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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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Khurshid Ahmed,
Myung Ho Jeong,
Rabin Chakraborty,
Young Joon Hong,
Doo Sun Sim,
Sumera Ahmed, Seung Hwan Hwang,
Min Goo Lee,
Keun Ho Park,
Ju Han Kim,
Youngkeun Ahn,
Myeong Chan Cho,
Chong Jin Kim,
Young Jo Kim,
Jong Chun Park,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to compare safety and efficacy of 4 homogenous overlapping drug-eluting stents (DES) in acute myocardial infarction (AMI) patients. We selected 1,349 consecutive patients (62.1 ± 14.9 yr, 69.4% male) who received homogenous overlapping DESs in diffuse de novo coronary lesions from Korea Acute Myocardial Infarction Registry from April 2006 through September 2010. They were divided into 4 groups based on type of DES implanted - Paclitaxel (PES), Sirolimus (SES), Zotarolimus (ZES) and Everolimus (EES)-eluting stents. Primary endpoint was 12-month MACE. We also studied EES versus other DESs (PES + SES + ZES). Mean stent length was 26.2 ± 7.5 mm and mean stent diameter was 3.1 ± 0.4 mm. Average number of stents used per vessel was 2.2 ± 0.5. Incidence of major adverse cardiac events (MACE) in PES, SES, ZES, and EES groups were 9.5%, 9.2%, 7.5%, and 3.8%, respectively (P = 0.013). In EES group, overall MACE and repeat revascularization were lowest, and no incidence of stent thrombosis was observed. Non-fatal MI was highest in PES, almost similar in SES and EES with no incidence in ZES group (P = 0.044). Cox proportional hazard analysis revealed no differences in the incidence of primary endpoint (P = 0.409). This study shows no significant differences in 12-month MACE among 4 groups.
Journal of Korean medical science 11/2012; 27(11):1339-1346. · 0.84 Impact Factor
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Khurshid Ahmed,
Myung Ho Jeong,
Rabin Chakraborty,
Young Joon Hong,
Mi Sook Oh,
Kyung Hoon Cho,
Min Chol Kim,
Daisuke Hachinohe, Seung Hwan Hwang,
Min Goo Lee,
Doo Sun Sim,
Keun Ho Park,
Ju Han Kim,
Youngkeun Ahn,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: Non-high density lipoprotein-cholesterol (non-HDL-C) and apolipoprotein B (ApoB) are markers of atherosclerotic risk and predictors of cardiovascular events. The aim of this study was to evaluate clinical impact of non-HDL-C and ApoB on clinical outcomes in metabolic syndrome (MS) patients with acute myocardial infarction (AMI) undergoing percuatneous coronary intervetion.
We analyzed 470 MS patients (64.4±12.0 years, 53.6% male) with AMI who were followed-up for 12-month after percutaneous coronary intervention (PCI) from December 2005 to January 2008 in a single center. These patients were divided into 2 groups based on median values of non-HDL-C and ApoB. We studied their baseline and follow-up relation with 12-month clinical outcomes, all-cause death and major adverse cardiac events (MACE).
Mean values of baseline non-HDL-C and ApoB were 141.2±43.1 mg/dL and 99.3±29.0 mg/dL respectively. During 12-month follow-up 32 MACE (6.8%) and 12 deaths (2.5%) occurred. We observed significant correlation between non-HDL-C and ApoB. Twelve-month MACE and all-cause death after PCI showed no significant relation as non-HDL-C or ApoB levels increased. Follow-up patients (n=306, rate 65%) also did not show significant relation with clinical outcomes. Twelve-month MACE decreased as non-HDL-C and ApoB reduction rates increased.
There was no significant association between higher non-HDL-C or ApoB and 12-month clinical outcomes in MS patients with AMI undergoing PCI. ApoB was found to be a better predictor of 12-month MACE than non-HDL-C based on their reduction rates.
Korean Circulation Journal 05/2012; 42(5):319-28.
