Search

Background: Although lone paroxysmal atrial fibrillation (LPAF) is clinically defined as an arrhythmia that occurs in the absence of structural heart disease, it has been suggested that the presence of anatomical substrate is related to LPAF. The aim of the present study is to determine whether structural and functional remodeling of the left atrium (LA) occurs in patients with LPAF, and to identify whether frequent episodes of atrial fibrillation (AF) contribute to LA remodeling. Methods and Results: Forty-five patients who diagnosed as LPAF and age-, gender-, and body mass index-matched healthy control subjects (n = 45) were enrolled. Patients were grouped based on the frequency of AF episodes. An echocardiography was performed >2 weeks after last episode of AF without antiarrhythmic drugs. There were no statistical differences in left ventricular (LV) diastolic and systolic functions as well as baseline characteristics between patients and controls, whereas, patients had significantly larger LA volume (LAV), lower active LA emptying fraction (LAEFactive, P = 0.009) and total LAEF (LAEFtotal, P = 0.005) compared with controls. Passive LAEF (LAEFpassive) was not different between patients and controls (P = 0.664). LAEFactive was significantly depressed in patients with frequent episodes of AF than the others (P = 0.034). Conclusions: Compared with healthy controls, patients with LPAF had increased LAV and depressed LAEFactive and LAEFtotal without accompanying compensatory increase in LAEFpassive. LAEFactive was influenced by frequent episodes of AF. These findings may support the hypothesis that LPAF is “not-so-lone AF” and related to the concealed cardiac dysfunctions. (Echocardiography 2011;28:44-51)

Aims Although atrial septal aneurysm (ASA) is frequently combined with patent foramen ovale and associated with cryptogenic stroke (CS), a pathophysiologic correlation between CS and ASA alone has not been fully elucidated. The aims of this study were to assess transport functions of the left atrium (LA) and left atrial appendage (LAA), and to evaluate their relationship in CS subjects with ASA alone. Methods and results This study consisted of 38 CS subjects with ASA alone and 38 matched controls. Transthoracic echocardiography including tissue Doppler imaging was performed in all subjects and transesophageal echocardiography was conducted in CS subjects to assess LAA emptying velocity (LAAev). We also measured soluble P- and E-selectin, interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) as indices of prothrombogenic and proinflammatory activity. Although there were no differences in left ventricular functions and baseline characteristics between the two groups, CS subjects had significantly larger LA volume and lower LA active pump function compared with controls. LAAev was significantly correlated with LA active function. CS subjects had significantly higher E-selectin ( P = 0.046), IL-6 ( P = 0.040), and hs-CRP ( P = 0.001) compared with controls. Conclusions Compared with controls, LA active pump function was significantly depressed and closely correlated with LAAev in CS subjects with ASA alone. Moreover, plasma levels of E-selectin, IL-6, and hs-CRP were significantly higher in CS subjects with ASA alone. These findings suggest that impaired LA and LAA functions are a crucial pathophysiologic mechanism for ischaemic stroke in subjects with ASA alone.

Post-stenting balloon dilation is associated with improvement of stent deploymanet and better angiographic results in percutaneous coronary intervention (PCI). However, it had not been evaluated competently in setting of acute coronary syndrom (ACS) undergoing PCI. There are limited data regarding

Percutaneous coronary intervention (PCI) for ostial coronary lesions associated with inappropriate angiographic results, challenging adjustment of stent position and higher risk of cardiovascular complications. A total 3747 patients underwent PCI were included. Patients were divided into two groups

Left ventricular hypertrophy (LVH) is associated with increased risk for vascular events and mortality. This study investigated 8-year clinical outcomes of hypertensive patients with LVH who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) compared with hypertensive patients without LVH. A total of 1704 consecutive hypertensive patients who underwent PCI from 2004 to 2014 were enrolled. We classified them into either the LVH group (n = 406) or the control group (without LVH, n = 1298). LVH was defined by LV mass index > 115 g/m2 in men and > 95 g/m2 in women. After propensity score matched (PSM) analysis, 2 PSM groups (366 pairs, n = 732, c-statistic = 0.629) were generated. For up to 8 years, the LVH group showed a higher incidence of cardiac death (4.4% vs 1.2%, log-rank P = .023, hazard ratio: 3.371, 95% confidence interval: 1.109–10.25; P = .032) compared with the control group. However, there were no significant differences between the 2 groups in the incidence of total death, myocardial infarction, revascularization, and major adverse cardiac events up to 8 years. LVH in hypertensive patients who underwent successful PCI with DES was associated with higher incidence of cardiac death up to 8 years of follow-up. More careful managements and clinical follow-up are needed and treatment strategies should specifically focus to target prevention and reversal of LVH in hypertensive patients.

