[show abstract][hide abstract] ABSTRACT: Purpose: Thiazolidinediones are insulin-sensitizing agents that reduce neointimal proliferation and the adverse clinical outcomes associated with percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM). There is little data on whether or not low dose pioglitazone reduces adverse clinical outcomes. Materials and Methods: The study population included 121 DM patients with coronary artery disease and they were randomly assigned to 60 patients taking 15 mg of pioglitazone daily in addition to their diabetic medications and 61 patients with placebo after the index procedure with drug-eluting stents (DESs). The primary end points were rate of in-stent restenosis (ISR) and change in atheroma volume and in-stent neointimal volume. The secondary end points were all-cause death, myocardial infarction (MI), stent thrombosis and re-PCI. Results: There were no statistical differences in the clinical outcomes and the rate of ISR between the two groups [all-cause death; n=0 (0%) in the pioglitazone group vs. n=1 (1.6%) in the control group, p=0.504, MI; n=2 (3.3%) vs. n=1 (1.6%), p=0.465, re-PCI; n=6 (10.0%) vs. n=6 (9.8%), p=0.652, ISR; n=4 (9.3%) vs. n=4 (7.5%), p=1.000, respectively]. There were no differences in changes in neointimal volume, percent neointimal volume, total plaque volume and percent plaque volume between the two groups on intravascular ultrasonography (IVUS) study. Conclusion: Our study demonstrated that low dose pioglitazone does not reduce rate of ISR, neointimal volume nor atheroma volume in DM patients who have undergone PCI with DESs, despite the limitations of the study.
Yonsei medical journal 11/2013; 54(6):1313-20. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: It was demonstrated that the fractional flow reserve (FFR) with partial balloon obstruction may have implications for assessing viable myocardium. In a different way, the index of microcirculatory resistance (IMR) was introduced as a useful indicator for assessing microvascular function. We evaluated the relationship between the FFR0.8 and the IMR.
We studied 48 consecutive patients who had undergone coronary intervention for acute myocardial infarction (AMI). After revascularization using stent(s), an undersized short balloon was positioned inside the stent and inflated to create a specific normalized pressure drop of FFR (distal coronary/aortic pressure=0.80) at rest. The FFR0.8 was obtained during hyperemia with the fixed state balloon-induced partial obstruction. IMR was measured by three injections of saline. The association between the FFR0.8 and the IMR was investigated.
The mean age of the patients was 60±12 years and 36 (75%) overall presented with ST-segment elevation myocardial infarction. The mean FFR0.8 was 0.68±0.06. A statistically significant correlation between the FFR0.8 and the log-transformed IMRtrue (LnIMRtrue) was found through a multivariable linear regression analysis (β=0.056, p<0.001). Both the FFR0.8 and the LnIMRtrue had a positive correlation with the log-transformed peak troponin I (TnI) with statistical significance (r(2)=0.119, p=0.017; r(2)=0.225, p=0.006, respectively).
There was a positive correlation between the LnIMRtrue and the FFR0.8. Both of the values were associated with peak TnI. Those values may be used as appropriate surrogate measures of microvascular function after AMI.
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Intravenous nicorandil infusion dilates the coronary artery and reduces inflammation, coronary spasm, and arrhythmia. Periprocedural myocardial infarction (PMI) is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). This prospective randomized study was designed to evaluate the efficacy of intracoronary nicorandil on PMI after elective PCI. METHODS AND RESULTS: Eighty-one patients with stable or unstable angina undergoing PCIs of the left anterior descending artery were randomly assigned to the nicorandil group (n=41) or the control group (n=40). In the nicorandil group, 4mg of intracoronary nicorandil was infused prior to PCI. Post-PCI, peak levels of creatine kinase (CK)-MB and troponin I were measured and angiographic findings were analyzed. Side branch status was also assessed. All PCIs were successful. One cerebrovascular infarction and one acute ST segment elevation myocardial infarction with acute stent thrombosis occurred in the nicorandil group. No deaths occurred, and no other major cardiac adverse events were observed in either group over 6 months follow-up. The post-PCI peak CK-MB and troponin I levels were not significantly different between the two groups. There were no significant differences between the nicorandil and control subjects in side branch occlusion or flow reduction, or in the jail index. CONCLUSIONS: Intra-coronary nicorandil infusion had no significant effect on PMI and cardiac enzymes after PCI in patients with stable or unstable angina.
