No abstract available.

No abstract available.
Stents

Coronary bifurcation stenting is still complex and associated with a high risk of stent thrombosis and restenosis even with contemporary techniques. Although provisional approach has been proved to be the standard strategy of treatment, There is still lack of evidences for multiple steps of the procedure. For so many years we have been focused on the optimization of side branch (SB), but the clinical outcome is mostly dependent on the main vessel (MV) stenting. The optimal expansion of MV stent without the compromise of SB is the ultimate goal to achieve in the coronary bifurcation stenting. Understanding the anatomy and physiology of coronary bifurcation lesion should be the most important step to this goal. The relationship of vessel diameter between branches and the anatomical and functional significance of plaque shift and carina shift are two most important concepts to understand. They are the science behind the predictors of SB occlusion, and the rationale of proximal optimization technique and final kissing ballooning. This specific review will be devoted to review those concepts as well as clinical evidences to support them.
Percutaneous Coronary Intervention ; Physiology ; Stents ; Thrombosis

Coronary bifurcation stenting is still complex and associated with a high risk of stent thrombosis and restenosis even with contemporary techniques. Although provisional approach has been proved to be the standard strategy of treatment, There is still lack of evidences for multiple steps of the procedure. For so many years we have been focused on the optimization of side branch (SB), but the clinical outcome is mostly dependent on the main vessel (MV) stenting. The optimal expansion of MV stent without the compromise of SB is the ultimate goal to achieve in the coronary bifurcation stenting. Understanding the anatomy and physiology of coronary bifurcation lesion should be the most important step to this goal. The relationship of vessel diameter between branches and the anatomical and functional significance of plaque shift and carina shift are two most important concepts to understand. They are the science behind the predictors of SB occlusion, and the rationale of proximal optimization technique and final kissing ballooning. This specific review will be devoted to review those concepts as well as clinical evidences to support them.

BACKGROUND AND OBJECTIVE: Despite many multicenter trials on percutaneous coronary intervention (PCI), versus coronary artery bypass surgery (CABG), in multivessel coronary artery disease (MVCAD), the most appropriate treatment remains a matter of debate. Moreover, studies comparing the 2 strategies in eastern society are rare. The aim of this study was to assess the relative merits of PCI and CABG in MVCAD in the post-stent era. SUBJECTS AND METHODS: Patients, with MVCAD, indicated for revascularization were enrolled from 9 centers in Korea. Out of the 3,279 patients in the registry, 2102 (CABG 609 patients, PCI 1,493 patients) were selected for a comparison of their outcomes, after a statistical adjustments for the disparity for 6 independent risk factors, for the prognosis between the two groups. RESULTS: There was no significantly different in the 3 year survival rates between PCI and CABG groups. In the diabetic patients, the 3-year mortality rate in PCI group was 1.6-fold higher than in the CABG group, although it was not statistically significant (PCI 19.8%, CABG 12.5%, p=0.24). The incidence of cerebrovascular events (CVE) was higher in the CABG group. The thirty-day death rate, myocardial infarction or CVE were higher in the CABG group (PCI 1.3%, CABG 4.2%, p<0.001). Both the long and short-term revascularization rates were higher in PCI group compared to CABG group. CONCLUSION: Our Korean registry demonstrated a comparable survival rate between the PCI and CABG groups. A PCI was associated with a lower early morbidity, but with a greater need for repeated revascularization compared to a CABG.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass* ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Incidence ; Korea ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Prognosis ; Risk Factors ; Survival Rate

BACKGROUND AND OBJECTIVE: Abciximab has been shown to have beneficial effects beyond the improvement in the patency of an infarct-related artery and the microvascular integrity. However, it remains uncertain whether abciximab may lead to beneficial effects on the left ventricular remodeling in patients with an acute myocardial infarction, treated with primary percutaneous coronary intervention (PCI). Therefore, whether abciximab is effective in the left ventricular remodeling in patients with acute myocardial infarction, treated with primary PCI, was investigated. SUBJECTS AND METHODS: The study included 28 patients with an acute myocardial infarction (1 vessel disease) that had received either a primary PCI alone (group A, n=14) or an abciximab+primary PCI (group B, n=14). The baseline characteristics of the two groups were similar, with the exception of a thrombusburden lesion. All patients were examined by echocardiography within 72 hours, and at an average 11.7 months after the acute myocardial infarction. The change in the left ventricular end-diastolic volume index, end-systolic volume index and ejection fraction, between the two groups, were compared. RESULTS: At an average follow-up of 11.7 months, the left ventricular volume indices were smaller, and the left ventricular ejection fraction higher, compared with those at the baseline in each group. The change of the left ventricular end-diastolic volume index (-7+/-3 mL/m2 vs. -9+/-2 mL/m2, p=0.56), the left ventricular end-systolic volume index (-8+/-3 mL/m2 vs. -9+/-2 mL/m2, p=0.73) and the left ventricular ejection fraction (7+/-3% vs. 9+/-2%, p=0.49) did not show significant differences between groups A and B. CONCLUSION: These results suggest that abciximab does not improve the left ventricular remodeling in patient with an acute myocardial infarction, treated with primary PCI.
Arteries ; Echocardiography ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Platelet Aggregation Inhibitors ; Stroke Volume ; Ventricular Remodeling*

