Seung-Jea Tahk

Ajou University, Sŏul, Seoul, South Korea

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Publications (107)412.86 Total impact

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    ABSTRACT: We conducted a randomised, double blind, placebo controlled trial to assess the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase 3, in patients with vasospastic angina (VSA).
    Heart (British Cardiac Society) 06/2014; · 5.01 Impact Factor
  • Circulation journal : official journal of the Japanese Circulation Society. 05/2014;
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    ABSTRACT: We aimed to investigate whether combination therapy using intracoronary (IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusion compared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We enrolled 40 patients with STEMI, who presented within 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5. IMR was lower in the combination group than in the IC abciximab group (23.5±7.4 U vs. 66.9±48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5±7.4 U vs. 37.2±26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximab group (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9±48.7 U vs. 37.2±26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively). Combination treatment using IC abciximab and AT may synergistically improve myocardial perfusion in patients with STEMI undergoing primary PCI (Trial Registration: clinicaltrials. gov Identifier: NCT01404507).
    Yonsei medical journal 05/2014; 55(3):606-16. · 0.77 Impact Factor
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    ABSTRACT: Besides poor clinical outcomes, female gender has been known as a high-risk factor for bleeding complications. This study aimed to investigate the impact of gender on clinical outcomes and bleeding complications after transradial coronary intervention (TRI). The Korean TRI registry is a retrospective multicenter registry with 4,890 patients who underwent percutaneous coronary intervention in 2009 at 12 centers. To compare clinical outcomes and bleeding complications between the male and female groups, we performed a propensity score matching in patients who received TRI. A total of 1,194 patients (597 in each group) were studied. The primary outcome was 1-year major adverse cardiac events, including all-cause mortality, myocardial infarction, target vessel revascularization, and stroke. The secondary outcome was major bleeding (composite of bleeding requiring transfusion of ≥2 units of packed cells or bleeding that was fatal). The proportion of major adverse cardiac events was similar between the 2 groups (6.2% vs 4.7%, p = 0.308). The female group had a greater incidence of major bleeding (0.3% vs 3.2%, p <0.001). On multivariate analysis, female gender (odds ratio [OR] 7.748, 95% confidence interval [CI] 1.767 to 13.399), age ≥75 years (OR 5.824, 95% CI 2.085 to 16.274), and chronic kidney disease (OR 7.264, 95% CI 2.369 to 12.276) were independent predictors of major bleeding. In conclusion, the female gender had a tendency for more bleeding complications than male gender after TRI without difference in the clinical outcome.
    The American journal of cardiology 04/2014; · 3.58 Impact Factor
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    ABSTRACT: Objective: We aimed to assess the ideal cut-off value of minimal lumen area (MLA) by intravascular ultrasound (IVUS) and its diagnostic performance to predict ischemia, using a large-scale, pooled analysis. Methods: Eleven centers worldwide were invited to provide their clinical, IVUS and fractional flow reserve (FFR) data. A total of 881 lesions were enrolled. Results: Angiographic % diameter stenosis (r = -0.373, p < 0.0001) and IVUS MLA (r = 0.289, p < 0.0001) correlated with FFR. Best cut-off value (BCV) of IVUS MLA to define the functional significance (FFR <0.8) was 2.75 mm(2) (AUC 0.646, 95% CI 0.609-0.684). When the diagnostic performance of IVUS MLA was tested according to the lesion location, BCV could be found only in lesions in the proximal artery and the mid-left anterior descending artery. Interestingly, Asians (n = 623) and Westerners (n = 258) showed different demographic and lesion characteristics as well as different BCVs to define ischemia. The BCV for the proximal/mid-left anterior descending artery lesions was 2.75 mm(2) (AUC 0.688, 95% CI 0.635-0.742) in Asians and 3.0 mm(2) (AUC 0.695, 95% CI 0.605-0.786) in Westerners. Conclusion: In this pooled analysis, an IVUS MLA of 2.75 mm(2) was the BCV to define the functional significance of intermediate coronary stenosis. However, when IVUS MLA is used to determine the functional significance, both the lesion and patient characteristics should be considered. © 2014 S. Karger AG, Basel.
