BACKGROUND: The 5-level triage tool, the Korean Triage and Acuity Scale (KTAS), was developed based on the Canadian Triage and Acuity Scale and has been used for triage in all emergency medical institutions in Korea since 2016. This study evaluated the association between the decrease in level number and the change in its relative importance for disposition in the emergency department (ED). METHODS: Using the registry of the National Emergency Department Information System (NEDIS) ver. 3.1, data regarding consecutive emergency patients from March 2017 to October 2017 were reviewed retrospectively. Reconfiguring KTAS levels, a total of 15 multinomial logistic regression models (KTAS_0 to KTAS_14), including the KTAS, its variants, and covariates were constructed to determine significant factors affecting ED disposition. The relative importance of each model was obtained using a dominance analysis. RESULTS: A total of 79,771 patients were included in the analysis. In the model KTAS_0, the KTAS and 8 covariates were found to be significantly related to ED disposition. The KTAS and the decision maker of each ED visit, whether it was the physician or others, had the largest relative importance, 34.8% and 31.4%, respectively (P < 0.001). In other models of KTAS variants, including 4-level, 3-level and 2-level, the rates of the KTAS decreased to 31.8% (interquartile range [IQR], 28.9–34.2), 26.4% (IQR, 23.2–31.0), and 18.7% (IQR, 7.5–24.9), respectively (P = 0.016). On the other hand, the rates for covariates tended to be larger for smaller triage levels and so there was a significant interaction effect between the KTAS and the covariates according to the triage level (P < 0.001). CONCLUSION: The 5-level triage tool, the KTAS, had the largest relative importance among the predictors affecting ED disposition only at its original level. Therefore, it is recommended that no attempt should be made to reduce the number of levels in the triage tool.
Cohort Studies ; Emergencies ; Emergency Service, Hospital ; Hand ; Humans ; Information Systems ; Korea ; Logistic Models ; Registries ; Retrospective Studies ; Triage

BACKGROUND AND OBJECTIVES: Ezetimibe alone does not decrease C-reactive protein (CRP) levels in hypercholesterolemic patients. However, several reports have suggested that ezetimibe might potentiate the effect of statin not only on cholesterol but also on CRP when administered together. We investigated the effect of ezetimibe on CRP levels in patients taking statins. SUBJECTS AND METHODS: Patients who had not achieved recommended low density lipoprotein-cholesterol (LDL-C) goals with statin therapy were divided into two groups, the ezetimibe group (n=60) and the control group (n=60). A third group of hypercholesterolemic patients without statin therapy was treated with statin (n=59). Patients with CRP level 10 mg/L were excluded. Lipid and CRP levels were measured before therapy commenced, and after 2 months of therapy. RESULTS: Ezetimibe decreased cholesterol and LDL-C levels by 20.2% (p=0.000) and 28.1% (p=0.000) respectively. However, ezetimibe did not reduce CRP levels (from 0.83+/-0.68 to 1.14+/-1.21 mg/dL, p=0.11). CRP levels remained unchanged in the control group (p=0.42). In contrast, statin lowered CRP levels (from 0.82+/-0.73 to 0.65+/-0.57 mg/dL, p=0.008). In patients taking statins, changes in CRP levels were not associated with changes in LDL-C (r=-0.02, p=0.87), but with baseline CRP levels (r=-0.38, p=0.000). CONCLUSION: Ezetimibe failed to reduce CRP levels in hypercholesterolemic patients taking statins despite significant reduction of LDL-C. This finding suggests that the anti-inflammatory effect of statin may not be secondary to cholesterol reduction, but via other mechanisms.
Azetidines ; C-Reactive Protein ; Cholesterol ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Lipoproteins ; Ezetimibe

