[Show abstract][Hide abstract] ABSTRACT: Heart failure (HF) complicating acute myocardial infarction (AMI) is common and is associated with poor clinical outcome. Limited data exist regarding the incidence and in-hospital mortality of AMI with HF (AMI-HF). We retrospectively analyzed 1,427 consecutive patients with AMI in the five major university hospitals in Korea at two time points, 1998 (n = 608) and 2008 (n = 819). Two hundred twenty eight patients (37.5%) in 1998 and 324 patients (39.5%) in 2008 of AMI patients complicated with HF (P = 0.429). AMI-HF patients in 2008 were older, had more hypertension, previous AMI, and lower systolic blood pressure than those in 1998. Regarding treatments, AMI-HF patients in 2008 received more revascularization procedures, more evidence based medical treatment and adjuvant therapy, such as mechanical ventilators, intra-aortic balloon pulsation compared to those in 1998. However, overall in-hospital mortality rates (6.4% vs 11.1%, P = 0.071) of AMI-HF patients were unchanged and still high even after propensity score matching analysis, irrespective of types of AMI and revascularization methods. In conclusion, more evidence-based medical and advanced procedural managements were applied for patients with AMI-HF in 2008 than in 1998. However the incidence and in-hospital mortality of AMI-HF patients were not significantly changed between the two time points.
Journal of Korean medical science 04/2014; 29(4):544-9. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimsThe Korean Acute Heart Failure registry (KorAHF) aims to evaluate the clinical characteristics, management, hospital course, and long-term outcomes of patients hospitalized for acute heart failure syndrome (AHFS) in Korea.Methods and resultsThis is a prospective observational multicentre cohort study funded by the Korea National Institute of Health. Patients hospitalized for AHFS in 10 tertiary university hospitals across the country have been consecutively enrolled since March 2011. The study is expected to complete the scheduled enrolment of 5000 patients some time in 2014, and follow-up is planned through 2016. As of April 2012, the interim analysis of 2066 consecutive subjects was performed to understand the baseline characteristics of the population. The mean age was 69 ± 14 years; 55% were male; and 50% were de novo heart failure. The mean left ventricular ejection fraction (LVEF) was 40 ± 18%. Ischaemia was both the leading cause (38%) and the most frequent aggravating factor (26%) of AHFS. ACE inhibitors/ARBs and beta-blockers were prescribed at discharge in 65% and 51% of the patients, respectively. In-hospital mortality was 5.2%, and 0.9% of patients received urgent heart transplantation. Low blood pressure and azotaemia were the most important predictors of in-hospital mortality. The post-discharge 30-day and 180-day all-cause mortality were 1.2% and 9.2%, respectively.Conclusions
Our analysis reveals that the prognosis of AHFS in Korea is poor and that there are specific features, including lower blood pressures at admission and lower rates of heart failure related to hypertension, compared with other registries. Adherence to current guidelines should be improved.
European Journal of Heart Failure 04/2014; · 6.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Morning blood pressure (BP) surge (MS) has been known to be a predictor of cardiovascular events. Currently, few studies have evaluated the underlying mechanism underlying MS, which may include neurohormonal factors and the renin-angiotensin-aldosterone system (RAAS). This study aimed to examine plasma aldosterone concentration (PAC) and plasma renin activity (PRA) and BP parameters with or without MS in never-treated subjects with essential hypertension. This cross-sectional study included a total of 261 patients (mean age: 48.8 years; 60.5% male) with never-treated essential hypertension who were registered in a working group at The Catholic University of Korea. The patients were divided into the MS group, which was defined as having the highest quartile of morning BP increase from sleep (>31 mmHg; n = 66) and the non-MS group (≤31 mmHg; n = 195). We collected 24-h ambulatory BP, pulse wave velocity, ankle brachial index, PAC and PRA from all patients. The measured PAC and PRA were lower in the MS group than in the non-MS group (PAC: 9.0 ± 5.4 ng/dl versus 12.2 ± 8.7 ng/dl, p < 0.001; PRA: 1.7 ± 1.3 ng/ml/h versus 2.6 ± 3.6 ng/ml/h, p = 0.002). The MS group had greater variations in daytime, nighttime and 24-h systolic blood pressure (SBPs) than the non-MS group (24-h SBP: 15.6 ± 4.4 mm Hg for the non-MS group and 18.9 ± 4.9 mmHg for the MS group; p < 0.001 for each). It is generally accepted that the sympathetic nervous system plays a major role in the regulation of BP variability. Therefore, further studies on sympathetic nervous system activation in hypertensives with extreme MS are needed. MS in enrolled patients who were at relatively low risk in this study may be less affected by the RAAS.
