Sung Jin Oh

Anatomic and Functional Evaluation of Bifurcation Lesions Undergoing Percutaneous Coronary Intervention

Background—We sought to investigate the mechanism of geometric changes after main branch (MB) stent implantation and to identify the predictors of functionally significant “jailed” side branch (SB) lesions. Methods and Results—Seventy-seven patients with bifurcation lesions were prospectively enrolled from 8 centers. MB intravascular ultrasound was performed before and after MB stent implantation, and fractional flow reserve was measured in the jailed SB. The vessel volume index of both the proximal and distal MB was increased after stent implantation. The plaque volume index decreased in the proximal MB (9.1±3.0 to 8.4±2.4 mm3/mm, P=0.001), implicating plaque shift, but not in the distal MB (5.4±1.8 to 5.3±1.7 mm3/mm, P=0.227), implicating carina shifting to account for the change in vessel size (N=56). The mean SB fractional flow reserve was 0.71±0.20 (N=68) and 43% of the lesions were functionally significant. Binary logistic-regression analysis revealed that preintervention % diameter stenosis of the SB (odds ratio=1.05; 95% CI, 1.01 to 1.09) and the MB minimum lumen diameter located distal to the SB ostium (odds ratio=3.86; 95% CI, 1.03 to 14.43) were independent predictors of functionally significant SB jailing. In patients with ≥75% stenosis and Thrombolysis In Myocardial Infarction grade 3 flow in the SB, no difference in poststent angiographic and intravascular ultrasound parameters was found between SB lesions with and without functional significance. Conclusions—Both plaque shift from the MB and carina shift contribute to the creation/aggravation of an SB ostial lesion after MB stent implantation. Anatomic evaluation does not reliably predict the functional significance of a jailed SB stenosis. Clinical Trial Registration:http://www.clinicaltrials.gov. Unique Identifier: NCT00553670.

Comparison of sirolimus-eluting stent and paclitaxel-eluting stent for long-term cardiac adverse events in diabetic patients: the Korean Multicenter Angioplasty Team (KOMATE) Registry.

Background: There is some controversy on long‐term cardiac outcomes between sirolimus‐eluting stents (SES) and paclitaxel‐eluting stents (PES) in diabetes mellitus (DM). We compared cardiac adverse events after SES and PES implantation in patients with DM over a period of 3 year. Methods: A total of 634 patients with DM treated with SES (n = 428) or PES (n = 206) were consecutively enrolled in the KOMATE registry from 2003 to 2004. We assessed major adverse cardiac events (MACEs, cardiovascular death, nonfatal myocardial infarction, ischemia driven target vessel revascularization) and stent thrombosis (ST) according to the definitions set by the Academic Research Consortium. Results: Propensity score (PS) analysis was performed to adjust different baseline characteristics. The mean follow‐up duration was 38 ± 8 month (at least 36 month and up to 53 month). The 3‐year MACE rate did not show a significant difference between the two groups [52 (12.1%) in SES vs. 29 (14.1%) in PES, P = 0.496]. The definite and probable ST at 3 year were similar in both SES and PES [12 (2.8%) in SES vs. 7 (3.4%) in PES, P = 0.681]. There were no differences in hazard ratio for MACE and ST between two stents [MACE, crude: 0.844 (0.536–1.330) and adjusted for PS: 0.858 (0.530–1.389); ST, crude: 0.820 (0.323–2.083) and adjusted for PS: 0.960 (0.357–2.587)]. Conclusions: The present study demonstrated that long‐tem cardiac outcomes including ST were not significantly different between SES and PES in patients with DM.

