BACKGROUND AND OBJECTIVES: In this second report from Korean percutaneous coronary intervention (K-PCI) registry, we sought to describe the updated information of PCI practices and Korean practice pattern of PCI (KP3). METHODS: In addition to K-PCI registry of 2014, new cohort of 2016 from 92 participating centers was appended. Demographic and procedural information, as well as in-hospital outcomes, of PCI was collected using a web-based reporting system. KP3 class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or bypass-surgery. RESULTS: In 2016, total 48,823 PCI procedures were performed at 92 participating centers. Mean age of the patients was 65.7±11.6 years, and 71.7% were males. Overall patient characteristics and PCI practices in 2016 were similar to those in 2014. The biggest change was the decrease in the in-hospital occurrence of myocardial infarction (MI;1.6%→0.7%, p<0.001). Many associations between PCI volumes and demographic/procedural characteristics observed in 2014 have disappeared. The median of door-to-balloon time was 62 minutes, and 83.3% of ST-elevation MI patients received primary PCI within 90 minutes, while the median of total ischemic time was 168 minutes and patients who had total ischemic time within 120 and 180 minutes were 29.1% and 54.1%, respectively. The proportion of KP3 class C cases in non-acute coronary syndrome patients decreased from 13.5% in 2014 to 12.1% in 2016 (p<0.001). CONCLUSIONS: In this second report from K-PCI registry, we described the current practices of PCI and changes from 2014 to 2016 in Korea.
Cohort Studies ; Coronary Artery Disease ; Humans ; Korea ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: In this second report from Korean percutaneous coronary intervention (K-PCI) registry, we sought to describe the updated information of PCI practices and Korean practice pattern of PCI (KP3). METHODS: In addition to K-PCI registry of 2014, new cohort of 2016 from 92 participating centers was appended. Demographic and procedural information, as well as in-hospital outcomes, of PCI was collected using a web-based reporting system. KP3 class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or bypass-surgery. RESULTS: In 2016, total 48,823 PCI procedures were performed at 92 participating centers. Mean age of the patients was 65.7±11.6 years, and 71.7% were males. Overall patient characteristics and PCI practices in 2016 were similar to those in 2014. The biggest change was the decrease in the in-hospital occurrence of myocardial infarction (MI;1.6%→0.7%, p<0.001). Many associations between PCI volumes and demographic/procedural characteristics observed in 2014 have disappeared. The median of door-to-balloon time was 62 minutes, and 83.3% of ST-elevation MI patients received primary PCI within 90 minutes, while the median of total ischemic time was 168 minutes and patients who had total ischemic time within 120 and 180 minutes were 29.1% and 54.1%, respectively. The proportion of KP3 class C cases in non-acute coronary syndrome patients decreased from 13.5% in 2014 to 12.1% in 2016 (p<0.001). CONCLUSIONS In this second report from K-PCI registry, we described the current practices of PCI and changes from 2014 to 2016 in Korea.

BACKGROUND AND OBJECTIVES: Although several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country. MATERIALS AND METHODS: Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data. RESULTS: A total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively. CONCLUSION: These data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research.
Angiography ; Angioplasty, Balloon ; Cohort Studies* ; Data Collection ; Drug-Eluting Stents ; Emergencies ; Exercise Test ; Humans ; Incidence ; Korea* ; Length of Stay ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Radial Artery ; Registries ; Stents ; Stroke

BACKGROUND AND OBJECTIVES: Appropriate use criteria (AUC) was developed to improve the quality of percutaneous coronary intervention (PCI). However, these criteria should consider the current practice pattern in the country where they are being applied. MATERIALS AND METHODS: The algorithm for the Korean PCI practice pattern (KP3) was developed by modifying the United States-derived AUC in expert consensus meetings. KP3 class A was defined as any strategy with evidence from randomized trials that was more conservative for PCI than medical therapy or coronary artery bypass graft (CABG). Class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or CABG. Class B was defined as a strategy that was partly class A and partly class C. We applied the KP3 classification system to the Korean PCI registry. RESULTS: The KP3 class A was noted in 67.7% of patients, class B in 28.8%, and class C in 3.5%. The median proportion of class C cases per center was 2.0%. The distribution of KP3 classes varied significantly depending on clinical and angiographic characteristics. The proportion of KP3 class C cases per center was not significantly dependent on PCI volume, but rather on the percentage of ACS cases in each center. CONCLUSION: We report the current PCI practice pattern by applying the new KP3 classification in a nationwide PCI registry. The results should be interpreted carefully with due regard for the complex relationships between the determining variables and the healthcare system in Korea.
Area Under Curve ; Classification ; Cohort Studies* ; Consensus ; Coronary Artery Bypass ; Delivery of Health Care ; Humans ; Korea* ; Percutaneous Coronary Intervention* ; Transplants

In the article, “The Practice Pattern of Percutaneous Coronary Intervention in Korea.Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry.” in Volume 47(3), page 320-327, indexed color of Class A and Class C has been changed.

