M K Hong

Saint Luke's Hospital (NY, USA), New York City, New York, United States

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Publications (190)921.76 Total impact

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    ABSTRACT: TIMI frame count (TFC) provides a quantitative index of coronary microvascular dysfunction. Previous studies suggested the degree of frame count reserve (FCR) and slow coronary flow (SCF) correlated with microvascular dysfunction. We investigated the clinical implication of FCR and SCF for the evaluation of microvascular angina (MA). We included consecutive 77 patients with the complaint of chest pain, who subsequently had normal coronary angiography. TFC was obtained from left anterior descending artery. Intracoronary nitroprusside (15μg) was infused to induce hyperemia, and repeat angiogram was performed after 30seconds. FCR were calculated by dividing basal TFC by hyperemic TFC. SCF was defined as being present when TFC was more than 28. All patients underwent a treadmill test without medication after angiography. After the treadmill test, patients were divided into a MA group (40 patients) and a control group (37 patients). FCR were similar in both groups (2.0±1.0 and 2.1±0.9, MA and control group, respectively). However, hyperemic TFC induced by nitroprusside was significantly higher in the MA group (10.9±4.7) than in the control group (9.0±3.5, p<0.05). Patients who showed SCF had a significantly greater incidence of MA (78.5%; 11/14 patients) than that with normal coronary flow (46.0%; 29/63 patients, p<0.05). The higher hyperemic TFC and presence of SCF were found to have a diagnostic value for MA.
    Microvascular Research 02/2013; · 2.93 Impact Factor
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    ABSTRACT: Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.
    Journal of Korean medical science 02/2012; 27(2):211-4. · 0.84 Impact Factor
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    ABSTRACT: The efficacy of vein grafts used in coronary and peripheral artery bypass is limited by excessive hyperplasia and fibrosis that occur early after engraftment. In the present study, we sought to determine whether low-dose spironolactone alleviates maladaptive vein graft arterialization and alters intimal reaction to coronary artery stenting. Yorkshire pigs were randomized to treatment with oral spironolactone 25 mg daily or placebo. All animals underwent right carotid artery interposition grafting using a segment of external jugular vein and, 5 days later, underwent angiography of carotid and coronary arteries. At that time, a bare metal stent was placed in the left anterior descending artery and balloon angioplasty was performed on the circumflex coronary artery. Repeat carotid and coronary angiograms were performed before euthanasia and graft excision at 30 days. Angiography revealed that venous grafts of spironolactone-treated animals had lumen diameters twice the size of controls at 5 days, a finding that persisted at 30 days. However, neointima and total vessel wall areas also were 2- to 3-fold greater in spironolactone-treated animals, and there were no differences in vessel wall layer thicknesses or collagen and elastin densities. In the coronary circulation, there were no differences between treatment groups in any vessel wall parameters in either stented or unstented vessels. Taken together, these observations suggest that low-dose spironolactone may exert a novel protective effect on remodeling in venous arterial grafts that does not depend on the reduction of hyperplastic changes but may involve dilatation of the vessel wall.
    American journal of therapeutics 04/2009; 16(3):204-14. · 1.29 Impact Factor
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    ABSTRACT: Previously, we demonstrated that a novel opiate peptide, 2',6'-dimethyl-tyrosine-D-Arg-Phe-Lys-NH2, provided cardioprotection against myocardial stunning in vivo. We subsequently showed that this peptide targeted mitochondria and can scavenge reactive oxygen species. The objective of this study was to determine the role of opioid versus antioxidant activity in cardioprotection. We compared two mitochondria-targeted peptide analogs that lacked opioid activity: SS-31 (D-Arg-2',6'-dimethyl-tyrosine-Lys-Phe-NH2) and SS-20 (Phe-D-Arg-Phe-Lys-NH2). They differ in that only SS-31 has scavenging ability. Rats (n=8/group) were randomized to SS-31, SS-20 or placebo. The drugs (3 mg/kg) or saline was administered intraperitoneally 30 min before ligation of the left anterior descending artery for 60 min, and another dose given intraperitoneally 5 min before reperfusion for 60 min. Study endpoints included myocardial infarct size, cardiac arrhythmia and myocardial lipid peroxidation. The area at risk was similar among the groups. The infarct area/area at risk, however, was significantly smaller in the treatment groups (53.9+/-1.1% in SS-31 group, 47.1+/-1.4% in SS-20 group, versus 59.9+/-1% in the controls, P<0.01). Lipid peroxidation was significantly reduced by both SS-31 and SS-20 treatment. Arrhythmia occurred only during the early period of coronary occlusion and was less frequent and less severe in the peptide treatment groups than in the controls (Lambeth score 5 points, 3 points, versus 13 points in the controls, P<0.05). This study shows that pretreatment with both SS-31 and SS-20 significantly reduced myocardial lipid peroxidation and infarct size in ischemia-reperfusion injury, and suggests that the cardioprotective properties of 2',6'-dimethyl-tyrosine-D-Arg-Phe-Lys-NH2 was primarily mediated by its antioxidant properties. As SS-20 does not scavenge reactive oxygen species, it most likely reduces reactive oxygen species production during ischemia-reperfusion.
