1.Comparison of Short- and Long-Term Dual-Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: One-Year Outcomes
Jun-Hyok OH ; Jinmi KIM ; Jeong-Su KIM ; Hye Won LEE ; Sun Hack LEE ; Jeong Cheon CHOE ; Min Sun KIM ; Jinhee AHN ; Jung Hyun CHOI ; Han Cheol LEE ; Kwang Soo CHA
Journal of Korean Medical Science 2024;39(47):e294-
Background:
The optimal duration and net clinical benefit of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) have not been elucidated in realworld situations.
Methods:
Using nationwide claims data from 2013 to 2021, we selected patients who underwent TAVR and categorized them into two groups: short- and long-term (≤ 3 and > 3 months, respectively) DAPT group. Propensity score matching was used to balance baseline characteristics. The primary endpoint was the occurrence of net adverse clinical events (NACEs), including all-cause death, myocardial infarction, stroke, any coronary and peripheral revascularization, systemic thromboembolism, and bleeding events, at 1 year. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards regression.
Results:
Patients who met the inclusion criteria (1,695) were selected. Propensity score matching yielded 1,215 pairs of patients: 416 and 799 in the short- and long-term DAPT groups, respectively. In the unmatched cohort, the mean ages were 79.8 ± 6.1 and 79.7 ± 5.8 years for the short- and long-term DAPT groups, respectively. In the matched cohort, the mean ages were 80.6 ± 5.9 and 79.9 ± 5.9 years for the short- and long-term DAPT groups, respectively. Over one year in the unmatched cohort, the NACE incidence was 11.9% and 11.5% in the short- and long-term DAPT groups, respectively (P = 0.893). The all-cause mortality rates were 7.4% and 4.7% (P = 0.042), composite ischemic event rates were 2.5% and 4.7% (P = 0.056), and bleeding event rates were 2.7% and 4.7% (P = 0.056) in the shortand long-term groups, respectively. In the matched cohort, the incidence of NACE was 9.6% in the short-term DAPT group and 11.6% in the long-term DAPT group, respectively (P = 0.329).The all-cause mortality rates were 6.5% and 4.9% (P = 0.298), composite ischemic event rates were 1.4% and 4.5% (P = 0.009), and bleeding event rates were 2.2% and 4.4% (P = 0.072) in the short- and long-term groups, respectively.
Conclusion
In patients who successfully underwent transfemoral TAVR, the short- and longterm DAPT groups exhibited similar one-year NACE rates. However, patients in the long-term DAPT group experienced more bleeding and ischemic events.
2.Comparison of Short- and Long-Term Dual-Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: One-Year Outcomes
Jun-Hyok OH ; Jinmi KIM ; Jeong-Su KIM ; Hye Won LEE ; Sun Hack LEE ; Jeong Cheon CHOE ; Min Sun KIM ; Jinhee AHN ; Jung Hyun CHOI ; Han Cheol LEE ; Kwang Soo CHA
Journal of Korean Medical Science 2024;39(47):e294-
Background:
The optimal duration and net clinical benefit of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) have not been elucidated in realworld situations.
Methods:
Using nationwide claims data from 2013 to 2021, we selected patients who underwent TAVR and categorized them into two groups: short- and long-term (≤ 3 and > 3 months, respectively) DAPT group. Propensity score matching was used to balance baseline characteristics. The primary endpoint was the occurrence of net adverse clinical events (NACEs), including all-cause death, myocardial infarction, stroke, any coronary and peripheral revascularization, systemic thromboembolism, and bleeding events, at 1 year. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards regression.