    Cardiology 01/2014; 127(4):256-262. · 1.52 Impact Factor
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    ABSTRACT: In some patients with nonischemic idiopathic dilated cardiomyopathy (DCM), left ventricular (LV) dysfunction improves spontaneously but can recur. The factors predicting recurrence of LV dysfunction in recovered idiopathic DCM are poorly defined. We investigated the clinical, echocardiographic, and laboratory variables affecting recurrence of LV dysfunction in patients who recovered from DCM. The recurrence of LV dysfunction in recovered idiopathic DCM is impacted by clinical, echocardiographic, and laboratory variables. The study comprised 85 consecutively enrolled patients (62 males, age 57 ± 16 years) with DCM who achieved a restoration of LV systolic function. Patients were followed up for 50 ± 33 months after recovery from LV dysfunction without discontinuation of standard medication for heart failure with depressed ejection fraction. Clinical, echocardiographic, and laboratory variables were analyzed to identify factors independently associated with recurrence of LV dysfunction. LV dysfunction recurred in 33 patients (23 males, age 64 ± 12 years). Univariate analysis revealed that age, duration from initial presentation to recovery time, diabetes, and LV end-diastolic dimension (LVEDD) at initial presentation were associated with recurrence of LV dysfunction. Multivariate analysis revealed that only age, diabetes, and LVEDD at initial presentation were independent predictors in patients who recovered from LV dysfunction. The recurrence of LV dysfunction was significantly correlated with age, presence of diabetes, and LVEDD at initial presentation. Clinicians should consider maintenance of intensive care to patients who recovered from DCM with these factors.
    Clinical Cardiology 01/2014; · 1.83 Impact Factor
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    ABSTRACT: Objectives The authors sought to investigate whether the impact of treatment strategies on clinical outcomes differed between patients with left main (LM) bifurcation lesions and those with non-LM bifurcation lesions. Background Few studies have considered anatomic location when comparing 1- and 2-stent strategies for bifurcation lesions. Methods We compared the prognostic impact of treatment strategies on clinical outcomes in 2,044 patients with non-LM bifurcation lesions and 853 with LM bifurcation lesions. The primary outcome was target lesion failure (TLF) defined as a composite of cardiac death, myocardial infarction (MI), and target lesion revascularization. Results The 2-stent strategy was used more frequently in the LM bifurcation group than in the non-LM bifurcation group (40.3% vs. 20.8%, p < 0.01). During a median follow-up of 36 months, the 2-stent strategy was not associated with a higher incidence of cardiac death (hazard ratio [HR]: 1.24; 95% confidence interval [CI]: 0.72 to 2.14; p = 0.44), cardiac death or MI (HR: 1.12; 95% CI: 0.58 to 2.19; p = 0.73), or TLF (HR: 1.39; 95% CI: 0.99 to 1.94; p = 0.06) in the non-LM bifurcation group. In contrast, in patients with LM bifurcation lesions, the 2-stent strategy was associated with a higher incidence of cardiac death (HR: 2.43; 95% CI: 1.05 to 5.59; p = 0.04), cardiac death or MI (HR: 2.09; 95% CI: 1.08 to 4.04; p = 0.03), as well as TLF (HR: 2.38; 95% CI: 1.60 to 3.55; p < 0.01). Significant interactions were present between treatment strategies and bifurcation lesion locations for TLF (p = 0.01). Conclusions The 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of coronary bifurcation lesions, especially LM bifurcation lesions. (Korean Coronary Bifurcation Stenting [COBIS] Registry II; NCT01642992)
    JACC Cardiovascular Interventions 01/2014; · 7.42 Impact Factor
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    ABSTRACT: We report a rare case of thrombus formation in normal aorta causing myocardial infarction. A 44-year-old man who had no prothrombotic risk factors presented with acute myocardial infarction. Two-dimensional echocardiography revealed a hypoechoic homogenous mass occupying the left coronary sinus and attached at the nonatherosclerotic aorta. The mass seemed to cause myocardial infarction by occluding the left anterior descending artery with oscillating movement according to the cardiac cycles. After surgical resection, the histopathologic examination revealed the mass as an organized thrombus. This case implies that an aortic mural thrombus can form in a nonatherosclerotic aorta without any prothrombotic risk factors.
