOI: 10.1161/jaha.118.011685] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background An angiography-based supervised machine learning ( ML ) algorithm was developed to classify lesions as having fractional flow reserve ≤0.80 versus >0.80. Methods and Results With a 4:1 ratio, 1501 patients with 1501 intermediate lesions were randomized into training versus test sets. Between the ostium and 10 mm distal to the target lesion, a series of angiographic lumen diameter measurements along the centerline was plotted. The 24 computed angiographic features based on the diameter plot and 4 clinical features (age, sex, body surface area, and involve segment) were used for ML by XGBoost. The model was independently trained and tested by 2000 bootstrap iterations. External validation with 79 patients was conducted. Including all 28 features, the ML model with 5-fold cross-validation in the 1204 training samples predicted fractional flow reserve ≤0.80 with overall diagnostic accuracy of 78±4% (averaged area under the curve: 0.84±0.03). The 12 high-ranking features selected by scatter search were involved segment; body surface area; distal lumen diameter; minimal lumen diameter; length of a lumen diameter <2.0 mm, <1.5 mm, and <1.25 mm; mean lumen diameter within the worst segment; sex; diameter stenosis; distal 5-mm reference lumen diameter; and length of diameter stenosis >70%. Using those 12 features, the ML predicted fractional flow reserve ≤0.80 in the test set with sensitivity of 84%, specificity of 80%, and overall accuracy of 82% (area under the curve: 0.87). The averaged diagnostic accuracy in bootstrap replicates was 81±1% (averaged area under the curve: 0.87±0.01). External validation showed accuracy of 85% (area under the curve: 0.87). Conclusions Angiography-based ML showed good diagnostic performance in identifying ischemia-producing lesions and reduced the need for pressure wires.
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Affiliation(s)
- Hyungjoo Cho
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - June-Goo Lee
- 2 Biomedical Engineering Research Center Asan Institute for Life Sciences Seoul Korea
| | - Soo-Jin Kang
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Won-Jang Kim
- 3 Department of Cardiology CHA Bundang Medical Center CHA University Seongnam Korea
| | - So-Yeon Choi
- 4 Department of Cardiology Ajou University Suwon Korea
| | - Jiyuon Ko
- 2 Biomedical Engineering Research Center Asan Institute for Life Sciences Seoul Korea
| | - Hyun-Seok Min
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Gun-Ho Choi
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Do-Yoon Kang
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Pil Hyung Lee
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Jung-Min Ahn
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Duk-Woo Park
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Seung-Whan Lee
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Young-Hak Kim
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Cheol Whan Lee
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Seong-Wook Park
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
| | - Seung-Jung Park
- 1 Department of Cardiology University of Ulsan College of Medicine Asan Medical Center Seoul Korea
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Jeong HT, Kim WJ. Comparison of Hot Deformation Behavior Characteristics Between As-Cast and Extruded Al-Zn-Mg-Cu (7075) Aluminum Alloys with a Similar Grain Size. Materials (Basel) 2019; 12:ma12233807. [PMID: 31756980 PMCID: PMC6926894 DOI: 10.3390/ma12233807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/23/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/26/2022]
Abstract
The hot compressive behavior and processing maps of as-cast and extruded 7075 aluminum alloys with a similar grain size (320–350 μm) were studied and compared, which allows us to directly observe the effect of segregated phases in the as-cast microstructure on the deformation behavior and hot workability of 7075 alloys. In the as-cast alloy, the compound phases segregated along the interdendritic interfaces within the interiors of original grains provided the additional sites for continuous dynamic recrystallization via the particle stimulation nucleation mechanism. As a result, the as-cast alloy exhibited higher fractions of recrystallized grains and smaller grain sizes than the extruded alloy after compression. The stress exponent values of the as-cast alloy were smaller than those of the extruded alloy. In the processing maps, the domain associated with high power dissipation efficiencies (≥35%) occurred in a wider temperature range in the as-cast alloy compared to the extruded alloy. The segregated phases that remained undissolved in the as-cast alloy after compressive deformation could be effectively eliminated during the solid solution treatment (753 K for 2 h) for T6 aging applied after hot compression. The current results suggest the possibility and advantage of omitting the extrusion step when preparing 7xxx aluminum forging or extrusion feedstocks for hot working. The proposed method can be applied to other precipitation hardenable aluminum alloys.
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Affiliation(s)
- H T Jeong
- Department of Materials Science and Engineering, Hongik University, Mapo-gu, Sangsu-dong 72-1, Seoul 121-791, Korea
| | - W J Kim
- Department of Materials Science and Engineering, Hongik University, Mapo-gu, Sangsu-dong 72-1, Seoul 121-791, Korea
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Yang WI, Moon JY, Shim M, Yang PS, Kang SH, Kim SH, Kim WJ, Sung JH, Kim IJ, Lim SW, Cha DH, Ha JW. Clinical features differentiating Takotsubo cardiomyopathy in the peripartum period from peripartum cardiomyopathy. Heart Vessels 2019; 35:665-671. [PMID: 31705186 DOI: 10.1007/s00380-019-01537-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/01/2019] [Indexed: 12/21/2022]
Abstract
There are some similarities in clinical features between Takotsubo cardiomyopathy during the peripartum period (PTCM) and peripartum cardiomyopathy (PPCM). Both conditions present as acute heart failure and decreased left ventricular (LV) ejection fraction in the peripartum period in previously heart-healthy women. The present study aimed to evaluate the differences in clinical features and outcomes between PTCM and PPCM. Between January 2004 and December 2016, 37 consecutive patients who demonstrated LV dysfunction during the peripartum period without previous heart disease were recruited retrospectively. The clinical, laboratory, and echocardiographic data of these patients were comprehensively reviewed. Twenty-one (57%) and 16 (43%) patients were classified into PPCM and PTCM groups, respectively, based on echocardiographic findings. The initial LV ejection fraction did not differ significantly between the 2 groups. However, all patients with PTCM showed complete recovery of LV ejection fraction at the 1-month follow-up. However, among 20 patients with PPCM who underwent 1-month echocardiography, only 6 (30%) showed complete recovery of LV ejection fraction at the 1-month follow-up. At the 12-month follow-up, only 10 patients showed complete recovery of LV ejection fraction. The incidence of PTCM was much higher than expected. Although LV dysfunction was similar at the initial diagnosis, the prognosis of LV recovery was more favorable in PTCM than in PPCM. Therefore, physicians should differentiate these two diseases entities, although they have several similarities in acute LV dysfunction.