Results:
Patients who met the inclusion criteria (1,695) were selected. Propensity score matching yielded 1,215 pairs of patients: 416 and 799 in the short- and long-term DAPT groups, respectively. In the unmatched cohort, the mean ages were 79.8 ± 6.1 and 79.7 ± 5.8 years for the short- and long-term DAPT groups, respectively. In the matched cohort, the mean ages were 80.6 ± 5.9 and 79.9 ± 5.9 years for the short- and long-term DAPT groups, respectively. Over one year in the unmatched cohort, the NACE incidence was 11.9% and 11.5% in the short- and long-term DAPT groups, respectively (P = 0.893). The all-cause mortality rates were 7.4% and 4.7% (P = 0.042), composite ischemic event rates were 2.5% and 4.7% (P = 0.056), and bleeding event rates were 2.7% and 4.7% (P = 0.056) in the shortand long-term groups, respectively. In the matched cohort, the incidence of NACE was 9.6% in the short-term DAPT group and 11.6% in the long-term DAPT group, respectively (P = 0.329).The all-cause mortality rates were 6.5% and 4.9% (P = 0.298), composite ischemic event rates were 1.4% and 4.5% (P = 0.009), and bleeding event rates were 2.2% and 4.4% (P = 0.072) in the short- and long-term groups, respectively.
Conclusion
In patients who successfully underwent transfemoral TAVR, the short- and longterm DAPT groups exhibited similar one-year NACE rates. However, patients in the long-term DAPT group experienced more bleeding and ischemic events.
3.Comparison of Short- and Long-Term Dual-Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: One-Year Outcomes
Jun-Hyok OH ; Jinmi KIM ; Jeong-Su KIM ; Hye Won LEE ; Sun Hack LEE ; Jeong Cheon CHOE ; Min Sun KIM ; Jinhee AHN ; Jung Hyun CHOI ; Han Cheol LEE ; Kwang Soo CHA
Journal of Korean Medical Science 2024;39(47):e294-
Background:
The optimal duration and net clinical benefit of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) have not been elucidated in realworld situations.
Methods:
Using nationwide claims data from 2013 to 2021, we selected patients who underwent TAVR and categorized them into two groups: short- and long-term (≤ 3 and > 3 months, respectively) DAPT group. Propensity score matching was used to balance baseline characteristics. The primary endpoint was the occurrence of net adverse clinical events (NACEs), including all-cause death, myocardial infarction, stroke, any coronary and peripheral revascularization, systemic thromboembolism, and bleeding events, at 1 year. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards regression.
Results:
Patients who met the inclusion criteria (1,695) were selected. Propensity score matching yielded 1,215 pairs of patients: 416 and 799 in the short- and long-term DAPT groups, respectively. In the unmatched cohort, the mean ages were 79.8 ± 6.1 and 79.7 ± 5.8 years for the short- and long-term DAPT groups, respectively. In the matched cohort, the mean ages were 80.6 ± 5.9 and 79.9 ± 5.9 years for the short- and long-term DAPT groups, respectively. Over one year in the unmatched cohort, the NACE incidence was 11.9% and 11.5% in the short- and long-term DAPT groups, respectively (P = 0.893). The all-cause mortality rates were 7.4% and 4.7% (P = 0.042), composite ischemic event rates were 2.5% and 4.7% (P = 0.056), and bleeding event rates were 2.7% and 4.7% (P = 0.056) in the shortand long-term groups, respectively. In the matched cohort, the incidence of NACE was 9.6% in the short-term DAPT group and 11.6% in the long-term DAPT group, respectively (P = 0.329).The all-cause mortality rates were 6.5% and 4.9% (P = 0.298), composite ischemic event rates were 1.4% and 4.5% (P = 0.009), and bleeding event rates were 2.2% and 4.4% (P = 0.072) in the short- and long-term groups, respectively.
Conclusion
In patients who successfully underwent transfemoral TAVR, the short- and longterm DAPT groups exhibited similar one-year NACE rates. However, patients in the long-term DAPT group experienced more bleeding and ischemic events.
4.Comparison of Short- and Long-Term Dual-Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: One-Year Outcomes
Jun-Hyok OH ; Jinmi KIM ; Jeong-Su KIM ; Hye Won LEE ; Sun Hack LEE ; Jeong Cheon CHOE ; Min Sun KIM ; Jinhee AHN ; Jung Hyun CHOI ; Han Cheol LEE ; Kwang Soo CHA
Journal of Korean Medical Science 2024;39(47):e294-
Background:
The optimal duration and net clinical benefit of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) have not been elucidated in realworld situations.
