BACKGROUND AND OBJECTIVES: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. SUBJECTS AND METHODS: From the Korean Acute Myocardial Infarction Registry (KAMIR) database, 1,094 STEMI patients with multivessel disease who underwent primary PCI with drug-eluting stents were enrolled in this study. The patients were divided into two groups: culprit-vessel-only revascularization (COR, n=827) group; multivessel revascularization, including non-IRA (MVR, n=267) group. The primary endpoint of this study included major adverse cardiac events (MACEs), such as death, myocardial infarction, or target or nontarget lesion revascularization at one year. RESULTS: There was no difference in clinical characteristics between the two groups. During the one-year follow-up, 102 (15.2%) patients in the COR group and 32 (14.2%) in the MVR group experienced at least one MACE (p=0.330). There were no differences between the two groups in terms of rates of death, myocardial infarction, or revascularization (2.1% vs. 2.0%, 0.7% vs. 0.8%, and 11.7% vs. 10.1%, respectively; p=0.822, 0.910, and 0.301, respectively). The MACE rate was higher in the incompletely revascularized patients than in the completely revascularized patients (15% vs. 9.5%, p=0.039), and the difference was attributable to a higher rate of nontarget vessel revascularization (8.6% vs. 1.8%, p=0.002). CONCLUSION: Although multivessel angioplasty during primary PCI for STEMI did not reduce the MACE rate compared with culprit-vessel-only PCI, CR was associated with a lower rate of repeat revascularization after multivessel PCI.
Angioplasty ; Arteries ; Coronary Artery Disease ; Drug-Eluting Stents ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: We sought to characterize the lesion characteristics of mitral valve prolapse (MVP), which is being increasingly recognized as a cause of mitral regurgitation (MR) in Koreans SUBJECTS AND METHODS: 497 Patients with MVP that was diagnosed by echocardiography in 13 university-affiliated hospitals from Jan to Dec 2003 were prospectively enrolled in our study. RESULTS: A total of 497 patients (270 males, 54%) were enrolled and their mean age was 52+/-17 years. Grade 4 MR was present in 272 patients (54.7%); grade 3, 2 and 1 MR as present in 30.2%, 10.7% and 4.2%, respectively. MVP of the anterior and posterior mitral leaflet was present in 170 patients (34.2%) and 223 patients (44.9%), respectively; MVP developed in both leaflets in 104 patients (20.9%). In 37 patients (7.4%), MVP developed in all 6 segments of the mitral leaflet and these patients were younger (37+/-14 versus 54+/-16 years, respectively, p<0.05) and had a lower prevalence of chordae rupture and severe MR compared to the other patients. Among the 266 mitral segments showing prolapse in the 132 patients (26.6%) who underwent transesophageal echocardiography, the posterior medial scallop was the most frequently diseased one (26%), and this was followed by the posterior middle scallop (18%), the medial (17%), lateral (14%) and middle (13%) part of the anterior leaflet, and the posterior lateral scallop (12%). Younger patients with a mean age <45 years showed a lower prevalence of single segment prolapse, hypertension, severe MR and chordae rupture compared to the older patients (p<0.001, each). CONCLUSION: The medial part of both mitral leaflets was the predilection site for the development of MVP in Koreans and the lesion characteristics were different according to the patients' age.
Echocardiography* ; Echocardiography, Transesophageal ; Humans ; Hypertension ; Korea* ; Male ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pectinidae ; Prevalence ; Prolapse ; Prospective Studies* ; Rupture

BACKGROUND: In spite of yearly recalls, influenza immunization rate among healthcare workers (HCWs) remained low in Korea University Guro Hospital. This study was conducted to identify the causes of non-compliance against influenza immunization and to analyze the barrier factors for the immunization. MATERIALS & METHODS: Questionnaires were distributed in March of 2000 at Korea University Guro Hospital. We evaluated factors associated with acceptance of influenza vaccination and opinions regarding influenza prevention (knowledge about influenza vaccination efficacy, que to action in vaccinee, perceptible benefit, barrier to vaccination). RESULTS: 309 completed questionnaires from HCWs were returned. Mean age and mean duration of work in hospital were higher and longer among vaccinee than non-vaccinee. Even though the necessity of influenza vaccination among HCWs were accepted well in vaccinee compared to non- vaccinee, the accurate reasons for vaccination were not quite understood among HCWs regardless of compliance. Vaccine campaign (30.8%) and advise from doctors (24.7%) were important for the promotion of vaccination among vaccinee. However, major reason for non-compliance among nursing staff and was mis-confidence that their bodies' self defense mechanisms would ward off infection (33.5%) and 'too busy to get injection' for doctors (65%). CONCLUSION: We conclude that regular education about perceptible benefits and wrong concerns about influenza vaccination among HCW's and easy accessibility to vaccination were important determinants to improve the influenza vaccination. On-site availability of a vaccination-nurse also proved to be important.
