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The outcome benefits of β-blockers in chronic coronary artery disease (CAD) have not been fully assessed. We evaluated the prognostic impact of β-blockers on patients with chronic CAD after percutaneous coronary intervention (PCI).A total of 3,075 patients with chronic CAD were included from the Grand Drug-Eluting Stent registry. We analyzed β-blocker prescriptions, including doses and types, in each patient at 3-month intervals from discharge. After propensity score matching, 1,170 pairs of patients (β-blockers vs. no β-blockers) were derived. Primary outcome was defined as a composite endpoint of all-cause death and myocardial infarction (MI). We further analyzed the outcome benefits of different doses (low-, medium-, and high-dose) and types (conventional or vasodilating) of β-blockers.During a median (interquartile range) follow-up of 3.1 (3.0-3.1) years, 134 (5.7%) patients experienced primary outcome. Overall, β-blockers demonstrated no significant benefit in primary outcome (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.63-1.24), all-cause death (HR, 0.87; 95% CI, 0.60-1.25), and MI (HR, 1.25; 95% CI, 0.49-3.15). In subgroup analysis, β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/or revascularization (HR, 0.38; 95% CI, 0.14-0.99) (p for interaction=0.045). No significant associations were found for the clinical outcomes with different doses and types of β-blockers.Overall, β-blocker therapy was not associated with better clinical outcomes in patients with chronic CAD undergoing PCI. Limited mortality benefit of β-blockers may exist for patients with previous MI and/or revascularization.ClinicalTrials.gov Identifier: NCT03507205.

BACKGROUND AND OBJECTIVES A relationship between renin-angiotensin system (RAS) components and metabolic syndrome (MetS) has been suggested, but not elucidated clearly. We examined the levels of RAS components in patients with and without MetS and their association with MetS in Korean population. METHODS This study was approved by the review boards of the participating institutions and endorsed by the Korean Society of Lipid and Atherosclerosis. We screened 892 Koreans aged ≥20 years who underwent evaluation of hypertension, diabetes, or dyslipidemia at 6 tertiary hospitals in 2015-2016. After excluding patients who were taking diuretics, β-blockers, or RAS blockers, or suspected of primary aldosteronism, 829 individuals were enrolled. Anthropometric and biochemical parameters including aldosterone, plasma renin activity (PRA), and aldosterone-to-PRA ratio were evaluated. The homeostasis model assessment for insulin resistance (HOMA-IR) were used for evaluating insulin resistance. RESULTS The mean age of the participants was 52.8±12.8 years, 56.3% were male, and their mean systolic and diastolic blood pressures were 133.9±20.0 and 81.2±14.6 mmHg, respectively. The levels of serum aldosterone, but not PRA, were significantly higher in subjects with MetS than in those without (20.6±33.6 vs. 15.3±12.2 ng/dL, p

Background and Objectives Carbon monoxide (CO) poisoning can cause tissue hypoxia and left ventricular systolic dysfunction (LVSD) requiring intensive medical management. Our objectives were to find incidence and clinical course of LVSD CO intoxicated patients and make a clinical scoring to predict LVSD. Subjects and Methods We included all consecutive patients with CO exposure in the emergency room. LVSD was defined by LVEF 100/min), pulmonary edema on chest X-ray, serum NT pro-BNP (>100 pg/mL), troponin-I (>0.1 ng/mL) and lactic acid (>4.0 mg/dL) after a univariate analysis. Combining these into a clinical score, according to their beta score after a multivariate analysis (rage=0-16), allowed prediction of LVSD with a sensitivity of 84% and specificity of 91% (reference ≥8, area under the curve=0.952, p

