28 results on '"Yong-Joon Lee"'
Search Results
2. Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: Evidence and Clinical Trials
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Yong-Joon Lee and Myeong-Ki Hong
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Cardiology and Cardiovascular Medicine - Published
- 2023
3. Impact of one-month DAPT followed by aspirin monotherapy in patients undergoing percutaneous coronary intervention according to clinical presentation: a post hoc analysis of the randomised One-Month DAPT trial
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Yong-Joon Lee, Jae Young Cho, Kyeong Ho Yun, Seung-Jun Lee, Sung-Jin Hong, Chul-Min Ahn, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, and Jung-Sun Kim
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Percutaneous Coronary Intervention ,Ticlopidine ,Treatment Outcome ,Aspirin ,Humans ,Drug Therapy, Combination ,Drug-Eluting Stents ,Hemorrhage ,Coronary Artery Disease ,Acute Coronary Syndrome ,Cardiology and Cardiovascular Medicine ,Platelet Aggregation Inhibitors ,Clopidogrel - Abstract
The impact of 1-month dual antiplatelet therapy (DAPT) followed by aspirin monotherapy according to clinical presentation has not been elucidated.This study aimed to compare the impact of 1-month DAPT followed by aspirin monotherapy after polymer-free drug-coated stent (PF-DCS) implantation (1-month DAPT after PF-DCS) vs 6-12-month DAPT followed by aspirin monotherapy after biodegradable polymer drug-eluting stent (BP-DES) implantation (6-12-month DAPT after BP-DES) according to clinical presentation.This is a post hoc analysis of the One-Month DAPT trial. The primary outcome was the composite of major adverse cardiac and cerebrovascular events (MACCE; a composite of cardiac death, non-fatal myocardial infarction, target vessel revascularisation, and stroke) and major bleeding.Among 1,828 patients with stable coronary artery disease (CAD), 1-month DAPT after PF-DCS resulted in lower rates of the primary outcome than 6-12-month DAPT after BP-DES (3.9% vs 6.5%; hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.39-0.90; p=0.012). However, among 1,192 patients with acute coronary syndrome (ACS), the rates of the primary outcome were not significantly different between the two therapy groups (5.6% vs 3.6%; HR 1.57, 95% CI: 0.91-2.70; p=0.102) and a significant interaction was observed between therapy and clinical presentation regarding the primary outcome (PIn patients undergoing drug-eluting stent implantation for non-complex lesions, the benefits of 1-month DAPT followed by aspirin monotherapy for a composite of ischaemic and bleeding outcomes were found in patients with stable CAD, but not in those with ACS.gov: NCT02513810.
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- 2022
4. Sex Differences in Outcomes of Ticagrelor Therapy With or Without Aspirin After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome: A Post Hoc Secondary Analysis of the TICO Randomized Clinical Trial
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Bom Lee, Seung-Jun Lee, Byeong-Keuk Kim, Yong-Joon Lee, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Meyong-Ki Hong, and Yangsoo Jang
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Cardiology and Cardiovascular Medicine - Abstract
Background: We sought to explore the sex differences in clinical outcomes among patients with acute coronary syndrome treated with ticagrelor monotherapy after ticagrelor-based 3-month versus 12-month dual-antiplatelet therapy. Methods: This was a post hoc analysis of the TICO trial (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus-Eluting Stent for Acute Coronary Syndrome; n=3056)—a randomized controlled trial for patients with acute coronary syndrome treated with drug-eluting stent. The primary outcome was a net adverse clinical event (composite of major bleeding, death, myocardial infarction, stent thrombosis, stroke, or target-vessel revascularization) 1 year after drug-eluting stent implantation. Secondary outcomes included major bleeding and major adverse cardiac and cerebrovascular events. Results: There were 27.3% (n=628) women in the TICO trial; they were older with lower body mass index and higher prevalence of hypertension, diabetes, or chronic kidney disease than men. Compared with men, women had higher risk of net adverse clinical events (hazard ratio [HR], 1.89 [95% CI, 1.34–2.67]), major adverse cardiac and cerebrovascular events (HR, 1.69 [95% CI, 1.07–2.68]), and major bleeding (HR, 2.04 [95% CI, 1.25–3.35]). Among the groups stratified by sex and dual-antiplatelet therapy strategy, the incidences of primary and secondary outcomes were significantly different and the highest in women with ticagrelor-based 12-month dual-antiplatelet therapy ( P P =0.02) and comparable in men (HR, 0.77 [95% CI, 0.52–1.14]; P =0.19) without significant interaction ( P for interaction, 0.18). Conclusions: After percutaneous coronary intervention for acute coronary syndrome, women demonstrated worse clinical outcomes than men. Ticagrelor monotherapy after 3-month dual-antiplatelet therapy was associated with significantly lower risk of net adverse clinical events in women without sex interaction.
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- 2023
5. Body mass index affecting ticagrelor monotherapy vs. ticagrelor with aspirin in patients with acute coronary syndrome: A pre-specified sub-analysis of the TICO randomized trial
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Byung Gyu Kim, Sung-Jin Hong, Byeong-Keuk Kim, Yong-Joon Lee, Seung-Jun Lee, Chul-Min Ahn, Dong-Ho Shin, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, and Yangsoo Jang
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Cardiology and Cardiovascular Medicine - Abstract
BackgroundAlthough ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) results in a significantly greater net clinical benefit over that with ticagrelor-based 12-month DAPT in patients with acute coronary syndrome (ACS), it remains uncertain whether this effect is dependent on body mass index (BMI). We aimed to evaluate the BMI-dependent effect of these treatment strategies on clinical outcomes.MethodsThis was a pre-specified subgroup analysis from the TICO trial (Ticagrelor Monotherapy After 3 Months in Patients Treated With New Generation Sirolimus-eluting Stent for Acute Coronary Syndrome), evaluating the interaction between BMI and treatment strategies for the primary outcome [composite of major bleeding and adverse cardiac and cerebrovascular events (MACCE): death, myocardial infarction, stent thrombosis, stroke, or target-vessel revascularization]. The secondary outcomes were major bleeding and MACCE.ResultsBased on a pre-specified BMI threshold of 25 kg/m2, 3,056 patients were stratified. Patients with BMI 2 had a higher risk of primary and secondary outcomes than those with BMI ≥25 kg/m2. Regardless of the BMI subgroup, the effects of ticagrelor monotherapy after 3-month DAPT on the primary outcome (pint = 0.61), major bleeding (pint = 0.76), and MACCE (pint = 0.80) were consistent without significant interaction compared with ticagrelor-based 12-month DAPT. The treatment effects according to the BMI quartiles and age, sex, and diabetic status were also consistent without significant interaction.ConclusionThe BMI-dependent impact of ticagrelor monotherapy after 3-month DAPT compared with 12-month DAPT on clinical outcomes was not heterogeneous in patients with ACS.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT02494895].
