BACKGROUND: Everolimus-eluting stent (EES) implantations have a relatively low rate of major adverse cardiac event (MACE) and target lesion revascularization (TLR) in patients with off-label use. However, the clinical outcome in the Korean population regarding EES in patients with off-label use is not well known. OBJECTS: The aim of the current analysis was to compare the clinical outcomes of on-label and off-label EES use over a 2-year follow-up period. METHODS: Using patient-level data from a stent-specific, prospective, all-comer registry, we evaluated 987 patients (1,342 lesions) who received an EES (XIENCE V®, Abbott Vascular, Santa Clara, CA, USA) implantation between February 2009 and April 2011. The primary outcome was assessed: 2-year MACE (a composite endpoint of death from any cause, spontaneous myocardial infarction (MI), and any repeat revascularization). The clinical outcomes in the on- and off-label groups were compared at 2 years. RESULTS: The majority of patients (79.0%) were treated for ≥1 off-label indication. The median duration of the clinical follow-up in the overall population was 2.0 years (interquartile range 1.9–2.1). At 2-years after the EES implantation in the enrolled patients, MACE occurred in 71 (7.9%) patients, cardiac death in 12 (1.3%), MI in 4 (0.5%), target vessel revascularization (TVR) in 33 (3.8%), TLR in 22 (2.5%), and definite or probable stent thrombosis (ST) in 1 (0.1%). Off-label EES implantations tend to increase the risk of 2-year MACE (4.7% vs. 8.8%, p = 0.063) without statistical significance. However, the rates of TLR were higher in the off-label EES implantations (0.0% vs. 3.2%, p = 0.013). In the multivariable analysis, renal failure, previous bypass surgery, previous cerebrovascular accident, and left main lesions were associated with 2-year MACE in patients with EES implantations. CONCLUSIONS: The incidence of 2-year MACE was 7.9%, which that might be acceptable in all-comer patients treated with EES implantations. Although the off-label use of EES was not statistically associated with an increased risk of MACE, the TLR rate was higher in the off-label group, suggesting that physicians need to pay attention to high risk patients with the use of EES implantations.
Coronary Artery Disease ; Death ; Drug-Eluting Stents* ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Off-Label Use ; Prospective Studies ; Renal Insufficiency ; Stents* ; Stroke ; Thrombosis

BACKGROUND/AIMS: The mortality of hospitalized patients undergoing treatment with an intra-aortic balloon pump (IABP) due to cardiogenic shock is well known as quite high. The aim of this study was to evaluate the outcome of percutaneous coronary intervention (PCI) with an IABP in patients with acute coronary syndrome (ACS) and cardiogenic shock and identify the predictors of in-hospital mortality. METHODS: 134 patients who underwent PCI with IABP due to ACS complicated by cardiogenic shock were consecutively enrolled. Outcomes were obtained and analyzed during hospitalization and after 1 year. RESULTS: The incidence of all-cause mortality was 35.8% (in-hospital mortality, 34.3%; 1-year mortality, 1.5%). The nonsurvival group exhibited higher peak levels of creatine kinase MB; lower ejection fractions; and higher incidences of ST elevation myocardial infarction, ventricular arrhythmia, and use of an assistive device than did the survival group. Aging (hazard ratio 2.839; 95% confidence interval 1.408-5.723; p = 0.004), the use of a temporary pacemaker (2.035; 1.114-3.720; 0.021), the use of a mechanical ventilator (4.376; 1.852-10.341; 0.001), and the performance of cardiopulmonary resuscitation (CPR) (2.219; 1.017-4.839; 0.045) were independent predictors for in-hospital mortality. However, out-of-hospital mortality among in-hospital survivors was not affected by predictors of in-hospital mortality. CONCLUSIONS: The incidence of in-hospital mortality was high, as expected in patients undergoing PCI with IABP due to ACS with cardiogenic shock. Aging, CPR, and additional procedures such as pacemaker use and mechanical ventilation were predictors of in-hospital mortality. However, the patients who were successfully discharged after the complex procedure showed acceptable 1-year outcomes.
Acute Coronary Syndrome ; Aging ; Arrhythmias, Cardiac ; Cardiopulmonary Resuscitation ; Creatine Kinase ; Hospital Mortality ; Hospitalization ; Humans ; Incidence ; Intra-Aortic Balloon Pumping ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Respiration, Artificial ; Self-Help Devices ; Shock, Cardiogenic* ; Survivors ; Ventilators, Mechanical

