Publications by authors named "Jei Keon Chae"

103 Publications

Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction.

PLoS One 2021 13;16(10):e0258525. Epub 2021 Oct 13.

Korea Institute of Toxicology, Daejeon, Republic of Korea.

Background: A substantial number of patients presenting with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) have severe left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction (LVEF) less than 35%). But data are lacking regarding optimal percutaneous coronary intervention (PCI) strategy for these patients. The aim of this study was to compare the long-term outcomes of IRA (infarct-related artery)-only and multivessel PCI in patients with NSTEMI and MVD complicated by severe LVSD.

Methods: Among 13,104 patients enrolled in the PCI registry from November 2011 to December 2015, patients with NSTEMI and MVD with severe LVSD who underwent successful PCI were screened. The primary outcome was 3-year major adverse cardiovascular events (MACEs), defined as all-cause death, any myocardial infarction, stroke, and any revascularization.

Results: Overall, 228 patients were treated with IRA-only PCI (n = 104) or MV-PCI (n = 124). The MACE risk was significantly lower in the MV-PCI group than in the IRA-only PCI group (35.5% vs. 54.8%; hazard ratio [HR] 0.561; 95% confidence interval [CI] 0.378-0.832; p = 0.04). This result was mainly driven by a significantly lower risk of all-cause death (23.4% vs. 41.4%; hazard ratio [HR] 0.503; 95% confidence interval [CI] 0.314-0.806; p = 0.004). The results were consistent after multivariate regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences.

Conclusions: Among patients with NSTEMI and MVD complicated with severe LVSD, multivessel PCI was associated with a significantly lower MACE risk. The findings may provide valuable information to physicians who are involved in decision-making for these patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258525PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8513855PMC
October 2021

Gender differences in clinical outcomes of acute myocardial infarction undergoing percutaneous coronary intervention: insights from the KAMIR-NIH Registry.

J Geriatr Cardiol 2020 Nov;17(11):680-693

Division of Cardiology, Daejeon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Background: There are numerous but conflicting data regarding gender differences in outcomes following percutaneous coronary intervention (PCI). Furthermore, gender differences in clinical outcomes with acute myocardial infarction (AMI) following PCI in Asian population remain uncertain because of the under-representation of Asian in previous trials.

Methods: A total of 13, 104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) between November 2011 and December 2015 were classified into male ( = 8021, 75.9%) and female ( = 2547, 24.1%). We compared the demographic, clinical and angiographic characteristics, 30-days and 1-year major adverse cardiac and cerebrovascular events (MACCE) in women with those in men after AMI by using propensity score (PS) matching.

Results: Compared with men, women were older, had more comorbidities and more often presented with non-ST segment elevation myocardial infarction (NSTEMI) and reduced left ventricular systolic function. Over the median follow-up of 363 days, gender differences in both 30-days and 1-year MACCE as well as thrombolysis in myocardial infarction minor bleeding risk were not observed in the PS matched population (30-days MACCE: 5.3% . 4.7%, log-rank = 0.494, HR = 1.126, 95% CI: 0.800-1.585; 1-year MACCE: 9.3% . 9.0%, log-rank = 0.803, HR = 1.032, 95% CI: 0.802-1.328; TIMI minor bleeding: 4.9% . 3.9%, log-rank = 0.215, HR = 1.255, 95% CI: 0.869-1.814).

Conclusions: Among Korean AMI population undergoing contemporary PCI, women, as compared with men, had different clinical and angiographic characteristics but showed similar 30-days and 1-year clinical outcomes. The risk of bleeding after PCI was comparable between men and women during one-year follow up.
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http://dx.doi.org/10.11909/j.issn.1671-5411.2020.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729180PMC
November 2020

Clinical Implication of 'Obesity Paradox' in Elderly Patients With Acute Myocardial Infarction.

Heart Lung Circ 2021 Apr 1;30(4):481-488. Epub 2020 Oct 1.

Chonbuk National University Hospital, Jeonju, Republic of Korea.

Background: The clinical impact of body mass index (BMI), especially in the elderly with acute myocardial infarction (AMI), has not been sufficiently evaluated. The purpose of this study was to elucidate the clinical impact of BMI in very old patients (≥80 years) with AMI.

Methods: The study analysed 2,489 AMI patients aged ≥80 years from the Korea Acute Myocardial Infarction Registry and the Korea Working Group on Myocardial Infarction (KAMIR/KorMI) registries between November 2005 and March 2012. The study population was categorised into four groups based on their BMI: underweight (n=301), normal weight (n=1,150), overweight (n=890), and obese (n=148). The primary endpoint was major adverse cardiovascular event (MACE), a composite of cardiac death, myocardial infarction, target lesion revascularisation, and target vessel revascularisation.

Results: Baseline characteristics among the four groups were similar, except for hypertension (45.1 vs 58.4 vs 66.2 vs 69.9%, respectively; p<0.001) and diabetes (16.6 vs 23.6 vs 30.7 vs 35.1%, respectively; p<0.001). Coronary care unit length of stay was significantly different among the four groups during hospitalisation (5.3±5.9 vs 4.8±6.8 vs 4.2±4.0 vs 3.5±2.1 days; p=0.007). MACE (16.9 vs 14.9 vs 13.7 vs 8.8%; p=0.115) and cardiac death (10.3 vs 8.4 vs 7.9 vs 4.1%; p=0.043) less frequently occurred in the obese group than in other groups during the 1-year follow-up. A multivariate regression model showed obese status (BMI ≥27.5 kg/m) as an independent predictor of reduced MACE (hazard ratio [HR], 0.20; 95% confidence interval [CI], 0.06-0.69; p=0.010) along with reduced left ventricular ejection fraction (≤40%) as a predictor of increased MACE (HR,1.87; 95% CI, 1.31-2.68; p=0.001).

Conclusion: Body mass index in elderly patients with acute myocardial infarction was significantly associated with coronary care unit stay and clinical cardiovascular outcomes.
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http://dx.doi.org/10.1016/j.hlc.2020.08.013DOI Listing
April 2021

Safety and Efficacy of Pitavastatin in Patients With Impaired Fasting Glucose and Hyperlipidemia: A Randomized, Open-labeled, Multicentered, Phase IV Study.

Clin Ther 2020 10 10;42(10):2036-2048. Epub 2020 Sep 10.