Clinical and Experimental Hypertension 03/2014; · 1.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Stent length has been considered an important predictor of adverse events after percutaneous coronary intervention, even with the first-generation drug-eluting stents (DESs). The introduction of newer-generation DES has further reduced the rates of adverse clinical events such as restenosis, myocardial infarction, and stent thrombosis. The aim of this study was to compare the impact of stent length on the long-term clinical outcomes between first- and newer-generation DESs. The effects of stent length (≥32 vs <32 mm) on the clinical outcomes were evaluated in 8,445 patients who underwent percutaneous coronary intervention using either a first-generation DES (sirolimus- and paclitaxel-eluting stents, n = 6,334) or a newer-generation DES (everolimus- and zotarolimus-eluting stents, n = 2,111) from January 2004 to December 2009. The 3-year adverse outcomes (composite of all-cause death, nonfatal myocardial infarction, target vessel revascularization, and stent thrombosis) were compared using the inverse probability of treatment-weighted method according to the stent length. After adjustment for differences in the baseline risk factors, a stent length of ≥32 mm was significantly associated with higher cumulative rates of target vessel revascularization and stent thrombosis in the patients treated with a first-generation DES (adjusted hazard ratio 1.875, 95% confidence interval 1.531 to 2.297, p <0.001; adjusted hazard ratio 2.964, 95% confidence interval 1.270 to 6.917, p = 0.012), but it was not associated with the clinical outcomes in patients treated with a newer-generation DES. In conclusion, stent length might not be associated with long-term clinical outcomes in newer-generation DES era, whereas stent length might be associated with long-term clinical outcomes in the first-generation DESs.
The American journal of cardiology 11/2013; · 3.58 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; · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Clinical features of acute myocarditis range from a subclinical state to a fulminant state. Fulminant myocarditis with ventricular arrhythmia or atrioventricular block is associated with a high mortality rate. In cases in which aggressive medical therapy for fulminant myocarditis is not likely to be successful, intensive and emergency mechanical circulatory support, such as extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump, should be considered. We report life salvage of acute fulminant myocarditis in a 53-year-old woman presented with malignant arrhythmia and cardiogenic shock supported by ECMO.
[Show abstract][Hide abstract] ABSTRACT: Aim: We assessed the relationship between the level of high-sensitivity C-reactive protein (hsCRP) and cardiovascular risk factors in Korean adults.Methods: We reviewed 1,561 patients with cardiovascular disease or diabetes mellitus with hsCRP levels measured within the past year. Four cardiovascular risk groups were determined: low (<10%, 0-1 risk), moderate (<10%, >2 risk), high (10-20%) and very high (>20%) risk, according to the number of risk factors and the Framingham/NCEP ATP III risk score. The correlations between the hsCRP level and cardiovascular risk factors (age, smoking, hypertension, lipid profiles and familial history of premature coronary heart disease) were investigated.Results: The mean and median hsCRP (mg/L) levels were 1.32±9.69 and 0.29 (range: 0.01-7.48), respectively. Men had a higher median level of hsCRP than women (p<0.001). The levels of hs CRP significantly increased from the low to the very high risk group (0.15, 0.23, 0.27 and 0.47, respectively) and were significantly correlated with age, the level of glycosylated hemoglobin, body mass index (BMI), the level of high-density lipoprotein cholesterol (HDL-C), the low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio, the LDL-C/total cholesterol (TC) ratio, the HDL-C/TC ratio, the HDL-C/triglyceride (TG) ratio and the TC/TG ratio. Neither smoking, the LDL-C level nor the TG level affected the hsCRP level. In a multivariate regression analysis, age, the HDL-C level, the LDL-C/TC ratio and BMI were found to be independently correlated with the hsCRP level.Conclusions: There is a significant relationship between the degree of cardiovascular risk and the hsCRP level in Korean adults with cardiovascular disease or diabetes mellitus. Assessing the hsCRP levels may thus provide additive value in predicting cardiovascular risks.
