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Gestational hypertensive diseases (GHD) and gestational diabetes mellitus (GDM) increase the risk of cardiovascular disease (CVD) later in life. However, the association between gestational medical diseases and familial history of CVD has not been investigated to date. In the present study, we examined the association between familial history of CVD and GHD or GDM via reliable questionnaires in a large cohort of registered nurses.The Korean Nurses' Survey was conducted through a web-based computer-assisted self-interview, which was developed through consultation with cardiologists, gynecologists, and statisticians. We enrolled a total of 9,989 female registered nurses who reliably answered the questionnaires including family history of premature CVD (FHpCVD), hypertension (FHH), and diabetes mellitus (FHDM) based on their medical knowledge. Either multivariable logistic regression analysis or generalized estimation equation was used to clarify the effect of positive family histories on GHD and GDM in subjects or at each repeated pregnancy in an individual.In this survey, 3,695 subjects had at least 1 pregnancy and 8,783 cumulative pregnancies. Among them, 247 interviewees (6.3%) experienced GHD and 120 (3.1%) experienced GDM. In a multivariable analysis adjusted for age, obstetric, and gynecologic variables, age at the first pregnancy over 35 years (adjusted OR 1.61, 95% CI 1.02-2.43) and FHpCVD (adjusted OR 1.60, 95% CI 1.16-2.22) were risk factors for GHD in individuals, whereas FHH was not. FHDM and history of infertility therapy were risk factors for GDM in individuals (adjusted OR 2.68, 95% CI 1.86-3.86; 1.84, 95% CI 1.05-3.23, respectively). In any repeated pregnancies in an individual, age at the current pregnancy and at the first pregnancy, and FHpCVD were risk factors for GHD, while age at the current pregnancy, history of infertility therapy, and FHDM were risk factors for GDM.The FHpCVD and FHDM are significantly associated with GHD and GDM, respectively. Meticulous family histories should be obtained, and women with family histories of these conditions should be carefully monitored during pregnancy.

Few simple and effective tools are available for determining the prognosis of 30-day survivors after acute myocardial infarction. We aimed to assess whether the simple age, creatinine, and ejection fraction (ACEF) score could predict 1-year mortality of 12,000 post-myocardial infarction 30-day survivors who underwent percutaneous coronary intervention. The ACEF score was computed as follows: (age/ejection fraction) + 1, if the serum creatinine was >2 mg/dl. Accuracy was defined through receiver-operating characteristics analysis and area under the curve (AUC) evaluation. Twelve risk factors were selected and ranked according to their AUC value. Age, ejection fraction, and serum creatinine levels indicated the best AUC value. The ACEF score was significantly higher in the nonsurvivors (1.95 ± 0.82 vs 1.28 ± 0.50; p <0.001) and was an independent predictor of 1-year mortality (adjusted hazard ratio 2.26; p <0.001). The best accuracy was achieved by a prediction model including 12 risk factors (AUC = 0.80), but this did not significantly differ compared with the AUC (0.79) of the ACEF score (p = ns). Adjusted hazard ratios for 1-year mortality were 1 (reference), 3.11 (p <0.001), and 10.38 (p <0.001) for the ACEFLOW (ACEF score <1.0), ACEFMID (ACEF score 1.0 to 1.39), and ACEFHIGH (ACEF score ≥1.4) groups, respectively. The ACEF score may be a novel valid model to stratify the 1-year mortality risk in 30-day survivors who underwent percutaneous coronary intervention after acute myocardial infarction. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the prognostic value of heart block among patients with acute myocardial infarction (AMI) treated with drug-eluting stents. A total of 13,862 patients with AMI, registered in the nation-wide AMI database from January 2005 to June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block were considered as heart block in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated. Percutaneous coronary intervention with implantation of drug-eluting stent was performed in 89.8% of the patients. Heart block occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with heart block showed worse clinical parameters at initial admission, and the presence of heart block was associated with 30-day MACE in univariate analyses. However, the prognostic impact of heart block was not significant after adjustment of potential confounders (p = 0.489). Among patients with heart block, patients with a culprit in the left anterior descending (LAD) coronary artery had worse clinical outcomes than those of patients with a culprit in the left circumflex or right coronary artery. LAD culprit was a significant risk factor for 30-day MACE even after controlling for confounders (odds ratio 5.28, 95% confidence interval 1.22 to 22.81, p = 0.026). In conclusion, despite differences in clinical parameters at the initial admission, heart block was not an independent risk factor for 30-day MACE in adjusted analyses. However, a LAD culprit was an independent risk factor for 30-day MACE among patients with heart block. [ABSTRACT FROM AUTHOR]

