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.

Purpose: Predicting improvements in voiding symptoms following deobstructive surgery for male lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) is challenging when detrusor contractility is impaired. This study aimed to develop an artificial intelligence model that predicts symptom improvement after holmium laser enucleation of the prostate (HoLEP), focusing on changes in maximum flow rate (MFR) and voiding efficiency (VE) 1-month postsurgery. Methods: We reviewed 1,933 patients who underwent HoLEP at Samsung Medical Center from July 2008 to January 2024. The study employed a deep neural network (DNN) for multiclass classification to predict changes in MFR and VE, each divided into 3 categories. For comparison, additional machine learning (ML) models such as extreme gradient boosting, random forest classification, and support vector machine were utilized. To address class imbalance, we applied the least squares method and multitask learning. Results: A total of 1,142 patients with complete data were included in the study, with 992 allocated for model training and 150 for external validation. In predicting MFR, the DNN achieved a microaverage area under the receiver operating characteristic curve (AUC) of 0.884±0.006, sensitivity of 0.783±0.020, and specificity of 0.891±0.010. For VE prediction, the microaverage AUC was 0.817±0.007, with sensitivity and specificity values of 0.660±0.014 and 0.830±0.007, respectively. These results indicate that the DNN's predictive performance was superior to that of other ML models. Conclusions The DNN model provides detailed and accurate predictions for recovery after HoLEP, providing valuable insights for clinicians managing patients with LUTS/BPH.

Purpose: Predicting improvements in voiding symptoms following deobstructive surgery for male lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) is challenging when detrusor contractility is impaired. This study aimed to develop an artificial intelligence model that predicts symptom improvement after holmium laser enucleation of the prostate (HoLEP), focusing on changes in maximum flow rate (MFR) and voiding efficiency (VE) 1-month postsurgery. Methods: We reviewed 1,933 patients who underwent HoLEP at Samsung Medical Center from July 2008 to January 2024. The study employed a deep neural network (DNN) for multiclass classification to predict changes in MFR and VE, each divided into 3 categories. For comparison, additional machine learning (ML) models such as extreme gradient boosting, random forest classification, and support vector machine were utilized. To address class imbalance, we applied the least squares method and multitask learning. Results: A total of 1,142 patients with complete data were included in the study, with 992 allocated for model training and 150 for external validation. In predicting MFR, the DNN achieved a microaverage area under the receiver operating characteristic curve (AUC) of 0.884±0.006, sensitivity of 0.783±0.020, and specificity of 0.891±0.010. For VE prediction, the microaverage AUC was 0.817±0.007, with sensitivity and specificity values of 0.660±0.014 and 0.830±0.007, respectively. These results indicate that the DNN's predictive performance was superior to that of other ML models. Conclusions The DNN model provides detailed and accurate predictions for recovery after HoLEP, providing valuable insights for clinicians managing patients with LUTS/BPH.

Purpose: Predicting improvements in voiding symptoms following deobstructive surgery for male lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) is challenging when detrusor contractility is impaired. This study aimed to develop an artificial intelligence model that predicts symptom improvement after holmium laser enucleation of the prostate (HoLEP), focusing on changes in maximum flow rate (MFR) and voiding efficiency (VE) 1-month postsurgery. Methods: We reviewed 1,933 patients who underwent HoLEP at Samsung Medical Center from July 2008 to January 2024. The study employed a deep neural network (DNN) for multiclass classification to predict changes in MFR and VE, each divided into 3 categories. For comparison, additional machine learning (ML) models such as extreme gradient boosting, random forest classification, and support vector machine were utilized. To address class imbalance, we applied the least squares method and multitask learning. Results: A total of 1,142 patients with complete data were included in the study, with 992 allocated for model training and 150 for external validation. In predicting MFR, the DNN achieved a microaverage area under the receiver operating characteristic curve (AUC) of 0.884±0.006, sensitivity of 0.783±0.020, and specificity of 0.891±0.010. For VE prediction, the microaverage AUC was 0.817±0.007, with sensitivity and specificity values of 0.660±0.014 and 0.830±0.007, respectively. These results indicate that the DNN's predictive performance was superior to that of other ML models. Conclusions The DNN model provides detailed and accurate predictions for recovery after HoLEP, providing valuable insights for clinicians managing patients with LUTS/BPH.