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Shi Hyun Rhew,
Youngkeun Ahn,
Min Chul Kim,
Su Young Jang,
Kyung Hoon Cho, Seung Hwan Hwang,
Min Goo Lee,
Jum Suk Ko,
Keun Ho Park,
Doo Sun Sim,
Nam Sik Yoon,
Hyun Ju Yoon,
Kye Hun Kim,
Young Joon Hong,
Hyung Wook Park,
Ju Han Kim,
Myung Ho Jeong,
Jeong Gwan Cho,
Jong Chun Park,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: The present study aimed to investigate the clinical characteristics and 1-year outcomes of acute myocardial infarction (AMI) patients without significant stenosis on a coronary angiogram comparison with the clinical characteristics and outcomes of patients with significant coronary artery stenosis. A total of 1,220 patients with AMI were retrospectively classified into Group I (≥50% diameter stenosis, n=1,120) and Group II (<50%, n=100). Group II was further divided into two subgroups according to the underlying etiology: cryptogenic (Group II-a, n=54) and those with possible causative factors (Group II-b, n=46). Patients in Group II were younger, were more likely to be women, and were less likely to smoke and to have diabetes mellitus than were patients in Group I. The levels of cardiac enzymes, LDL-cholesterol levels, and the apo-B/A1 ratio were lower in Group II. However, 1-month and 12-month rates of major adverse cardiac events (MACE) were not significantly different between the two groups. The Group II-b subgroup comprised 29 patients with vasospasm, 11 with myocardial bridge, and 6 with spontaneous thrombolysis. Left ventricular ejection fraction and creatinine clearance were lower and levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) were higher in Group II-a than in Group II-b. However, outcomes including MACE and mortality at 12 months were not significantly different between the two subgroups. The 1-year outcomes of patients in Group II were similar to those of patients in Group I. The clinical outcomes in Group II-a were also similar to those of Group II-b, although the former group showed higher levels of NT-proBNP and hs-CRP.
Chonnam medical journal. 04/2012; 48(1):39-46.
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[show abstract]
[hide abstract]
ABSTRACT: Obesity is a well-established risk factor for many chronic disorders. However, the effect of weight change after acute myocardial infarction (AMI) is not well known. Among consecutive patients who underwent percutaneous coronary intervention between November 2005 and November 2007 due to AMI, patients who were overweight (23.0≤body mass index [BMI]<27.5 kg/m(2), n=341) and obese (BMI≥27.5 kg/m(2), n=80) were selected for analysis. According to weight change, the patients were divided into 4 groups: Group I (weight loss>5%, n=61), Group II (0%<weight loss≤5%, n=133), Group III (0%≤weight gain<5%, n=181), and Group IV (weight gain≥5%, n=46). We assessed the association between weight change and major adverse cardiac events (MACE). Greater weight loss was more frequent among older individuals (Group I: 64.1±12.4 years, II: 60.6±12.1 years, III: 59.0±11.9 years, IV: 61.4±10.6 years; p=0.028) and patients with diabetes (Group I: 34.4%, II: 27.1%, III: 21.2%, IV: 15.2%; p=0.009). However, there were no significant differences in baseline characteristics or in angiographic or procedural factors except for the proportions of patients with three-vessel disease, which were higher in patients with weight loss (Group I: 20.8%, II: 23.0%, III: 12.5%, IV: 11.6%; p=0.005). The group with greater weight loss had the highest MACE rate at the 12-month clinical follow-up (Group I: 36.9%, II: 25.0%, III: 25.9%, IV: 17.3%; p=0.020). Although weight loss after AMI appears to be associated with worse outcomes, it remains unclear whether the effect is of cardiac origin.
Chonnam medical journal. 04/2012; 48(1):32-8.
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Khurshid Ahmed,
Myung Ho Jeong,
Rabin Chakraborty,
Young Joon Hong,
Doo Sun Sim, Seung Hwan Hwang,
Min Goo Lee,
Keun Ho Park,
Ju Han Kim,
Youngkeun Ahn,
Myeong Chan Cho,
Chong Jin Kim,
Young Jo Kim,
Jong Chun Park,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: Coronary artery bypass grafting (CABG) has been the treatment of choice for management of multivessel coronary artery disease, but percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is increasingly being preferred. The aim of the present study was to compare outcomes of PCI with DES implantation (PCI-DES) and CABG for treating multivessel disease in metabolic syndrome patients with acute myocardial infarction (AMI).