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Affiliation(s)
- Woo-In Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Jae Youn Moon
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea.
| | - Minjung Shim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Sang-Hoon Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - In Jai Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Sang-Wook Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Dong-Hun Cha
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Jong-Won Ha
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim WJ, Gupta V, Nishimura M, Makita H, Idolor L, Roa C, Loh LC, Ong CK, Wang JS, Boonsawat W, Gunasekera KD, Madegedara D, Kuo HP, Wang CH, Wang C, Yang T, Lin YX, Ko FWS, Hui DSC, Lan LTT, Vu QTT, Bhome AB, Ng A, Seo JB, Lee BY, Lee JS, Oh YM, Lee SD. Identification of chronic obstructive pulmonary disease subgroups in 13 Asian cities. Int J Tuberc Lung Dis 2019; 22:820-826. [PMID: 29914609 DOI: 10.5588/ijtld.17.0524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition that can differ in its clinical manifestation, structural changes and response to treatment. OBJECTIVE To identify subgroups of COPD with distinct phenotypes, evaluate the distribution of phenotypes in four related regions and calculate the 1-year change in lung function and quality of life according to subgroup. METHODS Using clinical characteristics, we performed factor analysis and hierarchical cluster analysis in a cohort of 1676 COPD patients from 13 Asian cities. We compared the 1-year change in forced expiratory volume in one second (FEV1), modified Medical Research Council dyspnoea scale score, St George's Respiratory Questionnaire (SGRQ) score and exacerbations according to subgroup derived from cluster analysis. RESULTS Factor analysis revealed that body mass index, Charlson comorbidity index, SGRQ total score and FEV1 were principal factors. Using these four factors, cluster analysis identified three distinct subgroups with differing disease severity and symptoms. Among the three subgroups, patients in subgroup 2 (severe disease and more symptoms) had the most frequent exacerbations, most rapid FEV1 decline and greatest decline in SGRQ total score. CONCLUSION Three subgroups with differing severities and symptoms were identified in Asian COPD subjects.
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Affiliation(s)
- W J Kim
- Department of Internal Medicine, Kangwon National University, Chuncheon, Korea
| | - V Gupta
- Department of Internal Medicine, Kangwon National University, Chuncheon, Korea, Adesh Institute of Medical Sciences and Research, Bathinda, India
| | - M Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - H Makita
- Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - L Idolor
- Section of Respiratory Services and Physical Therapy and Rehabilitation Lung Center of the Philippines, Quezon City
| | - C Roa
- College of Medicine and Philippine General Hospital, University of the Philippines, Manila, The Philippines
| | - L-C Loh
- Department of Medicine, Penang Medical College, Penang, Malaysia
| | - C-K Ong
- Department of Medicine, Penang Medical College, Penang, Malaysia
| | - J-S Wang
- Taipei Medical University, Taipei, Taiwan
| | - W Boonsawat
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - K D Gunasekera
- Central Chest Clinic, National Hospital of Sri Lanka, Colombo
| | - D Madegedara
- Respiratory Disease Treatment Unit, Teaching Hospital Kandy, Kandy, Sri Lanka
| | - H-P Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - C-H Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - C Wang
- Department of Respiratory and Critical Care Medicine, Beijing China-Japan Friendship Hospital, Beijing
| | - T Yang
- Department of Respiratory and Critical Care Medicine, Beijing China-Japan Friendship Hospital, Beijing
| | - Y-X Lin
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
| | - F W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - D S C Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - L T T Lan
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Q T T Vu
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Viet Nam
| | - A B Bhome
- Indian Coalition of Obstructive Lung Diseases Network, Pune, Maharashtra, India
| | - A Ng
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - J B Seo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - B Y Lee
- Division of Allergy and Respiratory Diseases, Soon Chun Hyang University Hospital, Seoul
| | - J S Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Y-M Oh
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S-D Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Shin HR, Bae HS, Kim BS, Yoon HI, Cho YD, Kim WJ, Choi KY, Lee YS, Woo KM, Baek JH, Ryoo HM. PIN1 is a new therapeutic target of craniosynostosis. Hum Mol Genet 2019; 27:3827-3839. [PMID: 30007339 PMCID: PMC6216213 DOI: 10.1093/hmg/ddy252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/16/2018] [Accepted: 07/05/2018] [Indexed: 01/14/2023] Open
Abstract
Gain-of-function mutations in fibroblast growth factor receptors (FGFRs) cause congenital skeletal anomalies, including craniosynostosis (CS), which is characterized by the premature closure of craniofacial sutures. Apert syndrome (AS) is one of the severest forms of CS, and the only treatment is surgical expansion of prematurely fused sutures in infants. Previously, we demonstrated that the prolyl isomerase peptidyl-prolyl cis-trans isomerase interacting 1 (PIN1) plays a critical role in mediating FGFR signaling and that Pin1+/- mice exhibit delayed closure of cranial sutures. In this study, using both genetic and pharmacological approaches, we tested whether PIN1 modulation could be used as a therapeutic regimen against AS. In the genetic approach, we crossbred Fgfr2S252W/+, a mouse model of AS, and Pin1+/- mice. Downregulation of Pin1 gene dosage attenuated premature cranial suture closure and other phenotypes of AS in Fgfr2S252W/+ mutant mice. In the pharmacological approach, we intraperitoneally administered juglone, a PIN1 enzyme inhibitor, to pregnant Fgfr2S252W/+ mutant mice and found that this treatment successfully interrupted fetal development of AS phenotypes. Primary cultured osteoblasts from Fgfr2S252W/+ mutant mice expressed high levels of FGFR2 downstream target genes, but this phenotype was attenuated by PIN1 inhibition. Post-translational stabilization and activation of Runt-related transcription factor 2 (RUNX2) in Fgfr2S252W/+ osteoblasts were also attenuated by PIN1 inhibition. Based on these observations, we conclude that PIN1 enzyme activity is important for FGFR2-induced RUNX2 activation and craniofacial suture morphogenesis. Moreover, these findings highlight that juglone or other PIN1 inhibitors represent viable alternatives to surgical intervention for treatment of CS and other hyperostotic diseases.
