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Daisuke Hachinohe,
Myung Ho Jeong,
Shigeru Saito,
Min Chol Kim,
Kyung Hoon Cho,
Khurshid Ahmed,
Seung Hwan Hwang,
Min Goo Lee,
Doo Sun Sim,
Keun-Ho Park, [......],
Taek Jong Hong,
Donghoon Choi,
Myeong Chan Cho,
Chong Jin Kim,
Ki Bae Seung,
Wook Sung Chung, Yang Soo Jang,
Seung Woon Rha,
Jang Ho Bae,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD).
This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) calculated by the modification of diet in renal disease method.
At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049).
Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.
The Korean Journal of Internal Medicine 12/2012; 27(4):397-406.
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Kang-Yin Chen,
Seung-Woon Rha,
Lin Wang,
Yong-Jian Li,
Guang-Ping Li,
Kanhaiya L Poddar,
Ji-Young Park,
Cheol Ung Choi,
Chang-Gyu Park,
Hong Seog Seo, [......],
Myeong Chan Cho,
Jang Ho Bae,
Dong Hoon Choi, Yang Soo Jang,
In Ho Chae,
Chong Jin Kim,
Jung Han Yoon,
Wook Sung Chung,
Ki Bae Seung,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: This study sought to compare everolimus-eluting stents (EES) with zotarolimus-eluting stents (ZES) in patients with acute myocardial infarction (AMI).
There is a paucity of data to exclusively evaluate the safety and efficacy of second-generation drug-eluting stents (DES) in the setting of AMI.
The present study enrolled 3,309 AMI patients treated with ZES (n = 1,608) or EES (n = 1,701) in a large-scale, prospective, multicenter registry-KAMIR (Korea Acute Myocardial Infarction Registry). Propensity score matching was applied to adjust for differences in baseline clinical and angiographic characteristics, producing a total of 2,646 patients (1,343 receiving ZES, and 1,343 receiving EES). Target lesion failure (TLF) was defined as the composite of cardiac death, recurrent nonfatal myocardial infarction, or target lesion revascularization. Major clinical outcomes at 1 year were compared between the 2 propensity score-matched groups.
After propensity score matching, baseline clinical and angiographic characteristics were similar between the 2 groups. Clinical outcomes of the propensity score-matched patients showed that, despite similar incidences of recurrent nonfatal myocardial infarction and in-hospital and 1-year mortality, patients in the EES group had significantly lower rates of TLF (6.5% vs. 8.7%, p = 0.029) and probable or definite stent thrombosis (0.3% vs. 1.6%, p < 0.001), compared with those in the ZES group. Furthermore, there was a numerically lower rate of target lesion revascularization (1.2% vs. 2.2%, p = 0.051) in the EES group than in the ZES group.
In this propensity-matched comparison, EES seems to be superior to ZES in reducing TLF and stent thrombosis in patients with AMI.
09/2012; 5(9):936-45. · 1.07 Impact Factor
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Joon Young Kim,
Myung Ho Jeong,
Jae Hyun Moon,
Yong Keun Ahn,
Shung Chull Chae,
Seung Ho Hur,
Taek Jong Hong,
Young Jo Kim,
In Whan Seong,
In Ho Chae,
Myeong Chan Cho, Yang Soo Jang,
Jung Han Yoon,
Ki Bae Seung,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: The optimal loading dose of clopidogrel in patients with chronic kidney disease who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction has not been investigated. The aim of this study was to assess the impact of clopidogrel loading dose on clinical outcomes in this setting. A total of 1,457 patients with CKD (estimated glomerular filtration rate <60 ml/min/1.73 m(2)) were evaluated according to clopidogrel loading dose: 600 mg (n = 861) versus 300 mg (n = 596). In-hospital complications, including major bleeding and clinical outcomes at 1 and 12 months, were compared between the 2 groups. The in-hospital major bleeding rate was similar (0.8% vs 0.2%, p = 0.09). Also, there were no differences in major adverse cardiac event rates, including death, recurrent myocardial infarction, target lesion revascularization, and stent thrombosis, at 1 month (15.6% vs 16.4%, p = 0.70) and 12 months (19.0% vs 21.3%, p = 0.32). On multivariate analysis, a 600-mg loading dose of clopidogrel was not an independent predictor of 1-month (odds ratio 1.13, 95% confidence interval 0.49 to 2.57, p = 0.78) and 12-month (odds ratio 0.89, 95% confidence interval 0.52 to 1.51, p = 0.66) major adverse cardiac events. After propensity score-matched analysis, these results were unchanged. In conclusion, a 600-mg loading dose of clopidogrel was not effective in reducing 1- and 12-month major adverse cardiac events in patients with chronic kidney disease who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, but this dose did not increase the in-hospital major bleeding rate.