Break of a stent delivery catheter and subsequent stent loss (SL) has been a rare event in the drug-eluting stent (DES) era. We here report a case of successful retrieval of a stent after a break if the delivery catheter and SL from a balloon catheter at a culprit lesion. We finally resolved this situation using a simple balloon technique for both the broken stent catheter inside of the guide catheter and the unexpanded stent in the culprit lesion. Thus balloons are an important weapon in our armamentarium in the cardiac catheterization laboratory for urgent retrieval of a lost stent. Their apt use definitely allowed our patient to avoid undergoing emergency cardiovascular thoracic surgery.

Depression is a risk factor for the development of coronary heart disease but the relationship between coronary endothelial dysfunction and depression is not yet known. This study investigated whether depressive symptomatology is associated with coronary endothelial dysfunction in patients without coronary artery disease (CAD).Incremental acetylcholine (Ach; 20, 50 and 100 microg/min) and nitrate (200 microg/min) were infused into the left coronary ostium of 52 patients (male 30, 51.8 years) with depressive symptoms as indicated by a Beck Depression Inventory (BDI) score ofor=10 and a Hamilton Depression Rating Scale (HAM-D17) ofor=7 but without overt CAD or any vasoactive medications. Vascular responses to each drug were measured quantitatively at the mid-segments of the left anterior descending artery (LAD) and compared to those of 103 matched control subjects (male 64, 51.3 years) with angiographically normal looking LAD and as estimated by BDI10 and HAM-D177. Patients in the depressive group showed significant vasoconstriction compared with patients in the non-depressive group (p=0.017, 0.090, 0.004 respectively). However, endothelium-independent vasodilatation to nitrates did not differ significantly between the two groups (p=0.461). No differences in risk factors were found between the two groups.Depressive mood is associated with coronary endothelial dysfunction in patients without CAD, suggesting a possible mechanism by which depressive mood may act as a cardiovascular risk factor.

Many studies showed that successful revascularization for chronic total occlusion (CTO) improved clinical outcomes. However, there are limited data regarding the impact of percutaneous coronary intervention (PCI) for CTO in multi-vessel disease (MVD) patients. We compared up to 5 years clinical

This study was to assess the optimal timing for non-cardiac surgery (NCS) after drug-eluting stents (DES) implantation in patients who are scheduled for NCS. In conclusions, patients undergoing early NCS within 3 months after the PCI with DES may associate with adverse outcomes. Therefore we suggest that NCS should be deferred at least 3 months after the DES implantation.

Summary Background We compared angiographic and clinical outcomes among different drug-eluting stents (DESs) in Korean acute myocardial infarction (AMI) patients. Methods A total of 109 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) with either sirolimus-eluting (SES, n = 56 pts) or paclitaxel-eluting stents (PES, n = 53 pts) were enrolled from August 2004 to December 2006. The angiographic outcomes at 6 months and clinical outcomes at 1 year were compared between the two groups. Results Baseline clinical and procedural characteristics were similar between the two groups. At 6 months, the rate of binary restenosis was 17.0% in the PES group compared with 3.6% in the SES group ( p = 0.026). Percent restenosis was 24.9 ± 28.6% in the PES group compared with 11.2 ± 17.6% in the SES group ( p = 0.004). Length of restenosis segment was 3.21 ± 9.02 mm in the PES group compared with 0.89 ± 2.38 mm in the SES group ( p = 0.048). Late loss was 0.73 ± 0.89 mm in the PES group compared with 0.28 ± 0.37 mm in the SES group ( p = 0.001). However, there were no differences in clinical outcomes at 1 year including mortality, myocardial infarction, repeat PCI, and major cardiac adverse events between two groups. Conclusion SES implantation in patients with AMI was associated with reduction in angiographic restenosis at 6 months compared with PES, however, these angiographic benefits were not translated into better clinical outcomes in real world clinical practice.