Yonsei University Severance Hospital, Seoul, South Korea. Electronic address:

Purpose: Although the role of high-intensity lipid-lowering therapy in cardiovascular protection has broadened, concerns still exist about new-onset diabetes mellitus (NODM), especially in vulnerable patients. This study aimed to compare the effect of high-dose (4 mg/d) and usual dose (2 mg/d) pitavastatin on glucose metabolism in patients with hyperlipidemia and impaired fasting glucose (IFG).

Methods: In this 12-month study, glucose tolerance and lipid-lowering efficacy of high-dose pitavastatin (4 mg [study group]) was compared with that of usual dose pitavastatin (2 mg [control group]) in patients with hyperlipidemia and IFG. The primary end point was the change of glycosylated hemoglobin (HbA) after 24 weeks of treatment. The secondary end points were as follows: (1) NODM within 1 year after treatment, (2) change of lipid parameters, (3) changes of adiponectin, and (4) change of blood glucose and insulin levels.

Findings: Of the total 417 patients screened, 313 patients with hypercholesterolemia and IFG were randomly assigned into groups. The mean (SD) change in HbA was 0.06% (0.20%) in the study group and 0.03% (0.22%) in the control group (P = 0.27). Within 1 year, 27 patients (12.3%) developed NODM, including 12 (10.6%) of 113 patients in the study group and 15 (14.2%) of 106 in the control group (P = 0.43). The study group had a significantly higher reduction of total cholesterol and LDL-C levels and a higher increase in apolipoprotein A1/apolipoprotein B ratio (0.68 [0.40] vs 0.51 [0.35], P < 0.01).

Implications: The high-dose pitavastatin therapy did not aggravate glucose metabolism compared with the usual dose therapy. Moreover, it had a better effect on cholesterol-lowering and apolipoprotein distribution in the patients with hyperlipidemia and IFG.
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http://dx.doi.org/10.1016/j.clinthera.2020.07.013DOI Listing
October 2020

Intensity of Statin Treatment in Korean Patients with Acute Myocardial Infarction and Very Low LDL Cholesterol.

J Lipid Atheroscler 2019 Sep 2;8(2):208-220. Epub 2019 Jul 2.

Division of Cardiology, Gyungsang National University Hospital, Jinju, Korea.

Objective: Data on the intensity of statin therapy for patients with acute myocardial infarction (MI) and very low baseline low-density lipoprotein (LDL) cholesterol level are lacking. We sought to assess the impact of statin intensity in patients with acute MI and LDL cholesterol <70 mg/dL.

Methods: A total of 1,086 patients with acute MI and baseline LDL cholesterol <70 mg/dL from the Korea Acute Myocardial Infarction Registry-National Institute of Health database were divided into less intensive statin (expected LDL reduction <40%, n=302) and more intensive statin (expected LDL reduction ≥40%, n=784) groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, MI, revascularization occurring at least 30 days after admission, and stroke, at 12 months.

Results: After 1:2 propensity matching, differences were not observed between less intensive (n=302) and more intensive statin (n=604) groups in incidence of cardiac death (0.3% vs. 0.3%) and hemorrhagic stroke (0.3% vs. 0.5%, =0.727) at 12 months. Compared with the less intensive statin group, the more intensive statin group showed lower target-vessel revascularization (4.6% vs. 1.8%, =0.027) and MACCE (11.6% vs. 7.0%, =0.021). Major bleeding was not different between less intensive and more intensive statin groups (1.0% vs. 2.6%, =0.118).

Conclusion: More intensive statin therapy was associated with significantly lower major adverse cardiovascular events in patients with acute MI and very low LDL cholesterol compared with less intensive statin therapy.
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http://dx.doi.org/10.12997/jla.2019.8.2.208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379123PMC
September 2019

Clinical Implications of Bifurcation Angles in Left Main Bifurcation Intervention Using a Two-Stent Technique.

J Interv Cardiol 2020 11;2020:2475930. Epub 2020 Jul 11.

Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of Korea.

Objectives: The aim of this study was to assess the clinical impact of 3 bifurcation angles in left main (LM) bifurcation treated with the 2-stent technique.

Background: Data are limited regarding the impact of bifurcation angles after LM percutaneous coronary intervention (PCI).

Methods: Using patient-level 4 multicenter registries in Korea, 462 patients undergoing LM bifurcation PCI with the 2-stent technique were identified (181 crush, 167 T-stenting; 63% 1 generation drug-eluting stent (DES), 37% 2 generation DES). Three bifurcation angles, between the LM and left anterior descending (LAD), the LM and left circumflex (LCX), and the LAD and LCX, were measured. The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR).

Results: In patients treated with the crush technique, the best cutoff value (BCV) to predict TLF was 152° of the LM-LAD angle. In the crush group, a significantly higher TLF rate, mostly driven by TLR, was observed in the LM-LAD angle ≥152° group compared with the <152° group (35.7% vs. 14.6%; adjusted hazard ratio 3.476; 95% confidence interval 1.612-7.492). An LM-LAD angle ≥152° was an independent predictor of TLF. In the T-stenting, no bifurcation angle affected the clinical outcomes.

Conclusions: In LM bifurcation PCI using the 2-stent technique, wide LM-LAD angle (≥152°) was associated with a greater risk of TLF in the crush, whereas none of the bifurcation angles affected T-stenting outcomes.
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http://dx.doi.org/10.1155/2020/2475930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374237PMC
November 2020

Clinical Impact of Atypical Chest Pain and Diabetes Mellitus in Patients with Acute Myocardial Infarction from Prospective KAMIR-NIH Registry.

J Clin Med 2020 Feb 12;9(2). Epub 2020 Feb 12.

Department of Internal Medicine, Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.

Atypical chest pain and diabetic autonomic neuropathy attract less clinical attention, leading to underdiagnosis and delayed treatment. To evaluate the long-term clinical impact of atypical chest pain and diabetes mellitus (DM), we categorized 11,159 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into four groups (atypical DM, atypical non-DM, typical DM, and typical non-DM). The primary endpoint was defined as patient-oriented composite endpoint (POCE) at 2 years including all-cause death, any myocardial infarction (MI), and any revascularization. Patients with atypical chest pain showed higher 2-year mortality than those with typical chest pain in both DM (29.5% vs. 11.4%, < 0.0001) and non-DM (20.4% vs. 6.3%, < 0.0001) groups. The atypical DM group had the highest risks of POCE (hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.48-2.10), all-cause death (HR 2.23, 95% CI 1.80-2.76) and any MI (HR 2.34, 95% CI 1.51-3.64) in the adjusted model. In conclusion, atypical chest pain was significantly associated with mortality in patients with AMI. Among four groups, the atypical DM group showed the worst clinical outcomes at 2 years. Application of rapid rule in/out AMI protocols would be beneficial to improve clinical outcomes.
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http://dx.doi.org/10.3390/jcm9020505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074023PMC
February 2020

Effect of Low-Dose Nebivolol in Patients with Acute Myocardial Infarction: A Multi-Center Observational Study.