Methods:
Using nationwide claims data from 2013 to 2021, we selected patients who underwent TAVR and categorized them into two groups: short- and long-term (≤ 3 and > 3 months, respectively) DAPT group. Propensity score matching was used to balance baseline characteristics. The primary endpoint was the occurrence of net adverse clinical events (NACEs), including all-cause death, myocardial infarction, stroke, any coronary and peripheral revascularization, systemic thromboembolism, and bleeding events, at 1 year. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards regression.
Results:
Patients who met the inclusion criteria (1,695) were selected. Propensity score matching yielded 1,215 pairs of patients: 416 and 799 in the short- and long-term DAPT groups, respectively. In the unmatched cohort, the mean ages were 79.8 ± 6.1 and 79.7 ± 5.8 years for the short- and long-term DAPT groups, respectively. In the matched cohort, the mean ages were 80.6 ± 5.9 and 79.9 ± 5.9 years for the short- and long-term DAPT groups, respectively. Over one year in the unmatched cohort, the NACE incidence was 11.9% and 11.5% in the short- and long-term DAPT groups, respectively (P = 0.893). The all-cause mortality rates were 7.4% and 4.7% (P = 0.042), composite ischemic event rates were 2.5% and 4.7% (P = 0.056), and bleeding event rates were 2.7% and 4.7% (P = 0.056) in the shortand long-term groups, respectively. In the matched cohort, the incidence of NACE was 9.6% in the short-term DAPT group and 11.6% in the long-term DAPT group, respectively (P = 0.329).The all-cause mortality rates were 6.5% and 4.9% (P = 0.298), composite ischemic event rates were 1.4% and 4.5% (P = 0.009), and bleeding event rates were 2.2% and 4.4% (P = 0.072) in the short- and long-term groups, respectively.
Conclusion
In patients who successfully underwent transfemoral TAVR, the short- and longterm DAPT groups exhibited similar one-year NACE rates. However, patients in the long-term DAPT group experienced more bleeding and ischemic events.
5.Fracture of the Femoral Component after Total Knee Arthroplasty Using Anterior-Posterior Glide Mobile-Bearing System
Kwang-Hwan JUNG ; Sung-Cheon NA ; So-Yeon CHOI ; Ki-Bong PARK
The Journal of the Korean Orthopaedic Association 2022;57(4):339-344
The authors diagnosed femoral component fracture after total knee arthroplasty (TKA) using an anterior-posterior glide mobile-bearing system in a 78-year-old female patient who visited with severe pain and flexion limitations in the left knee and performed revision TKA. The fracture of the femoral component after TKA is a rare complication, and various factors cause the fracture of the femoral component. This case is reported along with a literature review.
6.Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvement
Jihoon KANG ; Seong-Eun KIM ; Hong-Kyun PARK ; Yong-Jin CHO ; Jun Yup KIM ; Keon-Joo LEE ; Jong-Moo PARK ; Kwang-Yeol PARK ; Kyung Bok LEE ; Soo Joo LEE ; Ji Sung LEE ; Juneyoung LEE ; Ki Hwa YANG ; Ah Rum CHOI ; Mi Yeon KANG ; Nack-Cheon CHOI ; Philip B. GORELICK ; Hee-Joon BAE
Journal of Korean Medical Science 2020;35(41):e347-
Background:
To track triage, routing, and treatment status regarding access to endovascular treatment (EVT) after acute ischemic stroke (AIS) at a national level.
Methods:
From national stroke audit data, potential candidates for EVT arriving within 6 hours with National Institute of Health Stroke Scale score of ≥ 7 were identified. Acute care hospitals were classified as thrombectomy-capable hospitals (TCHs, ≥ 15 EVT cases/year) or primary stroke hospital (PSH, < 15 cases/year), and patients' initial routes and subsequent inter-hospital transfer were described. Impact of initial routing to TCHs vs. PSHs on EVT and clinical outcomes were analyzed using multilevel generalized mixed effect models.
