PURPOSE: There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR). MATERIALS AND METHODS: 2,845 patients with acute NSTEMI (65.6 +/- 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 +/- 12.6 years, 856 males) and late invasive treatment (65.3 +/- 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score. RESULTS: There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p < 0.001, 10.0% vs. 13.5%, p = 0.004, respectively). According to the TIMI risk score, there was no significant difference of long-term clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (> or = 5 points). Conclusions: The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI.
Age Factors ; Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Female ; Fibrinolytic Agents/*therapeutic use ; Hemodynamics/drug effects ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/*drug therapy/pathology/therapy ; Prospective Studies ; Thrombolytic Therapy/*methods

PURPOSE: The aim of this study is to identify the extent of initial malapposition using optical coherence tomography (OCT) in ST-elevation myocardial infarctions (STEMI) treated with different types of drug-eluting stents (DES). MATERIALS AND METHODS: Twenty four STEMI patients that underwent primary percutaneous coronary intervention (PCI) were enrolled. The OCT and intravascular ultrasound (IVUS) were performed within 72 hours after the primary PCI. Distances between the endo-luminal surface of the strut reflection and the vessel wall and the extent of malapposition were measured and analyzed. RESULTS: Sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES) and zotarolimus-eluting stents (ZES) were deployed in 7 patients (29%), 7 patients (29%) and 10 patients (42%). In total, 4951 struts in 620 mm single-stent segments were analyzed (1463 struts in SES, 1522 in PES, and 1966 in ZES). In strut analysis by OCT, the incidence of malapposition was 17 % (860/4951) and in stent analysis by IVUS, malapposition rate was 21% (5/24). The malapposition rate of strut level using OCT in 5 patients who had malapposition in IVUS was significantly higher than the 19 of those who had not (32 +/- 5% vs. 12 +/- 6%, p = 0.001). In addition, the frequency of malapposition was also significantly different (28% in SES, 11% in PES, 10% in ZES, p = 0.001). The use of SES was an independent predictor of malapposed struts. CONCLUSION: The incidence of malapposition using OCT was quite prevalent in STEMI after primary PCI with DES implantation and SES has especially higher rates of malapposition compared to other DESs.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary/methods ; *Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/pathology/*therapy ; Paclitaxel/therapeutic use ; Sirolimus/analogs & derivatives/therapeutic use ; Tomography, Optical Coherence/*methods

PURPOSE: To evaluate the potential of prospective electrocardiography (ECG)-gated 64-slice multidetector computed tomography (MDCT) for evaluation of myocardial enhancement, infarct size, and stent patency after percutaneous coronary intervention (PCI) with stenting in patients with myocardial infarction. MATERIALS AND METHODS: Seventeen patients who were admitted with acute myocardial infarction were examined with prospective ECG-gated 64-slice cardiac MDCT and magnetic resonance (MR) imaging after reperfusion using PCI with stenting. Cardiac MDCT was performed with two different phases: arterial and delayed phases. We evaluated the stent patency on the arterial phase, and nonviable myocardium on the delayed phase of computed tomography (CT) image, and they were compared with the results from the delayed MR images. RESULTS: Total mean radiation dose was 7.7 +/- 0.5 mSv on the two phases of CT images. All patients except one showed good patency of the stent at the culprit lesion on the arterial phase CT images. All patients had hyperenhanced area on the delayed phase CT images, which correlated well with those on the delayed phase MR images, with a mean difference of 1.6% (20 +/- 10% vs. 22 +/- 10%, r = 0.935, p = 0.10). Delayed MR images had a better contrast-to-noise ratio (CNR) than delayed CT images (27.1 +/- 17.8% vs. 4.3 +/- 2.1%, p < 0.001). CONCLUSION: Prospective ECG-gated 64-slice MDCT provides the potential to evaluate myocardial viability on delayed phase as well as for stent patency on arterial phase with an acceptable radiation dose after PCI with stenting in patients with myocardial infarction.
Adult ; Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Electrocardiography/*methods ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Myocardial Infarction/*pathology/therapy ; Myocardial Reperfusion ; Prospective Studies ; Tomography, X-Ray Computed/*methods