    Coronary Artery Disease 06/2007; 18(3):215-20. · 1.11 Impact Factor
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    ABSTRACT: To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. Subendocardial (n = 9) or transmural (n = 6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n = 6); (2) transmural late enhancement (n = 1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n = 2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction.
    Clinical Radiology 06/2006; 61(5):417-22. · 1.82 Impact Factor
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    ABSTRACT: Dual antiplatelet therapy of aspirin and a thienopyridine is the standard of care following coronary stenting. Patients who are on chronic warfarin therapy and receive a coronary stent need to be treated with the triple therapy of aspirin, clopidogrel and warfarin; however, the bleeding risk in these patients is unknown. To evaluate the bleeding risk in patients requiring chronic warfarin therapy and undergoing stent implantation, we compared 107 consecutive patients on chronic warfarin therapy who underwent coronary stenting and were discharged on aspirin, clopidogrel and warfarin to 107 contemporary patients who were treated with aspirin and clopidogrel. We evaluated their bleeding history before and after coronary stenting. Major bleeding was defined as bleeding that was significantly disabling, intraocular or requiring at least 2 units of blood transfusion. Minor bleeding was defined as other bleeding that led to interruption of the medications. Patients on triple therapy were younger and more likely to have hypertension. This group had significantly higher major bleeding (6.6% vs. 0%; p = 0.03) and minor bleeding (14.9% vs. 3.8%; p = 0.01) compared with the dual antiplatelet therapy group. In the triple therapy group, the international normalized ratio or aspirin dosage did not influence the bleeding risk. In patients requiring warfarin therapy, the addition of dual antiplatelet therapy is associated with an approximately 7% major bleeding risk. Thus, novel regimens are needed to reduce the bleeding risk.
    The Journal of invasive cardiology 05/2006; 18(4):162-4. · 1.57 Impact Factor
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    ABSTRACT: The conventional strategy for primary angioplasty during acute myocardial infarction is angioplasty of the infarct-related vessel, even in patients with multi-vessel disease. Patients, however, often have significant lesions in multiple coronary arteries and a strategy for multi-vessel angioplasty during acute myocardial infarction has not been explored. The purpose of this study was to examine whether multi-vessel angioplasty is as safe as infarct-related vessel angioplasty in patients with multi-vessel coronary artery disease during acute myocardial infarction. Using the 2000-2001 New York State Angioplasty Registry database, we compared the in-hospital clinical outcomes of patients with multi-vessel disease (>70% stenosis in at least two major coronary arteries), who underwent either multi-vessel angioplasty (n=632) or infarct-related vessel angioplasty (n=1350) within 24 h of acute myocardial infarction. Patients with previous myocardial infarction, angioplasty, bypass surgery, or cardiogenic shock were excluded. Patients in the multi-vessel angioplasty group were less likely to be female, to have peripheral vascular disease or diabetes. They had more complex lesions and were more likely to receive stents. In-hospital mortality was three-fold lower (0.8 versus 2.3%, P=0.018) in the multi-vessel angioplasty group. No differences were observed in other ischemic complications, renal failure, or length of stay. After multivariate analysis, multi-vessel angioplasty remained a significant predictor of lower in-hospital death (odds ratio=0.27, 95% confidence interval=0.08-0.90, P=0.03). Despite the added complexity of multi-vessel angioplasty, patients in this group had significantly lower in-hospital mortality. Therefore, a strategy of multi-vessel angioplasty during acute myocardial infarction may be safe compared with infarct-related angioplasty in selected patients.
