Publications by authors named "Oh Hyun Lee"

26 Publications

  • Page 1 of 1

Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure.

Heart 2021 Oct 22. Epub 2021 Oct 22.

Severance Cardiovascular Hospital, Yonsei, Korea (the Republic of).

Objective: Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus.

Methods: This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively.

Results: IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102).

Conclusion: In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up.
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http://dx.doi.org/10.1136/heartjnl-2021-319811DOI Listing
October 2021

Comparison of Distal Radial, Proximal Radial, and Femoral Access in Patients with ST-Elevation Myocardial Infarction.

J Clin Med 2021 Aug 2;10(15). Epub 2021 Aug 2.

Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea.

Recent studies have indicated that distal radial access (DRA) is feasible in patients undergoing percutaneous coronary intervention (PCI). The present study aimed to compare DRA, proximal radial access (PRA), and femoral access (FA) in patients with ST-elevation myocardial infarction (STEMI) undergoing PCI. Data were analyzed for 109 patients with STEMI treated via primary PCI from March 2020 to May 2021. The success rate of DRA was 83.3% (35/42), including seven cases of failed puncture (puncture failure = 5, severe radial artery spasm = 2). Primary PCI via the DRA was successful in all 35 patients. After classifying the patients requiring crossover into a separate group, the percentage of the puncture time in the door-to-wiring time was 2.7% [2.2-4.3], 3.3% [2.3-4.0], 2.6% [1.2-4.9], and 27.0% [13.5-29.3] in the DRA ( = 35), PRA ( = 24), FA ( = 26), and crossover ( = 9) groups, respectively ( < 0.01). Only two local hematomas (≤5 cm) occurred in the DRA group, while one patient in the FA group required surgical treatment and a transfusion for an access-site vascular injury. When performed by an experienced operator, DRA may represent a feasible alternative to other access routes in select patients with STEMI undergoing PCI, such as those with a high risk of bleeding.
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http://dx.doi.org/10.3390/jcm10153438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348546PMC
August 2021

Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion.

J Am Coll Cardiol 2021 07;78(4):297-313

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background: Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited.

Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT.

Methods: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT.

Results: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors.

Conclusions: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.
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http://dx.doi.org/10.1016/j.jacc.2021.04.098DOI Listing
July 2021

Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular Atrial Fibrillation.

Korean Circ J 2021 Jul;51(7):626-638

Department of Cardiology, Charite University Hospital Campus Benjamin Franklin, Berlin, Germany.

Background And Objectives: Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy.

Methods: Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment. Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke.

Results: mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively. Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01).

Conclusions: Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.
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http://dx.doi.org/10.4070/kcj.2020.0527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263298PMC
July 2021

The learning curve of the distal radial access for coronary intervention.

Sci Rep 2021 06 24;11(1):13217. Epub 2021 Jun 24.

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

Recently, coronary angiography (CAG) and percutaneous coronary intervention (PCI) via the distal radial access (DRA), are gaining attention owing to fewer complications. Despite the advantages of the DRA, there is difficulty to initiate this new vascular approach. The data from 1000 patients who underwent CAG and PCI via the DRA by a single experienced radial operator were retrospectively analyzed. The primary outcome was the success rate of the DRA per 100 cases. Moreover, the predictors of the failed DRA were analyzed. Overall, 952 (95.2%) of the total 1,000 patients underwent a successful DRA. After experiencing 200 cases, the DRA success rate was well maintained at > 94%, and there was no difference in success rate per 100 cases (P = 0.216). The predictors of failure were female sex [odds ratio (OR) 1.84, 95% confidence interval (CI) 1.01-3.39, P = 0.049] and systolic blood pressure (SBP) of < 120 mmHg (OR 1.87, 95% CI 1.04-3.36, P = 0.036). For achieving a stable DRA with the success rate of > 94%, 200 procedures would be needed. Moreover, this new approach could fail in women and patients with low SBP.Trial registration: https://cris.nih.go.kr/cris/index/index.do (Unique identifier: KCT0005349).
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http://dx.doi.org/10.1038/s41598-021-92742-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225842PMC
June 2021

Feasibility and Safety of the Left Distal Radial Approach in Percutaneous Coronary Intervention for Bifurcation Lesions.

J Clin Med 2021 May 19;10(10). Epub 2021 May 19.

Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea.

