Recently the incidence of coronary artery disease has been increasing in Korea. Percutaneous coronary intervention (PCI) has been established as one of the most effective therapeutic methods in addition to medical therapies, especially for patients with acute coronary syndrome (ACS). ACS refers to unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). UA/NSTEMI is a common but heterogeneous disorder with patients exhibiting a wide variety of risks. In patients with UA/NSTEMI, early risk stratification is at the center of the management program and can be achieved by using clinical criteria, electrocardiographic changes and biomarkers, or both. Platelet glycoprotein (GP) IIb/IIIa receptor blockers are indicated in high-risk patients who are likely to undergo PCI, but are not indicated in the management of lower risk patients who do not undergo PCI. There is a hard evidence to support the substitution of the lowmolecular weight heparin for unfractionated heparin. Many recent trials have demonstrated the benefit of an early invasive strategy with coronary angiography followed by PCI in patients at high and intermediate risk. Prompt reperfusion of ischemic myocardium is the major focus of acute treatment of patients with STEMI. Two reperfusion strategies have been developed: thrombolytic therapy and primary PCI. Although these two strategies have t raditionally been considered distinct and at times competing options, it is likely that the care of patients with STEMI will be improved in the future if they are viewed as a single integrated effort for reperfusion. However, PCI has been shown to be superior to thrombolysis in the treatment of STEMI admitted to highly experienced PCI centers. A meta-analysis of many randomized trials found significantly lower mortality rate, and lower rate of nonfatal reinfarction and intracerebral hemorrhage with primary PCI compared with thrombolysis. Currently, a primary PCI strategy may begin with the initiation of a platelet GP IIb/IIIa receptor blocker in the emergency center, together with aspirin and heparin (especially low molecular weight heparin), followed by rapid application of coronary angioplasty with stenting. Primary PCI is feasible in community hospitals without surgical capability, however, due to the conc erns about timing and safety margin, this approach is not yet advocated in the current guidelines.
Acute Coronary Syndrome ; Angina, Unstable ; Angioplasty ; Aspirin ; Biomarkers ; Blood Platelets ; Cerebral Hemorrhage ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography ; Emergencies ; Glycoproteins ; Heparin ; Hospitals, Community ; Humans ; Incidence ; Korea ; Molecular Weight ; Mortality ; Myocardial Infarction ; Myocardium ; Percutaneous Coronary Intervention* ; Reperfusion ; Stents ; Thrombolytic Therapy

No abstract available.
Perfusion*

No abstract available.
Perfusion*

The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry that reflects current therapeutic approaches and acute myocardial infarction (AMI) management in Korea. The results of the KAMIR demonstrated different risk factors and responses to medical and interventional treatments. The results indicated that the incidence of ST-elevation myocardial infarction (STEMI) was relatively high, and that the prevalence of dyslipidemia was relatively low with higher triglyceride and lower high-density lipoprotein cholesterol levels. Percutaneous coronary intervention (PCI) rates were high for both STEMI and non-ST-elevation myocardial infarction (NSTEMI) with higher use of drug-eluting stents (DESs). DES were effective and safe without increased risk of stent thrombosis in Korean AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel, and cilostazol, was effective in preventing adverse clinical outcomes after PCI. Statin therapy was effective in Korean AMI patients, including those with very low levels of low-density lipoprotein cholesterol and those with cardiogenic shock. The KAMIR score had a greater predictive value than Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores for long-term mortality in AMI patients. Based on these results, the KAMIR will be instrumental for establishing new therapeutic strategies and effective methods for secondary prevention of AMI and guidelines for Asian patients.
Asian Continental Ancestry Group ; Aspirin ; Cholesterol ; Drug-Eluting Stents ; Dyslipidemias ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Korea* ; Lipoproteins ; Mortality ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Prevalence ; Registries* ; Risk Factors ; Secondary Prevention ; Shock, Cardiogenic ; Stents ; Thrombosis ; Triglycerides

No abstract available.
Acute Coronary Syndrome* ; Blood Platelets* ; Glycoproteins*