Journal of atherosclerosis and thrombosis 05/2013; · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The association between microalbuminuria (MAU) and the indices of macrovascular complication in patients with newly diagnosed type 2 diabetes (D) or essential hypertension (H) was evaluated. Total 446 patients were classified into four groups according to the urinary albumin-to-creatinine ratio: MAU-D (n = 104), normoalbuminuria (NAU)-D (n = 114), MAU-H (n = 116), and NAU-H (n = 112). The indices of macrovascular complication including arterial stiffness evaluated by pulse-wave-velocity (PWV), carotid intima-media thickness (IMT), and vascular inflammation marked by high-sensitivity C-reactive protein (hsCRP) were assessed. PWV, IMT, and hsCRP were higher in patients with MAU than in those with NAU in both diabetes and hypertension groups. In both MAU-D and MAU-H groups, PWV and hsCRP levels were positively correlated with MAU level (MAU-D: r = 0.47, 0.41, MAU-H: r = 0.36, 0.62, respectively, P < 0.05). Additionally, PWV and hsCRP were independent factors predicting MAU (diabetes group: OR 1.85, 1.54, hypertension group: OR 1.38, 1.51, respectively, P < 0.001), but not IMT. MAU is independently associated with arterial stiffness and vascular inflammation but not with IMT in patients with newly diagnosed type 2 diabetes or essential hypertension, which emphasizes the importance of proactive clinical investigations for atherosclerotic complications in patients with MAU, even in newly diagnosed diabetes or hypertension.
Journal of Korean medical science 02/2013; 28(2):252-60. · 0.84 Impact Factor
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[Show abstract][Hide abstract] ABSTRACT: Cardiac myxoma represents the most common primary cardiac neoplasm, accounting for nearly 75% of benign cardiac tumor. Tumor embolisms occur in 30% to 40% of patients with myxoma, and half of these are cerebral arteries. To our knowledge, this is the first published report of multiregional tumor embolizations except for cerebral artery and Takotsubo cardiomyopathy in patients with left atrial myxoma.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 08/2012;
[Show abstract][Hide abstract] ABSTRACT: Background: The rate of percutaneous coronary intervention (PCI) due to the development of significant atherosclerosis and the cardiac mortality rate in Korean patients with vasospastic angina (VSA) was estimated. Methods and Results: A total of 831 patients with VSA from 8 centers were registered in the Vasospastic Angina in the Catholic Medical Center (VA-CMC) registry. Their provocation tests for VSA showed positive results. The patients with significant atherosclerosis (>50% luminal narrowing) on the baseline angiography were excluded. Subjects were VSA patients without significant atherosclerosis. A total of 745 patients were included in the final analysis. The mean follow-up duration was 36.1±9.8 months. The PCI rate was 2.01% (15/745). Current smoking (odds ratio: 2.31, P<0.05) and high levels of baseline high-sensitivity C-reactive protein (hsCRP) (odds ratio: 1.57, P<0.05) were independent risk factors for PCI. The mortality rate was 2.55% (19/745). Eleven patients died of cardiac causes (1.48%). Cessation of medication was an independent risk factor for cardiac mortality (odds ratio: 1.47, P<0.05). The mean duration from the diagnosis to the cardiac deaths was 10.6±4.3 months. Conclusions: Korean patients with VSA demonstrated low rates of development of significant atherosclerosis leading to PCI and cardiac mortality. However, cessation of medication, smoking, and high baseline hsCRP were the independent risk factors for unfavorable outcomes. (Circ J 2012; 76: 2681-2689).
[Show abstract][Hide abstract] ABSTRACT: For patients with variant angina it is very important to start medical therapy using calcium-channel blockers. However, the decision of physicians regarding whether to decrease the dose of the drug or discontinue it is controversial. We investigated whether the nature of spasm is remissive and whether the termination of medications is safe. The subjects studied were included in the Vasospastic Angina in Catholic Medical Center Registry from March 2001 to December 2009. We analyzed 37 patients (62 lesions) with variant angina, diagnosed using coronary angiography (CAG) and he acetylcholine provocation test, without any organic coronary stenosis, whose symptoms were well controlled after medication. The follow-up CAG with provocation test was performed at a median interval of 44 months. The characteristics of spasm were analyzed on each pair of CAGs. The study group consisted of 23 men (62.2 %) and 14 women (37.8 %) with a mean age of 59 ± 11.1 years. The follow-up CAG with provocation test showed that the characteristics of the spasmodic nature were consistent with the first test in all patients. Although the patients with variant angina had no chest pain after medical treatment, the spasmodic nature of coronary arteries still remained. We may decrease the drug dosage after carefully checking the patient's symptoms but recommend not discontinuing therapy, even if the patient is asymptomatic.
