BACKGROUND: To compare the effects of low dose and high dose of statin treatment on endothelial function and carotid intima-media thickness (IMT) in patients with variant angina (VAP). METHODS: A total of 70 patients with VAP were divided into two groups; atorvastatin 10 mg treatment group (group I: n = 35, 54.2 +/- 12.5 years) versus atorvastatin 40 mg treatment group (group II: n = 35, 52.6 +/- 9.8 years). Flow mediated vasodilation (FMD) of the brachial artery and IMT of the carotid artery were compared between the groups after 6 months of statin treatment. RESULTS: The baseline FMD and carotid IMT were not different between the groups. After 6 months of statin therapy, FMD was significantly improved in both groups (7.7 +/- 2.5% to 8.9 +/- 2.2% in group I, p = 0.001, 7.9 +/- 2.7% to 9.5 +/- 2.8% in group II, p < 0.001), but the degree of FMD change and FMD at 6 month were not different between the groups. Carotid IMT were not changed in both groups after 6 months of statin therapy. CONCLUSION: The use of statin for 6 months significantly improved endothelial function in patients with VAP, but carotid IMT was not changed. The use of high dose statin did not show significant additional benefit as compared with the use of low dose statin. The present study suggested that statin therapy would be beneficial in the treatment of VAP.
Atorvastatin Calcium ; Brachial Artery ; Carotid Arteries ; Carotid Intima-Media Thickness ; Heptanoic Acids ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Pyrroles ; Vasodilation

BACKGROUND: Chronic total occlusion (CTO) has been considered as an unsuitable lesion for percutaneous coronary intervention (PCI) because of technical difficulty and low success rate. Owing to technical advances and increased operator's experience, PCI has been attempted in a large number of patients with CTO in recent years, but there are few long-term follow-up reports for PCI to CTO. METHODS: We analyzed 83 patients (59.7+/-9.2 years, 28 female) with CTO on diagnostic coronary angiogram at the Heart Center and Coronary Care Unit of Chonnam National Hospital from January 1996 to July 1997. The patients were divided into two groups according to revascularization by PCI or CABG (coronary artery bypass graft): the revascularized group (received PCI or CABG, Group I) and non-revascularized group (Group II). RESULTS: PCI was tried in 46 patients and successful in 33 patients (71.7% of the success rate). Eleven patients (13.3%) were treated with the coronary artery bypass graft (CABG) and 31 (37.3%) patients were medically treated. During 5-year clinical follow-up 11 patients died [13.1%; cardiac death 6 (7.1%), non-cardiac death 5 (6.0%)] and the major adverse cardiac events occurred to 24 (28.6%) patients. Cardiac death occurred to one patient of the Group I and 5 patients of Group II (p=0.06). The mean survival time was significantly different (57.8+/-9.2 months in Group I and 50.9+/-19.5 months in Group II, p=0.038). CONCLUSIONS: Revascularization for CTO prolonged the mean survival time of the patients on long- term clinical follow-up.
Angioplasty ; Arteries ; Coronary Artery Bypass ; Coronary Care Units ; Coronary Disease ; Coronary Vessels* ; Death ; Follow-Up Studies* ; Heart ; Humans ; Jeollanam-do ; Percutaneous Coronary Intervention ; Survival Rate ; Transplants

BACKGROUND: Sinus node dysfunction (SND) is caused not only by intrinsic sinus node disease, but also by the extrinsic factors. Among the extrinsic factors, autonomic imbalance is most common. Symptomatic SND usually requires permanent pacemaker therapy. However, the clinical characteristics and patient response to medical therapy for hypervagotonic SND have not been properly clarified. MATERIALS AND METHODS: Thirty two patients (14 men, 18 women, 51 +/- 14 years) with hypervagotonic SND were included in this study, but those patients who had taken calcium antagonists, beta-blockers or other antiarrhythmic drugs were excluded. Hypervagotonic SND was diagnosed if the abnormal electrophysiologic properties of the sinus node were normalized after the administration of atropine (0.04 mg/kg). RESULTS: The presenting arrhythmias were 16 cases of sinus bradycardia (50.0%), 12 of sinus pause (37.5%), 3 of sinoatrial block (9.4%) and 1 of tachy-bradycardia (3.1%). Nine (28.1%) patients had hypertension, 7 (21.9%) smoked, 2 (6.3%) had diabetes mellitus, and 1 (3.1%) had hypercholesterolemia. Among the patients, 3 had no remarkable symptoms, 13 had dizziness, 7 had syncope, 3 had weakness and 6 had shortness of breath. Twenty five (78.1%) patients were treated with theophylline, 1 patient with tachy-bradycardia syndrome was treated with digoxin and propafenone, and 6 (18.8%) were treated with no medication. During the 43 +/- 28 month follow-up, 25 patients remained asymptomatic, but 6 who took no medication developed mild dizziness. One patient needed permanent pacemaker implantation owing to recurrent syncope despite of theophylline treatment. CONCLUSION: These results show that hypervagotonic SND has a benign course and most of the patients can be managed safely without implanting a pacemaker. (Ed note: I like the abstract. It is short and direct, as it should be.)
Dizziness/etiology ; Dyspnea/etiology ; Female ; Humans ; Male ; Middle Aged ; Muscle Weakness/etiology ; Sick Sinus Syndrome/*complications/drug therapy ; Syncope/etiology ; Theophylline/therapeutic use ; Vasodilator Agents/therapeutic use