The post cardiac injury syndrome is characterized by the development of a fever, pleuropericarditis, and parenchymal pulmonary infiltrates in the weeks following trauma to the pericardium or myocardium. According to previous reports, almost all cases develop after major cardiac surgery or a myocardial infarction. Recently, a few reports have described post cardiac injury syndrome as a complication of endovascular procedures such as percutaneous cardiac intervention. Here we describe an unusual case of post cardiac injury syndrome after a percutaneous coronary intervention.
Angioplasty, Transluminal, Percutaneous Coronary/*adverse effects ; Heart Diseases/diagnosis/*etiology ; Humans ; Male ; Middle Aged

BACKGROUND/AIMS: In patients with coronary artery stents, the cost of clopidogrel has been cited as a factor in the premature discontinuation of therapy. Thus, the introduction of lower-cost generic clopidogrel may increase patient compliance. However, platelet inhibition by generic clopidogrel has not been compared to the original clopidogrel formulation in patients with coronary artery stents. METHODS: We prospectively enrolled 20 patients receiving chronic therapy with the original clopidogrel bisulfate (Plavix(R)). After assessing patient compliance with Plavix(R), maintenance therapy was switched to generic clopidogrel bisulfate (Plavitor(R)). Platelet reactivity was assessed at baseline and 30-day after the switch using conventional aggregometry and the VerifyNow P2Y12 assay. RESULTS: All patients completed maintenance therapy with Plavitor(R). Before and after switching therapy maximal (36.5 +/- 7.9% vs. 39.8 +/- 16.2%, p = 0.280) and late platelet aggregation (23.5 +/- 10.9% vs. 29.1 +/- 18.3%, p = 0.156) with 5 micromol/L adenosine diphosphate (ADP) stimulus did not differ. Likewise, 20 micromol/L ADP-induced platelet aggregation and P2Y12 reaction unit in patients on Plavitor(R) therapy was comparable to that in patients on Plavix(R) therapy. However, Bland-Altman analysis showed wide limits of agreement between measured platelet reactivity on Plavix(R) vs. Plavitor(R) therapies. CONCLUSIONS: Among patients on Plavix(R) maintenance therapy with coronary stents, replacement with Plavitor(R) shows a comparable inhibition of ADP-induced platelet aggregation. However, due to poor inter-therapy agreement, between two regimens, physicians may be cautious when introducing generic clopidogrel bisulfate.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Combined Modality Therapy ; Coronary Artery Disease/*drug therapy/therapy ; *Drug-Eluting Stents ; Drugs, Generic/*administration & dosage/adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Compliance ; Platelet Aggregation/drug effects ; Platelet Aggregation Inhibitors/*administration & dosage/adverse effects ; Prospective Studies ; Receptors, Purinergic P2/metabolism ; Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives

BACKGROUND/AIMS: The usefulness of global longitudinal peak systolic strain (GLPSS) measurement by automated function imaging (AFI) in the prediction of perfusion status of infarct-related artery (IRA) before percutaneous coronary intervention (PCI) was evaluated. METHODS: Sixty-nine patients with acute myocardial infarction (AMI) who underwent successful primary PCI were divided into two groups; the patients with occlusion of IRA (Group I, 41 patients, 63.0 +/- 14.9 years of age, 31 males) versus the patients with patent IRA (Group II, 28 patients, 63.8 +/- 11.2 years of age, 15 males). GLPSS by AFI and wall-motion score index (WMSI) were analyzed in both groups. RESULTS: GLPSS was significantly decreased in Group I compared with Group II (-11.2 +/- 3.7 vs. -14.1 +/- 4.7%, p = 0.005), but WMSI (1.49 +/- 0.28 vs. 1.35 +/- 0.32, p = 0.062) did not differ between groups. GLPSS of infarct segments was significantly lower (-3.7 +/- 5.4 vs. -11.4 +/- 4.8%, p < 0.001), and WMSI of infarct segments was significantly higher (2.13 +/- 0.57 vs. 1.66 +/- 0.57, p = 0.001) in Group I compared with Group II. By receiver operation curve analysis, the area under the curve to predict IRA occlusion was 0.850 in GLPSS of infarct segments and 0.719 in WMSI of infarct segments. The optimal cut-off value to predict IRA occlusion was -9.4% in GLPSS of infarct segments (sensitivity, 85.4%; specificity, 67.9%) and 1.68 in WMSI of infarct segments (sensitivity, 78.0%; specificity, 60.7%). CONCLUSIONS: The present study suggested that GLPSS measured by AFI is a more sensitive predictor of IRA occlusion than is WMSI before PCI. Routine measurement of GLPSS by AFI can be a very useful tool in risk stratification of AMI.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Coronary Circulation ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*physiopathology/therapy/ultrasonography ; Myocardial Reperfusion ; Systole

