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.

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.

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.

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.

Background: Evaluation of regional left ventricle function using two-dimensional echocardiography (2DE) in patients with ischemic heart disease has limitations due to its low objectivity and qualitative nature. In addition, 2DE is limited because multiple acoustic windows are used to obtain the image, whereas three-dimensional echocardiography (3DE) uses a single window. This study aims to demonstrate the clinical utility of 3DE segmental volume analysis for evaluating regional wall motion abnormality (RWMA). Methods: This retrospective study included 33 patients with ischemic heart disease and single-vessel territory RWMA confirmed on coronary angiography. RWMA was visually assessed using 2DE, generating 17-segment bull’s-eye polar maps, and 3DE. In the 3DE study, two independent observers analyzed segmental volumes and segmental volume ejection fractions (SVEFs) using QLAB 3D quantification software. The optimal SVEF cutoff value differentiating normal from abnormal was determined using receiver operating curve analysis. The accuracy of 3DE in predicting culprit coronary arteries was compared with that of 2DE using Cohen κ coefficients, which also were used for interobserver and intraobserver variability assessments. Results: Mean 3DE SVEFs were significantly lower in segments showing RWMA on 2DE. The optimal SVEF cutoff value was 44%, with sensitivity of 75.0% and specificity of 73.9% (area under the curve, 0.801; 95% CI, 0.763–0.838; P < 0.001).The reliability of 3DE-derived bull’s-eye predictions of culprit coronary arteries was 81.8% (κ = 0.672; 95% CI, 0.555– 0.789; P < 0.001). Interobserver and intraobserver variabilities were 97.0% (κ = 0.947; 95% CI, 0.894–1.00; P < 0.001) and 93.9% (κ = 0.897; 95% CI, 0.827–0.967; P < 0.001), respectively. Conclusions The 3DE segmental volume analysis effectively quantified regional left ventricle function and aligned well with 2DE and coronary angiography findings in predicting culprit coronary arteries. Thus, 3DE segmental volume analysis can serve as a quantitative and objective tool for RWMA assessment in patients with ischemic heart disease.

In vasospastic angina, exercise typically does not lead to vasoconstriction. We present the case of a patient with an atypical presentation of vasospastic angina, characterized by regional wall motion abnormalities confirmed by exercise stress echocardiography. A 58-yearold female patient presented to the hospital reporting chest pain during both exercise. During the exercise stress echocardiogram, regional wall motion abnormality was confirmed.However, the coronary angiography did not reveal significant lesions. Subsequently, ergonovine test was positive and then exercise induced vasospastic angina was diagnosed. Following medical treatment, the patient’s symptoms showed improvement. This case underscores an uncommon presentation of vasospastic angina in an individual already diagnosed with coronary artery disease, indicating that exercise stress echocardiography could serve as a valuable screening tool for specific types of vasospastic angina.

Background: Evaluation of regional left ventricle function using two-dimensional echocardiography (2DE) in patients with ischemic heart disease has limitations due to its low objectivity and qualitative nature. In addition, 2DE is limited because multiple acoustic windows are used to obtain the image, whereas three-dimensional echocardiography (3DE) uses a single window. This study aims to demonstrate the clinical utility of 3DE segmental volume analysis for evaluating regional wall motion abnormality (RWMA). Methods: This retrospective study included 33 patients with ischemic heart disease and single-vessel territory RWMA confirmed on coronary angiography. RWMA was visually assessed using 2DE, generating 17-segment bull’s-eye polar maps, and 3DE. In the 3DE study, two independent observers analyzed segmental volumes and segmental volume ejection fractions (SVEFs) using QLAB 3D quantification software. The optimal SVEF cutoff value differentiating normal from abnormal was determined using receiver operating curve analysis. The accuracy of 3DE in predicting culprit coronary arteries was compared with that of 2DE using Cohen κ coefficients, which also were used for interobserver and intraobserver variability assessments. Results: Mean 3DE SVEFs were significantly lower in segments showing RWMA on 2DE. The optimal SVEF cutoff value was 44%, with sensitivity of 75.0% and specificity of 73.9% (area under the curve, 0.801; 95% CI, 0.763–0.838; P < 0.001).The reliability of 3DE-derived bull’s-eye predictions of culprit coronary arteries was 81.8% (κ = 0.672; 95% CI, 0.555– 0.789; P < 0.001). Interobserver and intraobserver variabilities were 97.0% (κ = 0.947; 95% CI, 0.894–1.00; P < 0.001) and 93.9% (κ = 0.897; 95% CI, 0.827–0.967; P < 0.001), respectively. Conclusions The 3DE segmental volume analysis effectively quantified regional left ventricle function and aligned well with 2DE and coronary angiography findings in predicting culprit coronary arteries. Thus, 3DE segmental volume analysis can serve as a quantitative and objective tool for RWMA assessment in patients with ischemic heart disease.

