Background and Objectives: Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy. Methods: Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment.Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke. Results: mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively.Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01). Conclusions Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.

Background and Objectives: Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy. Methods: Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment.Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke. Results: mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively.Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01). Conclusions Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.

BACKGROUND AND OBJECTIVES: There are no data comparing clinical outcomes of complex percutaneous coronary intervention (PCI) between biodegradable polymer-biolimus-eluting stents (BP-BES) and durable polymer-everolimus-eluting stents (DP-EES). We sought to evaluate the safety and efficacy of BP-BES compared with DP-EES in patients undergoing complex PCI. METHODS: Patients enrolled in the SMART-DESK registry were stratified into 2 categories based on the complexity of PCI. Complex PCI was defined as having at least one of the following features: unprotected left main lesion, ≥2 lesions treated, total stent length >40 mm, minimal stent diameter ≤2.5 mm, or bifurcation as target lesion. The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target vessel-related myocardial infarction (TV-MI), or target lesion revascularization (TLR) at 2 years of follow-up. RESULTS: Of 1,999 patients, 1,145 (57.3%) underwent complex PCI: 521 patients were treated with BP-BES and 624 with DP-EES. In propensity-score matching analysis (481 pairs), the risks of TLF (3.8% vs. 5.2%, adjusted hazard ratio [HR], 0.578; 95% confidence interval [CI], 0.246–1.359; p=0.209), cardiac death (2.5% vs. 2.5%, adjusted HR, 0.787; 95% CI, 0.244–2.539; p=0.689), TV-MI (0.5% vs. 0.4%, adjusted HR, 1.128; 95% CI, 0.157–8.093; p=0.905), and TLR (1.1% vs. 2.9%, adjusted HR, 0.390; 95% CI, 0.139–1.095; p=0.074) did not differ between 2 stent groups after complex PCI. CONCLUSIONS Clinical outcomes of BP-BES were comparable to those of DP-EES at 2 years after complex PCI. Our data suggest that use of BP-BES is acceptable, even for complex PCI.

BACKGROUND AND OBJECTIVES: There are no data comparing clinical outcomes of complex percutaneous coronary intervention (PCI) between biodegradable polymer-biolimus-eluting stents (BP-BES) and durable polymer-everolimus-eluting stents (DP-EES). We sought to evaluate the safety and efficacy of BP-BES compared with DP-EES in patients undergoing complex PCI. METHODS: Patients enrolled in the SMART-DESK registry were stratified into 2 categories based on the complexity of PCI. Complex PCI was defined as having at least one of the following features: unprotected left main lesion, ≥2 lesions treated, total stent length >40 mm, minimal stent diameter ≤2.5 mm, or bifurcation as target lesion. The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target vessel-related myocardial infarction (TV-MI), or target lesion revascularization (TLR) at 2 years of follow-up. RESULTS: Of 1,999 patients, 1,145 (57.3%) underwent complex PCI: 521 patients were treated with BP-BES and 624 with DP-EES. In propensity-score matching analysis (481 pairs), the risks of TLF (3.8% vs. 5.2%, adjusted hazard ratio [HR], 0.578; 95% confidence interval [CI], 0.246–1.359; p=0.209), cardiac death (2.5% vs. 2.5%, adjusted HR, 0.787; 95% CI, 0.244–2.539; p=0.689), TV-MI (0.5% vs. 0.4%, adjusted HR, 1.128; 95% CI, 0.157–8.093; p=0.905), and TLR (1.1% vs. 2.9%, adjusted HR, 0.390; 95% CI, 0.139–1.095; p=0.074) did not differ between 2 stent groups after complex PCI. CONCLUSIONS: Clinical outcomes of BP-BES were comparable to those of DP-EES at 2 years after complex PCI. Our data suggest that use of BP-BES is acceptable, even for complex PCI.
Coronary Artery Disease ; Death ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents

