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.

Objectives: Cognitive impairment is a fundamental symptom of schizophrenia, an often-overlooked aspect of the disorder that has gained recent attention due to its direct relation with functional outcomes and implications for medical and social costs. This study aims to investigate gender differences in cognitive function among patients with schizophrenia using Korean Wechsler Adult Intelligence Scale-IV (K-WAIS-IV). Methods: Data were collected from inpatients and outpatients treated at Presbyterian Medical Center between January 1, 2019, and December 31, 2023. Patients diagnosed with schizophrenia underwent evaluation with the K-WAIS-IV. Multivariate analysis of variance was utilized to assess cognitive differences between men and women participants, while correlation analysis was performed to explore associations between cognitive performance and clinical data. Results: Among 101 candidates, 26 male and 26 female patients were selected for analysis of their K-WAIS-IV scores and clinical data. The results revealed no statistically significant differences in cognitive function between male and female patients concerning Full-Scale Intelligence Quotient (FSIQ) and the four index scores: Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI). A trend indicating preserved verbal intelligence relative to performance intelligence was observed. Additionally, the VCI exhibited a positive correlation with age, while both FSIQ and PSI demonstrated positive correlations with years of education. Conclusion The findings of this investigation suggest that there are no significant differences in cognitive function between male and female patients with schizophrenia via K-WAIS-IV. Given the heterogeneity of the sample and potential limitations of the neurocognitive assessments employed, further research utilizing more targeted methodologies and sensitive measures is warranted.

Background and Objectives: This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods: A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results: During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated ontreatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10;95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.

Background/Aims: While switching strategies of P2Y12 receptor inhibitors (RIs) have sometimes been used in acute myocardial infarction (AMI) patients, the current status of in-hospital P2Y12RI switching remains unknown. Methods: Overall, 8,476 AMI patients who underwent successful revascularization from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) were divided according to in-hospital P2Y12RI strategies, and net adverse cardiovascular events (NACEs), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), stroke, or thrombolysis in myocardial infarction (TIMI) major bleeding during hospitalization were compared. Results: Patients with in-hospital P2Y12RI switching accounted for 16.5%, of which 867 patients were switched from clopidogrel to potent P2Y12RI (C-P) and 532 patients from potent P2Y12RI to clopidogrel (P-C). There were no differences in NACEs among the unchanged clopidogrel, the unchanged potent P2Y12RIs, and the P2Y12RI switching groups. However, compared to the unchanged clopidogrel group, the C-P group had a higher incidence of non-fatal MI, and the P-C group had a higher incidence of TIMI major bleeding. In clinical events of in-hospital P2Y12RI switching, 90.9% of non-fatal MI occurred during pre-switching clopidogrel administration, 60.7% of TIMI major bleeding was related to pre-switching P2Y12RIs, and 71.4% of TIMI major bleeding was related to potent P2Y12RIs. Only 21.6% of the P2Y12RI switching group switched to P2Y12RIs after a loading dose (LD); however, there were no differences in clinical events between patients with and without LD. Conclusions In-hospital P2Y12RI switching occurred occasionally, but had relatively similar clinical outcomes compared to unchanged P2Y12RIs in Korean AMI patients. Non-fatal MI and bleeding appeared to be mainly related to pre-switching P2Y12RIs.

Objectives: This study examined the level of depression and anxiety and the related factors, especially the knowledge and attitudes towards dementia, of people caring for a family member with dementia. Methods: Data on the demographics, care burdens, and clinical characteristics of dementia patients and their family caregivers were collected. The Center for Epidemiologic Studies Depression Scale (CES-D) and Korean Screening Tool for Anxiety disorders (K-ANX), Dementia Knowledge Scale (DKS), and Dementia Attitudes Scale (DAS) were performed. This study investigated whether depression and anxiety of caregivers differed according to the caregivers, patients, and the burden of caregivers. Multiple regression analysis was performed to investigate the potential factors that may influence the psychological symptoms in family caregivers. Results: There were 135 respondents. The scores of CES-D and K-ANX were 19.18±12.05 (probable depression) and 11.48±8.88 (mild anxiety), respectively. There was a significant difference in the degree of depression according to the level of education (F=4.14, p<0.05), the severity of dementia (F=3.63, p<0.05), and cohabitation with patients with dementia (t=2.07, p<0.05). On the other hand, the difference in the degree of anxiety was not significant depending on the stratified potential factors. The degree of depression in caregivers was positively associated with severe dementia (β=0.252, p<0.01) and negatively associated with the DAS score (β= -0.392, p<0.001). Anxiety was only inversely affected by the DAS score (β=-0.369, p<0.001). Conclusion This study shows that family caregivers of people with dementia experience high levels of depression and anxiety, which are influenced by the patient’s severity of dementia and the caregiver’s attitude toward dementia.

