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Find video protocols related to scientific articles indexed in Pubmed.
One-year clinical outcomes of everolimus- versus sirolimus-eluting stents in patients with acute myocardial infarction.
Int. J. Cardiol.
PUBLISHED: 06-02-2014
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In contrast to many studies comparing everolimus-eluting stent (EES) with paclitaxel-eluting stent (PES), data directly comparing EES with sirolimus-eluting stent (SES) are limited, especially in patients with acute myocardial infarction (AMI).
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Clinical Significance of Chronic Kidney Disease and Atrial Fibrillation on Morbidity and Mortality in Patients with Acute Myocardial Infarction.
Am. J. Nephrol.
PUBLISHED: 05-13-2014
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Background/Aims: Atrial fibrillation (AF) often coexists with acute myocardial infarction (AMI), and chronic kidney disease (CKD) is a major risk for AMI. However, the combined impact of CKD and AF on the mortality and morbidity in AMI population has not been determined. Methods: Between January 2004 and December 2009, a total of 4,738 AMI patients were enrolled prospectively. Patients were divided into four groups according to the combined status of CKD and AF. The primary endpoint was a combination of 5-year major adverse cardiac and cerebrovascular events (MACCE). Results: The prevalence of AF was significantly higher in CKD patients than in non-CKD patients (6.76 vs. 3.31%, p < 0.001). The highest cumulative event rate of MACCE and death was observed in patients with both CKD and AF (68.5 and 64.0%), respectively. In multivariable analyses, compared with patients with neither AF nor CKD, hazard ratios (HR) for composite of MACCE were 1.66 (95% CI, 1.14-2.41), 1.24 (95% CI, 1.06-1.46), and 2.10 (95% CI, 1.42-3.13) for patients with AF only, those with CKD only, and those with both CKD and AF, respectively (p for interaction = 0.935). Patients with both CKD and AF had a greatest risk for all-cause mortality (HR 2.54; 95% CI, 1.60-4.53), and the significant synergistic interaction was observed between CKD and AF (p for interaction = 0.015). Conclusion: The combined effect of AF and CKD on the risk of MACCE after an AMI is stronger than any separate condition, and it confers a synergistic effect on the all-cause mortality risk. © 2014 S. Karger AG, Basel.
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Status of hypertension and coronary stenosis in asymptomatic type 2 diabetic patients: analysis from Coronary Computed Tomographic Angiography Registry.
Int. J. Cardiol.
PUBLISHED: 01-05-2014
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Limited data exist regarding the prevalence of coronary artery disease (CAD) as well as clinical outcomes in asymptomatic diabetic patients with normotension, controlled hypertension, and uncontrolled hypertension.
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Impact of the Stent Length on Long-Term Clinical Outcomes Following Newer-Generation Drug-Eluting Stent Implantation.
Am. J. Cardiol.
PUBLISHED: 08-12-2013
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Stent length has been considered an important predictor of adverse events after percutaneous coronary intervention, even with the first-generation drug-eluting stents (DESs). The introduction of newer-generation DES has further reduced the rates of adverse clinical events such as restenosis, myocardial infarction, and stent thrombosis. The aim of this study was to compare the impact of stent length on the long-term clinical outcomes between first- and newer-generation DESs. The effects of stent length (?32 vs <32 mm) on the clinical outcomes were evaluated in 8,445 patients who underwent percutaneous coronary intervention using either a first-generation DES (sirolimus- and paclitaxel-eluting stents, n = 6,334) or a newer-generation DES (everolimus- and zotarolimus-eluting stents, n = 2,111) from January 2004 to December 2009. The 3-year adverse outcomes (composite of all-cause death, nonfatal myocardial infarction, target vessel revascularization, and stent thrombosis) were compared using the inverse probability of treatment-weighted method according to the stent length. After adjustment for differences in the baseline risk factors, a stent length of ?32 mm was significantly associated with higher cumulative rates of target vessel revascularization and stent thrombosis in the patients treated with a first-generation DES (adjusted hazard ratio 1.875, 95% confidence interval 1.531 to 2.297, p <0.001; adjusted hazard ratio 2.964, 95% confidence interval 1.270 to 6.917, p = 0.012), but it was not associated with the clinical outcomes in patients treated with a newer-generation DES. In conclusion, stent length might not be associated with long-term clinical outcomes in newer-generation DES era, whereas stent length might be associated with long-term clinical outcomes in the first-generation DESs.
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Impact of the CYP2C19*17 polymorphism on the clinical outcome of clopidogrel therapy in Asian patients undergoing percutaneous coronary intervention.
Pharmacogenet. Genomics
PUBLISHED: 08-08-2013
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The impact of the CYP2C19*17 polymorphism on the clinical outcome in Asians undergoing percutaneous coronary intervention (PCI) is unknown. We sought to assess the long-term impact of CYP2C19*17 on the risk for adverse clinical events in 2188 Korean patients taking clopidogrel after PCI. The prevalence of the CYP2C19*17 allele [*wt/*17: 2.4% (n = 53), *17/*17: 0%] was very low. The 2-year cumulative event rates for bleeding [*wt/*17 vs. *wt/*wt: 2 vs. 2.3%; adjusted hazard ratio (HR), 1.23; 95% confidence interval (CI), 0.16-9.45], stent thrombosis (2 vs. 1.1%; HR, 3.98; 95% CI, 0.49-31.6) or composite of any death, and myocardial infarction or stroke (5.4 vs. 7.1%; HR, 1.37; 95% CI, 0.32-5.73) did not differ on the basis of the presence of CYP2C19*17. In conclusion, in our study population of Asian patients, the CYP2C19*17 polymorphism was not associated with adverse clinical outcomes after PCI because of its low prevalence, the rarity of homozygotes, and the relatively low rate of adverse clinical events.