Recently, the left distal radial approach (DRA) for percutaneous coronary intervention (PCI) has been shown to be a feasible option, but there are limited data regarding the feasibility of performing bifurcation PCI via the left DRA. Therefore, this study aimed to describe our experience with the contemporary left DRA to perform PCI of bifurcation lesions. Between December 2017 and December 2019, we identified 106 patients treated with bifurcation PCI via the left DRA. We evaluated the success rate of PCI, access-site complications including major bleeding requiring surgery or transfusion, hematoma, distal and forearm radial artery occlusion, and 30-day mortality. Eleven patients (10.4%) treated with left main bifurcation and true bifurcations accounted for 39.6% of cases, with the left anterior descending artery/diagonal branch being the most frequent bifurcation site (57.5%, 61/106). PCI was performed using a 6-French guiding catheter in 101 (95.3%) cases. Successful PCI for bifurcation lesions via the left DRA was achieved in all 106 patients without access-site cross-over. There was no major bleeding, distal and forearm radial artery occlusion, forearm hematoma, or mortality at 30 days. The left DRA is a safe and feasible alternative access site for bifurcation PCI in selected patients.
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http://dx.doi.org/10.3390/jcm10102204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161320PMC
May 2021

Clinical Implications of Post-Stent Optical Coherence Tomographic Findings: Severe Malapposition and Cardiac Events.

JACC Cardiovasc Imaging 2021 May 11. Epub 2021 May 11.

Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

Objectives: This study sought to evaluate the impact of post-stent optical coherence tomography (OCT) findings, including severe malapposition, on long-term clinical outcomes.

Background: Suboptimal OCT findings following percutaneous coronary intervention (PCI) are highly prevalent; however, their clinical implications remain controversial.

Methods: Of the patients registered in the Yonsei OCT registry, a total of 1,290 patients with 1,348 lesions, who underwent OCT immediately post-stenting, were consecutively enrolled for this study. All patients underwent implantation of drug-eluting stents. Post-stent OCT findings were assessed to identify predictors of device-oriented clinical endpoints (DoCE), including cardiac death, target vessel-related myocardial infarction (MI) or stent thrombosis, and target lesion revascularization (TLR). Significant malapposition criteria associated with major safety events (MSE) were also investigated, such as cardiac death, target vessel-related MI, or stent thrombosis.

Results: The median follow-up period was 43.0 months (interquartile range [IQR] 21.4 to 56.0 months). The incidence rates of stent edge dissection, tissue prolapse, thrombus, and malapposition after intervention were not associated with occurrence of DoCE. However, patients with significant malapposition (total malapposition volume [TMV] ≥7.0 mm] exhibited more frequent MSE. A smaller minimal stent area (MSA) was identified as an independent predictor for DoCE (hazard ratio [HR]: 1.20 [95% confidence interval [CI]: 1.00 to 1.43]; p = 0.045). Malapposition with TMV ≥7.0 mm was found to be an independent predictor of MSE (HR: 6.12 [95% CI: 1.88 to 19.95]; p = 0.003). Follow-up OCT at 3, 6, or 9 months after PCI showed that post-stent TMV ≥7.0 mm was related to a greater occurrence of late malapposition and uncovered struts.

Conclusions: Although most suboptimal OCT findings were not associated with clinical outcomes, a smaller MSA was associated with DoCE, driven mainly by TLR, and significant malapposition with TMV ≥7.0 mm was associated with more MSE after PCI. (Yonsei OCT [Optical Coherence Tomography] Registry for Evaluation of Efficacy and Safety of Coronary Stenting; Yonsei OCT registry; NCT02099162).
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http://dx.doi.org/10.1016/j.jcmg.2021.03.008DOI Listing
May 2021

Consensus Decision-Making for the Management of Antiplatelet Therapy before Non-Cardiac Surgery in Patients Who Underwent Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents: A Cohort Study.

J Am Heart Assoc 2021 04 10;10(8):e020079. Epub 2021 Apr 10.

Division of Cardiology Department of Internal Medicine Severance Cardiovascular Hospital Yonsei University College of Medicine Seoul Korea.