Summary Background Although drug-eluting stents (DES) have been shown to dramatically reduce restenosis and improve the rate of event-free survival in large randomized trials, the benefit of DES appears to be limited to restenosis. In large arteries, it is not clear which type of stent is more superior in angiographic and clinical outcomes between DES and bare-metal stents (BMS). We compared the angiographic and clinical outcomes of DES versus BMS in large arteries (≥3.5 mm). Method Two hundred and forty patients from March 2002 to March 2007 received stents; 196 patients were treated with DES (44.9% sirolimus-eluting stents; 43.9% paclitaxel-eluting stents; 11.2% zotarolimus-eluting stents) and 44 with cobalt–chromium BMS for single de novo lesions in a large vessel. All subjects received aspirin, clopidogrel, and/or cilostazol as the standard antiplatelet regimen. The angiographic and clinical outcomes were evaluated at 6 months. Results For the baseline characteristics, there were no significant differences between the DES and BMS groups. In addition, for the initially implanted stent there was no difference in the length, stent diameter, and lesion site between the two groups. After 6 months, the follow-up angiogram showed that in-stent diameter restenosis and late loss was more common with BMS than DES (39 ± 21% vs. 19 ± 17%, p = 0.007; 1.44 ± 0.83 mm vs. 0.62 ± 0.58 mm, p = 0.009, respectively). However, the target-lesion revascularization/target-vessel revascularization, and total major adverse cardiac events showed no significant differences between the groups (5.3% vs. 3.6%, p = 0.62; 5.3% vs. 4.6%, p = 0.86, respectively). Conclusion The DES and cobalt–chromium BMS placed in large coronary arteries showed equally favorable 6-month clinical outcomes, although the 6-month angiographic results appeared more favorable in the DES group than in the BMS group.

Objectives We prospectively compared coronary endothelial dysfunction in patients with zotarolimus-eluting stent (ZES) versus sirolimus-eluting stent (SES) implantation at 6-month follow-up. Background A ZES has been associated with uniform and rapid healing of the endothelium. Methods Fifty patients were randomly treated with intravascular ultrasound-guided stenting with a single stent to the mid-segment of the left anterior descending artery (20 ZES, 20 SES, and 10 bare-metal stents), and endothelial function was estimated before and after intervention at 6-month follow-up by incremental acetylcholine (Ach) (10, 20, 50, and 100 μg/min) and nitrate (200 μg/min) infusions into the left coronary ostium. The vascular response was quantitatively measured in the 5-mm segments proximal and distal to the stent. Results In the drug-eluting stent groups, more intense vasoconstriction to incremental doses of Ach was observed at 6-month follow-up compared with the responses before stenting. Endothelial function associated with the ZES was more preserved at 6-month follow-up compared with the SES. Vasoconstriction to Ach was more prominent in the distal segments than the proximal segments in both the ZES and SES groups. Endothelium-independent vasodilation to nitrate did not differ significantly among the study groups. Conclusions Vasoconstriction in response to Ach in the peri-stent region was less pronounced in the ZES group than the SES group at 6-month follow-up, which suggests that endothelial function associated with ZES can be more preserved than the SES.

Congenital absence of left circumflex coronary artery (LCX) is a very rare congenital anomaly of the coronary circulation, and few cases have been reported in the literature. We report a case of a 48-year-old male who had congenital absence of LCX presented with vasospastic angina. Routine coronary angiography showed congenital absence of the LCX, typical myocardial bridge in the mid left anterior descending coronary artery (LAD) and super-dominant right coronary artery (RCA). The dominant LAD showed a spastic appearance at the baseline coronary angiography and significant spasm was induced by incremental intracoronary acetylcholine (ACh) provocation test at mid LAD where the myocardial bridge site was observed and was extended to the distal LAD. Typical anginal chest pain was documented during the Ach provocation test and the patient was stabilized with conventional anti-anginal medication. Precise morphological and functional evaluation of the anomalous coronary artery is important for selecting the best treatment modality and better prognosis.

