Young Wook Jeong

Impact of high admission blood pressure without history of hypertension on clinical outcomes of patients with acute myocardial infarction: From Korea Acute Myocardial Infarction Registry

Impact of high admission blood pressurewithout history of hypertension on clinical outcomes of patients with acute myocardial infarction: From Korea Acute Myocardial Infarction Registry Jae Yeong Cho , Myung Ho Jeong ⁎, Youngkeun Ahn , Hae Chang Jeong , Su Young Jang , Sung Soo Kim , Shi Hyun Rhew , Young Wook Jeong , Ki Hong Lee , Keun-Ho Park , Doo Sun Sim , Nam Sik Yoon , Hyun Ju Yoon , Kye Hun Kim , Young Joon Hong , Hyung Wook Park , Ju Han Kim , Jeong Gwan Cho , Jong Chun Park , Young Jo Kim , Chong Jin Kim , Myeong Chan Cho , Kyoo Rok Han , Hyo Soo Kim , the Korea Acute Myocardial Infarction Registry Investigators

CHA2DS2-VASc scoring system as an initial method for screening high-risk patients in acute myocardial infarction

CHA2DS2-VASc scoring system as an initial method for screening high-risk patients in acute myocardial infarction Young Wook Jeong , Myung Ho Jeong ⁎, Sung Soo Kim , Shi Hyun Rhew , Youngkeun Ahn , Jong Hyun Kim , Shung Chull Chae , Young Jo Kim , Seung Ho Hur , In Whan Seong , Taek Jong Hong , Dong Hoon Choi , Myeong Chan Cho , Chong Jin Kim , Ki Bae Seung , Wook Sung Chung , Yang Soo Jang , Seung Yun Cho , Seung Woon Rha , Jang Ho Bae , Jeong Gwan Cho , Seung Jung Park o a Chonnam National University Hospital, Gwangju, South Korea b Busan Hanseo Hospital, Busan, South Korea c Kyungpook National University Hospital, Daegu, South Korea d Yeungnam University Hospital, Gyeongsan, South Korea e Keimyung University Hospital, Daegu, South Korea f Chungnam National University Hospital, Daejeon, South Korea g Busan National University Hospital, Busan, South Korea h Yonsei University Severance Hospital, Seodaemun-gu, South Korea i Chungbuk National University Hospital, Cheongju-si, South Korea j Kyung Hee University Hospital, Seoul, South Korea k Catholic University Hospital, Seoul, South Korea l Yonsei University Hospital, Seoul, South Korea m Korea University Hospital, Seoul, South Korea n Konyang University Hospital, Daejeon, South Korea o Ulsan University Hospital, Ulsan, South Korea

Relation between renal function and neointimal tissue characteristics after drug-eluting stent implantation: Virtual histology-intravascular ultrasound analysis

BACKGROUND Few data are available about neointimal tissue characteristics after drug-eluting stent (DES) implantation in patients with decreased renal function. We used virtual histology-intravascular ultrasound (VH-IVUS) to assess the neointimal tissue characteristics according to the baseline renal function. METHODS We compared neointimal tissue components between patients with chronic kidney disease (CKD) [n=19, estimated creatinine clearance (CrCl) <60mL/min] and those without CKD (n=229). The region of interest was placed between the luminal border and the inner border of the stent struts and tissue components were reported as percentages of neointimal volume. RESULTS Mean follow-up durations between DES implantation and follow-up VH-IVUS study were 12.0±4.1 months in the CKD group and 11.4±5.6 months in the non-CKD group (p=0.519). At follow-up, neointima volume was significantly greater (72±47mm(3) vs. 47±26 mm(3), p<0.001) and %neointima necrotic core (NC) volume was significantly greater (25.0±11.4% vs. 17.9±10.2%, p=0.012) in the CKD group compared with the non-CKD group. There was negative correlation between CrCl and neointima volume (r=-0.250, p<0.001), however, there was no significant correlation between CrCl and %neointima NC volume (r=-0.034, p=0.591). The only independent predictor of follow-up %neointima NC volume ≥10% was neointima volume (odds ratio 1.025, 95% confidence interval 1.013-1.036, p<0.001). CONCLUSIONS Renal function was associated with in-stent neointimal growth, but it was not associated with neointima NC formation. Instead, the amount of neointima was associated with more neoatherosclerosis in patients who underwent DES implantation.

Predictors of recurrent sudden cardiac death in patients associated with coronary vasospasm