Background: The importance of digital technology is increasing among older adults. In this study, the digital health technology utilization status, purpose, and satisfaction of older adults were investigated according to frailty. Methods: A face-to-face survey was conducted among adults aged 65 years or older. Frailty was defined using the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight scale. Results: A total of 505 participants completed the survey, with 153 (30.3%) identified as pre-frail or frail and 352 (69.7%) as healthy. All respondents used smartphones; 440 (87.1%) were application users, and 290 (57.4%) were healthcare application users. Wearable devices were used by only 36 patients (7.1%). Pre-frail or frail respondents used social media more frequently than healthy respondents (19.4% vs. 7.4%, P < 0.001). Among the respondents, 319 (63.2%) were not able to install or delete the application themselves, and 277 (54.9%) stated that the application was recommended by their children (or partner). Pre-frail and frail respondents used more healthcare applications to obtain health information (P = 0.002) and were less satisfied with wearable devices (P = 0.02). Conclusion The usage rate of digital devices, including mobile phones among older adults in Korea is high, whereas that of wearable devices is low. There was a notable difference in the services used by pre-frail and frail respondents compared to healthy respondents. Therefore, when developing digital devices for pre-frail and frail older adults, it is crucial to incorporate customized services that meet their unique needs, particularly those services that they frequently use.

Background: The benefits of transradial access (TRA) over transfemoral access (TFA) for bifurcation percutaneous coronary intervention (PCI) are uncertain because of the limited availability of device selection. This study aimed to compare the procedural differences and the in-hospital and long-term outcomes of TRA and TFA for bifurcation PCI using secondgeneration drug-eluting stents (DESs). Methods: Based on data from the Coronary Bifurcation Stenting Registry III, a retrospective registry of 2,648 patients undergoing bifurcation PCI with second-generation DES from 21 centers in South Korea, patients were categorized into the TRA group (n = 1,507) or the TFA group (n = 1,141). After propensity score matching (PSM), procedural differences, in-hospital outcomes, and device-oriented composite outcomes (DOCOs; a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) were compared between the two groups (772 matched patients each group). Results: Despite well-balanced baseline clinical and lesion characteristics after PSM, the use of the two-stent strategy (14.2% vs. 23.7%, P = 0.001) and the incidence of in-hospital adverse outcomes, primarily driven by access site complications (2.2% vs. 4.4%, P = 0.015), were significantly lower in the TRA group than in the TFA group. At the 5-year follow-up, the incidence of DOCOs was similar between the groups (6.3% vs. 7.1%, P = 0.639). Conclusion The findings suggested that TRA may be safer than TFA for bifurcation PCI using second-generation DESs. Despite differences in treatment strategy, TRA was associated with similar long-term clinical outcomes as those of TFA. Therefore, TRA might be the preferred access for bifurcation PCI using second-generation DES.

Background/Aims: The ursodeoxycholic acid (UDCA) response score (URS) was developed to identify poor responders to UDCA before treatment, in order to offer timely and proactive intervention. However, validation of the URS in Asian population is warranted. Methods: A total of 173 Asian patients diagnosed with primary biliary cholangitis (PBC) between 2007 and 2016 at seven academic institutions in Korea who started UDCA treatment were analyzed to validate the performance of URS. UDCA response was defined as an alkaline phosphatase level less than 1.67 times the upper limit of normal after 1-year of UDCA treatment. In addition, prognostic performance of URS for liver-related events, defined as newly developed hepatic decompensation or hepatocellular carcinoma was evaluated. Results: After 1 year of UDCA treatment, 133 patients (76.9%) achieved UDCA response. UDCAresponse rate was 98.7% for those with URS ≥1.41 (n=76) and 58.8% for those with URS <1.41(n=97). The area under the receiver operating characteristic curve of URS in predicting UDCAresponse was 0.84 (95% confidence interval, 0.78 to 0.88). During a median follow-up of 6.5years, liver-related events developed in 18 patients (10.4%). Among 117 patients with PBC stage I-III by histological evaluation, the 5-year liver-related event-free survival rate differed accordingto the URS; 100% for URS ≥1.41 and 86.5% for URS <1.41 (p=0.005). Conclusions URS demonstrated good performance in predicting a UDCA treatment response in Asian PBC patients. In addition, the risk of liver-related events differed according to the URS for the PBC stage. Thus, URS can be used to predict the response and clinical outcome in patients with PBC.