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Affiliation(s)
- H R Shin
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - H S Bae
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - B S Kim
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - H I Yoon
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Y D Cho
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea.,Department of Periodontology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - W J Kim
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - K Y Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Y S Lee
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - K M Woo
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - J H Baek
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - H M Ryoo
- BK21 Program, Department of Molecular Genetics and Dental Pharmacology and Therapeutics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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Hae H, Kang SJ, Kim WJ, Choi SY, Lee JG, Bae Y, Cho H, Yang DH, Kang JW, Lim TH, Lee CH, Kang DY, Lee PH, Ahn JM, Park DW, Lee SW, Kim YH, Lee CW, Park SW, Park SJ. Machine learning assessment of myocardial ischemia using angiography: Development and retrospective validation. PLoS Med 2018; 15:e1002693. [PMID: 30422987 PMCID: PMC6233920 DOI: 10.1371/journal.pmed.1002693] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/11/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Invasive fractional flow reserve (FFR) is a standard tool for identifying ischemia-producing coronary stenosis. However, in clinical practice, over 70% of treatment decisions still rely on visual estimation of angiographic stenosis, which has limited accuracy (about 60%-65%) for the prediction of FFR < 0.80. One of the reasons for the visual-functional mismatch is that myocardial ischemia can be affected by the supplied myocardial size, which is not always evident by coronary angiography. The aims of this study were to develop an angiography-based machine learning (ML) algorithm for predicting the supplied myocardial volume for a stenosis, as measured using coronary computed tomography angiography (CCTA), and then to build an angiography-based classifier for the lesions with an FFR < 0.80 versus ≥ 0.80. METHODS AND FINDINGS A retrospective study was conducted using data from 1,132 stable and unstable angina patients with 1,132 intermediate lesions who underwent invasive coronary angiography, FFR, and CCTA at the Asan Medical Center, Seoul, Korea, between 1 May 2012 and 30 November 2015. The mean age was 63 ± 10 years, 76% were men, and 72% of the patients presented with stable angina. Of these, 932 patients (assessed before 31 January 2015) constituted the training set for the algorithm, and 200 patients (assessed after 1 February 2015) served as a test cohort to validate its diagnostic performance. Additionally, external validation with 79 patients from two centers (CHA University, Seongnam, Korea, and Ajou University, Suwon, Korea) was conducted. After automatic contour calibration using the caliber of guiding catheter, quantitative coronary angiography was performed using the edge-detection algorithms (CAAS-5, Pie-Medical). Clinical information was provided by the Asan BiomedicaL Research Environment (ABLE) system. The CCTA-based myocardial segmentation (CAMS)-derived myocardial volume supplied by each vessel (right coronary artery [RCA], left anterior descending [LAD], left circumflex [LCX]) and the myocardial volume subtended to a stenotic segment (CAMS-%Vsub) were measured for labeling. The ML for (1) predicting vessel territories (CAMS-%LAD, CAMS-%LCX, and CAMS-%RCA) and CAMS-%Vsub and (2) identifying the lesions with an FFR < 0.80 was constructed. Angiography-based ML, employing a light gradient boosting machine (GBM), showed mean absolute errors (MAEs) of 5.42%, 8.57%, and 4.54% for predicting CAMS-%LAD, CAMS-%LCX, and CAMS-%RCA, respectively. The percent myocardial volumes predicted by ML were used to predict the CAMS-%Vsub. With 5-fold cross validation, the MAEs between ML-predicted percent myocardial volume subtended to a stenotic segment (ML-%Vsub) and CAMS-%Vsub were minimized by the elastic net (6.26% ± 0.55% for LAD, 5.79% ± 0.68% for LCX, and 2.95% ± 0.14% for RCA lesions). Using all attributes (age, sex, involved vessel segment, and angiographic features affecting the myocardial territory and stenosis degree), the ML classifiers (L2 penalized logistic regression, support vector machine, and random forest) predicted an FFR < 0.80 with an accuracy of approximately 80% (area under the curve [AUC] = 0.84-0.87, 95% confidence intervals 0.71-0.94) in the test set, which was greater than that of diameter stenosis (DS) > 53% (66%, AUC = 0.71, 95% confidence intervals 0.65-0.78). The external validation showed 84% accuracy (AUC = 0.89, 95% confidence intervals 0.83-0.95). The retrospective design, single ethnicity, and the lack of clinical outcomes may limit this prediction model's generalized application. CONCLUSION We found that angiography-based ML is useful to predict subtended myocardial territories and ischemia-producing lesions by mitigating the visual-functional mismatch between angiographic and FFR. Assessment of clinical utility requires further validation in a large, prospective cohort study.
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Affiliation(s)
- Hyeonyong Hae
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - So-Yeon Choi
- Department of Cardiology, Ajou University, Suwon, Korea
| | - June-Goo Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Seoul, Korea
| | - Youngoh Bae
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyungjoo Cho
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae-Hwan Lim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Hyun Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Do-Yoon Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Pil Hyung Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lim YM, Moon JY, Min D, Kim SH, Yang WI, Kim WJ, Sung JH, Kim IJ, Lim SW, Cha DH. Serial measurements of neutrophil gelatinase-associated lipocalin: prognostic value in patients with ST-segment elevation myocardial infarction treated with a primary percutaneous coronary intervention. Coron Artery Dis 2018; 28:690-696. [PMID: 28737526 DOI: 10.1097/mca.0000000000000542] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND There are no previous data on serial changes in neutrophil gelatinase-associated lipocalin (NGAL) levels in ST-segment elevation myocardial infarction (STEMI) patients before and after a primary percutaneous coronary intervention (pPCI). The aim of the present study was to evaluate the prognostic value of serial NGAL measurements in patients with STEMI treated by pPCI. MATERIALS AND METHODS We identified 169 STEMI patients who underwent pPCI within 12 h of symptom onset and had plasma NGAL measurements before (pre-NGAL) and 6 h after (post-NGAL) pPCI. The primary endpoint was 30-day all-cause mortality, including cardiac death, whereas the secondary endpoint was the change in NGAL levels from before to after pPCI. RESULTS The mean pre-NGAL and post-NGAL levels were 109.2±76.1 and 93.3±83.8 ng/ml, respectively. Thirty-day mortality occurred in 12 (7.1%) patients. In terms of changes in serial NGAL levels, post-NGAL levels were decreased in 132 (79%) patients. Patients with elevated post-NGAL levels showed increased mortality compared with patients with decreased post-NGAL levels (P=0.005). Multivariate analyses indicated that old age and high post-NGAL levels were independent risk factors for 30-day mortality. CONCLUSION In a large percentage of STEMI patients, plasma post-pPCI NGAL levels were decreased compared with pre-pPCI NGAL levels, even with the administration of potentially nephrotoxic contrast medium. Post-NGAL levels seemed to be superior to pre-NGAL levels for the prediction of 30-day mortality outcome.