Chonnam Med J 2020 Jan 22;56(1):55-61. Epub 2020 Jan 22.

Department of Cardiology, Kyungsang National University Hospital, Jinju, Korea.

The optimal dose of beta blockers after acute myocardial infarction (MI) remains uncertain. We evaluated the effectiveness of low-dose nebivolol, a beta1 blocker and a vasodilator, in patients with acute MI. A total of 625 patients with acute MI from 14 teaching hospitals in Korea were divided into 2 groups according to the dose of nebivolol (nebistol®, Elyson Pharmaceutical Co., Ltd., Seoul, Korea): low-dose group (1.25 mg daily, n=219) and usual- to high-dose group (≥2.5 mg daily, n=406). The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE, composite of death from any cause, non-fatal MI, stroke, repeat revascularization, rehospitalization for unstable angina or heart failure) at 12 months. After adjustment using inverse probability of treatment weighting, the rates of MACCE were not different between the low-dose and the usual- to high-dose groups (2.8% and 3.1%, respectively; hazard ratio: 0.92, 95% confidence interval: 0.38 to 2.24, p=0.860). The low-dose nebivolol group showed higher rates of MI than the usual- to high-dose group (1.2% and 0%, p=0.008). The 2 groups had similar rates of death from any cause (1.1% and 0.3%, p=0.273), stroke (0.4% and 1.1%, p=0.384), repeat PCI (1.2% and 0.8%, p=0.428), rehospitalization for unstable angina (1.2% and 1.0%, p=0.743) and for heart failure (0.6% and 0.7%, p=0.832). In patients with acute MI, the rates of MACCE for low-dose and usual- to high-dose nebivolol were not significantly different at 12-month follow-up.
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http://dx.doi.org/10.4068/cmj.2020.56.1.55DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976776PMC
January 2020

Practical guidance for P2Y12 inhibitors in acute myocardial infarction undergoing percutaneous coronary intervention.

Eur Heart J Cardiovasc Pharmacother 2021 Mar;7(2):112-124

Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea.

Aims: Potent P2Y12 inhibitors for dual antiplatelet therapy (DAPT) is crucial for managing acute myocardial infarction; however, the selection of drugs is based on limited clinical information such as age and body weight. The current study sought to develop and validate a new risk scoring system that can be used to guide the selection of potent P2Y12 inhibitors by balancing ischaemic benefit and bleeding risk.

Methods And Results: Derivation cohort of 10 687 patients who participated in the Korea Acute Myocardial Infarction Registry-National Institutes of Health study was used to construct a new scoring system. We combined the ischaemic and bleeding models to establish a simple clinical prediction score. Among the low score group (n = 1764), the observed bleeding risk (8.7% vs. 4.4%, P < 0.001) due to potent P2Y12 inhibitors exceeded ischaemic benefit (1.3% vs. 2.2%, P = 0.185) during 12 months. Conversely, the high score group (n = 1898) showed an overall benefit from taking potent P2Y12 inhibitors from the standpoint of observed ischaemic (17.1% vs. 8.6%, P < 0.001) and bleeding events (10.1% vs. 6.8%, P = 0.073). The performance of ischaemic [integrated area under the curve (iAUC) = 0.809] and bleeding model (iAUC = 0.655) was deemed to be acceptable.

Conclusion: The new scoring system is a useful clinical tool for guiding DAPT by balancing ischaemic benefit and bleeding risk, especially among Asian populations. Further validation studies with other cohorts will be required to verify that the new system meets the needs of real clinical practice.
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http://dx.doi.org/10.1093/ehjcvp/pvaa005DOI Listing
March 2021

Clopidogrel versus Aspirin after Dual Antiplatelet Therapy in Acute Myocardial Infarction Patients Undergoing Drug-Eluting Stenting.

Korean Circ J 2020 Feb 11;50(2):120-129. Epub 2019 Oct 11.

Department of Cardiology, Kyungsang National University Hospital, Jinju, Korea.

Background And Objectives: There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI).

Methods: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months.

Results: After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31-3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924).

Conclusions: Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.
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http://dx.doi.org/10.4070/kcj.2019.0166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974667PMC
February 2020

Pre-hospital delay and emergency medical services in acute myocardial infarction.

Korean J Intern Med 2020 01 28;35(1):119-132. Epub 2019 Nov 28.

Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.

Background/aims: Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay.

Methods: Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center).

Results: A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS.

Conclusion: Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.
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http://dx.doi.org/10.3904/kjim.2019.123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960059PMC
January 2020

Effect of Pre-Procedural Beta-Blocker on Clinical Outcome after Percutaneous Coronary Intervention in Acute Coronary Syndrome.

Int Heart J 2019 Nov 15;60(6):1284-1292. Epub 2019 Nov 15.

Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University.

The efficacy of pre-procedural beta-blocker use in patients with acute coronary syndrome (ACS) is not well established in the current percutaneous coronary intervention (PCI) era. We investigate the effect of pre-procedural beta-blocker use on clinical outcomes in patients with ACS undergoing PCI. Among 44,967 consecutive cases of PCI enrolled in the nationwide, retrospective, multicenter registry (K-PCI registry), 31,040 patients with ACS were selected and analyzed. We classified patients into pre-procedural beta-blocker group (n = 8,678) and pre-procedural no-beta-blocker group (n = 22,362) according to the use of beta-blockers at least for two weeks before index PCI. Propensity score-matching analysis was performed and resulted in 7,445 pairs. The primary outcome was in-hospital cardiac death. In propensity score-matched populations, the pre-procedural beta-blocker group had a lower incidence of in-hospital cardiac death compared with the pre-procedural no-beta-blocker group (1.1% versus 2.0%, unadjusted odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.42-0.73, P < 0.01). In subgroup analysis, the pre-procedural beta-blocker group had a lower incidence of in-hospital cardiac death, compared with the pre-procedural no-beta-blocker group in ST-segment elevation myocardial infarction subpopulation (3.1% versus 6.1%, unadjusted OR: 0.49, 95% CI: 0.34-0.71, P < 0.01) and non-ST-segment elevation myocardial infarction subpopulation (1.5% versus 2.9%, unadjusted OR: 0.51, 95% CI: 0.33-0.79, P < 0.01). However, in unstable angina subpopulation, the in-hospital cardiac death rate was comparable between both groups. In conclusion, the use of pre-procedural beta-blocker was associated with a lower risk of in-hospital cardiac death in patients with ACS undergoing PCI. This result adds to the body of evidence that use of pre-procedural beta-blocker in patients with ACS might be reasonable.
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http://dx.doi.org/10.1536/ihj.19-175DOI Listing
November 2019

Dual antiplatelet therapy beyond 12 months versus for 12 months after drug-eluting stents for acute myocardial infarction.

