1.Prognostic Impact of Baseline High-Sensitivity C-Reactive Protein in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention Based on Body Mass Index.
Khurshid AHMED ; Myung Ho JEONG ; Rabin CHAKRABORTY ; Kyung Hoon CHO ; Doo Sun SIM ; Young Joon HONG ; Youngkeun AHN ; Daisuke HACHINOHE ; Myeong Chan CHO ; Chong Jin KIM ; Young Jo KIM
Korean Circulation Journal 2012;42(3):164-172
BACKGROUND AND OBJECTIVES: Serum high sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and may lead to the development of atherosclerosis, adversely affecting mortality. The aim of this study was to evaluate the relationship between baseline hs-CRP level and 12-month clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) according to their body mass index (BMI) status. SUBJECTS AND METHODS: Using data from the Korea Acute Myocardial Infarction Registry from November 2005 to September 2008, a total of 8174 consecutive AMI patients were studied. Cox proportional hazard model revealed that higher baseline levels of hs-CRP was associated with 12-month all-cause mortality (p=0.045). To further understand this association, patients were divided into 3 groups based on their body mass index: 1) overweight/obese, 2) normal weight, and 3) underweight patients. Then each group was stratified into quartiles based on their hs-CRP. RESULTS: In overweight/obese patients, Cox model showed significant association of hs-CRP with 12-month mortality when adjusted for age and gender (p<0.001), however, after adjustment with multiple covariates, mortality was highest in the 4th quartile {HR 2.382, (1.079-5.259), p=0.032} though statistically insignificant (p=0.172). We observed no significant association of serum hs-CRP with 12-month mortality in normal weight (p=0.681) and underweight (p=0.760) patients. CONCLUSION: Higher baseline hs-CRP level (> or =4.08 mg/dL) in overweight/obese AMI patients showed significant association with 12-month all-cause mortality independent of other prognostic markers.
Atherosclerosis
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Body Mass Index
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C-Reactive Protein
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Humans
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Inflammation
;
Korea
;
Myocardial Infarction
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Obesity
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Overweight
;
Percutaneous Coronary Intervention
;
Proportional Hazards Models
;
Thinness
2.Clinical Impact of Non-High Density Lipoprotein-Cholesterol and Apolipoprotein B on Clinical Outcomes in Metabolic Syndrome Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention.
Khurshid AHMED ; Myung Ho JEONG ; Rabin CHAKRABORTY ; Young Joon HONG ; Mi Sook OH ; Kyung Hoon CHO ; Min Chol KIM ; Daisuke HACHINOHE ; Seung Hwan HWANG ; Min Goo LEE ; Doo Sun SIM ; Keun Ho PARK ; Ju Han KIM ; Youngkeun AHN ; Jung Chaee KANG
Korean Circulation Journal 2012;42(5):319-328
BACKGROUND AND OBJECTIVES: Non-high density lipoprotein-cholesterol (non-HDL-C) and apolipoprotein B (ApoB) are markers of atherosclerotic risk and predictors of cardiovascular events. The aim of this study was to evaluate clinical impact of non-HDL-C and ApoB on clinical outcomes in metabolic syndrome (MS) patients with acute myocardial infarction (AMI) undergoing percuatneous coronary intervetion. SUBJECTS AND METHODS: We analyzed 470 MS patients (64.4+/-12.0 years, 53.6% male) with AMI who were followed-up for 12-month after percutaneous coronary intervention (PCI) from December 2005 to January 2008 in a single center. These patients were divided into 2 groups based on median values of non-HDL-C and ApoB. We studied their baseline and follow-up relation with 12-month clinical outcomes, all-cause death and major adverse cardiac events (MACE). RESULTS: Mean values of baseline non-HDL-C and ApoB were 141.2+/-43.1 mg/dL and 99.3+/-29.0 mg/dL respectively. During 12-month follow-up 32 MACE (6.8%) and 12 deaths (2.5%) occurred. We observed significant correlation between non-HDL-C and ApoB. Twelve-month MACE and all-cause death after PCI showed no significant relation as non-HDL-C or ApoB levels increased. Follow-up patients (n=306, rate 65%) also did not show significant relation with clinical outcomes. Twelve-month MACE decreased as non-HDL-C and ApoB reduction rates increased. CONCLUSION: There was no significant association between higher non-HDL-C or ApoB and 12-month clinical outcomes in MS patients with AMI undergoing PCI. ApoB was found to be a better predictor of 12-month MACE than non-HDL-C based on their reduction rates.