Background and Objectives When monotherapy is inadequate for blood pressure control, the next step is either to continue monotherapy in increased doses or to add another antihypertensive agent. However, direct comparison of double-dose monotherapy versus combination therapy has rarely been done. The objective of this study is to compare 10 mg of amlodipine with an amlodipine/valsartan 5/160 mg combination in patients whose blood pressure control is inadequate with amlodipine 5 mg. Subjects and Methods This study was conducted as a multicenter, open-label, randomized controlled trial. Men and women aged 20-80 who were diagnosed as having hypertension, who had been on amlodipine 5 mg monotherapy for at least 4 weeks, and whose daytime mean systolic blood pressure (SBP) ≥135 mmHg or diastolic blood pressure (DBP) ≥85 mmHg on 24-hour ambulatory blood pressure monitoring (ABPM) were randomized to amlodipine (A) 10 mg or amlodipine/valsartan (AV) 5/160 mg group. Follow-up 24-hour ABPM was done at 8 weeks after randomization. Results Baseline clinical characteristics did not differ between the 2 groups. Ambulatory blood pressure reduction was significantly greater in the AV group compared with the A group (daytime mean SBP change: -14±11 vs. -9±9 mmHg, p

Background and Objectives Apurinic/apyrimidinic endonuclease 1/redox effector factor-1 (APE1/Ref-1) is a multifunctional protein involved in the DNA base excision repair pathway, inflammation, angiogenesis, and survival pathways. We investigated serum APE1/Ref-1 in patients with coronary artery disease (CAD). Subjects and Methods Serum APE1/Ref-1 was measured with a sandwich enzyme-linked immunosorbent assay from 360 patients who received coronary angiograms. They were divided into two groups; a control (n=57) and a CAD group (n=303), the latter included angina (n=128) and myocardial infarction (MI, n=175). Results The levels of APE1/Ref-1 were higher in the CAD than the control (0.63±0.07 vs. 0.12±0.07 ng/100 µL, respectively; p

Pathologic diagnosis of a cardiac mass is vital in determining the proper treatment modality. Open heart surgery or transesophageal echocardiography guided biopsy can be feasible methods to confirm the pathology. However, the former is highly invasive and both methods require general anesthesia. The introduction of intracardiac echocardiography (ICE) can provide good anatomic information of heart and does not require general anesthesia. In this report, we present two cases of cardiac tumors which were confirmed by percutaneous biopsy under the guidance of an ICE. The patients underwent cardiac biopsy without any complications.

Background and objectives Although complete revascularization is known superior to incomplete revascularization in ST elevation myocardial infarction (STEMI) patients with multi-vessel coronary artery disease (MVCD), there are no definite instructions on the optimal timing of non-culprit lesions percutaneous coronary intervention (PCI). We compared 1-year clinical outcomes between 2 different complete multi-vessel revascularization strategies. Methods From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 606 patients with STEMI and MVCD who underwent complete revascularization were enrolled from November 2011 to December 2015. The patients were assigned to multi-vessel single-staged PCI (SS PCI) group (n=254) or multi-vessel multi-staged PCI (MS PCI) group (n=352). Propensity score matched 1-year clinical outcomes were compared between the groups. Results At one year, MS PCI showed a significantly lower rate of all-cause mortality (hazard ratio [HR], 0.42; 95% confidential interval [CI], 0.19-0.92; p=0.030) compared with SS PCI. In subgroup analysis, all-cause mortality increased in SS PCI with cardiogenic shock (HR, 4.60; 95% CI, 1.54-13.77; p=0.006), age ≥65 years (HR, 4.00; 95% CI, 1.67-9.58, p=0.002), Killip class III/IV (HR, 7.32; 95% CI, 1.68-31.87; p=0.008), and creatinine clearance ≤60 mL/min (HR, 2.81; 95% CI, 1.10-7.18; p=0.031). After propensity score-matching, MS PCI showed a significantly lower risk of major adverse cardiovascular event than SS PCI. Conclusions SS PCI was associated with worse clinical outcomes compared with MS PCI. MS PCI for non-infarct-related artery could be a better option for patients with STEMI and MVCD, especially high-risk patients.