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Affiliation(s)
- Yeong-Min Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Park SH, Kim WJ, Kang DH. Effect of relative humidity on inactivation of foodborne pathogens using chlorine dioxide gas and its residues on tomatoes. Lett Appl Microbiol 2018; 67:154-160. [PMID: 29719930 DOI: 10.1111/lam.13002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/27/2018] [Accepted: 04/22/2018] [Indexed: 11/26/2022]
Abstract
The effect of relative humidity (RH) on the antimicrobial efficacy of chlorine dioxide (ClO2 ) gas against foodborne pathogens on tomatoes was evaluated. Also, levels of ClO2 residues on tomatoes after exposure to ClO2 gas under different RH conditions were measured to determine the quantity of solubilized ClO2 gas on tomato surfaces. Escherichia coli O157:H7, Salmonella Typhimurium and Listeria monocytogenes were inoculated on tomatoes and exposed to ClO2 gas (5, 10, 20 and 30 ppmv) under different RH conditions (50, 70 and 90%). As ClO2 gas concentration and treatment time increased, significant differences (P < 0·05) were observed between inactivation levels under different RH conditions. Exposure to 30 ppmv of ClO2 gas (50% RH) for 20 min resulted in 1·22-1·52 log reductions of the three foodborne pathogens. Levels of the three foodborne pathogens were reduced to below the detection limit (0·48 log CFU per cm2 ) within 15 min when exposed to 30 ppmv of ClO2 gas at 70% RH and within 10 min at 90% RH. At a given ClO2 gas concentration, ClO2 residues on tomatoes significantly (P < 0·05) increased with increasing RH, and there were close correlations between log reductions of pathogens and ClO2 residues on tomatoes. SIGNIFICANCE AND IMPACT OF THE STUDY This study reported on the correlation between the amount of ClO2 residues on produce surfaces and the level of inactivation of pathogens after ClO2 gas treatment. Variations in RH have great effect on the solubilization of ClO2 gas on tomato surfaces considering that ClO2 residues on tomatoes increased with increasing RH. Also, the amount of ClO2 residues on tomatoes is positively correlated with the level of inactivation of pathogens. The results of this study provide insights for predicting inactivation patterns of foodborne pathogens by ClO2 gas for practical application by the fresh produce industry.
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Affiliation(s)
- S H Park
- Department of Food and Animal Biotechnology, Center for Food and Bioconvergence, Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Korea.,Department of Agricultural Biotechnology, Center for Food and Bioconvergence, Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Korea
| | - W J Kim
- Department of Food and Animal Biotechnology, Center for Food and Bioconvergence, Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Korea.,Department of Agricultural Biotechnology, Center for Food and Bioconvergence, Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Korea
| | - D H Kang
- Department of Food and Animal Biotechnology, Center for Food and Bioconvergence, Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Korea.,Department of Agricultural Biotechnology, Center for Food and Bioconvergence, Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Korea
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Kim WJ, Kang H, Yang SY, Shin HY, Baek CW, Jung YH, Woo YC, In JY. Effective Dose of Remifentanil for Control of Haemodynamic Response to Insertion of the Streamlined Liner of the Pharyngeal Airway. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To determine the dose of remifentanil needed to achieve successful insertion of the Streamlined Liner of the Pharyngeal Airway (SLIPA™) without the development of hypertension in 95% of the patients. Design Randomised controlled trial. Setting operating theatre of a university hospital Methods A total of 100 ASA I or II patients requiring SLIPA insertion were randomly assigned to receive normal saline (Group C) or one of the four different doses (0.5 µg/kg [Group R0.5], 1.0 µg/kg [Group R1], 1.5 µg/kg [Group R1.5] or 2.0 µg/kg [Group R2]) of remifentanil. Arterial blood pressure and heart rate were recorded at preanesthetic baseline, preinserton, and every one minute during the initial 3 minutes period after insertion. Results A Probit model of remifentanil concentration was predictive of successful insertion of SLIPA without the development of hypertension. The ED95 of remifentanil needed to suppress haemodynamic response from SLIPA insertion was 1.39 µg/kg (95% confidence interval, 1.06-2.61 µg/kg). Conclusions A single administration of remifentanil can effectively suppress haemodynamic changes due to the insertion of SLIPA.
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Affiliation(s)
| | | | | | | | | | | | | | - JY In
- Dongguk University College of Medicine, Department of Anesthesiology and Pain Medicine, Ilsan Hospital, 814, Siksa-dong, Ilsan-gu, Goyang 411-773, Korea
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Kong JS, Jeong CY, Shim MJ, Kim WJ, Yeo SW, Park SN. Comparative study of new autologous material, bone-cartilage composite graft, for ossiculoplasty with Polycel ® and Titanium. Clin Otolaryngol 2017; 43:434-439. [PMID: 28944619 DOI: 10.1111/coa.12987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Ossiculoplasty is a surgical procedure that recreates sound transmission of the middle ear in conductive hearing loss. Various materials have been used for ossicular reconstruction, but the most ideal material for ossiculoplasty remains controversial. The purpose of this study was to introduce a novel method of autologous ossiculoplasty, bone-cartilage composite graft (BCCG) and to compare its surgical results with different types of ossiculoplastic prostheses. STUDY DESIGN A retrospective study was performed in a tertiary referral centre. METHODS Data of 275 patients who received ossiculoplasty using the three different materials of BCCG, Polycel® and titanium were analysed according to type of ossiculoplasty: partial or total ossicular replacement prosthesis (PORP or TORP). Hearing results, complication rates and clinical parameters including age, sex, past history, preoperative diagnosis and surgery type were compared among different groups. RESULTS Ossiculoplasty with BCCG showed satisfactory hearing outcomes and the lowest complication rate among the three different materials. In particular, its extrusion rate was 0%. CONCLUSION We propose that the BCCG technique is a useful alternative method for ossiculoplasty, with proper patient selection.