Background: Evaluation of regional left ventricle function using two-dimensional echocardiography (2DE) in patients with ischemic heart disease has limitations due to its low objectivity and qualitative nature. In addition, 2DE is limited because multiple acoustic windows are used to obtain the image, whereas three-dimensional echocardiography (3DE) uses a single window. This study aims to demonstrate the clinical utility of 3DE segmental volume analysis for evaluating regional wall motion abnormality (RWMA). Methods: This retrospective study included 33 patients with ischemic heart disease and single-vessel territory RWMA confirmed on coronary angiography. RWMA was visually assessed using 2DE, generating 17-segment bull’s-eye polar maps, and 3DE. In the 3DE study, two independent observers analyzed segmental volumes and segmental volume ejection fractions (SVEFs) using QLAB 3D quantification software. The optimal SVEF cutoff value differentiating normal from abnormal was determined using receiver operating curve analysis. The accuracy of 3DE in predicting culprit coronary arteries was compared with that of 2DE using Cohen κ coefficients, which also were used for interobserver and intraobserver variability assessments. Results: Mean 3DE SVEFs were significantly lower in segments showing RWMA on 2DE. The optimal SVEF cutoff value was 44%, with sensitivity of 75.0% and specificity of 73.9% (area under the curve, 0.801; 95% CI, 0.763–0.838; P < 0.001).The reliability of 3DE-derived bull’s-eye predictions of culprit coronary arteries was 81.8% (κ = 0.672; 95% CI, 0.555– 0.789; P < 0.001). Interobserver and intraobserver variabilities were 97.0% (κ = 0.947; 95% CI, 0.894–1.00; P < 0.001) and 93.9% (κ = 0.897; 95% CI, 0.827–0.967; P < 0.001), respectively. Conclusions The 3DE segmental volume analysis effectively quantified regional left ventricle function and aligned well with 2DE and coronary angiography findings in predicting culprit coronary arteries. Thus, 3DE segmental volume analysis can serve as a quantitative and objective tool for RWMA assessment in patients with ischemic heart disease.

Purpose: We aimed to evaluate the outcomes of prolonged dual antiplatelet therapy (DAPT) depending on baseline anemia after percutaneous coronary intervention (PCI). Materials and Methods: Among the 1470 study participants, 448 (30.5%) were classified as having baseline anemia. We categorized the study population according to baseline anemia and DAPT duration: ≤12-month (m) DAPT (n=226) vs. >12-m DAPT (n= 222) in anemic patients, and ≤12-m DAPT (n=521) vs. >12-m DAPT (n=501) in non-anemic patients. Results: During a follow-up of 80.8 (interquartile range 60.6–97.1) months, anemic patients showed a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) (26.9% vs. 17.1%, p<0.001) and major bleeding (9.8% vs. 5.1%, p=0.006). Among the non-anemic patients, prolonged DAPT was associated with a reduced rate of MACCEs [inverse probability of treatment weighting (IPTW) adjusted hazard ratio (HR), 0.78; 95% confidence interval (CI), 0.63–0.96; p=0.019] without an increase in major bleeding (IPTW adjusted HR, 1.12; 95% CI, 0.75–1.68; p=0.574). However, prolonged DAPT was not related to the incidence of MACCEs (IPTW adjusted HR, 1.11; 95% CI, 0.88–1.39; p=0.387), with increased major bleeding (IPTW adjusted HR, 2.01; 95% CI, 1.32–3.06; p=0.001) among anemic patients. Conclusion Although extended DAPT led to a reduction in MACCEs in non-anemic patients, it was related to increased major bleeding without reducing MACCEs in anemic patients.

Background/Aims: The clinical benefit of strict blood glucose-lowering therapy for patients with coronary artery disease (CAD) is still debated. We aimed to evaluate the long-term outcomes of patients with diabetes who underwent percutaneous coronary intervention (PCI), according to the mean hemoglobin A1c (HbA1c) level after PCI. Methods: We evaluated 675 diabetes patients with CAD treated with PCI. We categorized the study population into three groups based on the mean observed HbA1c levels during the follow-up duration, as follows: aggressive control (AC) group (HbA1c level < 6.5%, n = 148), moderate control (MC) group (HbA1c level ≥ 6.5% and < 7.0%, n = 138), and uncontrolled (UC) group (HbA1c level ≥ 7.0%, n = 389). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as cardiac death, myocardial infarction, repeat target vessel revascularization, and stroke. Results: The mean HbA1c level of the AC group was significantly lower than that of the MC and UC groups (6.04% ± 0.36% vs. 6.74% ± 0.14% vs. 8.39% ± 1.20%, p < 0.001). The incidence of MACCEs was significantly lower in the AC group than in the MC and UC groups (16.0% vs. 24.3% vs. 26.3%, p = 0.010), mostly driven by the incidence of stroke (4.4% vs. 14.0% vs. 11.4%, p = 0.013). Multivariate Cox regression analysis showed that only the AC group was associated with a reduced rate of MACCEs (hazard ratio, 0.499; 95% confidence interval, 0.316 to 0.786; p = 0.004) compared with the UC group. Conclusions Our study showed that intensive glycemic control (HbA1c level < 6.5%) is associated with improved clinical outcomes after PCI in patients with diabetes.