Heart and Vessels 04/2012; 28(3). · 2.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Infarct-related left main coronary artery disease (LMCAD) is associated with an increased cardiac mortality in the setting of acute myocardial infarction (AMI). However, the prevalence and prognostic impact of significant (≥50% stenosis) non-infarct-related LMCAD in patients with AMI have not yet been elucidated.
We prospectively analyzed 7655 AMI patients who had undergone a percutaneous coronary intervention (PCI) in the Korea Acute Myocardial Infarction Registry from November 2005 to January 2008. We compared major adverse cardiac events (MACEs) in AMI patients with non-infarct-related LMCAD and those without LMCAD.
Of 99 (1.3%) non-infarct-related LMCAD patients, 40 patients had undergone PCI due to their lesions on the left main coronary artery. The incidences of all-cause death, cardiac death, recurrent myocardial infarction, and composite of MACE except repeat revascularization were higher in patients with non-infarct-related LMCAD at 12 months. In Cox proportional hazard analysis for the prediction of MACE at 12 months, the hazard ratio of LMCAD was 2.189 (95% confidence interval 1.230-3.896, P=0.008). In subgroup analysis, there was no significant cumulative difference between patients who had undergone non-infarct-related left main coronary artery PCI and those who did not undergo PCI at 1 and 12 months.
The significant, non-infarct-related LMCAD in patients with AMI remains a major adverse prognostic indicator even after receiving optimal culprit-lesion PCI.
[Show abstract][Hide abstract] ABSTRACT: Stent fracture is likely to be caused due to mechanical stress at the hinge point or kinking movement at the point of aneurysm formation with stent malapposition. To our knowledge, this is the first published report of stent fracture at the proximal shaft of the left main stem in a patient with acute myocardial infarction.
[Show abstract][Hide abstract] ABSTRACT: Vasospastic angina (VA) is a specific type of coronary artery disease and develops as a result of coronary artery spasm. Recently, a few studies have revealed that VA caused by coronary artery spasm is related to genetic traits. The objective of this study was to use the recently developed technique of array comparative genomic hybridization (CGH) to screen the genetic aberrations of VA.
To identify candidate genes that might be causally involved in the pathogenesis of VA, genomic deoxyribonucleic acids were extracted from whole blood of 28 patients with VA who presented at Department of Cardiology at Seoul St. Mary's Hospital, Seoul, Korea. The copy number profiles of these patients was then analyzed using array CGH and reverse transcriptase (RT) quantitative polymerase chain reaction (PCR).
Array CGH revealed gains in 31 different regions, with losses in the 4q35.2, 7q22.1, 10q26.3, 15q11.2, 16p13.11, 17p11.2 and 19q13.3 regions (more than 32% aberration in these regions). Several loci were found to be frequently including gains of 5p and 11q (50% of samples). The most common losses were found in 7q (54% of samples). Copy number aberrations in chromosomal regions were detected and corresponding genes were confirmed by RT quantitative PCR. The fold change levels were highest in the CTDP1 (18q23), HDAC10 (22q13.33), KCNQ1 (11p15.5-p15.4), NINJ2 (12p13.33), NOTCH2 (1p12-p11.2), PCSK6 (15q26.3), SDHA (5p15.33), and MUC17 (7q22.1) genes.
Many candidate chromosomal regions that might be related to the pathogenesis of VA were detected by array CGH and should be systematically investigated to establish the causative and specific genes for VA.
Korean Circulation Journal 07/2011; 41(7):385-93.
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[Show abstract][Hide abstract] ABSTRACT: The roles of soluble and endogenous secretory receptors for advanced glycation endproducts (sRAGE and esRAGE, respectively) in plaque vulnerability are unknown in patients with acute myocardial infarction (AMI).
