To estimate the factors to the inclination of the criminal violence, the content of trace minerals and toxic metals in the scalp hair were measured during the period from May 1992 to october 1992. One hundred eleven violent and 89 nonviolent criminal inmates of Taegu correctional Institute were selected. The inmates of violent criminals were imprisoned by murder, robber, rape, injury and violent acts. Those of nonviolent criminals were swindle, larceny, and adultery and had no history of institutional violence. The contents of two toxic metals(cadmium, lead) and five trace minerals(Cu, Fe, Zn, Mg, Na) were determined by an atomic absorption spectrophotometer(lL. 551). The contents of cadmium and lead in hair of violent criminals were significantly higher as 0.56+/-0.14ppm, 11.53+/-3.32ppm, respectively, than 0.42+/-0.20ppm, 9.63+/-4.31ppm of nonviolent group (P<0.01). But the level of copper was significantly lower than nonviolent group (P<0.05). The factors that had a significant correlation with the inclination of violence in multiple logistic regression analysis were cadmium (odds ratio=98.09), unmarried (odds ratio=0.39), many times of criminal history (odds ratio=l.57) and residence of rural area (odds ratio=0.44). The results suggest that the sub-toxic contents of cadmium and lead in the hair may be of potential effect on behavior, and the mineral analysis may be an important adjunctive diagnostic procedure. Further studies into this problem are necessary.
Absorption ; Cadmium ; Copper ; Criminals* ; Daegu ; Extramarital Relations ; Hair* ; Homicide ; Humans ; Logistic Models ; Metals ; Minerals* ; Rape ; Scalp* ; Single Person ; Violence

BACKGROUND AND OBJECTIVES: Slow flow or no-reflow during the primary angioplasty is associated with a poor prognosis. The impact of adjuvant balloon inflation on infarct artery flow after successful primary stenting has not yet been studied. Therefore, we investigated the effect of adjuvant balloon inflation on infarct related artery flow after successful stenting in patients with acute myocardial infarction. SUBJECTS AND METHODS: The changes in infarct artery flow before and after adjuvant balloon inflation were assessed in 46 patients with a first episode of acute myocardial infarction (pain duration > 12 hr) who underwent adjuvant balloon inflation after successful primary stenting. Infarct artery flow was evaluated by corrected TIMI frame count (CTFC). RESULTS: After adjuvant balloon inflation, 20 patients (43%) showed a slower flow. The minimal lumen diameter became greater (3.0 > 0.5 mm vs. 3.2 > 0.5 mm, p=0.002) and the residual stenosis lessened (12.2 > 9.6% vs. 6.4 > 8.1%, p<0.001). There was no change in reference vessel diameter. CTFC was significantly increased after adjuvant balloon inflation (21.6 > 11.5 frames vs. 26.9 > 20.5 frames, p=0.005). On multivariate analysis, only pre-adjuvant balloon CTFC was a predictor of a slower flow after adjuvant balloon inflation (odds ratio 1.148, 95% CI:1.014-1.301). CONCLUSION: Adjuvant balloon inflation after successful primary stenting reduced residual stenosis but deteriorated the infarct artery flow. Further studies are required to define the clinical impact of the positive and negative effects of adjuvant balloon inflation.
Angioplasty ; Arteries* ; Constriction, Pathologic ; Coronary Circulation ; Humans ; Inflation, Economic* ; Multivariate Analysis ; Myocardial Infarction ; Prognosis ; Stents*

BACKGROUND AND OBJECTIVES: Insulin resistance has been suggested to be an important risk factor in the development of arteriosclerosis. The correlation between insulin sensitivity and the degree of coronary atherosclerosis in patients with angina pectoris was investigated. SUBJECTS AND METHODS: The study population consisted of 74 subjects with angina (54 men, 20 women), aged from 31 to 73 years. Coronary angiograms were evaluated by 3 semiquantitative scoring systems (vessel score, stenosis score and extent score) to estimate the extent of focal and diffuse coronary artery disease (CAD). Insulin sensitivity (K ITT) was determined by an insulin tolerance test. RESULTS: There were significant correlations between K ITT and all 3 coronary scores. Multivariate analysis revealed significant and independent correlations between all 3 coronary scores and K ITT , even in patients without diabetes mellitus. Both HDL cholesterol level and K ITT were significantly lower in patients with CAD than in those without. CONCLUSION: Decreased insulin sensitivity was significantly associated with the presence and extent of CAD. These results suggest the potential benefits of insulin-sensitizing treatment strategies for patients with decreased insulin sensitivity.
Angina Pectoris ; Arteriosclerosis ; Cholesterol, HDL ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Insulin Resistance* ; Insulin* ; Male ; Multivariate Analysis ; Risk Factors

Background and Objectives: De-escalation of dual-antiplatelet therapy through dose reduction of prasugrel improved net adverse clinical events (NACEs) after acute coronary syndrome (ACS), mainly through the reduction of bleeding without an increase in ischemic outcomes. Whether the benefits of de-escalation are sustained in highly thrombotic conditions such as ST-elevation myocardial infarction (STEMI) is unknown. We aimed to assess the efficacy and safety of de-escalation therapy in patients with STEMI or non-STsegment elevation ACS (NSTE-ACS). Methods: This is a pre-specified subgroup analysis of the HOST-REDUCE-POLYTECH-ACS trial. ACS patients were randomized to prasugrel de-escalation (5 mg daily) or conventional dose (10 mg daily) at 1-month post-percutaneous coronary intervention. The primary endpoint was a NACE, defined as a composite of all-cause death, non-fatal myocardial infarction, stent thrombosis, clinically driven revascularization, stroke, and bleeding events of grade ≥2 Bleeding Academic Research Consortium (BARC) criteria at 1 year. Results: Among 2,338 patients included in the randomization, 326 patients were diagnosed with STEMI. In patients with NSTE-ACS, the risk of the primary endpoint was significantly reduced with de-escalation (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.48– 0.89; p=0.006 for de-escalation vs. conventional), mainly driven by a reduced bleeding. However, in those with STEMI, there was no difference in the occurrence of the primary outcome (HR, 1.04; 95% CI, 0.48–2.26; p=0.915; p for interaction=0.271). Conclusions Prasugrel dose de-escalation reduced the rate of NACE and bleeding, without increasing the rate of ischemic events in NSTE-ACS patients but not in STEMI patients.

