Soon Yong Suh

Six-Month Comparison of Coronary Endothelial Dysfunction Associated With Sirolimus-Eluting Stent Versus Paclitaxel-Eluting Stent

OBJECTIVES This study was designed to investigate whether endothelial dysfunction is related to drug-eluting stent (DES) implantation at 6 months after stenting. BACKGROUND Current available DES could delay vessel healing and subsequently impair endothelial function. METHODS Endothelial function was estimated at 6-month follow-up in 75 patients (31 men, mean age 62.1 years) with a DES (39 sirolimus-eluting stents [SES], 36 paclitaxel-eluting stents [PES]), and 10 patients with a bare-metal stent (BMS) to the left anterior descending artery, by incremental acetylcholine (Ach) infusion (20 microg/min, 50 microg/min, 100 microg/min) and nitrate (200 microg/min) into the left coronary ostium. Vascular responses were quantitatively measured in arterial segments 5 mm proximal and distal to DES and compared with corresponding segments in the BMS group and midsegments in the left circumflex artery as a reference nonstented artery. All antianginal agents were withheld for at least 72 h before coronary angiography. RESULTS Greater vasoconstriction to Ach was observed in both the SES and PES groups than in the BMS group or control segments of left circumflex artery. Vasoconstriction to Ach was more prominent in arterial segments distal to stents in both SES and PES groups compared with those in the BMS group (p < 0.001). The degree of vasoconstriction to Ach was similar between the SES and PES groups. Endothelium-independent vasodilatation to nitrate did not differ significantly between the study groups. CONCLUSIONS Abnormal vasoconstriction to Ach was found in the SES and PES groups, especially in arterial segments distal to DES at 6 months after stenting, which suggests that DES has a potential long-term adverse effect on local coronary endothelial dysfunction.

Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study

Blood pressure (BP) is one of the most important contributing factors to pulse wave velocity (PWV), a classic measure of arterial stiffness. Although there have been many non-invasive studies to show the relation between arterial stiffness and BP, the results are controversial. The aim of this study is to evaluate the role of BP as an influencing factor on PWV using invasive method. We observed 174 normotensive and untreated hypertensive subjects using coronary angiography. Arterial stiffness was assessed through aorto-femoral PWV by foot-to-foot velocity method using fluid-filled system. And BP was measured by pressure wave at the right common femoral artery. From univariate analysis, age, diabetes mellitus (DM), hypertension, waist, waist-to-hip ratio, total cholesterol-to-high-density lipoprotein cholesterol ratio, systolic BP (SBP), pulse pressure (PP) and mean arterial pressure (MAP) showed significant association with PWV. To avoid multiple colinearity among SBP, PP and MAP, we performed multiple regression analysis predicting PWV thrice. Age, DM and each BP were significantly and consistently correlated to PWV. In the first and third modules, compared to age, SBP and MAP were less strong predictors, respectively. However, PP was the stronger predictor than age and DM in the second module. Lastly, we simultaneously forced MAP and PP with other variables in the fourth multivariate analysis. Age, DM and PP remained significantly correlated with PWV, but the significance of MAP was lost. This is the first invasive study to suggest that PP has the strongest correlation with PWV among a variety of BP parameters.

Myocardial bridging is related to endothelial dysfunction but not to plaque as assessed by intracoronary ultrasound