Background Although antiplatelet therapy (APT) has been recommended to balance ischemic-bleeding risks, it has been left to an individualized decision-making based on physicians' perspectives before non-cardiac surgery. The study aimed to assess the advantages of a consensus among physicians, surgeons, and anesthesiologists on continuation and regimen of preoperative APT in patients with coronary drug-eluting stents. Methods and Results A total of 3582 adult patients undergoing non-cardiac surgery after percutaneous coronary intervention with second-generation stents was retrospectively included from a multicenter cohort. Physicians determined whether APT should be continued or discontinued for a recommended period before non-cardiac surgery. There were 3103 patients who complied with a consensus decision. Arbitrary APT, not based on a consensus decision, was associated with urgent surgery, high bleeding risk of surgery, female sex, and dual APT at the time of preoperative evaluation. Arbitrary APT independently increased the net clinical adverse event (adjusted odds ratio [OR], 1.98; 95% CI, 1.98-3.11), major adverse cardiac event (OR, 3.11; 95% CI, 1.31-7.34), and major bleeding (OR, 2.34; 95% CI, 1.45-3.76) risks. The association was consistently noted, irrespective of the surgical risks, recommendations, and practice on discontinuation of APT. Conclusions Most patients were treated in agreement with a consensus decision about preoperative APT based on a referral system among physicians, surgeons, and anesthesiologists. The risk of perioperative adverse events increased if complying with a consensus decision was failed. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03908463.
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http://dx.doi.org/10.1161/JAHA.120.020079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174156PMC
April 2021

Ambiguous lesion on coronary angiography diagnosed as a calcified plaque using optical coherence tomography.

Anatol J Cardiol 2021 02;25(2):E6-E7

Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea.

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http://dx.doi.org/10.14744/AnatolJCardiol.2020.62042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114643PMC
February 2021

Successful optical coherence tomography-guided stent ablation with rotational atherectomy for an underexpanded stent.

Cardiol J 2020 ;27(6):897-898

Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, 363 Dongbaekjukjeon-daero, Giheung-gu, 16995 Yongin, Korea, Republic Of.

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http://dx.doi.org/10.5603/CJ.2020.0173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079103PMC
September 2021

Determinants and Clinical Outcomes of Extended Dual Antiplatelet Therapy over 3 Years after Drug-Eluting Stent Implantation: A Retrospective Analysis.

Yonsei Med J 2020 Jul;61(7):597-605

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Although current guidelines recommend the administration of dual antiplatelet therapy (DAPT) for up to 12 months after the implantation of a drug-eluting stent (DES), extended DAPT is frequently used in real-world practice.

Materials And Methods: From the Korean Multicenter Angioplasty Team registry, we identified a total of 1414 patients who used DAPT for >3 years after DES implantation (extended-DAPT group) and conducted a landmark analysis at 36 months after the index procedure. We evaluated the determinants for and long-term outcomes of extended DAPT and compared the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as the composite of all-cause death, myocardial infarction, stent thrombosis, and stroke, between the extended-DAPT group and the guideline-DAPT group [DAPT <1 year after DES implantation (n=1273)].

Results: Multivariate analysis indicated the occurrence of acute coronary syndrome as the most significant clinical determinant of the use of extended DAPT. Bifurcation, stent diameter ≤3.0 mm, total stented length ≥28 mm, and use of first-generation DESs were also significant angiographic and procedural determinants. MACCE rates were similar between the extended-DAPT group and the guideline-DAPT group in crude analysis [hazard ratio (HR), 1.08; 95% confidence interval (CI), 0.69-1.68; =0.739] and after propensity matching (HR, 1.22; 95% CI, 0.72-2.07; =0.453). Major bleeding rates were comparable between the two groups.

Conclusion: In patients undergoing percutaneous coronary intervention, indefinite use of DAPT does not show superior outcomes to those of guideline-DAPT. Major bleeding rates are also similar.
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http://dx.doi.org/10.3349/ymj.2020.61.7.597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329747PMC
July 2020

Patterns of Antiplatelet Therapy During Noncardiac Surgery in Patients With Second-Generation Drug-Eluting Stents.

J Am Heart Assoc 2020 06 16;9(11):e016218. Epub 2020 May 16.

Division of Cardiology Department of Internal Medicine Severance Cardiovascular Hospital Yonsei University College of Medicine Seoul Korea.

