Search

There are scarce data on the optimal duration and prognostic impact of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents for left main coronary artery (LMCA) disease. The aim of this study was to investigate the practice pattern and long-term prognostic effect of DAPT duration in patients undergoing PCI with second-generation drug-eluting stents for LMCA disease.Using individual patient-level data from the IRIS-MAIN and KOMATE registries, 1827 patients undergoing PCI with second-generation drug-eluting stents for LMCA disease with valid information on DAPT duration were included. The efficacy outcome was major adverse cardiovascular events (MACE, a composite of cardiac death, myocardial infarction, and stent thrombosis) and the safety outcome was TIMI major bleeding.DAPT duration was6 months (n=273), 6 to 12 months (n=477), 12 to 24 months (n=637), and ≥ 24 months (n=440). The median follow-up duration was 3.9 [interquartile range, 3.01-5.00] years. Prolonged DAPT duration was associated with lower incidences of MACE. In multigroup propensity score analysis, adjusted HR for MACE were significantly higher for DAPT6 months and DAPT 6 to 12 months than for DAPT 12 to 24 months (HR, 4.51; 95%CI, 2.96-6.88 and HR 1.92; 95%CI, 1.23-3.00). There was no difference in HR for major bleeding among the assessed groups.DAPT duration following PCI for LMCA disease is highly variable. Although the duration of DAPT should be considered in the context of the clinical situation of each patient,12 months of DAPT was associated with higher incidence of MACE. Registration identifiers: NCT01341327; NCT03908463.

PURPOSE We investigated whether the combination therapy of low-intensity rosuvastatin and ezetimibe is an useful alternative to moderate-intensity rosuvastatin monotherapy in patients requiring cholesterol-lowering therapy. METHODS This was a multicenter randomized, double-blind study to investigate the safety and efficacy of a fixed-dose combination of rosuvastatin 2.5 mg and ezetimibe 10 mg (R2.5+E10) compared to those of ezetimibe 10 mg monotherapy (E10), rosuvastatin 2.5 mg (R2.5), and rosuvastatin 5 mg monotherapy (R5) in patients with hypercholesterolemia. A total of 348 patients at 15 centers in Korea were screened, and 279 patients were randomized to different groups in the study. Clinical and laboratory examinations were performed at baseline and 4 and 8 weeks after intervention. The primary endpoint was the percentage change of low-density lipoprotein (LDL) cholesterol levels at the 8-week follow-up. FINDINGS Baseline characteristics were similar among the four groups. There were significant changes in lipid profiles at the 8-week follow-up. A greater decrease in the LDL cholesterol levels (primary endpoint) were found in the R2.5+E10 group (-45.7±18.6%) than in the E10 group (-16.7±14.7%, p

Objectives The goal of this study was to evaluate whether the beneficial effect of use of intravascular ultrasound (IVUS) is sustained for long-term follow-up. Background The use of IVUS promoted favorable 1-year clinical outcome in the IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) trial. It is not known, however, whether this effect is sustained for long-term follow-up. Methods The IVUS-XPL trial randomized 1,400 patients with long coronary lesions (implanted stent length ≥28 mm) to receive IVUS-guided (n = 700) or angiography-guided (n = 700) everolimus-eluting stent implantation. Five-year clinical outcomes were investigated in patients who completed the original trial. The primary outcome was the composite of major adverse cardiac events, including cardiac death, target lesion–related myocardial infarction, or ischemia-driven target lesion revascularization at 5 years, analyzed by intention-to-treat. Results Five-year follow-up was completed in 1,183 patients (85%). Major adverse cardiac events at 5 years occurred in 36 patients (5.6%) receiving IVUS guidance and in 70 patients (10.7%) receiving angiographic guidance (hazard ratio: 0.50; 95% confidence interval: 0.34 to 0.75; p = 0.001). The difference was driven mainly by a lower risk for target lesion revascularization (31 [4.8%] vs. 55 [8.4%]; hazard ratio: 0.54; 95% confidence interval: 0.33 to 0.89; p = 0.007). By landmark analysis, major adverse cardiac events between 1 and 5 years occurred in 17 patients (2.8%) receiving IVUS guidance and in 31 patients (5.2%) receiving angiographic guidance (hazard ratio: 0.53; 95% confidence interval: 0.29 to 0.95; p = 0.031). Conclusions Compared with angiography-guided stent implantation, IVUS-guided stent implantation resulted in a significantly lower rate of major adverse cardiac events up to 5 years. Sustained 5-year clinical benefits resulted from both within 1 year and from 1 to 5 years post-implantation. (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions [IVUS-XPL Study]: Retrospective and Prospective Follow-Up Study; NCT03866486)