Journal of Cardiology 05/2013; · 2.30 Impact Factor
[show abstract][hide abstract] ABSTRACT: Neurologic impairments are very common among patients who get a recovery of spontaneous circulation after suffering from out-of-hospital cardiac arrest. Therapeutic hypothermia is established as a standardized therapeutic strategy for those patients in whom it decreases mortality rate and improves neurologic outcome. Herein, we report a case of patient who experienced out-of-hospital cardiac arrest with ischaemic heart disease and ventricular arrhythmia and got a full recovery without any neurologic impediments 2 months after being managed with therapeutic hypothermia.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 02/2013; 23(2):144-6.
[show abstract][hide abstract] ABSTRACT: A 55-year-old male was admitted to our hospital with severe heart failure. He was diagnosed with triple valve regurgitation and an aneurysm of patent ductus arteriosus (PDA). Infectious etiology was suspected because of the valve morphology, but the patient had no sign of infection. After confirming the complete control of infection, a hybrid operation was planned. The opening of PDA at the pulmonary artery side was closed with a patch, accompanied by a multiple valve surgery, after which the aorta side entry of the aneurism was covered with a stent graft. The patient was treated successfully without complications.
The Annals of thoracic surgery 01/2013; 95(1):e15-7. · 3.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: While thoracic endovascular aortic repair is an effective treatment option for descending thoracic aorta pathology, it does have limitations. The main limitation is related to the anatomical difficulties when disease involves the aortic arch. A fenestrated, branched aortic stent graft and hybrid operation has been introduced to overcome this limitation, but it is a custom-made device and is time consuming to manufacture. Furthermore, these devices cannot be used in an emergency setting. We report two patients with massive descending thoracic aortic aneurysm and ruptured aortic dissection very near the aortic arch who underwent a procedure which we named the modified chimney technique. The modified chimney technique can be used as a treatment option in such an emergency situation or as a rescue procedure when aortic pathology is involved near the supra-aortic vessels.
[show abstract][hide abstract] ABSTRACT: Treatment of critical limb ischemia (CLI) by bypass operation or percutaneous vascular intervention is occasionally difficult. The safety and efficacy of multiple intramuscular adipose tissue-derived mesenchymal stem cells (ATMSC) injections in CLI patients was determined in the study.
The study included 15 male CLI patients with ischemic resting pain in 1 limb with/without non-healing ulcers and necrotic foot. ATMSC were isolated from adipose tissue of thromboangiitis obliterans (TAO) patients (B-ATMSC), diabetes patients (D-ATMSC), and healthy donors (control ATMSC). In a colony-forming unit assay, the stromal vascular fraction of TAO and diabetic patients yielded lesser colonies than that of healthy donors. D-ATMSC showed lower proliferation abilitythan B-ATMSC and control ATMSC, but they showed similar angiogenic factor expression with control ATMSC and B-ATMSC. Multiple intramuscular ATMSC injections cause no complications during the follow-up period (mean follow-up time: 6 months). Clinical improvement occurred in 66.7% of patients. Five patients required minor amputation during follow-up, and all amputation sites healed completely. At 6 months, significant improvement was noted on pain rating scales and in claudication walking distance. Digital subtraction angiography before and 6 months after ATMSC implantation showed formation of numerous vascular collateral networks across affected arteries.
Multiple intramuscular ATMSC injections might be a safe alternative to achieve therapeutic angiogenesis in patients with CLI who are refractory to other treatment modalities.
[show abstract][hide abstract] ABSTRACT: n-3 fatty acids and lifestyle also are closely related to risk of CVD. Most Koreans have higher fish consumption than people of Western populations. However, little is known about the recommended value of omega-3 index in Korean patients with acute ST-elevation myocardial infarction (STEMI) taking statins. Here, we tested the hypothesis that lower omega-3 fatty acids and/or smoking are associated with acute STEMI, even though patients with dyslipidemia who were taking statins and who attained their LDL-C goals.
We conducted a case-control study in which omega-3 fatty acids and lifestyle factors were determined in 24 consecutive Korean patients taking statins with angiographically confirmed acute STEMI and 68 healthy controls without acute STEMI. The omega-3 index was calculated by the sum of eicosapentaenoic acid and docosahexaenoic acid in erythrocyte membranes. Multivariable adjusted regression analysis was used to assess independent associations between acute STEMI, omega-3 index, and lifestyle factors after adjusting for age, sex, and body mass index (BMI).
The mean age of total subjects was 59.9 years, and 57.6% of the subjects were male. The omega-3 index was significantly lower in cases (8.83%) than controls (11.13%; P < 0.001); however, total trans-fatty acids were not different between the two groups. The omega-3 index was inversely associated with odds for being a case (OR 0.16 (95% CI 0.03-1.14); P = 0.047), while smoking was positively associated with odds for being a case (OR 6.67 (95% CI 1.77-25.23); P = 0.005) after adjusting for all confounding variables.
