BACKGROUND: Cardiogenic shock (CS) after acute myocardial infarction (AMI) develops in 5~10% of patients and it is associated with high mortality. The aim of this study is to assess the predictive factors of mortality for patients with AMI and CS. METHODS: Two hundred fifty five AMI patients with CS (the mean age was 66.0 +/- 11.0 years, M: F=156: 99) out of 1, 268 AMI patients who admitted at Chonnam National University Hospital between July 2000 and June 2002 were analyzed according to the clinical characteristics, coronary angiographic findings and MACE during admission and for the 1-year clinical follow-up. RESULTS: Among the enrolled patients, 129 patients survived without MACE (Group I, mean age 64.2 +/- 10.6 years, M: F=76: 53), and 126 patients had MACE (Group II, mean age 68.1 +/- 10.0 years, M: F=80: 46) during admission or during the 1-year follow-up period. There were significant differences in age between the Groups I and II (64.2 +/- 10.6 vs. 68.1 +/- 11.0 years, respectively, p=0.004) and the previous MI history (0 vs. 17.4%, respectively, p< 0.001). The left ventricular ejection fraction (EF) was lower in Group II (Group I vs. II: 49.1 +/- 13.0 vs. 39.1 +/- 12.9%, p< 0.001). The levels of troponin (Tn) I and C-reactive protein (CRP) were higher in Group II (Group I vs. II: 29.2 +/- 7.72 vs. 50.8 +/- 5.17 ng/dL, p=0.017, 3.8 +/- 0.48 vs. 9.9 +/- 1.21 mg/dL, p< 0.001 respectively). Left main stem lesion (LMSL) was more common in Group II than in Group I (0.7% vs. 22.0%, respectively, p=0.004). In-hospital death was associated with low Thrombolysis In Myocardial Infarction (TIMI) flow after coronary revascularization. CONCLUSION: Old age, a previous MI history, high Tn and CRP, low EF and LMSL are associated with higher MACE for patients with AMI and CS. Coronary revascularization with TIMI 3 flow lowers the in-hospital mortality.
Aged ; Female ; Hospital Mortality ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Myocardial Infarction/complications/*mortality ; Prognosis ; Shock, Cardiogenic/etiology/*mortality

BACKGROUNDThe most appropriate surgical approach for patients with post-infarction left ventricular (LV) aneurysm remains undetermined. We compared the efficacy of the linear versus patch repair techniques, and investigated the mid-term changes of LV geometry and cardiac function, for repair of LV aneurysms.

METHODSWe reviewed the records of 194 patients who had surgery for a post-infarction LV aneurysm between 1998 and 2010. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. LV end-diastolic and systolic dimensions (LVEDD and LVESD), LV end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI) and LV ejection fraction (LVEF) were measured on pre-operative and follow-up echocardiography.

RESULTSOverall in-hospital mortality was 4.12%, and major morbidity showed no significant differences between the two groups. Multivariate analysis identified preoperative left ventricular end diastolic pressure > 20 mmHg, low cardiac output and aortic clamping time > 2 hours as risk factors for early mortality. Follow-up revealed that LVEF improved from 37% pre-operation to 45% 12 months post-operation in the patch group (P = 0.008), and from 44% pre-operation to 40% 12 months postoperation in the linear group (P = 0.032). In contrast, the LVEDVI and LVESVI in the linear group were significantly reduced immediately after the operation, and increased again at follow-up. However, in the patch group, the LVEDVI and LVESVI were significantly reduced at follow-up. And there were significant differences in the correct value changes of LVEF and left ventricular remodeling between linear repair and patch groups.

CONCLUSIONSPersistent reduction of LV dimensions after the patch repair procedure seems to be a procedure-related problem. The choice of the technique should be tailored on an individual basis and surgeon's preference. The patch remodeling technique results in a better LVEF improvement, further significant reductions in LV dimensions and volumes than does the linear repair technique. The results suggest that LV patch remodeling is a better surgical choice for patients with post-infarction LV aneurysm.