The aim of this study was to investigate the optimal strategy for antiplatelet therapy in patients with lower extremity peripheral artery disease (PAD) after endovascular revascularization.The optimal strategy for antiplatelet therapy in patients with PAD after endovascular revascularization has not been established.From March 2008 to February 2013, 693 patients with lower extremity PAD treated with different antiplatelet therapies, such as mono-antiplatelet therapy (MAPT) and dual-antiplatelet therapy (DAPT), of various durations after endovascular revascularization were analyzed. They were classified into 2 groups (DAPT 6 months or MAPT vs. DAPT ≥6 months). The primary outcomes were major adverse cardiovascular events and major adverse limb events. The safety outcome was major bleeding.During 5-year follow-up, major adverse cardiovascular events occurred less frequently in the DAPT ≥6-month group than the DAPT 6-month or MAPT group (17.3% vs. 31.3%; hazard ratio: 0.44; 95% confidence interval: 0.30 to 0.65; p 0.001). Major adverse limb events also occurred less frequently in the DAPT ≥6-month group than the DAPT 6-month or MAPT group (21.5% vs. 43.7%; hazard ratio: 0.42; 95% CI: 0.30 to 0.58; p 0.001). However, major bleeding events were infrequent, with no signal toward harm with DAPT ≥6 months. Results were consistent after inverse probability-weighted adjustment and propensity score matching.Following endovascular revascularization for lower extremity PAD, DAPT ≥6 months was associated with decreased 5-year major adverse cardiovascular events and major adverse limb events.

In 2010, Korea’s authorities announced foreign exchange-related macroprudential measures (MPMs) aimed at building resilience against external financial shocks. These measures have greatly contributed to limit systemic risk by curbing excessive capital inflows. Twelve years have passed since the global financial crisis started and ten years after the introduction of Korea’s FX-related macro-prudential policy measures. Accordingly, this study check the performance and effectiveness of these policies and discuss how to improve macroprudential measures in response to emerging external risks.

Background Acute mechanical circulatory support (aMCS) can be a lifesaving therapy for patients with refractory cardiogenic shock. As device safety and technology improve, so will the ability to extend aMCS to patients at remote hospitals. The Intermountain West is unique because of the large geographical area, making transport of critically ill patients a logistical challenge. Methods We reviewed our experience of transporting patients in cardiogenic shock over long distances who had already been placed on aMCS: Impella and extracorporeal membrane oxygenator devices. Survival data was compared to international benchmark data published by the Extracorporeal Life Support Organization. Results A total of 11 patients (91% male; mean age 56 ± 5.4 y) were transported via fixed-wing aircraft to our center. The etiology of cardiogenic shock was ST-elevation myocardial infarction ( n = 4), acutely decompensated chronic systolic heart failure ( n = 4), postcardiotomy shock ( n = 2), and acute myocarditis ( n = 1). Average transport distance was 364 ± 139 miles (585 ± 264 km) and flight time was 170 ± 29 min. All patients were safely transported with no in-transit adverse events. The average duration of aMCS was 6.4 ± 3.3 d. Six patients (54.5%) survived to device explantation and 3 (27.2%) survived to hospital discharge. For comparison, Extracorporeal Life Support Organization benchmark data for adult cardiogenic shock patients report 56% survival to device explantation and 41% to hospital discharge. Conclusions Patient transport with aMCS over long distances can be done safely without serious adverse events using good protocols and well-trained personnel. Although survival data are slightly below benchmark data, they appear reasonable, given the severity of illness and challenges of transferring critically ill patients to an expert center.

Since the global financial crisis, low interest rates have continued throughout the world. However, financial imbalance has deepened as much of the expanded investment during low interest rates did not lead to increased productivity. This study focused on the increase of marginal firms as a result of the adverse effects of financial imbalances on firms. The marginal firms were identified based on the company's financial statement, and the share of marginal firms by country was compared and analyzed using Worldscope data. As a detailed analysis on the marginal firms, the impact of borrowing interest rate on the possibility of becoming a marginal company was analyzed in the case of Korea with KED data. According to the international comparison, East Asia including Korea, China and Japan has shown a lower share of marginal companies than Europe, South Asia and Latin America. Empirical results through Panel Logit with Sector Fixed Effect Model show that the borrowing rate has a negative correlation with the probability the company will become a marginal company in the case of Korea. However, the impact of an increase in borrowing rates on the likelihood of becoming a marginal company depends on the degree of financial vulnerability. Specifically, an increase in the borrowing rate has a greater impact on the possibility to become ICR

Most previous studies have shown that push factors have had a greater impact on capital outflows in emerging economies than pull factors. Meanwhile, in May 2018, the US Federal Reserve Chairman Jerome Powell addressed the controversy over capital movements to emerging economies after the global financial crisis. Powell said the inflows of capital into emerging economies are unlikely to have been caused by the Fed's interest rate policy. Powell's speech contains "implied" warnings that the US monetary policy is not a triggering force of a capital outflow in emerging economies. This is why Powell’s speech is adding to the difficulty of policy responses in emerging countries. This, in turn, suggests that it is necessary to check the determinants of global capital flows. In addition, the impact of US monetary policy on Korea's financial markets and capital outflows needs to be analyzed in depth. In this paper, the discussion of push (external) vs. pull (internal) factors of capital flow is examined using panel data of 47 countries. Our empirical results show that the push and pull factors determining capital flows to advanced economies and emerging market economies are different. This study also analyzes the impact of the normalization of US monetary policy on the domestic financial market and foreign exchange market by using the TVP-VAR model. Our analysis shows that US credit spread shock, which is an indicator of uncertainty in international financial markets, has had a negative impact on domestic financial markets and capital inflows. On the other hand, the impact of the US policy rate hike after 2015 was limited.