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Comparison of clinical efficacy and safety of clopidogrel resinate with clopidogrel bisulfate in patients undergoing percutaneous coronary intervention.
Cardiovasc Drugs Ther
PUBLISHED: 07-06-2013
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A new polymeric salt form of clopidogrel, clopidogrel resinate (CR), is a resinate complex of the (+)-clopidogrel optical isomer wherein the (+)-clopidogrel isomer binds to a water-soluble cation exchange resin via sulfonic acid groups. CR was approved for marketing by the Korean Food and Drug Administration based on a Phase I bioequivalence study. However, no data are available regarding its impact on adverse clinical outcomes in patients undergoing percutaneous coronary intervention (PCI).
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Comparative assessment of angiotensin ii type 1 receptor blockers in the treatment of acute myocardial infarction: surmountable vs. insurmountable antagonist.
Int. J. Cardiol.
PUBLISHED: 06-23-2013
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The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI).
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Comparison of clinical outcomes between octogenarians and non-octogenarians with acute myocardial infarction in the drug-eluting stent era: analysis of the Korean Acute Myocardial Infarction Registry.
J Cardiol
PUBLISHED: 04-13-2013
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Octogenarians (age ? 80 years) with coronary artery disease constitute a high-risk group. However, octogenarian patients with acute myocardial infarction (AMI) in the drug-eluting stents (DES) era have not been widely reported. We aimed to identify clinical outcomes in octogenarian compared with non-octogenarian AMI patients.
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Comparison of outcomes of patients with painless versus painful ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention.
Am. J. Cardiol.
PUBLISHED: 08-05-2011
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There are few data available on the prognosis of painless ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the incidence, clinical characteristics, and outcomes of painless STEMI. We analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) study, which enrolled 7,288 patients with STEMI (61.8 ± 12.8 years old, 74% men; painless STEMI group, n = 763; painful STEMI group, n = 6,525). End points were in-hospital mortality and 1-year major adverse cardiac events (MACEs). Patients with painless STEMI were older and more likely to be women, nonsmokers, diabetic, and normolipidemic and to have a higher Killip class. The painless group had more in-hospital deaths (5.9% vs 3.6%, p = 0.026) and 1-year MACEs (26% vs 19%, p = 0.002). In Cox proportional hazards analysis, hypotension (hazard ratio [HR] 4.40, 95% confidence interval [CI] 1.41 to 13.78, p = 0.011), low left ventricular ejection fraction (HR 3.12, 95% CI 1.21 to 8.07, p = 0.019), and a high Killip class (HR 3.48, 95% CI 1.19 to 10.22, p = 0.023) were independent predictors of 1-year MACEs in patients with painless STEMI. In conclusion, painless STEMI was associated with more adverse outcomes than painful STEMI and late detection may have contributed significantly to total ischemic burden. These results warrant more investigations for methodologic development in the diagnosis of silent ischemia and painless STEMI.
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Comparison of paclitaxel-, sirolimus-, and zotarolimus-eluting stents in patients with acute ST-segment elevation myocardial infarction and metabolic syndrome.
Circ. J.
PUBLISHED: 07-14-2011
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The purpose of the present study was to compare the efficacy and safety of paclitaxel-eluting stent (PES), sirolimus-eluting stent (SES), and zotarolimus-eluting stent (ZES) in primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI) with metabolic syndrome (MS).
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Long-term clinical outcomes of overlapping heterogeneous drug-eluting stents compared with homogeneous drug-eluting stents.
Heart
PUBLISHED: 06-30-2011
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To evaluate long-term clinical outcomes of overlapping heterogeneous drug-eluting stents (DES) compared with homogeneous DES.
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Plasma B-type natriuretic peptide level can predict myocardial tissue perfusion in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.
Coron. Artery Dis.
PUBLISHED: 06-25-2011
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Inadequate myocardial tissue perfusion after successful revascularization in ST-segment elevation myocardial infarction (STEMI) is associated with worse clinical outcomes. We investigated whether the plasma B-type natriuretic peptide (BNP) level on admission could predict the status of myocardial tissue perfusion in patients who underwent primary percutaneous coronary intervention (PCI).
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High-density lipoprotein cholesterol as a predictor of clinical outcomes in patients achieving low-density lipoprotein cholesterol targets with statins after percutaneous coronary intervention.
Heart
PUBLISHED: 06-10-2011
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A low level of high-density lipoprotein cholesterol (HDL-C) is strongly associated with cardiovascular events. However, the significance of HDL-C after statin therapy on the outcome of patients who have undergone percutaneous coronary intervention (PCI) with drug eluting stents (DES) is unclear.
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Pneumopericardium as a complication of pericardiocentesis.
Korean Circ J
PUBLISHED: 05-31-2011
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Pneumopericardium is a rare complication of pericardiocentesis, occurring either as a result of direct pleuro-pericardial communication or a leaky drainage system. Air-fluid level surrounding the heart shadow within the pericardium on a chest X-ray is an early observation at diagnosis. This clinical measurement and process is variable, depending on the hemodynamic status of the patient. The development of a cardiac tamponade is a serious complication, necessitating prompt recognition and treatment. We recently observed a case of pneumopericardium after a therapeutic pericardiocentesis in a 20-year-old man with tuberculous pericardial effusion.
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Soluble receptor of advanced glycated endproducts is associated with plaque vulnerability in patients with acute myocardial infarction.
Circ. J.