Background: Myocardial bridge (MB) is characterised by focal compression of a coronary artery in systole by an overlying band of myocardium. Chronic compression and relaxation of the MB may produce endothelial dysfunction by direct stress. Objective: To determine whether MB alters endothelial function, thus influencing the plaque formation. Methods: 128 patients (mean (SD) age 54.7 (10.9) years, 56 men) with typical angiographic systolic milking effects and >30% reduction in diameter of the coronary artery during systole after intracoronary nitrate (glyceryl trinitrate, 200 μg) infusion were studied. 231 control patients (mean (SD) age 52.9 (12.1) years, 111 men) without overt coronary artery disease including MB were also studied. Endothelial function was estimated by incremental acetylcholine (Ach) infusion into the left coronary ostium. Intracoronary ultrasound assessments were obtained in 74/128 patients with MB and 81/231 controls. Results: The mean (SD) vasoconstrictive response to maximal Ach was more pronounced at the bridging segments than at matched segments in controls (−71.9 (14.9) vs −30.3 (22.6), p = 0.009). Coronary vasoconstriction (>50%) to Ach was seen more often in the MB group than in controls (114/128 (89.1%) vs 81/231 (35.1%), p = 0.007). No significant correlation was found between the severity of MB and vasoconstriction in response to Ach. A typical half-moon phenomenon was seen in 71/74 (95.9%) cases of the MB group, but not in controls (p<0.001). Plaques at the bridging segments were absent in 67/74 (90.5%) and mild in 7/74 (9.5%) cases, as compared with those of matched segments of the left anterior descending coronary artery in controls (plaque burden 5.91 (1.37)% vs 24.71 (24.21)%, p = 0.002). Conclusion: Despite the prominent relationship between MB and endothelial dysfunction, bridging segments are spared from atherosclerotic plaque formation.

Diffuse multi-vessel coronary artery spasm: Incidence and clinical prognosis

BACKGROUND The incidence and clinical prognosis of diffuse and multivessel coronary spasm has not been reported. METHODS Patients with suspected vasospastic angina were prospectively enrolled. Left and right coronary angiogram was performed simultaneously after intravenous ergonovine injection. Spasm (>70% luminal narrowing) was sub-classified as diffuse (more than 20mm length), multivessel (more than 2 epicardial arteries). Clinical characteristics and prognosis were analyzed. RESULTS Patients (96 consecutive patients, 56 males, mean age 48 years) were divided into 3 groups: diffuse-multivessel spasm (group I, n=16, 16.7%), other types of spasm (group II, n=12, 12.5%) and control group (group III, n=68, 70.8%). The rates of males, alcohol drinkers and the mean triglyceride were higher, and high density lipoprotein was lower in group I compared to group III (all p<0.05), but similar to group II (all p=NS). Hard cardiovascular event rates did not differ among groups (one cardiac arrest but successful resuscitation in group I, one non-fatal myocardial infarction in group III) during follow up periods (mean, 41.2 ± 13.7 months). Chest pain free survivals during 1 year were lower in group I (66.7%) compared to group III (90%), but similar to group II (58.3%) (group I vs III, p<0.05 and group I vs II, p=NS). CONCLUSIONS Diffuse-multivessel spasm was not rare in patients with vasospastic angina and its prognosis is pretty good similar to patients with previously known variant angina with recommended medical treatment.

Efficacy and safety of aspirin, clopidogrel, and warfarin after coronary artery stenting in Korean patients with atrial fibrillation.

There are limited data on the optimal antithrombotic therapy for patients with atrial fibrillation (AF) who undergoing coronary stenting. We reviewed 203 patients (62.6 % men, mean age 68.3 ± 10.1 years) between 2003 and 2012, and recorded clinical and demographic characteristics of the patients. Clinical follow-up included major adverse cardiac and cerebrovascular events (MACCE) (cardiac death, myocardial infarction, target lesion revascularization, and stroke), stent thrombosis, and bleeding. The most commonly associated comorbidities were hypertension (70.4 %), diabetes mellitus (35.5 %), and congestive heart failure (26.6 %). Sixty-three percent of patients had stroke risk higher than CHADS2 score 2. At discharge, dual-antiplatelet therapy (aspirin, clopidogrel) was used in 166 patients (81.8 %; Group I), whereas 37 patients (18.2 %) were discharged with triple therapy (aspirin, clopidogrel, warfarin; Group II). The mean follow-up period was 42.0 ± 29.0 months. The mean international normalized ratio (INR) in group II was 1.83 ± 0.41. The total MACCE was 16.3 %, with stroke in 3.4 %. Compared with the group II, the incidence of MACCE (2.7 % vs 19.3 %, P = 0.012) and cardiac death (0 % vs 11.4 %, P = 0.028) were higher in the group I. Major and any bleeding, however, did not differ between the two groups. In multivariate analysis, no warfarin therapy (odds ratio 7.8, 95 % confidence interval 1.02–59.35; P = 0.048) was an independent predictor of MACCE. By Kaplan–Meier survival analysis, warfarin therapy was associated with a lower risk of MACCE (P = 0.024). In patients with AF undergoing coronary artery stenting, MACCE were reduced by warfarin therapy without increased bleeding, which might be related to tighter control with a lower INR value.