The American journal of cardiology 08/2012; · 3.58 Impact Factor
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Keun-Ho Park,
Youngkeun Ahn,
Myung Ho Jeong,
Shung Chull Chae,
Seung Ho Hur,
Young Jo Kim,
In Whan Seong,
Jei Keon Chae,
Taek Jong Hong,
Myeong Chan Cho,
Jang Ho Bae,
Seung Woon Rha, Yang Soo Jang
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the impact of diabetes mellitus (DM) on in-hospital and 1-year mortality in patients who suffered acute myocardial infarction (AMI) and underwent successful percutaneous coronary intervention (PCI).
Among 5,074 consecutive patients from the Korea AMI Registry with successful revascularization between November 2005 and June 2007, 1,412 patients had a history of DM.
The DM group had a higher mean age prevalence of history of hypertension, dyslipidemia, ischemic heart disease, high Killip class, and diagnoses as non-ST elevation MI than the non-DM group. Left ventricular ejection fraction (LVEF) and creatinine clearance were lower in the DM group, which also had a significantly higher incidence of in-hospital and 1-year mortality of hospital survivors (4.6% vs. 2.8%, p = 0.002; 5.0% vs. 2.5%, p < 0.001). A multivariate analysis revealed that independent predictors of in-hospital mortality were Killip class IV or III at admission, use of angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers, LVEF, creatinine clearance, and a diagnosis of ST-elevated MI but not DM. However, a multivariate Cox regression analysis showed that DM was an independent predictor of 1-year mortality (hazard ratio, 1.504; 95% confidence interval, 1.032 to 2.191).
DM has a higher association with 1-year mortality than in-hospital mortality in patients with AMI who underwent successful PCI. Therefore, even when patients with AMI and DM undergo successful PCI, they may require further intensive treatment and continuous attention.
The Korean Journal of Internal Medicine 06/2012; 27(2):180-8.
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Futoshi Yamanaka,
Myung Ho Jeong,
Shigeru Saito,
Youngkeun Ahn,
Shung Chull Chae,
Seung Ho Hur,
Taek Jong Hong,
Young Jo Kim,
In Whan Seong,
Jei Keon Chae, [......],
Jang Ho Bae,
Seung Woon Rha,
Chong Jin Kim,
Donghoon Choi, Yang Soo Jang,
Junghan Yoon,
Wook Sung Chung,
Jeong Gwan Cho,
Ki Bae Seung,
Seung Jung Park
International journal of cardiology 05/2012; 158(1):139-43. · 7.08 Impact Factor
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Nam Sik Yoon,
Myung Ho Jeong,
Youngkeun Ahn,
Jong Hyun Kim,
Shung Chull Chae,
Young Jo Kim,
Seung Ho Hur,
In Whan Seong,
Taek Jong Hong,
Donghoon Choi,
Myeong Chan Cho,
Chong Jin Kim,
Ki Bae Seung,
Wook Sung Chung, Yang Soo Jang,
Jeong Gwan Cho,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: Prehypertension according to JNC7 is common and is associated with increased vascular mortality. The importance of management in high-normal blood pressure (BP) is underemphasized.
We analyzed major adverse cardiac events (MACEs) in the Korea Acute Myocardial Infarction Registry in normal BP (group I) and high-normal BP (group II) patients.