    The Canadian journal of cardiology 11/2013; · 3.12 Impact Factor
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    ABSTRACT: Objective. Epicardial adipose tissue (EAT), deposited around subepicardial coronary vessels, may contribute directly to perivascular inflammation and smooth muscle cell proliferation. This study assessed the relationship between EAT and in-stent restenosis. Methods. Four hundred and seven patients had received successful coronary intervention. EAT thickness was measured by echocardiography. Angiographic follow-up was obtained between 6 months and 2 years. Restenosis was defined as target lesion revascularization (TLR). EAT thickness of patients was compared by TLR controlling for additional well-known predictors of restenosis. The TLR-free survival analysis according to EAT thickness was estimated using the Kaplan-Meier method and the differences between groups were assessed by the log-rank test. Results. Median EAT thickness was significantly increased in patients undergoing TLR compared with those without restenosis (3.7 vs. 3.0 mm, p = 0.001). EAT thickness was one of the independent factors associated with restenosis (Odds ratio = 1.19, 95% confidence interval = 1.01-1.33, p = 0.007). The TLR-free survival of patients with thick EAT was significantly worse than patients with thin EAT (log-rank p = 0.001). Conclusions. EAT thickness is related with restenosis and may provide additional information for future restenosis.
    Scandinavian cardiovascular journal: SCJ 08/2013; · 1.07 Impact Factor
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    ABSTRACT: This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. SB occlusion is a serious complication during percutaneous coronary intervention (PCI) for bifurcation lesions. Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3. SB occlusion occurred in 187 (8.4%) of 2227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were preprocedural percent diameter stenosis of the SB ≥50% (odds ratio [OR] 2.34; 95% confidence interval [CI] 1.59-3.43; p<0.001) and the proximal MV ≥50% (OR 2.34; 95% CI 1.57-3.50; p<0.001), SB lesion length (OR 1.03; 95% CI 1.003-1.06; p=0.03), and acute coronary syndrome (OR 1.53; 95% CI 1.06-2.19; p=0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%), but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% versus 57.8%, p=0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than those without SB occlusion (adjusted hazard ratio 2.34; 95% CI 1.15-4.77; p=0.02). Angiographic findings of the SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes.
    Journal of the American College of Cardiology 08/2013; · 14.09 Impact Factor
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    ABSTRACT: We evaluated the effectiveness of genotype- and phenotype-directed individualization of P2Y12 inhibitors to decrease high on-treatment platelet reactivity (HOPR). Sixty-five patients undergoing percutaneous coronary intervention for non-ST elevation acute coronary syndromes were randomly assigned to genotype- or phenotype-directed treatment. All patients were screened for CYP2C19(*)2, (*)3, or (*)17 alleles by using the Verigene CLO assay (Nanosphere, Northbrook, IL, USA). The P2Y12 reaction unit (PRU) was measured using the VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA). 21 CYP2C19 (*)2 or (*)3 carriers (65.6%) and 11 patients with HOPR (33.3%), defined as a PRU value ≥230, were given 90 mg ticagrelor twice daily; non-carriers and patients without HOPR were given 75 mg clopidogrel daily. The primary endpoint was the percentage of patients with HOPR after 30 days of treatment. PRU decreased following both genotype- and phenotype-directed therapies (242±83 vs. 109±90, p<0.001 in the genotype-directed group; 216±74 vs. 109±90, p=0.001 in the phenotype-directed group). Five subjects (16.2%) in the genotype-directed group and one (3.3%) in the phenotype-directed group had HOPR at day 30 (p=0.086). All patients with HOPR at the baseline who received ticagrelor had a PRU value of <230 after 30 days of treatment. Conversely, clopidogrel did not lower the number of patients with HOPR at the baseline. Tailored antiplatelet therapy according to point-of-care genetic and phenotypic testing may be effective in decreasing HOPR after 30 days.
    Korean Circulation Journal 08/2013; 43(8):541-9.