In this case report, we describe a 59-year-old man with stentotic lesion of mid LAD and connection of bilateral coronary artery to pulmonary artery with some communications between two fistulas identified on multidetector computed tomography.

Superior mesenteric artery (SMA) aneurysms are the third most common visceral artery aneurysms. Diagnosis of SMA aneurysm can be achieved by abdominal ultrasonogram, postcontrast computed tomography (CT), three-dimensional (3-D) multidetector (MD) CT, or selective angiography of the SMA. 3-D MD CT may play an important role for the evaluation of characteristic morphology of SMA aneurysm and for delineation of the correct relationship between SMA aneurysm and other adjacent branches of the abdominal aorta. We report a case of huge SMA aneurysm visualized by 3-D MD CT images in detecting anatomic details and its role for the best surgical approach in a patient with huge SMA aneurysm.

Myocardial bridge (MB) is characterised by focal compression of a coronary artery in systole by an overlying band of myocardium. Chronic compression and relaxation of the MB may produce endothelial dysfunction by direct stress.To determine whether MB alters endothelial function, thus influencing the plaque formation.128 patients (mean (SD) age 54.7 (10.9) years, 56 men) with typical angiographic systolic milking effects and30% reduction in diameter of the coronary artery during systole after intracoronary nitrate (glyceryl trinitrate, 200 mug) infusion were studied. 231 control patients (mean (SD) age 52.9 (12.1) years, 111 men) without overt coronary artery disease including MB were also studied. Endothelial function was estimated by incremental acetylcholine (Ach) infusion into the left coronary ostium. Intracoronary ultrasound assessments were obtained in 74/128 patients with MB and 81/231 controls.The mean (SD) vasoconstrictive response to maximal Ach was more pronounced at the bridging segments than at matched segments in controls (-71.9 (14.9) vs -30.3 (22.6), p = 0.009). Coronary vasoconstriction (50%) to Ach was seen more often in the MB group than in controls (114/128 (89.1%) vs 81/231 (35.1%), p = 0.007). No significant correlation was found between the severity of MB and vasoconstriction in response to Ach. A typical half-moon phenomenon was seen in 71/74 (95.9%) cases of the MB group, but not in controls (p0.001). Plaques at the bridging segments were absent in 67/74 (90.5%) and mild in 7/74 (9.5%) cases, as compared with those of matched segments of the left anterior descending coronary artery in controls (plaque burden 5.91 (1.37)% vs 24.71 (24.21)%, p = 0.002).Despite the prominent relationship between MB and endothelial dysfunction, bridging segments are spared from atherosclerotic plaque formation.

The longstanding compression-relaxation effects of myocardial bridging may produce endothelial dysfunction by direct stress on the endothelium. We tested the hypothesis that myocardial bridging induces endothelial dysfunction and subsequently increases the risk of coronary spasm and investigated the symptomatic response to medication in patients with documented myocardial bridging and coronary spasm. In 81 patients with myocardial bridging (44 men; mean age 57.2 years) and 195 control patients without bridging and atherosclerotic lesions confirmed by angiography (97 men; mean age 58.4 years), spasm provocation testing was done by incremental acetylcholine infusion into the left coronary artery. Spasm was documented in 62 of 81 patients with bridging and in 31 of 195 controls (p0.001). A focal spasm was limited to the bridging segments compared with controls (p0.001). In conclusion, the results of this study showed that myocardial bridging increased the risk of coronary spasm by endothelial dysfunction in the bridging segment.