The anomalous origin of the right coronary artery (RCA) is a rare condition. Most RCA anomalies are usually found incidentally, but these findings have clinical significance because many patients, particularly young ones, present with sudden death, myocardial ischemia and syncope without other symptoms. We describe a case of a 39-year-old male patient that presented with effort chest pain and was diagnosed with anomalous RCA that originated from the ascending aorta with prior history of repairing ruptured sinus valsalva and ventricular septal defect. The anomalous origin of RCA was identified by multidetector computed tomography (MDCT). Successful percutaneous coronary intervention was performed guided by MDCT coronary images and intravascular ultrasound.

Background and Objectives: The comparison of long-term clinical effects between Sirolimus-eluting stent (SES) and Paclitaxel-eluting stents (PES) for treatment of acute myocardial infarction (AMI) remains unclear. Seeking to clarify this issue, we performed a retrospective analysis to evaluate four-year clinical outcomes of SES compared to PES treated AMI patients. Subjects and Methods: From January 2004 to August 2006, all patients with acute ST-segment elevation myocardial infarction and acute non-ST segment elevation myocardial infarction who underwent percutaneous coronary intervention (PCI) by implantation of either SES or PES were enrolled. The occurrences of cardiac and non-cardiac deaths, recurrent infarction, target vessel revascularization (TVR) and stent thrombosis were analyzed. The composite end points of these major adverse cardiac events (MACE) were also analyzed. Results: During the study period, a total of 668 AMI patients had visited, of which 522 patients (299 with SES and 223 with PES) were enrolled. During the four-year clinical follow-up, both groups showed similar occurrences of non-cardiac death (14.6±2.2% vs. 18.3±3.0%, p=0.26); cardiac death (6.8±1.52% vs. 11.2±2.6%, p=0.39); re-infarction (3.3±1.1% vs. 6.4±1.8%, p=0.31); and stent thrombosis (3.2±1.1% vs. 5.4±1.7%, p=0.53). However, occurrences of TVR {4.0±1.2% vs. 10.0±3.0%, hazard ratio (HR)=0.498, 95% confidence interval (CI)= 0.257-0.967, p=0.039} and MACE (19.4±2.5% vs. 29.4±3.5%, HR=0.645, 95% CI=0.443-0.940, p=0.021) were significantly lower in the SES population. Conclusion: In AMI patients treated with either SES or PES implantation, the former had a significantly lower risk of TVR and MACE during four-year clinical follow-up. Rates of death, cardiac death or recurrent infarction, and stent thrombosis were similar. (Korean Circ J 2012; 42:266-273)

Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.

Background and objectives There are no data comparing clinical outcomes of complex percutaneous coronary intervention (PCI) between biodegradable polymer-biolimus-eluting stents (BP-BES) and durable polymer-everolimus-eluting stents (DP-EES). We sought to evaluate the safety and efficacy of BP-BES compared with DP-EES in patients undergoing complex PCI. Methods Patients enrolled in the SMART-DESK registry were stratified into 2 categories based on the complexity of PCI. Complex PCI was defined as having at least one of the following features: unprotected left main lesion, ≥2 lesions treated, total stent length >40 mm, minimal stent diameter ≤2.5 mm, or bifurcation as target lesion. The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target vessel-related myocardial infarction (TV-MI), or target lesion revascularization (TLR) at 2 years of follow-up. Results Of 1,999 patients, 1,145 (57.3%) underwent complex PCI: 521 patients were treated with BP-BES and 624 with DP-EES. In propensity-score matching analysis (481 pairs), the risks of TLF (3.8% vs. 5.2%, adjusted hazard ratio [HR], 0.578; 95% confidence interval [CI], 0.246-1.359; p=0.209), cardiac death (2.5% vs. 2.5%, adjusted HR, 0.787; 95% CI, 0.244-2.539; p=0.689), TV-MI (0.5% vs. 0.4%, adjusted HR, 1.128; 95% CI, 0.157-8.093; p=0.905), and TLR (1.1% vs. 2.9%, adjusted HR, 0.390; 95% CI, 0.139-1.095; p=0.074) did not differ between 2 stent groups after complex PCI. Conclusions Clinical outcomes of BP-BES were comparable to those of DP-EES at 2 years after complex PCI. Our data suggest that use of BP-BES is acceptable, even for complex PCI.