Even though coronary heart disease is the leading cause of sudden cardiac death (SCD), there is increasing evidence that SCD can be developed in the absence of organic heart disease. Coronary vasospasm or primary electrical disorder may play an important role in these circumstances. In aborted SCD patients associated with coronary vasospasm, medical treatment is recommended as the first line therapy. However, some patients experience recurrent SCD events despite medical treatment. Furthermore, although coronary vasospasm can cause life threatening arrhythmia, some patients did not have any ischemic symptoms before the index event. Therefore, coronary vasospasm itself might not be the sole cause of SCD event. We hypothesized that primary electrical abnormalities might be one of the important causes in recurrent SCD. A total of 68 aborted SCD patients who have angiographically proven coronary vasospasmwere analyzed. Patients were divided into 2 groups according to the presence of recurrent SCD episode (group 1, patients with recurrent events, n = 13; group 2, patients without recurrent events, n = 55). Coronary vasospasm was defined when coronary angiographic finding showed no significant obstructive coronary artery stenosis (stenosis b 50%) and either spontaneous coronary spasm or ergonovine induced vasospasm. Primary electrical disorders including Brugada syndrome, arrhythmogenic right ventricular dysplasia (ARVD), long QT syndrome (LQTS), and early repolarization syndrome were analyzed by two electrophysiologists blinded to clinical outcomes at the time of and after the index SCD event during 3.9 years median follow-up based on standard electrocardiographic diagnostic criteria [1–4]. The electrocardiographic diagnosis of early repolarization should have J point elevation≥0.1 mV in at least 2 inferior or lateral leads. These ECG findings were divided into notched or slurred type. ST segment patterns after the J point elevation were classified as concave/rapidly ascending (as N0.1 mVelevation of ST segment within 100 ms after the J point or a persistently elevated ST segment of N0.1 mV throughout the ST segment) or horizontal/ descending (≤0.1 mV elevation of the ST segment within 100 ms after the J point) [4]. The methods of unpaired t test, chi-square test, Kaplan–Meier estimation and Cox proportional hazards regression analysis were used (SPSS for window 18.0). Group 1 patients were younger (46.7 ± 10.2 vs. 52.5 ± 9.6 years old, p = 0.050). There were no differences in laboratory results and concomitant medications. Analysis of angiographic findings showed that the prevalence of coronary spasm was 57.4% in left anterior descending artery, 52.9% in right coronary artery, and 20.6% in left circumflex artery. Among the patients with right coronary artery vasospasm, diffuse type spasmwasmore common in the group 1 than the group 2 (50.0% vs. 5.3%, p = 0.017). Primary electrical abnormalities were found in 40 (58.8%) patients: Brugada type ECG in 5 (7.4%), ARVD in 3 (4.4%), LQTS in 2 (2.9%) and early repolarization in 33 (48.5%) patients. Two patients had both Brugada type 1 ECG and early repolarization, whereas one patient had both LQTS and early repolarization at a different time point of ECG follow-up. Group 1 had higher prevalence of Brugada type ECG (23.1% vs. 3.6%, p = 0.045), LQTS (15.4% vs. 0%, p = 0.034) than group 2. Among early repolarization subtype, horizontal/descending ST segment was more common in group 1 than group 2 (46.2% vs. 14.5%, p = 0.011). Recurrent SCD events developed in 13 (19.1%) patients. Kaplan– Meier estimation showed that patients with horizontal/descending ST segment experienced significantly higher recurrent SCD events than those patients without horizontal/descending ST segment (42.9% vs. 13.0%, log rank p = 0.005, Fig. 1). Cardiovascular risk factors including age, sex, hypertension, diabetes mellitus and smoking did not predict recurrent SCD events before and after covariate adjustment. Early repolarization with horizontal/descending STsegment (adjustedhazard ratio [HR]4.41, 95% confidence interval [CI] 1.26 to 15.40, p = 0.020) and right coronary artery diffuse type vasospasm (adjusted HR 4.03, 95% CI 1.09–14.96, p = 0.037) were associated with recurrent SCD events before and after covariate adjustment (Table 1). Coronary vasospasm without obstructive lesion may trigger fatal ventricular arrhythmia. Although medical therapy including calcium channel blockers and nitrates has been known to be effective in preventing coronary vasospasm and related ventricular arrhythmias, some of them experience recurrent SCD events.

Successful Treatment of a Ruptured Subclavian Artery Aneurysm Presenting as Hemoptysis with a Covered Stent

An aneurysm of the subclavian artery is rare. Recently, we experienced a case of a ruptured subclavian artery aneurysm presenting as hemoptysis. The patient had experienced atypical chest discomfort, and computed tomography (CT) revealed a small aneurysm of the left subclavian artery (SCA). Hemoptysis occurred 2 weeks later. Follow-up CT showed a ruptured aneurysm at the proximal left SCA. Endovascular treatment with a graft stent was performed by bilateral arterial access with a 12-Fr introducer sheath placed via cutdown of the left axillary artery and an 8-Fr sheath in the right femoral artery. A self-expandable Viabahn covered stent measuring 13×5 mm was introduced retrogradely via the left axillary sheath and was positioned under contrast guidance with an 8-Fr JR4 guide through the femoral sheath. After the procedure, hemoptysis was not found, and the 3-month follow-up CT showed luminal patency of the left proximal SCA and considerable reduction of the hematoma.

One-year clinical impact of cardiac arrest in patients with first onset acute ST-segment elevation myocardial infarction

BACKGROUND Cardiac arrest complicating acute ST elevation myocardial infarction (STEMI) is known to be associated with increased in-hospital mortality. However, little is known about the long-term outcomes after cardiac arrest complicating first onset STEMI in contemporary percutaneous coronary intervention (PCI) era. METHODS We analyzed 7942 consecutive patients who were diagnosed with STEMI and had no previous history of MI. They were divided into two groups according to the presence of cardiac arrest (group I, patients with cardiac arrest; n=481, group II, patients without cardiac arrest; n=7641). RESULTS In a stepwise multivariate model, previous history of chronic kidney disease, high serum level of glucose and low high density lipoprotein-cholesterol was an independent predictor of cardiac arrest complicating STEMI. Group I had significantly higher in-hospital mortality (adjusted hazard ratio [HR] 3.06, 95% confidence interval [CI] 2.08-4.51, p<0.001) and 30-day mortality after hospital discharge (adjusted HR 2.92, 95% CI 1.86-4.58, log-rank p<0.001). However, there was no significant increase in mortality beyond 30 days (6-month, adjusted HR 1.46, 95% CI 0.45-4.77, log rank p=0.382; 1-year, adjusted HR 1.84, 95% CI 0.83-4.05, log-rank p=0.107). Also, there were no significant differences in 6-month and 1-year major adverse cardiac events in 30-day survivors. Performing PCI was associated with decreased 12-month mortality in 30-day survivors. CONCLUSIONS Although patients with cardiac arrest complicating first onset STEMI had higher in-hospital and 30-day mortality after hospital discharge, cardiac arrest itself did not have any residual impact on mortality as well as clinical outcomes.