Among 14871 patients, 159 (61±12.3 years, 122 males) satisfied the study indication. Six-month and one-year clinical follow-up rate was 88.9% and 85.8%, respectively. Group I had 78 patients (60.9±12.4 years). Group II had 81 patients (61.6±12.5 years). Demographics of patients were not different between groups. Treatment strategy was not different. Initial Thrombolysis in Myocardial Infarction flow grade 0 was less frequent in group II (n=32, 47.1%) than in group I (n=16, 21.9%) (p=0.001). Successful intervention rate was not different between group II (93.8%) and group I (97.1%) (p=0.590). Six-month MACE occurred in 3 patients in group I (4.4%) and 10 in group II (15.6%) (p=0.031). Compared with normal BP, the odds ratio for patients with high-normal BP was 1.147 (p=0.045, 95% confidence interval 1.011-1.402) for 6-month MACE.
Even though high-normal BP patients had a better baseline clinical status, the prognosis was poorer than patients with normal BP. Therapeutic BP target goal for the patients with acute myocardial infarction should be <140/90 mm Hg, which is recommended in JNC7.
Korean Circulation Journal 05/2012; 42(5):304-10.
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Hae Chang Jeong,
Ji Min Jeong,
Myung Ho Jeong,
Youngkeun Ahn,
Shung Chull Chae,
Seung Ho Hur,
Taek Jong Hong,
Young Jo Kim,
In Whan Seong,
Jei Keon Chae, [......],
Jang Ho Bae,
Seung Woon Rha,
Chong Jin Kim,
Donghoon Choi, Yang Soo Jang,
Junghan Yoon,
Wook Sung Chung,
Jeong Gwan Cho,
Ki Bae Seung,
Seung Jung Park
International journal of cardiology 04/2012; 157(3):408-11. · 7.08 Impact Factor
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Min Goo Lee,
Myung Ho Jeong,
Youngkeun Ahn,
Shung Chull Chae,
Seung Ho Hur,
Taek Jong Hong,
Young Jo Kim,
In Whan Seong,
Jei Keon Chae,
Jay Young Rhew, [......],
Myeong Chan Cho,
Jang Ho Bae,
Seung Woon Rha,
Chong Jin Kim,
Donghoon Choi, Yang Soo Jang,
Junghan Yoon,
Wook Sung Chung,
Ki Bae Seung,
Seung Jung Park
International journal of cardiology 04/2012; 157(2):283-5. · 7.08 Impact Factor
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Daisuke Hachinohe,
Myung Ho Jeong,
Shigeru Saito,
Min Chol Kim,
Kyung Hoon Cho,
Khurshid Ahmed,
Seung Hwan Hwang,
Min Goo Lee,
Doo Sun Sim,
Keun-Ho Park, [......],
Taek Jong Hong,
Donghoon Choi,
Myeong Chan Cho,
Chong Jin Kim,
Ki Bae Seung,
Wook Sung Chung, Yang Soo Jang,
Seung Woon Rha,
Jang Ho Bae,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: The role of thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PPCI) remains a matter of controversy.
A total of 2105 patients enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry, a cohort of 745 (35.4%) patients who underwent TA during PPCI was compared with 1360 (64.6%) patients who underwent conventional PCI without TA. Clinical outcomes at 12-months of overall enrolled patients and subgroups according to key variables were assessed using Cox regression models adjusted by propensity score. Although there was no significant difference among overall patients, in subgroup analyses, administration of glycoprotein (GP) IIb/IIIa inhibitor during PPCI [adjusted hazard ratio (HR) 0.329, 95% confidence interval (CI) 0.126-0.860, p=0.023] and left anterior descending (LAD) as a culprit lesion (adjusted HR 0.516, 95% CI 0.275-0.971, p=0.040) were the settings, in which TA was associated with a lower major adverse cardiac events (MACE) rate compared with non-TA.
Although TA does not improve clinical outcomes in overall patients who underwent PPCI, TA for LAD occlusion improves 12-month MACE. Furthermore, use of GP IIb/IIIa inhibitor with TA has a synergistic effect on clinical outcomes.
Journal of Cardiology 02/2012; 59(3):249-57. · 1.28 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: SCN5A encodes the cardiac-specific Na(V)1.5 sodium channel, and Brugada syndrome is a cardiac conduction disorder associated with sodium channel α-subunit (SCN5A) mutation. The SCN5A-encoded Na(V)1.5 channel is also found on gastrointestinal smooth muscle and interstitial cells of Cajal. We investigated the relationship between functional dyspepsia (FD) and SCN5A mutation to evaluate sodium channelopathy in FD.
