1.Trans-Radial versus Trans-Femoral Intervention for the Treatment of Coronary Bifurcations: Results from Coronary Bifurcation Stenting Registry.
Seungmin CHUNG ; Sung Ho HER ; Pil Sang SONG ; Young Bin SONG ; Joo Yong HAHN ; Jin Ho CHOI ; Sang Hoon LEE ; Yangsoo JANG ; Jung Han YOON ; Seung Jea TAHK ; Seung Jung PARK ; Seung Hyuk CHOI ; Ki Bae SEUNG ; Hyeon Cheol GWON
Journal of Korean Medical Science 2013;28(3):388-395
Trans-radial (TR) approach is increasingly recognized as an alternative to the routine use of trans-femoral (TF) approach. However, there are limited data comparing the outcomes of these two approaches for the treatment of coronary bifurcation lesions. We evaluated outcomes of TR and TF percutaneous coronary interventions (PCI) in this complex lesion. Procedural outcomes and clinical events were compared in 1,668 patients who underwent PCI for non-left main bifurcation lesions, according to the vascular approach, either TR (n = 503) or TF (n = 1,165). The primary outcome was major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) in all patients and in 424 propensity-score matched pairs of patients. There were no significant differences between TR and TF approaches for procedural success in the main vessel (99.6% vs 98.6%, P = 0.08) and side branches (62.6% vs 66.7%, P = 0.11). Over a mean follow-up of 22 months, cardiac death or MI (1.8% vs 2.2%, P = 0.45), TLR (4.0% vs 5.2%, P = 0.22), and MACE (5.2% vs 7.0%, P = 0.11) did not significantly differ between TR and TF groups, respectively. These results were consistent after propensity score-matched analysis. In conclusion, TR PCI is a feasible alternative approach to conventional TF approaches for bifurcation PCI (clinicaltrials.gov number: NCT00851526).
Aged
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Angioplasty, Balloon, Coronary/adverse effects/*methods
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Coronary Angiography
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Coronary Stenosis/mortality/radiography/*therapy
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Coronary Vessels/radiography/surgery
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*Drug-Eluting Stents
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Female
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Follow-Up Studies
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Hemorrhage/etiology
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Humans
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Kaplan-Meier Estimate
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Male
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Middle Aged
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Myocardial Infarction/etiology
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Myocardial Revascularization
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Proportional Hazards Models
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Registries
2.Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed Tomography Angiography.
Hack Lyoung KIM ; Yong Jin KIM ; Yeonyee E YOON ; Seung Pyo LEE ; Hyung Kwan KIM ; Goo Yeong CHO ; Joo Hee ZO ; Dong Ju CHOI ; Dae Won SOHN
Journal of Korean Medical Science 2015;30(9):1273-1278
This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 +/- 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.
Adult
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Aged
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Aged, 80 and over
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Cardiovascular Diseases/diagnosis/*mortality
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Comorbidity
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Coronary Angiography/*statistics & numerical data
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Coronary Stenosis/mortality/radiography
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Female
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Humans
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Incidence
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Kidney Diseases/*diagnosis/*mortality
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Kidney Function Tests/*statistics & numerical data
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Male
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Middle Aged
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Prognosis
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Reproducibility of Results
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Republic of Korea/epidemiology
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Risk Assessment
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Sensitivity and Specificity
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Survival Rate
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Tomography, X-Ray Computed/*statistics & numerical data
3.Prognosis in Patients Having Chronic Obstructive Pulmonary Disease with Significant Coronary Artery Lesion Angina.