Background and objectives There are limited data regarding the clinical efficacy of the proximal optimization technique (POT) in the treatment of coronary bifurcation lesions. We investigated the influence of POT on the clinical outcomes of patients with coronary bifurcation lesions. Methods We enrolled a total of 1,191 patients with a bifurcation lesion with a side branch (SB) diameter ≥2.5 mm treated with a drug-eluting stent from 18 centers between January 2003 and December 2009. The primary outcome was major adverse cardiac events (MACEs: cardiac death, myocardial infarction or target lesion revascularization [TLR]). We performed one-to-many (1:N) propensity score matching with non-fixed matching ratio. Results POT was performed in 252 patients. During follow-up (median 37 months), the incidence of MACE was lower in the POT group than it was in the non-POT group (adjusted hazard ratio, 0.43; 95% confidence interval [CI], 0.24-0.79; p=0.006). After propensity score matching, these were 0.34; 95% CI, 0.17-0.69; p=0.003 for MACE and 0.37; 95% CI, 0.17-0.78; p=0.01 for TLR. The use of POT was associated with significantly lower TLR in patients treated without kissing ballooning, but was not in those who underwent kissing ballooning (p for interaction=0.03). Conclusions In coronary bifurcation lesions with a large SB, POT may be beneficial to improve long-term clinical outcome, particularly in patients treated without kissing ballooning during the procedure. Trial registration ClinicalTrials.gov Identifier: NCT01642992.

Background and objectives Vascular smooth muscle cell (VSMC) proliferation is responsible for the restenosis of previously inserted coronary stents. Angiotensin II (Ang II) is known to regulate VSMC proliferation. LKB1, a serine/threonine kinase, interacts with the p53 pathway and acts as a tumor suppressor. Materials and methods We assessed the association of Ang II and the expression of LKB1 in primary cultured murine VSMCs and neointima of the Sprague Dawley rat carotid artery injury model. We created carotid balloon injuries and harvested the injured carotid arteries 14 days after the procedure. Results Ang II increased LKB1 expression in a time-dependent manner and peaked at an Ang II concentration of 10(-7) mole/L in VSMCs. In the animal experiment, neointima was markedly increased after balloon injury compared to the control group. Immunohistochemical studies showed that LKB1 expression increased according to neointima thickness. Ang II augmented LKB1 expression after the injury. Western blot analysis of LKB1 with carotid artery lysate revealed the same pattern as LKB1 immunohistochemistry. Increased LKB1 expression started at 5 days after the balloon injury, and peaked at 14 days after the injury. Although LKB1 expression was increased after the injury, LKB1 kinase activity was not increased. Ang II or balloon-injury increased the expression of LKB1 although the LKB1 activity was reduced. Conclusion Ang II increased LKB1 expression in VSMCs and neointima. These findings were not kinase dependant.