    Coronary Artery Disease 03/2006; 17(1):71-5. · 1.11 Impact Factor
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    ABSTRACT: Sirolimus-eluting stents (Cypher) have been shown to reduce the frequency of neointimal hyperplasia and restenosis compared with bare metal stents. However, the clinical implication of overlapping stents with regard to the pattern of restenosis is unclear. All patients who underwent angiography at our institution from May 2003 to March 2005 who had previously received 2 overlapping Cypher stents in native coronary lesions and had binary restenosis were included in our study. Quantitative coronary analysis was performed to determine the degree and location of the restenotic lesion with respect to the overlapping stented segment. The primary end point was to determine how often restenotic lesions occurred at the overlapped segment versus the nonoverlapped stented segments. During the study, 11 patients fit the inclusion criteria for our study; 91% were men and 55% had diabetes mellitus. The mean total stent length was 33.7 +/- 8.2 mm. The mean length of the overlapped segment was 5.9 +/- 3.8 mm, equating to 19 +/- 16% of the total stented area. The average time to follow-up angiography was 277 +/- 126 days. All 11 lesions exhibited type 1 (focal) restenosis. Of these 11 lesions, 10 had focal restenosis at the overlapped segment (p = 0.01, binomial test). The single case involving in-stent restenosis in the nonoverlapped segment occurred at the proximal stent edge. In conclusion, the pattern of restenosis observed in our study suggests a higher relative incidence of binary restenosis in the overlapped stented segment in patients who receive 2 overlapping Cypher stents.
    The American Journal of Cardiology 03/2006; 97(4):499-501. · 3.21 Impact Factor
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    ABSTRACT: Studies regarding the impact of race and ethnicity on outcomes after percutaneous coronary intervention (PCI) in the modern era are limited. Using the 2000 and 2001 New York State PCI Databases, we compared baseline clinical, demographic, and angiographic characteristics and subsequent inhospital events among 76,928 patients of black, Hispanic, and white racial/ethnic backgrounds. We sought to determine the influence of race and ethnicity, if any, on post-PCI outcomes. Blacks and Hispanics were younger and more likely to be hypertensive, diabetic, obese, in congestive heart failure, and have chronic renal insufficiency. Whites were more likely to be men, have multivessel disease, and receive a stent. There was no significant difference in unadjusted post-PCI inhospital mortality (0.7% for all groups) or major adverse cardiac event (defined as death, emergent coronary bypass, or stroke) among all 3 racial groups. After correcting for clinical and demographic variables, race/ethnicity was not a significant predictor of death or major adverse cardiac event. Minority patients of black and Hispanic decent have a significantly higher incidence of traditional cardiovascular risk factors and present for angioplasty at a younger age compared with whites. However, there is no significant difference in outcomes after angioplasty among these racial/ethnic groups.
    American heart journal 02/2006; 151(1):164-7. · 4.65 Impact Factor
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    ABSTRACT: Based on the role of tumor necrosis factor-alpha (TNF-alpha) in ischemic preconditioning (IPC) and the age-associated loss of both TNF-alpha-induced platelet-derived growth factor-AB (PDGF-AB)-mediated cardioprotection and IPC-mediated cardioprotection, we hypothesized that targeting of PDGF-AB-based pathways would restore cardioprotection by IPC in the aging heart. To study this, IPC was induced in 4- and 24-mo-old F344 rats. Sections of young hearts isolated 1 day post-IPC revealed increased TNF-alpha compared with controls. In old rats, TNF-alpha was higher at baseline than IPC young rats and was not significantly altered after IPC. Treatment of old rats with PDGF-AB with vascular endothelial growth factor and angiopoietin-2 (a combination termed PVA), but not PDGF-AB alone, at the time of IPC decreased TNF-alpha. In addition, when compared with young hearts, IPC induced greater apoptosis in the old hearts, which was decreased with PVA treatment but was markedly increased with PDGF-AB. To test the significance of these findings, additional rats underwent permanent coronary ligation 1 day post-IPC. IPC was cardioprotective in young rats [14 days postmyocardial infarction (MI), fractional shortening 29 +/- 6% vs. control MI 17 +/- 4%, P < 0.05; Masson's trichrome stain MI size: 13 +/- 2% vs. control MI 17 +/- 4% left ventricular area (LVA); P < 0.05]. In old rats, however, IPC reduced the post-MI 14-day survival (33% vs. controls 67%; P < 0.05). Treatment of IPC-aging rats with PVA, but not PDGF-AB-alone, reversed IPC-induced mortality (PVA-IPC-MI survival, 88%; PDGF-AB-IPC-MI, 14%) and reduced myocardial injury (fractional shortening: PVA-IPC, 31 +/- 1% vs. control MI, 21 +/- 6%, P < 0.05; MI size: PVA-IPC, 12 +/- 2% vs. control MI, 18 +/- 3% LVA, P < 0.05) and thus demonstrated that PDGF-AB-based pathways can reverse the senescent impairment in IPC-mediated cardioprotection.