PUBLISHED: 05-17-2011
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The roles of soluble and endogenous secretory receptors for advanced glycation endproducts (sRAGE and esRAGE, respectively) in plaque vulnerability are unknown in patients with acute myocardial infarction (AMI).
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Relationship between plasma adiponectin, retinol-binding protein 4 and uric Acid in hypertensive patients with metabolic syndrome.
Korean Circ J
PUBLISHED: 04-30-2011
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Adipokines have been suggested for their potential use in tracking the clinical progress in the subjects with metabolic syndrome (MS). To investigate the relationship between the serum levels of adipokines {adiponectin and retinol-binding protein 4 (RBP4)} and the serum level of uric acid in hypertensive (HTN) patients with MS.
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Association between plaque thickness of the thoracic aorta and recurrence of atrial fibrillation after ablation.
Korean Circ J
PUBLISHED: 04-30-2011
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Several predictors of recurrence of atrial fibrillation (AF) after ablation have been identified, including age, type of AF, hypertension, left atrial diameter and impaired left ventricular ejection fraction. The aim of this study was to investigate whether the atherosclerotic plaque thickness of the thoracic aorta is associated with a recurrence of AF after circumferential pulmonary vein ablation (CPVA).
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Culprit-Lesion-Only Versus Multivessel Revascularization Using Drug-Eluting Stents in Patients With ST-Segment Elevation Myocardial Infarction: A Korean Acute Myocardial Infarction Registry-Based Analysis.
Korean Circ J
PUBLISHED: 02-22-2011
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In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI.
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Two cases of percutaneous intervention for coronary artery bypass graft anastomoses with Paclitaxel-eluting balloon catheters.
Korean Circ J
PUBLISHED: 02-09-2011
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Coronary artery bypass graft (CABG) intervention, particularly anastomosis site intervention, is challenging for interventional cardiologists. A paclitaxel-eluting balloon catheter (SeQuent Please) is a recently-introduced device capable of delivering paclitaxel homogeneously into the targeted vessel wall. We herein report our experience with two cases. In the first case, coronary angiography showed significant stenosis at the site of anastomosis between the saphenous vein graft and the left anterior descending artery (LAD). In the second case, coronary angiography showed significant stenosis at the site of anastomosis between the left internal mammary artery and the LAD. We performed percutaneous intervention of these CABG anastomoses using paclitaxel-eluting balloon catheters, and obtained favorable angiographic and clinical outcomes.
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Hospital discharge risk score system for the assessment of clinical outcomes in patients with acute myocardial infarction (Korea Acute Myocardial Infarction Registry [KAMIR] score).
Am. J. Cardiol.
PUBLISHED: 01-20-2011
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Assessment of risk at time of discharge could be a useful tool for guiding postdischarge management. The aim of this study was to develop a novel and simple assessment tool for better hospital discharge risk stratification. The study included 3,997 hospital-discharged patients with acute myocardial infarction who were enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry-1 (KAMIR-1) from November 2005 through December 2006. The new risk score system was tested in 1,461 hospital-discharged patients who were admitted from January 2007 through January 2008 (KAMIR-2). The new risk score system was compared to the Global Registry of Acute Coronary Events (GRACE) postdischarge risk model during a 12-month clinical follow-up. During 1-year follow-up, all-cause death occurred in 228 patients (5.7%) and 81 patients (5.5%) in the development and validation cohorts, respectively. The new risk score (KAMIR score) was constructed using 6 independent variables related to the primary end point using a multivariable Cox regression analysis: age, Killip class, serum creatinine, no in-hospital percutaneous coronary intervention, left ventricular ejection fraction, and admission glucose based on multivariate-adjusted risk relation. The KAMIR score demonstrated significant differences in its predictive accuracy for 1-year mortality compared to the GRACE score for the developmental and validation cohorts. In conclusion, the KAMIR score for patients with acute myocardial infarction is a simpler and better risk scoring system than the GRACE hospital discharge risk model in prediction of 1-year mortality.
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Uptake of F-18 FDG and ultrasound analysis of carotid plaque.
J Nucl Cardiol
PUBLISHED: 01-16-2011
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To elucidate the relation between the echolucent plaque on carotid ultrasound and acute inflammation on F-18 FDG carotid PET/CT.
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Standard versus high loading doses of clopidogrel in Asian ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention: insights from the Korea Acute Myocardial Infarction Registry.
Am. Heart J.
PUBLISHED: 01-15-2011
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The optimal loading dose of clopidogrel in Asian patients with ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. We compared bleeding, vascular complications, and midterm outcomes of a 300-mg versus a 600-mg loading dose of clopidogrel in a large series of Korean patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
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Optimal antithrombotic strategy in patients with atrial fibrillation after coronary stent implantation.
Korean Circ J
PUBLISHED: 01-12-2011
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Little evidence is available on the optimal antithrombotic therapy following percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF). We investigated the outcomes of antithrombotic treatment strategies in AF patients who underwent PCI.
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Benefit of early statin therapy in patients with acute myocardial infarction who have extremely low low-density lipoprotein cholesterol.
J. Am. Coll. Cardiol.
PUBLISHED: 01-12-2011
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We investigated whether statin therapy could be beneficial in patients with acute myocardial infarction (AMI) who have baseline low-density lipoprotein cholesterol (LDL-C) levels below 70 mg/dl.
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Clinical outcomes of acute myocardial infarction with occluded left circumflex artery.
