1.Low-Density Lipoprotein Cholesterol Level, the Lower the Better? Analysis of Korean Patients in the Treat Stroke to Target Trial
Hanim KWON ; Jae-Chan RYU ; Jae-Kwan CHA ; Sang Min SUNG ; Tae-Jin SONG ; Kyung Bok LEE ; Eung-Gyu KIM ; Yong-Won KIM ; Ji Hoe HEO ; Man Seok PARK ; Kyusik KANG ; Byung-Chul LEE ; Keun-Sik HONG ; Oh Young BANG ; Jei KIM ; Jong S. KIM
Journal of Stroke 2025;27(2):228-236
Background:
and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear.
Methods:
Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death.
Results:
Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis.
Conclusion
In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.
2.Complete or incomplete revascularization in patients with left main culprit lesion acute myocardial infarction with multivessel disease: a retrospective observational study
Sun Oh KIM ; Hong-Ju KIM ; Jong-Il PARK ; Kang-Un CHOI ; Jong-Ho NAM ; Chan-Hee LEE ; Jang-Won SON ; Jong-Seon PARK ; Sung-Ho HER ; Ki-Yuk CHANG ; Tae-Hoon AHN ; Myung-Ho JEONG ; Seung-Woon RHA ; Hyo-Soo KIM ; Hyeon-Cheol GWON ; In-Whan SEONG ; Kyung-Kuk HWANG ; Seung-Ho HUR ; Kwang-Soo CHA ; Seok-Kyu OH ; Jei-Keon CHAE ; Ung KIM
Journal of Yeungnam Medical Science 2025;42(1):18-
Background:
Complete revascularization has demonstrated better outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, in the case of left main (LM) culprit lesion AMI with multivessel disease, there is limited evidence to suggest that complete revascularization is better.
Methods:
We reviewed 16,831 patients in the Korea Acute Myocardial Infarction Registry who were treated from July 2016 to June 2020, and 399 patients were enrolled with LM culprit lesion AMI treated with percutaneous coronary intervention. We categorized the patients as those treated with complete revascularization (n=295) or incomplete revascularization (n=104). The study endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, ischemia-driven revascularization, stent thrombosis, and stroke. We performed propensity score matching (PSM) and analyzed the incidence of MACCE at 1 year.
Results:
After PSM, the two groups were well balanced. There was no significant difference between the two groups in MACCE at 1 year (12.1% vs. 15.2%; hazard ratio, 1.28; 95% confidence interval, 0.60–2.74; p=0.524) after PSM. The components of MACCE and major bleeding were also not significantly different.
Conclusion
There was no significant difference in clinical outcomes between the groups treated with complete or incomplete revascularization for LM culprit lesion AMI with multivessel disease.
3.Complete or incomplete revascularization in patients with left main culprit lesion acute myocardial infarction with multivessel disease: a retrospective observational study
Sun Oh KIM ; Hong-Ju KIM ; Jong-Il PARK ; Kang-Un CHOI ; Jong-Ho NAM ; Chan-Hee LEE ; Jang-Won SON ; Jong-Seon PARK ; Sung-Ho HER ; Ki-Yuk CHANG ; Tae-Hoon AHN ; Myung-Ho JEONG ; Seung-Woon RHA ; Hyo-Soo KIM ; Hyeon-Cheol GWON ; In-Whan SEONG ; Kyung-Kuk HWANG ; Seung-Ho HUR ; Kwang-Soo CHA ; Seok-Kyu OH ; Jei-Keon CHAE ; Ung KIM
Journal of Yeungnam Medical Science 2025;42(1):18-
Background:
Complete revascularization has demonstrated better outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, in the case of left main (LM) culprit lesion AMI with multivessel disease, there is limited evidence to suggest that complete revascularization is better.
Methods:
We reviewed 16,831 patients in the Korea Acute Myocardial Infarction Registry who were treated from July 2016 to June 2020, and 399 patients were enrolled with LM culprit lesion AMI treated with percutaneous coronary intervention. We categorized the patients as those treated with complete revascularization (n=295) or incomplete revascularization (n=104). The study endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, ischemia-driven revascularization, stent thrombosis, and stroke. We performed propensity score matching (PSM) and analyzed the incidence of MACCE at 1 year.
Results:
After PSM, the two groups were well balanced. There was no significant difference between the two groups in MACCE at 1 year (12.1% vs. 15.2%; hazard ratio, 1.28; 95% confidence interval, 0.60–2.74; p=0.524) after PSM. The components of MACCE and major bleeding were also not significantly different.
Conclusion
There was no significant difference in clinical outcomes between the groups treated with complete or incomplete revascularization for LM culprit lesion AMI with multivessel disease.
4.Low-Density Lipoprotein Cholesterol Level, the Lower the Better? Analysis of Korean Patients in the Treat Stroke to Target Trial
Hanim KWON ; Jae-Chan RYU ; Jae-Kwan CHA ; Sang Min SUNG ; Tae-Jin SONG ; Kyung Bok LEE ; Eung-Gyu KIM ; Yong-Won KIM ; Ji Hoe HEO ; Man Seok PARK ; Kyusik KANG ; Byung-Chul LEE ; Keun-Sik HONG ; Oh Young BANG ; Jei KIM ; Jong S. KIM
Journal of Stroke 2025;27(2):228-236
Background:
and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear.