J Cardiol 2020 01 24;75(1):66-73. Epub 2019 Sep 24.

Kyungsang National University Hospital, Jinju, Republic of Korea.

Background: The optimal duration of dual antiplatelet therapy (DAPT) after acute coronary syndrome remains uncertain. This study investigated the benefit of DAPT beyond 12 months after drug-eluting stents (DES) for acute myocardial infarction (MI).

Methods: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 6199 patients treated with DAPT for 12 months after DES (second-generation DES 98%) without ischemic or bleeding events were analyzed. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), a composite of death from any cause, MI, or ischemic stroke during the period from 12 to 24 months.

Results: After adjustment using inverse probability of treatment weighting, patients who received DAPT beyond 12 months (n=4795), compared to patients treated with 12-month DAPT (n=1404), had a similar incidence of MACCE (1.3% vs. 1.0%, HR: 1.32, 95% CI: 0.71-2.45, p=0.378). The 2 groups did not differ significantly in the rates of death (0.1% vs. 0.1%), MI (0.8% vs.0.6%), stent thrombosis (0.1% vs. 0.2%), ischemic stroke (0.4% vs. 0.2%), and major bleeding (0.1% vs. 0.1%). The rate of net adverse clinical events was 1.4% with DAPT beyond 12 months and 1.1% with 12-month DAPT (p=0.466).

Conclusions: DAPT beyond 12 months, as compared with 12-month DAPT, in real-world patients with acute MI treated predominantly with second-generation DES did not reduce the risk of MACCE. The rates of major bleeding and net adverse clinical events did not differ significantly between the 2 treatments.
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http://dx.doi.org/10.1016/j.jjcc.2019.06.006DOI Listing
January 2020

Clinically Significant Bleeding With Ticagrelor Versus Clopidogrel in Korean Patients With Acute Coronary Syndromes Intended for Invasive Management: A Randomized Clinical Trial.

Circulation 2019 12 25;140(23):1865-1877. Epub 2019 Sep 25.

Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (D.W.P., H.P., D.Y.K., J.M.A., P.H.L., S.W.L., S.W.P., S.J.P.).

Background: Owing to the differential propensity for bleeding and ischemic events with response to antiplatelet therapy, the safety and effectiveness of potent P2Y12 inhibitor ticagrelor in East Asian populations remain uncertain.

Methods: In this multicenter trial, 800 Korean patients hospitalized for acute coronary syndromes with or without ST elevation and intended for invasive management were randomly assigned to receive, in a 1:1 ratio, ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) or clopidogrel (600 mg loading dose, 75 mg daily thereafter). The primary safety outcome was clinically significant bleeding (a composite of major bleeding or minor bleeding according to PLATO (Platelet Inhibition and Patient Outcomes) criteria at 12 months.

Results: At 12 months, the incidence of clinically significant bleeding was significantly higher in the ticagrelor group than in the clopidogrel group (11.7% [45/400] vs 5.3% [21/400]; hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.34 to 3.79; =0.002). The incidences of major bleeding (7.5% [29/400] vs 4.1% [16/400], =0.04) and fatal bleeding (1% [4/400] vs 0%, =0.04) were also higher in the ticagrelor group. The incidence of death from cardiovascular causes, myocardial infarction, or stroke was not significantly different between the ticagrelor group and the clopidogrel group (9.2% [36/400] vs 5.8% [23/400]; HR, 1.62; 95% CI, 0.96 to 2.74; =0.07). Overall safety and effectiveness findings were similar with the use of several different analytic methods and in multiple subgroups.

Conclusions: In Korean acute coronary syndrome patients intended to receive early invasive management, standard-dose ticagrelor as compared with clopidogrel was associated with a higher incidence of clinically significant bleeding. The numerically higher incidence of ischemic events should be interpreted with caution, given the present trial was underpowered to draw any conclusion regarding efficacy.

Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02094963.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.119.041766DOI Listing
December 2019

Comparison of Two-Year Outcomes of Acute Myocardial Infarction Caused by Coronary Artery Spasm Versus that Caused by Coronary Atherosclerosis.

Am J Cardiol 2019 11 23;124(10):1493-1500. Epub 2019 Aug 23.

Chonnam National University Hospital, Gwangju, South Korea.

The study compared the 2-year outcomes of patients diagnosed with acute myocardial infarction (AMI) triggered by coronary artery atherosclerosis and AMI caused by coronary artery spasm. A total of 36,797 patients in the Korea AMI Registry were grouped into 2 categories-(1) AMI due to coronary artery spasm without stenotic lesion (CAS-AMI, n = 484); and (2) AMI induced by coronary artery atherosclerosis (CAA-AMI, n = 36,313). The major clinical outcomes of the 2 groups were compared over a 2-year clinical follow-up period. Major adverse cardiac events (MACE) were defined as the composite of total death, nonfatal myocardial infarction, and repeat revascularization. The incidence of MACE (7.1% vs 11.1%; p = 0.007) and repeat revascularization (0.4% vs 4.2%; p <0.001) in the CAS-AMI group were significantly lower than in the CAA-AMI group at 2 years. However, the incidence of total death and nonfatal myocardial infarction was similar in both the groups. Aborted cardiac arrest was strongly associated with 2-year mortality in the CAS-AMI group (hazard ratios 13.5, 95% confidence interval 5.34 to 34.15, p <0.001) The incidence of MACE in CAS-AMI patients was significantly lower than in the CAA-AMI group of patients up to 2 years due to the relatively lower rate of repeat revascularization in CAS-AMI patients. However, the incidence of total death or nonfatal myocardial infarction in CAS-AMI patients was not different from that of patients with CAA-AMI.
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http://dx.doi.org/10.1016/j.amjcard.2019.08.019DOI Listing
November 2019

Association between body mass index and 1-year outcome after acute myocardial infarction.