BACKGROUND/AIMS: The aim of this study was to quantitatively measure changes in lipids and lipoproteins during perimenopause and to identify variables related to these changes. METHODS: Among women who had three regular health evaluations over a span of 2-4 years, 34 women remained in the premenopausal state, 34 premenopausal women transitioned to the postmenopausal state, and 36 postmenopausal women were enrolled. The menopausal state was determined not only by a history of amenorrhea but also by levels of female sex hormones. Yearly changes in lipids were calculated using a linear regression of the three measurements. RESULTS: The transition from premenopause to postmenopause was associated with increased total cholesterol and low-density lipoprotein (LDL) cholesterol levels by 7.4 +/- 8.0 mg/dL (4.2 +/- 4.9%) and 6.9 +/- 6.5 mg/dL (6.8 +/- 7.0%) over one year, resulting in an elevation of 19.6 +/- 22.6 mg/dL (10.9 +/- 13.0%) and 18.9 +/- 19.5 mg/dL (18.6 +/- 20.3%), respectively, during perimenopause. There were no changes observed in premenopausal and postmenopausal women. Body weight, blood pressure, high-density lipoprotein (HDL) cholesterol, and triglycerides did not change in any of the three groups. In all women, changes in both total cholesterol and LDL cholesterol were associated with changes in follicle stimulating hormone (r = 0.40, p < 0.001 and r = 0.38, p < 0.001, respectively). Changes in triglycerides were associated with changes in body weight (r = 0.28, p = 0.005). CONCLUSIONS: During perimenopause, total and LDL cholesterol levels increase and these changes in cholesterol are mainly dependent on changes in female sex hormones.
Adult ; Cholesterol, HDL/blood ; Cholesterol, LDL/blood ; Female ; Follicle Stimulating Hormone/blood ; Humans ; Lipids/*blood ; Lipoproteins/*blood ; Middle Aged ; Postmenopause/*blood ; Premenopause/*blood

BACKGROUND AND OBJECTIVES: Mitral annular calcification (MAC) is known to be associated with degenerative processes of the cardiac fibrous skeleton and cardiovascular disease mortality. However, MAC has not been evaluated in an extreme age group (patients > or =90 years of age). In this study, the clinical significance of MAC associated with aging was examined in this age group and compared with MAC associated with aging in a younger (20 to 50 years of age) group of patients. SUBJECTS AND METHODS: We assessed echocardiographic parameters in 43 nonagenarians and 51 young patients. In the nonagenarian group, patient's age was 92+/-2 years and 27% were male; in the young control group, patient's age was 36+/-9 years and 51% were male. Comprehensive M-mode and Doppler echocardiography, including tissue Doppler imaging, were performed. The frequency and severity of MAC was assessed from the leading anterior to the trailing posterior edge at its largest width for least 3 cardiac cycles. RESULTS: Echocardiography showed that the left ventricular (LV) end-diastolic dimension was larger in the young controls (p=0.007); however, the ejection fraction (EF) was lower in the nonagenarian group (p=0.001). The frequency of MAC was greater in nonagenarians {42/43 (97%)} than in controls {9/51 (17%), p<0.0001}. The maximal width of MAC was larger in nonagenarians (0.52+/-0.17 mm and 0.05+/-0.13 mm, p<0.0001). MAC was correlated with LV mass index (g/m2) (r=0.280, p=0.014) and EF (%) (r=-0.340, p=0.001). More importantly, early mitral inflow velocity/early diastolic mitral annulus velocity (E/E') was strongly correlated with MAC in non-agenarians (r= 0.683, p<0.0001). CONCLUSION: MAC may be associated with extreme age and increased LV filling pressure in nonagenarians. Further study is necessary to assess the cardiovascular mortality and structural changes related to mitral annulus calcification associated with aging.
Aged, 80 and over ; Aging ; Cardiovascular Diseases ; Echocardiography ; Echocardiography, Doppler ; Heart Ventricles ; Humans ; Male ; Skeleton ; Ventricular Function, Left

Acute embolic occlusion of the common iliac artery is a rare medical emergency that is not only limbthreatening, but also potentially life-threatening. Several treatment options exist for acute limb ischemia, although no treatment is clearly best. We report a case of acute embolic occlusion of the left common iliac artery in a patient with atrial fibrillation who was treated successfully using mechanical thrombectomy following intra-arterial thrombolysis.
Acute Disease ; Arterial Occlusive Diseases/radiography/*therapy ; Combined Modality Therapy ; Embolism/radiography/*therapy ; Female ; Fibrinolytic Agents/*administration & dosage ; Humans ; *Iliac Artery/radiography ; Middle Aged ; *Thrombectomy ; *Thrombolytic Therapy ; Tomography, X-Ray Computed ; Treatment Outcome ; Urokinase-Type Plasminogen Activator/*administration & dosage

