Wan Ho Kim

Konyang University Hospital, Gaigeturi, Jeju, South Korea

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Publications (5)7.74 Total impact

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    ABSTRACT: It is unclear which plaque component is related with long-term clinical outcomes in patients with coronary artery occlusive disease (CAOD). We assessed the relationship between plaque compositions and long-term clinical outcomes in those patients. The study subjects consisted of 339 consecutive patients (mean 61.7±12.2 years old, 239 males) who underwent coronary angiogram and a virtual histology-intravascular ultrasound examination. Major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, cerebrovascular events, and target vessel revascularization were evaluated during a mean 28-month follow-up period. Patients with high fibrofatty volume (FFV, >8.90 mm(3), n=169) had a higher incidence of MACCE (25.4% vs. 14.7%, p=0.015), male sex (75.7% vs. 65.3%, p=0.043), acute coronary syndrome (53.3% vs. 35.9%, p=0.002), multivessel disease (62.7% vs. 41.8%, p<0.001) and post-stent slow flow (10.7% vs. 2.4%, p=0.002) than those with low FFV (FFV≤8.90 mm(3), n=170). Other plaque composition factors such as fibrous area/volume, dense calcified area/volume, and necrotic core area/volume did not show any impact on MACCE. Cardiogenic shock {hazard ratio (HR)=8.44; 95% confidence interval (CI)=3.00-23.79; p<0.001} and FFV (HR=1.85; 95% CI=1.12-3.07; p=0.016) were the independent predictors of MACCE by Cox regression analysis. Thin-cap fibroatheroma, necrotic core area, and necrotic core volume were not associated with MACCE. FFV of a culprit lesion was associated with unfavorable long-term clinical outcomes in patients with CAOD.
    Korean Circulation Journal 06/2013; 43(6):377-83.
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    ABSTRACT: Patients with diabetes mellitus (DM) are known to have large necrotic core in their coronary plaque compared to non-DM patients. We assessed coronary plaque composition in patients with angina and with/without DM according to glucose control. Study subjects consisted of 114 non-DM patients, 14 well-controlled DM patients (hemoglobin A1c [HbA1c] <7.0%), and 37 poorly controlled DM patients (HbA1c ≥7%) who underwent virtual histology intravascular ultrasound (VH-IVUS) examinations of culprit lesions. The DM patients had longer lesion length (20.2 ± 7.8 mm vs 17.0 ± 7.3 mm; P=.013) than non-DM patients. The plaque volume was highest in the poorly-controlled DM patients (188.9 ± 92.6 mm³) compared with the non-DM patients (144.1 ± 92.3 mm³; P=.011) and the well-controlled DM patients (151.7 ± 82.4 mm³; P=.194). The well-controlled DM patients had less dense calcium (0.33 ± 0.14 mm³/mm vs 0.71 ± 0.60 mm³/mm; P=.020) and less necrotic core (0.71 ± 0.48 mm³/mm vs 1.30 ± 0.94 mm³/mm; P=.029) than the poorly-controlled DM patients and had similar amounts of dense calcium and necrotic core with non-DM patients, whereas fibrous and fibro-fatty volume showed no significant differences among the groups. Coronary plaque composition and plaque volume in well-controlled DM patients are similar to those in non-DM patients and both groups had less dense calcium and necrotic core volume than the poorly-controlled DM patients. These findings suggest hyperglycemia control is important in DM patients with angina.
    The Journal of invasive cardiology 03/2013; 25(3):137-41. · 1.57 Impact Factor
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    ABSTRACT: Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease. Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (≥200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209). Hypercholesterolemic patients were younger (59.7±13.3 years vs. 62.6±11.5 years, p=0.036), than normocholesterolemic patients, whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume (1.23±0.85 mm(3)/mm vs. 1.02±0.80 mm(3)/mm, p=0.029) as well as percent necrotic core volume (20.5±8.5% vs. 18.0±9.2%, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area (21.4±10.5% vs. 18.4±11.3%, p=0.019) and necrotic core area (1.63±1.09 mm(2) vs. 1.40±1.20 mm(2), p=0.088) were also higher than normocholesterolemic patients. Multivariate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the culprit lesion after being adjusted with age, high density lipoprotein-cholesterol , hypertension, diabetes mellitus, smoking and acute coronary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037). Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery disease.
    Korean Circulation Journal 01/2013; 43(1):23-8.
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    ABSTRACT: We evaluated which plaque components are associated with long-term clinical events in patients who underwent primary percutaneous coronary intervention (PCI). The study subjects consisted of 57 consecutive patients (mean age, 58.5±14.5 years; 45 males) who underwent primary PCI and a virtual histology-intravascular ultrasound examination. Major adverse cardiac events (MACEs) including death, acute myocardial infarction, stroke, and revascularization were evaluated during the mean 28 month follow-up period. Patients with high fibro-fatty volume (FFV >13.4 mm(3), n=29; mean age, 61.3 years) had a lower ejection fraction (52.7% vs. 59.4%, p=0.022), a higher incidence of multi-vessel disease (69.0% vs. 28.6%, p=0.002), larger plaque area (25.7 mm(2) vs. 15.9 mm(2), p<0.001), and larger plaque volume (315 mm(3) vs. 142 mm(3), p<0.001) than those with a low FFV (≤13.4 mm(3), n=28; mean age, 55.6 years). Patients with high FFV had a significantly higher incidence (32.1% vs. 8.3%, p=0.036) of MACE than those with low FFV. When we divided the study population according to the necrotic core volume (NCV), fibrous volume, or dense calcified volume, no significant findings in terms of demographics and MACE rates were observed. A Cox regression analysis revealed that the independent factor for MACE was FFV (hazard ratio, 6.748; 95% confidence interval, 1.168-38.971, p=0.033) in this study population. The coronary plaque component, particularly FFV, but not NCV, was important in long-term clinical outcomes in patients who underwent primary PCI.
    Korean Circulation Journal 01/2012; 42(1):33-9.
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    ABSTRACT: BACKGROUND: It is still controversial whether carotid plaque is associated with cardiovascular events in patients with coronary artery disease (CAD). The aim of the present study is to evaluate the impact of carotid plaque on long term clinical outcomes especially in patients with CAD. METHODS: The study population consisted of 1390 consecutive patients with angiographically proven CAD. All subjects underwent carotid scanning 1day before or after coronary angiogram and were followed up for major adverse cardiovascular events (MACE; death, myocardial infarction, stroke, revascularization, restenosis and hospitalization for heart failure) during a mean of 54.2±23.9months. RESULTS: Patients with carotid plaque (n=433) were older, had higher prevalence of cardiovascular risk factors and acute coronary syndrome (34.2% vs. 24.6%, p<0.001) than those without carotid plaque (n=957). On univariate analysis, the presence of carotid plaque was a predictor of cardiac death, hard MACE (death, myocardial infarction and stroke) and total MACE, whereas carotid intima-media thickness (CIMT) was a predictor of total MACE. Multivariate analysis revealed that carotid plaque was associated with cardiac death (HR 6.99, 95% CI 1.88-25.95, p=0.004), hard MACE (HR 1.89, 95% CI 1.18-3.04, p=0.008) and total MACE (HR 1.47, 95% CI 1.13-1.90, p=0.004), whereas CIMT was associated only with total MACE (HR 1.39, 95% CI 1.06-1.81, p=0.017). CONCLUSIONS: Carotid plaque is a strong predictor of future cardiac death and MACE in patients with CAD. This study suggests that carotid plaque has additional value for secondary prevention and more important prognostic factor than CIMT in patients with CAD.
    International journal of cardiology 12/2011; · 6.18 Impact Factor