Compliance ; Defense Mechanisms ; Delivery of Health Care* ; Education ; Humans ; Immunization ; Influenza, Human* ; Korea ; Nursing Staff ; Vaccination* ; Surveys and Questionnaires

BACKGROUND: Influenza is one of the preventable respiratory disease by annual vaccination. Elderly people and patients with chronic medical disease are the primary target for influenza vaccination according to ACIP (Advisory Committee on Immunization). This study was done to determine whether influenza vaccination affects hospitalization due to influenza like illness or it's related complications among chronic ill patients. MATERIALS AND METHODS: Retrospective, case-control study was conducted for 5 months (Nov. 1999-Mar. 2000). Physicians from two-university hospitals in Korea were instructed to collect clinical data, sera from subjects presenting with a flu-like illness or flu-related exacerbation in patients with chronic underlying diseases. We compared the vaccination history of case patients with control. Logistic regression analysis was used to calculate the odd ratio and efficacy of influenza vaccination. RESULTS: Hospitalization due to ILI (influenza like illness) or it's related complications were observed more frequently in patients with chronic lung disease (25.3%) and chronic cardiac disease (31.3%) compared to others. Influenza vaccination resulted in fewer hospitalization with ILI or ILI-related acute exacerbation of underlying disease in chronic ill patients (adjusted odd ratio, 0.328 [CI, 0.14 to 0.73]) during influenza seasons. CONCLUSION: For patients with chronic disease, influenza vaccination is associated with substantial health benefit including fewer hospitalization. Health care providers should take advantage of all opportunities to immunize these high-risk patients.
Aged ; Case-Control Studies* ; Chronic Disease ; Health Personnel ; Heart Diseases ; Hospitalization ; Humans ; Influenza, Human* ; Insurance Benefits ; Korea ; Logistic Models ; Lung Diseases ; Retrospective Studies* ; Seasons ; Vaccination*

BACKGROUND: In spite of yearly recalls, influenza immunization rate among healthcare workers (HCWs) remained low in Korea University Guro Hospital. This study was conducted to identify the causes of non-compliance against influenza immunization and to analyze the barrier factors for the immunization. MATERIALS & METHODS: Questionnaires were distributed in March of 2000 at Korea University Guro Hospital. We evaluated factors associated with acceptance of influenza vaccination and opinions regarding influenza prevention (knowledge about influenza vaccination efficacy, que to action in vaccinee, perceptible benefit, barrier to vaccination). RESULTS: 309 completed questionnaires from HCWs were returned. Mean age and mean duration of work in hospital were higher and longer among vaccinee than non-vaccinee. Even though the necessity of influenza vaccination among HCWs were accepted well in vaccinee compared to non- vaccinee, the accurate reasons for vaccination were not quite understood among HCWs regardless of compliance. Vaccine campaign (30.8%) and advise from doctors (24.7%) were important for the promotion of vaccination among vaccinee. However, major reason for non-compliance among nursing staff and was mis-confidence that their bodies' self defense mechanisms would ward off infection (33.5%) and 'too busy to get injection' for doctors (65%). CONCLUSION: We conclude that regular education about perceptible benefits and wrong concerns about influenza vaccination among HCW's and easy accessibility to vaccination were important determinants to improve the influenza vaccination. On-site availability of a vaccination-nurse also proved to be important.
Compliance ; Defense Mechanisms ; Delivery of Health Care* ; Education ; Humans ; Immunization ; Influenza, Human* ; Korea ; Nursing Staff ; Vaccination* ; Surveys and Questionnaires

BACKGROUND: Influenza is one of the preventable respiratory disease by annual vaccination. Elderly people and patients with chronic medical disease are the primary target for influenza vaccination according to ACIP (Advisory Committee on Immunization). This study was done to determine whether influenza vaccination affects hospitalization due to influenza like illness or it's related complications among chronic ill patients. MATERIALS AND METHODS: Retrospective, case-control study was conducted for 5 months (Nov. 1999-Mar. 2000). Physicians from two-university hospitals in Korea were instructed to collect clinical data, sera from subjects presenting with a flu-like illness or flu-related exacerbation in patients with chronic underlying diseases. We compared the vaccination history of case patients with control. Logistic regression analysis was used to calculate the odd ratio and efficacy of influenza vaccination. RESULTS: Hospitalization due to ILI (influenza like illness) or it's related complications were observed more frequently in patients with chronic lung disease (25.3%) and chronic cardiac disease (31.3%) compared to others. Influenza vaccination resulted in fewer hospitalization with ILI or ILI-related acute exacerbation of underlying disease in chronic ill patients (adjusted odd ratio, 0.328 [CI, 0.14 to 0.73]) during influenza seasons. CONCLUSION: For patients with chronic disease, influenza vaccination is associated with substantial health benefit including fewer hospitalization. Health care providers should take advantage of all opportunities to immunize these high-risk patients.