BACKGROUND AND OBJECTIVES: Compared to other target cells examined for gene therapy, vascular smooth muscle cells (VSMCs) have the unique advantages including proximity to blood stream and relative abundance in vasculature. With an ultimate goal of developing VSMC-based therapies for cardiovascular disorders, we explored the utility of VSMC as a target cell for ex vivo gene therapy using a set of retroviral vectors. MATERIALS AND METHODS: Cultured VSMCs were transduced with replication-defective recombinant retroviruses harboring LacZ, nlsLacZ, mVEGF, mGM-CSF or bacterial CAT reporter. The VSMCs were examined for G418-selection, transduction efficiency, the level of transgene expression, and longevity of gene expression. ResultsVSMCs were readily transduced with different kinds of retroviral vectors. The bacterial neo r gene-transduced VSMCs were successfully selected with G418. The G418-selected VSMCs could express the transduced genes at a level comparable to NIH3T3. The level of transgene expression did not appear to be affected by the increasing number of passages. CONCLUSION: The results demonstrate an efficient transduction of VSMCs by retroviral vectors in vitro and an sustained expression of retrovirally transduced genes in VSMCs. VSMCs could be one of the ideal target cells for ex vivo cardiovascular gene therapy employing retroviral vector.
Animals ; Cats ; Gene Expression ; Genetic Therapy* ; Longevity ; Muscle, Smooth, Vascular* ; Retroviridae ; Rivers ; Transgenes ; Zidovudine

Percutaneous catheter-based therapy has recently been introduced to decrease blood pressure by ablation of efferent and afferent sympathetic renal nerves. The patient described here had a seven-year history of hypertension and presented with poorly controlled blood pressure despite antihypertensive therapy with four different drugs. A 44-yr-old man underwent percutaneous renal denervation under local anesthesia using an ablation catheter. After six months of follow-up his blood pressure had dropped 49/37 mmHg with a decrease in 24-hr ambulatory BP of 20/18 mmHg. Renal Doppler ultrasound showed no significant stenosis in either renal artery. This is the first case of successful percutaneous renal denervation, which has recently become available in Korea.
Adult ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Heart Failure/complications ; Humans ; Hypertension/complications/*surgery ; Kidney/ultrasonography ; Male ; Renal Artery/radiography ; Republic of Korea ; Sympathectomy

This study was designed to assess the relative merits of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD), particularly for Korean diabetics. Among 3,279 patients with MVCAD who were recommended for revascularization were enrolled from nine centers in Korea, 2,154 were selected after statistical adjustments for the disparities between two groups. Survival rates were not significantly different for three years between two groups. Among diabetic patients, the three-year mortality rate in PCI group was 1.9-fold higher than that of CABG group, although it was not statistically significant (PCI 19.8%, CABG 11.4%, p=0.14). The three-year mortality rate was similar between the two groups in non-diabetics (PCI 8.3%, CABG 10.0%, p=0.50). The 30-day rate of cerebrovascular event was higher in CABG group, for both diabetic (CABG 3.6%, PCI 0.0%, p<0.001) and non-diabetic patients (CABG 2.4%, PCI 0.0%, p<0.001). Short- and long-term revascularization rates were higher in PCI group than in CABG group. As a conclusion, this Korean registry demonstrates that PCI was associated with comparable survival rates and lower short-term morbidity, but a greater requirement for repeated revascularization compared with CABG in Korean diabetics.
*Angioplasty, Transluminal, Percutaneous Coronary ; Comparative Study ; *Coronary Artery Bypass ; Coronary Disease/*therapy ; Diabetic Angiopathies/*therapy ; Humans ; *Registries ; Research Support, Non-U.S. Gov't ; Retrospective Studies ; Stents

BACKGROUND AND OBJECTIVES: Many western studies have shown that primary percutaneous transluminal coronary angioplasty (PTCA) may have better clinical result over thrombolytic therapy in patients with acute myocardial infarction. There are, however, few reports about the role of primary PTCA in Korea. We reviewed the cases of primary PTCA and thrombolysis with delayed PTCA in Samsung Medical Center to compare the clinical outcomes of two treatment modalities. MATERIALS AND METHOD: This study was a non-randomized and retrospective trial. From August 1995 to March 1998, 80 AMI patients within 12 hours of symptom onset underwent primary PTCA (n=26) or thrombolytic therapy (n=54) in Samsung Medical Center. Patients who had thrombolysis were performed coronary angiography fourth to fifth hospital day routinely. Risk factors and time to treatment (pain-to-needle time and door- to-needle time) were reviewed from patient record. Angiographic data including TIMI flow were obtained from angiography data base and angiographic film. We compared the 30-day and 8-month event rate of death, re-infarction, re-PTCA, and CABG between two groups. RESULTS: Baseline characteristics (sex, age, blood pressure, heart rate, AMI location, ejection fraction of left ventricle) were similar between two groups. There was no statistically significant difference in pain-to-needle time and door-to-needle time between two groups. The 30-day mortality rate was similar between two groups (primary group 3.8%, thrombolysis 5.6%, p=1.0). The 30-day event rate also showed no difference between two groups (primary PTCA 7.7%, thrombolysis 11.1%, p=1.0) and there was similar tendency in 8-month event rate (primary PTCA 19.2%, thrombolysis 14.8%, p=0.62). However, the admission duration of primary PTCA group was shorter than that of thrombolysis (8.7 vs 12 days, p=0.03). CONCLUSION: Primary PTCA have similar clinical outcome except shorter hospital admission duration when compared to thrombolysis with routine elective coronary angiography and delayed PTCA in AMI patients without cardiogenic shock.
Angiography ; Angioplasty, Balloon, Coronary ; Blood Pressure ; Coronary Angiography ; Heart Rate ; Humans ; Korea ; Mortality ; Myocardial Infarction* ; Retrospective Studies ; Risk Factors ; Shock, Cardiogenic ; Thrombolytic Therapy ; Time-to-Treatment