A total of 1,839 consecutive metabolic syndrome patients with AMI who underwent PCI-DES (n=1,715) and CABG (n=124) for treatment of multivessel disease were selected from Korea Acute Myocardial Infarction Registry from November 2005 through December 2006. Primary endpoint was 12-month all-cause mortality. The mortality rate at 12 months was significantly lower in the PCI-DES group (4.8% vs. 12.2% in CABG, P=0.014) on univariate analysis. According to a Cox model, 12-month mortality was similar between the 2 groups (P=0.603), which remained the same despite propensity score adjustment (P=0.485). Rate of repeat revascularization was significantly higher in the PCI-DES group compared to the CABG group (P<0.001). At 12 months, major adverse cardiovascular and cerebrovascular event (MACCE)-free survival was higher in ST-elevation MI (STEMI) patients in the CABG group.
PCI-DES had an equivalent 12-month mortality risk to CABG for the treatment of multivessel disease in metabolic syndrome patients with AMI. CABG is more favorable for STEMI patients in terms of MACCE.
Circulation Journal 02/2012; 76(3):721-8. · 3.77 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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Daisuke Hachinohe,
Myung Ho Jeong,
Min Chol Kim,
Kyung Hoon Cho,
Khurshid Ahmed, Seung Hwan Hwang,
Min Goo Lee,
Doo Sun Sim,
Keun-Ho Park,
Ju Han Kim,
Young Joon Hong,
Youngkeun Ahn,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: A 51-year-old man was admitted due to an acute anterior ST-segment elevation myocardial infarction. After thrombolytic therapy using recombinant tissue plasminogen activator, stent implantation was performed from the proximal left anterior descending artery (LAD) to the mid LAD using a bare-metal stent (BMS). Since then, the patient suffered five repeated episodes of in-stent restenosis (ISR). At the first ISR, he was treated with plain old balloon angioplasty (POBA). At the second ISR, he was treated with brachytherapy, and at the third ISR, he was treated with POBA and one more BMS distal to the previously implanted stent. At the forth, only POBA was performed, and finally, at the fifth ISR, a sirolimus-eluting stent was implanted. Following that, the patient remained asymptomatic and follow-up coronary angiography showed no ISR.
Korean Circulation Journal 11/2011; 41(11):677-80.
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Min Chul Kim,
Youngkeun Ahn,
Su Young Jang,
Kyung Hoon Cho, Seung Hwan Hwang,
Min Goo Lee,
Jum Suk Ko,
Keun Ho Park,
Doo Sun Sim,
Nam Sik Yoon,
Hyun Ju Yoon,
Kye Hun Kim,
Young Joon Hong,
Hyung Wook Park,
Ju Han Kim,
Myung Ho Jeong,
Jeong Gwan Cho,
Jong Chun Park,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: A controversy exists about which statin is preferable for patients with acute myocardial infarction (AMI), and clinical impacts of different statins according to lipophilicity have not been established.
The 1,124 patients with AMI included in the present study were divided into hydrophilic- and lipophilic-statin groups. In-hospital complications (defined as death, cardiogenic shock, ventricular arrhythmia, infection, bleeding, and renal insufficiency, and other fatal arrhythmias), major adverse cardiac events (MACE), all-cause death, re-myocardial infarction, re-percutaneous coronary intervention (re-PCI), and surgical revascularization were analyzed during a 1-year clinical follow-up.
Baseline characteristics were similar between the two groups, and in-hospital complication rates showed no between-group differences (11.7% vs. 12.8%, p = 0.688). Although MACE at the 1- and 6-month clinical follow-ups occurred more in hydrophilic statin group I (1 month: 10.0% vs. 4.4%, p = 0.001; 6 month: 19.9% vs. 14.2%, p = 0.022), no significant difference in MACE was observed at the 1-year follow-up (21.5% vs. 17.9%, p = 0.172). Both statin groups showed similar efficacy for reducing serum lipid concentrations. A Cox-regression analysis showed that the use of a hydrophilic statin did not predict 1-year MACE, all-cause death, AMI, or re-PCI.