Patients with Brugada syndrome or FD were examined using upper endoscopy, electrogastrography (EGG), FD symptom questionnaire based on Rome III criteria and genetic testing for SCN5A mutation. Symptom scores of FD and EGG findings were analyzed according to SCN5A mutation.
A total of 17 patients (4 Brugada syndrome and 13 FD) participated in the study. An SCN5A mutation was noted in 75.0% of the patients with Brugada syndrome and in 1 (7.7%) of the patients with FD. Of 4 patients with SCN5A mutation, 2 (50%) had FD. Postprandial tachygastria and bradygastria were noted in 2 (50%) and 1 (25%) of the patients with SCN5A mutation, respectively. The EGG findings were not significantly different between positive and negative mutation in 17 patients.
Although we did not find statistically significant results, we suggest that it is meaningful to attempt to identify differences in symptoms and gastric myoelectric activity according to the presence of an SCN5A mutation by EGG analysis. The relationship between FD and sodium channelopathy should be elucidated in the future by a large-scale study.
Journal of neurogastroenterology and motility 01/2012; 18(1):58-63.
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Hyun Su Jo,
Jong Seon Park,
Jang Won Sohn,
Joon Cheol Yoon,
Chang Woo Sohn,
Sang Hee Lee,
Geu Ru Hong,
Dong Gu Shin,
Young Jo Kim,
Myung Ho Jeong, [......],
Myeong Chan Cho,
Jang Ho Bae,
Seung Woon Rha,
Chong Jin Kim,
Dong Hoon Choi, Yang Soo Jang,
Jung Han Yoon,
Wook Sung Chung,
Ki Bae Seung,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI.
From the Korean Acute Myocardial Infarction Registry (KAMIR) database, 1,094 STEMI patients with multivessel disease who underwent primary PCI with drug-eluting stents were enrolled in this study. The patients were divided into two groups: culprit-vessel-only revascularization (COR, n=827) group; multivessel revascularization, including non-IRA (MVR, n=267) group. The primary endpoint of this study included major adverse cardiac events (MACEs), such as death, myocardial infarction, or target or nontarget lesion revascularization at one year.
There was no difference in clinical characteristics between the two groups. During the one-year follow-up, 102 (15.2%) patients in the COR group and 32 (14.2%) in the MVR group experienced at least one MACE (p=0.330). There were no differences between the two groups in terms of rates of death, myocardial infarction, or revascularization (2.1% vs. 2.0%, 0.7% vs. 0.8%, and 11.7% vs. 10.1%, respectively; p=0.822, 0.910, and 0.301, respectively). The MACE rate was higher in the incompletely revascularized patients than in the completely revascularized patients (15% vs. 9.5%, p=0.039), and the difference was attributable to a higher rate of nontarget vessel revascularization (8.6% vs. 1.8%, p=0.002).
Although multivessel angioplasty during primary PCI for STEMI did not reduce the MACE rate compared with culprit-vessel-only PCI, CR was associated with a lower rate of repeat revascularization after multivessel PCI.
Korean Circulation Journal 12/2011; 41(12):718-25.
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Min Chul Kim,
Myung Ho Jeong,
Youngkeun Ahn,
Jong Hyun Kim,
Shung Chull Chae,
Young Jo Kim,
Seung Ho Hur,
In Whan Seong,
Taek Jong Hong,
Dong Hoon Choi,
Myeong Chan Cho,
Chong Jin Kim,
Ki Bae Seung,
Wook Sung Chung, Yang Soo Jang,
Seung Yun Cho,
Seung Woon Rha,
Jang Ho Bae,
Jeong Gwan Cho,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: In patients with non-ST-elevation myocardial infarction (NSTEMI), current guidelines did not recommend optimal revascularization management in multivessel coronary artery disease. We compared clinical outcomes between multivessel revascularization and culprit-only revascularization in this setting.