Background and Objectives: Distal filter devices (DFDs) are known to reduce the occurrence of embolic events by capturing embolic debris and thereby preventing intracranial embolization during carotid artery stenting (CAS). However, there are few reports addressing DFD use in CAS procedures. Therefore, we evaluated the technical feasibility and clinical outcomes associated with DFD use in all CAS procedures. Subjects and Methods: Between June 2004 and June 2008, all CAS procedures performed at our center were completed with DFD protection. We recorded periprocedural data and watched for new neurologic abnormalities for 24 hours after the procedure. Onemonth clinical outcomes were also evaluated. Results: A total of 100 carotid lesions in 94 patients (age 68±8 years; 79 men) were treated with percutaneous stenting using DFDs (FilterWire EZ, Boston Scientific Co, US). DFD application was successful in all procedures. Periprocedural strokes occurred in five procedures (one major, one minor, and three transient ischemic attacks). The one-month rates of stroke and death were 6% and 2%, respectively. Difficult filter placement occurred in two procedures due to tight stenosis and severe common carotid artery (CCA)-to-internal carotid artery (ICA) angulation. Difficult stent delivery occurred in three instances: one due to severe lesion calcification and two due to proximal tortuosity. The retriever failed to acquire the filter in nine procedures. Four of nine retrieval difficulties were related to severe CCA-ICA angulation. Conclusion: DFD use was successful in all CAS procedures, was relatively safe, and had few periprocedural complications. (Korean Circ J 2008;38:659-665)

Background and Objectives:With the lower incidence of bleeding complications and earlier ambulation, transradial coronary intervention (TRI) is related with improved patient satisfaction compared with that of conventional transfemoral intervention (TFI). However, there is insufficient data about the efficacy of TRI in patients with an acute ST segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the safety and efficacy of TRI in selected patients with an acute STEMI. Subjects and Methods:Between March 2003 to August 2006, 386 acute STEMI patients were treated using primary percutaneous coronary intervention (PCI), of which 335 had undergone TRI and were included in the study. This study was performed retrospectively on 335 consecutive patients, including 246 males, with a mean age of 62±11 years. Results:Hemodynamically stable patients (n=335) underwent primary PCI via TRI. Fourteen of the TRI cases were changed to the TFI group during the procedure. The procedural success rate was 96%. The mean time interval from arterial access to balloon dilatation and total procedure time were 13.4±7.1 and 37±18 min, respectively. A 6 French sized guiding catheter was used in 235 cases (70%). There were no major bleeding complications, and the mean duration of hospital stay was 4.7±4.9 days. Conclusion:In the setting of primary PCI, TRI can be a feasible and safe approach in selected hemodynamically stability patients. (Korean Circulation J 2007;37:72-77)

Background and Objectives:The transradial approach has been increasingly used as an alternative to conventional transfemoral intervention. However, there is little data on the efficacy of transradial coronary intervention (TRI) in left main coronary arterial (LMCA) disease. The purpose of this study was to evaluate the feasibility of TRI in selective patients undergoing percutaneous coronary intervention (PCI) for LMCA disease. Subjects and Methods: Between Jan 2003 and May 2005, 83 patients with LMCA stenosis were treated with PCI. Of these, 40 selected patients having undergone TRI were included in this study. Results:The patients included 30 males and 10 females, with a mean age of 61±12 years. There were 28 cases (70%) involving coronary arteries other than the LMCA and 24 cases (60%) with bifurcation lesion involvement. In 28 cases (70%), a 6 Fr sized guiding catheter was used. No case required crossover from TRI to TFI due to procedural failure. During hospitalization, 2 patients who underwent primary PCI in the setting of STEMI died, but there were no other clinical events. Conclusion: In selected patients with LMCA disease, TRI can be a feasible and safe approach for PCI. (Korean Circulation J 2006;36:732-736)