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Affiliation(s)
- J S Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - C Y Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - M J Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - W J Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S W Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S N Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hong JA, Kim MS, Cho MS, Choi HI, Kang DH, Lee SE, Lee GY, Jeon ES, Cho JY, Kim KH, Yoo BS, Lee JY, Kim WJ, Kim KH, Chung WJ, Lee JH, Cho MC, Kim JJ. Clinical features of idiopathic restrictive cardiomyopathy: A retrospective multicenter cohort study over 2 decades. Medicine (Baltimore) 2017; 96:e7886. [PMID: 28885342 PMCID: PMC6393124 DOI: 10.1097/md.0000000000007886] [Citation(s) in RCA: 4] [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
Idiopathic restrictive cardiomyopathy (RCMP) has not been fully understood because this disease is difficult to diagnose. The present study aimed to assess the clinical profile and outcome of idiopathic RCMP from a multicenter cohort.This investigation is a retrospective study of consecutive patients with idiopathic RCMP at 10 centers in Korea between 1990 and 2010. We evaluated the clinical characteristics of the patients and prognostic factors associated with mortality using multivariate Cox proportional hazards regression analyses.The study included 53 patients (26 men, 49.1%). During a median follow-up of 1.7 years, 17 patients (32.1%) died and 5 patients (9.4%) received a heart transplant. The 5-year survival rate of the overall patients was 64.4% ± 7.8%. In multivariable analyses, the predictors of mortality were tricuspid regurgitation (TR) ≥ moderate (hazard ratio [HR] 32.55, P < .001) and left ventricular end-diastolic diameter (LVEDD) (HR 0.85, P < .001).Idiopathic RCMP showed unfavorable prognosis. Advanced TR and lower LVEDD are independent adverse predictors of mortality in patients with idiopathic RCMP.
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Affiliation(s)
- Jung Ae Hong
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Min-Seok Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Min-Su Cho
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyo In Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Duk-Hyun Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Sang-Eun Lee
- Department of Internal Medicine, Seoul National University Hospital
| | - Ga-Yeon Lee
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Eun-Seok Jeon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Jae-Yeong Cho
- Department of Cardiology, Translational Research Center on Aging, Chonnam National University Hospital, Gwangju
| | - Kye-Hun Kim
- Department of Cardiology, Translational Research Center on Aging, Chonnam National University Hospital, Gwangju
| | - Byung-Su Yoo
- Department of Internal Medicine, Wonju College of Medicine,Yonsei University, Wonju
| | - Jong-Young Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul
| | - Won-Jang Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University school of Medicine, Bundang
| | | | - Wook-Jin Chung
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon
| | - Ju-Hee Lee
- Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Jae-Joong Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
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Kim E, Choi SW, Min D, Kim SH, Yang WI, Moon JY, Sung JH, Kim IJ, Lim SW, Cha DH, Moon B, Cho SH, Kim WJ. A case of a resected benign myxoma-like hemorrhagic cyst, which later recurred as undifferentiated pleomorphic sarcoma in the left atrium. Medicine (Baltimore) 2017; 96:e6353. [PMID: 28422827 PMCID: PMC5406043 DOI: 10.1097/md.0000000000006353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE An intracardiac cystic mass is a rare type of mass found in the left atrium. The differential diagnosis of an intracardiac cystic mass includes hydatid cysts, bronchogenic cysts, intracardiac varices, and hemorrhages in some tumor types, including myxoma. PATIENT CONCERNS We present the case of a 68-year-old woman who presented with episodic dyspnea. DIAGNOSES-INTERVENTIONS-OUTCOMES Transthoracic echocardiography (TTE) revealed the presence of a left atrial mass mimicking myxoma. However, in postoperative findings, it was determined that the mass was actually a hemorrhagic cyst. Eighteen months later, the patient presented with recurrent exertional dyspnea and TTE revealed the recurrence of a left atrial mass. Computed tomography showed that the mass extended into the right atrium, inferior vena cava, and coronary sinus. After re-operation, the final histological diagnosis was determined to be an undifferentiated pleomorphic sarcoma in the left atrium. LESSONS An intracardiac hemorrhagic cyst was suspected during the operation of a benign-looking LA mass. As such, we recommend that other rare etiologies be considered and more biopsies be performed when possible.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Sang-Ho Cho
- Department of Pathology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Seongnam-si, Gyeonngi-do, Korea
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Kim WJ, Choi SW, Chang J, Min D, Kim MK, Yang WI, Kim SH, Moon JY, Sung JH, Kim IJ, Lim SW, Cha DH, Lee JY, Jang SJ, Kim DJ. PROLONGED INFLAMMATION LED TO AORTIC VALVE SCLEROSIS: LONGITUDINAL PET/CT STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kim S, Kim H, Kim WJ, Lee SJ, Hong Y, Lee HY, Lim MN, Han SS. Mortality and predictors in pulmonary tuberculosis with respiratory failure requiring mechanical ventilation. Int J Tuberc Lung Dis 2017; 20:524-9. [PMID: 26970163 DOI: 10.5588/ijtld.15.0690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyse the predictors and mortality rate among patients receiving mechanical ventilation (MV) for respiratory failure due to pulmonary tuberculosis (TB). DESIGN We retrospectively compared patients who required MV for TB with patients who required MV for community-acquired pneumonia (CAP). RESULTS In-hospital mortality was significantly different between the two groups: 95.1% in TB vs. 62.7% in CAP (P < 0.001 using the χ(2) test). TB patients had a higher 30-day mortality (P = 0.040 using log-rank test), although the median sequential organ failure assessment (SOFA) (7.0 vs. 6.0, P = 0.842) and mean Acute Physiology and Chronic Health Evaluation (APACHE) II scores (20.0 ± 6.7 vs. 21.2 ± 6.7, P = 0.379) for TB and CAP patients were not different. TB patients were more likely to have increased lung lesion intrusions (OR 1.307, 95%CI 1.042-1.641, P = 0.021), and reduced albumin (OR 0.073, 95%CI 0.016-0.335, P = 0.001), C-reactive protein (OR 0.324, 95%CI 0.146-0.716, P = 0.005) and CURB-65 score (confusion, uraemia, respiratory rate, blood pressure and age ⩾65 years) (OR 0.916, 95%CI 0.844-0.995, P = 0.037). CONCLUSIONS TB patients showed identical SOFA and APACHE II scores, but higher mortality than CAP patients. The higher mortality was not related to severity, but suggested an association with the extent of destructive lung lesions.