Although short-term cardiovascular outcomes were better in the lipophilic-statin group, 1-year outcomes were similar in patients with AMI who were administered hydrophilic and lipophilic statins. In other words, the type of statin did not influence 1-year outcomes in patients with AMI.
The Korean Journal of Internal Medicine 09/2011; 26(3):294-303.
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Young Joon Hong,
Myung Ho Jeong,
Sun-Jung Song,
Doo Sun Sim,
Jung Ha Kim,
Kyung Seob Lim,
Daisuke Hachinohe,
Khurshid Ahmed, Seung Hwan Hwang,
Min Goo Lee, [......],
Hyun Ju Yoon,
Nam Sik Yoon,
Kye Hun Kim,
Hyung Wook Park,
Ju Han Kim,
Youngkeun Ahn,
Jeong Gwan Cho,
Dong Lyun Cho,
Jong Chun Park,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: The renin-angiotensin-aldosterone system has been implicated in the pathogenesis of neointimal hyperplasia, and a role for angiotensin II in the migration and proliferation of vascular smooth muscle cells in restenotic lesions has been proposed. The aim of this study was to determine the anti-proliferative and anti-inflammatory effects of ramiprilat-coated stents in a porcine coronary overstretch restenosis model.
Pigs were randomized into two groups in which the coronary arteries {16 pigs (16 coronaries in each group)} had a 3.0×17 mm ramiprilat-coated MAC stent or a 3.0×17 mm control MAC stent (AMG, Munich, Germany) implanted with oversizing (stent-to-artery ratio, 1.3 : 1) in porcine coronary arteries, and histopathologic analysis was assessed 28 days after stenting.
There were no significant differences in the injury and inflammation scores between the two groups (1.20±0.43 vs. 1.23±0.57, p=0.8; and 1.21±0.39 vs. 1.25±0.49, p=0.6, respectively). Within the neointima, most inflammatory cells were lymphohistiocytes. Significant positive correlations existed between inflammatory cell counts and the neointima areas (r=0.567, p<0.001), and between inflammatory cell counts and the percent area stenosis (r=0.478, p<0.001). There was no significant difference in the inflammatory cell counts normalized to the injury (110±89 vs. 123±83, p=0.4) and fibrin scores (0.15±0.06 vs. 0.17±0.07, p=0.8) between the 2 groups. There were trends toward a smaller neointima area (1.06±0.51 mm(2) vs. 1.28±0.35 mm(2), p=0.083) and a smaller percent area stenosis (18.9±8.7% vs. 21.8±7.2%, p=0.088) in the ramiprilat-coated stent group.
Although the ramiprilat-coated stent did not show significant inhibitory effects on neointimal hyperplasia, the ramiprilat-coated stent showed good effects on the inflammatory reaction and arterial healing similar to the control stent in a porcine coronary restenosis model.
Korean Circulation Journal 09/2011; 41(9):535-41.
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Yun Ha Choi,
Young Joon Hong,
In Hyae Park,
Myung Ho Jeong,
Khurshid Ahmed, Seung Hwan Hwang,
Min Goo Lee,
Keun-Ho Park,
Doo Sun Sim,
Ju Han Kim,
Youngkeun Ahn,
Jeong Gwan Cho,
Jong Chun Park,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the relationship between coronary artery calcium score (CACS) assessed by multidetector computed tomography (MDCT) and plaque components assessed by virtual histology-intravascular ultrasound (VH-IVUS) in 172 coronary artery disease (CAD) patients with 250 coronary lesions. CACS was assessed according to Agatston scoring method by MDCT and patients were divided into four groups: Group I (CACS = 0 [n = 52]); Group II (CACS = 1-100 [n = 99]); Group III (CACS = 101-400 [n = 84]); and Group IV (CACS > 400 [n = 15]). Total atheroma volume was greatest in Group IV (152 ± 132 µL vs 171 ± 114 µL vs 195 ± 149 µL vs 321±182 µL, P < 0.001). The absolute dense calcium (DC) and necrotic core (NC) volumes were greatest, and relative DC volume was greatest in Group IV (5.5 ± 6.6 µL vs 11.0 ± 10.3 µL vs 15.6 ± 13.6 µL vs 36.6 ± 18.2 µL, P < 0.001, and 14.8 ± 18.2 µL vs 19.5 ± 18.9 µL vs 22.5 ± 19.1 µL vs 41.7 ± 27.9 µL, P < 0.001, and 6.4 ± 5.3% vs 11.0 ± 6.2% vs 14.0 ± 6.5% vs 20.0 ± 7.8%, P < 0.001, respectively). The absolute plaque and DC and NC volumes and the relative DC volume correlated positively with calcium score. CAD patients with high calcium score have more vulnerable plaque components (greater DC and NC-containing plaques) than those with low calcium score.