Coronary anomalies are rare angiographic findings. Moreover, there are few reports of cases of an anomalous origin of the right coronary artery from the left sinus of Valsalva and of the left coronary artery from the posterior sinus of Valsalva. Here, we report a case with an anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva and the left coronary artery from the posterior sinus of Valsalva. This was observed in a patient who was treated for a myocardial infarction of the inferior wall caused by a thrombus in the proximal right coronary artery. The patient was treated successfully with the implantation of a stent in the anomalous origin of the right coronary artery using a 6Fr Amplatz left 1 catheter.
Angioplasty, Transluminal, Percutaneous Coronary ; Aorta/*abnormalities ; Aortography ; *Coronary Angiography ; Coronary Vessel Anomalies/*radiography/therapy ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*radiography/therapy ; Sinus of Valsalva/*abnormalities/radiography ; Stents ; Tomography, X-Ray Computed

OBJECTIVES: To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser's comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. METHODS: This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. RESULTS: Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: +/-10.2) and 64.8% of the population was male. Among them, 1,598 (2.6%) had died in hospital. While the predictive ability of the Elixhauser s comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. CONCLUSIONS: In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.
Adult ; *Angioplasty, Transluminal, Percutaneous Coronary ; *Comorbidity ; Female ; Hospital Mortality ; Humans ; Insurance Claim Review ; Male ; Middle Aged ; Retrospective Studies

PURPOSE: The purpose of this study was to identify the factors that predict discomfort after coronary angiography or percutaneous coronary intervention (PCI) among hospitalized patients. METHODS: A total of 203 patients who underwent coronary angiography or PCI were recruited from C hospital located in S city, J province, from June through August 2008. The level of discomfort was measured and standardized by two instruments, discomfort questionnaire and the Visual Analogue Scale (VAS). RESULTS: Stepwise multiple regression showed that the factors predicting the level of discomfort were type of angiography, gender, previous angiography, dysuria, pre-information, and sleep satisfaction, which together explained 30.6% of the total variance of the level of discomfort. CONCLUSION: Patients who had previous experience with these procedures, received a pre-information about the upcoming procedure, had no dysuria, and had slept well after the procedure were less likely to complain discomfort. Pre-informed education should be given by nurses to patients who will have an angiography or PCI to reduce their physical and emotional discomforts.
Adult ; Aged ; Aged, 80 and over ; Angioplasty, Transluminal, Percutaneous Coronary ; Coronary Angiography/*psychology ; Coronary Disease/psychology/radiography ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Preoperative Care ; Questionnaires ; Sex Factors ; Sleep ; Urination

Based on data comparing coronary-artery bypass grafting (CABG) with medical therapy, the current guidelines recommend CABG as the treatment of choice for patients with left main coronary artery (LMCA) disease. Percutaneous coronary intervention (PCI) can be selectively performed in patients who are candidates for revascularization but who are ineligible for CABG. Current evidence indicates that stenting results in mortality and morbidity rates compared favorably with those seen after CABG. Data from several extensive registries and a large clinical trial may have prompted many interventional cardiologists to choose PCI with stenting as an alternative treatment option for such patients. In addition, these data may inform future guidelines and support the need for well-designed, adequately powered, prospective, randomized trials comparing the two revascularization strategies.
Angioplasty, Transluminal, Percutaneous Coronary/adverse effects/*methods ; Coronary Artery Bypass/*methods ; Coronary Artery Disease/*surgery/*therapy ; Humans ; Stents/adverse effects