A total of 1919 patients with multivessel disease (1011 patients; multivessel revascularization group, 908 patients; culprit-only revascularization group) diagnosed as NSTEMI was enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008. The primary end-points were major adverse cardiac events (MACE), all-causes of deaths, myocardial infarction (MI), and repeated percutaneous coronary intervention (PCI) during 1-year clinical follow-up. Also, subgroup analysis was performed in patients with high TIMI (Thrombolysis In Myocardial Infarction) risk score (≥ 4) to find efficacy of multivessel PCI in high-risk patients.
Baseline clinical characteristics and the risk factors of coronary artery disease were similar between both groups. In angiography, three-vessel lesion was more presented in the multivessel group (46.1% vs. 40.9%, p = 0.024) and rates of left anterior descending and left main stem coronary artery as culprit vessel were higher in the multivessel group (p = 0.003 and p = 0.001 respectively). In-hospital mortality was higher in the culprit-only group (1.4% vs. 2.9%, p = 0.025). Primary end-points occurred in 241 patients (15.5%) during 1-year follow-up. Multivessel revascularization reduced MACEs [hazard ratio (HR) 0.658, 95% confidence interval (CI) 0.45 to 0.96, p = 0.031], death or myocardial infarction (HR 0.58, 95% CI 0.35 to 0.97, p = 0.037) and non-target vessel revascularization (HR 0.44, 95% CI 0.24 to 0.81, p = 0.008). There were no significant differences in target lesion revascularization (TLR; HR 1.38, 95% CI 0.51 to 3.71, p = 0.529) and target vessel revascularization (TVR; HR 0.28, 95% CI 0.05 to 1.47, p = 0.131). In subgroup analysis in patients with a higher TIMI risk score, similar results were presented.
Multivessel revascularization in multivessel coronary artery disease presenting with NSTEMI showed better clinical outcomes without significant in-stent restenosis and progression of diseased-vessel compared to culprit-only revascularization.
International journal of cardiology 12/2011; 153(2):148-53. · 7.08 Impact Factor
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Jae Yeong Cho,
Myung Ho Jeong,
Young Keun Ahn,
Jong Hyun Kim,
Shung Chull Chae,
Young Jo Kim,
Seung Ho Hur,
In Whan Seong,
Taek Jong Hong,
Dong Hoon Choi,
Myeong Chan Cho,
Chong Jin Kim,
Ki Bae Seung,
Wook Sung Chung, Yang Soo Jang,
Seung Yun Cho,
Seung Woon Rha,
Jang Ho Bae,
Jeong Gwan Cho,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: There are few data available on the prognosis of painless ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the incidence, clinical characteristics, and outcomes of painless STEMI. We analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) study, which enrolled 7,288 patients with STEMI (61.8 ± 12.8 years old, 74% men; painless STEMI group, n = 763; painful STEMI group, n = 6,525). End points were in-hospital mortality and 1-year major adverse cardiac events (MACEs). Patients with painless STEMI were older and more likely to be women, nonsmokers, diabetic, and normolipidemic and to have a higher Killip class. The painless group had more in-hospital deaths (5.9% vs 3.6%, p = 0.026) and 1-year MACEs (26% vs 19%, p = 0.002). In Cox proportional hazards analysis, hypotension (hazard ratio [HR] 4.40, 95% confidence interval [CI] 1.41 to 13.78, p = 0.011), low left ventricular ejection fraction (HR 3.12, 95% CI 1.21 to 8.07, p = 0.019), and a high Killip class (HR 3.48, 95% CI 1.19 to 10.22, p = 0.023) were independent predictors of 1-year MACEs in patients with painless STEMI. In conclusion, painless STEMI was associated with more adverse outcomes than painful STEMI and late detection may have contributed significantly to total ischemic burden. These results warrant more investigations for methodologic development in the diagnosis of silent ischemia and painless STEMI.
The American journal of cardiology 11/2011; 109(3):337-43. · 3.58 Impact Factor
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Kyung Woo Park,
In-Ho Chae,
Do-Sun Lim,
Kyoo-Rok Han,
Han-Mo Yang,
Hae-Young Lee,
Hyun-Jae Kang,
Bon-Kwon Koo,
Taehoon Ahn,
Jung-Han Yoon, [......],
Seung-Ho Hur,
Hyuck-Moon Kwon,
Dong-Woon Jeon,
Byung-Ok Kim,
Si-Hoon Park,
Nam-Ho Lee,
Hui-Kyung Jeon,
Hyeon-Cheol Gwon, Yang-Soo Jang,
Hyo-Soo Kim
[show abstract]
[hide abstract]
ABSTRACT: The goal of this study was to compare the angiographic outcomes of everolimus-eluting stents (EES) and sirolimus-eluting stents (SES) in a head-to-head manner.
