Ki-Dong Yoo

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

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Publications (50)112.91 Total impact

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    ABSTRACT: Home blood pressure (BP) monitoring offers clinically relevant information enriched with more abundant data. However, there are few studies addressing the reliability of home BP devices and the quality of its data. This study aimed to evaluate the current status of home BP devices in terms of validation and accuracy. Hypertensive patients with automated upper arm-type BP devices were consecutively enrolled. First, the validation status of each device was assessed through the website. Next, the accuracy of the individual device was evaluated by comparing the mean BP values between the automated device and a mercury sphygmomanometer. Accuracy of the device was defined as having less than a 5 mmHg difference in the mean BP values. A total of 212 individuals were analyzed; 38.7% (82 of 212) of the participants used validated devices and 85.4% (181 of 212) were accurate. Inaccuracy was more common with nonvalidated devices than validated devices [19.2% (n=25) vs. 7.3% (n=6), P=0.017]. The range of inaccuracy of the validated devices was 6-26 mmHg for the systolic BP and 6-11 mmHg for the diastolic BP. The present study showed that nonvalidated devices are used widely in clinical practice and a substantial portion is inaccurate. Therefore, recommendation of validated devices should be the first step. Furthermore, all devices need to be examined for accuracy before use irrespective of their validation status.
    Blood pressure monitoring 04/2015; DOI:10.1097/MBP.0000000000000121 · 1.18 Impact Factor
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    ABSTRACT: Considering that contrast medium is excreted through the whole kidney in a similar manner to drug excretion, the use of raw estimated glomerular filtration rate (eGFR) rather than body surface area (BSA)-normalized eGFR is thought to be more appropriate for evaluating the risk of contrast-induced acute kidney injury (CI-AKI). This study included 2,189 myocardial infarction patients treated with percutaneous coronary intervention. Logistic regression analysis was performed to identify the independent risk factors. We used receiver-operating characteristic (ROC) curves to compare the ratios of contrast volume (CV) to eGFR with and without BSA normalization in predicting CI-AKI. The area under the curve (AUC) of the ROC curve for the model including all the significant variables such as diabetes mellitus, left ventricular ejection fraction, preprocedural glucose, and the CV/raw modification of diet in renal disease (MDRD) eGFR ratio was 0.768 [95% confidence interval (CI), 0.720-0.816; p < 0.001]. When the CV/raw MDRD eGFR ratio was used as a single risk value, the AUC of the ROC curve was 0.650 (95% CI, 0.590-0.711; p < 0.001). When the CV/MDRD eGFR ratio with BSA normalization ratio was used, the AUC of the ROC curve further decreased to 0.635 (95% CI, 0.574-0.696; p < 0.001). The difference between the two AUCs was significant (p = 0.002). Raw eGFR is a better predictor for CI-AKI than BSA-normalized eGFR.
    02/2015; 5(1):61-68. DOI:10.1159/000369940
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    ABSTRACT: We investigated the association between cardiovascular autonomic neuropathy (CAN) and the future development of chronic kidney disease (CKD) in patients with type 2 diabetes. From Jan 2003 to Dec 2004, 1117 patients with type 2 diabetes without CKD (estimated glomerular filtration rate [eGFR]≥60ml/min/1.73m(2)), aged 25-75 years, were consecutively enrolled. A cardiovascular autonomic function test (AFT) was performed using heart rate variability parameters. The eGFR was measured at least more than once every year, and new onset CKD was defined as eGFR<60ml/min/1.73m(2) using a Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Among the 755 (67.6%) patients who completed the follow-up evaluation for 9.6 years, 272 patients (36.0%) showed a CKD stage ≥3. The patients who developed CKD were older, had a longer duration of diabetes, had hypertension, received more insulin and ACE inhibitor/angiotensin receptor blocker (ARB) treatment, and exhibited lower baseline eGFR, HbA1c, and albuminuria levels. Compared to patients without CKD, more patients with CKD at follow-up had CAN at baseline. In a multivariate analysis, after adjustment for age, sex, diabetes duration, presence of hypertension, mean HbA1c, diabetic complications, use of insulin, ACE inhibitor/ARB, statin, and baseline eGFR, the development of CKD was significantly associated with the presence of CAN (HR 2.62, 95% CI 1.87-3.67, P<0.001). In this prospective, longitudinal, observational cohort study, we demonstrated that diabetic CAN was an independent prognostic factor for the future development of CKD in type 2 diabetes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Diabetes Research and Clinical Practice 01/2015; 108(1). DOI:10.1016/j.diabres.2015.01.031 · 2.54 Impact Factor
