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Jae-Sik Jang,
Han-Young Jin,
Jeong-Sook Seo,
Tae-Hyun Yang,
Dae-Kyeong Kim,
Tae Hee Kim,
Sang-Hwa Urm,
Dong-Soo Kim,
Dong-Kie Kim,
Sang-Hoon Seol,
Doo-Il Kim,
Kyoung-Im Cho, Bo-Hyun Kim,
Yong Hyun Park,
Hyung-Gon Je,
Jung-Min Ahn,
Won-Jang Kim,
Jong-Young Lee,
Seung-Whan Lee
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ABSTRACT: Background: Sodium bicarbonate has been postulated to prevent contrast-induced acute kidney injury (CI-AKI) by various mechanisms, although the reports are conflicting. Methods and Results: We searched MEDLINE, EMBASE, and the Cochrane databases for randomized controlled trials that compared a sodium chloride with a sodium bicarbonate hydration regimen with regard to CI-AKI. Data across 19 clinical trials consisting of 3,609 patients were combined. Preprocedural hydration with sodium bicarbonate was associated with a significant decrease in the rate of CI-AKI (odds ratio [OR] 0.56; 95% confidence interval [CI] 0.36-0.86; P=0.008). Stratified analyses by the type of contrast medium suggested lower odds of CI-AKI with sodium bicarbonate in studies using low-osmolar contrast media (OR 0.40; 95% CI 0.23-0.71, P=0.002) compared with those using the iso-osmolar agents (OR 0.76; 95% CI 0.41-1.43; P=0.40). No significant difference in the rates of postprocedural death (OR 0.49; 95% CI 0.23-1.04; P=0.06) and the requirement for renal replacement therapy (OR 0.94; 95% CI 0.46-1.91; P=0.86) was observed. However, we found significant changes in serum bicarbonate and potassium levels after sodium bicarbonate infusion. Conclusions: This updated meta-analysis demonstrates that sodium bicarbonate-based hydration is superior to sodium chloride in preventing CI-AKI of patients undergoing exposure to iodinated contrast media. (Circ J 2012; 76: 2255-2265).
Circulation Journal 08/2012; 76(9):2255-65. · 3.77 Impact Factor
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Jae-Sik Jang,
Han-Young Jin,
Jeong-Sook Seo,
Tae-Hyun Yang,
Dae-Kyeong Kim,
Dong-Soo Kim,
Dong-Kie Kim,
Sang-Hoon Seol,
Doo-Il Kim,
Kyoung-Im Cho, Bo-Hyun Kim,
Yong Hyun Park,
Hyung-Gon Je,
Young-Hoon Jeong,
Won-Jang Kim,
Jong-Young Lee,
Seung-Whan Lee
[show abstract]
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ABSTRACT: To evaluate the impact of cilostazol on the angiographic and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with stents and treated with aspirin and thienopyridine.
A total of 11 randomized controlled trials including 8,525 patients comparing triple antiplatelet therapy (aspirin, thienopyridine and cilostazol) with standard dual antiplatelet therapy were included in the analysis. The primary end points were in-segment late loss and angiographic restenosis at angiographic follow-up. Secondary end points included mortality, stent thrombosis, target lesion revascularization (TLR) and major adverse cardiac events (MACE).
Triple antiplatelet therapy was associated with a significant reduction in late loss [weighted mean difference 0.14, 95% confidence interval (CI) 0.08-0.20; p < 0.001] and angiographic restenosis [odds ratio (OR) 0.58, 95% CI 0.48-0.71; p < 0.001]. Addition of cilostazol to dual antiplatelet therapy was associated with a significant reduction in TLR (OR 0.56, 95% CI 0.41-0.77; p < 0.001) and MACE (OR 0.72, 95% CI 0.60-0.86; p < 0.001) with no differences in mortality (p = 0.29), stent thrombosis (p = 0.60) or bleeding episodes (p = 0.77).
Cilostazol in addition to dual antiplatelet therapy appears to be effective in reducing the risk of restenosis and repeat revascularization after PCI without any significant benefits for mortality or stent thrombosis.
