BACKGROUND: Coronary angioplasty has been replacing coronary artery bypass grafting (CABG) because of the relative advantage in terms of recovery time and noninvasiveness of the procedure. Compared to other Organization for Economic Cooperation and Development (OECD) countries, Korea has experienced a rapid increase in coronary angioplasty volumes. METHODS: We analyzed changes in procedure volumes of CABG and of percutaneous coronary intervention (PCI) from three sources: the OECD Health Data, the National Health Insurance Service (NHIS) surgery statistics, and the National Health Insurance claims data. RESULTS: We found the ratio of procedure volume of PCI to that of CABG per 100,000 population was 19.12 in 2014, which was more than triple the OECD average of 5.92 for the same year. According to data from NHIS statistics, this ratio was an increase from 11.4 to 19.3 between 2006 and 2013. CONCLUSION: We found that Korea has a higher ratio of total procedure volumes of PCI with respect to CABG and also a more rapid increase of volumes of PCI than other countries. Prospective studies are required to determine whether this increase in absolute volumes of PCI is a natural response to a real medical need or representative of medical overuse.
Administrative Claims, Healthcare ; Angioplasty ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Vessels* ; Korea ; Medical Overuse ; Myocardial Infarction ; National Health Programs ; Organisation for Economic Co-Operation and Development ; Percutaneous Coronary Intervention* ; Prospective Studies ; Quality of Health Care

BACKGROUND: The purpose of this study is to evaluate the concentration of cardiovascular surgical procedures in a metropolitan area and investigate the perception of specialists regarding governmental policies to resolve this imbalance. METHODS: From March to May 2015, surveys were distributed to members of the Thoracic and Cardiovascular Surgery Association. The final pool of research subjects consisted of 75 respondents. Subjects were queried regarding the concentration of cardiovascular operations in metropolitan areas, alternatives to the imbalance, and governmental policies to resolve the inequalities. RESULTS: Survey participants responded that South Korea needs governmental policies to alleviate the concentration of cardiovascular surgery patients in large metropolitan hospitals. Participants agreed that the freedom to choose medical institutions and improved accessibility to metropolitan hospitals due to advanced transportation systems were some of the causes for the concentration. A majority (98.7%) of respondents thought establishing thoracic and cardiovascular surgery centers in provinces was an appropriate solution to alleviate the concentration. Thoracic and cardiovascular surgery specialists were ranked as the number one group on which to focus development. CONCLUSION: Developing and carrying out policies to establish thoracic and cardiovascular surgery centers in provinces will alleviate the regional imbalance in available heart surgery services and an overall improvement in cardiovascular disease treatment in South Korea.
Cardiovascular Diseases ; Cardiovascular Surgical Procedures ; Decision Making ; Freedom ; Health Care Surveys ; Health Policy ; Hospitals, Urban ; Humans ; Korea ; Research Subjects ; Seoul* ; Socioeconomic Factors ; Specialization ; Surveys and Questionnaires ; Thoracic Surgery ; Transportation

BACKGROUND: The new Multidetector Computed Tomography (MDCT) is useful in visualization of complex coronary artery anatomy. We investigated usefulness comparing of invasive coronary angiography with noninvasive MDCT in judgment of functional degree of coronary arteries grafts after coronary artery bypass graft operation. MATERIAL AND METHOD: We analyzed the patency of 52 conduits from 15 patients whom consented to take both 32 Channel MDCT and coronary angiography from November 2003 to November 2004. Comparisons were performed for sensitivity, specificity, positive prediction value and negative prediction value between coronary angiography and 3 dimensional reconstruction image using MDCT. RESULT: The average graft used was 3.4+/-0.8 per patient. Average heart rate during MDCT was 86/minute (Range, 60~110/minute) without administration ofbeta-blocker. All patients could hold breath as much as necessary. The average graft patency obtained through coronary angiography was 96.2%. In MDCT group, the sensitivity, the specificity, the positive predictive value and the negative predictive value for diagnosis was 100%, 98.0%, 100% and 66.6% respectively. CONCLUSION: The effectiveness of 32 Channel MDCT may be compared to coronary angiography in grasping about patency and bloodstream of graft conduits after coronary artery bypass graft. Also MDCT has the advantage of noninvasiveness and inexpensiveness compared to coronary angiography.
Coronary Angiography* ; Coronary Artery Bypass* ; Coronary Vessels* ; Diagnosis ; Hand Strength ; Heart Rate ; Humans ; Judgment ; Multidetector Computed Tomography* ; Sensitivity and Specificity ; Transplants ; Vascular Patency