Capital market integration contributes to economic growth and it can be more beneficial for emerging market economies (EMEs, hereafter) at their early stages of development where the capital is relatively insufficient. An open capital market also enables investor to share the country-specific risks by holding foreign assets. However, there are also some negative side effects of capital market integration. Financial shocks originating in the center country can be quickly propagated through the integrated financial market. The Global Financial Crisis (GFC, hereafter) is a good example of the contagion of the financial crisis. Volatile cross-border capital inflows and outflows negatively affect financial stability, which eventually lowers economic growth by causing financial crises. Despite of these negative side effects, capital market integration has been an inevitable long-term trend for many EMEs over the past few decades (Aizenman et al. 2010). There have been continuous capital flows to EMEs, which started even before GFC and this trend has been more pronounced during the U.S. zero-interest rate period (Ahmed and Zlate 2014). Though some monetary authorities in EMEs tried to moderate the procyclicality of credit flows by implementing policy instruments such as capital controls or macro-prudential policy measures after GFC (Kim and Mehrotra 2018), the common factors in the global financial market still play a crucial role in determining capital inflows to EMEs. The relationship between the global financial condition and its impact on capital inflows to EMEs, has been a long-debated issue. This issue concerns whether push or pull factors are the major determinant of capital flows. The push factor represents the common factor that exists in the global financial market or center countries, which influences capital inflows to peripheral countries. These factors are interest rates and GDP growth rates of advanced economies (AEs, hereafter), global risk factors such as VIX (S&P 500 Volatility Index), and the commodity price index. The pull factor denotes domestic factors that attract funds from the global financial market to domestic financial markets. These factors are domestic interest rates, domestic GDP growth rates, and other country-specific characteristics such as exchange rate regime, degree of the capital account openness, institutional quality, and stages of economic development. In previous literature, many scholars have found strong evidence for push factors being the major determinant of capital movement. The interest rates of mature economies and VIX are significant determinants of capital inflows to EMEs. However, there is only some evidence that higher domestic interest rates and higher domestic GDP growth rates pull capital from the center countries to individual EMEs (Koepke 2015). Related to this long-debated issue in academia, the Chairman of the Federal Reserve, Jerome H. Powell recently stated, "... I will argue that, while global factors play an important role in influencing domestic financial conditions, the role of U.S. monetary policy is often exaggerated." With this statement, he also pointed out that the slowdown in capital inflows to EMEs which has been happening ever since 2011 has been mainly due to the narrowing of GDP gaps between AEs and EMEs, i.e., the recent decrease in capital in-flows to EMEs can be attributed to the decline in EMEs' GDP growth rates given the fact that the U.S. GDP growth rate has picked up. In this paper, we revisit this issue of push and pull factors of capital inflows. To this end, we consider the heterogeneity that exists in EMEs by dividing them into four subgroups. We investigate which is the main driver of capital inflows between push and pull factors across country groups. Categorizing subgroups is important for two reasons. First, EMEs are so heterogeneous that we make subgroups which share similar economic fundamentals by regions. Second, making subgroups across EMEs is an effective way to indirectly consider the regional contagion effect. With this cross-country analysis, we can figure out the differing effects of push and pull factors across country groups, and this can eventually lead to the development and implementation of appropriate policy instruments. Our empirical finding shows that the push and pull factors play a different role in determining capital inflows to AEs and EMEs. The major drivers of capital inflows to AEs are both push and pull factors, but push factors turn out to be the main determinant of capital inflows to EMEs. When EMEs are divided into four subgroups, we find sizable heterogeneity across subgroups. In Asian countries, both push and pull factors are significant, which is similar to AEs, but only U.S. interest rate plays a major role in Eastern Europe. Some pull factors are important in Latin American countries and other EMEs, but these are not robust to alternative empirical models and measures.