EES have been shown to be superior to paclitaxel-eluting stents in inhibiting late loss (LL) and clinical outcome. Whether EES may provide similar angiographic and clinical outcomes compared with SES is undetermined.
This was a prospective, randomized, open-label, multicenter trial to demonstrate the noninferiority of EES compared with SES in preventing LL at 9 months. A total of 1,443 patients undergoing percutaneous coronary intervention were randomized 3:1 to receive EES or SES. Routine follow-up angiography was recommended at 9 months. The primary endpoint was in-segment LL at 9 months, and major secondary endpoints included in-stent LL at 9 months, target lesion failure, cardiac death, nonfatal myocardial infarction, target lesion revascularization, and stent thrombosis at 12 months. Data were managed by an independent management center, and clinical events were adjudicated by an independent adjudication committee.
Clinical follow-up was available in 1,428 patients and angiographic follow-up in 924 patients (1,215 lesions). The primary endpoint of the study (in-segment LL at 9 months) was 0.11 ± 0.38 mm and 0.06 ± 0.36 mm for EES and SES, respectively (p for noninferiority = 0.0382). The in-stent LL was also noninferior (EES 0.19 ± 0.35 mm; SES 0.15 ± 0.34 mm; p for noninferiority = 0.0121). The incidence of clinical endpoints was not statistically different between the 2 groups, including target lesion failure (3.75% vs. 3.05%; p = 0.53) and stent thrombosis (0.37% vs. 0.83%; p = 0.38).
EES were noninferior to SES in inhibition of LL after stenting, which was corroborated by similar rates of clinical outcomes. (Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting [EXCELLENT]; NCT00698607).
Journal of the American College of Cardiology 10/2011; 58(18):1844-54. · 14.16 Impact Factor
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Ki Hong Lee,
Myung Ho Jeong,
Ha Mi Kim,
Youngkeun Ahn,
Jong Hyun Kim,
Shung Chull Chae,
Young Jo Kim,
Seung Ho Hur,
In Whan Seong,
Taek Jong Hong,
Dong Hoon Choi,
Myeong Chan Cho,
Chong Jin Kim,
Ki Bae Seung,
Wook Sung Chung, Yang Soo Jang,
Seung Woon Rha,
Jang Ho Bae,
Jeong Gwan Cho,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: We investigated whether statin therapy could be beneficial in patients with acute myocardial infarction (AMI) who have baseline low-density lipoprotein cholesterol (LDL-C) levels below 70 mg/dl.
Intensive lipid-lowering therapy with a target LDL-C value <70 mg/dl is recommended in patients with very high cardiovascular risk. However, whether to use statin therapy in patients with baseline LDL-C levels below 70 mg/dl is controversial.
We analyzed 1,054 patients with AMI who had baseline LDL-C levels below 70 mg/dl and survived at discharge from the Korean Acute MI Registry between November 2005 and December 2007. They were divided into 2 groups according to the prescribing of statins at discharge (statin group n = 607; nonstatin group n = 447). The primary endpoint was the composite of 1-year major adverse cardiac events, including death, recurrent MI, target vessel revascularization, and coronary artery bypass grafting.
Statin therapy significantly reduced the risk of the composite primary endpoint (adjusted hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.34 to 0.89; p = 0.015). Statin therapy reduced the risk of cardiac death (HR: 0.47; 95% CI: 0.23 to 0.93; p = 0.031) and coronary revascularization (HR: 0.45, 95% CI: 0.24 to 0.85; p = 0.013). However, there were no differences in the risk of the composite of all-cause death, recurrent MI, and repeated percutaneous coronary intervention rate.
Statin therapy in patients with AMI with LDL-C levels below 70 mg/dl was associated with improved clinical outcome.
