Ki-Dong Yoo

St. Vincent Hospital, Green Bay, Wisconsin, United States

Are you Ki-Dong Yoo?

Claim your profile

Publications (38)73.92 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The no-reflow phenomenon is a potential complication of primary percutaneous coronary intervention (PCI). Predictors of the no-reflow phenomenon and the impact on long-term mortality remain unclear. Two thousand and seventeen patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary PCI were consecutively enrolled in the multicentre Acute Myocardial Infarction registry of Korea. The no-reflow phenomenon was diagnosed on the basis of angiographic criteria. The primary outcome was all-cause mortality. The no-reflow phenomenon was diagnosed in 262 patients (13.0%). Independent predictors of no-reflow were older age, high Killip class, reduced pre-PCI thrombolysis in myocardial infarction flow grade, and longer stent length in the culprit vessel. During a median follow-up period of 4.1 years (interquartile range: 3.0-5.2 years), patients with no-reflow showed a higher rate of mortality than that observed in patients with reflow (30.2 vs. 18.3%, P<0.001). The multivariate Cox proportional hazards model identified the no-reflow phenomenon as an independent correlate of long-term mortality [adjusted hazard ratio (HR): 1.45; 95% confidence interval (CI): 1.12-1.86; P=0.004]. Time period-specific analyses demonstrated that the association between no-reflow and mortality was significant and stronger for short-term (<30 days) mortality (adjusted HR: 3.11; 95% CI: 1.91-5.05; P<0.001) but was not significant for longer-term mortality (≥30 days; adjusted HR: 1.12; 95% CI: 0.82-1.52; P=0.47). In patients with STEMI who had undergone primary PCI, the no-reflow phenomenon was an independent predictor of short-term but not long-term mortality.
    Coronary artery disease 03/2014; · 1.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: β-blockers are the standard treatment for myocardial infarction (MI) based on evidence from the pre-thrombolytic era. The aim of this study was to examine the effect of β-blocker treatment in patients with acute MI and preserved systolic function in the era of percutaneous coronary intervention (PCI). We analysed a multicentre registry and identified 3019 patients who presented with acute MI between 2004 and 2009. Patients were treated with PCI, had left ventricular EFs ≥50% according to echocardiograms that were performed during the index PCI, and were alive at the time of discharge. The association between β-blocker use after discharge and mortality (all-cause death and cardiac death) within 3 years was examined. Patients who were not treated with β-blockers (n=595) showed higher rates of all-cause death and cardiac death compared to patients treated with β-blockers (10.8% vs 5.7%, p<0.001, 7.6% vs 2.6%, p<0001). The multivariate Cox proportional hazards model showed that β-blocker treatment was associated with a significant reduction in all-cause death (adjusted HR 0.633, 95% CI 0.464 to 0.863; p=0.004) and cardiac death (adjusted HR 0.47, 95% CI 0.32 to 0.70; p<0.001). Comparable results were obtained after propensity score matching. β-blocker treatment was associated with reduced long term mortality in patients with acute MI and preserved systolic function who received PCI.
    Heart (British Cardiac Society) 01/2014; · 5.01 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Arterial stiffness, as assessed by the brachial-ankle pulse wave velocity (baPWV), is associated with arterial aging and has been consistently linked to cardiovascular disease. The factors involved in reducing the progression of arterial stiffness in patients with type 2 diabetes mellitus (DM) have not yet been fully established.
    Clinical Interventions in Aging 01/2014; 9:1321-5. · 2.65 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Diastolic dysfunction is associated with increased arterial stiffness in patients with hypertension. However, the role of arterial stiffness in diastolic dysfunction in subjects without hypertension has not been fully established. A total of 287 subjects (male:female ratio 121:166, mean age 53.0±14.4 years) without hypertension or any heart disease who simultaneously received transthoracic echocardiography and noninvasively semiautomated radial artery applanation tonometry (with an Omron HEM-9000AI) in the Department of Internal Medicine, St Vincent's Hospital, from July 2011 to September 2012, were enrolled in this study. A total of 147 subjects (male:female ratio 59:88, mean age 61.7±9.9 years), representing 51.2% of the 287 subjects, had diastolic dysfunction (defined as abnormal relaxation pattern of mitral inflow). There were significant differences in systolic blood pressure (BP), pulse pressure, late systolic peak pressure (SBP2), and radial augmentation index (RaAIx) between normal diastolic function and diastolic dysfunction. ΔBP was defined as systolic BP minus SBP2, because of the difference in systolic BP between the two groups. ΔBP (odds ratio [OR] 1.059, 95% confidence interval [CI] 1.005-1.115; P=0.032) and RaAIx (odds ratio 1.027, 95% CI 1.009-1.044, P=0.003) were associated with diastolic dysfunction. A receiver operating-characteristic curve showed that ΔBP (area under the curve 0.875, 95% CI 0.832-0.911) and RaAIx (area under the curve 0.878, 95% CI 0.835-0.914) were associated with diastolic dysfunction. We found that ΔBP and increased RaAIx were associated with diastolic dysfunction in subjects without hypertension after adjustment for age and sex. Therefore, it is suggested that noninvasive estimation of central BP may be useful to reflect diastolic dysfunction in subjects with normal peripheral BP.