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    ABSTRACT: Cystatin-C, a marker of mild renal dysfunction, has been reported to be associated with cardiovascular diseases including vasospastic angina (VSA). We aimed to investigate the impact of cystatin-C level on the prevalence and angiographic characteristics of VSA in Korean patients.A total of 549 patients in the VA-KOREA (Vasospastic Angina in KOREA) registry who underwent ergonovine provocation tests were consecutively enrolled. Estimated glomerular filtration rate (eGFR) and levels of serum creatinine (Cr) and cystatin-C were assessed before angiography.The patients were classified into two groups: the VSA group (n = 149, 27.1%) and the non-VSA group (n = 400). Although eGFR and Cr levels were similar between the two groups, the VSA group had a significantly higher level of cystatin-C (P < 0.05). A high level of cystatin-C (second tertile, hazard ratio 1.432; 95% confidence interval [1.1491.805]; P = 0.026, third tertile, 1.947 [1.132-2.719]; P = 0.003) and current smoking (2.710 [1.415-4.098]; P < 0.001) were independently associated with the prevalence of VSA. Furthermore, the highest level of cystatin-C (> 0.96 ng/mL) had a significant impact on the incidence of multivessel spasm (2.608 [1.061-4.596]; P = 0.037).A high level of cystatin-C was independently associated with the prevalence of VSA and with a high-risk type of VSA in Korean patients, suggesting that proactive investigation of VSA should be considered for patients with mild renal dysfunction indicated by elevated cystatin-C.
    International Heart Journal 01/2015; 56(1):49-55. DOI:10.1536/ihj.14-213 · 1.13 Impact Factor
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    ABSTRACT: ObjectiveArterial 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.MethodsOf 478 patients who underwent two baPWV measurements (at baseline and 1 year later) at the Department of Internal Medicine, St Vincent’s Hospital, from November 2009 to June 2011, 341 subjects were enrolled in this study (male to female ratio =150:191; mean age, 62.1±7.7 years). The 341 subjects were over the age of 50 with type 2 DM, were diagnosed without peripheral artery disease, and 170 if the subjects (50%) had hypertension.ResultsbaPWV at baseline increased in a linear manner along with age (β=22.8, t=10.855; P<0.0001, R2=0.258). After 1 year follow-up, the change in baPWV (ΔbaPWV) was variable (median 32.7 cm/s [approximate range, −557 to ∼745]). In multiple linear regression, the change in systolic blood pressure (β=7.142, 95% confidence interval =4.557–9.727; P<0.0001, R2=0.305) was associated with ΔbaPWV during follow-up. The change in glycated hemoglobin (HbA1c) and a glycemic control of keeping HbA1c levels below 7.0% were not associated with ΔbaPWV.ConclusionWe found that the variation of blood pressure was associated with the progression of vascular aging of the large- to middle-sized arteries in patients with type 2 DM. Therefore, control of blood pressure might be important in reducing arterial aging or PWV in patients with type 2 DM.
    Clinical Interventions in Aging 08/2014; 9:1321-5. DOI:10.2147/CIA.S66019 · 1.82 Impact Factor
  • Journal of the American College of Cardiology 04/2014; 63(12):S47. DOI:10.1016/j.jacc.2014.02.565 · 15.34 Impact Factor
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    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 03/2014; 9:527-33. DOI:10.2147/CIA.S58810 · 1.82 Impact Factor
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    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; 25(5). DOI:10.1097/MCA.0000000000000108 · 1.30 Impact Factor
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    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; DOI:10.1136/heartjnl-2013-305137 · 6.02 Impact Factor
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    ABSTRACT: Complete atrioventricular block (CAVB) in acute inferior ST-segment elevation myocardial infarction (STEMI) is associated with poor clinical outcomes after noninvasive treatment. This study was designed to determine the effect of primary percutaneous coronary intervention (PCI) in patients with CAVB complicating acute inferior STEMI, at a single center. We enrolled 138 consecutive patients diagnosed with STEMI involving the inferior wall; of these, 27 patients had CAVB. All patients received primary PCI. The clinical characteristics, procedural data, and clinical outcomes were compared in patients with versus without CAVB. Baseline clinical characteristics were similar between patients with and without CAVB. Patients with CAVB were more likely to present with cardiogenic shock, and CAVB was caused primarily by right coronary artery occlusion. Door-to-balloon time was similar between those two groups. After primary PCI, CAVB was reversed in all patients. The peak creatinine phosphokinase level, left ventricular ejection fraction and in-hospital mortality rate were similar between the two groups. After a median follow up of 318 days, major adverse cardiac events did not differ between the groups (8.1% in patients without CAVB; 11.1% in patients with CAVB) (P=0.702). We conclude that primary PCI can ameliorate CAVB-complicated acute inferior STEMI, with an acceptable rate of major adverse cardiac events, and suggest that primary PCI should be the preferred reperfusion therapy in patients with CAVB complicating acute inferior myocardial infarction.