Apolipoproteins
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Apolipoproteins B
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Cholesterol
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Follow-Up Studies
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Humans
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Myocardial Infarction
;
Percutaneous Coronary Intervention
3.Coronary Stents in Patients with ST-Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention.
Khurshid AHMED ; Myung Ho JEONG ; Rabin CHAKRABORTY ; Sumera AHMED ; Young Joon HONG ; Doo Sun SIM ; Keun Ho PARK ; Ju Han KIM ; Youngkeun AHN ; Jung Chaee KANG ; Myeong Chan CHO ; Chong Jin KIM ; Young Jo KIM
Korean Circulation Journal 2012;42(12):830-838
BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). We sought to compare different coronary stents used during primary PCI in patients with ST-elevation myocardial infarction (STEMI) and CKD. SUBJECTS AND METHODS: We selected 2408 consecutive STEMI patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) undergoing primary PCI and divided them into 5 groups based on the type of stent implanted: 1) bare metal stent (BMS), 2) paclitaxel-eluting stent (PES), 3) sirolimus-eluting stent (SES), 4) zotarolimus-eluting stent (ZES), or 5) everolimus-eluting stent (EES). The study endpoint was the number of major adverse cardiac events (MACE) at 12 months. RESULTS: There was no significant difference in the incidence of 12-month myocardial infarction, target lesion revascularization, or target vessel revascularization between stent groups; however, the overall rate of repeat revascularization differed significantly between groups. All-cause death differed significantly among the groups. The incidence of 12-month MACE in BMS, PES, SES, ZES, and EES was 8.3%, 9.8%, 8.6%, 5.5%, and 2.6%, respectively (p<0.001). Kaplan-Meier analysis did not show a significant differences in 12-month MACE-free survival among the groups (log-rank p=0.076). This finding remained the same after adjusting for multiple confounders (p=0.147). CONCLUSION: Any of the 5 stents can be used to treat STEMI patients with CKD undergoing primary PCI; all have similar risk of 12-month MACE. This result is hypothesis-generating and warrants further evaluation with a long-term randomized study.
Angioplasty
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Glomerular Filtration Rate
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Glycosaminoglycans
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Humans
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Incidence
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Kaplan-Meier Estimate
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Kidney Failure, Chronic
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Myocardial Infarction
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Percutaneous Coronary Intervention
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Renal Insufficiency, Chronic
;
Stents
4.Safety and Efficacy of Overlapping Homogenous Drug-Eluting Stents in Patients with Acute Myocardial Infarction: Results from Korea Acute Myocardial Infarction Registry.
Khurshid AHMED ; Myung Ho JEONG ; Rabin CHAKRABORTY ; Young Joon HONG ; Doo Sun SIM ; Sumera AHMED ; Seung Hwan HWANG ; Min Goo LEE ; Keun Ho PARK ; Ju Han KIM ; Youngkeun AHN ; Myeong Chan CHO ; Chong Jin KIM ; Young Jo KIM ; Jong Chun PARK ; Jung Chaee KANG
Journal of Korean Medical Science 2012;27(11):1339-1346
The aim of this study was to compare safety and efficacy of 4 homogenous overlapping drug-eluting stents (DES) in acute myocardial infarction (AMI) patients. We selected 1,349 consecutive patients (62.1 +/- 14.9 yr, 69.4% male) who received homogenous overlapping DESs in diffuse de novo coronary lesions from Korea Acute Myocardial Infarction Registry from April 2006 through September 2010. They were divided into 4 groups based on type of DES implanted - Paclitaxel (PES), Sirolimus (SES), Zotarolimus (ZES) and Everolimus (EES)-eluting stents. Primary endpoint was 12-month MACE. We also studied EES versus other DESs (PES + SES + ZES). Mean stent length was 26.2 +/- 7.5 mm and mean stent diameter was 3.1 +/- 0.4 mm. Average number of stents used per vessel was 2.2 +/- 0.5. Incidence of major adverse cardiac events (MACE) in PES, SES, ZES, and EES groups were 9.5%, 9.2%, 7.5%, and 3.8%, respectively (P = 0.013). In EES group, overall MACE and repeat revascularization were lowest, and no incidence of stent thrombosis was observed. Non-fatal MI was highest in PES, almost similar in SES and EES with no incidence in ZES group (P = 0.044). Cox proportional hazard analysis revealed no differences in the incidence of primary endpoint (P = 0.409). This study shows no significant differences in 12-month MACE among 4 groups.