Supplemental Digital Content is available in the text., Objective This study aimed to compare 1-year clinical outcomes in diabetic and nondiabetic patients with chronic total occlusion (CTO) lesions. Methods A total of 2865 patients (age 62.82±10.64 years; 74.0% men) undergoing percutaneous coronary intervention for CTO were analyzed. The patients were classified as diabetic (n=977) or nondiabetic (n=1888). One-year clinical outcomes were compared between the two groups. Results One year after percutaneous coronary intervention, 241 (8.4%) patients developed major adverse cardiac events (MACEs). Target lesion revascularization (TLR), target vessel revascularization (TVR), TLR-MACEs, and total MACEs were more common in diabetics than in nondiabetics (6.1 vs. 3.9%, P=0.021; 7.2 vs. 4.8%, P=0.023; 7.7 vs. 5.5%, P=0.017; and 10.3 vs. 7.7%, P=0.011; respectively). In multivariate analysis, diabetes mellitus was an independent predictor for 1-year TLR (odds ratio: 2.201, P=0.001) and total MACEs (odds ratio: 1.677, P=0.002). Among diabetic patients, total death, TLR, TVR, TLR-MACEs, TVR-MACEs, and total MACEs were more common in patients who used insulin than in those who did not (6.1 vs. 1.9%, P=0.018; 11.3 vs. 4.6%, P=0.007; 12.2 vs. 5.9%, P=0.025; 14.8 vs. 5.9%, P=0.003; 16.5 vs. 8.0%, P=0.008; and 17.4 vs. 9.2%, P=0.012, respectively). Insulin use was an independent predictor for total death, 12-month TLR, TVR, TLR-MACEs, TVR-MACEs, and total MACEs. Conclusion This study identified diabetes mellitus as an independent risk factor for 1-year TLR and total MACEs in patients with CTO lesions.

There have been several reports showing that the statin use is associated with new-onset diabetes mellitus (DM). The aim of the present study was to evaluate the impact of chronic statin use on development of new-onset DM in a series of Asian population. The patients were retrospectively enrolled using the electronic database of Korea University Guro Hospital from January 2004 to February 2010. A total of 10,994 patients without a history of diabetes were analyzed. Baseline lipid profiles, fasting glucose, Hemoglobin (Hb) A1c, and glucose tolerance tests were measured in all patients before statin treatment. Included patients had HbA1c ≤ 5.7% and fasting glucose level ≤ 100 (mg/dl). The patients were divided into 2 groups according to the use of statins (the statin group, n = 2,324 patients and the nonstatin group, n = 8,670 patients). To adjust baseline potential confounders, a propensity score-matched analysis was performed using logistic regression model. After propensity score matching, 2 propensity-matched groups (1,699 pairs, n = 3,398, C statistic = 0.859) were generated and analyzed. After propensity score matching, baseline characteristics of both groups were balanced except that the statin group was older and had higher rate of coronary artery disease compared with the nonstatin group. During a 3-year follow-up, the statin group had higher incidence of new-onset DM compared with the nonstatin group (hazard ratio 1.99, 95% CI 1.36 to 2.92, p0.001), but the statin group showed lower incidence of major adverse cerebral-cardiovascular events compared with the nonstatin group (hazard ratio 0.40, 95% CI 0.19 to 0.85, p0.001). In the present study, although the use of statins was associated with higher rate of new-onset DM, it markedly improved 3-year cardiovascular outcomes in Asian population.

Structural remodeling of the left atrium is a risk factor for recurrent arrhythmia after catheter ablation for atrial fibrillation; however, data are sparse regarding the role of functional left atrial remodeling in predicting procedural outcomes. We evaluated whether left atrial transport function could be used to predict recurrent atrial fibrillation. From July 2008 through August 2010, we enrolled 202 consecutive patients who underwent catheter ablation for atrial fibrillation (paroxysmal=120, persistent=82). Left atrial volumes (LAVs) were measured by means of multislice computed tomography at every 10% of the R-R interval, and measurements were adjusted for body surface area to yield the LAV index (LAVI) at baseline. The left atrial emptying fraction (LAEF) was calculated according to LAV differences. During the mean follow-up period of 10 ± 4 months after a single ablation procedure, atrial fibrillation recurred in 59 patients (paroxysmal=19, persistent=40). Multivariate analysis revealed that persistent atrial fibrillation, early mitral inflow velocity, LAVImax, LAVImin, LAEF, LAVImax/LAEF, and LAVImin/LAEF were all independent predictors of atrial fibrillation, but the best predictor was LAVImin/LAEF (β=1.329, P=0.001). The cutoff value was 1.61 (mL/m2)/%, and the sensitivity and specificity were 74.6% and 62.2%, respectively (area under the curve=0.761). Our study shows that adjusted left atrial emptying fraction with use of multislice computed tomography might be a useful, noninvasive method to select patients for ablation.