Background Continuing antiplatelet therapy (APT) has been generally recommended during noncardiac surgery, but it is uncertain if preoperative discontinuation of APT has been avoided or harmful in patients with second-generation drug-eluting coronary stents. Methods and Results Patients undergoing noncardiac surgery after second-generation drug-eluting coronary stent implantation were assessed in a multicenter cohort in Korea. Net adverse clinical events within 30 days postoperatively, defined as all-cause death, major adverse cardiac events, and major bleeding, were evaluated. Of 3582 eligible patients, 49% patients discontinued APT during noncardiac surgery. The incidence of net adverse clinical events was comparable between patients with continuation versus discontinuation (4.1% versus 3.4%; =0.257) of APT during noncardiac surgery. Perioperative discontinuation of APT did not impact on net adverse clinical events (adjusted hazard ratio [HR], 1.00; 95% CI, 0.69-1.44; =0.995). In subgroup analysis, patients undergoing intra-abdominal surgery were exposed to less risk of major bleeding by discontinuing APT (adjusted HR, 0.26; 95% CI, 0.08-0.91; =0.035). Prolonged discontinuation of APT for ≥9 days was associated with higher risk of a major adverse cardiac event compared with continuing APT (adjusted HR, 3.38; 95% CI, 1.36-8.38; =0.009). Conclusions APT was discontinued preoperatively in almost half of patients with second-generation drug-eluting coronary stents. Our explorative analysis showed that there was no significant impact of discontinuing APT on the risk of perioperative adverse events except that discontinuing APT may be associated with decreased hemorrhagic risk in patients undergoing intra-abdominal surgery. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT03908463.
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http://dx.doi.org/10.1161/JAHA.119.016218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428980PMC
June 2020

Anti-Inflammatory Effect for Atherosclerosis Progression by Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitor in a Normoglycemic Rabbit Model.

Korean Circ J 2020 05 12;50(5):443-457. Epub 2020 Feb 12.

Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Background And Objectives: We sought to investigate an anti-atherosclerotic and anti-inflammatory effect of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in normoglycemic atherosclerotic rabbit model.

Methods: Male New Zealand white rabbits (n=26) were fed with a 1% high-cholesterol diet for 7 weeks followed by normal diet for 2 weeks. After balloon catheter injury, the rabbits were administered with the Dapagliflozin (1mg/kg/day) or control-medium for 8 weeks (n=13 for each group). All lesions were assessed with angiography, optical coherence tomography (OCT), and histological assessment.

Results: Atheroma burden (38.51±3.16% vs. 21.91±1.22%, p<0.01) and lipid accumulation (18.90±3.63% vs. 10.20±2.03%, p=0.047) was significantly decreased by SGLT-2 inhibitor treatment. The SGLT-2 inhibitor group showed lower macrophage infiltration (20.23±1.89% vs. 12.72±1.95%, p=0.01) as well as tumor necrosis factor (TNF)-α expression (31.17±4.40% vs. 19.47±2.10%, p=0.025). Relative area of inducible nitric oxide synthase⁺ macrophages was tended to be lower in the SGLT-2 inhibitor-treated group (1.00±0.16% vs. 0.71±0.10%, p=0.13), while relative proportion of Arg1⁺ macrophage was markedly increased (1.00±0.27% vs. 2.43±0.64%, p=0.04). As a result, progression of atherosclerosis was markedly attenuated in SGLT-2 inhibitor treated group (OCT area stenosis, 32.13±1.20% vs. 22.77±0.88%, p<0.01). Mechanistically, SGLT-2 treatment mitigated the inflammatory responses in macrophage. Especially, Toll-like receptor 4/nuclear factor-kappa B signaling pathway, and their downstream effectors such as interleukin-6 and TNF-α were markedly suppressed by SGLT-2 inhibitor treatment.

Conclusions: These results together suggest that SGLT-2 inhibitor exerts an anti-atherosclerotic effect through favorable modulation of inflammatory response as well as macrophage characteristics in non-diabetic situation.
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http://dx.doi.org/10.4070/kcj.2019.0296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098824PMC
May 2020

Synergistic protective effects of a statin and an angiotensin receptor blocker for initiation and progression of atherosclerosis.

PLoS One 2019 3;14(5):e0215604. Epub 2019 May 3.

Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

Aim: Although the atheroprotective effects of statins and angiotensin II receptor blockers (ARBs) are well-established, little is known about their additive effects, especially during the early period of atherosclerosis. The aim of this study was to investigate whether combination of a statin and an ARB exerts synergistic anti-atherosclerotic effects, and to elucidate the mechanisms of combined effects.

Methods: Atherosclerotic plaques were developed in arteries of 23 rabbits using a high-cholesterol diet (HCD) and intra-arterial balloon inflation. Rabbits received one of five different treatment strategies for 4 weeks: positive control [n = 5, HCD]; negative control [n = 3, regular chow diet]; statin [n = 5, HCD and rosuvastatin 10 mg]; ARB [n = 5, HCD and olmesartan 20 mg]; and combination [n = 5, HCD and statin+ARB].