Results:
Out of 14,902 AIS patients, 2,180 (14.6%) were EVT candidates. Eighty-one percent of EVT candidates were transported by ambulance, but only one-third were taken initially to TCHs. Initial routing to TCHs was associated with greater chances of receiving EVT compared to initial routing to PSHs (33.3% vs 12.1%, P < 0.001; adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.59–2.92) and favorable outcome (38.5% vs. 28.2%, P < 0.001; aOR, 1.52; 95% CI, 1.16–2.00). Inter-hospital transfers to TCHs occurred in 17.4% of those initially routed to a PSH and was associated with the greater chance of EVT compared to remaining at PSHs (34.8% vs. 7.5%, P < 0.001), but not with better outcomes.
Conclusion
Two-thirds of EVT candidates were initially routed to PSHs despite greater chance of receiving EVT and having favorable outcomes if routed to a TCH in Korea. Process improvement is needed to direct appropriate patients to TCHs.
7.Induction of Melanoma Cell-Selective Apoptosis Using Anti-HER2 Antibody-Conjugated Gold Nanoparticles
Hyeon Jun JEON ; Byul Bo Ra CHOI ; Kwang Ha PARK ; Dae Seok HWANG ; Uk Kyu KIM ; Gyoo Cheon KIM
Yonsei Medical Journal 2019;60(6):509-516
PURPOSE: This study was conducted to verify the induction and mechanism of selective apoptosis in G361 melanoma cells using anti-HER2 antibody-conjugated gold nanoparticles (GNP-HER2). MATERIALS AND METHODS: Following GNP-HER2 treatment of G361 cells, cell cycle arrest and apoptosis were measured by WST-1 assay, Hemacolor staining, Hoechst staining, immunofluorescence staining, fluorescence-activated cell sorting analysis, and Western blotting.
Actins
;
Apoptosis Inducing Factor
;
Apoptosis
;
Blotting, Western
;
Caspase 3
;
Caspases
;
Cell Adhesion
;
Cell Cycle
;
Cell Cycle Checkpoints
;
Cell Death
;
Cyclin A
;
Cyclin D1
;
Cyclin E
;
Cyclins
;
Cytochromes c
;
Cytoplasm
;
DNA Fragmentation
;
Down-Regulation
;
Flow Cytometry
;
Fluorescent Antibody Technique
;
Focal Adhesions
;
Melanoma
;
Mitochondria
;
Nanoparticles
;
Phosphotransferases
;
Receptor, Epidermal Growth Factor
;
Up-Regulation
8.Normal Reference Plots for the Bioelectrical Impedance Vector in Healthy Korean Adults
Jun Hyok OH ; Seunghwan SONG ; Harin RHEE ; Sun Hack LEE ; Doo Youp KIM ; Jeong Cheon CHOE ; Jinhee AHN ; Jin Sup PARK ; Myung Jun SHIN ; Yun Kyung JEON ; Hye Won LEE ; Jung Hyun CHOI ; Han Cheol LEE ; Kwang Soo CHA
Journal of Korean Medical Science 2019;34(30):e198-
BACKGROUND: Accurate volume measurement is important in the management of patients with congestive heart failure or renal insufficiency. A bioimpedance analyser can estimate total body water in litres and has been widely used in clinical practice due to its non-invasiveness and ease of results interpretation. To change impedance data to volumetric data, bioimpedance analysers use equations derived from data from healthy subjects, which may not apply to patients with other conditions. Bioelectrical impedance vector analysis (BIVA) was developed to overcome the dependence on those equations by constructing vector plots using raw impedance data. BIVA requires normal reference plots for the proper interpretation of individual vectors. The aim of this study was to construct normal reference vector plots of bioelectrical impedance for Koreans. METHODS: Bioelectrical impedance measurements were collected from apparently healthy subjects screened according to a comprehensive physical examination and medical history performed by trained physicians. Reference vector contours were plotted on the RXc graph using the probability density function of the bivariate normal distribution. We further compared them with those of other ethnic groups. RESULTS: A total of 242 healthy subjects aged 22 to 83 were recruited (137 men and 105 women) between December 2015 and November 2016. The centers of the tolerance ellipses were 306.3 Ω/m and 34.9 Ω/m for men and 425.6 Ω/m and 39.7 Ω/m for women. The ellipses were wider for women than for men. The confidence ellipses for Koreans were located between those for Americans and Spaniards without overlap for both genders. CONCLUSION: This study presented gender-specific normal reference BIVA plots and corresponding tolerance and confidence ellipses on the RXc graph, which is important for the interpretation of BIA-reported volume status in patients with congestive heart failure or renal insufficiency. There were noticeable differences in reference ellipses with regard to gender and ethnic groups.