J Cardiol
PUBLISHED: 01-12-2011
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Left circumflex artery (LCX) related acute myocardial infarction (AMI) has been known to be under diagnosed with 12-lead electrocardiogram (ECG). However, there were only a few studies that have focused on the clinical characteristics of LCX-related AMI. We studied the clinical characteristics and hospital mortality in patients with angiographically confirmed LCX-related AMI. A total of 2281 AMI patients with single acutely occluded culprit vessel in coronary angiography (pre-Thrombolysis In Myocardial Infarction flow: 0) were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008. These patients were divided into three groups according to culprit vessel [left anterior descending artery (LAD), right coronary artery (RCA), and LCX]. This study showed the patients with LCX-related AMI were less likely to present with ST elevation in ECG (46.3%, 87.0%, and 82.3%; p<0.001) and primary percutaneous coronary intervention (PCI) (43.4%, 78.9%, and 74.5%; p<0.001) and door to balloon time <90 min (31.3%, 52.8%, and 51.0%; p<0.001), compared with LAD and RCA. However, no statistical difference was found in hospital mortality among the three groups. Multivariate analysis showed primary PCI decreased the hospital mortality in patients with occluded coronary artery. In conclusion, AMI patients with an occluded LCX presented with less ST elevation and primary PCI. These results suggest that clinical physicians should be careful with patients presenting with chest pain but apparently normal ECG and must rule out LCX occlusion.
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Soluble receptor for advanced glycation end products is associated with in-stent restenosis in patients with type 2 diabetes with drug-eluting coronary stents.
Coron. Artery Dis.
PUBLISHED: 01-04-2011
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The levels of soluble receptor for advanced glycation end products (sRAGE) may reflect the activity of the advanced glycation end products-RAGE axis, which has been proposed as a potential mechanism of vascular inflammation in patients with type 2 diabetes (T2D). However, the role of sRAGE in in-stent restenosis (ISR) is not yet known in patients with T2D with drug-eluting stent (DES) implantation.
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Management of non-ST-segment elevation acute myocardial infarction in patients with chronic kidney disease (from the Korea Acute Myocardial Infarction Registry).
Am. J. Cardiol.
PUBLISHED: 01-02-2011
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The aim of this study was to compare clinical outcomes among early invasive (EI), deferred invasive (DI), and conservative strategies in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). High-risk patients with NSTEMI are believed to fare better with an EI strategy, but the optimal treatment for patients with NSTEMI and CKD is not known. In total 5,185 patients with acute NSTEMI were enrolled from the Korea Acute Myocardial Infarction Registry and followed for 1 year. Patients were divided into EI, DI, and conservative treatment groups and classified into 4 stages using references from the National Kidney Foundation. The invasive EI and DI groups were compared to the conservative groups, and the EI and DI groups were compared according to each renal function stage. At 1-year follow-up, mortality rates in the conservative group were significantly higher than in the invasive groups except for the severe CKD group. The benefit of the EI over the DI strategy, although there were no significant differences between the 2 groups, tended to decrease as renal function decreased. In conclusion, in the management of NSTEMI, an invasive strategy decreased mortality compared to a conservative strategy except for severe CKD. In the timing of an invasive strategy, the EI strategy was observed to be superior to the DI strategy in patients with mild CKD; however, this tendency reversed as renal function decreased. When patients with NSTEMI have severe CKD, a conservative or DI strategy with prescription of cardioprotective medications and prevention of further deterioration in renal function should be considered.
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Angiotensin II-induced smooth muscle cell migration is mediated by LDL receptor-related protein 1 via regulation of matrix metalloproteinase 2 expression.
Biochem. Biophys. Res. Commun.
PUBLISHED: 09-28-2010
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Angiotensin II (Ang II), one of the main vasoactive hormones of the renin-angiotensin system, contributes to the development and progression of atherosclerosis by inducing vascular smooth muscle cells (VSMCs) migration. Although previous studies have shown that Ang II upregulates low density lipoprotein receptor-related protein 1 (LRP1) expression in VSMCs and increases VSMCs migration, the role of LRP1 in Ang II-induced VSMCs migration remains unclear. Here, we reveal a novel mechanism by which LRP1 induces the expression of matrix metalloproteinase 2 (MMP2) and thereby promotes the migration of rat aortic SMCs (RAoSMCs). Knockdown of LRP1 expression greatly decreased RAoSMCs migration, which was rescued by forced expression of a functional LRP1 minireceptor, suggesting that LRP1 is a key regulator of Ang II-induced RAoSMCs migration. Inhibition of ligand binding to LRP1 by the specific antagonist receptor-associated protein (RAP) also led to reduced RAoSMCs migration. Because MMPs play critical roles in RAoSMCs migration, we examined the expression of several MMPs and found that the expression of functional MMP2 was selectively increased by Ang II treatment and decreased in LRP1-knockdown RAoSMCs. More interestingly, reduced MMP2 expression in LRP1-knockdown cells was completely rescued by exogenous expression of mLRP4, suggesting that MMP2 is a downstream regulator of LRP1 in Ang II-induced RAoSMCs migration. Together, our data strongly suggest that LRP1 promotes the migration of RAoSMCs by regulating the expression and function of MMP2.
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Safety of edoxaban, an oral factor Xa inhibitor, in Asian patients with non-valvular atrial fibrillation.
Thromb. Haemost.