    Clinical Interventions in Aging 01/2014; 9:527-33. · 2.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective The aim of this study was to investigate the development of severe hypoglycemia (SH) in the presence of cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes.Research design and methodsFrom January 2001 to December 2002, a total of 894 patients with type 2 diabetes were enrolled. A cardiovascular autonomic function test (AFT) was performed using heart rate variability parameters: expiration-to-inspiration ratio, response to Valsalva maneuver and standing. From the results of the each three test (0 for normal, 1 for abnormal), a total AFT score of 1 was defined as early CAN, and a AFT score of ≥ 2 was defined as definite CAN.ResultsThe median follow-up time was 9.5 years. The mean age was 54.5 ± 10.1 years and the duration of diabetes was 8.9 ± 6.3 years. One hundred and ninety-six (31.4%) patients showed an abnormal cardiovascular AFT score at baseline. Sixty-two (9.9%) patients experienced 77 episodes of SH (1.33 per 100 patient-years). The events of SH increased as the CAN score increased (23 (5.4%) patients with normal, 17 (17.2%) patients with early, and 22 (22.7%) patients with definite CAN; P for trends < 0.001). Cox proportional hazard regression analysis revealed that SH was associated with definite CAN (normal vs. definite CAN, HR 2.43, 95% CI 1.21 - 4.84; P = 0.012).Conclusions Definite CAN was an independent prognostic factor for the development of SH in patients with type 2 diabetes.
    Diabetes care 08/2013; · 7.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The impact of the CYP2C19*17 polymorphism on the clinical outcome in Asians undergoing percutaneous coronary intervention (PCI) is unknown. We sought to assess the long-term impact of CYP2C19*17 on the risk for adverse clinical events in 2188 Korean patients taking clopidogrel after PCI. The prevalence of the CYP2C19*17 allele [*wt/*17: 2.4% (n=53), *17/*17: 0%] was very low. The 2-year cumulative event rates for bleeding [*wt/*17 vs. *wt/*wt: 2 vs. 2.3%; adjusted hazard ratio (HR), 1.23; 95% confidence interval (CI), 0.16-9.45], stent thrombosis (2 vs. 1.1%; HR, 3.98; 95% CI, 0.49-31.6) or composite of any death, and myocardial infarction or stroke (5.4 vs. 7.1%; HR, 1.37; 95% CI, 0.32-5.73) did not differ on the basis of the presence of CYP2C19*17. In conclusion, in our study population of Asian patients, the CYP2C19*17 polymorphism was not associated with adverse clinical outcomes after PCI because of its low prevalence, the rarity of homozygotes, and the relatively low rate of adverse clinical events.
    Pharmacogenetics and Genomics 08/2013; · 3.61 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We investigated the relationship between endothelial dysfunction and diabetic retinopathy (DR) in patients with type 2 diabetes. We used a cross-sectional design to examine 167 patients with type 2 diabetes mellitus. All patients underwent biochemical and ophthalmological examination. We assessed endothelial dysfunction by a flow-mediated vasodilation method of the brachial artery. Changes in vasodilation (flow-mediated vasodilatation, %FMD) were expressed as percent change over baseline values. The mean±standard deviation of patient age was 54.1±8.6 years. The %FMD was significantly lower in patients with DR than without DR. The prevalence of retinopathy decreased across increasing tertiles of %FMD. After adjusting for patients' age, sex, diabetes duration, use of insulin, use of antihypertensive, antiplatelet, and lipid lowering medications, systolic blood pressure, fasting plasma glucose, 2-hour plasma glucose, glycated hemoglobin, and urinary albumin excretion, participants with a reduced %FMD were more likely to have DR (odds ratio, 11.819; 95% confidence interval, 2.201 to 63.461; P=0.004, comparing the lowest and highest tertiles of %FMD). Endothelial dysfunction was associated with DR, which was most apparent when the endothelial dysfunction was severe. Our study provides insights into the possible mechanism of the influence of endothelial dysfunction on the development of DR.