Journal of Korean medical science 08/2011; 26(8):1052-60. · 0.84 Impact Factor
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Young Joon Hong,
Myung Ho Jeong,
Yun Ha Choi,
Suk Hee Cho, Seung Hwan Hwang,
Jum Suk Ko,
Min Goo Lee,
Keun Ho Park,
Doo Sun Sim,
Nam Sik Yoon,
Hyun Ju Yoon,
Kye Hun Kim,
Hyung Wook Park,
Ju Han Kim,
Youngkeun Ahn,
Jeong Gwan Cho,
Jong Chun Park,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) levels and plaque components in 279 acute coronary syndrome (ACS) patients.
We divided patients into three groups according to their hs-CRP levels {lowest tertile <0.07 mg/dL (n=93), middle tertile ≥0.07, <0.4 mg/dL (n=93), and highest tertile ≥0.4 mg/dL (n=93)}. Thin-cap fibroatheroma (TCFA) was defined as focal, necrotic core (NC)-rich (≥10% of the cross-sectional area) plaques in contact with the lumen in a plaque burden ≥40%.
The highest tertile group was mostly diabetics (20%, 27%, 40%, p=0.009), and had the greatest plaque plus media volume (163±139/mm(3) vs. 201±155/mm(3) vs. 232±176/mm(3), p=0.013). The highest tertile group had the greatest absolute and % NC volumes (13.6±15.1 mm(3) vs. 14.8±14.2 mm(3) vs. 23.7±24.3 mm(3), p<0.001, and 14.9±8.7% vs. 16.0±8.7% vs. 19.5±10.2%, p=0.024, respectively). The culprit lesion TCFA was observed most frequently in the highest tertile group (28% vs. 35% vs. 55%, p=0.006). By multivariable analysis, absolute NC volume was an independent predictor of hs-CRP elevation {odds ratio (OR); 1.03, 95% confidence interval (CI)=1.06-1.21, p=0.004}, and hs-CRP was an independent predictor of TCFA (OR; 1.86, 95% CI=1.11-2.90, p=0.010).
VH-IVUS analysis has demonstrated that ACS patients with elevated hs-CRP have more vulnerable plaque component (NC-rich plaques and higher frequency of culprit lesion TCFA), compared with ACS patients with normal hs-CRP.
Korean Circulation Journal 08/2011; 41(8):440-6.
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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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Khurshid Ahmed,
Myung Ho Jeong,
Rabin Chakraborty,
Youngkeun Ahn,
Doo Sun Sim,
Keunho Park,
Young Joon Hong,
Ju Han Kim,
Kyung Hoon Cho,
Min Chol Kim,
Daisuke Hachinohe, Seung Hwan Hwang,
Min Goo Lee,
Myeong Chan Cho,
Chong Jin Kim,
Young Jo Kim,
Jong Chun Park,
Jung Chaee Kang
[show abstract]
[hide abstract]
ABSTRACT: Stent thrombosis and restenosis remain drawbacks of drug-eluting stents in patients with acute myocardial infarction (AMI). Intravascular ultrasound (IVUS) guidance for stent deployment helps optimize its results in stable patients. The aim of this study was to examine the utility of routine IVUS guidance in patients with AMI undergoing percutaneous coronary intervention (PCI). Employing data from Korea Acute Myocardial Infarction Registry (KAMIR), we analyzed 14,329 patients with AMI from April 2006 through September 2010. Patients with cardiogenic shock and rescue PCI after thrombolysis were excluded. Clinical outcomes of 2,127 patients who underwent IVUS-guided PCI were compared to those of 8,235 patients who did not. Mean age was 63.6 ± 13.5 years and 72.3% were men. Patients undergoing IVUS-guided PCI were younger, more often men, more hyperlipemic, and had increased body mass index and left ventricular ejection fraction. Number of treated vessels and stents used, stent length, and stent diameter were increased in the IVUS-guided group. Multivessel involvement was less frequent and American College of Cardiology/American Heart Association type C lesion was more frequent in the IVUS-guided group. Drug-eluting stents were more frequently used compared to bare-metal stents in the IVUS group. There was no significant relation of stent thrombosis between the 2 groups. Twelve-month all-cause death was lower in the IVUS group. After multivariate analysis and propensity score adjustment, IVUS guidance was not an independent predictor for 12-month all-cause death (hazard ratio 0.212, 0.026 to 1.73, p = 0.148). In conclusion, this study does not support routine use of IVUS guidance for stent deployment in patients who present with AMI and undergo PCI.