Journal of the American College of Cardiology 10/2011; 58(16):1664-71. · 14.16 Impact Factor
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Daisuke Hachinohe,
Myung Ho Jeong,
Shigeru Saito,
Khurshid Ahmed,
Seung Hwan Hwang,
Min Goo Lee,
Doo Sun Sim,
Keun-Ho Park,
Ju Han Kim,
Young Joon Hong, [......],
Taek Jong Hong,
Donghoon Choi,
Myeong Chan Cho,
Chong Jin Kim,
Ki Bae Seung,
Wook Sung Chung, Yang Soo Jang,
Seung Woon Rha,
Jang Ho Bae,
Seung Jung Park
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to compare clinical outcomes among early invasive (EI), deferred invasive (DI), and conservative strategies in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). High-risk patients with NSTEMI are believed to fare better with an EI strategy, but the optimal treatment for patients with NSTEMI and CKD is not known. In total 5,185 patients with acute NSTEMI were enrolled from the Korea Acute Myocardial Infarction Registry and followed for 1 year. Patients were divided into EI, DI, and conservative treatment groups and classified into 4 stages using references from the National Kidney Foundation. The invasive EI and DI groups were compared to the conservative groups, and the EI and DI groups were compared according to each renal function stage. At 1-year follow-up, mortality rates in the conservative group were significantly higher than in the invasive groups except for the severe CKD group. The benefit of the EI over the DI strategy, although there were no significant differences between the 2 groups, tended to decrease as renal function decreased. In conclusion, in the management of NSTEMI, an invasive strategy decreased mortality compared to a conservative strategy except for severe CKD. In the timing of an invasive strategy, the EI strategy was observed to be superior to the DI strategy in patients with mild CKD; however, this tendency reversed as renal function decreased. When patients with NSTEMI have severe CKD, a conservative or DI strategy with prescription of cardioprotective medications and prevention of further deterioration in renal function should be considered.
The American journal of cardiology 07/2011; 108(2):206-13. · 3.58 Impact Factor
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Min Goo Lee,
Myung Ho Jeong,
Youngkeun Ahn,
Jeong Gwan Cho,
Jong Chun Park,
Jung Chaee Kang,
Shung Chull Chae,
Seung Ho Hur,
Taek Jong Hong,
Young Jo Kim, [......],
Myeong Chan Cho,
Jang Ho Bae,
Seung Woon Rha,
Chong Jin Kim,
Donghoon Choi, Yang Soo Jang,
Junghan Yoon,
Wook Sung Chung,
Ki Bae Seung,
Seung Jung Park
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ABSTRACT: The purpose of the present study was to compare the efficacy and safety of paclitaxel-eluting stent (PES), sirolimus-eluting stent (SES), and zotarolimus-eluting stent (ZES) in primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI) with metabolic syndrome (MS).
Using data from Korea Acute Myocardial Infarction Registry (KAMIR; November 2005-December 2007), a total of 1,768 MS patients with STEMI who underwent primary PCI were enrolled: The PES group was 634, SES group, 906, and ZES group, 228. The primary endpoint was major adverse cardiac event (all-cause death, re-myocardial infarction, target lesion revascularization) during 12 months follow-up. At 12 months, the cumulative incidence of primary endpoint in the PES, SES, and ZES groups was 10.9%, 9.1%, and 11.0%, respectively (P=0.086). Incidence of death, recurrent myocardial infarction, or target lesion revascularization did not differ among the 3 groups. There were 7 episodes of acute (0.3% in PES group, 0.4% in SES group, and 0.4% in ZES group, respectively, P=0.773) and 18 episodes of cumulative stent thrombosis including late stent thrombosis (0.9% in PES group, 1.0% in SES group, and 1.3% in ZES group, respectively, P=0.448).
Implantation of SES, PES, and ZES in MS patients with STEMI undergoing primary PCI provided comparable clinical outcomes in patients enrolled in KAMIR.