BACKGROUND: A perioperative myocardial infarction(PMI) is one of the major complications after CABG. Among diagnostic methods of PMI, CK-MB activity assays have been increasingly replaced by CK-MB mass assays, which have more sensitive, simple measurement. Also, new cardiac-specific and -sensitive marker, cardiac troponin I(cTnI), has been shown to be a marker of myocardial infarction. We report our evaluation of clinical significance of CK-MB mass and cTnI as a marker of PMI after CABG. MATERIAL AND METHOD: We studied 32 patients who underwent CABG at Kangdong Sacred Hospital between April 2000 and April 2001. Postoperative serum CK-MB activity level, serum CK-MB mass, cTnI, electrocardiogram, echocardiogram, and clinical data were recorded prospectively. The diagnosis of PMI was defined as positive 2 among 3 or all of the following ; by a new Q wave on the electrocardiogram, by serum CK-MB activity higher than 200 IU/L within 72 hours after operation, and by new regional wall motion abnormality on the echocardiogram. RESULT: After CABG, 3 patients had sustained a PMI according to current diagnostic criteria. As serum CK-MB activity time course, a level of CK-MB activity 12 hours after CABG had very linear correlated significance with serum CK-MB mass 24 hours(R=0.946) and cTnI 48 hours(R=0.933) after CABG(p=0.000). As we used a receiver operating characteristics curve(ROC curve) for a diagnostic cutoff value in patients with PMI, serum CK-MB mass levels higher than 30.05 ug/L 24 hours after CABG detected the presence of PMI with an area under the ROC curve of 1.0, a sensitivity of 100%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 100%. Also serum cTnI levels higher than 17.15 ug/L 48 hours after CABG detected the presence of PMI with an area under the ROC curve of 0.98, a sensitivity of 100%, a specificity of 96.6%, a positive predictive value of 75%, and a negative predictive value of 100%. CONCLUSION: We concluded that both the measurement of CK-MB mass and cTnI are the easier, accurate methods as a diagnostic marker of PMI after CABG, also as a proposal of diagnostic cutoff value enables to an early detection of PMI. However, a larger number of patient will be needed because of statistic limitation that a small number of participating patients, a small number of PMI.
Coronary Artery Bypass* ; Coronary Vessels* ; Creatine Kinase* ; Creatine* ; Diagnosis ; Electrocardiography ; Humans ; Myocardial Infarction* ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Troponin I* ; Troponin*

A 55 year old male was admitted for dyspnea. The patient was diagnosed as acute myocardiac infarction, and coronary artery bypass grafting was performed with cardiopulmonary bypass. At postoperative day #1, Systemic Inflammatory Response Syndrome was developed with fever, leukocytosis, tachycardia, tachypnea and low systemic vascular resistance. The patient was recovered after being treated with high dose of (36 microgram/min) norepinephrine, and was discharged.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Dyspnea ; Fever ; Heart* ; Humans ; Infarction ; Leukocytosis ; Male ; Middle Aged ; Norepinephrine ; Shock* ; Systemic Inflammatory Response Syndrome* ; Tachycardia ; Tachypnea ; Thoracic Surgery* ; Vascular Resistance