PURPOSE: This retrospective cohort study was conducted to estimate the optimal interval for gastric cancer screening in Korean adults with initial negative screening results. MATERIALS AND METHODS: This study consisted of voluntary Korean screenees aged 40 to 69 years who underwent subsequent screening gastroscopies after testing negative in the baseline screening performed between January 2007 and December 2011. A new case was defined as the presence of gastric cancer cells in biopsy specimens obtained upon gastroscopy. The follow-up periods were calculated during the months between the date of baseline screening gastroscopy and positive findings upon subsequent screenings, stratified by sex and age group. The mean sojourn time (MST) for determining the screening interval was estimated using the prevalence/incidence ratio. RESULTS: Of the 293,520 voluntary screenees for the gastric cancer screening program, 91,850 (31.29%) underwent subsequent screening gastroscopies between January 2007 and December 2011. The MSTs in men and women were 21.67 months (95% confidence intervals [CI], 17.64 to 26.88 months) and 15.14 months (95% CI, 9.44 to 25.85 months), respectively. CONCLUSION: These findings suggest that the optimal interval for subsequent gastric screening in both men and women is 24 months, supporting the 2-year interval recommended by the nationwide gastric cancer screening program.
Adult* ; Biopsy ; Cohort Studies* ; Early Detection of Cancer ; Endoscopy, Gastrointestinal ; Female ; Follow-Up Studies ; Gastroscopy ; Humans ; Korea ; Male ; Mass Screening* ; Retrospective Studies* ; Stomach Neoplasms*

OBJECTIVES: This retrospective cohort study aimed at calculating some parameters of changes in the findings of the subsequent screening mammography (SSM) in female Korean volunteers. METHODS: The study included screenees aged 30 to 79 years who underwent SSM voluntarily after testing negative in the baseline screenings performed between January 2007 and December 2011. A change to a positive result was defined as category 4 or 5 by using the American College of Radiology Breast Imaging Reporting and Data System. The proportion of results that had changed to positive (CP, %) was calculated by dividing the number of cases with results that were positive in the SSM by the total number of study participants. The rate of results that had changed to positive (CR, cases per 100 000 screenee-months) was calculated by dividing the number of cases with results that were positive in the SSM by the total number of months of the follow-up period. RESULTS: The overall CP and CR in all age groups (n=77 908) were 2.26% and 93.94 cases per 100 000 screenee-months, respectively. The median CP interval in the subjects who had positive SSM results was 30 to 36 months, while that in the age group of 30 to 39 years was shorter. CONCLUSIONS: Different screening intervals should be considered among women aged between 30 and 59 years. In addition, a strategy for a screening program should be developed for the age group of 30 to 39 years, in particular.
Adult ; Aged ; Asian Continental Ancestry Group ; Breast Neoplasms/*diagnosis/epidemiology ; Early Detection of Cancer ; Female ; Follow-Up Studies ; Humans ; Incidence ; *Mammography ; Mass Screening ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Women

OBJECTIVES: This retrospective cohort study aimed to estimate the mean sojourn time (MST) of preclinical gastric cancer in Korean men. METHODS: The subjects consisted of voluntary male screenees aged 40 to 69 years who underwent subsequent screening gastroscopies after testing negative at a baseline screening performed between January 2007 and December 2011. A new case was defined if gastric cancer cells were present in the biopsy specimens obtained from gastroscopy. The follow-up period was calculated as the number of person-years between the date of baseline screening gastroscopy and positive findings at a subsequent screening. The MST was calculated using transition rates of gastric cancer to determine the best screening interval. RESULTS: Of the 171 979 voluntary male screenees, 61 688 (36%) underwent subsequent screening gastroscopies between January 2007 and December 2011. A total of 91 incident cases were found during 19 598 598 person-years of follow-up. The MST of gastric cancer was 2.37 years (95% confidence intervals, 1.92 to 2.96), and those aged 40 to 49 years had a shorter MST than those 50 to 69 years did. CONCLUSIONS: These findings support the 2-year interval of screening recommended by the nationwide gastric cancer screening program in Korea. Further studies for the age-specific MST among women are needed.
Adult ; Aged ; *Algorithms ; Asian Continental Ancestry Group ; Cohort Studies ; Early Detection of Cancer ; Gastroscopy ; Humans ; Incidence ; Male ; Mass Screening ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Stomach Neoplasms/*epidemiology/pathology ; Time Factors