BACKGROUND: Since December 15 2017, donors showing a non-discriminated reactive (NDR) result in the nucleic acid amplification test (NAT) have been temporarily deferred and anti-HBc and anti-HBs assays as additional tests were performed. Donors with an anti-HBc reactive result and less than 100 IU/L of anti-HBs could not be released and can request a reentry test after more than six months. This study considered the effects of additional tests for NDR donors by analyzing the reentry test results in donors not released in the additional test. METHODS: This study examined the results of the additional test for NDR donors from January 2017 to September 2018 and the reentry test of the donors not released in the additional test. RESULTS: NAT was conducted on 4,706,051 blood donors over the period and 2,545 (0.05%) of them showed NDR. A total of 656 (25.8%) of the NDR donors were not released in the additional test. Among them, 246 donors requested a reentry test; 222 (90.2%) donors were not reentered, and 23 (10.4%) showed HBV NAT reactive results in the reentry test. Among the remaining 24 reentered donors, 2 donors (8.3%) showed anti-HBc nonreactive results in the reentry test and 22 donors (91.7%) showed higher than 100 IU/L of anti-HBs. CONCLUSION: The follow-up of NDR donors may be significant because some donors showed different results between screening test and reentry test. In addition the effectiveness of the introduction of additional tests for the NDR donors has been proved to be effective.
Blood Donors ; Follow-Up Studies ; Humans ; Mass Screening ; Nucleic Acid Amplification Techniques ; Tissue Donors

BACKGROUND: If donors who were deferred due to the reactivity or grey zone in HBV surface antigen (HBsAg) assay want to donate blood again, they need to pass reentry tests. On the other hand, approximately half of the donors who are subject to the reentry tests cannot be reentered. This study examined the association between the sample to cutoff (S/Co) value of the HBsAg assay and the final results of the reentry test. METHODS: This study analyzed the S/Co values of the HBsAg assay and the final results of the reentry tests for the 3,947 donors from January 2008 to December 2017 using the database of Blood Information Management System of the Korean Red Cross. RESULTS: 1,767 donors (44.8%) were not reentered among 3,947 deferred donors. Among 1,585 donors showing ≥10 of the S/Co value in the HBsAg screening test, 1,542 donors (97.3%) were not reentered. The additional reentry tests were performed on 120 donors who were not reentered in the first reentry test; 98 donors (81.7%) were still not reentered. Overall, 4.6% of the donors showing a grey zone in the HBsAg assay were not reentered. CONCLUSION: The reentry test needs to be restricted for the deferred donors showing a more than 10 S/Co value. The application of the grey zone of current HBsAg assay will need to be continued to enhance the HBV-related blood safety.
Antigens, Surface* ; Blood Safety ; Hand ; Hepatitis B Surface Antigens ; Humans ; Immunoassay* ; Information Management ; Mass Screening ; Red Cross ; Tissue Donors*

BACKGROUND: A leukoreduction filter was recently developed in Korea to reduce various kinds of adverse transfusion reactions. The objective of this study was to propose a domestic evaluation system for leukoreduction filters and to apply this evaluation system to assess the newly developed leukoreduction filter. METHODS: We prepared packed red blood cells from 60 units of whole blood (400 mL) collected from 60 normal individuals and evaluated the efficacy of the newly developed filter (FINECELL, KOLON INDUSTRIES, Gumi, Korea) and a control filter (RCM1, Haemonetics, MA, USA). To verify the evaluation system, we assessed the filtration time, residual leukocyte count, RBC recovery, RBC hemolysis, hemoglobin concentration, and hematocrit using a control filter RCM1 and compared the results with those of an evaluation performed by the American Red Cross (ARC) in 2013. We then evaluated the efficacy of the test filter FINECELL using the methods established in this study and compared the results with those of the control filter RCM1. RESULTS: The results of the current study were similar to those of the ARC with the control filters. The test filters developed in Korea were not inferior to commonly used control filters regarding residual leukocyte count, RBC recovery, and RBC hemolysis at 35 days after filtration. All of the results in the evaluation satisfied the international standards. CONCLUSION: These results of this study showed that the efficacy of the newly developed domestic leukoreduction filter were satisfactory and will contribute to improvement of quality of blood components in Korea.
Erythrocytes ; Filtration ; Gyeongsangbuk-do ; Hematocrit ; Hemolysis ; Korea ; Leukocyte Count ; Methods* ; Red Cross ; Transfusion Reaction