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- 2023
6. Clinical Implications of Poststent Optical Coherence Tomographic Findings
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Oh Hyun Lee, Krzysztof Milewski, Yong Joon Lee, Byung Ok Kim, Seung Jun Lee, Young Guk Ko, Chul Min Ahn, Byeong Keuk Kim, Jung Sun Kim, Yangsoo Jang, Donghoon Choi, Dong Ho Shin, Giulio Guagliumi, In Soo Kim, Young Sup Byun, Choongki Kim, Sung Jin Hong, Mateusz Kachel, and Byung Gyu Kim
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Stent ,Percutaneous coronary intervention ,030204 cardiovascular system & hematology ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Drug-eluting stent ,Interquartile range ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,Clinical endpoint ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives This study sought to evaluate the impact of post-stent optical coherence tomography (OCT) findings, including severe malapposition, on long-term clinical outcomes. Background Suboptimal OCT findings following percutaneous coronary intervention (PCI) are highly prevalent; however, their clinical implications remain controversial. Methods Of the patients registered in the Yonsei OCT registry, a total of 1,290 patients with 1,348 lesions, who underwent OCT immediately post-stenting, were consecutively enrolled for this study. All patients underwent implantation of drug-eluting stents. Post-stent OCT findings were assessed to identify predictors of device-oriented clinical endpoints (DoCE), including cardiac death, target vessel-related myocardial infarction (MI) or stent thrombosis, and target lesion revascularization (TLR). Significant malapposition criteria associated with major safety events (MSE) were also investigated, such as cardiac death, target vessel-related MI, or stent thrombosis. Results The median follow-up period was 43.0 months (interquartile range [IQR] 21.4 to 56.0 months). The incidence rates of stent edge dissection, tissue prolapse, thrombus, and malapposition after intervention were not associated with occurrence of DoCE. However, patients with significant malapposition (total malapposition volume [TMV] ≥7.0 mm3] exhibited more frequent MSE. A smaller minimal stent area (MSA) was identified as an independent predictor for DoCE (hazard ratio [HR]: 1.20 [95% confidence interval [CI]: 1.00 to 1.43]; p = 0.045). Malapposition with TMV ≥7.0 mm3 was found to be an independent predictor of MSE (HR: 6.12 [95% CI: 1.88 to 19.95]; p = 0.003). Follow-up OCT at 3, 6, or 9 months after PCI showed that post-stent TMV ≥7.0 mm3 was related to a greater occurrence of late malapposition and uncovered struts. Conclusions Although most suboptimal OCT findings were not associated with clinical outcomes, a smaller MSA was associated with DoCE, driven mainly by TLR, and significant malapposition with TMV ≥7.0 mm3 was associated with more MSE after PCI. (Yonsei OCT [Optical Coherence Tomography] Registry for Evaluation of Efficacy and Safety of Coronary Stenting; Yonsei OCT registry; NCT02099162 )
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- 2022
7. Assessment of fractional flow reserve in intermediate coronary stenosis using optical coherence tomography-based machine learning
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Jung-Joon Cha, Ngoc-Luu Nguyen, Cong Tran, Won-Yong Shin, Seul-Gee Lee, Yong-Joon Lee, Seung-Jun Lee, Sung-Jin Hong, Chul-Min Ahn, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, Jinyong Ha, and Jung-Sun Kim
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Cardiology and Cardiovascular Medicine - Abstract
ObjectivesThis study aimed to evaluate and compare the diagnostic accuracy of machine learning (ML)- fractional flow reserve (FFR) based on optical coherence tomography (OCT) with wire-based FFR irrespective of the coronary territory.BackgroundML techniques for assessing hemodynamics features including FFR in coronary artery disease have been developed based on various imaging modalities. However, there is no study using OCT-based ML models for all coronary artery territories.MethodsOCT and FFR data were obtained for 356 individual coronary lesions in 130 patients. The training and testing groups were divided in a ratio of 4:1. The ML-FFR was derived for the testing group and compared with the wire-based FFR in terms of the diagnosis of ischemia (FFR ≤ 0.80).ResultsThe mean age of the subjects was 62.6 years. The numbers of the left anterior descending, left circumflex, and right coronary arteries were 130 (36.5%), 110 (30.9%), and 116 (32.6%), respectively. Using seven major features, the ML-FFR showed strong correlation (r = 0.8782, P < 0.001) with the wire-based FFR. The ML-FFR predicted wire-based FFR ≤ 0.80 in the test set with sensitivity of 98.3%, specificity of 61.5%, and overall accuracy of 91.7% (area under the curve: 0.948). External validation showed good correlation (r = 0.7884, P < 0.001) and accuracy of 83.2% (area under the curve: 0.912).ConclusionOCT-based ML-FFR showed good diagnostic performance in predicting FFR irrespective of the coronary territory. Because the study was a small-size study, the results should be warranted the performance in further large-scale research.
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- 2023
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8. Does Age Matter After Successful Left Atrial Appendage Closure?
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Yong-Joon Lee and Jung-Sun Kim
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Cardiology and Cardiovascular Medicine - Published
- 2023
9. Long coverage with drug-eluting stents is superior to spot coverage for long femoropopliteal artery disease: PARADE II study
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Jong-Il Park, Young-Guk Ko, Yong-Joon Lee, Seung-Jun Lee, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Myeong-Ki Hong, Cheol-Woong Yu, Seung-Woon Rha, Jong-Kwan Park, Pil-Ki Min, Chang-Hwan Yoon, Sang-Rok Lee, Sang-Ho Park, and Dong-Hoon Choi
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Cardiology and Cardiovascular Medicine - Abstract
BackgroundThe efficacy of spot stenting using drug-eluting stents (DES) for the treatment of long femoropopliteal (FP) lesion is unknown. This study aimed to compare clinical outcomes of long full coverage vs. spot coverage with DES for long FP artery disease.MethodsThis multicenter randomized trial compared long DES vs. spot DES for FP lesions longer than 150 mm. All lesions were treated with paclitaxel-eluting stents (Zilver PTX). The primary endpoint was primary patency at 12 months.ResultsThe study was terminated early after an interim analysis. A total of 103 patients (55 in the long DES group; 48 in the spot DES group) were eligible for analysis. There were no significant differences in baseline and lesion characteristics between groups. Total stent length was longer in the long DES group than in the spot DES group (225.6 ± 67.2 vs. 131.3 ± 48.7 mm, p < 0.001). Technical success was achieved in all patients. There was a trend toward a higher primary patency rate at 12 months in the long DES group than in the spot DES group (87.5% vs. 67.5%, p = 0.120). The rate of survival free from target lesion revascularization was significantly higher in the long DES group than in the spot DES group (91.7% vs. 72.0%, p = 0.044). In multivariate Cox regression analysis, spot DES [hazard ratio (HR) 2.42, 95% confidence interval (CI) 1.14–5.12, p = 0.021] and postdilation (HR 0.27, 95% CI 0.09–0.79, p = 0.018) were identified as independent predictors for loss of patency at 12 months post-procedure.ConclusionsLong DES were more effective than spot DES for treating long FP lesions.Clinical trial registrationClinicaltrials.gov, identifier: NCT02701881.