Background and Objectives:Platelets play an important role in the pathogenesis of acute coronary syndrome. Prostacyclin inhibits platelet aggregation, smooth muscle cell proliferation and vasoconstriction, and it counteracts thromboxane A2 activity. The purpose of this study is to evaluate the association between a single nucleotide polymorphism in the prostacyclin synthase gene and myocardial infarction in Koreans. Subjects and Methods:We studied total 119 patients (M:F=72:47, mean ages=57.9). We compared 60 acute coronary syndrome patients who underwent coronary angiography with the diagnosis of acute myocardial infarction (MI), with 59 normal control group patients who had normal coronary angiograms. With the use of polymerase chain reaction-restriction fragment length polymorphism analysis, we identified a single nucleotide polymorphism, C1117A, in exon 8. Results:The genotype distribution and allele frequencies were significantly different between the control group and MI group. Frequency of the genotype C1117A was:AA:AC:CC= 3.4%:30.5%:66.1% in control group, respectively, and AA:AC:CC=1.7%:10.0%:88.3% in MI group, respectively. Prostacyclin synthase polymorphism was observed in the MI group and the control group, but the frequency of the CC genotype was high in MI group (odds ratio, 3.88;95% CI 1.49-10.88, p=0.003). Compared to control group, being male, having diabetes, hypertension or obesity, and the smoking rate were high in MI group. There were not significantly differences between genotypes for clinical characteristics. Conclusion: We conclude that the C1117A polymorphism in exon 8 of the prostacyclin synthase gene is associated with MI, and it may be a genetic marker of MI in Koreans. (Korean Circulation J 2004;34(8):761-766)

Background and Objectives:The therapeutic duration of variant angina is controversial. This study sought to determine the remission rates for coronary artery spasms, the factors associated with remission and the changes in spasm sites. Subjects and Methods:Fifty-eight patients were enrolled in the study. Initial, and follow-up, coronary angiographies (CAG), with ergonovine stimulation tests, were performed. Paired CAG were performed at a mean interval of 27±17 months. Medication was stopped 3 days prior to the follow-up CAG, and the occurrence of chest pain during these 3 days was studied. Coronary spasms were confirmed by followup CAG. Any changes, and the diameters, of spasm sites were analyzed on each paired CAG. Results: The remission rate of coronary spasms was 24% (14 patients), when the smoking group (49 patients)stopped smoking (31 patients), the remission rate was 29% (9 patients). In the current smoking group (18 patients), the remission rate was 6% (1 patient, p=0.05). 31 patients had chest pains after stopping medication prior to their follow-up CAG. Of those patients, 1 patient had a remission (3%). Among another 27 patients with no chest pain, 13 patients had a remission (48%, p

Background and Objectives:Pulmonary embolism (PE) is a disease with high mortality if left untreated. However, confirmative diagnosis is difficult due to the fact that many diagnostic modalities are nonspecific. Pulmonary angiography, considered the gold-standard diagnostic tool, is invasive, costly, time-consuming, and not always available in small medical centers. However, as echocardiography is non-invasive and readily available in the emergency room, we investigated its potential as a screening test in patients with suspected PE. Materials and Methods:(A) Retrospective study:We analyzed the recorded transthoracic echocardiography videotapes from fifty patients with confirmed PE from January 1995 to August 1999. From the frequent echocardiographic findings of those patients, positive criteria were defined either as any 2 or more of the following or solely criterion No. (6). (1) RV or pulmonary artery dilatation (RVEDA/LVEDA≥0.6), (2) RV hypokinesis, (3) paradoxical septal wall motion, (4) pulmonary hypertension, (5) TR (moderate degree or more), and (6) visible thrombus. Even if the degree of TR was less than moderate, a degree of pulmonary hypertension more than moderate, was considered to indicate PE. (B) Prospective study:From November 1999 to June 2000, 34 patients with suspected pulmonary embolism underwent transthoracic echocardiography and perfusion-ventilation lung scan or chest CT. We assessed the echocardiographic findings, sensitivity and specificity of the previously defined echocardiographic positive criteria for PE. Results:(A) Retrospective study:The sensitivity of ech-ocardiography for PE was 74%. (B) Prospective study:Of 34 enrolled patients, 논문접수일:2001년 2월 2일 심사완료일:2001년 5월 2일 교신저자:박승우, 135-710 서울 강남구 일원동 50번지 성균관대학교 의과대학 내과학교실 순환기내과 삼성서울병원 심장혈관센터 전화:(02) 3410-3419·전송:(02) 3410-3417 E-mail:swpark@smc.samsung.co.kr