Tae Yun PARK ; Kyung Hee KIM ; Hyun Kyoung KOO ; Ji Yeon LEE ; Sang Min LEE ; Jae Jun YIM ; Chul Gyu YOO ; Young Whan KIM ; Sung Koo HAN ; Seok Chul YANG
The Korean Journal of Internal Medicine 2012;27(2):189-196
BACKGROUND/AIMS: Many studies have investigated angina and its relationship with chronic obstructive pulmonary disease (COPD). However, angina was diagnosed only by noninvasive tests or only by clinical symptoms in most of these studies. The aim of this study was to compare the prognosis, including rate of hospitalization and death from significant coronary artery lesion and nonsignificant coronary artery lesion angina, in patients with COPD. METHODS: Patients with COPD who underwent coronary angiography (CAG) due to angina were reviewed retrospectively at a tertiary referral hospital. COPD is defined as post-bronchodilator forced expiratory volume in 1 sec/forced vital capacity (FEV1/FVC) of < 70%. A significant coronary lesion is defined as at least 50% diameter stenosis of one major epicardial artery in CAG. RESULTS: In total, 113 patients were enrolled. Mean follow-up duration was 39 +/- 21 months. Of the patients, 52 (46%) had mild COPD and 48 (42%) had moderate COPD. Sixty-nine (61%) patients had significant stenosis in CAG. The death rate in the follow-up period was 2.21 per 100 patient-years. No significant difference was observed among the all-cause mortality rate, admission rate, or intensive care unit admission rate in patients who had COPD with or without significant coronary artery disease. Pneumonia or acute exacerbation of COPD was the most common cause of admission. CONCLUSIONS: In patients having COPD with angina who underwent CAG, no significant difference was observed in mortality or admission events depending on the presence of a significant coronary artery lesion during the 2-year follow-up period.
Aged
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Angina Pectoris/*etiology
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Chi-Square Distribution
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Coronary Angiography
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Coronary Stenosis/*complications/mortality/radiography
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Female
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Forced Expiratory Volume
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Hospitalization
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Humans
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Kaplan-Meier Estimate
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Lung/physiopathology
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Male
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Middle Aged
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Prognosis
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Pulmonary Disease, Chronic Obstructive/*complications/diagnosis/mortality/physiopathology
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Republic of Korea
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Retrospective Studies
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Risk Assessment
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Risk Factors
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Severity of Illness Index
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Spirometry
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Time Factors
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Vital Capacity
4.Seven-Year Clinical Outcomes of Sirolimus-Eluting Stent Versus Bare-Metal Stent: A Matched Analysis From A Real World, Single Center Registry.
Ung KIM ; Jong Seon PARK ; Sang Hee LEE ; Dong Gu SHIN ; Young Jo KIM
Journal of Korean Medical Science 2013;28(3):396-401
The aim of this study is to compare clinical outcomes for seven years, between sirolimus-eluting stent (SES) and bare metal stent (BMS). During the BMS and drug-eluting stent (DES) transition period (from April 2002 to April 2004), 434 consecutive patients with 482 lesions underwent percutaneous coronary intervention, using BMS or SES. Using propensity score matching, 186 patients with BMS and 166 patients with SES were selected. Seven year clinical outcomes of major adverse cardiac events (MACE), such as cardiac death, myocardial infarction (MI) and ischemia-driven target vessel revascularization (TVR), and angiographic definite stent thrombosis (ST) were compared. At one-year follow up, patients with SES showed significantly lower MACE (9.1% in BMS vs 3.0% in SES, P = 0.024). However, cumulative MACE for 7 yr was not significantly different between two groups (24.7% in BMS vs 17.4% in SES, P = 0.155). There was no significant difference in MI, TVR, death and ST. The TVR were gradually increased from 1 to 7 yr in SES, on the contrary to that of BMS. In conclusion, although SES showed better clinical outcomes in the early period after implantation, it did not show significant benefits in the long-term follow up, compared with that of BMS.
Aged
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Angioplasty, Balloon, Coronary/adverse effects/*methods
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Coronary Angiography
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Coronary Stenosis/mortality/radiography/*therapy
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Databases, Factual
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*Drug-Eluting Stents
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Female
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Follow-Up Studies
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Humans
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Ischemia/etiology
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Kaplan-Meier Estimate
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Male
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Middle Aged
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Myocardial Infarction/etiology
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Myocardial Revascularization
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Registries
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Sirolimus/*therapeutic use
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*Stents
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Thrombosis/etiology