Patients with acute coronary syndrome (ACS) are prone to ischemic stroke (IS) especially during the early phase. ACS patients are more likely to have concurrent complex carotid plaques which, when destabilized, may serve as a source of distal embolism. This study investigated whether inflammatory activity in carotid artery was increased in ACS survivors compared to chronic stable angina (CSA) patients.We prospectively enrolled 74 patients with ACS or CSA (39 ACS patients versus 35 CSA patients), and fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) was performed within 1 week after diagnosis. Carotid PET signal was quantified as standardized uptake value (SUV) and target-to-background ratio (TBR, carotid SUV/jugular venous SUV).Baseline characteristics were similar between groups. TBRs and SUVs were significantly higher in the carotid arteries of ACS patients than those of CSA patients (P.001). Systemic inflammatory biomarker correlated significantly with carotid FDG uptake (high-sensitivity C-reactive protein versus average SUV: r = .361, P = .002), and the presence of cardiovascular risk factors was also related to inflammation activity. During follow-up, 3 cerebrovascular events occurred in ACS patients (including 1 early IS in a patient with severe baseline carotid inflammation), whereas none in CSA patients (P = .057).This study provided in vivo evidence that ACS survivors might experience concurrent carotid arterial inflammation. Our findings supported the role of systemic immune activation contributing to multiarterial instability in symptomatic atherosclerosis as a possible mechanistic link between ACS and IS.

Critical limb ischemia (CLI) is associated with a high risk of cardiovascular ischemic events. We assessed the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty (PTA).Of a total 286 consecutive CLI patients treated by PTA, 252 patients who underwent coronary angiography before or after PTA were enrolled. Coronary artery disease (CAD) was defined as angiographic stenosis ≥50% and significant CAD as ≥70% stenosis.Of the 252 patients with CLI who underwent coronary angiography, a total of 167 patients (66.3%) had CAD and 85 patients (33.7%) did not have CAD. Patients in the CAD group were older, had a higher prevalence of diabetes and cerebrovascular disease, and had a lower mean ejection fraction. In the CAD group, of the 145 patients with significant CAD, percutaneous coronary intervention (PCI) was performed in 114 patients (78.6%). At 1 year, the CAD and non-CAD groups had no statistically significant differences in mortality (7.1% vs 4.7%; P=.45), myocardial infarction (1.1% vs 0%; P=.31), and PCI (4.7% vs 1.1%; P=.31). These outcomes were similar after the adjustment of baseline confounders. At 1 year, the CAD and non-CAD groups had similar rates of repeat PTA (16.7% vs 17.6%; P=.86), target lesion revascularization (13.7% vs 14.1%; P=.94), and amputation (19.1% vs 16.4%; P=.60).A strategy of routine coronary angiography and coronary revascularization may be a reasonable treatment option for these patients who have high risk for severe CAD. A randomized trial is needed to determine if this is the preferred strategy for CLI patients.

Peripheral arterial disease (PAD) is associated with poor outcomes. We assessed the clinical outcomes of diabetic versus non-diabetic patients with PAD who underwent peripheral transluminal angioplasty (PTA).The outcomes of 239 consecutive patients with symptomatic PAD who underwent PTA were analyzed. Restenosis and clinical outcomes were assessed at a follow-up of 2 years.Diabetic patients had a higher percentage of wound as the initial diagnosis for PTA (72.7% vs. 14.2%; P.001), chronic kidney disease (26.7% vs. 6.3%; P.01), need for dialysis (19.3% vs. 3.1%; P.01), and coronary artery disease (67.6% vs. 50.7%; P=.02). Infrapopliteal PTA was more commonly performed in the diabetic group (70.4% vs. 25.3%; P.001). Diabetic patients had lower rates of angiographic follow-up at 8 months (38.6% vs. 60.3%; P.01). Diabetic patients had higher binary restenosis (54.4% vs. 31.5%; P=.02) and had a trend toward a higher incidence of total occlusion (34.0% vs. 19.5%; P=.08). At 2-year follow-up, the amputation rate was higher in the diabetic group (24.4% vs. 1.5%; P.001) despite PTA.Diabetic patients more frequently presented with critical limb ischemia compared with non-diabetic patients and had higher rates of restenosis and amputation at 2 years following standard PTA. Improved therapies are needed for this high-risk group of patients.