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- 2022
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10. Moderate-intensity statin with ezetimibe vs. high-intensity statin in patients with diabetes and atherosclerotic cardiovascular disease in the RACING trial
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Yong-Joon Lee, Jae Young Cho, Seng Chan You, Yong-Ho Lee, Kyeong Ho Yun, Yun-Hyeong Cho, Won-Yong Shin, Sang Wook Im, Woong Chol Kang, Yongwhi Park, Sung Yoon Lee, Seung-Jun Lee, Sung-Jin Hong, Chul-Min Ahn, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, and Jung-Sun Kim
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Cardiology and Cardiovascular Medicine - Abstract
Aims This study evaluated the effect of moderate-intensity statin with ezetimibe combination therapy vs. high-intensity statin monotherapy among patients with diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD). Methods and results This was a pre-specified, stratified subgroup analysis of the DM cohort in the RACING trial. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke. Among total patients, 1398 (37.0%) had DM at baseline. The incidence of the primary outcome was 10.0% and 11.3% among patients with DM randomized to ezetimibe combination therapy vs. high-intensity statin monotherapy (hazard ratio: 0.89; 95% confidence interval: 0.64–1.22; P = 0.460). Intolerance-related discontinuation or dose reduction of the study drug was observed in 5.2% and 8.7% of patients in each group, respectively (P = 0.014). LDL cholesterol levels Conclusion Ezetimibe combination therapy effects observed in the RACING trial population are preserved among patients with DM. This study supports moderate-intensity statin with ezetimibe combination therapy as a suitable alternative to high-intensity statins if the latter cannot be tolerated, or further reduction in LDL cholesterol is required among patients with DM and ASCVD. Clinical Trial Registration ClinicalTrials.gov, Identifier:NCT03044665.
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- 2022
11. TCT-151 Dual Antiplatelet Therapy After Percutaneous Coronary Intervention for Left Main Coronary Artery Disease
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Sungsoo Cho, Do-Yoon Kang, Jung-Sun Kim, Duk-Woo Park, In-Soo Kim, Tae Soo Kang, Jung-Min Ahn, Pil Hyung Lee, Soo-Jin Kang, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Yong-Joon Lee, Seung-Jun Lee, Sung-Jin Hong, Chul-Min Ahn, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong-Ki Hong, and Seung-Jung Park
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Cardiology and Cardiovascular Medicine - Published
- 2022
12. Computational Fractional Flow Reserve From Coronary Computed Tomography Angiography-Optical Coherence Tomography Fusion Images in Assessing Functionally Significant Coronary Stenosis
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Yong-Joon Lee, Young Woo Kim, Jinyong Ha, Minug Kim, Giulio Guagliumi, Juan F. Granada, Seul-Gee Lee, Jung-Jae Lee, Yun-Kyeong Cho, Hyuck Jun Yoon, Jung Hee Lee, Ung Kim, Ji-Yong Jang, Seung-Jin Oh, Seung-Jun Lee, Sung-Jin Hong, Chul-Min Ahn, Byeong-Keuk Kim, Hyuk-Jae Chang, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, Joon Sang Lee, and Jung-Sun Kim
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Cardiology and Cardiovascular Medicine - Abstract
BackgroundCoronary computed tomography angiography (CTA) and optical coherence tomography (OCT) provide additional functional information beyond the anatomy by applying computational fluid dynamics (CFD). This study sought to evaluate a novel approach for estimating computational fractional flow reserve (FFR) from coronary CTA-OCT fusion images.MethodsAmong patients who underwent coronary CTA, 148 patients who underwent both pressure wire-based FFR measurement and OCT during angiography to evaluate intermediate stenosis in the left anterior descending artery were included from the prospective registry. Coronary CTA-OCT fusion images were created, and CFD was applied to estimate computational FFR. Based on pressure wire-based FFR as a reference, the diagnostic performance of Fusion-FFR was compared with that of CT-FFR and OCT-FFR.ResultsFusion-FFR was strongly correlated with FFR (r = 0.836, P < 0.001). Correlation between FFR and Fusion-FFR was stronger than that between FFR and CT-FFR (r = 0.682, P < 0.001; z statistic, 5.42, P < 0.001) and between FFR and OCT-FFR (r = 0.705, P < 0.001; z statistic, 4.38, P < 0.001). Area under the receiver operating characteristics curve to assess functionally significant stenosis was higher for Fusion-FFR than for CT-FFR (0.90 vs. 0.83, P = 0.024) and OCT-FFR (0.90 vs. 0.83, P = 0.043). Fusion-FFR exhibited 84.5% accuracy, 84.6% sensitivity, 84.3% specificity, 80.9% positive predictive value, and 87.5% negative predictive value. Especially accuracy, specificity, and positive predictive value were superior for Fusion-FFR than for CT-FFR (73.0%, P = 0.007; 61.4%, P < 0.001; 64.0%, P < 0.001) and OCT-FFR (75.7%, P = 0.021; 73.5%, P = 0.020; 69.9%, P = 0.012).ConclusionCFD-based computational FFR from coronary CTA-OCT fusion images provided more accurate functional information than coronary CTA or OCT alone.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT03298282].
