Won-Jang Kim

Comparison of effects of atorvastatin (20 mg) versus rosuvastatin (10 mg) therapy on mild coronary atherosclerotic plaques (from the ARTMAP trial).

High-dose rosuvastatin induces regression of coronary atherosclerosis, but it remains uncertain whether usual-dose statin has similar effects. We compared the effects of atorvastatin 20 mg/day versus rosuvastatin 10 mg/day on mild coronary atherosclerotic plaques (20% to 50% luminal narrowing and lesion length >10 mm) using intravascular ultrasound (IVUS). Three hundred fifty statin-naive patients with mild coronary atherosclerotic plaques were randomized to receive atorvastatin 20 mg/day or rosuvastatin 10 mg/day. IVUS examinations were performed at baseline and 6-month follow-up. Primary end point was percent change in total atheroma volume (TAV) defined as (TAV at 6 months - TAV at baseline)/(TAV at baseline) × 100. Evaluable IVUS was obtained for 271 patients (atorvastatin in 143, rosuvastatin in 128). Clinical characteristics, lipid levels, and IVUS measurements at baseline were similar between the 2 groups. At 6-month follow-up, percent change in TAV was significantly less in the atorvastatin group than in the rosuvastatin group (-3.9 ± 11.9% vs -7.4 ± 10.6%, respectively, p = 0.018). In contrast, change in percent atheroma volume was not different between the 2 groups (-0.3 ± 4.2 vs -1.1 ± 3.5, respectively, p = 0.157). Compared to baseline, TAV and TAV at the most diseased 10-mm subsegment were significantly decreased in the 2 groups (p <0.001). Changes in lipid profiles at 6-month follow-up were similar between the 2 groups. In conclusion, usual doses of atorvastatin and rosuvastatin induced significant regression of coronary atherosclerosis in statin-naive patients, with a greater decrease in favor of rosuvastatin.

Prevalence and Clinical Implications of Newly Revealed, Asymptomatic Abnormal Ankle-Brachial Index in Patients With Significant Coronary Artery Disease

OBJECTIVESnThis study sought to evaluate the association between newly revealed abnormal ankle-brachial index (ABI) and clinical outcomes in patients with significant coronary artery stenosis.nnnBACKGROUNDnLittle is known about the prevalence and clinical implications of ABI in patients with no claudication or previous history of peripheral artery disease who undergo diagnostic coronary angiography.nnnMETHODSnBetween January 1, 2006, and December 31, 2009, ABI was evaluated in 2,543 consecutive patients with no clinical history of claudication or peripheral artery disease who underwent diagnostic coronary angiography. Abnormal ABI was defined as ≤0.9 or ≥1.4. The primary endpoint was the composite of death, myocardial infarction, and stroke over 3 years.nnnRESULTSnOf the 2,543 patients, 390 (15.3%) had abnormal ABI. Of the 2,424 patients with at least 1xa0significant stenosis (≥50%) in a major epicardial coronary artery, 385 (15.9%) had abnormal ABI, including 348 (14.4%) with ABI ≤0.9 and 37 (1.5%) with ABI ≥1.4. During a median follow-up of 986xa0days, the 3-year major adverse event rate was significantly higher in patients with abnormal than normal ABI (15.7% vs. 3.3%, p < 0.001). After multivariate analysis, abnormal ABI was identified as a predictor of primary endpoint (hazard ratio [HR]: 1.87; 95% confidence interval [CI]: 1.23 to 2.84; pxa0=xa00.004). After adjustment by propensity-score matching, abnormal ABI could predict adverse clinical events in patients with established coronary artery disease (HR: 2.40; 95% CI: 1.41 to 4.10; pxa0=xa00.001).nnnCONCLUSIONSnThe prevalence of newly revealed abnormal, asymptomatic ABI among patients who have significant CAD on coronary angiography was 15.9%. The presence of abnormal ABI was associated with a higher incidence of adverse clinical outcomes over 3 years.