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    ABSTRACT: Objectives: The objective of this study was to assess the relationship between intravascular ultrasound (IVUS) parameters, including volumetric analysis, and fractional flow reserve (FFR). Background: Although it is known that coronary atherosclerosis burden measured by IVUS volumetric analysis is related with clinical outcomes, its relationship with functional significance remains unknown. Methods: Both IVUS and FFR were performed in 206 cases of intermediate stenosis of the left anterior descending artery (LAD). Myocardial ischemia was assessed by FFR and maximal hyperemia was induced by continuous intracoronary adenosine infusion. FFR < 0.80 was considered as significant inducible myocardial ischemia. We performed standard IVUS parameter measurements and volumetric analyses. IVUS parameter comparison was performed in the presence (n=90) or absence (n=116) of significant myocardial ischemia. Results: Lesions with minimal lumen area (MLA) ≥4.0mm(2) had FFR ≥0.80 in 91.4% of cases, while 50.9% of lesions with MLA <4.0mm(2) had FFR <0.80. The independent predictors of FFR <0.80 were IVUS lesion length (odds ratio [OR]: 1.1, 95% confidence interval [CI] =1.06-1.18, p<0.001) and MLA significance according to the lesion location (OR: 7.01, 95% CI =3.09-15.92, p=0.001). FFR correlated with plaque volume (r= -0.345, p<0.001) and percent atheroma volume (PAV) (r=-0.398, p<0.001). Lesions with significant ischemia (FFR <0.80) as compared to those with FFR >0.80 were associated with larger plaque volume (181.8±82.3 vs. 125.9±77.9 mm(3) , p<0.001) and PAV (58.9±5.6 vs. 53.8± 7.9 %, p<0.001).Conclusions: IVUS parameters representing severity and extent of atheromatous plaque correlated with functional significance in LAD lesions with intermediate stenosis. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 06/2013; · 2.51 Impact Factor
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    ABSTRACT: The electrocardiogram manifestations of hypothermia include J waves and prolongation of QT intervals. This study described changes in repolarization patterns during therapeutic hypothermia (TH). We measured the QTc and the interval from the peak to the end of the T wave (TpTe) from the V4 and V6 leads in 20 patients with TH. The TpTe was also expressed as a ratio to the duration of QT ([TpTe/QT]×100%), and to the corrected value for heart rate (TpTe/√RR). The QTc became prolonged in all patients during TH. While the TpTe/√RR did not change, the ([TpTe/QTe]×100%] decreased significantly during TH. The J wave developed during TH in seven patients. With one patient, ventricular fibrillation occurred preceded by an abnormal J wave and prolonged TpTe during TH. QTc prolongation without TpTe increase or abnormal J wave may not be arrhythmogenic during TH.
    Journal of electrocardiology 06/2013; · 1.08 Impact Factor
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    ABSTRACT: An early repolarization (ER) pattern on electrocardiogram (ECG) sometimes has the risk of polymorphic ventricular tachycardia (PVT) or ventricular fibrillation (VF). An abnormal ER pattern can develop in various experimental or clinical situations. We experienced 4 cases of abnormal ER pattern with or without PVT during the radiofrequency (RF) ablation of the left accessory pathway. An electrophysiologic study and RF ablation were performed in 4 patients. Four patients had atrioventricular reentrant tachycardia. During RF ablation of the left accessory pathway, severe chest pain developed and was followed by abnormal J-point elevation. During the ongoing chest pain and J-point elevation, coronary angiograms showed normal findings. The chest pain and J-point elevation were followed by PVT or VF that was unresponsive to defibrillation. The PVT was spontaneously terminated and repeated. After 0.5 mg atropin was given, chest pain and ECG change disappeared. The mechanisms of ER syndrome during RF ablation might be increased vagal tone due to chest pain or direct vagal stimulation.
    Journal of Cardiovascular Electrophysiology 06/2013; · 3.48 Impact Factor
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    ABSTRACT: Compared with ST elevation myocardial infarction (STEMI), long-term outcomes are known to be worse in patients with unstable angina/non-STEMI (UA/NSTEMI), which might be related to the worse health status of patients with UA/STEMI. In patients with UA/NSTEMI and STEMI underwent percutaneous coronary intervention (PCI), angina-specific and general health-related quality-of-life (HRQOL) was investigated at baseline and at 30 days after PCI. Patients with UA/NSTEMI were older and had higher frequencies in female, diabetes and hypertension. After PCI, both angina-specific and general HRQOL scores were improved, but improvement was much more frequent in angina-related HRQOL of patients with UA/NSTEMI than those with STEMI (44.2% vs 36.8%, P < 0.001). Improvement was less common in general HRQOL. At 30-days after PCI, angina-specific HRQOL of the patients with UA/NSTEMI was comparable to those with STEMI (56.1 ± 18.6 vs 56.6 ± 18.7, P = 0.521), but general HRQOL was significantly lower (0.86 ± 0.21 vs 0.89 ± 0.17, P = 0.001) after adjusting baseline characteristics (P < 0.001). In conclusion, the general health status of those with UA/NSTEMI was not good even after optimal PCI. In addition to angina-specific therapy, comprehensive supportive care would be needed to improve the general health status of acute coronary syndrome survivors.