Aged ; Female ; Heart Aneurysm ; etiology ; mortality ; surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; surgery ; Ventricular Remodeling

The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.
Acute Disease ; Age Factors ; Aged ; Cerebrovascular Disorders/etiology ; Diabetes Mellitus/etiology ; Female ; Heart Failure/etiology ; Hospital Mortality ; Humans ; Hyperlipidemias/etiology ; Hypertension/*complications ; Male ; Middle Aged ; Myocardial Infarction/complications/*mortality/therapy ; Peripheral Vascular Diseases/etiology ; Predictive Value of Tests ; Registries ; Sex Factors

BACKGROUNDCardiac arrest is one of the most serious complications of acute myocardial infarction (AMI), especially in the out-of-hospital patients. There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA). In our study, we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality, adverse cardiac events, stroke, acute renal failure, and gastrointestinal bleeding events.

METHODSA total of 1827 STEMI patients were enrolled in this study, where 81 were STEMI with OHCA. Between the patients with and without OHCA, and the OHCA patients with and without PCI, we compared the clinical characteristics during hospitalization, including total mortality and incidences of adverse cardiac events, and stroke.

RESULTSCompared to the patients without OHCA, the OHCA patients had significantly lower systolic blood pressure (P < 0.05) and a faster heart rate (P < 0.05), and a higher percentage of Killip class IV or Glasgow coma scale (GCS) ≤ 7 on admission (P < 0.001). And the in-hospital mortality was higher in the OHCA patients (55.6% vs. 2.4%, P < 0.001). Comparing the OHCA patients without PCI to the patients with PCI, there was no obvious difference of heart rate, blood pressure or the percentage of Killip class IV and GCS ≤ 7 on admission, but the incidences of cardiogenic shock, stroke were significantly lower in the with-PCI group during hospitalization (P < 0.001, P < 0.05). And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower (36.7% vs. 84.3%, P < 0.001).

CONCLUSIONSDuring hospitalization, the incidence of adverse events and mortality are higher in the STEMI with OHCA patients, comparing with the STEMI without OHCA. Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization, which is effective for treating STEMI with OHCA patients.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Electrocardiography ; Emergencies ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; therapy ; Out-of-Hospital Cardiac Arrest ; etiology

Intravascular ultrasound (IVUS) is a useful diagnostic method that provides valuable information in addition to angiography regarding the coronary vessel lumen, dimensions, plaque burden, and characteristics. The major use of IVUS in coronary intervention is to guide interventional strategies and assess optimal stent deployment. Since the introduction of the drug-eluting stent (DES), concerns about restenosis have decreased. However, high-risk lesion subsets are being routinely treated with DESs, and the incidence of suboptimal results after stent deployment, such as stent underexpansion, incomplete stent apposition, edge dissection, geographic miss, and the risk of stent thrombosis, have correspondingly increased. Thus, optimization of stent deployment under IVUS guidance may be clinically important. In this review, we focus on the potential role of IVUS in stent optimization during percutaneous coronary intervention and its clinical benefits.
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation/mortality ; Coronary Artery Disease/mortality/*therapy/*ultrasonography ; Coronary Restenosis/etiology ; Drug-Eluting Stents ; Evidence-Based Medicine ; Humans ; Myocardial Infarction/etiology ; Prosthesis Design ; *Stents ; Thrombosis/etiology ; Treatment Outcome ; *Ultrasonography, Interventional

Whether arterial conduits are superior to venous grafts in coronary artery bypassing has been debated. The aim of this study was to investigate clinical outcomes after total arterial revascularization versus conventional coronary bypassing using both arterial and venous conduits in isolated three-vessel coronary disease. Between 2003 and 2005, 503 patients who underwent isolated coronary artery bypass grafting for three-vessel coronary disease were enrolled. A total of 117 patients underwent total arterial revascularization (Artery group) whereas 386 patients were treated with arterial and venous conduits (Vein group). Major adverse outcomes (death, myocardial infarction, stroke and repeat revascularization) were compared. Clinical follow-up was complete in all patients with a mean duration of 6.1 +/- 0.9 yr. After adjustment for differences in baseline risk factors, risks of death (hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.51-1.82, P = 0.90), myocardial infarction (HR 0.20, 95% CI 0.02-2.63, P = 0.22), stroke (HR 1.29, 95% CI 0.35-4.72, P = 0.70), repeat revascularization (HR 0.64, 95% CI 0.26-1.55, P = 0.32) and the composite outcomes (HR 0.83, 95% CI 0.50-1.36, P = 0.45) were similar between two groups. Since the use of veins does not increase the risks of adverse outcomes compared with total arterial revascularization, a selection of the conduit should be more liberal.
Aged ; Cohort Studies ; *Coronary Artery Bypass ; Coronary Disease/complications/mortality/*surgery ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Revascularization ; Prospective Studies ; Risk Factors ; Stroke/etiology ; Treatment Outcome