Background In contrast to many studies comparing everolimus-eluting stent (EES) with paclitaxel-eluting stent (PES), data directly comparing EES with sirolimus-eluting stent (SES) are limited, especially in patients with acute myocardial infarction (AMI). Methods This study includes 2911 AMI patients treated with SES (n = 1264) or EES (n = 1701) in Korea Acute Myocardial Infarction Registry (KAMIR). Propensity score matching was applied to adjust for baseline imbalance in clinical and angiographic characteristics, yielding a total of 2400 well-matched patients (1200 receiving SES and 1200 receiving EES). One-year clinical outcomes were compared between the two propensity score matched groups. Results Baseline clinical and angiographic characteristics were similar between the two propensity score matched groups. One-year clinical outcomes of the propensity score matched cohort were comparable between the EES versus the SES groups including the rates of cardiac death (4.8% vs. 4.8%, P = 1.000), recurrent myocardial infarction (1.4% vs. 1.7%, P = 0.619), target lesion revascularization (1.4% vs. 1.6%, P = 0.737), target lesion failure (7.0% vs. 7.3%, P = 0.752), and probable or definite stent thrombosis (0.5% vs. 0.9%, P = 0.224) except for a trend toward lower incidence of target vessel revascularization (1.9% vs. 3.0%, P = 0.087) and a lower rate of total major adverse cardiac events (9.3% vs. 11.9%, P = 0.034) in the EES group. Conclusions The present propensity score matched analysis performed in a large-scale, prospective, multicenter registry suggests that the second-generation drug-eluting stent EES has at least comparable or even better safety and efficacy profiles as compared with SES in the setting of AMI. [ABSTRACT FROM AUTHOR]

The neurohumoral and inflammatory pathways are regarded as the main mechanisms for the progression of heart failure. We sought to investigate the prognostic value of highsensitivity C-reactive protein (hs-CRP) and N-terminal probrain natriuretic peptide (NTproBNP) by evaluating their relation with 12-month mortality rate in this prospective cohort study from 24 academic hospitals in Korea. In 1,608 patients with acute heart failure (AHF), the median hs-CRP and NT-proBNP values were 0.77 mg/dl (interquartile range 0.29 to 2.84) and 4,638 pg/ml (interquartile range 1,945 to 10,852), respectively. During the 12-month follow-up, 213 patients (13.3%) died. The mortality rate increased from the lowest to the highest hs-CRP quartiles (Q1 7.4%, Q2 9.5%, Q3 16.9%, Q4 19.3%, p <0.001) and NT-proBNP quartiles (Q1 7.0%, Q2 13.4%, Q3 11.6%, Q4 20.4%, p <0.001). After adjustment, both hs-CRP (hazard ratio [HR] 1.811, 95% confidence interval [CI] 1.138 to 2.882) and NT-proBNP (HR 1.971, 95% CI 1.219 to 3.187) were independent predictors of 12-month mortality among others. When combining both hs-CRP and NT-proBNP and stratifying the patients according to their median values, patients with elevation of both hs- CRP and NT-proBNP values had 2.4-fold increased hazards (HR 2.382, 95% CI 1.509 to 3.761) compared with those without elevation of both markers. In Korean patients with AHF, patients with increased levels of both hs-CRP and NT-proBNP had worse clinical outcomes. The combination of the neurohumoral and inflammatory markers may provide a better strategy for risk stratification of Asian patients with AHF. [ABSTRACT FROM AUTHOR]

STsegment myocardial infarction (NSTEMI) during off-hours. The purpose of this study was to compare the impact of patients' arrival time on the care of NSTEMI and whether this pattern might affect hospital mortality. This study analyzed 4,736 NSTEMI patients included in the Korea Acute Myocardial Infarction Registry from November 2005 to January 2008. Patients' arrival time was classified into regular hours (weekdays, 9:00 A.M. to 6:00 P.M.) and off-hours (weekdays 18:01 P.M. to 8:59 A.M., weekends, and holidays). A subtotal of 2,225 (46.9%) patients was admitted during off hours, compared with 2,511 (53.1%) patients with regular-hour admission. A higher proportion of patients admitted during off-hours had a higher Killip class, had more frequent cardiopulmonary resuscitation, were less likely to receive percutaneous coronary intervention (PCI) (67.7% vs 72.7%, p <0.001), and had longer door-to-balloon times (28 hours, interquartile range: 11 to 63 vs 23 hours, interquartile range 4 to 67, p <0.001). Although unadjusted hospital mortality was associated with admission during off-hours (4.5% vs 3.3%, p [ 0.023), after adjusting for all patients covariates, the difference in mortality was attenuated and was no longer statistically significant (odds ratio 0.94, 95% confidence interval 0.59 to 1.48, p[ 0.793). In conclusion, despite receiving fewer PCIs and having substantially longer waiting times to PCI, patients admitted during off-hours may not be at risk for increased in-hospital mortality. If patients are treated within an appropriate reperfusion strategy according to their clinical risk, arrival time may not influence on mortality. [ABSTRACT FROM AUTHOR]