Aged ; Case-Control Studies* ; Chronic Disease ; Health Personnel ; Heart Diseases ; Hospitalization ; Humans ; Influenza, Human* ; Insurance Benefits ; Korea ; Logistic Models ; Lung Diseases ; Retrospective Studies* ; Seasons ; Vaccination*

BACKGROUND: The purpose of this study is to recommend the initial therapeutic regimen for adult patients with acute pyelonephritis (APN) according to the changes of antimicrobial susceptibility patterns of causative microorganisms isolated from patients with APN. METHODS: We reviewed medical charts of 229 APN patients, who had been treated at Korea University Guro Hospital from 1st of January, 1999 to 31st of December, 2001. We investigated the demographic data, clinical findings, durations of hospital treatment, antimicrobial susceptibility patterns of the causative microorganisms and initial antibiotic regimens in patients with APN. RESULTS: In this study, 229 adult patients with APN were classified into simple APN patients (118 patients, 51.5%) and complicated APN patients (111 patients, 48.4%). Mean age of patients with simple APN was 38.2+/-14.1 years old and that of patients with complicated APN was 56.1+/-14.9 years old. Mean age of patients with complicated APN was significantly higher than that of simple APN patients (P<0.0001). Escherichia coli was the most common microorganism both in simple APN (96.7%) group and in complicated APN (90.6%) group. Antimicrobial susceptibility of E. coli was at the low level of ampicillin (31%/20%) and trimethoprim-sulfamethoxazole (42.6%/34.2%) in each group. In contrast, ciprofloxacin (11.5%/22.7%), gentamicin (16.4%/22%) and cefotaxime (0%/8.2%) resistance remained at relatively lower level. In comparison of simple APN with complicated APN, ciprofloxacin and gentamicin resistances were higher in complicted APN group. Average duration of hospitalization (5.9+/-2.3 days/8.2+/-4.6 days) and duration of antibiotic use (12.1+/-3.9 days/15.3+/-10.0 days) were significantly longer in complicated APN. CONCLUSIONS: The results of this study suggests that 3rd cephalosporin, aminoglycoside or quinolone antibiotic would considered as one of the initial therapeutic regimen for patients with simple APN in southwestern Seoul.
Adult* ; Ampicillin ; Cefotaxime ; Ciprofloxacin ; Escherichia coli ; Gentamicins ; Hospitalization ; Humans ; Korea ; Pyelonephritis* ; Seoul* ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND: The emergence of multi-drug resistant Gram-positive cocci, such as MRSA, VRE, and VRSA, necessitated to develop new antibiotics, which could replace the glycopeptide. As a result, a new antibiotics named linezolid was developed. Linezolid is different line of oxazolidinones with a good oral bioavailability, compared to other antibiotics. Since appropriate oral antibiotics are not presently available for MRSA, which is a major cause of nosocomial and community acquired infections, the introduction of linezolid will have favorable effect on treatment of infections such as pneumonia or skin infections. In this study, we investigated the antibiotic effect of linezolid on MRSA and VRE isolated from patients who were treated in Korea University Guro Hospital. MATERIAL AND METHODS: By using broth microdilution and agar dilution method we measured minimum inhibitory concentration (MIC) with sixty S. aureus, forty three Enterococcus spp., and twenty five S. pneumoniae isolates from patients who were diagnosed as skin, soft tissue, respiratory, and urinary infections in Korea University Guro Hospital from January, 1998 to December, 2002. RESULTS: All of S. aureus used in this study were MRSA, and MIC90 of linezolid was below 2 microgram/ml (MIC ranged between 1-2 microgram/ml). All of Enterococcus spp. were VRE, and had MIC90 of 2 microgram/ml (MIC ranged between 1 to 4 microgram/ml). One of the VRE showed intermediate susceptibility with MIC of 4 microgram/ml. However, none was resistant with MIC breakpoint above 8 microgram/ml. All of S. pneumoniae were resistant to penicillin, but they were susceptible to linezolid with MIC90 of 1 microgram/ml(MIC range 0.5-1 microgram/ml). CONCLUSION: In conclusions, linezolid has an excellent in vitro antibiotic effect on multi-drug resistant Gram-positive cocci, such as MRSA, PRSP, and VRE.