OBJECTIVES: This retrospective observational study evaluated the distribution of dense breasts by age group among healthy Korean women. METHODS: Participants were women aged 30 years and older who voluntarily underwent screening mammography between January 2007 and December 2011. Women who received the Breast Imaging Reporting and Data System for mammographic density of 3 or 4 were defined as having dense breasts. The proportion of women with dense breasts (PDB, %) was calculated by dividing the number of participants with dense breasts by the total number of participants. RESULTS: Among the 231,058 women who participated, 78.15% were classified as having dense breasts. PDB was highest in the youngest age group (PDB=94.87%) and lowest in the oldest age group. The greatest difference in PDB between adjacent age groups was observed in the group aged 60-64 years. CONCLUSIONS: The results show that the proportion of dense breasts by age group increased in all age groups, except in those aged 35-39 years. These findings suggest an association between the age distribution of dense breasts and trends in breast cancer incidence. Further studies are needed to estimate the change in breast cancer incidence rate by age and the accumulation of fatty breast tissue in Korean women.
Age Distribution ; Breast Neoplasms ; Breast* ; Early Detection of Cancer ; Female ; Humans ; Incidence ; Information Systems ; Mammography* ; Mass Screening* ; Observational Study* ; Retrospective Studies*

BACKGROUND: Shigellosis is one of the most important contagious diseases in Korea. Especially, Jeju island has been known as the main and large outbreak area in Korea. The purpose of this study was to investigate the epidemiologic characteristics of shigellosis in Jeju island, 2003. METHODS: Patients with shigellosis, confirmed by culture in Jeju island in 2003, were included in this study. We retrospectively reviewed epidemiologic questionnaires, medical records, and official documents. We also collected data from direct interview with the patients with shigellosis. Epidemiological analysis was performed by 3 categorized events and ages. RESULTS: Ninety-nine patients were included in this study. S. sonnei was identified in all of the patients. Shigellosis mainly occurred in preschool-aged children. However, there was no statistical difference according to sex. Although there were asymptomatic cases (15.15%), the chief complaints were loose stool (69.7%) and abdominal pain (12.12%). Initial symptoms in symptomatic patients were abdominal pain (43.43%) and fever (31.31%). The median duration of isolation in the hospital was 7 days. CONCLUSION: Large and chronic epidemic outbreaks of shigellosis have occurred in Jeju island. Throughout this survey, we could show the epidemiological characteristics and the nature of shigellosis in Jeju island.
Abdominal Pain ; Child ; Disease Outbreaks ; Dysentery, Bacillary* ; Fever ; Humans ; Korea ; Medical Records ; Retrospective Studies ; Surveys and Questionnaires

BACKGROUND: Shigellosis is one of the most important contagious diseases in Korea. Especially, Jeju island has been known as the main and large outbreak area in Korea. The purpose of this study was to investigate the epidemiologic characteristics of shigellosis in Jeju island, 2003. METHODS: Patients with shigellosis, confirmed by culture in Jeju island in 2003, were included in this study. We retrospectively reviewed epidemiologic questionnaires, medical records, and official documents. We also collected data from direct interview with the patients with shigellosis. Epidemiological analysis was performed by 3 categorized events and ages. RESULTS: Ninety-nine patients were included in this study. S. sonnei was identified in all of the patients. Shigellosis mainly occurred in preschool-aged children. However, there was no statistical difference according to sex. Although there were asymptomatic cases (15.15%), the chief complaints were loose stool (69.7%) and abdominal pain (12.12%). Initial symptoms in symptomatic patients were abdominal pain (43.43%) and fever (31.31%). The median duration of isolation in the hospital was 7 days. CONCLUSION: Large and chronic epidemic outbreaks of shigellosis have occurred in Jeju island. Throughout this survey, we could show the epidemiological characteristics and the nature of shigellosis in Jeju island.
Abdominal Pain ; Child ; Disease Outbreaks ; Dysentery, Bacillary* ; Fever ; Humans ; Korea ; Medical Records ; Retrospective Studies ; Surveys and Questionnaires