Hye Yoon Jang

An association between IL-9 and IL-9 receptor gene polymorphisms and atopic dermatitis in a Korean population

BACKGROUND The genes encoding IL-9 and IL-9R have recently been implicated in the genetic basis of asthma and allergy. Although studies performed on transgenic and knockout mice have shown conflicting results, no evidence of skin changes has ever been reported in these animals. OBJECTIVE To find association of the SNPs in IL-9 and IL-9R genes and interaction of these genes in atopic dermatitis. METHOD We genotyped 5 SNPs from the IL-9 and IL-9R genes of 1090 subject samples (631 AD patients and 459 normal controls). A luciferase assay was then performed for the rs31563 (-4091G/A) SNP located in the IL-9 gene promoter region. RESULT The rs31563 (-4091G/A) SNP in the IL-9 gene was significantly associated with the AD phenotype, especially allergic-type AD. In the luciferase assay, the rs31563 G construct was observed to have 1.54 times higher activity than the rs31563 A construct. Although no association was found between SNPs in IL-9R gene and AD, the rs3093467 SNP showed association with non-allergic AD. In the gene-gene interaction analysis, we found that IL-9/IL-9R genotype rs31563 GG/rs3093467 TT conveyed a greater risk for AD phenotype development. CONCLUSION Significant evidence exists to suggest that the rs31563 SNP (-4091G/A) located in the IL-9 gene is associated with an increased susceptibility to AD. Similarly, the rs3093467 SNP in IL-9R gene seems to be associated with an increased risk for developing non-allergic AD. In a subsequent gene-gene interaction analysis, the rs31563 GG/rs3093467 TT genotype combination (IL-9/IL-9R) was found to exert a synergistic effect in the development of the AD phenotype. As the classes of helper T cells are diverse and the function of IL-9 cytokine has not been fully described, the cutaneous function of IL-9 needs to be further explored in future studies.

Comparison of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction

BACKGROUND The transradial (TR) approach for percutaneous coronary intervention (PCI) is challenging and associated with failure in elderly patients. We compared the TR and transfemoral (TF) approaches in patients>80 years with acute myocardial infarction (MI) undergoing PCI. METHODS A total of 1945 (7.2%) octogenarians were enrolled from among 27,129 patients in the Korea Acute Myocardial Infarction Registry. The TR group (n=336, 17.3%) was compared with the TF group (n=1609, 82.7%) in the overall and propensity-matched cohorts with respect to procedural success, complications, in-hospital mortality, and one-year mortality and total major adverse cardiac event (MACE; death, MI, and revascularization) rate. RESULTS In the overall cohort, the TR group had lower incidence of Killip class III or IV compared to the TF group. The disease extent and lesion severity were similar between groups, as was the procedural success rate (97.7% vs. 98.3%); however, in-hospital complications were significantly lower in the TR group (8.1% vs. 20.3%). In-hospital mortality was significantly lower in the TR group than the TF group (3.4% vs. 11.4%), as were the one-year mortality and total MACE (9.8% vs. 18.4% and 13% vs. 21.9%, respectively). These outcomes were consistent in the propensity-matched cohort. The TR approach was found to be a significant predictor of low in-hospital mortality (OR 0.355, 95% CI 0.139-0.907), but not of one-year mortality (OR 0.644, 95% CI 0.334-1.240). CONCLUSIONS In octogenarians with acute MI undergoing PCI, the TR approach was more effective than the TF approach as it had lower complication rate and better clinical outcomes with comparable procedural success.

Outcomes of Acute Myocardial Infarction Patients Implanted With Biodegradable Polymer Biolimus-Eluting Stents Versus New-Generation Durable Polymer Drug-Eluting Stents A Retrospective Analysis

We compared outcomes between biodegradable polymer biolimus-eluting stent (BP-BES) and new-generation durable polymer drug-eluting stent (DP-DES) implantations in patients with acute myocardial infarction (MI). Among 13472 patients with acute MI in a nationwide registry, 557 (64.8%) were in the BP-BES and 303 (35.2%) in the new-generation DP-DES group following coronary reperfusion. The occurrence of major adverse cardiac events (MACE; death, MI, revascularization) and stent thrombosis was compared. Major adverse cardiac events occurred in 53 (6.2%) patients and showed similar rates between the BP-BES and new-generation DP-DES groups (all: 6.6% vs 5.9%, P = .652; propensity score [PS] matched: n = 380, 6.3% vs 5.3%, P = .623). Stent thrombosis did not differ between groups (all: 0.3% vs 0.4%, P = .892; PS matched: 0.5% vs 0.5%, P = 1.000). Major adverse cardiac event-free survival was comparable between groups (all: 93.4% vs 94.1%, log-rank P = .357; PS matched: 93.7% vs 94.7%, log-rank P = .445). Biodegradable polymer biolimus-eluting stent was not associated with MACE (all: hazard ratio [HR], 1.67; 95% confidence interval [CI], 0.75-3.74; P = 0.212; PS matched: HR, 1.05; 95% CI, 0.40-2.75; P = .915). In conclusion, in patients with acute MI, BP-BES was equivalent to the new-generation DP-DES in terms of outcomes.