Background and Objectives:This study was designed to evaluate the appropriate dose and dose-dependent effect of benidipine hydrochloride, a Ca-channel blocker, in patients with mild–moderate essential hypertension. Material and Methods:Benidipine was administered in 2 mg, 4 mg and 8 mg once daily with 1 month interval in 41 hypertensive patients with diastolic blood pressure over 90 mmHg and systolic blood pressure from 140 to 210 mmHg. Blood pressure, heart rate, subjective symptoms and adverse effects were checked every 4 weeks after benidipine administration. Laboratory examinations were performed before and after benidipine administration. Results:The dose-dependent, antihypertensive effect of benidipine was evaluated in 41 patients. The blood pressure significantly reduced from 166±15 mmHg/103±7 mmHg to 13815 mmHg/88±11 mmHg at 12 weeks administration of benidipine and overall effective rate was 95%. The systolic and diastolic blood pressure was reduced significantly in proportion to dose of benidipine (p

Background:Insertion/Deletion (I/D polymorphism of the angiotensin converting enzyme (ACE gene has been postulated as a risk factor for coronary artery disease. However, controversies exist whether deletion polymorphism in the ACE gene and/or high levels of ACE activity may be a risk factor for coronary artery disease (CAD. We investigated the association of the I/D polymorphism of the ACE gene and serum ACE activity in Korean patients with CAD. Methods:Study subjects were 629 patients who underwent coronary angiography. CAD group (n=477 was subdivided according to either clinical manifestation or the number of diseased vessels on angiography. The control group comprised 152 patients who did not have a significant coronary lesion. Low risk group (n=65 was defined as subjects with age

Background and Objectives:Compared to other target cells examined for gene therapy, vascular smooth muscle cells (VSMCs have the unique advantages including proximity to blood stream and relative abundance in vasculature. With an ultimate goal of developing VSMC-based therapies for cardiovascular disorders, we explored the utility of VSMC as a target cell for ex vivo gene therapy using a set of retroviral vectors. Materials and Methods:Cultured VSMCs were transduced with replication-defective recombinant retro- viruses harboring LacZ, nlsLacZ, mVEGF, mGM-CSF or bacterial CAT reporter. The VSMCs were examined for G418-selection, transduction efficiency, the level of transgene expression, and longevity of gene expression. Results:VSMCs were readily transduced with different kinds of retroviral vectors. The bacterial neo r gene- transduced VSMCs were successfully selected with G418. The G418-selected VSMCs could express the transduced genes at a level comparable to NIH3T3. The level of transgene expression did not appear to be affected by the increasing number of passages. Conclusion:The results demonstrate an efficient transduction of VSMCs by retroviral vectors in vitro and an sustained expression of retrovirally transduced genes in VSMCs. VSMCs could be one of the ideal target cells for ex vivo cardiovascular gene therapy employing retroviral vector. (Korean Circulation J 2000;30(6 :729-736

Background and Objectives:Previous studies have shown a high restenosis rate after balloon angioplasty for diffuse in-stent restenosis. Debulking strategy has been expected to be helpful to reduce the restenosis rate. This study evaluated the safety and long-term clinical event rate after excimer laser coronary angioplasty (ELCA) and adjunctive balloon angioplasty for in-stent restenosis. Materials and Method:We included 29 in-stent restenotic lesions treated in 28 patients (18 men, 10 women, mean age 60±2 years) admitted to Samsung Medical Center between June 1997 and August 1998. Quantitative coronary angiography was performed and clinical characteristics, acute complications, 30-day and 8-month major cardiac adverse event rate was analyzed. Results: Initial success rate was 97%. We stopped the ELCA procedure in one lesion located in the proximal left anterior descending artery due to bradycardia and hypotension. In the 28 lesions successfully treated with ELCA and adjunctive balloon angioplasty, the minimal luminal diameter increased from 0.7±0.1 mm before ELCA to 1.9± 0.1 mm after ELCA and to 2.7±0.1 mm after adjunctive balloon angioplasty (p