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- 2022
13. Impact of New-Onset Persistent Left Bundle Branch Block on Reverse Cardiac Remodeling and Clinical Outcomes After Transcatheter Aortic Valve Replacement
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Kyu Kim, Young-Guk Ko, Chi Young Shim, JiWung Ryu, Yong-Joon Lee, Jiwon Seo, Seung-Jun Lee, Iksung Cho, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Geu-Ru Hong, Jong-Won Ha, Donghoon Choi, and Myeong-Ki Hong
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Cardiology and Cardiovascular Medicine - Abstract
BackgroundThe clinical implication of new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains controversial. We investigated the impact of new-onset persistent LBBB on reverse cardiac remodeling and clinical outcomes after TAVR.MethodsAmong 478 patients who had undergone TAVR for symptomatic severe aortic stenosis from 2011 to 2021, we analyzed 364 patients after excluding patients with pre-existing intraventricular conduction disturbance or a pacing rhythm before or during the indexed hospitalization for TAVR. Echocardiographic variables of cardiac remodeling at baseline and 1 year after TAVR were comprehensively analyzed. The primary outcome was a composite of cardiovascular death and hospitalization for heart failure. Secondary outcomes were all-cause death and individual components of the primary outcome.ResultNew-onset persistent LBBB occurred in 41 (11.3%) patients after TAVR. The no LBBB group showed a significant increase in the left ventricular (LV) ejection fraction and decreases in LV dimensions, the left atrial volume index, and LV mass index 1 year after TAVR (all p < 0.001). However, the new LBBB group showed no significant changes in these parameters. During a median follow-up of 18.1 months, the new LBBB group experienced a higher incidence of primary outcomes [hazard ratio (HR): 5.03; 95% confidence interval (CI): 2.60–9.73; p < 0.001] and all-cause death (HR: 2.80; 95% CI: 1.38–5.69; p = 0.003). The data were similar after multivariable regression analysis.ConclusionNew-onset persistent LBBB after TAVR is associated with insufficient reverse cardiac remodeling and increased adverse clinical events.
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- 2022
14. Long-term outcomes after percutaneous coronary intervention relative to bypass surgery in diabetic patients with multivessel coronary artery disease according to clinical presentation
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Myeong Ki Hong, Chul Min Ahn, Donghoon Choi, Jung Sun Kim, Yangsoo Jang, Byeong Keuk Kim, Yongsung Suh, Yong Joon Lee, Sanghoon Shin, Sung Jin Hong, Seunghwan Kim, and Young Guk Ko
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Male ,Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Revascularization ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,Republic of Korea ,Diabetes Mellitus ,medicine ,Humans ,Angina, Stable ,Angina, Unstable ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Coronary Artery Bypass ,Mortality ,Non-ST Elevated Myocardial Infarction ,Propensity Score ,Aged ,Proportional Hazards Models ,business.industry ,Hazard ratio ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,medicine.disease ,Stroke ,Treatment Outcome ,surgical procedures, operative ,Bypass surgery ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background For diabetic patients with multivessel coronary artery disease (MVD), limited data exist on the long-term outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) according to clinical presentation [stable coronary artery disease (SCAD) or non-ST-elevation acute coronary syndrome (NSTE-ACS)]. Patients and methods From a Korean multicenter registry, we analyzed 1135 diabetic patients with MVD treated with PCI (n = 660) or CABG (n = 475). After propensity score matching, 8-year major adverse cardiovascular and cerebrovascular events [MACCE; composite of all-cause death, myocardial infarction (MI), or stroke] were compared between PCI and CABG according to clinical presentation. Results After matching, MACCE was not different between PCI and CABG for SCAD patients [15.6 vs. 17.2%, hazard ratio (HR) = 0.94, 95% confidence interval (CI) = 0.55-1.63, P = 0.837], whereas it was higher in PCI than in CABG for NSTE-ACS patients (31.1 vs. 22.4%, HR = 1.63, 95% CI = 1.03-2.59, P = 0.036), mainly driven by the higher MI occurrence (HR = 2.18, 95% CI = 1.04-4.59, P = 0.035). A significant interaction between revascularization strategy and clinical presentation was observed for MACCE (P-interaction = 0.022). However, when PCI was further classified according to revascularization completeness, the treatment gap between PCI and CABG with respect to MI in NSTE-ACS patients was improved by complete-revascularization PCI. Conclusion Among diabetic patients with MVD, the long-term outcomes of PCI versus CABG differed according to clinical presentation. CABG may be more beneficial for NSTE-ACS patients with MVD in reducing MACCE and MI, whereas PCI was as effective as CABG for SCAD patients with MVD. Therefore, clinical presentation must be considered when choosing revascularization strategies in these patients.
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- 2020
15. Is Routine Postdilation During Angiography-Guided Stent Implantation as Good as Intravascular Ultrasound Guidance?: An Analysis Using Data From IVUS-XPL and ULTIMATE
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Yong-Joon Lee, Jun-Jie Zhang, Gary S. Mintz, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Jing Kan, Tao Pan, Xiaofei Gao, Zhen Ge, Shao-Liang Chen, and Myeong-Ki Hong
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Percutaneous Coronary Intervention ,Treatment Outcome ,Humans ,Drug-Eluting Stents ,Stents ,Coronary Artery Disease ,Cardiology and Cardiovascular Medicine ,Coronary Angiography ,Ultrasonography, Interventional - Abstract
Background: There are 2 competing approaches to optimize drug-eluting stent implantation: angiography-guided routine postdilation or intravascular ultrasound (IVUS) guidance. Methods: From the pooled data of 2 randomized trials, IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) and ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions), that compared IVUS- versus angiography-guided drug-eluting stent implantation, we compared 1037 patients (1265 lesions) with IVUS-guided postdilation, 905 patients (1170 lesions) with angiography-guided postdilation, and 383 patients (397 lesions) with angiography-guided drug-eluting stent implantation without postdilation as a reference group; all patients required ≥28 mm long stents. The primary end point was composite of cardiac death, target lesion–related myocardial infarction, or ischemia-driven target lesion revascularization at 3 years. Results: Postintervention quantitative coronary angiography–based minimum lumen diameter was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (2.5±0.4 mm versus 2.5±0.4 mm; P =0.367). However, it was larger in the IVUS guidance with postdilation versus the angiography guidance without postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; P =0.046), and also in the IVUS guidance with postdilation versus the angiography guidance with postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; P P =0.473). However, it was lower after IVUS guidance with postdilation versus angiography guidance without postdilation (4.5% versus 9.8%; hazard ratio, 0.44 [95% CI, 0.28–0.68]; P P Conclusions: In patients undergoing long drug-eluting stent implantation, IVUS-guided postdilation was associated with improved long-term clinical outcomes, unlike angiography-guided postdilation.