    AJP Heart and Circulatory Physiology 02/2006; 290(2):H525-30. · 3.63 Impact Factor
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    ABSTRACT: Angiopeptin has been shown to reduce in-stent restenosis in various animal models. Meanwhile, BiodivYsio DD phosphorylcholine (PC)-coated stent provides a platform for local delivery of antiproliferative agents to the coronary artery. We studied the feasibility, safety, and impact on tissue growth of angiopeptin-eluting BiodivYsio DD PC-coated stents in human native de novo coronary lesions. We enrolled 14 patients (16 lesions) who underwent intravascular ultrasound (IVUS)-guided angiopeptin-eluting stent implantation in native coronary arteries between 3.0 and 4.0 mm in diameter with lesion length<or=18 mm. We successfully implanted 13 stents loaded with 22 microg of angiopeptin and three stents with 126 microg of angiopeptin. No major adverse cardiac events or target vessel failure occurred at 1-year clinical follow-up. All patients underwent 6-month angiographic and volumetric IVUS follow-up. In-stent late loss was 0.46+/-0.32 mm in the low-dose group and 0.26+/-0.14 mm in the high-dose group. Binary restenosis rate was 0%. Follow-up percentage neointimal hyperplasia by IVUS was 18.4%+/-22.5% for the low-dose group and 10.2%+/-5.8% for the high-dose group, respectively. There were no edge effect and late stent malapposition. Angiopeptin-eluting BiodivYsio DD PC stent appears feasible and safe in treating native de novo coronary lesions with modest degree of neointimal hyperplasia.
    Catheterization and Cardiovascular Interventions 12/2005; 66(4):541-6. · 2.51 Impact Factor
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    ABSTRACT: Stroke is 1 of the most devastating complications associated with percutaneous coronary intervention. The present study used the combined 2000 to 2001 New York State Angioplasty Registry to compare the clinical characteristics and in-hospital outcomes of patients with and without stroke after percutaneous coronary intervention. Of the 76,903 patients who underwent angioplasty, 140 (0.18%) experienced stroke. Multivariate regression analysis revealed age, glycoprotein IIb/IIIa inhibitor use, acute myocardial infarction or congestive heart failure on admission, history of carotid disease, chronic renal disease, and placement of an intra-aortic balloon pump as independent predictors for stroke complicating percutaneous coronary intervention.
    The American Journal of Cardiology 12/2005; 96(9):1248-50. · 3.21 Impact Factor
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    ABSTRACT: We previously demonstrated that sphingosine kinase (SPK) increases the level of extracellular sphingosine-1-phosphate and promotes neovascularization in a mouse matrigel model. In this study, we tested the hypothesis that SPK gene transfer using a novel adenoviral 'gutless' vector (AGV) can enhance arteriogenesis in a rabbit hindlimb ischemia model. Thirty-five male New Zealand white rabbits were randomized to the AGV-SPK group (n=13), AGV-null group (n=13), and control group (n=9). On day 10, after the induction of unilateral hindlimb ischemia, gene vectors or buffer were introduced and the effect examined on day 30, using calf blood pressure, quantitative angiographic analysis, and histology. Calf systolic blood pressure ratios of the ischemic limb to the normal limb on day 30 were 0.77+/-0.13 in control groups, including the AGV-null group, and 0.91+/-0.14 in the AGV-SPK group (P<0.05). Angiographic vessel counts were significantly increased (8.0+/-2.1 at baseline and 11.8+/-3.2 on day 30, P<0.001) in the AGV-SPK group. Histologic analysis showed that microscopic total vessel counts on day 30 were 3.5+/-1.8/field in the control and AGV-null group and 5.4+/-1.0/field in the AGV-SPK group. Arterioles (AGV-SPK; 3.0+/-0.8 versus control and AGV-null; 2.1+/-1.1, P<0.05) were significantly increased in the AGV-SPK group. This study shows that SPK promotes arteriogenesis, as evidenced by the maximal improvement in the blood pressure restoration and collateral vessel counts. SPK may be an important angiogenic target to improve perfusion in ischemic tissues.