PLoS One 2019 14;14(6):e0217525. Epub 2019 Jun 14.

Chonbuk National University Hospital, Jeonju, Republic of Korea.

Objectives: Beneficial effects of overweight and obesity on mortality after acute myocardial infarction (AMI) have been described as "Body Mass Index (BMI) paradox". However, the effects of BMI is still on debate. We analyzed the association between BMI and 1-year clinical outcomes after AMI.

Methods: Among 13,104 AMI patients registered in Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) between November 2011 and December 2015, 10,568 patients who eligible for this study were classified into 3 groups according to BMI (Group 1; < 22 kg/m2, 22 ≤ Group 2 < 26 kg/m2, Group 3; ≥ 26 kg/m2). The primary end point was all cause death at 1 year.

Results: Over the median follow-up of 12 months, the event of primary end point occurred more frequently in the Group 1 patients than in the Group 3 patients (primary endpoint: adjusted hazard ratio [aHR], 1.537; 95% confidence interval [CI] 1.177 to 2.007, p = 0.002). Especially, cardiac death played a major role in this effect (aHR, 1.548; 95% confidence interval [CI] 1.128 to 2.124, p = 0.007).

Conclusions: Higher BMI appeared to be good prognostic factor on 1-year all cause death after AMI. This result suggests that higher BMI or obesity might confer a protective advantage over the life-quality after AMI.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217525PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570024PMC
February 2020

Effectiveness and Safety of Zotarolimus-Eluting Stent (Resolute™ Integrity) in Patients with Diffuse Long Coronary Artery Disease.

Korean Circ J 2019 Aug 15;49(8):709-720. Epub 2019 May 15.

Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.

Background And Objectives: Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD.

Methods: From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months.

Results: Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE.

Conclusions: Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.
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http://dx.doi.org/10.4070/kcj.2019.0018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675695PMC
August 2019

Usefulness of Myocardial Longitudinal Strain in Prediction of Heart Failure in Patients with Successfully Reperfused Anterior Wall ST-segment Elevation Myocardial Infarction.

Korean Circ J 2019 Oct 8;49(10):960-972. Epub 2019 Apr 8.

Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

Background And Objectives: Acute myocardial infarction-related heart failure (HF) is associated with poor outcome. This study was designed to investigate the usefulness of global longitudinal strain (GLS), global circumferential strain (GCS) and mean longitudinal strain of left anterior descending artery territory (LS) measured by 2-dimensional speckle tracking echocardiography (2D STE) in prediction of acute anterior wall ST-segment elevation myocardial infarction (ant-STEMI)-related HF.

Methods: A total of 171 patients with ant-STEMI who underwent successful primary coronary intervention and had available 2D STE data were enrolled. Patients were divided into 3 groups: in-hospital HF, post-discharge HF, and no-HF groups.

Results: In-hospital and post-discharge HF developed in 39 (22.8%) and 13 (7.6%) of patients, respectively and 113 patients (69.6%) remained without HF. Multivariate analysis showed that GLS was the only factor significantly associated with the development of in-hospital HF. For post-discharge HF, LS was the only independent predictor. Other echocardiographic or laboratory parameters did not show independent association with the development of ant-STEMI-related HF.

Conclusions: GLS is a powerful echocardiographic parameter related to development of in-hospital HF and LS was significantly associated with post-discharge HF in patients with successfully reperfused ant-STEMI.
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http://dx.doi.org/10.4070/kcj.2018.0421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753029PMC
October 2019

Clinical profiles of patients with surgically resected pheochromocytoma and paraganglioma.

Korean J Intern Med 2020 03 28;35(2):351-359. Epub 2019 Feb 28.

Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea.

Background/aims: Pheochromocytoma and paraganglioma (PPGL) are catecholamine-producing tumors that can cause blood pressure (BP) elevation and cardiovascular complications. Clinical presentation of these tumors may be changed through widespread use of imaging studies, which enables detection of PPGLs before onset of symptoms. We investigated clinical profiles of patients with surgically resected PPGLs.

Methods: From 2005 to 2017, 111 consecutive patients with surgically resected PPGLs in two tertiary hospitals in Korea were studied.

Results: Mean age was 52 ± 16 years, 57 patients (51.4%) were male and 54 (48.6%) were hypertensive. Twenty-nine PPGLs (26.1%) were extra-adrenal paragangliomas. Sixteen (14.4%) and seven patients (6.3%) (Group 1, n = 23) were diagnosed during work-up of hypertension and transient cardiomyopathy respectively, and the remainder (Group 2, n = 88) were incidentalomas detected during routine abdominal imaging. Patients in the Group 1 were younger and more frequently symptomatic, and had higher BPs, heart rates and levels of urinary catecholamines than those in the Group 2. Paragangliomas were less frequent and secretion of epinephrine and metanephrine was more predominant in the Group 1 than in Group 2. After the surgical resections, 18.2% of patients still needed antihypertensive medications.

Conclusion: Out of 111 patients with surgically resected PPGLs, 88 (79.3%) were diagnosed as incidentalomas. Seven patients presented with transient cardiomyopathy and 16 with hypertension. Tumor location and secretion of catecholamine may vary depending on the presence of symptoms.
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http://dx.doi.org/10.3904/kjim.2018.231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061004PMC
March 2020

Immediate multivessel intervention versus culprit-vessel intervention only in patients with ST-elevation myocardial infarction and multivessel coronary disease: data from the prospective KAMIR-NIH registry.

Coron Artery Dis 2019 03;30(2):95-102

Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital.

Background: The safety and efficacy of immediate multivessel coronary intervention (MVI) remain controversial in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). This study aimed to investigate the clinical outcomes of immediate MVI compared with culprit-vessel intervention only (CVI-O) in diverse subgroups with STEMI and MVD.

Patients And Methods: We compared immediate MVI (n=260) and CVI-O (n=931) regarding 1-year major adverse cardiac event rates for cardiac death, recurrent myocardial infarction (MI), and repeat revascularization in 1191 STEMI patients with MVD using data from the Korea Acute Myocardial Infarction-National Institutes of Health registry (2011-2015). High-risk patients and those who underwent a staged procedure were excluded from the analysis. Furthermore, propensity score matching and stratified subgroup analyses were performed.