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- 2022
16. Optimal Strategy for Antiplatelet Therapy After Endovascular Revascularization for Lower Extremity Peripheral Artery Disease
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Sungsoo Cho, Yong Joon Lee, Seong-Hoon Lim, Tae Soo Kang, Donghoon Choi, Young Guk Ko, Yangsoo Jang, Jung Sun Kim, Byeong Keuk Kim, Myeong Ki Hong, Chul Min Ahn, and Sung Jin Hong
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Male ,medicine.medical_specialty ,Time Factors ,animal structures ,Endovascular revascularization ,Seoul ,Arterial disease ,Hemorrhage ,Disease ,030204 cardiovascular system & hematology ,Risk Assessment ,Drug Administration Schedule ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,In patient ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Middle Aged ,Surgery ,Treatment Outcome ,Lower Extremity ,Drug Therapy, Combination ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon ,Platelet Aggregation Inhibitors - Abstract
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.
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- 2019
17. Impact of Intravascular Ultrasound-Guided Optimal Stent Expansion on 3-Year Hard Clinical Outcomes
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Shao-Liang Chen, Chul Min Ahn, Young Guk Ko, Byeong Keuk Kim, Xiao-Fei Gao, Jung Sun Kim, Donghoon Choi, Jing Kan, Yangsoo Jang, Myeong Ki Hong, Jun-Jie Zhang, Zhen Ge, Yong Joon Lee, Tao Pan, Sung Jin Hong, and Gary S. Mintz
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Follow up studies ,Percutaneous coronary intervention ,Stent ,Drug-Eluting Stents ,Coronary Artery Disease ,equipment and supplies ,medicine.disease ,Coronary Angiography ,Percutaneous Coronary Intervention ,Treatment Outcome ,Intravascular ultrasound ,medicine ,Humans ,Stents ,cardiovascular diseases ,Myocardial infarction ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Ultrasonography, Interventional - Abstract
Background: Although stent underexpansion on intravascular ultrasound (IVUS) has been a major predictor for adverse outcomes in previous studies, these studies have primarily focused on angiographic restenosis or repeat revascularization with short-term follow-up. This study sought to evaluate the long-term benefit of different criteria for IVUS-defined optimal stent expansion on hard clinical outcomes. Methods: From the pooled data of 2 randomized trials, IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) and ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions) that compared IVUS- versus angiography-guided drug-eluting stent implantation, a total of 1254 patients with IVUS-guided drug-eluting stent implantation into 1484 long lesions (implanted stent length, ≥28 mm) were included. Different criteria for IVUS-defined optimal stent expansion based on minimum stent area (MSA) as an absolute measure or MSA relative to reference lumen area were applied and validated. The primary end point was composite of cardiac death, target lesion–related myocardial infarction, or stent thrombosis at 3 years. Results: The rate of the primary end point was lower in patients with optimal stent expansion versus those without optimal stent expansion according to 3 IVUS-defined optimal stent expansion criteria: MSA >5.5 mm 2 (0.5% versus 2.2%; hazard ratio, 0.21 [95% CI, 0.06–0.75]; P =0.008), MSA >5.0 mm 2 (0.6% versus 2.6%; hazard ratio, 0.24 [95% CI, 0.09–0.68]; P =0.003), and MSA/distal reference lumen area >90% (0.5% versus 2.4%; hazard ratio, 0.32 [95% CI, 0.12–0.88]; P =0.019). Achieving other relative expansion criteria, MSA/distal reference lumen area >100% or 80% or MSA/average reference lumen area >90% or 80%, was not associated with a reduction in hard clinical events. Conclusions: In patients undergoing IVUS-guided drug-eluting stent implantation for long lesions, achieving optimal stent expansion of MSA >5.5 mm 2 , >5.0 mm 2 , or MSA/distal reference lumen area >90% was associated with improved long-term hard clinical outcomes.
- Published
- 2021
18. Ticagrelor Monotherapy Versus Ticagrelor With Aspirin in Acute Coronary Syndrome Patients With a High Risk of Ischemic Events
- Author
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Byeong Keuk Kim, Donghoon Choi, Chul Min Ahn, Yong Joon Lee, Seung Jun Lee, Yangsoo Jang, Myeong Ki Hong, Jung Sun Kim, Young Guk Ko, and Sung Jin Hong
- Subjects
Ticagrelor ,Acute coronary syndrome ,medicine.medical_specialty ,Ischemia ,Hemorrhage ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Stroke ,Aspirin ,business.industry ,medicine.disease ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Background: In patients with acute coronary syndrome (ACS) with a high risk of ischemia, the impact of ticagrelor monotherapy after short-term dual antiplatelet therapy (DAPT) has not been clearly elucidated. Methods: This post hoc analysis of the TICO trial (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus-Eluting Stent for Acute Coronary Syndrome) compared the impact of ticagrelor monotherapy after 3-month DAPT versus ticagrelor-based 12-month DAPT in patients with high-ischemic risk ACS, defined as any of the following: number of stents implanted ≥3, total stent length >60 mm, complex procedures (chronic total occlusion, left main occlusion, or bifurcation plaques remedied using the 2-stent technique), or a history of diabetes or chronic kidney disease. Ischemic (composite of death, myocardial infarction, stent thrombosis, stroke, and target vessel revascularization) and bleeding outcomes (major bleeding) were evaluated at 12 months. Results: Of the total population (N=3056), 1473 (48.2%) patients were identified as having high-ischemic risk ACS. The rate of the ischemic outcome was significantly higher in high-ischemic risk ACS patients than in nonhigh-ischemic risk ACS patients (3.9% versus 1.9%, hazard ratio, 2.14 [95% CI, 1.37–3.35], P =0.001). Furthermore, the risk of major bleeding (3.2% versus 1.5%, hazard ratio, 2.23 [95% CI, 1.36–3.68], P =0.001) and the composite ischemic and bleeding outcome (6.6% versus 3.3%, hazard ratio, 2.02 [95% CI, 1.44–2.84], P P int =0.718), bleeding ( P int =0.092), and composite outcomes ( P int =0.094) without significant interactions. Conclusions: There were no significant heterogeneities in the impact of ticagrelor monotherapy after 3-month DAPT compared with that of ticagrelor-based 12-month DAPT on clinical outcomes according to the presence of high-ischemic risk. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02494895.