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Affiliation(s)
- S Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - H Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - W J Kim
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - S-J Lee
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Y Hong
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - H-Y Lee
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - M-N Lim
- Environmental Health Center, Kangwon National University Hospital, Chuncheon, Korea
| | - S-S Han
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
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Peppler WT, Kim WJ, Ethans K, Cowley KC. Precision of dual-energy X-ray absorptiometry of the knee and heel: methodology and implications for research to reduce bone mineral loss after spinal cord injury. Spinal Cord 2016; 55:483-488. [PMID: 27995940 DOI: 10.1038/sc.2016.170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 10/21/2016] [Accepted: 10/29/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Methodological validation of dual-energy x-ray absorptiometry (DXA)-based measures of leg bone mineral density (BMD) based on the guidelines of the International Society for Clinical Densitometry. OBJECTIVES The primary objective of this study was to determine the precision of BMD estimates at the knee and heel using the manufacturer provided DXA acquisition algorithm. The secondary objective was to determine the smallest change in DXA-based measurement of BMD that should be surpassed (least significant change (LSC)) before suggesting that a biological change has occurred in the distal femur, proximal tibia and calcaneus. SETTING Academic Research Centre, Canada. METHODS Ten people with motor-complete SCI of at least 2 years duration and 10 people from the general population volunteered to have four DXA-based measurements taken of their femur, tibia and calcaneus. BMDs for seven regions of interest (RIs) were calculated, as were short-term precision (root-mean-square (RMS) standard deviation (g cm-2), RMS-coefficient of variation (RMS-CV, %)) and LSC. RESULTS Overall, RMS-CV values were similar between SCI (3.63-10.20%, mean=5.3%) and able-bodied (1.85-5.73%, mean=4%) cohorts, despite lower absolute BMD values at each RIs in those with SCI (35%, heel to 54%, knee; P<0.0001). Precision was highest at the calcaneus and lowest at the femur. Except at the femur, RMS-CV values were under 6%. CONCLUSIONS For DXA-based estimates of BMD at the distal femur, proximal tibia and calcaneus, these precision values suggest that LSC values >10% are needed to detect differences between treated and untreated groups in studies aimed at reducing bone mineral loss after SCI.
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Affiliation(s)
- W T Peppler
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | - W J Kim
- Faculty of Science, University of Manitoba, Winnipeg, MB, Canada
| | - K Ethans
- Section of Physical Medicine and Rehabilitation, Department of Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - K C Cowley
- Department of Physiology and Pathophysiology, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Kim WJ, Ji Y, Choi G, Kang YM, Yang S, Moon BC. Molecular identification and phylogenetic analysis of important medicinal plant species in genus Paeonia based on rDNA-ITS, matK, and rbcL DNA barcode sequences. Genet Mol Res 2016; 15:gmr8472. [PMID: 27525917 DOI: 10.4238/gmr.15038472] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study was performed to identify and analyze the phylogenetic relationship among four herbaceous species of the genus Paeonia, P. lactiflora, P. japonica, P. veitchii, and P. suffruticosa, using DNA barcodes. These four species, which are commonly used in traditional medicine as Paeoniae Radix and Moutan Radicis Cortex, are pharmaceutically defined in different ways in the national pharmacopoeias in Korea, Japan, and China. To authenticate the different species used in these medicines, we evaluated rDNA-internal transcribed spacers (ITS), matK and rbcL regions, which provide information capable of effectively distinguishing each species from one another. Seventeen samples were collected from different geographic regions in Korea and China, and DNA barcode regions were amplified using universal primers. Comparative analyses of these DNA barcode sequences revealed species-specific nucleotide sequences capable of discriminating the four Paeonia species. Among the entire sequences of three barcodes, marker nucleotides were identified at three positions in P. lactiflora, eleven in P. japonica, five in P. veitchii, and 25 in P. suffruticosa. Phylogenetic analyses also revealed four distinct clusters showing homogeneous clades with high resolution at the species level. The results demonstrate that the analysis of these three DNA barcode sequences is a reliable method for identifying the four Paeonia species and can be used to authenticate Paeoniae Radix and Moutan Radicis Cortex at the species level. Furthermore, based on the assessment of amplicon sizes, inter/intra-specific distances, marker nucleotides, and phylogenetic analysis, rDNA-ITS was the most suitable DNA barcode for identification of these species.
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Affiliation(s)
- W J Kim
- K-herb Research Center, Korea Institute of Oriental Medicine, Yuseong-daero, Yuseong-gu, Daejeon, Republic of Korea
| | - Y Ji
- K-herb Research Center, Korea Institute of Oriental Medicine, Yuseong-daero, Yuseong-gu, Daejeon, Republic of Korea
| | - G Choi
- K-herb Research Center, Korea Institute of Oriental Medicine, Yuseong-daero, Yuseong-gu, Daejeon, Republic of Korea
| | - Y M Kang
- K-herb Research Center, Korea Institute of Oriental Medicine, Yuseong-daero, Yuseong-gu, Daejeon, Republic of Korea
| | - S Yang
- K-herb Research Center, Korea Institute of Oriental Medicine, Yuseong-daero, Yuseong-gu, Daejeon, Republic of Korea
| | - B C Moon
- K-herb Research Center, Korea Institute of Oriental Medicine, Yuseong-daero, Yuseong-gu, Daejeon, Republic of Korea
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Kang WH, Hwang S, Song GW, Jung DH, Kim KH, Park GC, Ha TY, Ahn CS, Moon DB, Yoon YI, Shin MH, Kim WJ, Kim SH, Lee SG. Donor Safety and Recipient Liver Function After Right-Lobe Liver Transplantation From Living Donors With Gilbert Syndrome. Transplant Proc 2016; 47:2827-30. [PMID: 26707296 DOI: 10.1016/j.transproceed.2015.10.050] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/28/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Donor safety is the most important aspect in living-donor liver transplantation (LDLT). Gilbert syndrome is an autosomal recessive condition that is a common cause of isolated unconjugated hyperbilirubinemia, and its prevalence is not negligibly low in the general population. This study intended to assess donor safety and recipient liver function after LDLT with the use of right liver grafts from living donors with Gilbert syndrome. METHODS Among 2,140 right liver transplantations performed from January 2002 to December 20113 at our institution, we identified 12 living donors (0.6%) who showed a preoperative serum total bilirubin level of ≥2 mg/dL. These donors were clinically diagnosed with Gilbert syndrome. The clinical outcomes of these donors and their recipients were analyzed retrospectively. RESULTS The mean donor age was 24.6 ± 7.1 years, and 11 donors were male. All subjects met the preoperative evaluation conditions for right liver donation except for the level of unconjugated hyperbilirubinemia. The mean serum total bilirubin level of the donors was 2.23 ± 0.20 mg/dL before and 1.79 ± 0.61 mg/dL 1 year after right liver donation. The preoperative donor direct bilirubin level was 0.43 ± 0.19 mg/dL. The preoperative indocyanine green retention rate at 15 minutes was 8.2 ± 2.8%. All donors and recipients recovered uneventfully and were alive at the time of writing. The recipient serum total bilirubin level was 1.29 ± 0.47 mg/dL 1 year after LDLT. CONCLUSIONS We suggest that LDLT with living donors with Gilbert syndrome can be safely performed, but that a meticulous preoperative evaluation is vital to maximize donor safety.