BACKGROUND AND OBJECTIVES: Although increasing evidence has indicated that radial access is a beneficial technique, few studies have focused on Korean subjects. The aim of this study was to evaluate current practice of coronary angiography (CAG) and percutaneous coronary intervention (PCI) using radial access in South Korea. SUBJECTS AND METHODS: A total of 6338 subjects were analyzed from Korean Transradial Intervention prospective registry that was conducted at 20 centers in Korea. After evaluating the initial access, subjects intended for radial access were assessed for their baseline, procedure-related, and complication data. Subjects were categorized into three groups: group of overall subjects (n=5554); group of subjects who underwent PCI (n=1780); and group of subjects who underwent primary percutaneous coronary intervention (PPCI) (n=167). RESULTS: The rate of radial artery as an initial access and the rate of access site crossover was 87.6% and 4.4%, respectively, in overall subjects. Those rates were 82.4% and 8.1%, respectively, in subjects who underwent PCI, and 60.1% and 4.8%, respectively, in subjects who underwent PPCI. For subjects who underwent CAG, a 6-F introducer sheath and a 5-F angiographic catheter was the most commonly used. During PCI, a 6-F introducer sheath (90.6%) and a 6-F guiding catheter were standardly used. CONCLUSION: The large prospective registry allowed us to present the current practice of CAG and PCI using radial access. These data provides evidence to achieve consensus on radial access in CAG and PCI in the Korean population.
Catheters ; Consensus ; Coronary Angiography* ; Korea ; Percutaneous Coronary Intervention ; Prospective Studies* ; Radial Artery ; Registries

The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.
Acute Coronary Syndrome/mortality/*pathology ; Aged ; Female ; Femoral Artery ; *Hemorrhage ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Odds Ratio ; Percutaneous Coronary Intervention ; Radial Artery ; Retrospective Studies ; Risk Factors ; Stents ; Treatment Outcome

BACKGROUND: In Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases, oncoplastic volume replacement techniques are more useful. METHODS: From January 2007 to December 2011, 104 women underwent a total of 107 breast-conserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD) myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP) flap or a thoracodorsal artery perforator (TDAP) flap. RESULTS: The mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9), thoracoepigastric flap (n=7), ICAP flap (n=25), TDAP flap (n=12), and LD flap (n=54). There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results. CONCLUSIONS: Oncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.
Arteries ; Breast ; Breast Neoplasms ; Congenital Abnormalities ; Cosmetics ; Displacement (Psychology) ; Estrogens, Conjugated (USP) ; Fat Necrosis ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy, Segmental ; Perforator Flap ; Surgical Flaps

PURPOSE: The osseointegration around titanium mini-implants installed in macroporous biphasic calcium phosphate (MBCP) blocks was evaluated after incubation with recombinant human bone morphogenetic protein-2 (rhBMP-2) in an ectopic subcutaneous rat model. METHODS: Mini-implants (phi1.8x12 mm) were installed in MBCP blocks (bMBCPs, 4x5x15 mm) loaded with rhBMP-2 at 0.1 mg/mL, and then implanted for 8 weeks into subcutaneous pockets of male Sprague-Dawley rats (n=10). A histomorphometric analysis was performed, and the bone-to-implant contact (BIC) and bone density were evaluated. RESULTS: Significant osteoinductive activity was induced in the rhBMP-2/bMBCP group. The percentage of BIC was 41.23+/-4.13% (mean+/-standard deviation), while bone density was 33.47+/-5.73%. In contrast, no bone formation was observed in the bMBCP only group. CONCLUSIONS: This model represents a more standardized tool for analyzing osseointegration and bone healing along the implant surface and in bMBCPs that excludes various healing factors derived from selected animals and defect models.
Animals ; Bone Density ; Bone Morphogenetic Protein 2 ; Calcium ; Dental Implants ; Humans ; Hydroxyapatites ; Male ; Nitrogen Mustard Compounds ; Osseointegration ; Osteogenesis ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins ; Titanium ; Transforming Growth Factor beta

PURPOSE: Since skin sparing mastectomy removes the mammary gland and the nipple-areolar complex preserving all mammary skin, it makes the widespread use of implants in immediate reconstruction. This article reports our experience in immediate breast reconstruction after skin sparing mastectomy by using the silicone implants in patients especially who have small to moderate sized and minimal ptotic breast. METHODS: From September of 2007 to July of 2009, we performed breast reconstruction for 44 breasts of 40 women with silicone implant after mastectomy. Tumors were divided into 5 malignant types (21 IDC, 18 DCIS, 2 ILC, 2 phylloides tumor, 1 mucinous carcinoma). The implant is placed in a submuscular pocket or in a submuscular-subfascial pocket depending upon the condition of the muscles and skin flaps after mastectomy. RESULTS: The mean age was 47 years and the average follow-up period was 11 months. Cosmetic outcome was assessed by evaluation of photographs and assessment of breast volume and shape, breast symmetry, and overall outcome. About 80% of each of these parameters was scored as good or excellent. Breast complication was developed in a total of 6 cases including 2 capsular contracture, 2 partial skin necrosis due to blue dye injection and 2 implant infection. CONCLUSION: The use of definitive implants in a skin sparing mastectomy is a one-stage immediate breast reconstruction with low morbidity and acceptable result. This method is considered reliable with favorable aesthetic result.
Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Contracture ; Cosmetics ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mammary Glands, Human ; Mastectomy ; Mucins ; Muscles ; Necrosis ; Prostheses and Implants ; Silicones ; Skin