Agar ; Anti-Bacterial Agents ; Biological Availability ; Community-Acquired Infections ; Enterococcus ; Gram-Positive Cocci ; Humans ; Korea ; Linezolid ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Oxazolidinones ; Penicillins ; Pneumonia ; Skin

BACKGROUND: The purpose of this study is to recommend the initial therapeutic regimen for adult patients with acute pyelonephritis (APN) according to the changes of antimicrobial susceptibility patterns of causative microorganisms isolated from patients with APN. METHODS: We reviewed medical charts of 229 APN patients, who had been treated at Korea University Guro Hospital from 1st of January, 1999 to 31st of December, 2001. We investigated the demographic data, clinical findings, durations of hospital treatment, antimicrobial susceptibility patterns of the causative microorganisms and initial antibiotic regimens in patients with APN. RESULTS: In this study, 229 adult patients with APN were classified into simple APN patients (118 patients, 51.5%) and complicated APN patients (111 patients, 48.4%). Mean age of patients with simple APN was 38.2+/-14.1 years old and that of patients with complicated APN was 56.1+/-14.9 years old. Mean age of patients with complicated APN was significantly higher than that of simple APN patients (P<0.0001). Escherichia coli was the most common microorganism both in simple APN (96.7%) group and in complicated APN (90.6%) group. Antimicrobial susceptibility of E. coli was at the low level of ampicillin (31%/20%) and trimethoprim-sulfamethoxazole (42.6%/34.2%) in each group. In contrast, ciprofloxacin (11.5%/22.7%), gentamicin (16.4%/22%) and cefotaxime (0%/8.2%) resistance remained at relatively lower level. In comparison of simple APN with complicated APN, ciprofloxacin and gentamicin resistances were higher in complicted APN group. Average duration of hospitalization (5.9+/-2.3 days/8.2+/-4.6 days) and duration of antibiotic use (12.1+/-3.9 days/15.3+/-10.0 days) were significantly longer in complicated APN. CONCLUSIONS: The results of this study suggests that 3rd cephalosporin, aminoglycoside or quinolone antibiotic would considered as one of the initial therapeutic regimen for patients with simple APN in southwestern Seoul.
Adult* ; Ampicillin ; Cefotaxime ; Ciprofloxacin ; Escherichia coli ; Gentamicins ; Hospitalization ; Humans ; Korea ; Pyelonephritis* ; Seoul* ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND: The emergence of multi-drug resistant Gram-positive cocci, such as MRSA, VRE, and VRSA, necessitated to develop new antibiotics, which could replace the glycopeptide. As a result, a new antibiotics named linezolid was developed. Linezolid is different line of oxazolidinones with a good oral bioavailability, compared to other antibiotics. Since appropriate oral antibiotics are not presently available for MRSA, which is a major cause of nosocomial and community acquired infections, the introduction of linezolid will have favorable effect on treatment of infections such as pneumonia or skin infections. In this study, we investigated the antibiotic effect of linezolid on MRSA and VRE isolated from patients who were treated in Korea University Guro Hospital. MATERIAL AND METHODS: By using broth microdilution and agar dilution method we measured minimum inhibitory concentration (MIC) with sixty S. aureus, forty three Enterococcus spp., and twenty five S. pneumoniae isolates from patients who were diagnosed as skin, soft tissue, respiratory, and urinary infections in Korea University Guro Hospital from January, 1998 to December, 2002. RESULTS: All of S. aureus used in this study were MRSA, and MIC90 of linezolid was below 2 microgram/ml (MIC ranged between 1-2 microgram/ml). All of Enterococcus spp. were VRE, and had MIC90 of 2 microgram/ml (MIC ranged between 1 to 4 microgram/ml). One of the VRE showed intermediate susceptibility with MIC of 4 microgram/ml. However, none was resistant with MIC breakpoint above 8 microgram/ml. All of S. pneumoniae were resistant to penicillin, but they were susceptible to linezolid with MIC90 of 1 microgram/ml(MIC range 0.5-1 microgram/ml). CONCLUSION: In conclusions, linezolid has an excellent in vitro antibiotic effect on multi-drug resistant Gram-positive cocci, such as MRSA, PRSP, and VRE.
Agar ; Anti-Bacterial Agents ; Biological Availability ; Community-Acquired Infections ; Enterococcus ; Gram-Positive Cocci ; Humans ; Korea ; Linezolid ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Oxazolidinones ; Penicillins ; Pneumonia ; Skin