Comparison of Dual Drug-Eluting Cilotax Stent and Paclitaxel-Eluting Taxus Liberte Stent in Native Coronary Artery Lesions

Cilotax stent is a new type of drug-eluting stent (DES) designed to increase the antirestenotic performance of the paclitaxel-eluting stent and decrease the risk of stent thrombosis by the incorporation of cilostazol. Therefore, we investigated the safety and efficacy of Cilotax dual DESs and compared their performance to that of paclitaxel-eluting Taxus Liberte. Patients undergoing percutaneous coronary intervention for de novo coronary artery lesions at 2 centers in Korea were randomized to receive Cilotax (n = 55) or Taxus Liberte (n = 56) stents. The primary end point was in-segment late loss at 8 months. The 2 groups had similar baseline characteristics. Cilotax stent was not inferior to Taxus Liberte stent as determined by in-segment late loss (0.28 ± 0.30 vs 0.42 ± 0.45 mm, difference -0.14, 95% confidence interval -0.27 to -0.01, 1-sided p = 0.028 for noninferiority). In-stent late loss was significantly lower in the Cilotax than in the Taxus Liberte group (0.22 ± 0.31 vs 0.50 ± 0.55 mm, p = 0.002). Although in-segment restenosis rate did not differ significantly between the 2 groups (3.8% vs 10.9%, respectively, p = 0.271), in-stent restenosis rate was significantly lower in the Cilotax stent group (0% vs 10.9%, p = 0.027). There was no stent thrombosis at 8 months in either group. Rates of death, myocardial infarction, and any target lesion revascularization at 8 months were 0%, 0%, and 1.9%, respectively, in the Cilotax group and 1.8%, 0% and 3.6%, respectively, in the Taxus Liberte group. In conclusion, the Cilotax stent was safe and effective in decreasing late loss, indicating that this stent represents a promising new type of DES system.

Long-term (8 year) outcomes and predictors of major adverse cardiac events after full metal jacket drug-eluting stent implantation.

We examined long‐term outcomes and predictors of major adverse cardiac events after the full metal jacket (FMJ) stent implantation.

PREDICTORS OF PERMANENT PACEMAKER INSERTION FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION WITH THE COREVALVE REVALVING SYSTEM BASED ON COMPUTED TOMOGRAPHY ANALYSIS: AN ASIAN MULTICENTER REGISTRY STUDY

BACKGROUNDnTo determine predictive variables for permanent pacemaker (PPM) insertion after transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS).nnnMETHODS AND RESULTSnA total of 121 patients with severe aortic stenosis (AS) were recruited from six Asian medical centers between March 2010 and May 2013. Four patients with preexisting PPM were excluded. The mean age of the remaining 117 patients was 81.2 ± 5.1 years. Twenty-three patients (19.7%) required post-TAVR PPM, with a median time-to-insertion of 7 days (interquartile range, 5-13 days). Two variables were identified as independent predictors of PPM: (1) device depth from the non-coronary cusp (NCC) (odds ratio [OR], 1.263; P=.02) determined by aortic root angiography; and (2) the perimeter stretching index (OR, 1.584; P<.001) determined by computed tomography. The predictive cut-off values were as follows: a perimeter stretching index >1.13 (P<.001) and a device depth from the NCC >7.8 mm (P<.001). The diagnostic accuracy of these variables was 93.2% and 71%, respectively.nnnCONCLUSIONnDepth of the device from the NCC and the perimeter stretching index are independent predictors of PPM insertion after CRS-TAVR.

VALIDATION OF THE GLOBAL RISK CLASSIFICATION FOR PREDICTION OF LONG-TERM OUTCOME AFTER UNPROTECTED LEFT MAIN CORONARY REVASCULARIZATION

The global risk classification (GRC) was created to incorporate clinical variables into angiographic SYNTAX score by combination with EuroSCORE. This study aimed to validate the ability of the GRC score to predict long-term outcome in patients underwent unprotected left main coronary artery (ULMCA)

DISTRIBUTION OF CORONARY ARTERY CALCIUM SCORE AND PREVALENCE OF CORONARY ARTERY DISEASE ACCORDING TO FRAMINGHAM RISK STRATA IN ASYMPTOMATIC KOREAN ADULTS

Background: Coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) have been proposed as possible way to screen of coronary artery disease (CAD) beyond Framingham risk strata (FRS). However, current guidelines recommended CACS screening only in intermediate-risk groups (FRS, 10% to 20%). Thus, we aimed to evaluate the distribution of CACS and the prevalence of CAD across FRS, and also determine whether lower-risk population could benefit from screening of CACS and CCTA.