This study shows that relative to controls, acute STEMI cases are more likely to be smokers and to have a lower omega-3 index, even though the cases were taking statins. An omega-3 index of at least 11% and abstinence from smoking are associated with cardioprotection for Koreans.
Lipids in Health and Disease 03/2012; 11:43. · 2.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: Many ST-segment elevation myocardial infarction (STEMI) patients have multivessel disease. There is still controversy in treatment strategy in STEMI patients with multivessel disease. We compared clinical outcomes of multivessel revascularization with infarct- related artery (IRA) revascularization in STEMI patients.
The 1,644 STEMI patients with multivessel disease (1,106 in IRA group, 538 in multivessel group) who were received primary percutaneous coronary intervention (PCI) were analyzed from a nationwide Korea Acute Myocardial Infarction Registry. Primary endpoint was 12-month major adverse cardiac events (MACE, defined as death, myocardial infarction, and repeated revascularization). Secondary endpoints were 1-month MACE and each component, stent thrombosis during 12 month follow-up, and each components of the 12-month MACE.
There were more patients with unfavorable baseline conditions in IRA group. 12-month MACE occurred in 165 (14.9%) patients in IRA group, 81 (15.1%) patients in multivessel group (p = 0.953). There were no statistical significance in the rate of 1-month MACE, each components of 1-month MACE, and stent thrombosis during 12 month follow-up. Each components of 12-month MACE were occurred similarly in both groups except for target lesion revascularization (2.4% in IRA group vs 5.9% in multivessel group, p < 0.0001). After adjusting for confounding factors, multivessel revascularization was not associated with reduced 12-month MACE (OR 1.096, 95% CI 0.676-1.775, p = 0.711).
There were no significant differences in clinical outcomes between both groups except for high risk of target lesion revascularization in multivessel revascularization group.
[show abstract][hide abstract] ABSTRACT: Aortic rupture has a high mortality rate and can be considered a medical emergency. The standard treatment for aortic rupture is surgical repair. An aortic stent graft for a ruptured descending aorta is considered an effective alternative treatment. However, an aortic stent graft is difficult when the aortic aneurysm is in the aortic arch due to supra-aortic vessels. We report on a patient with a ruptured aortic arch aneurysm treated with a hybrid procedure, which involved a carotid to carotid bypass operation and an aortic stent graft. A 71-year-old male patient visited our cardiovascular center suffering from hemoptysis. The chest CT and aortography showed a 9 cm sized aortic arch aneurysm 0.5 cm distal to the left subclavian artery and a hemothorax in the left lung. The patient refused to undergo a full open operation. We performed a carotid to carotid bypass in advance, and two pieces of aortic stent grafts were placed across the left carotid artery and left subclavian artery. The follow up CT showed the aortic stent grafts, no endoleaks and no thrombus in the aortic arch aneurysm. The patient was discharged from the hospital without complication.
[show abstract][hide abstract] ABSTRACT: Determination of the profile of genes that are commonly methylated aberrantly in colorectal cancer (CRC) will have substantial value for diagnostic and therapeutic applications. However, there is limited knowledge of the DNA methylation pattern in CRC.
We analyzed the methylation profile of 27,578 CpG sites spanning more than 14,000 genes in CRC and in the adjacent normal mucosa with bead-chip array-based technology.
We identified 621 CpG sites located in promoter regions and CpG islands that were greatly hypermethylated in CRC compared to normal mucosa. The genes on chromosome 18 showed promoter hypermethylation most frequently. According to gene ontology analysis, the most common biologically relevant class of genes affected by methylation was the class associated with the cadherin signaling pathway. Compared to the genome-wide expression array, mRNA expression was more likely to be downregulated in the genes demonstrating promoter hypermethylation, even though this was not statistically significant. We validated ten CpG sites that were hypermethylated (ADHFE1, BOLL, SLC6A15, ADAMTS5, TFPI2, EYA4, NPY, TWIST1, LAMA1, GAS7) and 2 CpG sites showing hypomethylation (MAEL, SFT2D3) in CRC compared to the normal mucosa in the array studies using pyrosequencing. The methylation status measured by pyrosequencing was consistent with the methylation array data.
Methylation profiling based on bead-chip arrays is an effective method for screening aberrantly methylated genes in CRC. In addition, we identified novel methylated genes that are candidate diagnostic or prognostic markers for CRC.