Overlapping vs. one long stenting in long coronary lesions

Intervention of long coronary lesions remains problematic, and optimal treatment strategy is yet to be determined. Despite advancement of stent technology, data are few regarding the efficacy of overlapping stents vs. a single long stent in long coronary lesions. This study was performed to evaluate the results of those strategies for long coronary lesions and to determine the predictors of in‐stent restenosis (ISR). Sixty‐four lesions (> 20 mm) in 64 patients were treated with either one long stent (group 1, n = 32) or two overlapping stents (group 2, n = 32). Overlapping stents were used at tortuous or calcified lesions and at lesions with diameter discrepancy or significant dissection. Immediate results, follow‐up clinical and angiographic outcomes, and predictors of ISR were evaluated. Procedures were successful in all patients in both groups. Clinical and angiographic follow‐ups were performed in 54 (84%) cases and 50 (78%) cases, respectively. During the follow‐up, major adverse cardiac event occurred in 36% of group 1 and 29% of group 2 (P = 0.56). Six‐month ISR rates were 39% in group 1 and 41% in group 2 (P = 0.91). Age (≥ 65 years old) was an independent risk factor of ISR (54% vs. 23%; OR = 4.4; P = 0.04), and distal reference diameter (RD) of less than 2.5 mm tended to predict ISR in multivariate analysis (60% vs. 25%; OR = 3.5; P = 0.06). In conclusion, stent overlapping can be used with outcome similar to that of one long stent in long coronary lesions. The optimal result may be obtained by considering the patients age and the distal vessel diameter of the lesion. Catheter Cardiovasc Interv 2004; 62:298–302.

A case of paraneoplastic pemphigus associated with Castleman disease reacting with multiple autoantigens, including the p200 protein.

isotretinoin were used separately; however, to our knowledge, only a few published reports describe this adverse effect when these drugs were used in combination. We conducted an online survey where dermatologists in the west of Scotland were asked to provide information regarding their standard practice when suggesting treatment escalation from oral tetracycline antibiotics to isotretinoin in patients with acne vulgaris. Of the 46 respondents, four (9%) suggested a ‘washout’ period of 5 days, 14 (30%) suggested 7 days, 22 (48%) suggested 2 weeks and six (13%) did not routinely suggest one. Assuming standard acne antibiotic doses and normal liver and renal function, it takes approximately 5–7 half-lives, from steady state, for a drug to be eliminated. Basing our calculation on seven halflives to achieve a theoretical 99% drug clearance, doxycycline (half-life 12–24 h) takes between 84 and 168 h (3 5–7 0 days) to be cleared. Similarly, minocycline (half-life 11–26 h) requires 77–182 h (3 2–7 5 days) to be eliminated. Half-life data for other tetracycline antibiotics used in the treatment of acne are generally shorter. Under the assumption that pseudotumour cerebri is caused by the presence of both drugs in the body, and not by a long-lasting effect, a 7-day ‘washout’ period would therefore be adequate. This means that a shorter ‘washout’ period may expose patients to a serious adverse effect, while prolonging this period may unnecessarily delay required treatment. As the use of oral isotretinoin is increasing and its prescribing subject to intense scrutiny and strict guidelines, it is useful to incorporate scientific pharmacology in the prescribing of acne medications. We hope this will be useful in standardizing practice for other dermatologists.

MECHANISM OF SIDE BRANCH JAILING IN BIFURCATION LESION: PLAQUE OR CARINA SHIFT?

Authors: Ji-Hyun Kim, Bon-Kwon Koo, Myung-Ki Seo, Seung-Jung Park, Kyung Woo Park, Hye-Young Lee, Hyun-Jae Kang, Hyo-Soo Kim, Byung-Hee Oh, Young-Bae Park, Chang-Wook Nam, Seung-Ho Hur, Donghoon Choi, Yangsoo Jang, Joo-Yong Hahn, Hyeon-Cheol Gwon, Myeong-Ho Yoon, SeungJea Tahk, Woo-Young Chung, Young-Seok Cho, Dong-Ju Choi, Sung Jin Oh, Yasuhiro Honda, Peter J. Fitzgerald, William F. Fearon, Seoul National University hospital, Seoul, South Korea, Stanford University Medical center, Stanford, CA