Korean Abstract: 2011년 이후 우리나라에서 거주자의 해외투자가 주식 및 채권을 중심으로 가파르게 증가하고 있다. 2010년경 1,000억 달러 수준이던 거주자 해외증권 투자는 2019년 3월 말 현재 4,984억 달러로 급증하였다. 이러한 추세는 거시경제 여건(저금리, 은퇴 대비 저축 확대 등), 정부정책 변화(해외투자 활성화, 해외투자 관련 규제 완화 등), 제도 변화(보험업종에서의 IFRS 도입 등)로 향후에도 지속될 전망이다. 이는 여러 경로를 통해 대외충격에 민감한 우리나라 금융시장에 다양한 영향을 미칠 것이다. 특히 외환ㆍ외화자금시장과 단기외채 등 대외부문 거시건전성(macro-prudential)에 영향을 미칠 가능성이 높아 그 영향을 분석하고 리스크에 대해서는 미리 대비책을 마련할 필요가 있다. 그래서 본 연구는 거주자의 해외증권투자가 스왑레이트(swap rate) 및 환율에 미치는 영향에 대한 실증분석, 과거 국내 해외증권투자 확대 시기의 사례분석 및 금융회사 전문가 심층 인터뷰를 통해 외환 및 외화자금시장 안정화 방안을 위한 정책적 시사점을 제시하고자 한다.제2장에서는 거주자의 해외증권투자(채권/주식)가 스왑레이트와 환율(exchange rate)에 어떠한 영향을 미치는지 분석하였다. 스왑레이트 및 환율에 영향을 미치는 다른 변수를 계량모형에 포함하여 통제하였으며, 내생성의 문제를 효과적으로 완화할 수 있는 연립방정식 모형(Simultaneous Equations Model, 이하 SEM으로 표기)을 사용하였다. 한국을 포함한 18개국, 2000년부터 2017년까지의 국가패널을 사용한 연립방정식 실증분석 결과 거주자의 해외채권투자와 주식투자가 스왑레이트 및 환율에 미치는 효과가 상이한 것을 확인할 수 있었다. 거주자의 해외채권투자는 스왑레이트를 낮추는 반면 거주자의 해외주식투자는 스왑레이트에 미치는 영향이 통계적으로 유의하지 않았다. 반면 환율과 의 관련성에서는 반대의 효과가 나타났다. 즉 거주자의 해외채권투자는 환율에 미치는 영향이 통계적으로 유의하지 않은 반면, 거주자의 해외주식투자는 자국통화가치의 평가절하와 관련되어 있는 것으로 분석되었다. 거주자 해외채권투자의 확대가 스왑레이트를 감소시키는 효과는 주로 신흥국에서 두드러졌다. 이러한 실증분석 결과는 채권과 주식의 상이한 환리스크(exchange risk) 헤지(hedge) 관행이 설명할 수 있다. 일반적으로 채권투자에서는 환리스크를 헤지하기 위해 외화자금시장을 이용하게 되면서 스왑레이트를 낮추게 되지만, 주식투자에서는 주로 현물환 시장에서 자국통화를 투자국통화로 교환한 후 해외주식투자가 이루어진다. 이러한 과정에서 자국통화의 가치가 절하되는 것이다. 이러한 실증분석 결과는 한국의 월별 자료를 사용한 VAR 분석 결과에서도 나타나는 강건한 결과임을 확인하였다. 제3장에서는 국내에서 거주자의 해외증권투자가 확대되었던 과거 시기와 최근 시기를 비교ㆍ분석하였다. 2000년대 중반 시기, 2010년 이후부터 최근 시기 등 두 시기의 해외증권투자 확대 배경, 투자 주체 및 방식, 영향 등에 대해 그 특징을 살펴보았다. 해외증권투자 확대 배경 측면에서는 두 시기 모두 공통적으로 국내 경상수지 흑자 및 외국인 자금 유입 지속, 저금리 지속, 정부의 해외투자 활성화 정책 요인이 크게 작용하였다. 즉 국내 경상수지 흑자 및 외국인 자금 유입 지속으로 외화 유동성이 풍부해지고 저금리 기조의 장기화로 원화 유동성도 풍부해져 국내에서 해외 고수익 투자 수요가 크게 확대되었다. 이러한 상황에서 정부는 국내의 풍부한 외화 유동성을 조절하고 원화 강세압력을 완화하기 위해 해외투자 활성화 정책을 추진하였다. 투자 주체 및 방식 측면에서는 두 시기가 차이점을 보였다. 투자 주체의 경우 2000년대 중반에는 자산운용사를 중심으로 해외주식투자가 확대된 반면, 최근 시기에는 보험사를 중심으로 해외채권투자가 크게 확대되었다. 해외투자방식의 경우도 두 시기가 차이점을 보였다. 2000년대 중반에는 해외증권투자 시 주식 및 채권을 불문하고 100% 환위험을 헤지한 반면, 최근 시기에는 채권에 대해서는 100% 환위험을 헤지하고, 주식에 대해서는 일정 비율 환위험을 헤지하지 않고 있다. 해외증권투자 확대의 영향 측면에서는 두 시기에 공통점과 차이점이 혼재한다. 2000년대 중반의 경우 해외증권투자는 100% 환위험 헤지로 원화강세 압력을 완화시키지 못한 반면, 스왑레이트 하락과 단기 외화차입 증대를 초래하였다. 스왑레이트 하락에 따른 재정거래차익 기회 확대로 외은지점 등 은행의 단기성 외화 차입이 늘어났다, 이는 우리나라의 국가신용도에 부정적인 영향을 미쳤다. 최근 시기에는 2000년 중반에 비해 환위험 헤지 비율이 낮아졌지만 여전히 보험사를 중심으로 한 높은 환헤지 비율이 지속되고 있다. 이로 인해 해외투자가 환율에 미치는 영향은 제한적이지만 스왑레이트에는 하락 압력요인으로 작용하고 있다. 끝으로 실증분석 결과, 사례분석 및 전문가 심층 면담 결과를 바탕으로 외환 및 외화자금시장 안정화를 위해 미헤지 외화증권투자에 대한 인센티브 확대 강구, 환헤지 규제 관련 정부 내 거버넌스 구조(governance framework) 필요, 보험사 회계기준 및 자본 적정성 규제 변경에 따른 리스크 대응 강화, 외화표시 보험 판매 활성화 유도, RBC 비율 규제 개선 등 정책적 시사점을 제시하였다. English Abstract: Since 2011, the overseas financial investment of residents in Korea has been increasing rapidly, mainly in stocks and bonds. Residents‘ portfolio investment, which was about 100 billion USD in 2010, has surged to 498 billion USD as of end-March 2019. This trend is expected to continue in the future due to macroeconomic conditions (low interest rates, expansion of savings over retirement), changes in government policies (activation of foreign investment, deregulation related to overseas investment), and institutional changes (introduction of IFRS in the insurance industry). This will have an influence on the Korean financial market through various channels. In particular, it is likely to affect the FX market, FX money market and the external macro-prudential elements such as short term external debt, meaning it will be necessary to analyze these effects and prepare for risks in advance. Therefore, this study is aimed at presenting policy implications for stabilizing the FX market and FX money market through empirical analysis, comparative analysis of the past and recent expansion period of overseas portfolio investment, and in-depth interviews with financial experts. In Chapter 2, we examine the impact of the residents' foreign portfolio investments(bonds/equity) on swap rates and exchange rates. We use the Simultaneous Equations Model (SEM), which can effectively mitigate the endogeneity problem under the control of other factors that might affect swap rates and exchange rates. The empirical results of the SEM using the panel data show that the effect of residents’ foreign bond investment and foreign equity investment on swap rates and exchange rates are different. Residents’ foreign bond investment lowers the swap rates, while the residents' foreign equity investment has no impact on the swap rates. On the other hand, the effect on the exchange rates is opposite. The effect of residents’ foreign bond investments on exchange rates are statistically insignificant but, residents’ foreign equity investments are closely related to the depreciation of the Korean won. The notable result is that the effect of residents’ foreign bond investment on swap rates is more pronounced in emerging market economies. These empirical results can be explained by the different hedge practices of foreign bond and equity investment to deal with the exchange risk. In general, residents’ foreign bond investment lowers the swap rate by utilizing the swap market to hedge exchange risk. However, investors in foreign equity investment normally exchange their local currency to foreign currency in the spot exchange market. In this process, the value of the local currency is depreciated. These empirical results are consistent with the results from our VAR model using Korean monthly data. In Chapter 3, we conduct a comparative analysis between the past and recent periods when residents’ overseas securities investment expanded. This study examines the background, investor, investment method, and impact of overseas portfolio investment expansion in the mid-2000s and from 2010 to the latest. The expansion of overseas portfolio investment in both periods was mainly caused by current account surplus, continued inflow of foreign funds, low interest rate, and government policy to revitalize overseas investment. In other words, as foreign currency liquidity and won-denominated liquidity are abundant due to the current account surplus, the inflow of foreign funds, and the prolonged low interest rate, the seeking for high-yield overseas investments has expanded greatly in Korea. Against this backdrop, the Korean government has promoted overseas investment in order to reduce the abundance of foreign currency liquidity and to ease the pressure on the strong won. The two periods show differences in terms of investor and FX risk hedge pattern. In the case of the investor, overseas equity investment was expanded mainly by asset management companies in the mid-2000s, while foreign bond investment was largely expanded by insurance companies in recent years. In the case of FX risk hedge pattern, in the mid-2000s, FX risk was fully hedged when investing overseas securities, regardless of stocks and bonds. However in recent years, FX risk is not fully hedged when investing in overseas stocks, while 100% hedged when investing in overseas bonds. In terms of the impact of overseas securities investments, there are commonalities and differences between the two periods. In the mid-2000s, foreign securities investment failed to alleviate the won's appreciation pressure due to a 100% hedge of FX risks, while causing a drop in swap rates and an increase in short-term external debts. Banks’ short-term external debts, including at branches of foreign banks, have increased thanks to increased opportunities for arbitrage transaction gains due to a drop in swap rates. The increase in short-term foreign debt has contributed to the decline in Korea's national credibility. In recent years, the rate of exchange risk hedging has been lower than in the mid-2000s. However, major overseas investors, especially insurers, still maintain high FX risk hedging rates. As a result, the impact of foreign investment on the exchange rate is limited, but instead, it acts as a factor to lower the swap rate. Finally, based on the results of empirical analysis, case analysis and in-depth interviews with experts, we suggest the policy implications for stabilizing the FX markets and FX money markets. These include: increased incentives for unhedged foreign currency investments, the need for a governance framework to reconcile differences between macroeconomic and financial regulators, stronger risk responses to changes in accounting standards and capital adequacy regulations, more active foreign currency denominated insurance sales, and improvements made in risk-based capital (RBC) ratio regulation.