BACKGROUNDSome larger scale, randomized studies have demonstrated the superiority of drug-eluting stents (DES) over bare metal stents (BMS) for the treatment of acute myocardial infarction (AMI). This study aimed to investigate the impact of DES, in comparison with BMS, on the 2-year clinical outcomes in patients with ST-elevation myocardial infarction (STEMI).

METHODSFrom January 2002 to December 2008, a total of 1301 consecutive STEMI patients treated with coronary stenting in Shenyang Northern Hospital were prospectively registered. Patients received BMS (n = 868) or DES (n = 435) implantation in the infarction related artery according to physician's discretion. A propensity score analysis was performed and two well matched subgroups were selected (BMS, n = 288; DES, n = 288) to evaluate the 2-year clinical outcomes. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, myocardial infarction (MI), or target vessel revascularization (TVR).

RESULTSSurvival salvage analysis showed that 2-year cumulative hazards were not significantly different between the two groups with respect to TVR (2.8% vs. 3.1%, log-rank P = 0.780), stent thrombosis (1.7% vs. 4.2%, log-rank P = 0.079) and MACE (8% vs. 10.8%, log-rank P = 0.236). Multivariate analysis showed that DES was an independent protective factor of MI (HR: 0.211, 95%CI: 0.049 to 0.908) and stent thrombosis (HR: 0.327, 95%CI: 0.107 to 0.994).

CONCLUSIONDES was associated with similar 2-year clinical outcomes to those of BMS for the treatment of STEMI in daily practice.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; mortality ; therapy ; Prospective Studies ; Stents ; adverse effects ; Thrombosis ; etiology ; Treatment Outcome

BACKGROUND: Cardiac troponin I (cTnI) is known as a sensitive and specific marker for myocardial ischemia. The purposes of this study are to establish cut-off values of cTnI for acute myocardial infarction (AMI) and to analyze clinical significance of minor elevation of cTnI. METHODS: Two hundred and four patients from whom cTnI was measured at Ewha Womans University Dongdaemun hospital from January to March, 2006 were enrolled in the study. cTnI was measured using Dimension RxL (Dade Behring, USA). The lower limit of detection (LLD), 10% CV value, 99th percentile of healthy individuals, and cut-off value for AMI by ROC curve analysis were determined. RESULTS: LLD, 10% CV value, and 99th percentile of cTnI were 0.00 ng/mL, 0.10 ng/mL, and 0.07 ng/mL, respectively. The cut-off value of peak cTnI for AMI by ROC curve analysis was 0.13 ng/mL with the sensitivity, specificity, and AUC of 90.9%, 87.7%, and 0.921, respectively. The peak value of cTnI of patients with ischemic heart disease (IHD) was higher than that of the patients without IHD (P<0.05). According to the above reference and cut-off values of the initial cTnI, patients were categorized into four groups; < or =0.05 ng/mL (group 1), 0.06-0.09 ng/mL (group 2), 0.10-0.59 ng/mL (group 3), > or =0.60 ng/mL (group 4), and compared frequencies of AMI, IHD, cardio vascular disease (CVD) and death after 1 month among groups. Frequencies of AMI, IHD, CVD, and death after 1 month were significantly increased as the cTnI concentrations were increased (P<0.05). CONCLUSIONS: Minor elevation of cTnI value, even in group 3 was significantly associated with high incidence of AMI, IHD, CVD, and death rate after 1 month.
Acute Disease ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Cardiovascular Diseases/*diagnosis/etiology/mortality ; Data Interpretation, Statistical ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*diagnosis/etiology/mortality ; Myocardial Ischemia/diagnosis/etiology/mortality ; Predictive Value of Tests ; ROC Curve ; Sensitivity and Specificity ; Survival Analysis ; Troponin I/*blood