Benefit of IVUS-guided PCI in diabetic patients presented with acute myocardial infarction- from Korea acute myocardial infarction registry

Purpose: Intravascular ultrasonography (IVUS) has been widely used in percutaneous coronary intervention (PCI) field. Precise measurement of reference vessel and early detection of various complications which cannot be distinguished by angiographic image led the outcome of IVUS-guided PCI more favorable. However, its beneficial effect was not thoroughly evaluated in the setting of acute myocardial infarction. Some studies documented that in the cases of AMI, IVUS-guided PCI was not superior to the conventional angiography guided PCI. We hypothesized that certain subjects such as patients with diabetes mellitus (DM) might receive benefits from IVUS-guided PCI. Methods: Patients were from Korea Acute Myocardial Infarction Registry (KAMIR) data. KAMIR was the retrospective observational study from 52 tertiary hospitals commemorating of the 50th anniversary of Korea Society of Cardiology. From 16,264 patients, 3,339 of consecutive patients were enrolled in this study. Patients with DM presented with AMI and received PCI were divided to two groups according to the use of IVUS during the procedure; IVUS group (n=683, 20.5%) and control group (n=2,656, 79.5%). Primary outcome was major adverse cardiovascular event (MACE) at one year follow up. Secondary outcomes were each component of MACE and stent thrombosis. Results: Mean age was 63.1 years and almost 75% were male. Patients in the IVUS group were younger and had better Killip class, more anterior infarction and target organ damage than the control group. They received longer, larger and more stents compared to patients in the control group. One month MACE was significantly lower in the IVUS group compared to the control group (4.6% vs. 10.6%, p<0.0001). Except for the one month death rate, other components of one month MACE were similar between the two groups. One month death rate was significantly lower in the IVUS group. Similar pattern was shown in the one year MACE. One year MACE was significantly lower in the IVUS group (10.1% vs. 15.1%, p=0.001). Also, but for the lower rate of one year death rate, other components showed no significant differences between two groups. One year stent thrombosis was not different, too (1.6% vs. 2.4%). However, after the multivariate logistic regression analysis, use of IVUS was not a significant predictor neither for one month MACE nor for one year MACE. This results reveals that this registry data represents IVUS was mostly done in patients with hemodynamic stable. Conclusion: From our study, IVUS-guided PCI was not associated with favorable clinical outcomes in diabetic patients with AMI.

Predictive value of glycosylated hemoglobin on cardiovascular outcomes in prediabetic patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Background: Prediabetes is well known to have a substantially greater cardiovascular risk as a result of insulin resistance, dysglycemia, dyslipidemia, hypertension, endothelial dysfunction or inflammation shown as in diabetes mellitus. Previous studies demonstrated impaired glucose tolerance and/or impaired fasting glucose are strong predictors of adverse outcome in acute coronary syndrome. However, the prognostic value of glycemic controlled level, determined by glycosylated hemoglobin (HbA1c), in prediabetic patients with ACS is still undefined. The aim of this study was to demonstrate the role of HbA1c at admission on major adverse cardiac events (MACE) in prediabetic patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: Using data from Korea Working Group on Myocardial Infarction (Kormi; February 2008-December 2011), this observational study included 1,536 patients who had not been diagnosed with DM before or after admission (HbA1c at admission less than 6.5%) with STEMI undergoing primary PCI. Patients were divided into two groups based on HbA1c at admission: non-diabetic (HbA1c≤5.6%, n=607, 39.5%) and pre-diabetic group (5.7%≤HbA1c≤6.4%, n=929, 60.5%). Results: One-year cumulative MACE which was defined as a composite of mortality, nonfatal MI, repeated PCI or coronary artery bypass graft, was not different between two groups (7.4% vs 9.4%, p=0.182). After multivariate logistic analysis, HbA1c was not associated with occurrence of MACE (OR 1.009, 95% CI 0.579-1.759, p=0.975). We conducted subgroup analysis and divided pre-diabetic patients into two groups by the HbA1c level of 6.0%. Both of one-year cumulative MACE (11.1% versus 7.5%) and OR for MACE were lower (OR 0.586) in patients with higher HbA1c level, but did not show any statistical significances, either. Conclusion: This study demonstrated HbA1c level at admission was not significantly associated with cardiovascular outcomes in prediabetic Korean populations with STEMI undergoing primary PCI.

TCT-416 Did the RIVAL Trial Increase Transradial Coronary Intervention in Patients with Acute Myocardial Infarction? Results from Korea Working Group on Myocardial Infarction Registry

The recent RIVAL trial has made substantial contributions to the world of percutaneous coronary intervention (PCI), drawing attention to access site and bleeding complications. However, it is not well known how often the transradial (TR) approach becomes used after the RIVAL trial in real world