BACKGROUND: Diabetes is a major risk factor for restenosis after percuataneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) has been considered desirable in diabetics with multivessel disease. However, recent developments in devices and techniques of PCI have led to speculation about advantages of CABG in diabetic patients. We sought to compare long-term clinical outcomes of coronary stenting and those of CABG in diabetics with coronary artery disease. METHODS: Among diabetics who underwent revascularization therapy in Chonnam National University Hospital between Mar 1998 and Feb 1999, 122 patients (Group I, 84 males, 60+/-8 years) who had stent implanted, and 38 patients (Group II, 24 males, 60+/-8 years) who had bypass surgery were selected and their short- and long-term clinical were compared. RESULTS: As for clinical diagnosis and risk factors there were no differences between the two groups. In ACC/AHA types Group II had more multiple and complex vessel disease than Group I (p<0.05). Incidences of in-hospital adverse cardiac events were not different between the two groups, but during the period of 30.5+/-6.7 months the incidence of target lesion revascularization was significantly higher in Group I (18.9% versus 5.7%, p<0.005). CONCLUSION: Short-term clinical outcomes of coronary stenting were comparable to those of CABG in patients with diabetes, but the incidence of repeat revascularization was higher in the coronary stenting group. With the advent of adjunctive therapies in the prevention of restenosis after PCI, these results require fu rther clinical assessment.
Angioplasty ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Diabetes Mellitus ; Diagnosis ; Humans ; Incidence ; Jeollanam-do ; Male ; Risk Factors ; Stents

BACKGROUND: The current techniques for percutaneous coronary interventions (PCI) remain limited by restenosis. Recent studies have provided evidence of inflammation playing a role in the pathogenesis of cardiovascular disease. METHODS: Whether inflammatory markers are predictors of subsequent restenosis were prospectively tested in 272 consecutive patients with angiographically proven coronary artery disease. Patients having undergone PCI at Chonnam National University Hospital, between Sept. 1999 and Mar. 2001, were divided into two groups according to the occurrence of restenosis on a follow-up coronary angiogram: Group I were patients with restenosis (n=99, 59.5 +/- 10.8 years, M: F=77: 22) and Group II were those without restenosis (n=173, 58.8 +/- 10.2 years, M: F=131: 42). The IgG seropositivity, cytomegalovirus (CMV) titers, C. pneumoniae, H. pylori and levels of C-reactive protein (CRP) were compared between the two groups. RESULTS: There were no statistical differences in the seropositivity of the CMV IgG C. pneumoniae IgG and H. pylori IgG between the two groups (Groups I vs. II: 100 vs. 100%, 24.7 vs. 25.7% and 62.2 vs. 63.7%, respectively). Of the angiographic parameters, a low Thrombolysis In Myocardial Infarction (TIMI) flow (TIMI 0 or I) was more common in Group I than Group II (p=0.038). The patients with an elevated CRP (> 0.5 mg/dL) were more common in Group I than Group II (57.6 vs. 36.4%, p=0.001), with the CRP values being higher in Group I than Group II (3.3 +/- 5.8 vs. 1.3 +/- 2.6 mg/dL, p=0.001). According to a multiple logistic regression analysis, the CRP was the only predictor of restenosis, with an odds ratio of 2.1169 (95% C.I. 1.2062-3.7154, p=0.009). CONCLUSION: The CRP value is the most important predictor of restenosis after PCI.
*Angioplasty, Transluminal, Percutaneous Coronary ; Antibodies, Bacterial/blood ; Antibodies, Viral/blood ; Biological Markers/analysis ; C-Reactive Protein/*analysis ; Chlamydophila pneumoniae/immunology ; Comparative Study ; Coronary Angiography ; Coronary Restenosis/*blood/diagnosis/*therapy ; Cytomegalovirus/immunology ; Female ; Helicobacter pylori/immunology ; Human ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Recurrence