- Published
- 2021
19. Clinical Outcomes of Atherectomy Plus Drug-coated Balloon Versus Drug-coated Balloon Alone in the Treatment of Femoropopliteal Artery Disease
- Author
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Young Guk Ko, Seung Jun Lee, Byeong Keuk Kim, Chul Min Ahn, Donghoon Choi, Jung Sun Kim, Jae-Hwan Lee, Yangsoo Jang, Yong Joon Lee, Jung-Joon Cha, Sung Jin Hong, Jae-Hyung Roh, Myeong Ki Hong, and Yong-Hoon Yoon
- Subjects
medicine.medical_specialty ,Drug coated balloon ,business.industry ,medicine.medical_treatment ,Femoral artery ,Popliteal artery ,Surgery ,Atherectomy ,chemistry.chemical_compound ,medicine.anatomical_structure ,Paclitaxel ,chemistry ,medicine.artery ,Internal Medicine ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Atherectomy as a pretreatment has the potential to improve the outcomes of drug-coated balloon (DCB) treatment by reducing and modifying atherosclerotic plaques. The present study investigated the outcomes of atherectomy plus DCB (A+DCB) compared with DCB alone for the treatment of femoropopliteal artery disease.A total of 311 patients (348 limbs) underwent endovascular therapy using DCB for native femoropopliteal artery lesions at two endovascular centers. Of these, 82 limbs were treated with A+DCB and 266 limbs with DCB alone. After propensity score matching based on clinical and lesion characteristics, a total of 82 pairs was compared for immediate and mid-term outcomes.For the matched study groups, the lesion length was 172.7±111.2 mm, and severe calcification was observed in 43.3%. The technical success rate was higher in the A+DCB group than in the DCB group (80.5% vs. 62.2%, p=0.015). However, the A+DCB group showed more procedure-related minor complications (37.0% vs. 13.4%, p=0.047). At 2-year follow-up, primary clinical patency (73.8% vs. 82.6%, p=0.158) and the target lesion revascularization (TLR)-free survival (84.3% vs. 88.2%, p=0.261) did not differ between the two groups. In Cox proportional hazard analysis, atherectomy showed no significant impact on the outcome of DCB treatments.The pretreatment with atherectomy improved technical success of DCB treatment; however, it was associated with increased minor complications. In this study, A+DCB showed no clinical benefit in terms of TLR-free survival or clinical patency compared with DCB treatment alone.
- Published
- 2021
20. Skin Perfusion Pressure Predicts Early Wound Healing After Endovascular Therapy in Chronic Limb Threatening Ischaemia
- Author
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Sung Jin Hong, Jin W. Lee, Kwang H. Park, Byeong Keuk Kim, Donghoon Choi, Chul Min Ahn, Myeong Ki Hong, Yong Joon Lee, Young Guk Ko, Jung Sun Kim, Yangsoo Jang, and Seung Jun Lee
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Ischemia ,Blood Pressure ,Endovascular therapy ,Peripheral Arterial Disease ,Re-Epithelialization ,medicine ,Humans ,Aged ,Retrospective Studies ,Skin ,Aged, 80 and over ,Wound Healing ,integumentary system ,business.industry ,Skin perfusion ,Middle Aged ,medicine.disease ,Predictive value ,Surgery ,Treatment Outcome ,Lower Extremity ,Regional Blood Flow ,Chronic Disease ,Female ,Cardiology and Cardiovascular Medicine ,business ,Wound healing ,Angioplasty, Balloon ,Major amputation - Abstract
Skin perfusion pressure (SPP) has been proposed as a method to predict wound healing in chronic limb threatening ischaemia (CLTI). However, studies regarding the impact of SPP before and after endovascular therapy (EVT) on wound healing are limited. This study sought to evaluate the predictive value of SPP for early wound healing in CLTI treated by EVT.Between January 2018 and June 2020, 236 limbs (172 patients) with CLTI that underwent SPP measurement before and after EVT were included. SPP was measured before and 24 - 48 hours after the procedure. Early wound healing was defined as the achievement of complete epithelisation of all wounds without major amputation within three months of EVT.Early wound healing was achieved in 145 (61.4%) limbs after EVT. Baseline SPP (44.1 ± 21.0 mmHg vs. 33.5 ± 21.7 mmHg; p.001) and post-procedural SPP (61.8 ± 18.5 mmHg vs. 37.4 ± 19.9 mmHg; p.001) were significantly higher in the wound healing (+) group than in the wound non-healing (-) group. The area under the receiver operating characteristics curve for early wound healing was 0.82 for post-procedural SPP with a cutoff value of 50 mmHg (sensitivity 74.5%, specificity 78.0%). The early wound healing rate was significantly higher with a post-procedural SPP ≥ 50 mmHg compared with a SPP50 mmHg (84.4% vs. 35.0%; p.001).Post-procedural SPP with a cutoff value of 50 mmHg was capable of predicting early wound healing after EVT in CLTI.
- Published
- 2021
21. Comparison of Transcatheter Aortic Valve Replacement between Self-Expanding versus Balloon-Expandable Valves in Patients with Small Aortic Annulus
- Author
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Donghoon Choi, Seung Jun Lee, Yangsoo Jang, Sung Jin Hong, Geu Ru Hong, Chi Young Shim, Young Guk Ko, Yong Joon Lee, Byeong Keuk Kim, Chul Min Ahn, Myeong Ki Hong, and Jung Sun Kim
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Acute kidney injury ,Hemodynamics ,Aortic valve stenosis ,medicine.disease ,Transcatheter aortic valve replacement ,Stenosis ,Aortic valve replacement ,Valve replacement ,Internal medicine ,Internal Medicine ,medicine ,Cardiology ,cardiovascular system ,Cardiac skeleton ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Original Research - Abstract
Background and objectives Transcatheter aortic valve replacement (TAVR) has been reported as a good alternative for surgical aortic valve replacement in patients with small aortic annulus. Head-to-head comparisons of different transcatheter aortic valves in these patients are insufficient. We compared the outcomes after TAVR between two different types of recent transcatheter aortic valves (self-expanding vs. balloon-expandable) in patients with small aortic annulus. Methods A total of 70 patients with severe aortic stenosis and small annulus (mean diameter ≤23 mm or minimal diameter ≤21 mm on computed tomography) underwent TAVR with either a self-expanding valve with supra-annular location (n=45) or a balloon-expandable valve with intra-annular location (n=25). The echocardiographic hemodynamic parameters after TAVR and 1-year follow-up were compared. Results Between the self-expanding and balloon-expandable valve-treated patients, the clinical outcomes including permanent pacemaker implantation (11.1% vs. 8.0%), acute kidney injury stage 2 or 3 (4.4% vs. 4.0%), and major vascular complication (4.4% vs. 0.0%) were similar without all-cause mortality, stroke, and life-threatening bleeding during 30-day follow-up. Compared with the balloon-expandable valve-treated patients, the self-expanding valve-treated patients presented larger effective orifice area (EOA) (1.46±0.28 vs. 1.75±0.42 cm², p=0.002) and indexed EOA (0.95±0.21 vs. 1.18±0.28 cm²/m², p=0.001), whereas mean aortic valve gradient (11.7±2.9 vs. 8.9±5.2 mmHg, P=0.005) and incidence of ≥moderate prosthesis-patient mismatch (36.0% vs. 8.9%, p=0.009) were lower. These hemodynamic differences were maintained at 1-year follow-up. Conclusions TAVR with self-expanding valves was associated with superior hemodynamic outcomes compared with balloon-expandable valves in patients with small aortic annulus.