This report looks at the current state of foreign currency deposits (FCDs) in Korea and identifies determinants of the foreign currency deposits and the relationship between foreign currency deposit and exchange rate stability. Based on empirical analysis and surveys of experts, this paper proposes a scheme to activate foreign currency deposits. Korea's foreign currency deposits have increased significantly since the global financial crisis, thanks to the continuation of the current account surplus. At the end of 2010, FCDs were $24 billion, and as of the end of 2017, FCDs increased to $87 billion. Accordingly, the role of FCDs as a source of foreign currency funds for domestic banks has increased significantly. In 2010–18, when looking at changes in the composition of foreign currency liabilities of domestic banks, the share of foreign borrowing decreased from 40.7% to 24.8%, while the reliance on FCDs rose from 20.1% to 35.3%. However, as corporations’ share of FCDs account for about 80%, Korea's FCDs are highly volatile depending on the size of imports and exports, exchange rate fluctuations, etc. In fact, during March–April 2019, the size of FCDs decreased sharply due to an increase in the exchange rate. In order to identify the determining factors of Korea’s FCDs, a structural VAR (vector autoregressive) model was used. When analyzed for the entire period, FCDs were found to respond significantly to the exchange rate shock, but were not significantly affected by the current account shocks. However, the impact of the two variables on FCDs varied significantly before and after the global financial crisis. Before the global financial crisis, while the effect of currency shocks on FCDs was not statistically significant, the impact of the current account balance on FCDs was significant. However, since the global financial crisis, the effect of commercial accounts on FCDs has been greatly weakened, while exchange rates have played an important role as a variable affecting FCDs. In addition, the report found that increased FCDs have a positive effect on exchange rate stability, thus increasing the legitimacy of policy efforts to expand FCDs. Using panel data from 21 countries, the impact of foreign exchange reserves and foreign currency deposits on exchange rate stability was demonstrated. It was confirmed that an increase in foreign currency deposits in countries or periods where foreign exchange reserves are relatively low reduces exchange rate volatility. Based on empirical findings and interviews with commercial bank officials and experts, the report provides several suggestions on how to raise FCDs. In order for FCDs to function as a stable source of foreign currency liquidity, banks must be given incentives in their management and procurement of FCDs. First of all, the current system where sell and buy transactions in the swap market lead to a reduction in foreign currency liquidity coverage ratio (LCR) should be improved. We suggest measures such as regarding foreign currencies that will be returned to the bank within a few days after a sell and buy transaction as cash inflows when conducting 3-month stress test calculations. In regard to the foreign currency LCR and three-month stress test, it will be necessary to check whether regulatory effects are overlapping with existing measures such as the foreign exchange stability levy or regulations on foreign exchange derivatives position, etc. In terms of foreign currency funding, we propose an improvement of the return on foreign currency deposits and the strengthening of global money management services. Should the current account surplus flow be disrupted, it will be difficult for the authorities to pursue the expansion of foreign currency deposits. However, based on the understanding of the incentive structure of the FCDs stakeholders analyzed in this report, it is necessary to promote the expansion of FCDs in a way that increases the attractiveness of FCDs as a financial product.