Cardiology 07/2012; 122(3):133-43. · 1.71 Impact Factor
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ABSTRACT: OBJECTIVES: To assess whether different degrees of creatine kinase-myocardial band isoenzyme (CK-MB) elevation after percutaneous coronary intervention (PCI) affect the subsequent risk of death. BACKGROUND: While there is consensus that extensive cardiac enzyme elevation increase mortality significantly, there is uncertainty about the exact clinical impact of smaller CK-MB elevations after PCI. METHODS: The published literature was scanned by formal searches of electronic databases such as PubMed and MEDLINE from January 1999 to October 2011. Risk ratio (RR) was used as summary estimate. RESULTS: Ten studies have been included totaling 48,022 patients who underwent PCI (12,246 patients with CK-MB elevation and 35,776 patients without CK-MB elevation). Mean follow-up duration for each study ranged from 6 to 48 months. CK-MB elevation >1× the upper limit of normal (ULN) conferred a significant increase in the risk of mortality with an overall RR of 1.74 (95% confidence interval [CI], 1.42 to 2.13, p<0.001). Compared with patients without CK-MB elevation, there was a dose-response relationship with RR for death being 1.48 (95% CI, 1.25 to 1.77, p<0.001) with CK-MB elevation 1 to <3× the upper limit of normal (ULN), 1.71 (95% CI, 1.23 to 2.37, p=0.001) with CK-MB elevation 3 to 5× ULN, and 2.83 (95% CI, 1.98 to 4.04, p<0.001) with CK-MB elevation ò 5× ULN. CONCLUSIONS: Even a small increase in CK-MB levels after PCI is associated with significantly higher risk of late mortality. Monitoring cardiac enzymes after PCI may help predict the long term clinical outcome. © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions 06/2012; · 2.29 Impact Factor
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Jae-Sik Jang,
Kyoung-Im Cho,
Han-Young Jin,
Jeong-Sook Seo,
Tae-Hyun Yang,
Dae-Kyeong Kim,
Dong-Soo Kim,
Sang-Hoon Seol,
Doo-Il Kim, Bo-Hyun Kim,
Yong Hyun Park,
Hyung-Gon Je,
Young-Hoon Jeong,
Seung-Whan Lee
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ABSTRACT: Loss-of-function (LOF) variants of cytochrome P450 2C19 (CYP2C19) have been hypothesized to be associated with lesser degrees of platelet inhibition and increased risk for recurrent ischemic events in patients with coronary artery disease on clopidogrel therapy; however, studies from Western countries have yielded mixed results. We aimed to assess the impact of CYP2C19 LOF variants on clinical outcomes from different ethnic groups. Sixteen prospective cohort studies including 7,035 patients carrying ≥ 1 CYP2C19 LOF allele and 13,750 patients with the wild-type genotype were included in this meta-analysis. Carriers of ≥ 1 CYP2C19 LOF allele were at significantly higher risk for adverse clinical events compared to noncarriers during clopidogrel therapy (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.13 to 1.78). The summary OR showed a significant association between CYP2C19 LOF variants and an increased risk of cardiac death (OR 2.18, 95% CI 1.37 to 3.47), myocardial infarction (OR 1.42, 95% CI 1.12 to 1.81), and stent thrombosis (OR 2.41, 95% CI 1.76 to 3.30). Stratified analysis by ethnicity of study population suggested higher odds of adverse clinical events in the Asian population with LOF variants of CYP2C19 (OR 1.89, 95% CI 1.32 to 2.72) compared to Western populations (OR 1.28, 95% CI 1.00 to 1.64). In conclusion, carrier status for LOF CYP2C19 is associated with an increased risk of adverse clinical events in patients with coronary artery disease on clopidogrel therapy despite differences in clinical significance according to ethnicity.
The American journal of cardiology 05/2012; 110(4):502-8. · 3.58 Impact Factor
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Jae-Sik Jang,
Han-Young Jin,
Jeong-Sook Seo,
Tae-Hyun Yang,
Dae-Kyeong Kim,
Dong-Kie Kim,
Doo-Il Kim,
Kyoung-Im Cho, Bo-Hyun Kim,
Yong Hyun Park,
Hyung-Gon Je,
Dong-Soo Kim
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ABSTRACT: There is an increasing amount of data suggesting that transradial approach is associated with lower incidence of complications in vascular access site and improved clinical outcomes compared with transfemoral approach in the setting of ST-segment elevation myocardial infarction (STEMI). The objective of this study was to assess the safety and efficacy of radial versus femoral percutaneous coronary intervention (PCI) for patients with STEMI.
We searched MEDLINE, EMBASE, and Cochrane databases for randomised, case-control, and cohort studies comparing access-related complications and clinical outcomes from January 2001 to October 2011. Twenty-one studies involving 8,534 patients were identified. Transradial approach was associated with a significant reductions in major adverse cardiac events (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44-0.72, p<0.001), mortality (OR 0.55, 95% CI 0.42-0.72, p<0.001), and major bleeding (OR 0.32, 95% CI 0.22-0.48, p<0.001) compared to transfemoral approach. There was a shorter hospital length of stay with transradial access with a weighted mean difference of 2.23 days (95% CI -3.32--1.14, p<0.001) compared to transfemoral access. There were no differences in fluoroscopic time, door-to-balloon time, and procedure time between the two access routes (p=0.09, p=0.38, p=0.82, respectively). The rate of access site crossover tended to be higher with transradial access (p=0.06).
This updated meta-analysis demonstrates that transradial PCI reduces the risk of significant periprocedural bleeding and improve clinical outcomes in patients with STEMI.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 05/2012; 8(4):501-10. · 3.29 Impact Factor