BACKGROUND/AIMS: The Taxus Liberte stent (Boston Scientific Co.) evolved from the Taxus Express stent, with enhanced stent deliverability and uniform drug delivery. This study was designed to compare angiographic and clinical outcomes in real-world practice between the Taxus Liberte and Taxus Express stents. METHODS: Between 2006 and 2008, 240 patients receiving the Taxus Liberte stent at three centers were registered and compared to historical control patients who had received the Taxus Express stent (n = 272). After propensity score matching, 173 patients treated with the Taxus Liberte stent and the same number of patients treated with the Taxus Express stent were selected. The primary outcome was a composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), ischemia driven target vessel revascularization (TVR), and stent thrombosis (ST) at 1 year. An additional angiographic assessment was conducted at 9 to 12 months. RESULTS: The study showed no significant difference between the Taxus Express and Taxus Liberte stents (death, 1.73% vs. 2.31%, p = 1.000; MI, 0% vs. 1.73%, p = 0.2478; TVR, 2.31% vs. 1.16%, p = 0.6848; and ST, 0% vs. 1.16%, p = 0.4986). The total MACE rate at 1 year did not differ between the groups (4.05% in Taxus Express vs. 4.05% in Taxus Liberte, p = 1.000). In addition, the binary restenosis rate did not differ (2.25% in Taxus Express vs. 1.80% in Taxus Liberte, p = 0.6848). CONCLUSIONS: In real-world experience with the two Taxus stent designs, both stents showed similarly good clinical and angiographic outcomes at 1 year. A long-term follow-up study is warranted.
Aged ; Angioplasty, Balloon, Coronary/adverse effects/*instrumentation/mortality ; Cardiovascular Agents/administration & dosage ; Chi-Square Distribution ; Coronary Angiography ; Coronary Artery Disease/mortality/radiography/*therapy ; Coronary Restenosis/etiology/mortality ; Coronary Thrombosis/etiology/mortality ; *Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology/mortality ; Paclitaxel/*administration & dosage ; Propensity Score ; Prosthesis Design ; Registries ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Stainless Steel ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: This meta-analysis compared the effects of amlodipine besylate, a charged dihydropyridine-type calcium channel blocker (CCB), with other non-CCB antihypertensive therapies regarding the cardiovascular outcome. METHODS: Data from seven long-term outcome trials comparing the cardiovascular outcomes of an amlodipine-based regimen with other active regimens were pooled and analyzed. RESULTS: The risk of myocardial infarction was significantly decreased with an amlodipine-based regimen compared with a non-CCB-based regimen (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.84 to 0.99; p = 0.03). The risk of stroke was also significantly decreased (OR, 0.84; 95% CI, 0.79 to 0.90; p < 0.00001). The risk of heart failure increased slightly with marginal significance for an amlodipine-based regimen compared with a non-CCB-based regimen (OR, 1.14; 95% CI, 0.98 to 1.31; p = 0.08). However, when compared overall with beta-blockers and diuretics, amlodipine showed a comparable risk. Amlodipine-based regimens demonstrated a 10% risk reduction in overall cardiovascular events (OR, 0.90; 95% CI, 0.82 to 0.99; p = 0.02) and total mortality (OR, 0.95; 95% CI, 0.91 to 0.99; p = 0.01). CONCLUSIONS: Amlodipine reduced the risk of total cardiovascular events as well as all-cause mortality compared with non-CCB-based regimens, indicating its benefit for high-risk cardiac patients.
Amlodipine/*therapeutic use ; Antihypertensive Agents/*therapeutic use ; Blood Pressure/*drug effects ; Calcium Channel Blockers/*therapeutic use ; Chi-Square Distribution ; Clinical Trials as Topic ; Heart Failure/etiology/mortality/*prevention & control ; Humans ; Hypertension/complications/diagnosis/*drug therapy/mortality/physiopathology ; Myocardial Infarction/etiology/mortality/*prevention & control ; Odds Ratio ; Risk Factors ; Stroke/etiology/mortality/*prevention & control ; Treatment Outcome