Predictors of Recovery of Left Ventricular Systolic Dysfunction after Acute Myocardial Infarction: From the Korean Acute Myocardial Infarction Registry and Korean Myocardial Infarction Registry

Background and Objectives We investigated the predictors of the recovery of depressed left ventricular ejection fraction (LVEF) in patients with moderate or severe left ventricular (LV) systolic dysfunction after acute myocardial infarction (MI). Subjects and Methods We analyzed 1307 patients, who had moderately or severely depressed LVEF (<45%) on echocardiography soon after acute MI and who underwent a follow-up echocardiography, among 27369 patients from the Korea Working Group on the Myocardial Infarction Registry. Patients were categorized into two groups according to recovery of LVEF: group I with consistently depressed LVEF (<45%) at the follow-up echocardiography and group II with a recovery of LVEF (≥45%). Results Recovery of LV systolic dysfunction was observed in 51% of the subjects (group II, n=663; ΔLVEF, 16.2±9.3%), whereas there was no recovery in the remaining subjects (group I, n=644; ΔLVEF, 0.6±7.1%). In the multivariate analysis, independent predictors of recovery of depressed LVEF were as follows {odds ratio (OR) [95% confidence interval (CI)]}: moderate systolic dysfunction {LVEF ≥30% and <45%; 1.73 (1.12-2.67)}, Killip class I-II {1.52 (1.06-2.18)}, no need for diuretics {1.59 (1.19-2.12)}, non-ST-segment elevation MI {1.55 (1.12-2.16)}, lower peak troponin I level {<24 ng/mL, median value; 1.55 (1.16-2.07)}, single-vessel disease {1.53 (1.13-2.06)}, and non-left anterior descending (LAD) culprit lesion {1.50 (1.09-2.06)}. In addition, the use of statin was independently associated with a recovery of LV systolic dysfunction {OR (95% CI), 1.46 (1.07-2.00)}. Conclusion Future contractile recovery of LV systolic dysfunction following acute MI was significantly related with less severe heart failure at the time of presentation, a smaller extent of myonecrosis, or non-LAD culprit lesions rather than LAD lesions.

Successful Percutaneous Renal Intervention in a Patient With Acute Traumatic Renal Artery Thrombosis

A 20-year-old male who had fallen from the third floor of a building after excessive alcohol intake presented to our emergency room. He complained of flank pain, and subsequent simple x-ray and pelvis computed tomography revealed a right acetabular fracture, which we decided to treat conservatively. There were no other major injuries. An abdominal computed tomography scan (Figure 1A and 1B) revealed bilateral multifocal renal infarction. An urgent technetium-labeled dimercaptosuccinic acid renal scan (Figure 1C and 1D) showed significantly reduced perfusion in both lower lobes of the kidney. An emergent renal angiogram showed normal right main renal artery (Figure 2A). The anomalous right inferior polar artery showed complete thrombotic occlusion (Figure 2B). We prudently pursued the percutaneous renal intervention because there were no …

Early repolarization with horizontal ST segment may be associated with aborted sudden cardiac arrest: a retrospective case control study.