BACKGROUND AND OBJECTIVES: Numbness on the hand occurs infrequently after a transradial cardiac catheterization (TRC). The symptom resembles that of neuropathy. We, therefore, investigated the prevalence, the predicting factors and the presence of neurological abnormalities of numbness, using a nerve conduction study (NCS). SUBJECTS AND METHODS: From April to December 2013, all patients who underwent a TRC were prospectively enrolled. From among these, the patients who experienced numbness on the ipsilateral hand were instructed to describe their symptoms using a visual analogue scale; subsequently, NCSs were performed on these patients. RESULTS: Of the total 479 patients in the study sample, numbness occurred in nine (1.8%) following the procedure. The NCS was performed for eight out of the nine patients, four (50%) of which had an abnormal NCS result at the superficial radial nerve. A larger sheath and history of myocardial infarction (p=0.14 and 0.08 respectively) tended towards the occurrence of numbness; however, only the use of size 7 French sheaths was an independent predictor for the occurrence of numbness (odds ratio: 5.50, 95% confidence interval: 1.06-28.58, p=0.042). The symptoms disappeared for all patients but one, within four months. CONCLUSION: A transient injury of the superficial radial nerve could be one reason for numbness after a TRC. A large sheath size was an independent predictor of numbness; therefore, large sized sheaths should be used with caution when performing a TRC.
Cardiac Catheterization* ; Cardiac Catheters* ; Hand ; Humans ; Hypesthesia* ; Myocardial Infarction ; Neural Conduction* ; Prevalence ; Prospective Studies ; Radial Nerve* ; Radial Neuropathy

Leiomyomatosis refers to benign smooth muscle cell tumors that often arise from unusual growth patterns and include benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, and intravenous leiomyomatosis. Intravenous leiomyomatosis is the extension of a vascular tumor into the venous channels, whereas disseminated peritoneal leiomyomatosis is characterized by multiple leiomyomas growing along the submesothelial tissues of the abdominopelvic peritoneum. It is extremely rare for intravenous leiomyomatosis and disseminated peritoneal leiomyomatosis to occur simultaneously. A 42-year-old female presented with disseminated peritoneal leiomyomatosis and intravenous leiomyomatosis extended through the inferior vena cava into the right side of the heart. The patient underwent one-stage surgery under simultaneous sternotomy and laparotomy, and radical excision of the tumor was achieved using cardiopulmonary bypass. Here we describe a case in which complete removal of a leiomyomatosis with an unusual growth pattern was successfully performed using one-stage surgery.
Adult ; Cardiopulmonary Bypass ; Female ; Heart* ; Humans ; Laparotomy ; Leiomyoma ; Leiomyomatosis* ; Myocytes, Smooth Muscle ; Peritoneum ; Sternotomy ; Vena Cava, Inferior

We report a case of intravenous infusion amiodarone induced acute hepatitis, occurs within 1 day after initiation of drug in a 72-year-old woman with paroxysmal atrial fibrillation. Liver function test before intravenous infusion amiodarone treatment was normal. She was treated with intravenous infusion amiodarone, and then developed acute hepatitis next day. We suspected drug induced hepatitis due to intravenous infusion amiodarone. The liver function test returned to normal after the amiodarone was stopped. We described an unusual case which intravenous infusion amiodarone induced acute hepatitis within.
Aged ; Amiodarone* ; Atrial Fibrillation* ; Female ; Hepatitis* ; Humans ; Infusions, Intravenous* ; Liver Function Tests