Machine learning (ML) might be useful to analysis various clinical information to make more accurate predictions. We sought to develop a ML model, utilizing clinical variables to predict the presence of stable obstructive coronary artery disease (CAD). We retrospectively analyzed 4906 patients who

Korean Abstract: 본 연구는 글로벌 자본유출입 결정요인 및 미국 통화정책이 국내 금융시장에 미치는 영향을 분석하였다. 실증분석 결과 신흥국의 자본유출입은 주로 대외요인에 의해 영향을 받았으나, 국가별로 자본유출입 결정요인이 상당히 상이한 것으로 나타났다. 미 연준 통화정책 정상화가 국내 금융시장, 외환시장에 미치는 파급영향을 분석한 결과 미 정책금리, 기간프리미엄, 신용스프레드 등이 높아지면 국내 신용스프레드 확대 및 원/달러 환율 상승(원화 약세) 등을 초래하여다. 아울러 내국인 해외투자자금이 회수되면서 외국인 국내투자자금 이탈을 상쇄시키는 모습을 보였다. 그동안 내외금리 차 확대가 곧바로 자본유출로 이어진다는 우려가 컸다. 하지만 2014년 이후 '내국인 해외 증권투자자산 > 외국인 국내 증권투자' 구조 정착 및 내국인 해외투자자금의 환류 가능성 상승 등으로 '내외금리차 확대 → 자본유출 증가' 리스크가 과거보다 줄어들었다는 점을 시사한다. English Abstract: During the global financial crisis, the US monetary authority (Fed) reduced the benchmark interest rate to 0% and provided massive liquidity through three quantitative easing measures. As a result, the US Fed balance sheet expanded five times ($ 4.5 trillion) from September 2008 ($ 0.9 trillion). Much of the increased global liquidity flowed into emerging economies. The influx of capital contributed to the growth of emerging economies, leading to new credit increases such as bank loans. Emerging markets, which supported 63% of global GDP, served as an engine of the global economy at a time when the growth in the US and Europe were subdued. While capital inflows have a supporting role in contributing to economic growth, they have also been a potential prompting factors to systemic risk in emerging countries and Korea. Emerging economies actively responded to systemic risks from foreign capital inflows. With the introduction of macro-prudential policy measures, emerging economies have been striving to maintain an external balance by responding to the surge in domestic credit and restraining excessive capital inflows. In order for emerging countries to adopt measures to curb inflows of capital, persuasiveness and legitimacy are secured only if external influences are triggered by external factors. Most previous studies have shown that push factors have had a greater impact on capital outflows in emerging economies than in pull factors. Raghuram Rajan, former central bank governor of India, has pointed out that the monetary policy impact of the US Fed and the developed country central bank is a major external factor (push factor). Meanwhile, in May 2018, the US Federal Reserve Chairman Jerome Powell addressed the controversy over capital movements to emerging economies after the global financial crisis. Powell said the inflows of capital into emerging economies is unlikely to have been caused by the Fed’s interest rate policy. According to the study, the US Fed’s quantitative easing has had the effect of lowering the Fed base rate by a further 4%. This means that normalization of the quantitative easing policy will lead to a policy rate hike of 4 percentage points. This is the reason why the normalization of US monetary policy will have a negative impact on the global economy. At the same time, the squeezing on capital outflows in emerging economies is increasing. Powell’s speech contains “implied” warnings that the US monetary policy is not a triggering force of a capital outflow in emerging economies. That’s why Powell’s speech is adding to the difficulty of policy responses in emerging countries. This suggests that it is necessary to check the determinants of global capital flows. In addition, the impact of US monetary policy on Korea's financial markets and capital outflows needs to be analyzed in depth.