BackgroundRisk stratification of the early repolarization pattern (ERP) is needed to identify malignant early repolarization. J-point elevation with a horizontal ST segment was recently suggested as a malignant feature of the ERP. In this study, the prevalence of the ERP with a horizontal ST segment was examined among survivors of sudden cardiac arrest (SCA) without structural heart disease to evaluate the value of ST-segment morphology in risk stratification of the ERP.MethodsWe reviewed the data of 83 survivors of SCA who were admitted from August 2005 to August 2010. Among them, 25 subjects without structural heart disease were included. The control group comprised 60 healthy subjects who visited our health promotion center; all control subjects were matched for age, sex, and underlying disease (diabetes mellitus, hypertension). Early repolarization was defined as an elevation of the J point of at least 0.1 mV above the baseline in at least two continuous inferior or lateral leads that manifested as QRS slurring or notching. An ST-segment pattern of <0.1 mV within 100 ms after the J point was defined as a horizontal ST segment.ResultsThe SCA group included 17 men (64%) with a mean age of 49.7 ± 14.5 years. The corrected QTc was not significantly different between the SCA and control groups (432.7 ± 37.96 vs. 420.4 ± 26.3, respectively; p = 0.089). The prevalence of ERP was not statistically different between the SCA and control groups (5/25, 20% vs. 4/60, 6.7%, respectively; p = 0.116). The prevalence of early repolarization with a horizontal ST segment was more frequent in the SCA than in the control group (20% vs. 3.3%, respectively; p = 0.021). Four SCA subjects (16%) and one control subject (1.7%) had a J-point elevation of >2 mm (p = 0.025). Four SCA subjects (16%) and one (1.7%) control subject had an ERP in the inferior lead (p = 0.025).ConclusionThe prevalence of ERP with a horizontal ST segment was higher in patients with aborted SCA than in matched controls. This result suggests that ST morphology has value in the recognition of malignant early repolarization.

Rosuvastatin treatment improves arterial stiffness with lowering blood pressure in healthy hypercholesterolemic patients

☆ We presented our study in part as abstracts in the A 2013, San Francisco, CA, USA, on March 10, 2013. ☆☆ All authors take responsibility for all aspects of the re of the data presented and their discussed interpretation. ⁎ Corresponding author at: Cardiology Division, Dep Gachon University Gil Hospitial, 1198 Guwol-dong, Na Republic of Korea. Tel.: +82 32 460 3054; fax: +82 32 46 E-mail address: shhan@gilhospital.com (S.H. Han).

Long-Term Safety and Efficacy of Pitavastatin in Patients With Acute Myocardial Infarction (from the Livalo Acute Myocardial Infarction Study [LAMIS])

Pitavastatin is a potent lipophilic statin and may play an important role in acute myocardial infarction (AMI) but there have been limited data on the safety and efficacy of pitavastatin in AMI. This study consisted of 1,039 consecutive patients with AMI (74.0% men, mean age 61.4 ± 12.6 years) who presented in 10 major percutaneous coronary intervention centers in Korea from February 2007 through September 2009. Pitavastatin 2 mg/day was routinely administered in patients with AMI from time of presentation. We investigated changes of lipid profiles, biochemical markers, adverse events, and clinical outcomes up to 12 months. During the study 318 events overall occurred in 220 patients (21.2%) who reported ≥1 treatment emergent adverse event, although 20 events in 14 patients (1.4%) were treatment-related adverse events. Low-density lipoprotein (LDL) cholesterol percent change was -25.6% and LDL cholesterol target attainment was 70.5% at 12-month follow-up. Levels of creatinine phosphokinase, serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and high-sensitivity C-reactive protein decreased significantly during the first 1 month of pitavastatin treatment and were sustained to 12-month follow-up. Major adverse cardiac events occurred in 66 patients (7.3%). All-cause deaths occurred in 32 patients (3.5%) including 19 (2.1%) cardiac deaths and recurrent MIs occurred in 14 (1.6%) and target lesion revascularizations in 42 (4.7%). In conclusion, administration of pitavastatin 2 mg/day in patients with AMI showed 70.5% LDL cholesterol target attainment with good tolerance and was associated with favorable clinical outcomes up to 12 months.