Results: Immediate MVI and CVI-O groups had similar 1-year major adverse cardiac event rates [7.7 vs. 8.9%, hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.50-1.47, log-rank P=0.5628]. No difference was found between the groups in terms of the 1-year rate of cardiac death (2.9 vs. 1.3%, HR: 2.24, 95% CI: 0.75-6.67) or recurrent MI (2 vs. 1.5%, HR: 1.41, 95% CI: 0.45-4.44). However, repeat revascularization occurred less frequently in the immediate MVI group than in the CVI-O group (2.0 vs. 5.7%, HR: 0.35, 95% CI: 0.13-0.90, log-rank P=0.0142). These findings were found to be consistent across a broad spectrum of subgroups.

Conclusion: Compared with CVI-O, immediate MVI did not improve 1-year net clinical outcomes in stable STEMI patients with MVD. The only benefit found was a reduced repeat revascularization in immediate MVI.
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http://dx.doi.org/10.1097/MCA.0000000000000684DOI Listing
March 2019

Association of potent P2Y12 blockers with ischemic and bleeding outcomes in non-ST-segment elevation myocardial infarction.

J Cardiol 2019 02 26;73(2):142-150. Epub 2018 Oct 26.

Kyungsang National University Hospital, Jinju, Republic of Korea.

Background: Potent P2Y12 blockers are preferred in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). However, the risk of bleeding remains a major concern. We assessed the association of potent P2Y12 blockers with ischemic and bleeding outcomes in patients with NSTEMI.

Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 4927 patients with NSTEMI receiving drug-eluting stents (DES) were divided into potent P2Y12 blocker (ticagrelor or prasugrel, n=901) and clopidogrel (n=3180) groups. Propensity-matched 12-month ischemic and bleeding events were compared. Patients who received anticoagulants or who discontinued P2Y12 blockers or switched between potent P2Y12 blockers and clopidogrel were excluded.

Results: In the overall population, patients at higher ischemic and bleeding risks more often received clopidogrel. After propensity matching (n=901 in each group), 12-month rates of major adverse cardiac and cerebrovascular events were lower (7.3% vs. 10.1%, p=0.038), but Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding rates were higher (5.9% vs. 2.2%, p<0.001) with potent P2Y12 blockers. Twelve-month rates of death from any cause, MI, stroke, or TIMI major bleeding were not different. On multivariate analysis, 12-month risk of TIMI major or minor bleeding was higher with B2 or C lesion, potent P2Y12 blocker use, body weight <60kg, and lower with time to PCI <12h and radial artery access.

Conclusions: In patients with NSTEMI receiving DES, potent P2Y12 blockers were associated with reduced ischemic but increased bleeding risk with similar net clinical benefits.
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http://dx.doi.org/10.1016/j.jjcc.2018.09.002DOI Listing
February 2019

Incremental age-related one-year MACCE after acute myocardial infarction in the drug-eluting stent era (from KAMIR-NIH registry).

J Geriatr Cardiol 2018 Sep;15(9):574-584

Statistical Manager, Institute of Toxicology, Daejeon, South Korea.

Objectives: To evaluate the age-related one-year major adverse cardiocerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). We analyzed the association between age and one-year MACCE after AMI.

Methods: A total of 13,104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institue of Health (KAMIR-NIH) between November 2011 and December 2015 were classified into four groups according to age (Group I, < 60 years, = 4199; Group II, 60-70 years, = 2577; Group III; 70-80 years, = 2774; Group IV, ≥ 80 years, = 1018). Patients were analyzed for one-year composite of MACCE (cardiac death, myocardial infarction, target vessel revascularization, cerebrovascular events) after AMI.

Results: The one-year MACCE in AMI were 3.5% (Group I), 6.3% (Group II), 9.6% (Group III) and 17.6% (Group IV). After adjustment for confounding parameters, the analysis results showed that patients with AMI had incremental risk of one-year MACCE [Group II, adjusted hazard ratios (aHR) = 1.224, 95% CI: 0.965-1.525, = 0.096; Group III, aHR = 1.316, 95% CI: 1.037-1.671, = 0.024; Group IV, aHR = 1.975, 95% CI: 1.500-62.601, < 0.001) compared to Group I. Especially, cardiac death in the composite of primary end point played a major role in this effect (Group II, aHR = 1.335, 95% CI: 0.941-1.895, = 0.106; Group III, aHR = 1.575, 95% CI: 1.122-2.210, = 0.009; Group IV, aHR = 2.803, 95% CI: 1.937-4.054, < 0.001).

Conclusions: Despite advanced techniques and medications for PCI in AMI, age still exerts a powerful influence in clinical outcomes. Careful approaches, even in the modern era of developed cardiology are needed for aged-population in AMI intervention.
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http://dx.doi.org/10.11909/j.issn.1671-5411.2018.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188977PMC
September 2018

Effects of Bisoprolol Are Comparable with Carvedilol in Secondary Prevention of Acute Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention.

Chonnam Med J 2018 May 25;54(2):121-128. Epub 2018 May 25.

Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.

Although the benefits of carvedilol have been demonstrated in the era of percutaneous coronary intervention (PCI), very few studies have evaluated the efficacy of bisoprolol in the secondary prevention of acute myocardial infarction (MI) in patients treated with PCI. We hypothesized that the effect of bisoprolol would not be different from carvedilol in post-MI patients. A total of 13,813 patients who underwent PCI were treated either with carvedilol or bisoprolol at the time of discharge. They were enrolled from the Korean Acute MI Registry (KAMIR). After 1:2 propensity score matching, 1,806 patients were enrolled in the bisoprolol group and 3,612 patients in the carvedilol group. The primary end point was the composite of major adverse cardiac events (MACEs), which was defined as cardiac death, nonfatal MI, target vessel revascularization, and coronary artery bypass surgery. The secondary end point was defined as all-cause mortality, cardiac death, nonfatal MI, any revascularization, or target vessel revascularization. After adjustment for differences in baseline characteristics by propensity score matching, the MACE-free survival rate was not different between the groups (HR=0.815, 95% CI:0.614-1.081, p=0.156). In the subgroup analysis, the cumulative incidence of MACEs was lower in the bisoprolol group in patients having a Killip class of III or IV than in the carvedilol group (HR=0.512, 95% CI: 0.263-0.998, p=0.049). The incidence of secondary end points was similar between the two beta-blocker groups. In conclusion, the benefits of bisoprolol were comparable with those of carvedilol in the secondary prevention of acute MI.
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http://dx.doi.org/10.4068/cmj.2018.54.2.121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5972125PMC
May 2018

A new risk score for ventricular tachyarrhythmia in acute myocardial infarction with preserved left ventricular ejection fraction.