Limited data exist on the long-term efficacy of extended dual antiplatelet therapy (DAPT) after left main coronary artery (LMCA) bifurcation stenting. This study investigated the long-term clinical outcomes associated with long-term DAPT after LMCA bifurcation stenting. Using data from the

Background The second-generation drug-eluting stents (DES) have shown superiority in many studies relating to safety and efficacy when compared with the first-generation DES. However, it is unclear whether there are differences in efficacy and safety among the second-generation DES after long-term follow-up. Methods This multicenter, prospective, randomized, open-labeled trial will directly compare the efficacy and safety among the patients treated with either everolimus-eluting stent (EES), zotarolimus-eluting stent with biolinx polymer (ZES-R), or biolimus-eluting stent (BES) with minimal exclusion criteria. The primary end point is a patient-oriented composite consisted of cardiac death, myocardial infarction not clearly attributable to a nontarget vessel and clinically indicated target lesion revascularization at 24-month clinical follow-up post-index procedure. With the hypothesis that “BES is non-inferior to EES” or “BES is non-inferior to ZES-R” in primary end point, approximately 2,600 patients will be assigned to one of the types of stents using a web-based randomization system. Conclusions The CHOICE trial will directly compare the efficacy and safety of EES, ZES-R, and BES in everyday clinical practice for long-term follow-up.

Objectives This study sought to assess the impact of intravascular ultrasound (IVUS) guidance on clinical outcomes following drug-eluting stent implantation when treating long lesions. Background The role of IVUS guidance when treating long lesions has been tested during bare-metal stent, but not during drug-eluting stent, implantation. Methods A total of 543 patients treated with stents ≥28 mm in length were randomly assigned to IVUS guidance (n = 269) versus angiography guidance (n = 274). The primary endpoint was a composite of major adverse cardiac events (MACE), including cardiovascular death, myocardial infarction, target vessel revascularization, or stent thrombosis at 1 year following intervention. Results In the intention-to-treat analysis, total stent length was 32.4 mm in the IVUS-guided arm versus 32.3 mm in angiography-guided arm (p = 0.84). Adjunct post-dilation was more frequently performed in the IVUS-guided arm (54.6% vs. 44.5%, p = 0.03); post-intervention minimal lumen diameters were similar (2.55 vs. 2.55 mm, respectively, p = 0.50); and MACE occurred in 12 (4.5%) patients in IVUS-guided arm and in 20 (7.3%) patients in the angiography-guided arm (p = 0.16). However, among the 269 patients assigned to IVUS guidance, IVUS was not used in 13 patients (4.8%); conversely, in 274 patients assigned to angiography alone, 41 patients (15.0%) were treated with IVUS guidance. Therefore, in a per-protocol analysis according to actual IVUS usage, minimum lumen diameter was larger (2.58 vs. 2.51 mm, p = 0.04), and MACE rates were lower: 4.0% in the IVUS-guided arm versus 8.1% in the angiography-guided arm (p = 0.048). Conclusions A strategy of routine IVUS for drug-eluting stent implantation in long lesions did not improve the 1-year MACE rates. The IVUS use per operator decision was associated with improved results. (A New Strategy Regarding Discontinuation of Dual Antiplatelet; NCT01145079 )

Objectives The goal of this study was to evaluate shorter duration (3 months) dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation. Background There have been few published reports of prospective randomized clinical studies comparing the safety and efficacy of shorter duration DAPT after DES implantation. Methods We randomly assigned 2,117 patients with coronary artery stenosis into 2 groups according to DAPT duration and stent type: 3-month DAPT following Endeavor zotarolimus-eluting stent (E-ZES) implantation (E-ZES+3-month DAPT, n = 1,059) versus 12-month DAPT following the other DES implantation (standard therapy, n = 1,058). We hypothesized that the E-ZES+3-month DAPT would be noninferior to the standard therapy for the primary composite endpoint (cardiovascular death, myocardial infarction, stent thrombosis, target\vessel revascularization, or bleeding) at 1 year. Results The primary endpoint occurred in 40 (4.7%) patients assigned to E-ZES+3-month DAPT compared with 41 (4.7%) patients assigned to the standard therapy (difference: 0.0%; 95% confidence interval [CI]: −2.5 to 2.5; p = 0.84; p Conclusions E-ZES+3-month DAPT was noninferior to the standard therapy with respect to the occurrence of the primary endpoint. (REal Safety and Efficacy of a 3-month dual antiplatelet Therapy following E-ZES implantation [RESET]; NCT01145079 )

Patient initials or identifier number LKT ### Relevant clinical history and physical exam An 82-years-old male suffered chest pain and dyspnea for 6 hours. He has the history of hypertension. Initial his EKG showed ST-segment elevation in II, III, aVF lead and ST-segment depression in other

While second generation drug-eluting stents (DES) promote more favorable vascular healing, biodegradable polymer containing stents might have a yield in terms of duration of dual antiplatelet therapy (DAPT) than durable polymer stents. We aimed to test whether 6-month DAPT would be non-inferior 12