BACKGROUND: High-risk percutaneous coronary interventions (PCIs) are associated with a high complication rate, a low procedural success rate and a high restenosis rate, especially in diabetics. We sought to determine whether abciximab (ReoPro (R) ) therapy affects long-term clinical outcomes of Korean patients with diabetes undergoing high-risk PCI. METHODS: One hundred and nineteen patients with 152 lesion sites were administered ReoPro (R) among 2, 231 patients who underwent PCI at Chonnam National University Hospital from March 1999 to Feb 2001. These 119 patients were divided into two groups, 30 were allocated to a diabetic group (Group I, 57.7 +/- 8.2 years, 22 male), and 89 to a non-diabetic group (Group II, 59.6 +/- 10.8 years, 68 male). Early and long-term clinical outcomes after PCI were analyzed. RESULTS: In terms of clinical diagnosis, the number of acute myocardial infarctions in Group I was 25 (83.3%) and 76 in Group II (85.4%). As for risk factors, target artery lesions, and ACC/AHA types, no differences were found between the two groups. The number of patients with total occlusion was 21 (55.3%) and 62 (53.9%), and the number with a thrombus-containing lesion was 28 (93.3%) and 88 (98.9%) in Groups I and II, respectively. The procedure was successful in 27 (90.0%) in Group I, and in 80 (89.9%) in Group II, and no differences were evident between the two groups in terms of bleeding complications. No major adverse cardiac events (MACE), including myocardial infarction, repeat revascularization or cardiac death, were observed in Group I, but 8 cases of MACE occurred in Group II during hospitalization. Clinical follow-up was performed in 116 patients (97.5%) over 18.5 +/- 6.7 (5-28) months. The number of overall MACEs was 10 (3.3%) in Group I and 14 (15.7%) in Group II (p=0.038). CONCLUSION: ReoPro (R) used in high-risk PCI in diabetics was effective in terms of early clinical outcomes, but its long-term clinical benefits were not proven.
*Angioplasty, Transluminal, Percutaneous Coronary ; Antibodies, Monoclonal/*therapeutic use ; Comparative Study ; Coronary Angiography ; Coronary Stenosis/*therapy ; Diabetes Mellitus/*complications/drug therapy/radiography ; Female ; Human ; Immunoglobulins, Fab/*therapeutic use ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/*therapeutic use ; Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors ; Risk Factors ; Safety ; Stents ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Angiotensin converting enzyme inhibitor is known to be effective in the prevention of left ventricular remodeling following myocardial infarction. However, little data is available concerning the clinical effects of angiotensin (AT) receptor blocker in ischemic cardiomyopathy. This study evaluated the clinical effects of the concomitant use of losartan with low doses of hydrochlorthiazide in cases of ischemic cardiomyopathy. SUBJECTS AND METHODS: A combined agent of 50 mg of losartan potassium with 12.5 mg of hydrochlorthiazide (HCTZ) was administrated once daily over a 12-week period to 29 patients (M:F=26:3, 61.4+/-8.7 years) who were diagnosed with ischemic heart failure (ejection fraction lower than 50% by echocardiography) at Chonnam National University Hospital. RESULTS: Clinical symptoms of dyspnea in the 29 patients improved from 2.08+/-0.49 to 1.15+/-0.38 as measured by New York Heart Association class. The systolic and diastolic blood pressure did not change significantly following treatment (116.5+/-18.0/77.0+/-11.9 mmHg vs. 118.7+/-15.1/78.1+/-11.1 mmHg). The ejection fraction following administration of Losartan/HCTZ increased from 40.3+/-8.1% to 46.7+/-10.8% (p=0.001). Losartan/HCTZ was well tolerated in all patients without significant adverse effects or laboratory changes. CONCLUSION: A fixed combination of losartan and low dose hydrochlorthiazide is effective in patients with ischemic heart failure.
Angiotensins ; Blood Pressure ; Cardiomyopathies ; Diuretics ; Dyspnea ; Heart Failure* ; Heart* ; Humans ; Jeollanam-do ; Losartan* ; Myocardial Infarction ; Peptidyl-Dipeptidase A ; Ventricular Remodeling