Acute Disease
;
Aged
;
Aged, 80 and over
;
Antineoplastic Agents, Phytogenic/adverse effects/*therapeutic use
;
Coronary Angiography
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Drug-Eluting Stents/*adverse effects
;
Female
;
Humans
;
Immunosuppressive Agents/adverse effects/*therapeutic use
;
Male
;
Middle Aged
;
Myocardial Infarction/*drug therapy/mortality/pathology
;
Myocardial Revascularization
;
Paclitaxel/adverse effects/therapeutic use
;
Proportional Hazards Models
;
Registries
;
Republic of Korea
;
Sirolimus/adverse effects/analogs & derivatives/therapeutic use
;
Survival Analysis
5.Safety and Efficacy of Overlapping Homogenous Drug-Eluting Stents in Patients with Acute Myocardial Infarction: Results from Korea Acute Myocardial Infarction Registry.
Khurshid AHMED ; Myung Ho JEONG ; Rabin CHAKRABORTY ; Young Joon HONG ; Doo Sun SIM ; Sumera AHMED ; Seung Hwan HWANG ; Min Goo LEE ; Keun Ho PARK ; Ju Han KIM ; Youngkeun AHN ; Myeong Chan CHO ; Chong Jin KIM ; Young Jo KIM ; Jong Chun PARK ; Jung Chaee KANG
Journal of Korean Medical Science 2012;27(11):1339-1346
The aim of this study was to compare safety and efficacy of 4 homogenous overlapping drug-eluting stents (DES) in acute myocardial infarction (AMI) patients. We selected 1,349 consecutive patients (62.1 +/- 14.9 yr, 69.4% male) who received homogenous overlapping DESs in diffuse de novo coronary lesions from Korea Acute Myocardial Infarction Registry from April 2006 through September 2010. They were divided into 4 groups based on type of DES implanted - Paclitaxel (PES), Sirolimus (SES), Zotarolimus (ZES) and Everolimus (EES)-eluting stents. Primary endpoint was 12-month MACE. We also studied EES versus other DESs (PES + SES + ZES). Mean stent length was 26.2 +/- 7.5 mm and mean stent diameter was 3.1 +/- 0.4 mm. Average number of stents used per vessel was 2.2 +/- 0.5. Incidence of major adverse cardiac events (MACE) in PES, SES, ZES, and EES groups were 9.5%, 9.2%, 7.5%, and 3.8%, respectively (P = 0.013). In EES group, overall MACE and repeat revascularization were lowest, and no incidence of stent thrombosis was observed. Non-fatal MI was highest in PES, almost similar in SES and EES with no incidence in ZES group (P = 0.044). Cox proportional hazard analysis revealed no differences in the incidence of primary endpoint (P = 0.409). This study shows no significant differences in 12-month MACE among 4 groups.
Acute Disease
;
Aged
;
Aged, 80 and over
;
Antineoplastic Agents, Phytogenic/adverse effects/*therapeutic use
;
Coronary Angiography
;
Drug-Eluting Stents/*adverse effects
;
Female
;
Humans
;
Immunosuppressive Agents/adverse effects/*therapeutic use
;
Male
;
Middle Aged
;
Myocardial Infarction/*drug therapy/mortality/pathology
;
Myocardial Revascularization
;
Paclitaxel/adverse effects/therapeutic use
;
Proportional Hazards Models
;
Registries
;
Republic of Korea
;
Sirolimus/adverse effects/analogs & derivatives/therapeutic use
;
Survival Analysis