PUBLISHED: 07-15-2010
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Edoxaban is an oral, reversible, direct factor Xa inhibitor in phase III clinical development for the prevention of stroke in atrial fibrillation (AF). A phase II study was undertaken to evaluate the safety and efficacy of edoxaban in Asian patients with non-valvular AF with CHADS2 score ?1. In a multicentre, active-controlled, double-blind edoxaban and open-label warfarin, parallel-group study, a total of 235 patients from four Asian countries were randomly assigned to edoxaban 30 mg qd, 60 mg qd or warfarin dose adjusted to international normalised ratio of 2-3 for three months. The primary endpoint was the incidence of centrally adjudicated all bleeding events (major, clinically relevant non-major and minor). Secondary endpoints included thromboembolic events, biomarkers of thrombus formation and all adverse events (AEs). The incidence of all bleeding events (95% CI) was 20.3% (12.9, 30.4) for edoxaban 30 mg, 23.8% (15.8, 34.1) for edoxaban 60 mg, and 29.3% (20.2, 40.4) for warfarin. A subgroup analysis suggested low body weight (?60 kg) may affect the incidence of bleeding events with edoxaban. The incidence of study drug-related AEs was 22% for edoxaban 30 mg, 29% for edoxaban 60 mg and 33% for warfarin. No thromboembolic events occurred in any treatment group. In conclusion, this phase II study found a trend for a reduction in the incidence of all bleeding events in Asian AF patients with edoxaban 30 mg and 60 mg compared with warfarin. Adverse events were similar between the edoxaban 60-mg and warfarin groups and were lower with the edoxaban 30-mg group.
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Gender differences in clinical features and in-hospital outcomes in ST-segment elevation acute myocardial infarction: from the Korean Acute Myocardial Infarction Registry (KAMIR) study.
Clin Cardiol
PUBLISHED: 07-01-2010
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Studies have suggested that women are biologically different and that female gender itself is independently associated with poor clinical outcome after an acute myocardial infarction (AMI).
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What is optimal revascularization strategy in patients with multivessel coronary artery disease in non-ST-elevation myocardial infarction? Multivessel or culprit-only revascularization.
Int. J. Cardiol.
PUBLISHED: 05-11-2010
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In patients with non-ST-elevation myocardial infarction (NSTEMI), current guidelines did not recommend optimal revascularization management in multivessel coronary artery disease. We compared clinical outcomes between multivessel revascularization and culprit-only revascularization in this setting.
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Clinical benefit of low molecular weight heparin for ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with glycoprotein IIb/IIIa inhibitor.
J. Korean Med. Sci.
PUBLISHED: 05-04-2010
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The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.
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Impact of the metabolic syndrome on the clinical outcome of patients with acute ST-elevation myocardial infarction.
J. Korean Med. Sci.
PUBLISHED: 04-12-2010
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We sought to determine the prevalence of metabolic syndrome (MS) in patients with acute myocardial infarction and its effect on clinical outcomes. Employing data from the Korea Acute Myocardial Infarction Registry, a total of 1,990 patients suffered from acute ST-elevation myocardial infarction (STEMI) between November 2005 and December 2006 were categorized according to the National Cholesterol Education Program-Adult Treatment Panel III criteria of MS. Primary study outcomes included major adverse cardiac events (MACE) during one-year follow-up. Patients were grouped based on existence of MS: group I: MS (n=1,182, 777 men, 62.8±12.3 yr); group II: Non-MS (n=808, 675 men, 64.2±13.1 yr). Group I showed lower left ventricular ejection fraction (LVEF) (P=0.005). There were no differences between two groups in the coronary angiographic findings except for multivessel involvement (P=0.01). The incidence of in-hospital death was higher in group I than in group II (P=0.047), but the rates of composite MACE during one-year clinical follow-up showed no significant differences. Multivariate analysis showed that low LVEF, old age, MS, low high density lipoprotein cholesterol and multivessel involvement were associated with high in-hospital death rate. In conclusion, MS is an important predictor for in-hospital death in patients with STEMI.
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A transthoracic echocardiographic follow-up study after catheter ablation of atrial fibrillation: can we detect pulmonary vein stenosis by transthoracic echocardiography?
Korean Circ J
PUBLISHED: 03-15-2010
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While pulmonary vein isolation (PVI) is an effective curative procedure for patients with atrial fibrillation (AF), pulmonary vein (PV) stenosis is a potential complication which may lead to symptoms that are often unrecognized. The aim of this study was to compare differences between ablation sites in pulmonary venous flow (PVF) measured by transthoracic Doppler echocardiography (TTE) before and after PVI.
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Relation between C-reactive protein, homocysteine levels, fibrinogen, and lipoprotein levels and leukocyte and platelet counts, and 10-year risk for cardiovascular disease among healthy adults in the USA.
Am. J. Cardiol.
PUBLISHED: 03-11-2010
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The association between systemic inflammation and the estimated 10-year risk for coronary artery disease (CAD) according to the Framingham risk score is largely unknown. In this study, 6,371 participants in the Third National Health and Nutrition Examination Survey (NHANES III) aged 40 to 79 years, who had no histories of heart attack, stroke, peripheral artery disease, or diabetes mellitus, were categorized into groups at low (<10%), intermediate (10% to 20%), and high (>20%) risk according to 10-year risk for CAD, calculated using the Framingham risk score modified by the National Cholesterol Education Program Adult Treatment Panel III. After adjustments for age, gender, race, body mass index, and co-morbidities, participants at high risk were more likely to have elevated circulating C-reactive protein levels (>/=2.2 mg/L: adjusted odds ratio [OR] 1.61, 95% confidence interval [CI] 1.30 to 2.01, p <0.0001; >10.0 mg/L: OR 1.41, 95% CI 1.03 to 1.93, p = 0.034). The high-risk group had circulating fibrinogen, homocysteine, leukocyte, and platelet levels that were 20.98 mg/dl (95% CI 12.53 to 29.43, p <0.0001), 1.54 mumol/L (95% CI 0.76 to 2.32, p = 0.002), 0.90 mumol/L (95% CI 0.36 to 1.43, p = 0.001), 910/microl (95% CI 670 to 1,160, p <0.0001), and 10,220/microl (95% CI 2,830 to 17,610, p <0.0001) higher, respectively, than in those in the low-risk group. There was also a dose-dependent increase in circulating levels of inflammatory markers across the categories of CAD risk. In conclusion, these findings indicate that low-grade systemic inflammation and hyperhomocysteinemia were present in participants with high 10-year risk for CAD.