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Affiliation(s)
- W H Kang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - G W Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - D H Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - K H Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G C Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - T Y Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - C S Ahn
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - D B Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Y I Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M H Shin
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - W J Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S H Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S G Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sung JH, Kim SH, Yang WI, Kim WJ, Moon JY, Kim IJ, Cha DH, Cho SY, Kim JO, Kim KA, Kim OJ, Lim SW, Kim NK. miRNA polymorphisms (miR-146a, miR-149, miR-196a2 and miR-499) are associated with the risk of coronary artery disease. Mol Med Rep 2016; 14:2328-42. [DOI: 10.3892/mmr.2016.5495] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 06/01/2016] [Indexed: 11/06/2022] Open
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Kim WJ, Kwon CH, Han S, Lee WS, Kang JW, Ahn JM, Lee JY, Park DW, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park SJ. Role of Coronary Artery Calcium Scoring in Detection of Coronary Artery Disease according to Framingham Risk Score in Populations with Low to Intermediate Risks. J Korean Med Sci 2016; 31:902-8. [PMID: 27247499 PMCID: PMC4853669 DOI: 10.3346/jkms.2016.31.6.902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 03/28/2016] [Indexed: 11/25/2022] Open
Abstract
Current guidelines recommend that coronary artery calcium (CAC) screening should only be used for intermediate risk groups (Framingham risk score [FRS] of 10%-20%). The CAC distributions and coronary artery disease (CAD) prevalence in various FRS strata were determined. The benefit to lower risk populations of CAC score-based screening was also assessed. In total, 1,854 participants (aged 40-79 years) without history of CAD, stroke, or diabetes were enrolled. CAC scores of > 0, ≥ 100, and ≥ 300 were present in 33.8%, 8.2%, and 2.9% of the participants, respectively. The CAC scores rose significantly as the FRS grew more severe (P < 0.01). The total CAD prevalence was 6.1%. The occult CAD prevalence in the FRS ≤ 5%, 6%-10%, 11%-20%, and > 20% strata were 3.4%, 6.7%, 9.0%, and 11.6% (P < 0.001). In multivariate logistic regression analysis adjusting, not only the intermediate and high risk groups but also the low risk (FRS 6%-10%) group had significantly increased odds ratio for occult CAD compared to the very low-risk (FRS ≤ 5%) group (1.89 [95% confidence interval, CI, 1.09-3.29] in FRS 6%-10%; 2.48 [95% CI, 1.47-4.20] in FRS 11%-20%; and 3.10 [95% CI, 1.75-5.47] in FRS > 20%; P < 0.05). In conclusion, the yield of screening for significant CAC and occult CAD is low in the very low risk population but it rises in low and intermediate risk populations.
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Affiliation(s)
- Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Chang Hee Kwon
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Korea
| | - Woo Seok Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon Won Kang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong-Young Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Jung JY, Woo SM, Kim WJ, Lee BN, Nör JE, Min KS, Choi CH, Koh JT, Lee KJ, Hwang YC. Simvastatin inhibits the expression of inflammatory cytokines and cell adhesion molecules induced by LPS in human dental pulp cells. Int Endod J 2016; 50:377-386. [PMID: 27003335 DOI: 10.1111/iej.12635] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 04/22/2015] [Accepted: 03/17/2016] [Indexed: 11/30/2022]
Abstract
AIM To investigate the effect of simvastatin on lipopolysaccharide (LPS)-stimulated inflammatory cytokines, cell adhesion molecules and nuclear factor-κB (NF-κB) transcription factors in human dental pulp cells (HDPCs). METHODOLOGY The effect of LPS and simvastatin on human dental pulp cell (HDPCs) viability was measured using a 3-[4, 5-dimethylthiazol-2-yl]-2, 5 diphenyltetrazolium bromide (MTT) assay. The expression of inflammatory cytokines and cell adhesion molecules was evaluated by reverse-transcription polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay (ELISA) and Western blot analysis. NF-κB transcription factors were evaluated by Western blot analysis. Statistical analysis was performed with analysis of variance (anova). RESULTS The viability of cells exposed to different concentrations of E. coli LPS, P. gingivalis LPS and simvastatin was not significantly different compared with that of control cells (P > 0.05). LPS significantly increased interleukin (IL)-1β (P < 0.05) and IL-6 mRNA expression (P < 0.05) and vascular cell adhesion molecule-1 (VCAM-1) (P < 0.05) and intercellular adhesion molecule-1 (ICAM-1) protein expression (P < 0.05) in HDPCs. Treatment with simvastatin significantly attenuated LPS-stimulated production of IL-1β, IL-6, VCAM-1 and ICAM-1 (P < 0.05). Treatment with simvastatin decreased LPS-induced expression of p65 and phosphorylation of IκB and also significantly decreased the phosphorylation of p65 and IκB in the cytoplasm and the level of p65 in the nucleus (P < 0.05). CONCLUSIONS Simvastatin has a suppressing effect on LPS-induced inflammatory cytokine, cell adhesion molecules and NF-κB transcription factors in HDPCs. Therefore, simvastatin might be a useful candidate as a pulp-capping agent in vital pulp therapy.