    Diabetes & metabolism journal 08/2013; 37(4):262-9.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Anemia is associated with an increased risk of mortality in patients who underwent percutaneous coronary intervention (PCI) in the bare-metal stent era. However, there have been no data concerning the clinical importance of anemia improvement during the follow-up period after discharge from the hospital during the drug-eluting stent era. To assess anemia, the hemoglobin level was measured at the time of index PCI with drug-eluting stents and at the subsequent outpatient visit between 3 and 12 months later. Improvement of anemia was defined by the normalization of the hemoglobin level at the follow-up laboratory examination. We analyzed 4300 patients who were tested for initial and follow-up hemoglobin levels. We compared major adverse cardiac and cerebrovascular events (MACCE) between the normal group and the anemia group and between the improved anemia group and the sustained anemia group. The median follow-up period was 25.4 months. There was poorer clinical outcome in the anemia group than in the normal group in terms of MACCE (adjusted hazard ratio 1.479, 95% confidence interval 1.025-2.134, P=0.037). Furthermore, the sustained anemia group showed poorer MACCE than did the improved anemia group (hazard ratio 3.558, 95% confidence interval 2.285-5.539, P<0.0001). On the basis of the multivariate Cox hazard regression model and propensity-score matching, the overall findings were consistent between sustained and improved anemia groups. The follow-up of hemoglobin level is important, and improvement of anemia is associated with favorable long-term clinical outcomes.
    Coronary artery disease 07/2012; 23(6):391-9. · 1.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Drug-eluting balloon (DEB) with angioplasty a paclitaxel-coated balloon catheter is an effective treatment option in patients with in-stent restenosis (ISR) after a drug-eluting stent (DES). We describe a case in which 'no-reflow' phenomenon developed after DEB angioplasty of a DES ISR lesion. Coronary flow was restored after intracoronary administration of nicorandil.
    Korean Circulation Journal 06/2012; 42(6):431-3.
  • Source
    Korean Circulation Journal 03/2012; 42(3):220-1.
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is unknown whether using a single guiding catheter for both nonculprit and culprit vessel angiography and intervention during transradial primary percutaneous coronary intervention (PCI) is feasible. This single-center study enrolled 242 consecutive patients with ST segment elevation myocardial infarction (STEMI) who received primary PCI. Among them, 102 patients received primary PCI via transfemoral approach (TFI), 109 patients received primary PCI via transradial approach using conventional technique (Conventional TRI), and 31 underwent primary TRI using a single guiding catheter (Single Guiding TRI). The catheter used for this purpose was 6 Fr RM® 3.5 guiding catheter. Using a single guiding catheter, both coronary artery angiograms and intervention were successful in 30 of 31 patients (96.7%). Needle-to-balloon time (from puncture to first balloon) and door-to-balloon (D2B) time were similar between TFI and Conventional TRI groups and significantly lower in the Single Guiding TRI group (13.8 [TFI] and 14.1 [Conventional TRI] vs. 7.6 minutes, P < 0.001; 89.5 [TFI] and 91.0 [Conventional TRI] vs. 68.5 minutes, P = 0.008, respectively), whereas proportion of patients achieving D2B time within 90 minutes increased significantly in the Single Guiding TRI group from 51.0% for TFI and 49.5% for Conventional TRI to 74.2% (P = 0.023). Primary transradial PCI using a single guiding catheter is feasible and highly successful and might allow timely restoration of blood flow in infarct-related artery.
    Journal of Interventional Cardiology 02/2012; 25(4):330-6. · 1.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We quantified radial artery atherosclerosis by intravascular ultrasound (IVUS) and determined the relationship between established cardiovascular risk factors and the extent of atherosclerotic plaque. Intravascular ultrasound examination of the radial artery was performed in patients undergoing transradial angiography or intervention. Total 50-mm segments starting at the radioulnar bifurcation were analyzed at 2-mm intervals to compute atheroma volume. In 115 consecutive patients, atheroma volume averaged 67.4 mm(3) and percentage atheroma volume was 25.2%. Radial arteries showed age-related acceleration of atherosclerosis. Total atheroma volume was strongly associated with square of age and male gender. Hypertension and diabetes were strong independent predictors of larger radial artery atheroma burden. Radial artery atherosclerosis, which can be quantitatively analyzed by IVUS, could be used as a surrogate marker for atherosclerosis.