A 55 year old male was admitted for dyspnea. The patient was diagnosed as acute myocardiac infarction, and coronary artery bypass grafting was performed with cardiopulmonary bypass. At postoperative day #1, Systemic Inflammatory Response Syndrome was developed with fever, leukocytosis, tachycardia, tachypnea and low systemic vascular resistance. The patient was recovered after being treated with high dose of (36 microgram/min) norepinephrine, and was discharged.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Dyspnea ; Fever ; Heart* ; Humans ; Infarction ; Leukocytosis ; Male ; Middle Aged ; Norepinephrine ; Shock* ; Systemic Inflammatory Response Syndrome* ; Tachycardia ; Tachypnea ; Thoracic Surgery* ; Vascular Resistance

BACKGROUND: Although great concerns have been raised regarding the suitability of the use of the radial artery as a bypass conduit after transradial catheterization, there has been no studies that examined this issue in Korea. The purpose of this study was to compare clinical and angiographic results of radial artery grafting between patients with and without previous transradial catheterization. MATERIAL AND METHOD: From January 2000 to February 2004, a total of 93 patients underwent coronary artery bypass grafting using the radial artery: 49 patients received preoperative transradial catheterization for coronary angiography (group I) and 44 patients did not (group II). These patients were retrospectively reviewed. RESULT: There was no significant difference in sex ratio, age, clinical diagnosis, risk factors, ejection fraction and early clinical outcomes between two groups. The graft patency rates in groups I and II were both 100% in the internal thoracic artery and in the radial artery, and 85% and 86% in the saphenous vein. respectively. The stenosis-free graft patency in groups I and II were 93% and 81% in the radial artery respectively but no statistical significance was shown. CONCLUSION: There was no significant difference in graft patency at postoperative coronary angiography between two groups. Radial artery graft after transradial catherization seems to be suitable for bypass conduit in short-term analysis.
Cardiac Catheterization ; Catheterization* ; Catheters* ; Coronary Angiography ; Coronary Artery Bypass ; Diagnosis ; Humans ; Korea ; Mammary Arteries ; Radial Artery* ; Retrospective Studies ; Risk Factors ; Saphenous Vein ; Sex Ratio ; Transplants* ; Vascular Patency

BACKGROUND: Although great concerns have been raised regarding the suitability of the use of the radial artery as a bypass conduit after transradial catheterization, there has been no studies that examined this issue in Korea. The purpose of this study was to compare clinical and angiographic results of radial artery grafting between patients with and without previous transradial catheterization. MATERIAL AND METHOD: From January 2000 to February 2004, a total of 93 patients underwent coronary artery bypass grafting using the radial artery: 49 patients received preoperative transradial catheterization for coronary angiography (group I) and 44 patients did not (group II). These patients were retrospectively reviewed. RESULT: There was no significant difference in sex ratio, age, clinical diagnosis, risk factors, ejection fraction and early clinical outcomes between two groups. The graft patency rates in groups I and II were both 100% in the internal thoracic artery and in the radial artery, and 85% and 86% in the saphenous vein. respectively. The stenosis-free graft patency in groups I and II were 93% and 81% in the radial artery respectively but no statistical significance was shown. CONCLUSION: There was no significant difference in graft patency at postoperative coronary angiography between two groups. Radial artery graft after transradial catherization seems to be suitable for bypass conduit in short-term analysis.
Cardiac Catheterization ; Catheterization* ; Catheters* ; Coronary Angiography ; Coronary Artery Bypass ; Diagnosis ; Humans ; Korea ; Mammary Arteries ; Radial Artery* ; Retrospective Studies ; Risk Factors ; Saphenous Vein ; Sex Ratio ; Transplants* ; Vascular Patency