    Coronary Artery Disease 11/2005; 16(7):451-6. · 1.11 Impact Factor
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    ABSTRACT: Chronic total occlusion (CTO) of coronary arteries represents a challenge for percutaneous treatment. Although ameroid constrictors have been used to create CTOs from extrinsic compression of coronary arteries, this model is not suitable for evaluation of novel angioplasty equipment. Thus, the objective of this study was to create a new percutaneous animal model of CTO. To create an animal model of CTO, we implanted copper-plated stents in the left circumflex coronary arteries of 18 pigs, and assigned the pigs to early group (n = 6; sacrifice at approximately 1 week), intermediate group (n = 6; sacrifice at approximately 4 weeks), and late group (n = 6; sacrifice at approximately 8 weeks). Follow-up angiography prior to sacrifice revealed complete occlusion in 14 of 17 animals, with the subtotal occlusive lesions (mean 60% stenosis) only in the early group. Most of the pigs with total occlusions (12 of 14) showed bridging collateral flow greater than or equal to grade 2 (grade 2: 4; grade 3: 8). Histology revealed organizing thrombus in the early group with persistent inflammation, and organized thrombus with fibrosis and calcification in the intermediate and late groups. Interestingly, there were fibrotic components in the proximal and distal edges of the occlusions with softer, organizing thrombus in the middle of the CTO in the late group, suggesting that the major areas of difficulty are at the entrance and exit segments of the CTO with percutaneous recanalization. This study shows the feasibility and reproducibility of a new porcine coronary percutaneous CTO model. This model may be useful in improving our percutaneous treatment of CTO.
    The Journal of invasive cardiology 10/2005; 17(9):452-4. · 1.57 Impact Factor
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    ABSTRACT: Opioids have a cardioprotective effect during ischemia. Previously, we showed in an ex-vivo model of myocardial ischemia and reperfusion that 2',6'-dimethyltyrosine-D-Arg-Phe-Lys-NH2, a highly potent and long-acting opioid peptide analgesic with fewer side effects than morphine, provides improved cardioprotection compared with morphine. The purpose of this study was to confirm, in an in-vivo model, the cardioprotective effect of 2',6'-dimethyltyrosine-D-Arg-Phe-Lys-NH2. Rats (n=6/group) were randomized to 2',6'-dimethyltyrosine-D-Arg-Phe-Lys-NH2 therapy (intravenous 10 nmol bolus 30 min before ligation and 10 nmol/h continuous infusion), morphine (100 nmol bolus and 100 nmol/h infusion), or placebo, and underwent left anterior descending (LAD) ligation for 10 min followed by reperfusion for 30 min. Continuous transesophageal echocardiogram and electrocardiogram were monitored. Fractional shortening and systolic wall thickening of the ischemic area were calculated. Time to recovery of left ventricular function was the duration of time needed for fractional shortening to recover to 90% of baseline following reperfusion. Duration of reperfusion arrhythmia was the time to the cessation of salvo (at least three consecutive premature ventricular contractions (PVCs)) following reperfusion. Time to recovery of left ventricular function was significantly shorter in the 2',6'-dimethyltyrosine-D-Arg-Phe-Lys-NH2 (4.4+/-2.2 min) and morphine groups (6.0+/-2.5 min) than in the controls (10.5+/-2.2 min; p<0.01). The 2',6'-dimethyltyrosine-D-Arg-Phe-Lys-NH2 group showed significantly higher fractional shortening and systolic wall thickening of the ischemic area than the control group. Duration of reperfusion arrhythmia was also significantly shorter in the 2',6'-dimethyltyrosine-D-Arg-Phe-Lys-NH2 (2.8+/-1.7 min) and morphine groups (5.8+/-3.9 min) than in the controls (11.8+/-2.0 min; p<0.05). 2',6'-Dimethyltyrosine-D-Arg-Phe-Lys-NH2 provides a cardioprotective effect against myocardial ischemia and reperfusion in vivo.