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Comparison of outcomes between Zotarolimus- and sirolimus-eluting stents in patients with ST-segment elevation acute myocardial infarction.
Am. J. Cardiol.
PUBLISHED: 03-10-2010
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Zotarolimus-eluting stents (ZESs) demonstrated greater in-segment late luminal loss and in-segment binary restenosis rates compared to sirolimus-eluting stents (SESs) in several studies. However, no data are available in direct comparison between the clinical outcomes of the 2 stents in unselected patients with ST-segment elevation acute myocardial infarction (STEMI). The aim of the present study was to compare the clinical outcomes of ZESs and SESs in real-world patients with STEMI. A total of 873 patients with STEMI (306 patients in the ZES group and 567 patients in the SES group) were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) from January 2007 to January 2008. The primary end points were major adverse cardiac events, a composite of all causes of death, myocardial infarction, and target lesion revascularization during a 12-month clinical follow-up. During 1 year of follow-up, the primary end points occurred in 140 patients (16.0%). The use of glycoprotein IIb/IIIa inhibitors and the occurrence of multivessel disease were more common in the SES group. The SES group had a significantly lower incidence of major adverse cardiac events (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.07 to 2.16, p = 0.02), target lesion revascularization (HR 2.16, 95% CI 1.01 to 4.59, p = 0.046), and target vessel revascularization (HR 2.24, 95% CI 1.18 to 4.24, p = 0.013). However, no significant differences were found in death or myocardial infarction (HR 1.37, 95% CI 0.91 to 2.05, p = 0.129). In conclusion, SESs provided superior angiographic outcomes, translating into better clinical outcomes and negating any change in STEMI patient safety profiles compared to ZESs.
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Effect of Lacidipine on Blood Pressure and Endothelial Function in Mild-to-Moderate Essential Hypertension Patients With Diabetes in Korea.
Korean Circ J
PUBLISHED: 03-03-2010
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The aim of this study was to evaluate the efficacy of lacidipine in reducing blood pressure (BP) and to determine its effect on endothelial function in mild-to-moderate hypertensive patients with type 2 diabetes mellitus (DM).
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Pentraxin 3 as a novel marker predicting congestive heart failure in subjects with acute coronary syndrome.
Korean Circ J
PUBLISHED: 02-05-2010
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Pentraxin 3 (PTX3) was shown to be elevated in the acute phase of acute myocardial infarction (AMI) and to have prognostic significance in AMI patients. The aim of this study was to estimate whether the value of PTX3 could be used as a prognostic biomarker, with the global registry of acute coronary events (GRACE) risk assessment tool, in patients with acute coronary syndrome (ACS).
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The effect of cilostazol on stent thrombosis after drug-eluting stent implantation.
Korean Circ J
PUBLISHED: 01-27-2010
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Placement of drug-eluting stents (DES) can be complicated by stent thrombosis; prophylactic antiplatelet therapy has been used to prevent such events. We evaluated the efficacy of cilostazol with regard to stent thrombosis as adjunctive antiplatelet therapy.
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Relationship between obesity and N-terminal brain natriuretic Peptide level as a prognostic value after acute myocardial infarction.
Korean Circ J
PUBLISHED: 01-22-2010
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Recently, the prognostic value of N-terminal brain natriuretic peptide (NT-proBNP) in acute coronary syndrome has been demonstrated in many studies. However, NT-proBNP levels are influenced by various factors such as sex, age, renal function, heart failure severity, and obesity. NT-proBNP concentrations tend to decrease with higher body mass index (BMI). The aim of this study was to examine the influence of obesity on NT-proBNP as a predictive prognostic factor in acute myocardial infarction (AMI) patients.
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The Relationship Between Serum Pentraxin 3 and Central Obesity in ST-Segment Elevation Myocardial Infarction Patients.
Korean Circ J
PUBLISHED: 01-04-2010
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As shown in previous studies, pentraxin 3 (PTX3) can be a useful inflammatory marker for metabolic syndrome and central obesity. Serum PTX3 levels are also an independent factor associated with visceral fat area. The aim of this study was to assess the role of PTX3 as an inflammatory maker in patients with central obesity undergoing primary percutaneous coronary intervention (PCI) following an ST-segment elevation myocardial infarction (STEMI).
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Comparison of Left Ventricular Hypertrophy, Fibrosis and Dysfunction According to Various Disease Mechanisms such as Hypertension, Diabetes Mellitus and Chronic Renal Failure.
J Cardiovasc Ultrasound
PUBLISHED: 10-21-2009
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Left ventricular hypertrophy (LVH) has been known as an important predictor of prognosis of cardiovascular disease. Carboxy-terminal propeptide of procollagen type I (PIP) is related with myocardial fibrosis. We sought to analyze the differences in the characteristics of LVH, myocardial fibrosis, and LV functions among hypertension (HBP), diabetes mellitus (DM) and chronic renal failure (CRF).
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Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe?
Int. J. Cardiol.
PUBLISHED: 06-17-2009
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There is a paucity of data concerning the clinical outcome of patients presenting with acute myocardial infarction (AMI) and near-normal coronary angiograms. The purpose of this study was to evaluate the clinical outcome and the prognosis of the patients with near-normal coronary angiograms who were registered in the Korean Acute Myocardial Infarction Registry (KAMIR).