Results: Histological analysis demonstrated that development of atherosclerotic plaques was inhibited more in combination group than in statin group (P = 0.001). Although macrophage infiltration identified by RAM11 staining was not significantly different between combination and individual treatment groups (31.76±4.84% [combination] vs. 38.11±6.53% [statin; P = 0.35] or 35.14±2.87% [ARB; P = 0.62]), the relative proportion of pro-inflammatory M1-macrophages was significantly lower in combination group than in ARB group (3.20±0.47% vs. 5.20±0.78%, P = 0.02). Furthermore, M2-macrophage polarization was higher in combination group than in statin group (17.70±3.04% vs. 7.86±0.68%, P = 0.001).

Conclusion: Combination treatment with a statin and an ARB produced synergistic protective effects for atherosclerosis initiation and progression, which may be attributed to modulation of macrophage characteristics in the early period of atherosclerosis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215604PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499436PMC
January 2020

The Incidence of Non-Cardiac Surgery in Patients Treated With Drug-Eluting Stents According to Age.

J Invasive Cardiol 2019 02;31(2):E9-E14

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722 South Korea.

Objectives: The impact of age on the incidence and timing of non-cardiac surgery after coronary stent implantation is unknown. We evaluated the incidence and timing of non-cardiac surgery after drug-eluting stent (DES) implantation according to patient age.

Methods: A total of 37,915 consecutive patients treated by DES implantation between February 2003 and April 2014 were included in this study. The number of patients who underwent non-cardiac surgery were as follows: 4263 (11.2%) within 1 year, 5357 (14.1%) within 2 years, and 6311 (16.6%) within 3 years of DES implantation. Patients were divided into four groups according to age: <50 years (n = 5785), between 50 and 59 years (n = 9639), between 60 and 69 years (n = 13,566), and between 70 and 79 years (n = 8925).

Results: The rates of non-cardiac surgery within 1 year among patients aged <50 years, 50-59 years, 60-69 years, and 70-79 years were 8.0% (461/5785), 8.9% (855/9639), 12.1% (1636/13,566), and 14.7% (1311/8925), respectively (P-value for trend <.01). The cut-off age at which non-cardiac surgery was more likely to occur within 1 year of DES implantation was 62 years. The rate of non-cardiac surgery within 3 years of DES implantation reached a peak among patients who were 73 years old (23.9%).

Conclusions: Non-cardiac surgery with requests for cessation of dual-antiplatelet treatment was frequently performed in patients ≥62 years old who were treated with DES implantation in a real-world clinical practice.
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February 2019

Favorable neurological outcome after ischemic cerebrovascular events in patients treated with percutaneous left atrial appendage occlusion compared with warfarin.

Catheter Cardiovasc Interv 2019 07 2;94(1):E23-E29. Epub 2018 Oct 2.

Department of Cardiology, Coburg Hospital, Coburg, Germany.

Objectives: This study sought to investigate neurological disability after ischemic cerebrovascular events in patients treated with left atrial appendage (LAA) occlusion compared with those on warfarin.

Background: Prior studies demonstrated that cerebrovascular events after LAA occlusion in patients with nonvalvular atrial fibrillation (NVAF) is largely nondisabling.

Methods: From the 1,189 patients in the Korean LAA Occlusion and European Amplatzer Cardiac Plug Multi-Center Registry, 24 patients who experienced ischemic cerebrovascular events after LAA occlusion were enrolled. The neurological outcomes were compared with those in 68 patients who experienced an ischemic cerebrovascular event while on warfarin (Yonsei Stroke Registry). A modified Rankin scale (mRS) score of 3-6 categorized the cerebrovascular event as disabling. The mRS at discharge and at 3 and 12 months postcerebrovascular event in the two groups was compared.

Results: The percentages of disabling cerebrovascular events were 37.5% and 58.8% at discharge (P = 0.07), 20.8% and 42.6% at 3 months (P = 0.08), and 12.5% and 39.7% at 12 months (P = 0.02) in the LAA occlusion and warfarin groups, respectively. The mRS was significantly lower in the LAA occlusion group at discharge and at 3 months (P < 0.01) and 12 months (P < 0.01) postcerebrovascular event despite no significant difference in mRS before cerebrovascular events (P = 0.98). Patients in the LAA occlusion group demonstrated a significant reduction in mRS between discharge and 12 months (P < 0.01), unlike patients in the warfarin group (P = 0.10).

Conclusions: Ischemic cerebrovascular events in patients who previously underwent percutaneous LAA occlusion for NVAF were more favorable than in patients on warfarin.
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http://dx.doi.org/10.1002/ccd.27913DOI Listing
July 2019

Peripheral artery disease is associated with poor clinical outcome in patients with abdominal aortic aneurysm after endovascular aneurysm repair.