BACKGROUND AND OBJECTIVES: Brachytherapy is a promising method in the prevention and treatment of coronary stent restenosis. We sought to observe the therapeutic effects of a radioactive balloon loaded with Holmium-166 (166Ho) in a porcine coronary stent restenosis model. Materials and Methods: A radioisotope of (166Ho) was coated on the balloon surface using a polyurethane coating (20 Gy in 0.5 mm depth). Stent overdilation injuries were performed in two coronary arteries in 8 pigs. Four weeks after the stent overdilation injury, radiation therapies were performed using a control balloon dilation in one coronary artery (Group I:n = 8) and a 166Ho-coated balloon in the other coronary artery in each pig (Group II:n = 8). Follow-up coronary angiogram and histopathologic assessment were performed at 4 weeks after the therepy was administered. RESULTS: Laboratory findings did not differ significantly between the pre-treatment baseline and the measurements taken after radiation. On quantitative coronary angiogram, the coronary artery diameters were not significantly different between the two groups before stenting or at 4 and 8 weeks after stenting. On histopathologic analysis, injury score, internal elastic lamina area and lumen area did not differ significantly between the two groups. The neointimal area was 1.78 +/- 0.11 mm2 in group I and 1.36 +/- 0.12 mm2 in group II (p=0.017), and the histopathologic area of stenosis was 35.1 +/- 1.6% in Group I, 27.6 +/- 1.9% in Group II (p=0.005). CONCLUSION: A treatment of beta-radiation in a stented porcine coronary artery using radioactive Ho-166 coated balloon inhibits stent restenosis without any side effects.
Brachytherapy ; Constriction, Pathologic ; Coronary Disease ; Coronary Restenosis ; Coronary Vessels ; Follow-Up Studies ; Hyperplasia* ; Polyurethanes ; Radiation Injuries ; Radioisotopes ; Stents* ; Swine

BACKGROUND: Current techniques of percutaneous coronary interventions (PCI) remain limited by the restenosis. Recent studies provide evidence that inflammation plays a role in the pathogenesis of cardiovascular disease. METHODS: We prospectively tested whether inflammatory markers are predictors of subsequent restenosis in 272 consecutive patients with angiographically proved coronary artery disease. The patients who underwent PCI at Chonnam National University Hospital between Sep. 1999 and Mar. 2001 were divided into two groups according to the occurrence of restenosis on follow-up coronary angiogram: patients with restenosis (Group I : n=99, 59.5 10.8 years, M : F=77:22) and patients without restenosis (Group II : n=173, 58.8 10.2 years, M : F=131:42). IgG seropositivity and titer of CMV, C. pneumoniae, H. pylori, levels of C-reactive protein (CRP) were compared between two groups. RESULTS: There were no statistical differences in the seropositivity of CMV IgG, C. pneumoniae IgG, H. pylori IgG between two groups (Group I vs. II : 100% vs. 100%, 24.7% vs. 25.7%, 62.2% vs. 63.7% in group I vs. II respectively). Among angiographic parameters, low TIMI flow (TIMI 0 or I) was more common in Group I than in Group II (p=0.038). The patients with elevated CRP (>0.5 mg/dL) were more common in Group I than those in Group II (57.6% vs. 36.4%, p=0.001) and the value of CRP was higher in Group I than in Group II (3.3+/-5.8 mg/dL vs. 1.3+/-2.6 mg/dL, p=0.001). According to multiple logistic regression analysis, CRP was the only predictor of restenosis with odd ratio of 2.1169 (95% C.I. 1.2062-3.7154, p=0.009). CONCLUSION: The value of CRP is the most important predictor of restenosis after PCI.
C-Reactive Protein* ; Cardiovascular Diseases ; Coronary Artery Disease ; Follow-Up Studies ; Humans ; Immunoglobulin G ; Inflammation ; Jeollanam-do ; Logistic Models ; Percutaneous Coronary Intervention* ; Pneumonia ; Prospective Studies

The entrapment and detachment of a cutting balloon catheter during the treatment of in-stent restenosis (ISR) has never been reported. We describe a case of a cutting balloon catheter impinged within the stent mesh, which fractured during pull-back. We report a case of a 52-year old male patient who had been stented for the management of critical stenosis of the proximal left anterior descending artery (LAD) seven months previously. A follow-up coronary angiogram revealed a critical diffuse ISR at the proximal LAD, so cutting balloon angioplasty was tried. The guide wire went through the lesion without difficulties ; however the cutting balloon was entrapped in the proximal LAD during advancement. We tried to pull-back the cutting balloon, but the balloon fractured, and disconnected at the mid-shaft portion. The broken distal cutting balloon impacted in the proximal LAD and left main stem, and the proximal shaft of balloon catheter was floating in the descending aorta. ST segment elevation was demonstrated on ECG monitoring ; as a result emergent coronary bypass surgery was performed. The broken catheter was removed from left coronary artery successfully.
Angioplasty ; Angioplasty, Balloon ; Aorta, Thoracic ; Arteries ; Catheterization ; Catheters* ; Constriction, Pathologic ; Coronary Restenosis ; Coronary Vessels ; Electrocardiography ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Stents*