- Published
- 2020
22. Drug Eluting Stent vs. Drug Coated Balloon for Native Femoropopliteal Artery Disease: A Two Centre Experience
- Author
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Yong Joon Lee, Hyung Joon Joo, Chul Min Ahn, Young Guk Ko, Cheol Woong Yu, Hyungdon Kook, and Donghoon Choi
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,030230 surgery ,Atherectomy ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Clinical endpoint ,medicine ,Humans ,Popliteal Artery ,Prospective Studies ,Prospective cohort study ,Propensity Score ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Drug-Eluting Stents ,Middle Aged ,Surgery ,Clinical trial ,Femoral Artery ,medicine.anatomical_structure ,Logistic Models ,Treatment Outcome ,Drug-eluting stent ,Propensity score matching ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon ,Artery ,Follow-Up Studies - Abstract
There have been limited clinical trials comparing drug eluting stents (DESs) and drug coated balloons (DCBs) in the treatment of femoropopliteal artery disease. This two centre retrospective and prospective cohort study sought to compare DES with DCB for the treatment of native femoropopliteal artery disease.A total of 288 limbs (242 patients) with native femoropopliteal artery disease were treated with DESs (Zilver PTX; 102 limbs) or DCBs (IN.PACT Admiral; 186 limbs) in two Korean endovascular centres between 19 January 2013 and 5 May 2018 and followed for a median duration of 19.6 months. The primary endpoint was primary clinical patency. Propensity score matching (PSM, 162 limbs) and inverse probability weighted (IPW) adjustment were performed to adjust for confounding baseline characteristics.The DCB group had fewer lesions with Trans-Atlantic Inter-Society Consensus (TASC) II type C/D (55.9% vs. 70.6%, p = .021) or total occlusions (43.5% vs. 77.5%, p .001) and showed shorter lesion lengths (164.2 ± 105.4 mm vs. 194.8 ± 86.8 mm, p = .009) than the DES group. After PSM, baseline clinical and lesion characteristics of the two groups were comparable except for larger reference vessel diameter in the DES group (5.4 ± 0.6 vs. 5.1 ± 0.7, p = .025). Adjunctive atherectomy was performed in 32.1% of the DCB group and in 2.5% of the DES group (p .001). The provisional stenting was required in 14.8% of the DCB group. At two year follow up, the DCB group showed higher primary clinical patency (74.6% vs. 56.7%, hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.27-0.96, p = .032) and freedom from target lesion revascularisation (85.9% vs. 71.3%, HR 0.39, 95% CI 0.17-0.89, p = .021) than the DES group. Survival from all cause death did not differ between groups (87.6% vs. 92.1%, HR 1.85, 95% CI 0.62-5.52, p = .26).In this two centre cohort, DCBs with selective use of adjunctive atherectomy achieved more favourable outcomes than DESs for native femoropopliteal artery disease.
- Published
- 2020
23. Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial
- Author
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Yong-Joon, Lee, Yongsung, Suh, Jung-Sun, Kim, Yun-Hyeong, Cho, Kyeong Ho, Yun, Yong Hoon, Kim, Jae Young, Cho, Ae-Young, Her, Sungsoo, Cho, Dong Woon, Jeon, Sang-Yong, Yoo, Deok-Kyu, Cho, Bum-Kee, Hong, Hyuckmoon, Kwon, Sung-Jin, Hong, Chul-Min, Ahn, Dong-Ho, Shin, Chung-Mo, Nam, Byeong-Keuk, Kim, Young-Guk, Ko, Donghoon, Choi, Myeong-Ki, Hong, and Yangsoo, Jang
- Subjects
Internal Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Identifying patients with high bleeding risk (HBR) is important when making decisions for antiplatelet therapy strategy. This study evaluated the impact of ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) according to HBR in acute coronary syndrome (ACS) patients treated with drug eluting stents (DESs).In this post-hoc analysis of the TICO trial, HBR was defined by 2 approaches: meeting Academic Research Consortium for HBR (ARC-HBR) criteria or Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT (PRECISE-DAPT) score ≥25. The primary outcome was a 3-12 months net adverse clinical event (composite of major bleeding and adverse cardiac and cerebrovascular events).Of the 2,980 patients without adverse events during the first 3 months after DES implantation, 453 (15.2%) were HBR by ARC-HBR criteria and 504 (16.9%) were HBR by PRECISE-DAPT score. The primary outcome rate was higher in HBR versus non-HBR patients (by ARC-HBR criteria: hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.76-4.69; p0.001; by PRECISE-DAPT score: HR, 3.09; 95% CI, 1.92-4.98; p0.001). Ticagrelor monotherapy after 3-month DAPT was associated with lower primary outcome rate than ticagrelor-based 12-month DAPT regardless of HBR by ARC-HBR criteria, with similar magnitudes of therapy effect for HBR and non-HBR patients (p-interaction=0.400). Results were consistent by PRECISE-DAPT score (p-interaction=0.178).In ACS patients treated with DESs, ticagrelor monotherapy after 3-month DAPT was associated with lower rate of adverse clinical outcomes regardless of HBR, with similar magnitudes of therapy effect between HBR and non-HBR.ClinicalTrials.gov Identifier: NCT02494895.