Methods:
Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death.
Results:
Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis.
Conclusion
In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.
5.Complete or incomplete revascularization in patients with left main culprit lesion acute myocardial infarction with multivessel disease: a retrospective observational study
Sun Oh KIM ; Hong-Ju KIM ; Jong-Il PARK ; Kang-Un CHOI ; Jong-Ho NAM ; Chan-Hee LEE ; Jang-Won SON ; Jong-Seon PARK ; Sung-Ho HER ; Ki-Yuk CHANG ; Tae-Hoon AHN ; Myung-Ho JEONG ; Seung-Woon RHA ; Hyo-Soo KIM ; Hyeon-Cheol GWON ; In-Whan SEONG ; Kyung-Kuk HWANG ; Seung-Ho HUR ; Kwang-Soo CHA ; Seok-Kyu OH ; Jei-Keon CHAE ; Ung KIM
Journal of Yeungnam Medical Science 2025;42(1):18-
Background:
Complete revascularization has demonstrated better outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, in the case of left main (LM) culprit lesion AMI with multivessel disease, there is limited evidence to suggest that complete revascularization is better.
Methods:
We reviewed 16,831 patients in the Korea Acute Myocardial Infarction Registry who were treated from July 2016 to June 2020, and 399 patients were enrolled with LM culprit lesion AMI treated with percutaneous coronary intervention. We categorized the patients as those treated with complete revascularization (n=295) or incomplete revascularization (n=104). The study endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, ischemia-driven revascularization, stent thrombosis, and stroke. We performed propensity score matching (PSM) and analyzed the incidence of MACCE at 1 year.
Results:
After PSM, the two groups were well balanced. There was no significant difference between the two groups in MACCE at 1 year (12.1% vs. 15.2%; hazard ratio, 1.28; 95% confidence interval, 0.60–2.74; p=0.524) after PSM. The components of MACCE and major bleeding were also not significantly different.
Conclusion
There was no significant difference in clinical outcomes between the groups treated with complete or incomplete revascularization for LM culprit lesion AMI with multivessel disease.
6.Low-Density Lipoprotein Cholesterol Level, the Lower the Better? Analysis of Korean Patients in the Treat Stroke to Target Trial
Hanim KWON ; Jae-Chan RYU ; Jae-Kwan CHA ; Sang Min SUNG ; Tae-Jin SONG ; Kyung Bok LEE ; Eung-Gyu KIM ; Yong-Won KIM ; Ji Hoe HEO ; Man Seok PARK ; Kyusik KANG ; Byung-Chul LEE ; Keun-Sik HONG ; Oh Young BANG ; Jei KIM ; Jong S. KIM
Journal of Stroke 2025;27(2):228-236
Background:
and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear.
Methods:
Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death.
Results:
Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis.
Conclusion
In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.
7.Complete or incomplete revascularization in patients with left main culprit lesion acute myocardial infarction with multivessel disease: a retrospective observational study
Sun Oh KIM ; Hong-Ju KIM ; Jong-Il PARK ; Kang-Un CHOI ; Jong-Ho NAM ; Chan-Hee LEE ; Jang-Won SON ; Jong-Seon PARK ; Sung-Ho HER ; Ki-Yuk CHANG ; Tae-Hoon AHN ; Myung-Ho JEONG ; Seung-Woon RHA ; Hyo-Soo KIM ; Hyeon-Cheol GWON ; In-Whan SEONG ; Kyung-Kuk HWANG ; Seung-Ho HUR ; Kwang-Soo CHA ; Seok-Kyu OH ; Jei-Keon CHAE ; Ung KIM
Journal of Yeungnam Medical Science 2025;42(1):18-
Background:
Complete revascularization has demonstrated better outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, in the case of left main (LM) culprit lesion AMI with multivessel disease, there is limited evidence to suggest that complete revascularization is better.
Methods:
We reviewed 16,831 patients in the Korea Acute Myocardial Infarction Registry who were treated from July 2016 to June 2020, and 399 patients were enrolled with LM culprit lesion AMI treated with percutaneous coronary intervention. We categorized the patients as those treated with complete revascularization (n=295) or incomplete revascularization (n=104). The study endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, ischemia-driven revascularization, stent thrombosis, and stroke. We performed propensity score matching (PSM) and analyzed the incidence of MACCE at 1 year.
Results:
After PSM, the two groups were well balanced. There was no significant difference between the two groups in MACCE at 1 year (12.1% vs. 15.2%; hazard ratio, 1.28; 95% confidence interval, 0.60–2.74; p=0.524) after PSM. The components of MACCE and major bleeding were also not significantly different.
Conclusion
There was no significant difference in clinical outcomes between the groups treated with complete or incomplete revascularization for LM culprit lesion AMI with multivessel disease.