    Angiology 02/2012; · 2.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The transradial approach is currently popular for vascular access during percutaneous coronary angiography and intervention. Catheter kinking during catheter manipulation is not uncommon, but mostly the kinked catheter can be unraveled by gentle rotation of catheter in the opposite direction. We describe a case in which the diagnostic catheter was kinked and entrapped in the small radial artery during transradial angiography. Attempts to withdraw or to unravel the catheter with gentle rotation were unsuccessful. We were able to catch the catheter tip with a 6 Fr Amplatz goose-neck snare kit (ev3, Inc.) guided by an 8 Fr guiding catheter via right femoral approach. We pulled the kinked catheter up into the brachial artery with large diameter where successful unraveling was possible, allowing for its successful removal through the radial sheath.
    The Journal of invasive cardiology 01/2012; 24(1):E3-4. · 1.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: WEBSITE FEATURE.
    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2012; 39(3):452-3. · 0.67 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study is to investigate the relationship between serum ferritin levels and metabolic risk factors in nonobese Korean young adults. We analysed the fourth annual Korea National Health and Nutrition Examination Survey (KNHANES) in young adults (aged 19-39 years), conducted between 2007 and 2008. A total of 1542 nonobese [body mass index (BMI) <25 kg/m(2) ] young adults (684 men and 858 women) were enrolled. Using blood pressure and levels of serum triglycerides, plasma glucose and high-density lipoprotein (HDL) cholesterol, the Asian criteria for abdominal obesity (Waist circumference ≥90 cm in men or ≥80 cm in women) was used to identify individuals with metabolic syndrome. Data on anthropometry, fasting plasma glucose, insulin, lipid profile and ferritin levels were analysed. The prevalence of metabolic syndrome was 4·1% for men and 2·7% for women. High fasting glucose and the prevalence of metabolic syndrome increased progressively across three different tertiles of ferritin levels in men. However, high ferritin levels were associated with high triglycerides, low HDL cholesterol and metabolic syndrome in women. After adjustment for age, smoking, alcohol consumption, BMI and ALT levels, low HDL cholesterol (OR 1·66, 95% confidence interval (CI) 1·16-2·36) and the presence of metabolic syndrome (OR 3·87, 95% CI 1·34-11·2) were independently associated with high serum ferritin levels in Korean nonobese young women. Our results suggest that elevated serum ferritin levels may be employed as a marker of metabolic syndrome in nonobese young adult women.
    Clinical Endocrinology 10/2011; 77(2):233-40. · 3.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Little evidence is available on the optimal antithrombotic therapy following percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF). We investigated the outcomes of antithrombotic treatment strategies in AF patients who underwent PCI. Three hundred sixty-two patients (68.0% men, mean age: 68.3±7.8 years) with AF and who had undergone PCI with stent implantation between 2005 and 2007 were enrolled. The clinical, demographic and procedural characteristics were reviewed and the stroke risk factors as well as antithrombotic regimens were analyzed. THE ACCOMPANYING COMORBIDITIES WERE AS FOLLOWS: hypertension (59.4%), diabetes (37.3%) and congestive heart failure (16.6%). The average number of stroke risk factors was 1.6. At the time of discharge after PCI, warfarin was prescribed for 84 patients (23.2%). Cilostazol was used in addition to dual antiplatelet therapy in 35% of the patients who did not receive warfarin. The mean follow-up period was 615±385 days. The incidences of major adverse cardiac events (MACE), stroke and major bleeding were 11.3%, 3.6% and 4.1%, respectively. By Kaplan-Meier survival analysis, warfarin treatment was not associated with a lower risk of MACE (p=0.886), but it was associated with an increased risk of major bleeding (p=0.002). Oral anticoagulation therapy after PCI may increase hemorrhagic events in Korean AF patients.
    Korean Circulation Journal 10/2011; 41(10):578-82.
  • Source
    Journal of cardiovascular ultrasound 09/2011; 19(3):167.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Warfarin is a commonly prescribed anticoagulant drug for the prevention of thromboembolic disorders. We investigated the contribution of genetic variations of four genes and clinical factors to warfarin dose requirement and provided a warfarin-dosing algorithm based on genetic and clinical variables in Korean patients. We recruited 564 Korean patients on stable anticoagulation. Single nucleotide polymorphisms (SNPs) for the VKORC1, CYP2C9, CYP4F2 and GGCX were analyzed. Using multiple regression analysis, we developed a model to predict the warfarin requirement. The SNPs of VKORC1, CYP2C9, CYP4F2 and GGCX showed significant correlation with warfarin dose. Patients with the 3730AA genotype received significantly higher doses of warfarin than those with the 3730GG (P=0.0001). For CYP2C9, the highest maintenance dose was observed in the patients with wild-type genotype compared with the variant allele carriers (P<0.0001). The multiple regression model including age, gender, body surface area (BSA), international normalized ratio (INR) and four genetic polymorphisms accounted for 35% of total variations in warfarin dose (R(2)=0.3499; P<0.0001). This study shows that age, gender, BSA, INR and VKORC1, CYP2C9 and CYP4F2 polymorphism affect warfarin dose requirements in Koreans. Translation of this knowledge into clinical guidelines for warfarin prescription may contribute to improve the efficacy and safety of warfarin treatment for Korean patients.