BACKGROUND AND OBJECTIVES: Virtual histology-intravascular ultrasound (VH-IVUS) studies on early-stage fibroatheroma, the probable precursor lesion of progression to thin-cap fibroatheroma (TCFA), have only rarely been done in man. We investigated the progression and observational frequency of fibroatheromas, and compared plaque components between early-stage and advance-staged fibroatheromas in the general population. SUBJECTS AND METHODS: We assessed coronary fibroatheromas using VH-IVUS and histopathologic analysis of 109 coronary lesions from 40 autopsied cases that were not due to sudden cardiac death (NSCD cases). Fibroatheromas were grouped into early fibroatheroma, late fibroatheroma, thick-cap fibroatheroma (TkCFA), and thin-cap fibroatheroma. RESULTS: Mean patient age was 45+/-11 years old and 71% were males. Of 109 lesions, 27% were early fibroatheromas, 53% late fibroatheromas, 9% TkCFA, and 11% TCFA. VH-IVUS showed that there was relatively less fibrotic and fibrofatty plaque and more dense calcium deposits as fibroatheromas progressed. Furthermore, the relative amounts of fibrotic and fibrofatty plaque decreased (r=0.773, p<0.001 and r=0.538, p<0.001, respectively) as the necrotic core increased, while the relative area of dense calcium increased (r=0.665, p<0.001) as the size of the necrotic core increased. CONCLUSION: Of NSCD cases in Korea, 27% were early fibroatheromas, 53% were late fibroatheromas, 9% were TkCFA, and 11% were TCFA. Advance-staged fibroatheromas show more necrotic core volume and more dense calcium than small, early-stage fibroatheromas.
Atherosclerosis ; Calcium ; Coronary Vessels ; Death, Sudden, Cardiac ; Humans ; Korea ; Male ; Plaque, Atherosclerotic ; Ultrasonography, Interventional

The relation of Nogo-B to atherosclerotic plaque progression is not well understood. Thus, the purpose of this study was to assess the expression of Nogo-B in fibroatheromas (FA) of different stages, classified using virtual histology intravascular ultrasound (VH-IVUS) analysis in 19 autopsied cases of non-sudden cardiac death. VH-IVUS imaging analysis was performed 30 mm from the ostium of each coronary artery. VH-IVUS revealed 11 early FAs (34.5+/-8.3 yr), 12 late FAs (42.6+/-16.6 yr), 8 thick-cap FAs (TkCFAs) (46.4+/-11.1 yr), and 6 thin-cap FAs (TCFAs) (51.8+/-6.8 yr). TkCFAs and TCFAs were defined as advanced FA. FA progression advanced with age (P=0.04). VH-IVUS analysis of small, early FAs showed smaller necrotic cores and relatively less calcium compared to more advanced FAs with large necrotic cores (P<0.001). Histopathology and immunohistochemical stains demonstrated that early or late FAs had smaller necrotic cores, less empty space of decalcification, and greater Nogo-B expression compared to advanced FAs (vs. early FA, P=0.013; vs. late FA, P=0.008, respectively). These findings suggest that FA progression is inversely associated with Nogo-B expression. Local reduction of Nogo-B may contribute to plaque formation and/or instability.
Adult ; Age Factors ; Coronary Artery Disease/*diagnosis/pathology/ultrasonography ; Coronary Vessels/*pathology/*ultrasonography ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Myelin Proteins/*metabolism ; Ultrasonography, Interventional