Annals of Surgical Oncology 02/2011; 18(8):2338-47. · 4.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: Patients with acute coronary syndrome without ST-segment elevation (ACS- -NSTE) are at risk for adverse cardiac events. Based on data in the Korean Acute Myocardial Infarction Registry (KAMIR), we analyzed the prognosis according to the timing of percutaneous coronary intervention (PCI) in patients with NSTEMI in Korea.
2,455 patients with NSTEMI in KAMIR were classified according to the time interval from the onset of cardiac symptoms to PCI. Patients in Group I underwent PCI within 24 hours of the onset of symptoms; in Group II between 24 and 48 hours; and in Group III after 48 hours. Major adverse cardiac events (MACEs) are defined as cardiac death, non-cardiac death, myocardial infarction, revascularization and coronary-artery bypass graft surgery. The MACEs were compared between groups. Of the 2,455 patients, 743 (30.2%) were assigned to Group I, 583 (23.7%) to Group II, and 1,129 (45.9%) to Group III. The total incidence of MACEs was higher in Group I than Group III, and similar between Groups I and II (Group I: 15.1%, Group II: 14.4%, Group III: 11.6%, p = 0.053). The incidence of MACEs in the intermediate TIMI risk score group had decreased as the intervention time was delayed.
The prognosis according to the timing of PCI in patients with NSTEMI was similar based on the data in KAMIR. TIMI risk score was related to a high incidence of MACEs.
[show abstract][hide abstract] ABSTRACT: We investigated the impact of metabolic syndrome (MS) on the occurrence of in-stent restenosis (ISR) and long-term major adverse cardiac events (MACEs), including cardiovascular death, myocardial infarction, and target vessel revascularization (TVR) during a follow-up period of 36 months after percutaneous coronary intervention (PCI) with stent implantation in patients with significant preexisting coronary artery disease. MS was not an independent predictor of increased ISR and MACE after PCI.
Diabetes research and clinical practice 06/2010; 88(3):e38-41. · 2.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: Takayasu's arteritis can involve the ostia of coronary arteries. We report a patient with Takayasu's arteritis involving the ostia of three large coronary arteries who was successfully treated by percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) and had a good clinical outcome after 12 months. A 37-year-old male with unstable angina was admitted to our cardiovascular center. The patient had Takayasu's arteritis and an aortic valve replacement with a metallic valve due to severe aortic regurgitation 7 years previously. Coronary angiography (CAG) showed a 95% discrete eccentric luminal narrowing at the ostia of the large left anterior descending (LAD) and left circumflex (LCX) arteries, and a 99% discrete eccentric luminal narrowing at the ostium of the large right coronary artery (RCA). The patient was treated with prednisolone for 14 days. Two large paclitaxel-eluting stents (PES) were then implanted in the distal left main coronary artery using the kissing stent technique. After 6 months, a CAG did not reveal restenosis or recurrent coronary artery disease. Thus, PCI with a DES for patients with significant coronary involvement secondary to Takayasu's arteritis is an effective and an alternative treatment when coronary bypass grafting is not option.
[show abstract][hide abstract] ABSTRACT: The biological characteristics of intestinal-type early gastric cancers (ICs) differ based on mucin phenotypes. Beta-catenin delocalization is a predictive marker of aggressive biological behavior (submucosal invasion and lymph node metastasis) of ICs. The presumptive causative genetic alterations leading to delocalization of beta-catenin in ICs are still controversial, and there are only a few reports regarding beta-catenin expression in gastric cancer based on mucin phenotypes. Therefore, in the current study, the expression and mechanisms of delocalization of beta-catenin were elucidated on the basis of mucin phenotypes in 109 cases of ICs. There was increased cytoplasmic and nuclear beta-catenin expression (delocalization) in ICs with a predominant intestinal mucin phenotype (ICIP; 46.3% [25/54 cases]) compared to ICs with a predominant gastric mucin phenotype (ICGP; 20% [11/55 cases]). There were no beta-catenin or APC mutations in ICs. APC promoter hypermethylation was present in 49 of 105 (46.7%) cases of ICs. There was a significant relationship between APC promoter hypermethylation and beta-catenin delocalization in ICs, especially in ICIPs. There was no relationship between beta-catenin delocalization and APC gene loss of heterozygosity in ICs. In conclusion, we showed that beta-catenin delocalization was more evident in ICIPs, and APC promoter hypermethylation might play a role in delocalization of beta-catenin, especially in ICIPs.
Histology and histopathology 08/2009; 24(7):831-8. · 2.28 Impact Factor