We enrolled 54 patients with AMI (27 patients had type 2 diabetes mellitus [DM]) who had undergone primary percutaneous coronary intervention, and 54 controls who were matched for age, gender and the presence of DM. Plasma levels of s/esRAGE and matrix metalloproteinase (MMP)-9 were measured at the time of coronary angiography. There were no significant differences in the baseline characteristics of the AMI and control groups, except for the C-reactive protein levels (CRP: 14.1 ± 14.2 mg/L vs. 3.7 ± 5.2 mg/L, P < 0.001). The plasma levels of MMP-9 (28.6 ± 21.4 vs. 14.3 ± 8.5 ng/ml P < 0.001) and sRAGE (0.61 ± 0.28 vs. 0.41 ± 0.17 ng/ml, P < 0.001) were higher in the AMI group than in the controls. In multivariate logistic regression analysis, the plasma levels of MMP-9 and sRAGE above the median (odds ratio [OR], 2.39; 95% confidence interval [CI], 1.02-5.58; P = 0.044; OR, 2.47; 95%CI, 1.05-5.80; P = 0.039, respectively) were independent predictors of AMI, as well as being a current smoker (OR, 2.98; 95%CI, 1.18-7.55; P = 0.021) and CRP ≥ 3.0 mg/L (OR, 3.08; 95%CI, 1.25-7.59; P = 0.015).
An elevated plasma level of sRAGE might be independently associated with plaque vulnerability, as well as MMP-9, in patients with AMI.
[Show abstract][Hide abstract] ABSTRACT: Inadequate myocardial tissue perfusion after successful revascularization in ST-segment elevation myocardial infarction (STEMI) is associated with worse clinical outcomes. We investigated whether the plasma B-type natriuretic peptide (BNP) level on admission could predict the status of myocardial tissue perfusion in patients who underwent primary percutaneous coronary intervention (PCI).
The study prospectively enrolled 102 patients with STEMI who underwent primary PCI within 12 h of symptom onset. The grade of myocardial tissue perfusion was measured by ST-segment resolution, corrected thrombolysis in myocardial infarction frame count, and myocardial blush grade after primary PCI. All-cause mortality at 1 month after PCI was assessed.
All patients were divided into two groups according to the BNP level; high-BNP group (≥80 pg/ml, n=43) and low-BNP group (<80 pg/ml, n=59). High-BNP group had significantly lower ST-segment resolution (42.69 ± 24.85 vs. 71.15 ± 19.37%, P<0.001), higher corrected thrombolysis in myocardial infarction frame count (53.7 ± 19.7 vs. 44.5 ± 15.5, P=0.04), lower myocardial blush grade (2.4 ± 0.9 vs. 2.9 ± 0.3, P=0.001), and higher short-term mortality (16.2 vs. 3.3%, P=0.023). In multivariate logistic regression analysis for prediction of good myocardial tissue perfusion after PCI, the odds ratio of low-BNP group was 4.12 (95% confidence interval 1.49-13.08, P<0.01).
The patients with STEMI who had higher BNP level on admission showed inadequate myocardial tissue perfusion status after primary PCI. The plasma BNP level on admission may serve as a predictor of tissue perfusion after primary PCI in patients with STEMI.
[Show abstract][Hide abstract] ABSTRACT: A low level of high-density lipoprotein cholesterol (HDL-C) is strongly associated with cardiovascular events. However, the significance of HDL-C after statin therapy on the outcome of patients who have undergone percutaneous coronary intervention (PCI) with drug eluting stents (DES) is unclear.
To investigate the significance of HDL-C after statin therapy on cardiovascular events in patients with coronary artery disease after DES implantation.
Patients who underwent PCI with DES from January 2004 to December 2009 were prospectively enrolled. The follow-up lipid panel of 2693 patients (median lab follow-up duration 225 days) who had continued using statins after PCI and who attained low-density lipoprotein cholesterol (LDL-C) <100 mg/dl was analysed. Major adverse cardiac events (MACE), including all-cause death, non-fatal myocardial infarction, and target vessel revascularisation according to follow-up HDL-C level (40 mg/dl for men or 50 mg/dl for women) were compared with the use of propensity scores matching.
Median follow-up duration was 832 days. 1585 (58.9%) patients had low follow-up HDL-C and 1108 had high follow-up HDL-C. The low follow-up HDL-C group had significantly higher rates of MACE. Low follow-up HDL-C was a significant independent predictor of MACE (adjusted HR 1.404, 95% CI 1.111 to 1.774, p=0.004). In further analysis with propensity scores matching, overall findings were consistent.
Raising HDL-C levels may be a subsequent goal after achieving target LDL-C levels in patients with DES implantation.