    Journal of Korean medical science 06/2013; 28(6):848-54. · 0.84 Impact Factor
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    ABSTRACT: Trans-radial (TR) approach is increasingly recognized as an alternative to the routine use of trans-femoral (TF) approach. However, there are limited data comparing the outcomes of these two approaches for the treatment of coronary bifurcation lesions. We evaluated outcomes of TR and TF percutaneous coronary interventions (PCI) in this complex lesion. Procedural outcomes and clinical events were compared in 1,668 patients who underwent PCI for non-left main bifurcation lesions, according to the vascular approach, either TR (n = 503) or TF (n = 1,165). The primary outcome was major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) in all patients and in 424 propensity-score matched pairs of patients. There were no significant differences between TR and TF approaches for procedural success in the main vessel (99.6% vs 98.6%, P = 0.08) and side branches (62.6% vs 66.7%, P = 0.11). Over a mean follow-up of 22 months, cardiac death or MI (1.8% vs 2.2%, P = 0.45), TLR (4.0% vs 5.2%, P = 0.22), and MACE (5.2% vs 7.0%, P = 0.11) did not significantly differ between TR and TF groups, respectively. These results were consistent after propensity score-matched analysis. In conclusion, TR PCI is a feasible alternative approach to conventional TF approaches for bifurcation PCI (clinicaltrials.gov number: NCT00851526).
    Journal of Korean medical science 03/2013; 28(3):388-95. · 0.84 Impact Factor
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    ABSTRACT: We assessed the ethnic differences in coronary atherosclerosis lesion morphology between white and Asian patients. Our hypothesis was that left main coronary artery (LMCA) disease was more focal and less complex in Asian than in Western white patients. We studied 99 Asian patients (Japan and South Korea) and 99 matched control United States white patients with a stable clinical presentation and >30% LMCA angiographic diameter stenosis by visual estimation. The matching parameters included age, gender, and diabetes mellitus. The vessel and lumen areas and calcium arc were analyzed every 0.5 mm and normalized for analysis length. Overall, 75.1% of the patients were men and 34.1% had diabetes. The patient age was 68.0 ± 10 years, with no differences between the Asian and white patients. The Asian patients had a lower prevalence of hyperlipidemia than the white patients (41.4% vs 81.8%; p <0.0001) and were smaller in size, and the white patients were more obese (body mass index 23.7 ± 2.6 vs 27.6 ± 4.1 kg/m(2), p <0.0001). The Asian patients had a smaller lumen area (5.2 ± 1.8 vs 6.2 ± 14 mm(2); p <0.0001), larger vessel area (20.0 ± 4.9 vs 18.4 ± 4.4 mm(2); p <0.0001), and larger plaque burden (72 ± 10 vs 64 ± 12%: p <0.0001) at the minimum lumen site and over the entire LMCA length. The white patients had more calcification, whether assessed by the maximum arc (82° ± 74° vs 49° ± 45°; p <0.0001) or total length (3.6 ± 3.2 vs 2.1 ± 2.1 mm; p <0.0001). In conclusion, after matching well-known risk factors, there appeared to be ethnic differences in coronary atherosclerosis morphology between Asian and white patients, at least as it affected LMCA morphology.
    The American journal of cardiology 01/2013; · 3.58 Impact Factor
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    ABSTRACT: The aim of this study is to assess the relationship of epicardial adipose tissue (EAT) and plaque vulnerability. We consecutively enrolled 82 patients with coronary artery disease (CAD). A symptom-related vessel was imaged by virtual histology intravascular ultrasound (VH-IVUS). In 60 out of 82 patients, all three vessels were studied by VH-IVUS. EAT thickness was measured by echocardiography. All patients were divided into thick (≥3.5 mm) and thin EAT groups (<3.5 mm). VH-IVUS parameters were compared according to the EAT group. To evaluate the independent effect of EAT thickness on plaque vulnerability, a set of well-known CAD risk factors and EAT thickness were included in multiple linear regression models of VH-IVUS parameters which denotes plaque vulnerability. In a symptom-related vessel analysis, the thick EAT group had significantly more thin-cap fibroatheromas (TCFAs). In a symptom-related vessel analysis among 62 patients with unstable angina out of 82 patients, the thick EAT group had significantly more thin-cap fibroatheromas (TCFAs). In all three vessels analysis, the thick EAT group was associated with significantly larger total plaque volume, higher total plaque volume index, higher mean plaque burden, higher plaque volume indexes of the necrotic core (NC), and more total number of TCFAs than the thin EAT group. By multivariate analysis, total TCFAs of a symptom-related vessel, both in total population and in patients with unstable angina, and plaque volume index of the NC of all three vessels were independent factors associated with thick EAT. In multiple linear regression models of VH-IVUS parameters which means plaque vulnerability, EAT thickness was one of the independent factors. In the present study, the VH-IVUS parameters indicating vulnerable plaque were significantly related with the thickness of EAT.