    Coronary Artery Disease 10/2005; 16(6):407-10. · 1.11 Impact Factor
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    ABSTRACT: Longer bare metal stent lengths have been associated with greater restenosis. However, the effect of the ratio of stent length to lesion length on clinical and angiographic restenosis after implantation of bare metal and drug-eluting stents has not been clearly defined. Patients in the TAXUS-IV study who underwent single-study stent placement were categorized into tertiles based on ratios of stent length to lesion length. Clinical results at 1 year and angiographic outcomes at 9 months were compared across the 3 groups. The median ratios of stent length to lesion length were 1.20, 1.58, and 2.27 in the 3 tertiles. Analysis segment restenosis rates at 9 months were similar across the 3 tertiles with bare metal stents (24.7% vs 26.7% vs 23.8%, respectively, p = 0.90 for trend) and paclitaxel-eluting stents (11.7% vs 6.5% vs 5.4%, respectively, p = 0.24). Similarly, there were no differences in 1-year rates of target lesion revascularization across the 3 tertiles for bare metal stents (14.6% vs 14.8% vs 13.7%, respectively, p = 0.91) or paclitaxel-eluting stents (6.1% vs 3.6% vs 4.0%, respectively, p = 0.38). By multivariate analysis, the ratio of stent length to lesion length was an independent predictor of neither 9-month angiographic restenosis nor 1-year target lesion revascularization in the bare metal stent arm (odds ratio 1.21, p = 0.36, and hazard ratio 0.80, p = 0.31, respectively) or in the paclitaxel-eluting stent arm (odds ratio 0.86, p = 0.76, and hazard ratio 0.58, p = 0.21, respectively). These data do not support the arbitrary use of larger ratios of stent length to lesion length in patients who undergo implantation of drug-eluting stents.
    The American Journal of Cardiology 06/2005; 95(9):1043-8. · 3.21 Impact Factor
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    ABSTRACT: Balloon angioplasty results in a combination of plaque compression and fracture, creation of intimal flaps and localized medial dissection, as well as the stretching and remodeling of the arterial wall. The application of eccentric pressure to the vessel wall allows for the balloon force to be focused along a specified line resulting in a reduction in vessel resistance with an improved or equivalent result at a lower pressure. The FX miniRAIL is a novel balloon angioplasty catheter that has two external wires that are compressed by the inflating balloon into the vessel wall. It was tested in comparison to conventional balloon injury in a porcine coronary model. At equivalent balloon artery ratios no increase in the length of dissections occurred, but a characteristic longitudinal "cut" was noted in the presence of the FX miniRAIL. A similar finding was demonstrated in sample human cases when interrogated by IVUS and OCT.
    The Journal of invasive cardiology 05/2005; 17(4):203-6. · 1.57 Impact Factor
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    ABSTRACT: Mild systemic hypothermia has been shown to be feasible and safe in patients during acute myocardial infarction (AMI). Regional myocardial hypothermia of the ischemic myocardium only may be more effective in myocardial salvage with fewer side effects compared with systemic hypothermia. The purpose of this study was to evaluate the feasibility and safety of regional myocardial hypothermia in pigs. Open-chest pigs with (n=5) or without (n=4) myocardial infarction underwent left anterior descending coronary artery (LAD) ligation followed by intracoronary infusion of lactated Ringer's solution (at room temperature and at 15 degrees C between 20-35 ml/min for 3 min) via the central lumen of a specially designed balloon catheter at the time of reperfusion. Intramyocardial temperatures via thermocouples at the ischemic zone (LAD territory) and non-ischemic zone (circumflex territory) as well as systemic temperature were constantly recorded, as were the hemodynamics. Each pig acted as its control regarding the myocardial temperature response to both solutions. In addition, intracoronary versus intramyocardial temperatures were compared with thermocouples in both territories during infusion. There was no hemodynamic compromise or arrhythmia seen during the intracoronary infusion of either temperature solution. There was a linear relationship between the infusion solution temperature and infusion rate versus intramyocardial temperature response, with the cooled solution providing 2 degrees C lower temperature and faster infusion resulting in lower intramyocardial temperature. There was no change in the non-ischemic zone or systemic temperature. On average, 6-8 degrees C reduction in tissue temperature, potential target temperature range for hypothermic therapy, was achieved in all animals. In addition, intracoronary temperature in distal LAD measured by intracoronary thermocouples correlated with the intramyocardial temperature (2 degrees C lower temperature in the coronary artery). It is feasible and safe to achieve regional myocardial hypothermia by intracoronary infusion of cooled solution in pigs.