J Cardiol 2018 11 17;72(5):420-426. Epub 2018 May 17.

Department of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea.

Background: Ventricular tachycardia or fibrillation (VT/VF) is a major cause of sudden cardiac death after acute myocardial infarction (AMI). This study aims to investigate the clinical characteristics and outcomes of VT/VF, to identify the variables associated with VT/VF, and to construct a new scoring system.

Methods: Patients with relatively preserved left ventricular ejection fraction (LVEF) (≥40%) included in the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were enrolled in this study. Among 13,109 patients in the registry, a total of 10,334 (78.8%) had relatively preserved LVEF after AMI. Patients were divided into two groups based on whether they experienced life-threatening VT/VF during hospitalization or not. The predictors for VT/VF during hospitalization were assessed. In-hospital mortality and complications were recorded.

Results: A total of 358 (3.5%) experienced life-threatening VT/VF. The VT/VF group was at an increased risk of in-hospital mortality (odds ratio 2.99) and cardiac death (odds ratio 3.40). Variables of diagnosis, Killip class, smoking, initial rhythm, left bundle branch block, and LVEF were significant indicators of VT/VF. A new risk score system yielded acceptable discrimination function (c-statistics=0.773).

Conclusions: Relatively preserved LVEF patients could still be at risk of life-threatening VT/VF, which is related to a poor prognosis during the admission period. This new scoring system can be adopted to stratify the risk of VT/VF.
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http://dx.doi.org/10.1016/j.jjcc.2018.04.008DOI Listing
November 2018

Utility of GRACE and ACUITY-HORIZONS risk scores to guide dual antiplatelet therapy in Korean patients with acute myocardial infarction undergoing drug-eluting stenting.

J Cardiol 2018 11;72(5):411-419

Kyungsang National University Hospital, Jinju, Republic of Korea.

Background: Dual antiplatelet therapy (DAPT) is recommended in patients receiving drug-eluting stents (DES). However, bleeding risk should be weighed against ischemic risk. Utility of GRACE risk score and ACUITY-HORIZONS bleeding risk score was assessed in patients with acute myocardial infarction (MI) according to use of P2Y12 blocker.

Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 7791 patients with acute MI receiving DES were divided into ticagrelor (n=1554) and clopidogrel (n=6237) groups. Propensity-matched 12-month mortality and bleeding event rates were compared according to GRACE and ACUITY-HORIZONS scores. Patients who received thrombolysis, prasugrel or anticoagulants, or who discontinued or switched DAPT were excluded.

Results: In all patients, high-risk patients more often received clopidogrel. After propensity score matching (n=1553 in each group), 12-month mortality was not different, but TIMI major bleeding rate was higher with ticagrelor (2.8% vs. 1.4%, p=0.007). On subgroup analysis, 12-month mortality was lower with ticagrelor in patients with high (>140) compared to low-to-moderate risk GRACE score (5.1% vs. 7.9%, p=0.04). When combined with ACUITY-HORIZONS bleeding score, 12-month mortality was lower with ticagrelor in patients with high GRACE score but without very high (≥20) ACUITY-HORIZONS score (2.4% vs. 5.3%, p=0.03).

Conclusions: In patients with acute MI receiving DES, GRACE and ACUITY-HORIZONS scores may help guide DAPT. In patients with high GRACE score, a more potent P2Y12 blocker may be considered, particularly in the subset not at very high risk of bleeding.
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http://dx.doi.org/10.1016/j.jjcc.2018.04.006DOI Listing
November 2018

Influence of obesity and metabolic syndrome on clinical outcomes of ST-segment elevation myocardial infarction in men undergoing primary percutaneous coronary intervention.

J Cardiol 2018 10 27;72(4):328-334. Epub 2018 Apr 27.

Department of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea.

Background: The correlation between obesity and metabolic syndrome (MetS) and its impact on cardiovascular disease remains unclear. This study aims to investigate the impact of metabolic status and obesity on clinical outcomes of male patients with ST-segment elevation myocardial infarction (STEMI).

Methods: Data from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were used to evaluate the impact of obesity and MetS on patients undergoing primary percutaneous coronary intervention (PPCI) from November 2005 to November 2015. Patients were grouped according to the presence or absence of obesity and MetS ('obese-/MetS-', 'obese-/MetS+', 'obese+/MetS-', or 'obese+/MetS+', respectively). All-cause death and major adverse cardiac events (MACE) were recorded during 12 months of follow-up.

Results: A total of 14,357 patients were included. Multivariate analysis showed that the presence of MetS was an independent risk factor for all-cause death (HR 2.08, 95% CI 1.30-3.31, p=0.002) and cardiovascular death (HR 2.44, 95% CI 1.33-4.46, p=0.004) at 12 months among normal weight patients. The protective effect of obesity was observed, compared with the obese-/MetS+ group, in terms of all-cause death (HR 0.50, 95% CI 0.31-0.81, p=0.005) and cardiovascular death (HR 0.52, 95% CI 0.28-0.96, p=0.038; vs. total obese individuals), but it might have disappeared compared with the obese-/MetS- group. The rate of MACE did not differ significantly according to category by obesity and MetS.

Conclusions: The obesity paradox has not been observed between obese and normal weight patients without MetS. Risk stratification on the basis of the presence or absence of MetS is not a clinically useful indicator of outcome in obese male patients with STEMI after PPCI.
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http://dx.doi.org/10.1016/j.jjcc.2018.03.010DOI Listing
October 2018

Optimal Timing of Percutaneous Coronary Intervention in Patients With Non-ST-Segment Elevation Myocardial Infarction Complicated by Acute Decompensated Heart Failure (from the Korea Acute Myocardial Infarction Registry-National Institutes of Health [KAMIR-NIH]).

Am J Cardiol 2018 06 1;121(11):1285-1292. Epub 2018 Mar 1.

Chonbuk National University Hospital, Jeonju, Republic of Korea.