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Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Circulation
PUBLISHED: 06-15-2009
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Whether triple antiplatelet therapy is superior or similar to dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention in the era of drug-eluting stents remains unclear.
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High echogenic thickening of proximal coronary artery predicts the far advanced coronary atherosclerosis.
Echocardiography
PUBLISHED: 05-29-2009
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Detection of subclinical, nonobstructive coronary artery disease will require the evaluation of coronary arterial walls and external coronary diameter in order to detect increases in arterial wall thickness and compensatory remodeling before luminal narrowing. We assessed the meaning of high echogenic thickening (HET) on transthoracic coronary echogram of proximal coronary arteries and evaluated whether HET predicts the severity of coronary artery disease on angiogram.
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Obesity paradox in Korean patients undergoing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction.
J Cardiol
PUBLISHED: 05-20-2009
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The effect of body mass index (BMI) on outcomes after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is not well known. In patients registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between November 2005 and November 2007, 3824 STEMI patients who arrived at hospital within 12h after onset of chest pain and underwent primary PCI were analyzed, and divided into four groups according to their BMI: underweight (BMI<18.5 kg/m(2), n=129); normal weight (18.5 < or =BMI <23.0 kg/m(2), n=1253); overweight (23.0 < or =BMI <27.5 kg/m(2), n=1959); and obese (BMI > or =27.5 kg/m(2), n=483). In-hospital mortality, revascularization in 1 year, mortality in 1 year, and overall mortality were compared between groups. Overweight and obese group were significantly younger, had normal left ventricular ejection fraction, and were more likely to be men with a higher incidence of hypertension, diabetes, and hyperlipidemia. There were no significant differences in symptom-to-door time and door-to-balloon time between groups. Obese patients had significantly lower in-hospital and overall mortalities. Major adverse cardiac events showed a bimodal pattern. Obese STEMI patients treated with primary PCI were associated with lower mortality, which may be explained by better use of medical treatment, hemodynamic stability, and younger age.
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The measurement of opening angle and orifice area of a bileaflet mechanical valve using multidetector computed tomography.
Korean Circ J
PUBLISHED: 04-28-2009
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The aim of this study was to assess mechanical valve function using 64-slice multidetector computed tomography (MDCT).
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Measurement of the intimal thickness of the carotid artery: comparison between 40 MHz ultrasound and histology in rats.
Ultrasound Med Biol
PUBLISHED: 03-14-2009
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Common carotid artery intimal thickness (IT) has been shown to be as useful as a measurement of the whole layer of intima-media thickness (IMT) for evaluating the early phase of atherosclerosis. The aim of this study was to elucidate the relationship between high echogenic intimal thickening (HEIT), which was measured using a 40 MHz ultrasound biomicroscope (UBM), and the histologically determined IT in rat carotid arteries. HEIT was estimated in 10 Wistar-Kyoto rats (group I), 15 spontaneous hypertensive rats (SHR) fed a standard diet (group II) and 10 SHR fed a high-fat diet (group III). IT and IMT measurements were determined in Masson trichrome-stained tissues and were compared with the HEIT and IMT evaluated using the UBM. In group I, the HEIT and the IT were 33 +/- 4 microm and 12 +/- 1 mirom, respectively. In group II, the HEIT and the IT were 68 +/- 8 microm and 16 +/- 2 microm, respectively. In group III, the HEIT and the IT were 65 +/- 26 microm and 33 +/- 14 microm, respectively. In SHR, the HEIT and the mean IMT measured with echography were significantly correlated with the IT and the IMT that were determined by histologic measurement (r = 0.60, p = 0.003 and r = 0.53, p = 0.01, respectively). Moreover, HEIT may be associated with the intimal pathology and atherosclerotic burden. The HEIT measurement is a noninvasive method that may be used to assess atherosclerosis in humans.
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Long-Term clinical outcomes according to initial management and thrombolysis in myocardial infarction risk score in patients with acute non-ST-segment elevation myocardial infarction.
Yonsei Med. J.
PUBLISHED: 02-03-2009
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There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR).
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A new risk score system for the assessment of clinical outcomes in patients with non-ST-segment elevation myocardial infarction.
Int. J. Cardiol.
PUBLISHED: 01-21-2009
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Prediction for long-term clinical outcomes in patients with non-ST elevation acute coronary syndrome is important as well as early risk stratification. The aim of this study is to develop a simple assessment tool for better early bedside risk stratification for both short- and long-term clinical outcomes.
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Comparison of clinical outcomes following acute myocardial infarctions in hypertensive patients with or without diabetes.
Korean Circ J
PUBLISHED: 01-16-2009
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It is thought that patients with diabetes mellitus (DM) have a poor prognosis after an acute myocardial infarction (AMI), but the effect of diabetes on the outcomes of hypertensive patients with AMIs has not been elucidated in the Korean population. The aim of this study was to investigate the effects of diabetes on long-term clinical outcomes following AMIs in patients with hypertension.
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Age is an Independent Risk Factor for the Early Morning Blood Pressure Surge in Patients Never-Treated for Hypertension.
Korean Circ J
PUBLISHED: 01-08-2009
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The early morning blood pressure surge (EMBPS) has been reported to be associated with cardiovascular events. The aim of this study was to investigate the relationship between 24-hour ambulatory BP monitoring (ABPM) parameters and conventional cardiovascular risk factors.
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Effect of Angiotensin converting enzyme inhibitors and Angiotensin receptor blockers on patients following ablation of atrial fibrillation.
Korean Circ J
PUBLISHED: 01-02-2009
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It is known that angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor blockers (ACEIs and ARBs, respectively) are effective in preventing atrial fibrillation (AF) in high-risk patients. However, it is not known whether ACEIs and ARBs are effective in preventing the recurrence of AF after catheter ablation.