    Coronary Artery Disease 04/2005; 16(2):125-9. · 1.11 Impact Factor
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    ABSTRACT: Coronary artery plaque rupture is a sudden, unpredictable event leading to acute coronary syndrome. Thus far, there is no clinical characteristic to distinguish the patients at risk for acute myocardial infarction from those with more stable coronary artery disease. The purpose of this study was to identify clinical predictors of first ST-segment elevation myocardial infarction (STEMI). We retrospectively compared 116 consecutive patients presenting with their first STEMI for primary angioplasty and 216 ambulatory patients with stable angina requiring their first coronary intervention. Patients with STEMI were younger, more likely to be smokers, but less likely to have hypertension or hypercholesterolemia. Diabetes was present equally between the two groups. Cardioprotective medication usage, such as aspirin and statin, was much lower among patients presenting with their first STEMI. Thus, patients with STEMI presumably from plaque rupture have fewer traditional risk factors compared with patients with stable angina. Identifying these vulnerable patients at risk for plaque rupture may enable early institution of cardioprotective pharmacotherapy to prevent their first acute coronary syndrome occurrence.
    Coronary Artery Disease 01/2005; 15(8):467-9. · 1.11 Impact Factor
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    ABSTRACT: Although obesity traditionally has been considered a risk factor for coronary revascularization, recent data from registry studies have shown a possible protective effect of obesity on outcomes after percutaneous coronary intervention (PCI). Using data from the New York State Angioplasty database over a 4-year period, we analyzed 95,435 consecutive patients who underwent PCI. Classification of body mass index (BMI) was: underweight (<18.5 kg/m(2)), healthy weight (18.5 to 24.9 kg/m(2)), overweight (25 to 29.9 kg/m(2)), moderate obesity (class I) (30 to 34.9 kg/m(2)), severe obesity (class II) (35 to 39.9 kg/m(2)), and very severe obesity (class III) (>40 kg/m(2)). In-hospital postprocedural mortality and complications were compared among these groups. Compared with healthy weight patients, patient with class I or II obesity had lower in-hospital mortality and major adverse cardiac events (MACE) (combined death, myocardial infarction, and emergency surgery), whereas patients at the extremes of BMI (underweight and class III obese patients) had significantly higher mortality and MACE rates. Adjusted hazards ratios for in-hospital mortality according to BMI were: underweight (2.69), healthy weight (1.0), overweight (0.90), class I obese (0.74), class II obese (0.67), and class III obese (1.63). Patients at the extremes of BMI (<18.5 and >40 kg/m(2)) were at increased risk of MACEs, including mortality after PCI, whereas patients who were moderately to severely obese (BMIs 30 to 40 kg/m(2)) were at lower risk than healthy weight patients.
    The American Journal of Cardiology 06/2004; 93(10):1229-32. · 3.21 Impact Factor

Publication Stats

4k Citations
921.76 Total Impact Points


  • 2012–2013
    • Saint Luke's Hospital (NY, USA)
      New York City, New York, United States
  • 2004–2007
    • Weill Cornell Medical College
      • Division of Cardiology
      New York City, New York, United States
  • 2006
    • Lenox Hill Hospital
      New York City, New York, United States
  • 2000–2006
    • New York Presbyterian Hospital
      • • Department of Cardiology
      • • Department of Internal Medicine
      New York City, New York, United States
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
    • Chonbuk National University Hospital
      Sŏul, Seoul, South Korea
  • 2005
    • Shaare Zedek Medical Center
      • Department of Cardiology
      Jerusalem, Jerusalem District, Israel
  • 2001–2003
    • Cornell University
      • Department of Medicine
      Ithaca, NY, United States
  • 2000–2001
    • Cardiovascular Research Foundation
      New York City, New York, United States
  • 1998–2001
    • University of Ulsan
      • • College of Medicine
      • • Department of Medicine
      Urusan, Ulsan, South Korea
  • 1997–2001
    • Asan Medical Center
      • Department of Cardiology
      Seoul, Seoul, South Korea
    • Keimyung University
      • College of Medicine
      Sŏul, Seoul, South Korea
  • 1994–2000
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States
    • Yonsei University Hospital
      Sŏul, Seoul, South Korea
  • 1993–2000
    • Washington Hospital Center
      Washington, Washington, D.C., United States