Restenosis and stent thrombosis remain major concerns after percutaneous coronary intervention for the treatment of coronary artery disease. The present review was undertaken in order to highlight the various coronary stents that have been investigated in our Heart Research Center, and how far we have come from the first heparin-coated stent first used in the late 1990s. Thereafter, from the abciximab-coated stent to the current gene-delivery stent and other newer agents, our group has applied a range of techniques in this field. However, in groups similar to ours, the restenosis rates of such stents are still high for second-generation drug-eluting stents (DESs). Moreover, our nation imports almost all of these types of stents from other countries. Thus, we need to develop domestic coronary stents. Research into newer DESs are warranted in Korea so as to achieve improved safety and efficacy outcomes.
Coronary Artery Disease ; Heart ; Korea ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents ; Thrombosis

In Korea, the incidence of acute myocardial infarction has been increasing rapidly. Twelve-month clinical outcomes for 13,133 patients with acute myocardial infarction enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry study were analyzed according to the presence or absence of ST-segment elevation. Patients with ST-segment elevation myocardial infarction (STEMI) were younger, more likely to be men and smokers, and had poorer left ventricular function with a higher incidence of cardiac death compared to patients with non-ST-segment elevation myocardial infarction (NSTEMI). NSTEMI patients had a higher prevalence of 3-vessel and left main coronary artery disease with complex lesions, and were more likely to have co-morbidities. The in-hospital and 1-month survival rates were higher in NSTEMI patients than in STEMI patients. However, 12-month survival rates was not different between the two groups. In conclusion, NSTEMI patients have worse clinical outcomes than STEMI patients, and therefore should be treated more intensively during clinical follow-up.
Coronary Artery Disease ; Death ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Male ; Myocardial Infarction ; Prevalence ; Prognosis ; Survival Rate ; Ventricular Function, Left

Delayed arterial healing at culprit sites after drug-eluting stent (DES) placement for acute myocardial infarction (AMI) is associated with increased risk of late stent thrombosis. The Korea Acute Myocardial Infarction Registry was established in commemoration of the 50(th) anniversary of Korea Circulation Society. Between November 2005 and December 2016, more than 62,000 patients were registered from 50 primary percutaneous coronary intervention (PCI) centers in Korea. DES in AMI may be safe and effective, however, there is concern about increased stent thrombosis after DES implantation in AMI patients, requiring longer-term dual anti-platelet therapy to reduce the risk of late stent thrombosis. Device innovation is needed to overcome issues such as stent thrombosis and restenosis by using new coating materials with biocompatible polymers, different coating methods using non-polymer techniques, bioabsorbable stents and pro-healing stents. In this review article, we describe the current usage of DES in AMI in Korea and introduce novel DES uses in development for patients with AMI. We have developed many types of DES in our research laboratory. Abciximab-coated stents inhibited platelet thrombi and restenosis. Furthermore, anti-oxidants (carvedilol, probucol and alpha-lipoic acid) were used for stent coating. Currently we are developing novel DESs using polymer-free and natural binding techniques, peptide coating stents, gene-and-drug delivery, bioabsorbable stents using 3D printing, endothelial progenitor cell capturing stents to promote reendothelialization and reduce stent thrombosis. New DESs in development may be safe and effective in preventing late stent thrombosis and restenosis in patients with AMI.
Anniversaries and Special Events ; Blood Platelets ; Drug-Eluting Stents ; Endothelial Progenitor Cells ; Humans ; Korea ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Polymers ; Printing, Three-Dimensional ; Probucol ; Stents ; Thrombosis

Intracoronary stent implantation can improve coronary hemodynamics and myocardial ischemia in patients with symptomatic bridging. However, percutaneous coronary intervention for this lesion is limited due to the high prevalence of restenosis and risk of complications. We present a case of a totally occluded long-segment myocardial bridge in a patient with hypertrophic cardiomyopathy who was successfully implanted with a bare metal stent under intravascular ultrasound guidance without complications. The patient has been free of ischemic symptoms with stent patency for 10 years.
Cardiomyopathy, Hypertrophic* ; Follow-Up Studies* ; Hemodynamics ; Humans ; Myocardial Bridging ; Myocardial Ischemia ; Percutaneous Coronary Intervention* ; Prevalence ; Stents ; Ultrasonography

No abstract available.
Brachytherapy* ; Stents*