Circulation Journal 07/2011; 75(9):2120-7. · 3.77 Impact Factor
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Cheol Ung Choi,
Seung-Woon Rha,
Dong Joo Oh,
Kanhaiya L Poddar,
Jin Oh Na,
Jin Won Kim,
Hong Euy Lim,
Eung Ju Kim,
Chang Gyu Park,
Hong Seog Seo, [......],
Chong Jin Kim,
Jung Han Yoon,
Tae Hoon Ahn,
Seung-Jea Tahk,
Wook Sung Chung,
Ki Bae Seung,
Shung Chall Chae,
Seung-Jung Park,
Young Keun Ahn,
Myung Ho Jeong
American heart journal 07/2011; 162(1):e21-2. · 4.65 Impact Factor
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Kyung Woo Park,
Seok-Jae Hwang,
Dong-A Kwon,
Byung-Hee Oh,
Young-Bae Park,
In-Ho Chae,
Hyeon-Cheol Gwon,
Seung-Jung Park,
Ki Bae Seung,
Taehoon Ahn,
Jung-Han Yoon, Yang-Soo Jang,
Myung-Ho Jeong,
Seung-Jea Tahk,
Hyo-Soo Kim
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ABSTRACT: Previous studies have reported possible predictors of drug-eluting stent thrombosis (ST), but data for Asians are relatively limited. This study was performed to elucidate clinical predictors of ST in Koreans.
From May 2003 to May 2007, consecutive patients presenting with ST were enrolled from 10 cardiovascular centers in Korea. They were compared with 2,192 controls (3,223 lesions) who had received percutaneous coronary intervention with at least 6 months of follow-up without ST. On multivariate analysis, acute myocardial infarction (AMI) as initial diagnosis, drug-eluting stents (DES) in-stent restenosis (ISR), low ejection fraction (EF), small stent diameter, left anterior descending artery intervention, and young age were independent predictors of total ST. When divided into early (ST within 30 days of index procedure) and delayed ST (ST after 30 days of index procedure), low EF, small stent diameter, DES ISR and AMI as initial diagnosis were universal risks for both early and delayed ST. The time from antiplatelet agent discontinuation to ST occurrence was significantly shorter in late compared with very late ST.
Predictors of ST may be slightly different for early vs. delayed ST. However, low EF, small stent diameter, DES ISR lesion, and AMI as initial diagnosis were universal risk factors for both early and delayed ST cases. The relationship between antiplatelet agent discontinuation and ST occurrence seems stronger in late compared with very late ST.
Circulation Journal 06/2011; 75(7):1626-32. · 3.77 Impact Factor
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Seok-Jae Hwang,
Kyung Woo Park,
Dong-A Kwon,
Hyun-Jae Kang,
Bon-Kwon Koo,
In-Ho Chae,
Hyeon-Cheol Gwon,
Seung-Jung Park,
Ki Bae Seung,
Taehoon Ahn,
Jung-Han Yoon, Yang-Soo Jang,
Myung-Ho Jeong,
Seung-Jea Tahk,
Hyo-Soo Kim
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ABSTRACT: Inflammation might contribute to the development of stent thrombosis (ST). The association between inflammatory cytokine concentrations and drug-eluting ST were evaluated.
Among the 123 ST patients enrolled in the multicenter Korea Stent Thrombosis registry, plasma samples were available in 41 patients. The patients' clinical characteristics and plasma concentrations of monocyte chemoattractant protein-1, tumor necrosis factor-alpha, and interleukin (IL)-6 were compared with 81 matched controls. Although the concentrations of 3 cytokines were higher in the ST group, they did not have significant differences. When divided into quartiles, the proportion of patients with the highest quartile of IL-6 was higher in the ST group than in the control group (44% vs. 16%, P = 0.001), and the highest IL-6 quartile was an independent predictor of ST for both early (adjusted hazard ratio [HR] 6.96; 95% confidence interval [CI] 1.75-27.66) and late ST (adjusted HR 4.71; 95%CI 1.06-20.92). In addition, the highest IL-6 quartile was an independent predictor of ST in those on clopidogrel (adjusted HR 7.70; 95%CI 1.97-30.13) but not in those who were off clopidogrel.
Highest IL-6 quartile was associated with ST, especially in clopidogrel users regardless of the time of ST, suggesting the involvement of inflammatory cytokines in ST.
Circulation Journal 05/2011; 75(6):1350-7. · 3.77 Impact Factor