Objective: There are reports that cognitive training improves cognitive performance in patients with mild cognitive impairment and dementia. However, the research on the effects of cognitive training in the community-dwelling elderly is insufficient. This study aimed to verify the effectiveness of cognitive training in the community-dwelling elderly. Methods: The participants were community-dwelling elderly aged 60 years or over. We collected demographic data and assessed Korean Version of Montreal Cognitive Assessment (MoCA-K), The Short form of the Geriatric Depression Scale-Korean (SGDS-K), and Geriatric Quality of Life-Dementia (GQOL-D). Cognitive training consisted of performing tasks for multi-cognitive domains. It was a paper- and group-based program, conducted 15 sessions each 60 minute. After the intervention, clinical characteristics were reassessed. Paired t-test, pearson correlation, analysis of covariance (ANCOVA) were performed using R version 3.6.1. Results: There were 206 participants. 162 participants completed the intervention, and were eligible for analyses. After the cognitive intervention, MoCA-K was improved 2.10±0.61 which was statistically significant (p<0.001). SGDS-K was decreased 0.57± 0.46 (p=0.003). GQOL-D was increased 1.65±1.64 (p=0.048). ANCOVA showed that the score change in MoCA-K was not in-fluenced by baseline SGDS-K or baseline GQOL-D score. Conclusion Group-and paper-based cognitive training could improve MoCA-K, SGDS-K, and GQOL-D for the communitydwelling elderly. Baseline SGDS-K and GQOL-D scores were not associated with cognitive training effects in the community-dwelling elderly.

We reviewed the clinical features, prevalence, pathophysiology, and prevention and treatment of delirium in patients with coronavirus disease of 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, has neurotropic properties, and can penetrate the central nervous system and affect brain neurons. These characteristics may explain the fact that COVID-19 patients may be particularly susceptible to delirium. COVID-19 delirium occurred more frequently in intensive care unit and emergency room settings. Patients with neurologic disorders and the elderly were more vulnerable to delirium. Clinical symptoms of COVID-19 delirium may manifest as a hyper/hypoactive type. Prevention and treatment appear to be similar to conventional treatment strategies. And the patient’s feeling of isolation due to social distancing and a highly intensive labor force of medical personnel must be overcome. Melatonin, alpha-2 agonist, antipsychotics, and valproic acid have been recommended for the treatment of delirium symptoms. However, this article did not go through a systematic literature review.

Objective: The purpose of this study was to investigate the related factors of elderly depression among Korean adults aged 60 years and above. Methods: From the database of Korea National Health and Nutrition Examination Survey conducted in 2018, data of 2,288 adults over age 60 who responded to the questionnaires of health interview were included in this study. We analyzed the data using logistic regression analysis. Results: According to our results, the number of chronic diseases seemed to be associated with depression in elderly people, es-pecially when they have more than 4 chronic diseases. Poorer self-rated health was identified as a significant factor and the odd ratio was the highest among all independent variables in our study. Walking over 10 minutes more than 4 times a week was considered as a protective factor for elderly depression. The association between education level and depression was inconsistent. Variables such as female gender, single status, smoking showed statistically insignificant results. Older age itself was not identified as a risk factor as odd ratios of all groups (over age 65) compared to reference group (age 60-64) were below 1. Conclusion This study confirms several related factors for elderly depression. Having more than 4 chronic diseases, poorer self-rated health were identified as a significant risk factor for depression. Regular walking was considered as a protective factor for elderly depression. The knowledge of these factors might help to manage risks of elderly depression and devise early intervention approaches.

Objective: There are reports that cognitive training improves cognitive performance in patients with mild cognitive impairment and dementia. However, the research on the effects of cognitive training in the community-dwelling elderly is insufficient. This study aimed to verify the effectiveness of cognitive training in the community-dwelling elderly. Methods: The participants were community-dwelling elderly aged 60 years or over. We collected demographic data and assessed Korean Version of Montreal Cognitive Assessment (MoCA-K), The Short form of the Geriatric Depression Scale-Korean (SGDS-K), and Geriatric Quality of Life-Dementia (GQOL-D). Cognitive training consisted of performing tasks for multi-cognitive domains. It was a paper- and group-based program, conducted 15 sessions each 60 minute. After the intervention, clinical characteristics were reassessed. Paired t-test, pearson correlation, analysis of covariance (ANCOVA) were performed using R version 3.6.1. Results: There were 206 participants. 162 participants completed the intervention, and were eligible for analyses. After the cognitive intervention, MoCA-K was improved 2.10±0.61 which was statistically significant (p<0.001). SGDS-K was decreased 0.57± 0.46 (p=0.003). GQOL-D was increased 1.65±1.64 (p=0.048). ANCOVA showed that the score change in MoCA-K was not in-fluenced by baseline SGDS-K or baseline GQOL-D score. Conclusion Group-and paper-based cognitive training could improve MoCA-K, SGDS-K, and GQOL-D for the communitydwelling elderly. Baseline SGDS-K and GQOL-D scores were not associated with cognitive training effects in the community-dwelling elderly.

BACKGROUND AND OBJECTIVES: There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI). METHODS: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months. RESULTS: After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31–3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924). CONCLUSIONS Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.