Jei-Keon Chae

Comparative Study of Low Doses of Rosuvastatin and Atorvastatin on Lipid and Glycemic Control in Patients with Metabolic Syndrome and Hypercholesterolemia

Background/Aims This multicenter, open-labeled, randomized trial was performed to compare the effects of rosuvastatin 10 mg and atorvastatin 10 mg on lipid and glycemic control in Korean patients with nondiabetic metabolic syndrome. Methods In total, 351 patients who met the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for metabolic syndrome with low-density lipoprotein cholesterol (LDL-C) levels ≥ 130 mg/dL were randomized to receive either rosuvastatin 10 mg (n = 173) or atorvastatin 10 mg (n = 178) for over 6 weeks. Results After 6 weeks of treatment, greater reductions in total cholesterol (- 35.94 ± 11.38 vs. - 30.07 ± 10.46%, p < 0.001), LDL-C (48.04 ± 14.45 vs. 39.52 ± 14.42%, p < 0.001), non-high-density lipoprotein cholesterol (- 42.93 ± 13.15 vs. - 35.52 ± 11.76%, p < 0.001), and apolipoprotein-B (- 38.7 ± 18.85 vs. - 32.57 ± 17.56%, p = 0.002) levels were observed in the rosuvastatin group as compared to the atorvastatin group. Overall, the percentage of patients attaining the NCEP ATP III goal was higher with rosuvastatin as compared to atorvastatin (87.64 vs. 69.88%, p < 0.001). Changes in glucose and insulin levels, and homeostasis model assessment of insulin resistance index were not significantly different between the two groups. The safety and tolerability of the two agents were similar. Conclusions Rosuvastatin 10 mg was more effective than atorvastatin 10 mg in achieving NCEP ATP III LDL-C goals in patients with nondiabetic metabolic syndrome, especially in those with lower NCEP ATP III target level goals.

Comparison of Outcomes of Percutaneous Mitral Valvuloplasty Versus Mitral Valve Replacement After Resolution of Left Atrial Appendage Thrombi by Warfarin Therapy

This study assesses the efficacy of oral anticoagulation in resolving left atrial appendage (LAA) thrombi and evaluates clinical outcomes of percutaneous mitral valvuloplasty after resolution of LAA thrombi compared with mitral valve replacement. Warfarin therapy is successful in resolving LAA thrombi; percutaneous mitral valvuloplasty after resolution of LAA thrombi is an effective alternative to surgical treatment.

Tachycardiomyopathy Induced by Ventricular Premature Complexes: Complete Recovery after Radiofrequency Catheter Ablation

Ventricular premature complexes (VPCs) are known to be one of the most benign cardiac arrhythmias when they occur in structurally normal hearts. We experienced a 32-year old man who presented with dyspnea, palpitations and very frequent VPCs (31% of the total heart beats). Echocardiography revealed a dilated left ventricle (LV 66 mm at end-diastole and 57 mm at end-systole) and a decreased ejection fraction (34%). Very frequent VPCs had been detected 10 years previously and he underwent a failed radiofrequency catheter ablation (RFCA) procedure at that time. The patient had been treated with heart failure medications including betablockers, ACE inhibitors and spironolactone for the two most recent years. Six months after we eliminated these VPCs with a second RFCA procedure, the heart returned to normal function and size. Long standing and very frequent VPCs could be the cause of left ventricular dysfunction in a subset of patients who suffer with dilated cardiomyopathy, and RFCA should be the choice of therapy for these patients.

Optimal Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent ImplantationCLINICAL PERSPECTIVE: A Randomized, Controlled Trial

Background— The risks and benefits of long-term dual antiplatelet therapy remain unclear. Methods and Results— This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4%) and 61 dual-therapy group patients (2.6%; hazard ratio, 0.94; 95% confidence interval, 0.66–1.35; P=0.75). The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1%) and 34 (1.4%) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95% confidence interval, 0.42–1.20; P=0.20). Conclusions— Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01186146.

Optimal Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent ImplantationCLINICAL PERSPECTIVE

Background— The risks and benefits of long-term dual antiplatelet therapy remain unclear. Methods and Results— This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4%) and 61 dual-therapy group patients (2.6%; hazard ratio, 0.94; 95% confidence interval, 0.66–1.35; P=0.75). The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1%) and 34 (1.4%) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95% confidence interval, 0.42–1.20; P=0.20). Conclusions— Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01186146.

AS-096 Late Clinical Impact of Postprocedural Incomplete Stent Apposition and Late Acquired Incomplete Stent Apposition After Deployment of Zotarolimus Eluting Stent or Everolimus Eluting Stent

Background: We already reported the preliminary data for the one year clinical impact of post-procedural incomplete stent apposition (PISA) and late incomplete stent apposition (LISA) in the newer generation of drug eluting stent. The aim of this study was to investigate the clinical impact of LISA and PISA during 24-month clinical follow up. Methods: We prospectively enrolled 178 patients who underwent percutaneous coronary intervention (PCI) in de novo coronary lesions; stable angina (n 41), unstable angina (n 91), and non-ST segment elevation myocardial infarction (n 46) (63.7 9.4 years, 125 male, 187 lesions). The group was randomly assigned (proportion of 1:2) to everolimus eluting stent (group I, n 65, Xience V, Abbott Vascular, Illinois) or zotarolimmus eluting stent (group II, n 122, Endeavor Resolute, Medtronic, MN). Post-PCI and follow up intravascular ultrasound (IVUS, mean 10.2 2.9 months) were performed in all patients. We analyzed 24-month major adverse cardiac events including death, myocardial infarction (MI) and target lesion failure (TLR). Results: The Post-PCI external elastic membrane (EEM) volume vs follow up EEM volume (group I: 368.0 169.6 mm vs 373.6 167.2 mm, p NS, group II: 431.0 167.5 vs 440.1 172.0 mm, p NS), and post-PCI lumen volume vs follow up lumen volume (group I: 203.0 86.8 vs 201.7 86.0 mm, p NS, group II: 239.2 92.7 vs 239.5 92.5 mm, p NS) by IVUS were not different. There were three LISAs [1.6%, group I (n 1) vs group II (n 2)] and sixty four PISAs [34.2%, group I (n 24 vs group II (n 40)] that were resolved [12.5%, group I (n 2) vs group II (n 6)]. Post-PCI and follow up volume of PISA was not significantly different in both group I (6.4 4.3 vs 6.3 3.9 mm, p NS) and group II (6.4 5.3 vs 6.2 4.3 mm, p NS). Both PISA and LISA were not related with cardiac death or MI during 24-month clinical follow up. However, there were four TLRs in PISA subgroup [6.3%, group I (n 0) vs group II (n 4)]. Conclusions: The incidence of LISA was low in both groups. Both PISA and LISA were not related with cardiac death or MI during 24-month clinical follow up. Future long-term follow up study to clarify the clinical course of LISA and PISA would be needed to confirm our results.