Int J Cardiol 2018 Oct;268:208-213

Division of Cardiology, Department of Internal Medicine, & Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: We investigated the effects of coronary artery disease (CAD) or peripheral artery disease (PAD) on clinical outcomes of patients with abdominal aortic aneurysm (AAA) treated with endovascular aortic aneurysm repair (EVAR).

Methods: We retrospectively evaluated a total of 475 patients with AAA treated with EVAR at a single center. Patients were divided into three groups: group A (n = 166), patients without CAD or PAD; group B (n = 196), patients with CAD but without PAD; and group C (n = 113), patients with PAD regardless of CAD. The primary endpoint was the accumulated rate of major adverse cardiovascular and cerebrovascular event (MACCE), a composite of all-cause death, myocardial infarction (MI), or stroke.

Results: The prevalence of CAD and PAD in patients with AAA was 55.8 and 23.8%, respectively. Patients were followed for 40.2 ± 35.3 months. Baseline characteristics were similar among the groups except for current smoking (A, 27.4%; B, 20.8%; C, 50.5%; p = 0.001). Three years after EVAR, the incidences of MACCE (A, 5.6%; B, 9.5%; C, 16.7%; p = 0.021) and stroke (A, 0%; B, 2.2%; C, 5.2%; p = 0.025) were highest in group C. All-cause death and aneurysm death did not differ among the groups. PAD [hazard ratio (HR) 2.88, 95% confidence interval (CI) 1.32-6.29, p = 0.008] and previous stroke (HR 4.39, 95% CI 1.94-9.93, p < 0.001) were independent predictors of MACCE.

Conclusions: PAD was an independent risk factor of increased MACCE and stroke for patients with AAA undergoing EVAR. More intensive secondary prevention may be needed to reduce adverse cardiovascular events in AAA patients with PAD.
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http://dx.doi.org/10.1016/j.ijcard.2018.03.109DOI Listing
October 2018

Feasibility of Left Atrial Appendage Occlusion for Left Atrial Appendage Thrombus in Patients With Persistent Atrial Fibrillation.

Am J Cardiol 2018 06 14;121(12):1534-1539. Epub 2018 Mar 14.

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

This study sought to investigate the safety of percutaneous left atrial appendage (LAA) occlusion for stroke prevention in patients with nonvalvular atrial fibrillation who have LAA thrombus. From October 2010 to October 2016, LAA occlusions were performed in facilities within a Korean multicenter registry in patients without (n = 132) or with (n = 10) LAA thrombus (detected during preprocedural assessments). The incidences of periprocedural complications, including stroke, pericardial tamponade, major bleeding, and device embolization, were assessed and compared between the groups. The incidence of periprocedural complications was not significantly different between patients with and without LAA thrombus (0% vs 5% [6 of 132]; p = 0.49). During the mean 23.2 ± 17.5-month follow-up duration, 7 major adverse cardiac events occurred (1 cardiovascular death, 6 ischemic strokes), but overall event rates were not significantly different between the groups (14% vs 9%; p = 0.47). In conclusion, percutaneous LAA occlusion in nonvalvular atrial fibrillation patients with LAA thrombus may be a safe and feasible alternative to anticoagulation in select patients at a high risk of bleeding or contraindication to anticoagulation, or in whom anticoagulation failed to prevent stroke.
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http://dx.doi.org/10.1016/j.amjcard.2018.02.045DOI Listing
June 2018

Simultaneous Closure of a Left Atrial Appendage through an Atrial Septal Defect and the Atrial Septal Defect.

Yonsei Med J 2017 Nov;58(6):1237-1240

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.

Left atrial appendage (LAA) occlusion can be employed as an alternative treatment to oral anticoagulation in patients with atrial fibrillation to prevent embolic events. Atrial septal defect (ASD) may be related with right heart dysfunction and allow paradoxical embolism to occur. However, occlusion of both LAA through atrial access with ostium secundum ASD and ASD in the same setting is unusual. Therefore, we report a case in which a LAA and an ASD was sequentially occluded.
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http://dx.doi.org/10.3349/ymj.2017.58.6.1237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653491PMC
November 2017

Successful Treatment of Unprotected Left Main Coronary Bifurcation Lesion Using Minimum Contrast Volume with Intravascular Ultrasound Guidance.

Yonsei Med J 2017 Sep;58(5):1066-1070

Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.