The growth behavior of ultrathin (∼5 nm) SrRuO3 films prepared by pulsed laser deposition (PLD) on SrTiO3 (001) was investigated particularly as a function of growth temperature mainly using synchrotron X-ray diffraction. At a critical growth temperature (~500 °C), below which no crystallization occurs, an epitaxial SrRuO3 film starts to grow with a broad distribution of single (110) domain along the film growth direction maintaining the epitaxial relationship of SrRuO3[001]/SrTiO3[100] and SrRuO3[−110] SrTiO3[010]. Its in-plane and out-of-plane crystal alignments improve sharply when a higher growth temperature of 600 °C is applied, presumably due to the more thermal energy supplied to the substrate. However, more increase of the growth temperature to 650 °C results in no enhancement of atomic ordering but a rougher surface, suggesting that a careful adjustment in the growth temperature is needed to grow an epitaxially well aligned SrRuO3 film possessing a smooth surface.

Europium doped yttrium oxide (Y 2 O 3 :Eu) luminescent thin films were grown on Si(0 0 1) substrates using a pulsed laser deposition technique and their microstructures and growth behavior were investigated by synchrotron X-ray scattering and atomic force microscopy. We observed that the surface morphology of the Y 2 O 3 :Eu films was very smooth with typically a 0.5-nm root mean square roughness for the films up to 750 nm in thickness and the film strain increased gradually with film thickness, suggesting that the Y 2 O 3 :Eu films are grown with a layer-like growth mode. Grown with the (1 1 1) preferred orientation, the Y 2 O 3 :Eu films significantly improved in crystallinity with film thickness, showing a characteristic red luminescence of Y 2 O 3 :Eu materials.

Korean Abstract: 2008년 9월 글로벌 금융위기 이후 저금리가 장기간 지속되는 과정에서 국제금융시장 가격변수들의 변동성도 낮게 유지되었다. 낮은 변동성의 지속은 리스크 프리미엄의 하락을 초래하고, 이로 인해 글로벌 투자자들이 위험을 감수하는 행위가 증가한다. 2009년 이후 신흥국으로 대규모 자금이 유입되는 국제자본 흐름의 큰 변화가 발생하였는데, 이는 글로벌 투자자들의 위험자산에 대한 선호도가 높아짐에 따라 신용위험이 상대적으로 높은 신흥국에 대한 투자가 증가한데 기인한다. 신흥국으로의 자본유입 증가는 국내신용 증가 및 자산가격 왜곡 등 금융시스템의 취약성을 증대시킨다. 이는 향후 자본유출 압력이 강해지면 국내 자산가격의 하락 및 경기위축 등이 초래될 수 있음을 시사한다. 2015년 말 이후 미국 연방준비제도이사회(Federal Reserve Board)가 통화정책을 정상화하면서 자산가격의 변동성과 리스크 프리미엄이 다시 상승(정상화) 할 경우 우리나라를 포함한 신흥국으로 유입된 외국인자금에 대한 유출압력이 증가할 것으로 예상된다. 이에 따라 본 보고서는 국제금융시장의 변동성과 자본 흐름의 변화를 살펴보고, 신흥국 자금유출입의 변동요인을 분석하였다. 또한 신흥국 및 우리나라의 자본이동관리정책을 살펴보았으며, 새로운 정책대응수단으로 자산지준제도의 효과를 분석하였다.English Abstract: Volatilities of price indicators have remained extremely stable during the period of low interest rates since the Global Financial Crisis (GFC) of September 2009. Low volatility pushes down the risk premium which could cause global investors’ risk appetite to increase. There has been a big change in global liquidity flows since 2009. Emerging market economies (EMEs), with relatively high credit risk, received huge capital inflows backed up by the increased risk appetite of global investors. US Federal Reserve is now trying to normalize its monetary policy by increasing the policy rate tied at zero low bound for about seven years. This will bring asset price volatility and risk premiums to normalize. We remain concerned about the downside risk to the capital outflows from EMEs, including Korea. And it may well potentially cause a decrease in asset price and a growth contraction in EMEs. Accordingly, we provide an overview of the volatility of financial market and new trends in capital flows, and identify the determinants of capital flows to/from EMEs. We also review the use of capital flow management policies in EMEs including Korea, and examine the effectiveness of Asset？Based Reserve Requirements (ABRR) as an alternative macro-prudential policy measure to manage capital flows.

Conductive LaNiO 3 (LNO) thin films were prepared on Si(001) by pulsed laser deposition and their microstructures were investigated using synchrotron X-ray scattering and atomic force microscopy. We observed that the surface morphology of the LNO thin films was extremely smooth with typically a 1.0-nm root-mean-squared roughness for films up to 360 nm in thickness and the film strain increased monotonically with the film thickness, suggesting that the LNO/Si(001) films be grown with a layer-like growth mode. Grown with the (00 l ) preferred orientation, the LNO films showed a significant anisotropic structural order; the coherence length of the out-of-plane stacking order was one order of magnitude larger than that of the in-plane atomic order.

Extracorporeal Membrane Oxygenation (ECMO) is an increasingly used supportive measurement for patients with Acute coronary syndrome (ACS) complicated by cardiogenic shock. Despite its increasing use, clinical outcomes still remain very poor. We investigated the clinical features and predictors of 1