    Clinical Interventions in Aging 01/2014; 9:2027-31. DOI:10.2147/CIA.S74088 · 1.82 Impact Factor
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    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; 37(1). DOI:10.2337/dc13-1164 · 8.57 Impact Factor
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    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; 23(10). DOI:10.1097/FPC.0b013e328364eb92 · 3.45 Impact Factor
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    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. DOI:10.4093/dmj.2013.37.4.262
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    ABSTRACT: OBJECTIVE: Dyslipidemia, a risk factor for cardiovascular diseases, is more prevalent in patients with rheumatoid arthritis (RA) than in the general population. We investigated whether single-nucleotide polymorphisms (SNP) modulating low-density lipoprotein (LDL) cholesterol affect susceptibility, severity, and progression of RA. METHODS: We enrolled 302 patients with RA and 1636 healthy controls, and investigated the SNP modulating LDL cholesterol. Clinical characteristics of RA, serum adipocytokine concentrations, and radiographic severity were analyzed according to genotype score based on the number of unfavorable alleles. The influence of genotype score on radiographic progression was also investigated using multivariable logistic models. RESULTS: We identified 3 SNP (rs688, rs693, and rs4420638) modulating LDL cholesterol in Koreans, which correlated well with LDL cholesterol levels in both patients with RA and controls. Among them, 2 SNP, rs688 and rs4420638, were more prevalent in patients with RA than in controls. In patients with RA carrying more unfavorable alleles (genotype score ≥ 3), disease activity measures, serum adipocytokine levels, and radiographic severity were all increased. The genotype score was an independent risk factor for radiographic progression of RA over 2 years, and its effect was greater than the influence of conventional risk factors. CONCLUSION: SNP modulating LDL cholesterol influence the risk, activity, and severity of RA. These results provide the first evidence that genetic mechanisms linked to dyslipidemia may directly contribute to the susceptibility and prognosis of RA, a representative of chronic inflammatory diseases, explaining the high incidence of dyslipidemia in RA.
    The Journal of Rheumatology 04/2013; 40(6). DOI:10.3899/jrheum.120954 · 3.17 Impact Factor
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    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. DOI:10.1097/MCA.0b013e3283564869 · 1.30 Impact Factor
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    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. DOI:10.4070/kcj.2012.42.6.431
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    Korean Circulation Journal 03/2012; 42(3):220-1. DOI:10.4070/kcj.2012.42.3.220
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    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. DOI:10.1111/j.1540-8183.2011.00717.x · 1.32 Impact Factor
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    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; 64(1). DOI:10.1177/0003319712437030 · 2.37 Impact Factor
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    ABSTRACT: The objective of the present study was to investigate in vitro biocompatibility of ultra high molecular weight polyethylene (UHMWPE)/zirconia-polymerized composite (PC) using human peripheral blood mononuclear cells (PBMCs). This study was undertaken to compare the levels of free radical generations for neat UHMWPE and PC through irradiation sterilization, and their response to PBMCs viability. Electron spin resonance (ESR) studies showed that γ-ray irradiation of the samples generated free radicals; the extent was inversely related to zirconia content, and the free radicals strongly influenced cell viability. DNA fragmentation and DAPI staining assays revealed that cell death was associated with the induction of apoptosis. Flow cytometry also showed that cell death was largely dependent upon both early and late apoptosis, and, importantly, oxidized PC (ox-PC) exhibited a significantly lower rate for late apoptosis compared to that of oxidized UHMWPE (ox-UHMWPE).
    Macromolecular Research 01/2012; 21(1). DOI:10.1007/s13233-013-1055-0 · 1.68 Impact Factor