Contrast-induced nephropathy (CIN) is a serious complication in patients undergoing percutaneous coronary intervention (PCI), and is associated with higher morbidity and mortality. The limiting volume of contrast medium is safest and most reliable strategy for CIN prevention. Intravascular ultrasound (IVUS) serves as an attractive alternative imaging tool to angiography in many steps during PCI, thereby reducing the use of contrast agents. Here, we reported a case of successfully treated unprotected left main bifurcation lesion with heavily calcified and diffuse lesion under the IVUS-guided PCI using low volumes of contrast dye of total 12 cc in an elderly patient.
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http://dx.doi.org/10.3349/ymj.2017.58.5.1066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552637PMC
September 2017

Percutaneous isolation of left atrial appendage thrombus.

J Cardiol Cases 2017 Sep 16;16(3):67-69. Epub 2017 Jun 16.

Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea.

Most physicians regard left atrial appendage (LAA) thrombus as a contraindication for LAA occlusion due to risk of distal embolization which is a serious complication. Here we report a case of successfully implanted Amplazter cardiac plug without complication in elderly patients having LAA thrombus with recurrent embolic events despite oral anticoagulants for prevention of thromboembolic events. < LAA thrombus is not completely resolved in all cases and can be a potential source of stroke or embolization even during anti-coagulation. We would like to share a case that suffered from 6 strokes or embolizations despite anti-coagulation, warfarin or non-vitamin K antagonist oral anti-coagulants due to incomplete resolution of LAA thrombus. In this clinical situation, we can suggest LAA occlusion to isolate thrombus from LA and prevent further stroke or embolization.>.
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http://dx.doi.org/10.1016/j.jccase.2017.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149266PMC
September 2017

Successful Retrieval of a Dislodged Left Atrial Appendage Closure Device.

JACC Cardiovasc Interv 2017 01;10(1):98-100

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. Electronic address:

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http://dx.doi.org/10.1016/j.jcin.2016.10.044DOI Listing
January 2017

Anomalous origin of the left circumflex artery from the right sinus of valsalva: non-ST-segment elevation myocardial infarction.

Intern Med 2015 1;54(9):1053-6. Epub 2015 May 1.

Department of Cardiology, Inha University School of Medicine, Korea.

An anomalous origin of the left coronary artery from the right sinus of Valsalva (RSV) is rare. We herein report the case of an 80-year-old woman who presented to the emergency department with chest pain. Emergent coronary angiography was performed following a diagnosis of non-ST segment elevation myocardial infarction. A right coronary angiogram showed that the common trunk originating from the RSV branched into the left anterior descending and right coronary arteries. Although the initial angiogram failed to show the left circumflex artery (LCx), considered to be the culprit vessel, computed tomographic angiography demonstrated that the LCx was located immediately below the common trunk and exhibited a retroaortic course. We successfully treated the patient and obtained optimal angiography results.
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http://dx.doi.org/10.2169/internalmedicine.54.2956DOI Listing
September 2015

In vitro Antagonism between Cefotaxime and Anti-Rickettsial Antibiotics against Orientia tsutsugamushi.

Infect Chemother 2014 Sep 24;46(3):189-93. Epub 2014 Sep 24.

Department of Microbiology, Inha University School of Medicine, Incheon, Korea.

We have investigated the in vitro antimicrobial effects of antibiotic combinations against Orientia tsutsugamushi, the causative agent of scrub typhus. ECV304 cells were infected with the Boryong strain of O. tsutsugamushi and incubated in a medium containing doxycycline (4 µg/mL), azithromycin (0.5 µg/mL), rifampin (4 µg/mL), ciprofloxacin (25 µg/mL), gentamicin (5 µg/mL), cefotaxime (2 µg/mL), or combinations of these agents for 7 days, after which immunofluorescent staining for O. tsutsugamushi was performed. The percentages of infective foci in cultures containing antibiotics compared to those in cultures without antibiotics were 6.2% for doxycycline, 9.6% for azithromycin, 8.8% for rifampin, 96.6% for cefotaxime, 29.7% for doxycycline plus cefotaxime, 23.6% for azithromycin plus cefotaxime, and 41.4% for rifampin plus cefotaxime. These findings show an in vitro antagonism between anti-rickettsial agents and cefotaxime against O. tsutsugamushi. These results suggest that the efficacy of antibiotic combinations involving cefotaxime for the treatment of patients with scrub typhus, particularly those with severe pneumonia, needs to be investigated.
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http://dx.doi.org/10.3947/ic.2014.46.3.189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189142PMC
September 2014

The association between mortality and abdominal aortic calcification and relation between its progression and serum calcium concentration in chronic hemodialysis patients.