BACKGROUND: The indications of closed thoracostomy drainage in management of primary spontaneous pneumothorax is well known, but there is no special specification for the size to be inserted. Recently, various minimally invasive operational techniques have been introduced and researched. According to the trend, we tried to ascertain the efficacy of 12 Fr. chest tubes instead of the existing 24 Fr. chest tubes. MATERIAL AND METHOD: Patients who were younger than 30 years old and diagnosed as primary spontaneous pneumothorax and treated with closed thoracostomy drainage were enrolled in this study. We retrospectively compared group A who were drained with 24 Fr. chest tubes from January to May 2003 with group B with 12 Fr. chest tubes from November 2003 to April 2004 on procedure time for closed thoracostomy drainage, duration of chest tube drain, duration of hospital stay, complication, and recurrence. RESULT: The male to female ratio was 16:3 in group A and 18:2 in group B. The mean age of patients of group A was 21.7+/-4.0 and group B was 20.0+/-3.7. The mean procedure time for closed thoracostomy drainage in group A (21.6+/-2.9 minutes) was significantly longer than group B (10.8+/-1.9 minutes)(p<0.05). The mean duration of chest tube drain was 3.8+/-1.7 days in group A and 4.3+/-2.2 in group B, and the mean duration of hospital stay was 5.6+/-1.9 days in group A and 5.2+/-1.5 days in group B. There was no complication in both groups and 6 cases in group A (35%) and 5 cases in group B (25%) were operated because of recurrence and persistent air leakage. In conclusion, there was no statistical difference except for the procedure time for closed thoracostomy drainage between two groups. CONCLUSION: We concluded that there were no significant differences in efficacy between 12 Fr. chest tube and 24 Fr. chest tube in closed thoracostomy drainage for primary spontaneous pneumothorax and we found advantages of 12 Fr. chest tube in shortening procedure time because of easy and simple techniques.
Adult ; Chest Tubes ; Drainage* ; Female ; Humans ; Length of Stay ; Male ; Pneumothorax* ; Recurrence ; Retrospective Studies ; Thoracostomy*

BACKGROUND: The indications of closed thoracostomy drainage in management of primary spontaneous pneumothorax is well known, but there is no special specification for the size to be inserted. Recently, various minimally invasive operational techniques have been introduced and researched. According to the trend, we tried to ascertain the efficacy of 12 Fr. chest tubes instead of the existing 24 Fr. chest tubes. MATERIAL AND METHOD: Patients who were younger than 30 years old and diagnosed as primary spontaneous pneumothorax and treated with closed thoracostomy drainage were enrolled in this study. We retrospectively compared group A who were drained with 24 Fr. chest tubes from January to May 2003 with group B with 12 Fr. chest tubes from November 2003 to April 2004 on procedure time for closed thoracostomy drainage, duration of chest tube drain, duration of hospital stay, complication, and recurrence. RESULT: The male to female ratio was 16:3 in group A and 18:2 in group B. The mean age of patients of group A was 21.7+/-4.0 and group B was 20.0+/-3.7. The mean procedure time for closed thoracostomy drainage in group A (21.6+/-2.9 minutes) was significantly longer than group B (10.8+/-1.9 minutes)(p<0.05). The mean duration of chest tube drain was 3.8+/-1.7 days in group A and 4.3+/-2.2 in group B, and the mean duration of hospital stay was 5.6+/-1.9 days in group A and 5.2+/-1.5 days in group B. There was no complication in both groups and 6 cases in group A (35%) and 5 cases in group B (25%) were operated because of recurrence and persistent air leakage. In conclusion, there was no statistical difference except for the procedure time for closed thoracostomy drainage between two groups. CONCLUSION: We concluded that there were no significant differences in efficacy between 12 Fr. chest tube and 24 Fr. chest tube in closed thoracostomy drainage for primary spontaneous pneumothorax and we found advantages of 12 Fr. chest tube in shortening procedure time because of easy and simple techniques.
Adult ; Chest Tubes ; Drainage* ; Female ; Humans ; Length of Stay ; Male ; Pneumothorax* ; Recurrence ; Retrospective Studies ; Thoracostomy*