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Affiliation(s)
- J Y Jung
- Department of Physiology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - S M Woo
- Department of Physiology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - W J Kim
- Department of Physiology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea.,Research Center for Biomineralization Disorders, Chonnam National University, Gwangju, Korea
| | - B N Lee
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - J E Nör
- Angiogenesis Research Laboratory, Department of Cariology, Restorative Sciences, Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - K S Min
- Department of Conservative Dentistry, School of Dentistry, Chonbuk National University, Jeonju, Korea
| | - C H Choi
- Department of Preventive and Public Health Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - J T Koh
- Research Center for Biomineralization Disorders, Chonnam National University, Gwangju, Korea
| | - K J Lee
- Department of Convergence Medicine, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Y C Hwang
- Research Center for Biomineralization Disorders, Chonnam National University, Gwangju, Korea.,Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
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Moon BC, Kim WJ, Ji Y, Lee YM, Kang YM, Choi G. Molecular identification of the traditional herbal medicines, Arisaematis Rhizoma and Pinelliae Tuber, and common adulterants via universal DNA barcode sequences. Genet Mol Res 2016; 15:gmr7064. [PMID: 26909979 DOI: 10.4238/gmr.15017064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Methods to identify Pinelliae Tuber and Arisaematis Rhizoma are required because of frequent reciprocal substitution between these two herbal medicines and the existence of several closely related plant materials. As a result of the morphological similarity of dried tubers, correct discrimination of authentic herbal medicines is difficult by conventional methods. Therefore, we analyzed DNA barcode sequences to identify each herbal medicine and the common adulterants at a species level. To verify the identity of these herbal medicines, we collected five authentic species (Pinellia ternata for Pinelliae Tuber, and Arisaema amurense, A. amurense var. serratum, A. erubescens, and A. heterophyllum for Arisaematis Rhizoma) and six common adulterant plant species. Maturase K (matK) and ribulose-1,5-bisphosphate carboxylase/oxygenase large subunit (rbcL) genes were then amplified using universal primers. In comparative analyses of two DNA barcode sequences, we obtained 45 species-specific nucleotides sufficient to identify each species (except A. erubescens with matK) and 28 marker nucleotides for each species (except P. pedatisecta with rbcL). Sequence differences at corresponding positions of the two combined DNA barcodes provided genetic marker nucleotides that could be used to identify specimens of the correct species among the analyzed medicinal plants. Furthermore, we generated a phylogenetic tree showing nine distinct groups depending on the species. These results can be used to authenticate Pinelliae Tuber and Arisaematis Rhizoma from their adulterants and to identify each species. Thus, comparative analyses of plant DNA barcode sequences identified useful genetic markers for the authentication of Pinelliae Tuber and Arisaematis Rhizoma from several adulterant herbal materials.
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Affiliation(s)
- B C Moon
- K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - W J Kim
- K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Y Ji
- K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Y M Lee
- K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Y M Kang
- K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - G Choi
- K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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Han SS, Kim S, Lee SJ, Kim WJ, Hong Y, Lee HY. Clinical characteristics and prognostic factors in patients with pulmonary tuberculosis as a primary cause of respiratory failure admitted to intensive care units. Intensive Care Med Exp 2015. [PMCID: PMC4797566 DOI: 10.1186/2197-425x-3-s1-a383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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48
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Choi HY, Kim WJ. Effect of thermal treatment on the bio-corrosion and mechanical properties of ultrafine-grained ZK60 magnesium alloy. J Mech Behav Biomed Mater 2015; 51:291-301. [PMID: 26275491 DOI: 10.1016/j.jmbbm.2015.07.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 11/17/2022]
Affiliation(s)
- H Y Choi
- Department of Materials Science and Engineering, Hongik University, Mapo-gu, Sangsu-dong 72-1, Seoul 121-791, South Korea
| | - W J Kim
- Department of Materials Science and Engineering, Hongik University, Mapo-gu, Sangsu-dong 72-1, Seoul 121-791, South Korea.
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Kim WJ, Lee E, Kim KR, Namkoong K, Park ES, Rha DW. Progress of PTSD symptoms following birth: a prospective study in mothers of high-risk infants. J Perinatol 2015; 35:575-9. [PMID: 25856762 DOI: 10.1038/jp.2015.9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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: 09/26/2014] [Revised: 01/03/2015] [Accepted: 01/20/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To understand how postpartum posttraumatic stress disorder (PTSD) symptoms in mothers of high-risk infants progress and identify what factors predict postpartum PTSD. STUDY DESIGN We prospectively obtained self-reported psychological data from neonatal intensive care unit discharged infants' mothers (NICU mothers) at the infants' corrected ages of 1 (T0), 3 (T1) and 12 months (T2) and mothers of healthy infants (controls). Maternal sociodemographic and infant-related factors were also investigated. RESULT PTSD was present in 25 and 9% of NICU mothers and controls, respectively. We identified four PTSD patterns: none, persistent, delayed and recovered. The postpartum PTSD course was associated with trait anxiety. Whether the infant was the first child who predicted PTSD at year 1 (adjusted odds ratio=7.62, 95% confidence interval=1.07 to 54.52). CONCLUSION Mothers of high-risk infants can develop early or late PTSD, and its course can be influenced by factors besides medical status. We therefore recommend regular screenings of postpartum PTSD.
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Affiliation(s)
- W J Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - E Lee
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - K R Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - K Namkoong
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - E S Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - D-w Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
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50
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Kim WJ, Ko YG, Han S, Kim YH, Dy TC, Posas FEB, Lee MKY, Kim HS, Hong MK, Jang Y, Grube E, Park SJ. Predictors of Permanent Pacemaker Insertion Following Transcatheter Aortic Valve Replacement With the CoreValve Revalving System Based on Computed Tomography Analysis: An Asian Multicenter Registry Study. J Invasive Cardiol 2015; 27:334-340. [PMID: 26136283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND To determine predictive variables for permanent pacemaker (PPM) insertion after transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS). METHODS AND RESULTS A total of 121 patients with severe aortic stenosis (AS) were recruited from six Asian medical centers between March 2010 and May 2013. Four patients with preexisting PPM were excluded. The mean age of the remaining 117 patients was 81.2 ± 5.1 years. Twenty-three patients (19.7%) required post-TAVR PPM, with a median time-to-insertion of 7 days (interquartile range, 5-13 days). Two variables were identified as independent predictors of PPM: (1) device depth from the non-coronary cusp (NCC) (odds ratio [OR], 1.263; P=.02) determined by aortic root angiography; and (2) the perimeter stretching index (OR, 1.584; P<.001) determined by computed tomography. The predictive cut-off values were as follows: a perimeter stretching index >1.13 (P<.001) and a device depth from the NCC >7.8 mm (P<.001). The diagnostic accuracy of these variables was 93.2% and 71%, respectively. CONCLUSION Depth of the device from the NCC and the perimeter stretching index are independent predictors of PPM insertion after CRS-TAVR.
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Affiliation(s)
- Won-Jang Kim
- Department of Cardiology, University of Ulsan College of Medicine, Cardiac Center, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736 Korea.
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