The American journal of cardiology 07/2011; 108(1):8-14. · 3.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The prognosis of stress induced cardiomyopathy (SCMP) is generally known to be excellent, however, several fatal complications such as cardiac rupture and left ventricular (LV) thrombosis with subsequent embolic complications have been described. We report a rare case of SCMP complicated by LV thrombosis and multiple cerebral infarctions in a patient with essential thrombocythemia. After intravenous anticoagulation with heparin and general managements for heart failure and cerebral infarctions, her neurologic symptoms and the wall motion abnormalities of the LV apex were improved, and the thrombus was disappeared on follow-up echocardiography.
Journal of cardiovascular ultrasound 06/2011; 19(2):87-90.
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Seung Hwan Hwang,
Myung Ho Jeong,
Khurshid Ahmed,
Min Chul Kim,
Kyung Hoon Cho,
Min Goo Lee,
Jum Suk Ko,
Keun Ho Park,
Doo Sun Sim,
Nam Sik Yoon,
Hyun Ju Yoon,
Kye Hun Kim,
Young Joon Hong,
Hyung Wook Park,
Ju Han Kim,
Young Keun Ahn,
Jeong Gwan Cho,
Jong Chun Park,
Jung Chaee Kang
International journal of cardiology 04/2011; 150(1):99-101. · 7.08 Impact Factor
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Young Joon Hong,
Myung Ho Jeong,
Daisuke Hachinohe,
Khurshid Ahmed,
Yun Ha Choi,
Sook Hee Cho, Seung Hwan Hwang,
Jum Suk Ko,
Min Goo Lee,
Keun Ho Park,
Doo Sun Sim,
Nam Sik Yoon,
Hyun Ju Yoon,
Kye Hun Kim,
Hyung Wook Park,
Ju Han Kim,
Youngkeun Ahn,
Jeong Gwan Cho,
Jong Chun Park,
Jung Chaee Kang
[show abstract]
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ABSTRACT: Serial intravascular ultrasound (IVUS) was used to compare the effects of moderate doses of rosuvastatin and atorvastatin on plaque regression in patients with intermediate coronary stenosis.
This was a prospective, randomized, and comparative study for lipid-lowering therapy with rosuvastatin 20mg (n=65) and atorvastatin 40mg (n=63) using serial IVUS (baseline and 11-month follow-up). Efficacy parameters included changes in total atheroma volume (TAV) and percent atheroma volume (PAV) from baseline to follow-up. Changes of TAV (-4.4±7.3 vs. -3.6±6.8mm(3), P=0.5) and PAV (-0.73±2.05 vs. -0.19±2.00%, P=0.14) from baseline to follow-up were not significantly different between the 2 groups. Plaque was increased in 15% in the rosuvastatin group and in 30% in the atorvastatin group at follow-up (P=0.064). The plaque increase group had higher baseline high-sensitivity C-reactive protein (hs-CRP; 1.28±2.70mg/dl vs. 0.54±1.16mg/dl, P=0.034) and higher follow-up low-density lipoprotein cholesterol (LDL-C) (78±24mg/dl vs. 63±21mg/dl, P=0.002) compared with the plaque non-increase group. Follow-up LDL-C (odds ratio [OR]=1.038, 95% confidence interval [CI]=1.003-1.060, P=0.036) and baseline hs-CRP (OR=1.025, 95%CI=1.001-1.059, P=0.046), not the type of statin, were the independent predictors of plaque increase at follow-up.