    Journal of Human Genetics 02/2011; 56(4):290-5. · 2.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The levels of soluble receptor for advanced glycation end products (sRAGE) may reflect the activity of the advanced glycation end products-RAGE axis, which has been proposed as a potential mechanism of vascular inflammation in patients with type 2 diabetes (T2D). However, the role of sRAGE in in-stent restenosis (ISR) is not yet known in patients with T2D with drug-eluting stent (DES) implantation. We enrolled 35 patients with T2D with ISR (T2D-ISR) and 35 patients with age-matched T2D without ISR (T2D-control) at the time of follow-up coronary angiography after DES implantation. Plasma levels of glycosylated hemoglobin (HbA(1c)), C-reactive protein (CRP), insulin-like growth factor-1 (IGF-1), and sRAGE were measured in blood samples obtained at the time of the index procedure. Baseline characteristics showed no difference between the groups. Plasma levels of sRAGE were significantly higher in the T2D-ISR group than in the T2D-control group (7.29 ± 2.91 vs. 5.36 ± 2.20 ng/ml, P= 0.003), but levels of HbA(1c) (7.65 ± 1.59% vs. 7.60 ± 1.65%, P = 0.89), CRP (8.15 ± 13.82 vs. 5.59 ± 7.68 mg/l, P = 0.34), and IGF-1 (0.93 ± 0.37 vs. 0.99 ± 0.30 ng/ml, P = 0.42) did not differ significantly between the two study groups. In multivariate logistic regression analysis, elevated plasma level of sRAGE (above the median) was a significant predictor of ISR [odds ratio (OR): 4.33, 95% confidence interval (CI): 1.38–13.59, P = 0.01], followed by mean stent diameter less than 3.0mm (OR: 3.35, CI: 0.98–11.46, P = 0.05). Plasma level of sRAGE may be positively associated with ISR and RAGE-dependent inflammatory responses may contribute more to ISR development than IGF-1-dependent proliferative responses in patients with T2D with DES implantation.
    Coronary artery disease 01/2011; 22(1):12-7. · 1.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The long-term prognosis of patients with heart failure with preserved left ventricular ejection fraction (HFPEF) and coexistent chronic obstructive pulmonary disease (COPD) has not been previously investigated. The primary aim of this study was to determine whether the long-term prognosis of HFPEF patients with COPD differs from that of heart failure patients with reduced left ventricular ejection fraction (HFREF) and COPD. The secondary aim was to identify independent predictors of event-free survival in patients with HF and COPD. We investigated 184 patients with coexistent HF and COPD. Heart failure with preserved left ventricular ejection fraction was present in 98 cases (53%) and HFREF in the remaining 86 cases (47%). Mean follow-up time was 731±369 days. Cardiovascular/pulmonary hospitalization or mortality occurred in 71 patients (39%). No significant difference was observed between the two study groups in terms of event-free survival (P=0.457), but event-free survival was found to be independently associated with New York Heart Association (NYHA) class [III vs. I, hazard ratio (HR) 2.92, 95% confidence interval (CI) 1.09-7.82], Global initiative for chronic Obstructive Lung Disease (GOLD) stage (III vs. I, HR 3.20, 95% CI 1.33-7.68), systemic hypertension (SHT; HR 2.99, 95% CI 1.41-6.33), and pulmonary hypertension (PH; HR 4.35, 95% CI 1.95-9.68). In HF patients with coexisting COPD, cardiovascular and pulmonary event-free survival of HFPEF was found to be similar to that of HFREF over 3 years follow-up. Furthermore, severe NYHA class, severe GOLD stage, SHT, and PH were found to be independent predictors of event-free survival.
    European Journal of Heart Failure 12/2010; 12(12):1339-44. · 5.25 Impact Factor

Publication Stats

88 Citations
73.92 Total Impact Points

Institutions

  • 2011–2014
    • St. Vincent Hospital
      Green Bay, Wisconsin, United States
    • International St. Mary's Hospitals
      Chemulpo, Incheon, South Korea
  • 2005–2014
    • Catholic University of Korea
      • • Department of Internal Medicine
      • • College of Medicine
      Sŏul, Seoul, South Korea