    Atherosclerosis 11/2012; · 3.71 Impact Factor
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    ABSTRACT: This study sought to investigate the clinical, electrocardiographic, and physiological relevance of main and side branches in coronary bifurcation lesions. Discrepancy exists between stenosis severity and clinical outcomes in bifurcation lesions. However, its mechanism has not been fully evaluated yet. Sixty-five patients with left anterior descending coronary artery (LAD) bifurcation lesions were prospectively enrolled. Chest pain and 12-lead electrocardiogram were assessed after 1-min occlusion of coronary flow and coronary wedge pressure (Pw) was measured using a pressure wire. ST-segment elevation was more frequent during LAD occlusion (92%) than during diagonal branch occlusion (37%) (p < 0.001). Pain score was also higher with the occlusion of LAD than with the diagonal branch (p < 0.001). However, both Pw and Pw/aortic pressure (Pa) were lower in the LAD than in diagonal branches (Pw: 21.0 ± 6.5 vs. 26.7 ± 9.4, p < 0.0001; Pw/Pa: 0.22 ± 0.07 vs. 0.27 ± 0.08, p = 0.001). The corrected QT interval was prolonged with LAD occlusion (435.0 ± 39.6 ms to 454.0 ± 45.4 ms, p < 0.0001) but not with diagonal branch occlusion. There was no difference in vessel size between the diagonal branches with and without ST-segment elevation during occlusion. Positive and negative predictive values of vessel size (≥2.5 mm) to determine the presence of ST-segment elevation were 48% and 72%, respectively. Diagonal branch occlusion caused fewer anginas, less electrocardiogram change, less arrhythmogenic potential, and higher Pw than did a LAD occlusion. These differences seem to be the main mechanism explaining why aggressive treatment for side branches has not translated into clinical benefit in coronary bifurcation lesions. (Comparison Between Main Branch and Side Branch Vessels; NCT01046409).
    JACC. Cardiovascular Interventions 11/2012; 5(11):1126-32. · 1.07 Impact Factor
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    ABSTRACT: Objectives: We aimed to compare long-term clinical outcomes between Modified mini-crush (modi-MC) technique with classic crush (Crush) technique for treatment of bifurcation lesions. Background: The Modi-MC technique showed excellent procedural success and favorable 9-month clinical outcomes. Methods: From Jan 2005 to Nov 2009, we enrolled patients with de novo bifurcation lesions treated with modi-MC (n=112 lesions in 111 patients) and Crush technique (n=69 lesions in 67 patients). Primary endpoint was rate of major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR) at 3 years. Results: There was no significant difference in baseline characteristics. The modi-MC technique showed a significantly higher success rate of final kissing balloon inflation (84.1% vs. 98.2%, p=0.001). After 3 years, MACE rate was significantly lower in the modi-MC group (25.4% vs. 12.6%, p =0.030). The incidence of all-cause death was 7.5% vs. 2.7% (p =0.087), MI was 4.5% vs. 1.8% (p =0.290), TLR was 17.4% vs. 8.9% (p =0.093) and stent thrombosis was 3.0% vs. 1.8% (p =0.632) in the Crush and modi-MC groups, respectively. Conclusions: The modified mini-crush technique showed more favorable 3-year clinical outcomes compared to the classic crush technique. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 08/2012; · 2.51 Impact Factor

Publication Stats

758 Citations
412.86 Total Impact Points

Institutions

  • 2004–2014
    • Ajou University
      • • Department of Cardiology
      • • Department of Medicine
      Sŏul, Seoul, South Korea
  • 2010–2013
    • Sungkyunkwan University
      • School of Medicine
      Seoul, Seoul, South Korea
  • 2005–2013
    • Catholic University of Korea
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2012
    • Inje University Paik Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
    • Ulsan University Hospital
      Urusan, Ulsan, South Korea
  • 2011–2012
    • Seoul National University Hospital
      • Department of Internal Medicine
      Seoul, Seoul, South Korea
    • Chonnam National University
      • Department of Internal Medicine
      Gwangju, Gwangju, South Korea
  • 2009–2012
    • Asan Medical Center
      • Department of Cardiology
      Seoul, Seoul, South Korea
  • 2007
    • Zhejiang University
      • School of Medicine
      Hangzhou, Zhejiang Sheng, China