- Published
- 2022
24. IMPACT OF TICAGRELOR MONOTHERAPY AFTER 3-MONTH DUAL ANTIPLATELET THERAPY IN ACUTE CORONARY SYNDROME BY HIGH BLEEDING RISK: A POST HOC ANALYSIS OF THE RANDOMIZED TICO TRIAL
- Author
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Young Guk Ko, Byeong Keuk Kim, Yun-Hyeong Cho, Donghoon Choi, Chul Min Ahn, Yong Joon Lee, Yongsung Suh, Jung Sun Kim, Sung Jin Hong, Myeong Ki Hong, and Yangsoo Jang
- Subjects
Acute coronary syndrome ,medicine.medical_specialty ,business.industry ,Internal medicine ,Post-hoc analysis ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Ticagrelor ,medicine.drug - Published
- 2021
25. Bleeding risk and major adverse events in patients with cancer on oral anticoagulation therapy
- Author
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Hui Nam Pak, Jin-Kyu Park, Jae Sun Uhm, Boyoung Joung, Jong Yun Kim, Moon Hyoung Lee, Jung Hoon Sung, and Yong Joon Lee
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,Administration, Oral ,Hemorrhage ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Internal medicine ,Atrial Fibrillation ,Republic of Korea ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Survival rate ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Anticoagulants ,Cancer ,Retrospective cohort study ,Atrial fibrillation ,Vitamin K antagonist ,medicine.disease ,Surgery ,Survival Rate ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Follow-Up Studies - Abstract
Background The efficacy of oral anticoagulation therapy (OAT) has not been revealed in atrial fibrillation (AF) patients with newly diagnosed cancers. This study evaluated the thromboembolic and bleeding events in AF patients with malignancies according to OAT. Methods and results In 2168 consecutive non-valvular AF patients with newly diagnosed malignancies, we analyzed the composite endpoints including major adverse cardiac events (MACEs) and major bleeding. Based on a propensity score matching, two groups with 690 matched pairs were created. Patient baseline characteristics were comparable between the matched groups. During a follow-up period of 3.9±2.8years, 72 (10%) and 65 (9%) patients had MACEs in the propensity score-matched OAT+ and OAT− groups, respectively (p=0.461). There was no significant difference in the major bleeding (10% vs. 8%, p=0.300) and composite endpoints (18% vs. 16%, p=0.181) between OAT+ and OAT− patients. During the first year after the cancer diagnosis, 66 (48%) MACEs, 52 (41%) major bleedings, and 116 (49%) composite end points of all events occurred. The optimal international normalized ratio (2.0 to 3.0) level was achieved in only 85 (12%) patients. However, 1year after cancer diagnosis, OAT+ patients with the target therapeutic range of ≥60% demonstrated better cumulative survival free of composite end point than OAT− patients (p=0.026). Conclusion During the first year after the cancer diagnosis, OAT did not improve the composite end point because of poor INR control caused by cancer treatment. However, after 1year after diagnosis of cancer, optimal anticoagulation significantly reduced the composite end point.
- Published
- 2016
26. Transvascular Implantation of an Implantable Cardioverter-Defibrillator in a Patient Who has Undergone One-and-a-Half Ventricle Repair
- Author
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Dong Hyuk Park, Jae Sun Uhm, Seng Chan You, Je Wook Park, Nam Kyun Kim, Pil Sung Yang, Dong-Jun Kim, and Yong Joon Lee
- Subjects
medicine.medical_specialty ,Heart disease ,business.industry ,medicine.medical_treatment ,Bidirectional cavopulmonary shunt ,Heart defects, congenital ,Case Report ,Arrhythmogenic right ventricular dysplasia ,medicine.disease ,Implantable cardioverter-defibrillator ,Right ventricular cardiomyopathy ,Surgery ,Sudden cardiac death ,Icd implantation ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Internal Medicine ,Cardiology ,Medicine ,In patient ,Cardiology and Cardiovascular Medicine ,business - Abstract
Implantable cardioverter-defibrillator (ICD) therapy is acknowledged as a valid treatment method for the effective prevention of sudden cardiac death, which is a major cause of mortality in adult congenital heart disease patients. But ICD implantation by the conventional transvascular approach is not always possible in patients who have undergone palliative surgery due to congenital and structural heart disease. Here, we report a case in which an ICD was transvascularly implanted in an arrhythmogenic right ventricular cardiomyopathy patient who had undergone a one-and-a-half ventricle repair.
- Published
- 2015
27. Effect of Non-vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients with Newly Diagnosed Cancer
- Author
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Tae Hoon Kim, Yong Joon Lee, Kyu Yeun Kim, Jae Sun Uhm, Boyoung Joung, Hui Nam Pak, and Moon Hyoung Lee
- Subjects
medicine.medical_specialty ,business.industry ,medicine.drug_class ,Incidence (epidemiology) ,Antagonist ,Warfarin ,Cancer ,Atrial fibrillation ,030204 cardiovascular system & hematology ,Vitamin K antagonist ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Propensity score matching ,Internal Medicine ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,medicine.drug - Abstract
BACKGROUND AND OBJECTIVES There are limited data on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer. We aimed to assess the efficacy and safety of NOACs in AF patients with cancer in this study. METHODS In 2,568 consecutive non-valvular AF patients with newly diagnosed cancer, we analyzed ischemic stroke/systemic embolism (SE), major bleeding, and all-cause death. Based on propensity score matching, 388 matched pairs were included in the NOAC and warfarin groups. RESULTS Patient baseline characteristics were comparable between the matched groups. During median follow-up of 1.8 years, the NOAC group had significantly lower incidences of ischemic stroke/SE (p
- Published
- 2018
28. Femoropopliteal Artery Stent Fracture with Recurrent In-Stent Reocclusion and Aneurysm Formation: Successful Treatment with Self-Expandable Viabahn Endoprosthesis
- Author
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Yangsoo Jang, Young Guk Ko, Yong Joon Lee, Myeong Ki Hong, Byeong Keuk Kim, Donghoon Choi, Dong Ho Shin, and Jung Sun Kim
- Subjects
Bare-metal stent ,Blood vessel prosthesis ,medicine.medical_specialty ,business.industry ,Self expandable ,medicine.medical_treatment ,Occlusive disease ,Stent ,Case Report ,equipment and supplies ,Surgery ,Aneurysm, false ,surgical procedures, operative ,medicine.anatomical_structure ,Graft occlusion, vascular ,Internal Medicine ,Medicine ,cardiovascular diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Aneurysm formation ,Artery - Abstract
Primary stenting in femoropopliteal lesions of intermediate length has recently shown favorable outcomes. However, stent fractures are a concern after bare metal stent implantation. The incidence of stent fracture varies widely (ranging from 2% to 65%) depending on factors such as the treated lesions or stent type and may potentially lead to various complications. We reported a case of stent fracture with complete dislocation combined with recurrent in-stent reocclusion and aneurysm formation in a patient with occlusive disease of the femoropopliteal artery, which was successfully treated with self-expandable endovascular stent graft.
- Published
- 2015
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