BACKGROUND AND OBJECTIVES: The prevalence of coronary artery disease is lower in Korea compared to most western countries. The increasing prevalence of the traditional atherosclerotic risk factors has been documented but the impact of inflammatory activity on coronary artery disease remains unclear. In this study, the role of inflammatory activity on coronary artery disease in Koreans was investigated. SUBJECTS AND METHODS: This study included a consecutive cohort of 1057 patients who underwent coronary angiography. Patients with conditions that might change the CRP levels were excluded and 227 patients were finally enrolled. The CRP was measured using a highly sensitive Behring nephelometer BN II. RESULTS: The mean CRP value of the enrolled patients was 1.06+/-0.51 mg/L (median : 0.95 mg/L). There were no differences in the CRP levels (1.17 +/-0.57 vs. 0.92+/-0.42 mg/L, p=0.11) between patients with and without coronary artery disease. In logistic regression analysis, only the traditional risk factors (age, being male, hyperlipidemia, and diabetes) were independently associated with coronary artery disease. In patients with coronary artery disease, those with unstable angina had significantly higher CRP levels than those with stable angina (1.85+/-0.94 vs. 0.97+/-0.45 mg/L, p=0.02). However, the CRP levels were not correlated with the angiographic severity. 16.7% (15/89) of coronary artery disease patients without hyperlipidemia had a CRP level>3 mg/L. CONCLUSION: The CRP level is not an independent risk factor for coronary artery disease in Koreans. However, the CRP level was higher in patients with unstable angina than in those with stable clinical conditions.
Angina, Stable ; Angina, Unstable ; C-Reactive Protein ; Cohort Studies ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Hyperlipidemias ; Inflammation* ; Korea ; Logistic Models ; Male ; Prevalence ; Risk Factors

BACKGROUND AND OBJECTIVES: Although percutaneous coronary intervention (PCI) is recommended to improve symptoms in patients with stable ischemic heart disease (SIHD), improvement of exercise performance is controversial. This study aimed to investigate changes in exercise duration after PCI according to functional completeness of revascularization by comparing pre- and post-PCI exercise stress test (EST). METHODS: Patients with SIHD were enrolled from a prospective PCI registry, and divided into 2 groups: 1) functional complete revascularization (CR) group had a positive EST before PCI and negative EST after PCI, 2) functional incomplete revascularization (IR) group had positive EST before and after PCI. Primary outcome was change in exercise duration after PCI and secondary outcome was major adverse cardiac events (MACE, a composite of any death, any myocardial infarction, and any ischemia-driven revascularization) at 3 years after PCI. RESULTS: A total of 256 patients (149 for CR group, and 107 for IR group) were eligible for analysis. Before PCI, exercise duration was not significantly different between the functional CR and IR groups (median 540 [interquartile range; IQR, 414, 602] vs. 480 [402, 589] seconds, p=0.091). After PCI, however, the CR group had a significantly higher increment of exercise duration than the IR group (median 62.0 [IQR, 12.0, 141.0] vs. 30.0 [−11.0, 103.5] seconds, p=0.011). The functional CR group also had a significantly lower risk of 3-year MACE (6.2% vs. 26.1%; adjusted hazard ratio, 0.19; 95% confidence interval, 0.09–0.41; p<0.001). CONCLUSIONS Functional CR showed a higher increment of exercise duration than functional IR.

BACKGROUND AND OBJECTIVES: Although percutaneous coronary intervention (PCI) is recommended to improve symptoms in patients with stable ischemic heart disease (SIHD), improvement of exercise performance is controversial. This study aimed to investigate changes in exercise duration after PCI according to functional completeness of revascularization by comparing pre- and post-PCI exercise stress test (EST).METHODS: Patients with SIHD were enrolled from a prospective PCI registry, and divided into 2 groups: 1) functional complete revascularization (CR) group had a positive EST before PCI and negative EST after PCI, 2) functional incomplete revascularization (IR) group had positive EST before and after PCI. Primary outcome was change in exercise duration after PCI and secondary outcome was major adverse cardiac events (MACE, a composite of any death, any myocardial infarction, and any ischemia-driven revascularization) at 3 years after PCI.RESULTS: A total of 256 patients (149 for CR group, and 107 for IR group) were eligible for analysis. Before PCI, exercise duration was not significantly different between the functional CR and IR groups (median 540 [interquartile range; IQR, 414, 602] vs. 480 [402, 589] seconds, p=0.091). After PCI, however, the CR group had a significantly higher increment of exercise duration than the IR group (median 62.0 [IQR, 12.0, 141.0] vs. 30.0 [−11.0, 103.5] seconds, p=0.011). The functional CR group also had a significantly lower risk of 3-year MACE (6.2% vs. 26.1%; adjusted hazard ratio, 0.19; 95% confidence interval, 0.09–0.41; p<0.001).CONCLUSIONS: Functional CR showed a higher increment of exercise duration than functional IR.
Angina, Stable ; Exercise Test ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Prognosis ; Prospective Studies

Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.

Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.