Background and Objectives:It has been well known that the Braunwald classification is an appropriate clin- ical parameter in the prediction of the outcome in patients with unstable angina. However, the ability of the cla- ssification to predict prognosis of unstable angina according to treatment strategy is not established. We evaluated the relation between severity of angina on admission and outcome of primary unstable angina with early invasive strategy. Materials and Method:148 patients (M 85, F 63, age 61±10 with suspected unstable an- gina were divided into three subgroups on the basis of the Braunwald classification on admission. The patients were followed up to 6 months prospectively if the final diagnosis was primary unstable angina. Early invasive strategy was used for the treatment of unstable angina. Major cardiac events were assessed during hospitalization and 6 months follow-up period according to the Braunwald classification. Results:Unstable angina was diagnosed in 95 patients (64%. Among these patients, 89 patients with primary unstable angina were followed up to 6 months. Clinical characteristics including number of patients, mean age, sex ratio, risk factors, coronary angiographic findings and revascularization rate during hospitalization were not different in three subgroups of these patients. Among these patients, early coronary revascularizations was performed in 67 patients (75% and 2 (2% deaths/myocardial infarctions occurred during hospitalization. During the follow-up period, 1 (1% myocardial infarction/death and 12 (13% revascularizations occurred. Cardiac event rate (death, myoca- rdial infarction or revascularization was not different during hospitalization and 6 months follow-up period among subgroups of severity class. Conclusion:Clinical outcome should be reevaluated after early coronary

Background:The prophylactic use of temporary pacemaker during coronary intervention has been markedly decreased since 1980’s. There is, however, few systematic report focusing on right coronary intervention in which temporary pacemaker would be most beneficial. Moreover, there has been marked development in coronary intervention recent years that risk and benefit of prophylactic pacemaker should be reconsidered. Method:We performed right coronary artery intervention without prophylactic use of temporary pacemaker in 100 successive patients in Samsung Medical Center. Patients with previous AV block and rotational atherectomy cases were excluded. The incidence of all complications and changes of blood pressure as well as heart rate during coronary intervention were examined prospectively. Results:The lesion type was B2 or C in 52% and intracoronary thrombus was found in 18% of patients. Nevertheless, there was neither life threatening bradycardia nor new onset arrhythmia in any patient during right coronary intervention. Conclusion:These data suggest that omission of prophylactic use of temporary pacemaker may be safe in right coronary intervention only if excluding previous patients with high degree atrioventricular block and rotational atherectomy cases. This approach may reduce procedure time and cost as well as pacemaker-associated complications. (Korean Circulation J 1999;29(11): 1182-1187)

For the treatment of coarctation of aorta, surgical intervention has been known as a standard therapy. During last decade balloon angioplasty for coarctation of the aorta has been reported as a successful and safe procedure in about 300 cases. This angioplasty was done mainly in infants and children, and little cases in adults and adolescents. A 22 year-old adult with coarctation of aorta have recieved balloon angioplasty. He visited to emergency room due to severe headache and the blood presure of arm was 240/130mmHg at emergency room. The blood pressure at ward was 168/92mmHg in upper extremities, 104/82mmHg in lower extrimities. His aortogram showed coarctation of thoracic aorta below left subclavian artery. The pressure gradient between ascending aorta and right femoral artery was decreased from 60mmHg to 0mmHg after balloon dilatation(2 times, balloon diameter 18mm). There were no significant complications. The follow-up magnetic resonance image in 4 month after balloon angio-plasty showed no evidence of restenosis or saccular aneurysm. Initial hypertension turned to normal blood pressure in 4 months after balloon angioplasty. This adult case of successful balloon angio-plasty for coarctation of aorta is the first case reported in Korea.