8.Performance of indicators used in regular risk assessments for COVID-19 in association with contextual factors
Sujin HONG ; Jiyoung OH ; Jia LEE ; Yongmoon KIM ; Bryan Inho KIM ; Min Jei LEE ; Hyunjung KIM ; Sangwoo TAK
Osong Public Health and Research Perspectives 2024;15(5):420-428
Objectives:
This study aimed to summarize the results of coronavirus disease 2019 (COVID-19) risk assessments and to examine the associations between risk levels and various indicators, including COVID-19 incidence, risk perception, community mobility, and government policy.
Methods:
The results of the risk assessment and the indicators utilized were summarized. From November 2021 to May 2022, the COVID-19 risk level was evaluated on a weekly basis, and its correlation with these indicators was analyzed. Data were obtained from press releases by the Korea Disease Control and Prevention Agency, regular surveys conducted by Hankook Research, and information available on the Google and Oxford websites.
Results:
Weekly risk assessments were conducted for 30 weeks, using different indices depending on the phases. Correlation analysis revealed the strongest positive correlation between risk level and risk perception (r=0.841). The risk level from “1-week lead” demonstrated a strong positive correlation with the time-varying reproduction number (Rt). Similarly, the risk level from “week lagged value” showed a strong positive correlation with the number of severe cases in the hospital.
Conclusion
At the time of risk assessment, the Rt precedes the risk level, while severe cases in hospitals follow. Therefore, the assessed risk level functioned as an early warning system. Risk perception demonstrated the strongest correlation with the risk level, suggesting consistency throughout the assessment period. Contextual indicators (e.g., risk perception) that consider time lags and implementation scales, could improve the evaluation of future risk assessment results, particularly when there are challenges in reflecting specific situations in coordinated emergency response.
9.Performance of indicators used in regular risk assessments for COVID-19 in association with contextual factors
Sujin HONG ; Jiyoung OH ; Jia LEE ; Yongmoon KIM ; Bryan Inho KIM ; Min Jei LEE ; Hyunjung KIM ; Sangwoo TAK
Osong Public Health and Research Perspectives 2024;15(5):420-428
Objectives:
This study aimed to summarize the results of coronavirus disease 2019 (COVID-19) risk assessments and to examine the associations between risk levels and various indicators, including COVID-19 incidence, risk perception, community mobility, and government policy.
Methods:
The results of the risk assessment and the indicators utilized were summarized. From November 2021 to May 2022, the COVID-19 risk level was evaluated on a weekly basis, and its correlation with these indicators was analyzed. Data were obtained from press releases by the Korea Disease Control and Prevention Agency, regular surveys conducted by Hankook Research, and information available on the Google and Oxford websites.
Results:
Weekly risk assessments were conducted for 30 weeks, using different indices depending on the phases. Correlation analysis revealed the strongest positive correlation between risk level and risk perception (r=0.841). The risk level from “1-week lead” demonstrated a strong positive correlation with the time-varying reproduction number (Rt). Similarly, the risk level from “week lagged value” showed a strong positive correlation with the number of severe cases in the hospital.
Conclusion
At the time of risk assessment, the Rt precedes the risk level, while severe cases in hospitals follow. Therefore, the assessed risk level functioned as an early warning system. Risk perception demonstrated the strongest correlation with the risk level, suggesting consistency throughout the assessment period. Contextual indicators (e.g., risk perception) that consider time lags and implementation scales, could improve the evaluation of future risk assessment results, particularly when there are challenges in reflecting specific situations in coordinated emergency response.
10.Performance of indicators used in regular risk assessments for COVID-19 in association with contextual factors
Sujin HONG ; Jiyoung OH ; Jia LEE ; Yongmoon KIM ; Bryan Inho KIM ; Min Jei LEE ; Hyunjung KIM ; Sangwoo TAK
Osong Public Health and Research Perspectives 2024;15(5):420-428
Objectives:
This study aimed to summarize the results of coronavirus disease 2019 (COVID-19) risk assessments and to examine the associations between risk levels and various indicators, including COVID-19 incidence, risk perception, community mobility, and government policy.
Methods:
The results of the risk assessment and the indicators utilized were summarized. From November 2021 to May 2022, the COVID-19 risk level was evaluated on a weekly basis, and its correlation with these indicators was analyzed. Data were obtained from press releases by the Korea Disease Control and Prevention Agency, regular surveys conducted by Hankook Research, and information available on the Google and Oxford websites.
Results:
Weekly risk assessments were conducted for 30 weeks, using different indices depending on the phases. Correlation analysis revealed the strongest positive correlation between risk level and risk perception (r=0.841). The risk level from “1-week lead” demonstrated a strong positive correlation with the time-varying reproduction number (Rt). Similarly, the risk level from “week lagged value” showed a strong positive correlation with the number of severe cases in the hospital.
Conclusion
At the time of risk assessment, the Rt precedes the risk level, while severe cases in hospitals follow. Therefore, the assessed risk level functioned as an early warning system. Risk perception demonstrated the strongest correlation with the risk level, suggesting consistency throughout the assessment period. Contextual indicators (e.g., risk perception) that consider time lags and implementation scales, could improve the evaluation of future risk assessment results, particularly when there are challenges in reflecting specific situations in coordinated emergency response.

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