The optimal timing of percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI), complicated by acute decompensated heart failure (ADHF), is unclear. A total of 1,027 patients with NSTEMI complicated by ADHF who underwent successful PCI were analyzed using a Korean multicenter registry. All patients were divided into 4 groups by the timing of PCI: group 1 (PCI < 2 hour after admission, n = 149), group 2 (2 to 24 hours, n = 577), group 3 (24 to 72 hours, n = 189), and group 4 (≥72 hours, n = 112). We analyzed the incidences of 12-month mortality, nonfatal myocardial infarction (MI), target-vessel revascularization, and rehospitalization because of HF. The prevalence of ADHF in patients with NSTEMI was 15.2% at initial presentation, and in-hospital mortality was higher in group 1 than in the other groups. There were no significant differences in mortality, nonfatal MI, target-vessel revascularization, or rehospitalization for HF during the 12-month follow-up between groups, regardless of initial PCI timing, except for a higher 12-month mortality in patients who received PCI within 24 hours (vs ≥24 hours) (hazard ratio 1.52, 95% confidence interval 1.09 to 2.29, p = 0.046). Early PCI did not reduce adverse clinical outcomes in patients with NSTEMI complicated by ADHF. Delayed PCI after stabilization may be reasonable in such high-risk patients.
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http://dx.doi.org/10.1016/j.amjcard.2018.01.051DOI Listing
June 2018

Comparison of Clinical Outcomes Between Ticagrelor and Prasugrel in Patients With ST-Segment Elevation Myocardial Infarction - Results From the Korea Acute Myocardial Infarction Registry-National Institutes of Health.

Circ J 2018 06 12;82(7):1866-1873. Epub 2018 Apr 12.

Department of Internal Medicine, Chonbuk National University Hospital.

Background: There is little information regarding comparison of ticagrelor and prasugrel in patients with ST-segment elevation myocardial infarction (STEMI). We sought to compare clinical outcomes between ticagrelor and prasugrel in STEMI.Methods and Results:A total of 1,440 patients with STEMI who underwent successful primary percutaneous coronary intervention were analyzed; the data were obtained from the Korea Acute Myocardial Infarction Registry-National Institutes of Health. Of the patients, 963 received ticagrelor, and 477 received prasugrel. The primary study endpoint was 12-month major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR). MACE occurred in 91 patients (6.3%) over the 1-year follow-up, and there were no differences in the incidence of MACE (hazard ratio [HR] 1.20, 95% confidence interval [CI] 0.76-1.91, P=0.438) between the 2 groups. Analysis by propensity score matching (429 pairs) did not significantly affect the results. The incidence of in-hospital major bleeding events was still comparable between the 2 groups (2.4% vs. 2.5%, odds ratio 0.75, 95% CI 0.30-1.86, P=0.532), and there was no significant difference in the incidence of MACE (5.4% vs. 5.8%, HR 0.98, 95% CI 0.56-1.74, P=0.951) after matching.

Conclusions: Ticagrelor and prasugrel showed similar efficacy and safety profiles for treating STEMI in this Korean multicenter registry.
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http://dx.doi.org/10.1253/circj.CJ-18-0112DOI Listing
June 2018

Third-Generation P2Y12 Inhibitors in East Asian Acute Myocardial Infarction Patients: A Nationwide Prospective Multicentre Study.

Thromb Haemost 2018 03 13;118(3):591-600. Epub 2018 Mar 13.

Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.

Third-generation P2Y inhibitors (prasugrel, ticagrelor) are recommended in acute myocardial infarction (AMI). We aimed to evaluate the efficacy and safety of third-generation P2Y inhibitors in East Asian AMI patients. From the Korean AMI Registry, 9,355 patients who received dual antiplatelet agent (aspirin with clopidogrel [AC], 6,444 [70.5%] patients; aspirin with prasugrel [AP], 1,100 [11.8%] patients; or aspirin with ticagrelor [AT], 1,811 [19.4%] patients) were analysed. In-hospital endpoints were all-cause mortality or bleeding events during admission and 1-year endpoints were major adverse cardiac and cerebrovascular events (MACCE) and major bleeding events. Regarding in-hospital events, AP and AT showed similar all-cause mortality rates but higher bleeding event rates compared with AC. This trend was extended to 1-year endpoints; Cox regression analysis showed that third-generation P2Y inhibitors had significantly higher bleeding risk (AP vs. AC: hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.53-2.99;  < 0.001; AT vs. AC: HR, 2.26; 95% CI, 1.73-2.95;  < 0.001). A propensity score matched triplet of 572 patients showed similar 1-year MACCE and higher bleeding events with third-generation P2Y inhibitors (2.1 vs. 2.6 vs. 2.1%,  = 0.790 for MACCE and 3.1 vs. 8.0 vs. 8.0%,  < 0.001 for bleeding events, in AC, AP and AT groups, respectively). Inverse probability weighted regression analysis and pooled analysis after randomly imputing missing variables showed consistent results. Collectively, prasugrel and ticagrelor showed similar rates of 1-year MACCE, but a higher rate of bleeding events, compared with clopidogrel in Korean AMI patients. Further studies are warranted to adapt Western guidelines on third-generation P2Y inhibitors for East Asians.
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http://dx.doi.org/10.1055/s-0038-1626697DOI Listing
March 2018

Safety and Efficacy of the Endeavor Resolute® Stent in Patients with Multivessel Disease: The HEART (Honam EndeAvor ResoluTe) Prospective, Multicenter Trial.

Chonnam Med J 2018 Jan 25;54(1):55-62. Epub 2018 Jan 25.

Department of Cardiology, St. Carollo Hospital, Suncheon, Korea.

The Endeavor Resolute® (ER) is a zotarolimus-eluting stent (ZES) with a biocompatible BioLinx polymer. This study prospectively compared the clinical outcomes of 2 versions of ZES, ER and Endeavor Sprint® (ES), in patients with multivessel disease. A total of 488 patients who underwent multivessel percutaneous coronary intervention (PCI) were divided into 2 groups the ER group (n=288) and the ES group (n=200). The primary endpoint was a composite of major adverse cardiac events (MACE) consisting of death, myocardial infarction, and target vessel revascularization after 12 months. In all patients, the prevalence of diabetes was higher in the ER group (42.7% vs. 31.0%, p=0.009). The rate of post-PCI Thrombolysis in Myocardial Infarction flow grade 3 was higher in the ER group (100.0% vs. 98.0%, p=0.028). There were no between-group differences in the in-hospital, 1-month and 12-month clinical outcomes. In the propensity score matched cohort (n=200 in each group), no differences were observed in the baseline and procedural characteristics. There were no statistical differences in the rates of in-hospital, 1-month and 12-month events (12-month MACE in the ER and ES groups: 6.0% vs. 3.5%, p=0.240, respectively). The safety and efficacy of both versions of ZES were comparable in patients with multivessel disease during a 12-month clinical follow-up.
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http://dx.doi.org/10.4068/cmj.2018.54.1.55DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794480PMC
January 2018
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