Kidney Res Clin Pract 2014 Jun 13;33(2):95-102. Epub 2014 Jun 13.

Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.

Background: The composite summary score (range, 0-24) of abdominal aortic calcification (AAC) devised by Kauppila et al is a simple method of assessing AAC severity. However, few studies have been conducted to determine an optimal AAC cutoff score for the prediction of mortality or to investigate the relation between mineral metabolism and AAC progression using the scoring system.

Methods: The medical records of 112 patients on hemodialysis who had undergone simple lateral lumbar radiography every 6 months from August 2009 were reviewed. Patients were followed until November 2012, and the relationship between the degree of AAC at baseline and mortality was evaluated. In addition, the relationship between the progression of AAC and serum concentrations of calcium and phosphate was evaluated in the 75 patients who were successfully followed until November 2012.

Results: The mean AAC score at baseline was 5.5±4.8, and the cutoff calcification score for the prediction of mortality was 7.75 (sensitivity=61%, specificity=81%). Patients were allocated to Group A (baseline total calcification score ≤8.0, n=85) or Group B (baseline total calcification score>8.0, n=27), and multivariate analysis showed that Group B was an independent risk factor of all-cause mortality and cardiovascular events. Of the 75 patients successfully followed, 51 showed AAC progression (Group 1) and 24 showed no change or improvement (Group 2). Group 1 was found to have significantly higher mean serum corrected calcium levels during the 2(nd) year and 3(rd) year of follow-up than Group 2. Furthermore, repeated-measures analysis of variance showed higher monthly corrected calcium concentrations (P=0.099) and mean corrected calcium levels during the 1(st) year, 2(nd) year, and 3(rd) year of follow-up (P=0.062) in Group 1, but without statistical significance. The cutoff values of mean corrected calcium of the 2(nd) year and 3(rd) year for the prediction of AAC progression during follow-up years were 8.96 mg/dL and 9.45 mg/dL, respectively. Serum phosphate levels and corrected calcium×phosphate values were similar in Groups 1 and 2.

Conclusion: Patients with an AAC score of>8 at baseline seem to be at higher risk of mortality during follow-up. Of the serum variables examined, such as corrected calcium, phosphate, and corrected calcium×phosphate, corrected calcium was found to be marginally associated with AAC progression. However, a larger-scale prospective study is required to confirm our findings.
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http://dx.doi.org/10.1016/j.krcp.2014.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714181PMC
June 2014

Transarterial chemoembolization versus surgery/radiofrequency ablation for recurrent hepatocellular carcinoma with or without microvascular invasion.

J Gastroenterol Hepatol 2014 May;29(5):1056-64

Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.

Background/aims: Microvascular invasion (MVI) is a well-known prognostic factor of postoperative recurrence and of overall survival (OS) in patients with hepatocellular carcinoma (HCC). We compared the treatment outcomes of transarterial chemoembolization (TACE) and surgery/radiofrequency ablation (RFA) according to the presence of MVI in patients with early or late recurrent HCC that presented as Barcelona Clinical Liver Cancer (BCLC) stage 0 or A after curative resection for HCC.

Methods: A consecutive 68 patients with recurrent HCC of BCLC stage 0 or A at our institution between 1998 and 2012 were retrospectively enrolled. We compared the outcomes of patients treated by TACE or surgery/RFA. Tumor recurrence after curative resection was classified as early (≤ 12 months) or late (> 12 months) recurrence.

Results: Median tumor size was 1.5 cm (range, 1-10 cm), and 67 (98.5%) had HCCs within the Milan criteria. Median post-retreatment follow-up duration was 27 months (range, 1-109 months). Of the 68 patients, 19 (27.9%) underwent surgery/RFA, 47 (69.1%) TACE, and 2 (2.9%) were lost to follow-up. After retreatment, TACE showed significantly higher OS and recurrence-free survival rates than surgery/RFA in MVI-positive patients (P = 0.03 and P = 0.05, respectively), but not in MVI-negative patients (P = 0.95 and P = 0.98, respectively). In particular, in early recurred MVI-positive patients, TACE had a significantly higher OS rate than surgery/RFA (P = 0.01).

Conclusions: TACE may be the more effective treatment option for recurrent HCC of BCLC stage 0 or A than surgery/RFA in MVI-positive patients, especially in those that recur early after curative resection.
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http://dx.doi.org/10.1111/jgh.12507DOI Listing
May 2014
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