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Comparison of clinical and imaging characteristics and outcomes between provoked and unprovoked acute pulmonary embolism in Koreans.
J. Korean Med. Sci.
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This study was performed to compare clinical and imaging parameters and prognosis of unprovoked pulmonary embolism (PE), provoked PE with reversible risk factors (provoked-rRF), and provoked PE with irreversible risk factors (provoked-iRF) in Koreans. Three hundred consecutive patients (mean age, 63.6 ± 15.0 yr; 42.8% male) diagnosed with acute PE were included. The patients were classified into 3 groups; unprovoked PE, provoked-rRF, and provoked-iRF; 43.7%, 14.7%, and 41.7%, respectively. We followed up the patients for 25.4 ± 33.7 months. Composite endpoint was all-cause mortality and recurrent PE. The provoked-iRF group had significantly higher all-cause mortality, mortality from PE and recurrent PE than the unprovoked and provoked-rRF groups (P < 0.001, P < 0.001, and P = 0.034, respectively). Prognostic factors of composite endpoint in the unprovoked group were high creatinine (> 1.2 mg/dL; P < 0.001; hazard ratio [HR], 4.735; 95% confidence interval [CI], 1.845-12.152), C-reactive protein (CRP; > 5 mg/L; P = 0.002; HR, 5.308; 95% CI, 1.824-15.447) and computed tomography (CT) obstruction index (P = 0.034; HR, 1.090; 95% CI, 1.006-1.181). In conclusion, provoked-iRF has a poorer prognosis than unprovoked PE and provoked-rRF. Renal insufficiency, high CRP, and CT obstruction index are poor prognostic factors in unprovoked PE.
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Predictors of early and late target lesion revascularization after drug-eluting stent implantation.
J Interv Cardiol
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Recent studies have suggested the existence of a late catch-up phenomenon after drug-eluting stent (DES) implantation. The aim of this study is to identify predictors of early (?1 year) and late (>1 year) target lesion revascularization (TLR) in DESs.
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Incidence and clinical impact of fracture of drug-eluting stents widely used in current clinical practice: comparison with initial platform of sirolimus-eluting stent.
J Cardiol
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Almost all data on drug-eluting stents (DES) fracture have been derived from initial platform of first-generation DES such as Cypher Bx® (CBX) and Taxus Express®. However, incidence and clinical impact of fracture of newer DES platforms (including Cypher Select®, Taxus® Liberté™, Endeavor®, and Xience™ V) that have been used widely in current clinical practice have not yet been studied.
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Improved anemia is associated with favorable long-term clinical outcomes in patients undergoing PCI.
Coron. Artery Dis.
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Anemia is associated with an increased risk of mortality in patients who underwent percutaneous coronary intervention (PCI) in the bare-metal stent era. However, there have been no data concerning the clinical importance of anemia improvement during the follow-up period after discharge from the hospital during the drug-eluting stent era.
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Impact of high-normal blood pressure measured in emergency room on adverse cardiac events in acute myocardial infarction.
Korean Circ J
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Prehypertension according to JNC7 is common and is associated with increased vascular mortality. The importance of management in high-normal blood pressure (BP) is underemphasized.
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Prognostic impact of significant non-infarct-related left main coronary artery disease in patients with acute myocardial infarction who receive a culprit-lesion percutaneous coronary intervention.
Coron. Artery Dis.
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Infarct-related left main coronary artery disease (LMCAD) is associated with an increased cardiac mortality in the setting of acute myocardial infarction (AMI). However, the prevalence and prognostic impact of significant (?50% stenosis) non-infarct-related LMCAD in patients with AMI have not yet been elucidated.
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Persistent coronary artery spasm documented by follow-up coronary angiography in patients with symptomatic remission of variant angina.
Heart Vessels
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For patients with variant angina it is very important to start medical therapy using calcium-channel blockers. However, the decision of physicians regarding whether to decrease the dose of the drug or discontinue it is controversial. We investigated whether the nature of spasm is remissive and whether the termination of medications is safe. The subjects studied were included in the Vasospastic Angina in Catholic Medical Center Registry from March 2001 to December 2009. We analyzed 37 patients (62 lesions) with variant angina, diagnosed using coronary angiography (CAG) and he acetylcholine provocation test, without any organic coronary stenosis, whose symptoms were well controlled after medication. The follow-up CAG with provocation test was performed at a median interval of 44 months. The characteristics of spasm were analyzed on each pair of CAGs. The study group consisted of 23 men (62.2 %) and 14 women (37.8 %) with a mean age of 59 ± 11.1 years. The follow-up CAG with provocation test showed that the characteristics of the spasmodic nature were consistent with the first test in all patients. Although the patients with variant angina had no chest pain after medical treatment, the spasmodic nature of coronary arteries still remained. We may decrease the drug dosage after carefully checking the patients symptoms but recommend not discontinuing therapy, even if the patient is asymptomatic.
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Long-term outcomes of percutaneous coronary intervention versus coronary artery bypass grafting for unprotected left main coronary bifurcation disease in the drug-eluting stent era.
Heart
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There are limited data on long-term outcomes (i.e., beyond 4 years) for patients with unprotected left main bifurcation disease who underwent percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the drug-eluting stent (DES) era. This study therefore compared the treatment effects of PCI and CABG in unprotected left main bifurcation disease.
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Positive result in the early passive phase of the tilt-table test: a predictor of neurocardiogenic syncope in young men.
Korean J. Intern. Med.
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This study elucidated the prognostic factors for neurocardiogenic syncope in males in their late teens and early twenties.
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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.