Adult
;
Blood Volume
;
Body Fluid Compartments
;
Body Water
;
Electric Impedance
;
Ethnic Groups
;
Female
;
Healthy Volunteers
;
Heart Failure
;
Humans
;
Male
;
Physical Examination
;
Renal Insufficiency
9.Erratum: Correction of Figure in the Article: Normal Reference Plots for the Bioelectrical Impedance Vector in Healthy Korean Adults
Jun Hyok OH ; Seunghwan SONG ; Harin RHEE ; Sun Hack LEE ; Doo Youp KIM ; Jeong Cheon CHOE ; Jinhee AHN ; Jin Sup PARK ; Myung Jun SHIN ; Yun Kyung JEON ; Hye Won LEE ; Jung Hyun CHOI ; Han Cheol LEE ; Kwang Soo CHA
Journal of Korean Medical Science 2019;34(35):e242-
The present erratum notice corrects one figure of the article.
10.Safety and Efficacy of an Aortic Arch Stent Graft with Window-Shaped Fenestration for Supra-Aortic Arch Vessels: an Experimental Study in Swine.
Jong Ha PARK ; Han Cheol LEE ; Jeong Cheon CHOE ; Sang Pil KIM ; Tae Sik PARK ; Jinhee AHN ; Jin Sup PARK ; Hye Won LEE ; Jun Hyok OH ; Jung Hyun CHOI ; Kwang Soo CHA
Korean Circulation Journal 2017;47(2):215-221
BACKGROUND AND OBJECTIVES: Thoracic endovascular aortic repair exhibits limitations in cases where the aortic pathology involves the aortic arch. We had already developed a fenestrated aortic stent graft (FASG) with a preloaded catheter for aortic pathology involving the aortic arch. FASG was suitable for elective cases. MATERIALS AND METHODS: An aortic arch stent graft with a window-shaped fenestration (FASG-W) for supra-aortic arch vessels is suitable for emergent cases. This study aims to test a FASG-W for supra-aortic arch vessels and to perform a preclinical study in swine to evaluate the safety and efficacy of this device. Six FASG-Ws with 1 preloaded catheter were advanced through the iliac artery in 6 swine. The presence of endoleak and the patency and deformity of the grafts were examined with computed tomography (CT) at 4 weeks postoperatively. A postmortem examination was performed at 8 weeks. The mean procedure time for FASG-W was 27.15±4.02 minutes. The mean time for the selection of the right carotid artery was 5.72±0.72 minutes. RESULTS: Major adverse events were not observed in any of the 6 pigs who survived for 8 weeks. For the FASG-W, no endoleaks, no disconnection, and no occlusion of the stent grafts were observed in the CT findings or the postmortem gross findings. CONCLUSION: The procedure with the FASG-W was able to be performed safely in a relatively short procedure time and involved an easy technique. The FASG-W was found to be safe and convenient for use in this preclinical study of swine.
Animal Experimentation
;
Aorta, Thoracic*
;
Aortic Aneurysm, Thoracic
;
Aortic Diseases
;
Autopsy
;
Blood Vessel Prosthesis*
;
Carotid Arteries
;
Catheters
;
Congenital Abnormalities
;
Endoleak
;
Iliac Artery
;
Pathology
;
Stents*
;
Swine*
;
Transplants

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