BACKGROUND/AIMS: In hypertensive patients, LV ejection fraction may be normal or high, thus limiting assessment of prognosis. This has led to a growing body of research using LV midwall fractional shortening (MWS) instead. The current study aims to assess LV midwall function in hypertension patients and to study its correlation with the intima-media thickness (IMT) of the carotid artery. METHODS: Echocardiography and ultrasonography of the carotid artery were conducted to establish a group of hypertension patients without major complications (n=136) and a control group (n=48). LV MWS was determined using two cylindrical models, and the IMT was measured. RESULTS: Compared with normotensive subjects, hypertensive adults exhibited higher LV mass index and lower LV MWS. A statistically significant correlation was found between the LV MWS and the average IMT in hypertension patients (r=-0.41). There was also a significant negative correlation among the maximum IMT (r=-0.40), LV mass index (r=-0.32), age (r=-0.31), and systolic blood pressure (r=-0.22). Regarding the prevalence of plaque in the carotid artery, the stage 1 hypertension group exhibited 16.7% prevalence, and the stage 2 hypertension group 32.9% prevalence, thereby showing far higher figures than the control group's 4.2%. CONCLUSIONS: The LV MWS in hypertension patients underwent a statistically significant decrease, and the correlation between LV MWS and the IMT of the carotid artery was found to be high compared with the general blood pressure index. LV MWS can be used as an indicator to assess the prognosis of hypertension patients.
Adult ; Blood Pressure ; Carotid Arteries ; Carotid Intima-Media Thickness ; Echocardiography ; Humans ; Hypertension ; Prevalence ; Prognosis

BACKGROUND AND OBJECTIVES: Irregular RR intervals in atrial fibrillation (AF) results in beat to beat changes in hemodynamical parameters. Early diastolic mitral annulus velocity (E') is one of the parameters that represent diastolic function of the left ventricle (LV). In this study, we have investigated the effects of continuous changes of systolic functions in AF on the diastolic functions of the LV. SUBJECTS AND METHODS: E' (35-40 beats) was recorded in 31 AF patients that did not have significant valvular heart diseases. The relationships between preceding RR intervals (RR-1) or pre-preceding RR intervals (RR-2) and E's were obtained using a logarithmic function. RESULTS: Slopes between RR-1 and E' varied from -1.62 to 1.04 in total coordinates. In the logistic regression analysis patients with negative slopes were found to have a larger left atrial size than patients with positive slopes (5.5+/-0.67 cm vs. 4.9+/-0.56 cm, p=0.02). Slopes were negatively related with mean RR intervals in the Pearson correlation analysis (r=-0.40, p=0.028). Slopes between RR-2 and E' were also variable and were not associated with other parameters. CONCLUSION: Beat to beat changes in systolic functions derived from irregular RR intervals in AF had variable effects on diastolic functions among patients. The relationship between RR-1 and E' was associated with LA sizes and mean RR intervals.
Atrial Fibrillation ; Echocardiography, Doppler, Pulsed ; Electrocardiography ; Heart Valve Diseases ; Heart Ventricles ; Humans ; Logistic Models ; Ventricular Function, Left

BACKGROUND AND OBJECTIVES: The recent data has revealed that the first 1 minute and 2 minutes of heart rate recovery of patients who are being evaluated for chest pain and asymptomatic adults are associated with the overall mortality. However, the clinical significance of the heart rate recovery after exercise testing during the first 2 minutes for predicting the presence or severity of coronary artery disease and the correlation with the Duke treadmill score (DTS) have not been fully evaluated. SUBJECTS AND METHODS: The study population included 39 patients with significant coronary artery stenosis and 39 subjects with normal coronary arteries. All of them underwent a tread-mill exercise testing prior to coronary angiography. The differences in the heart rate recovery and the DTS between the two groups were investigated. The heart rate recovery and DTS between the multivessel disease group and single vessel disease group were also investigated. RESULTS: The heart rate recovery during the second minute (calculated by the heart rate at 1 minute-the heart rate at 2 minute) after exercise and the DTS were significantly lower in the coronary artery disease group. These parameters were also significantly lower in the multivessel disease group than those in the single vessel disease group. The heart rate recovery during the second minute and the DTS had positive linear correlation (R=0.281, p<0.05). CONCLUSION: In this study, the heart rate recovery during the second minute was considered to be an additional important variable to predict the presence and severity of coronary artery disease.
Adult ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Stenosis ; Coronary Vessels* ; Exercise Test* ; Heart Rate* ; Heart* ; Humans ; Mortality