Moderate doses of rosuvastatin and atorvastatin could contribute to effective plaque regression. Follow-up LDL-C and baseline hs-CRP are associated with plaque progression in patients with intermediate coronary stenosis.
Circulation Journal 02/2011; 75(2):398-406. · 3.77 Impact Factor
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Young Joon Hong,
Myung Ho Jeong,
Yun Ha Choi, Seung Hwan Hwang,
Jum Suk Ko,
Min Goo Lee,
Keun Ho Park,
Doo Sun Sim,
Nam Sik Yoon,
Hyun Ju Yoon,
Kye Hun Kim,
Hyung Wook Park,
Ju Han Kim,
Youngkeun Ahn,
Jeong Gwan Cho,
Jong Chun Park,
Jung Chaee Kang
International journal of cardiology 01/2011; 146(2):275-6. · 7.08 Impact Factor
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Kyung Hoon Cho,
Myung Ho Jeong,
Khurshid Ahmed,
Daisuke Hachinohe,
Hong Sang Choi,
Soo Young Chang,
Min Chul Kim, Seung Hwan Hwang,
Keun-Ho Park,
Min Goo Lee, [......],
Doo Sun Sim,
Nam Sik Yoon,
Hyun Ju Yoon,
Young Joon Hong,
Kye Hun Kim,
Ju Han Kim,
Youngkeun Ahn,
Jeong Gwan Cho,
Jong Chun Park,
Jung Chaee Kang
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ABSTRACT: Complete blood count is the most widely available laboratory datum in the early in-hospital period after ST-elevation myocardial infarction (STEMI). We assessed the clinical utility of the combined use of hemoglobin (Hb) level and neutrophil-to-lymphocyte ratio (N/L) for early risk stratification in patients with STEMI. We analyzed 801 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) within 12 hours of onset of symptoms. Patients with cardiogenic shock or underlying malignancy were excluded, and 739 patients (63 ± 13 years, 74% men) were included in the final analysis. Patients were categorized into 3 groups using the median value of N/L (3.86) and the presence of anemia (Hb <13 mg/dl in men and <12 mg/dl in women); group I had low N/L and no anemia (n = 272), group II had low N/L and anemia, or high N/L and no anemia (n = 331), and group III had high N/L and anemia (n = 136). There were significant differences on clinical outcomes during 6-month follow-up among the 3 groups. Prognostic discriminatory capacity of combined use of Hb level and N/L was also significant in high-risk subgroups such as patients with advanced age, diabetes mellitus, multivessel coronary disease, low ejection fraction, and even in those having higher mortality risk based on Thrombolysis In Myocardial Infarction risk score. In a Cox proportional hazards model, after adjusting for multiple covariates, group III had higher mortality at 6 months (hazard ratio 5.6, 95% confidence interval 1.1 to 27.9, p = 0.036) compared to group I. In conclusion, combined use of Hb level and N/L provides valuable timely information for early risk stratification in patients with STEMI undergoing primary PCI.
The American journal of cardiology 01/2011; 107(6):849-56. · 3.58 Impact Factor
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ABSTRACT: Splenic abscess is an unusual condition usually seen in immunocompromised patients or associated with intravenous drug abuses. Several conditions including trauma, immunodeficiency, corticosteroid and/or immunosuppressive therapy and diabetes mellitus have been listed under the predisposing factors for a splenic abscess. Splenic abscess in a patient on hemodialysis is a rare but life-threatening condition if not corrected. We describe a case of splenic abscess with bacterial endocarditis on maintenance hemodialysis. He had staphylococcal septicemia secondary to bacterial endocarditis at the mitral valve from the dialysis access-site infection. Although hematologic seeding from endocarditis has been the predisposing factor for splenic abscess, we postulate that access-site infections may predispose hemodialysis patients to splenic abscess. Splenic abscess may be considered as one of the causes when patients on hemodialysis develop unexplained fever.
Journal of Korean Medical Science 05/2005; 20(2):313-5. · 0.99 Impact Factor