Recently, it was reported that statins are associated with lower rates of major adverse cardiovascular events and amputations in critical limb ischemia (CLI) patients (pts). However, the impact of statin administration duration on clinical outcomes for pts undergoing percutaneous transluminal

There are limited data comparing the safety and efficacy of newer generation Platinum Chromium Everolimus-eluting Stent (PtCr-EES, Promus ElementTM, Boston Scientific) with Cobalt Chromium EES (CoCr-EES, PromusTM, Boston Scientific and XienceTM, Abbott Vascular) in a series of Asian population. A

Macrophages are an essential component of the immune response to ischaemic injury and play an important role in promoting inflammation and its resolution, which is necessary for tissue repair. The type I transmembrane glycoprotein CD163 is exclusively expressed on macrophages, where it acts as a receptor for haemoglobin:haptoglobin complexes. An extracellular portion of CD163 circulates in the blood as a soluble protein, for which no physiological function has so far been described. Here we show that during ischaemia, soluble CD163 functions as a decoy receptor for TWEAK, a secreted pro-inflammatory cytokine of the tumour necrosis factor family, to regulate TWEAK-induced activation of canonical nuclear factor-κB (NF-κB) and Notch signalling necessary for myogenic progenitor cell proliferation. Mice with deletion of CD163 have transiently elevated levels of TWEAK, which stimulate muscle satellite cell proliferation and tissue regeneration in their ischaemic and non-ischaemic limbs. These results reveal a role for soluble CD163 in regulating muscle regeneration after ischaemic injury., CD163 is a glycoprotein receptor expressed on the surface of macrophages. Here, the authors demonstrate that a soluble form of CD163 can act as a decoy receptor for the pro inflammatory cytokine TWEAK, thereby revealing a new mechanism for the regulation of tissue repair after ischaemic injury.

Diabetes mellitus (DM) is known to be a risk factor of significant coronary artery disease (CAD) and endothelial dysfunction. However, currently there is limited data regarding the impact of insulin treatment on significant coronary artery spasm (CAS) in real world clinical practice particularly in

Hypertension (HTN) and its organ damage such as left ventricular hypertrophy (LVH) can lead to worsening heart failure, cardiovascular morbidity and mortality. However, there are limited data regarding the impact of LVH in HTN patients (pts) who underwent successful percutaneous coronary

There is limited long-term clinical outcome data comparing 1st- versus 2nd-generation drug-eluting stents (DESs) in patients with coronary chronic total occlusion (CTO) who underwent successful percutaneous coronary intervention (PCI). We investigated the 5-year major clinical outcomes of 1st

Background: Stent overlapping was associated with adverse clinical outcomes and inreased target lesion revasularization (TLR) after percutaneous coronary intervention (PCI) using bare-metal stents....

Purpose: There are few clinical outcome data comparing first- versus second-generation drug-eluting stents (DESs) in patients with acute myocardial infarction (AMI) who underwent successful percutaneous coronary intervention (PCI). We investigated the 3-year major clinical outcomes between first- versus second-generation DESs in AMI patients. Methods: From January 2004 to May 2011, a total of 883 AMI patients were enrolled. Patients were excluded if they had: (1) bare-metal stent or other types of DESs (e.g., third generation DESs or Bioabsorbable vascular scaffold) implantation, (2) balloon angioplasty alone, (3) incomplete or invalid data. Finally a total of 749 eligible AMI patients who underwent PCI with first-generation DESs (Paclitaxel- or Sirolimus-eluting stent, n = 386) or second-generation DESs (Zotarolimus or Everolimus-eluting stent, n = 363) were enrolled. To adjust baseline confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model and 2 propensi...

Stent length is one of the predictors of adverse clinical outcomes after percutaneous coronary intervention (PCI) with the bare-metal and first-generation drug eluting stents (DES). The aim of this study is to assess the impact of stent length on long-term clinical outcomes following PCI with second

Background: Unprotected left main coronary artery (ULMCA) in the setting of acute myocardial infarction (AMI) is rare but devastating with high mortality rate. However there were limited data regarding incidence and prognosis of AMI with ULMCA disease treated with percutaneous coronary intervention

Background: Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARB) are known to have similar effects on cardiovascular outcomes including total mortality in head-to-head trials, and ACE inhibitors, in particular, are recommended for diabetic patients. However, data is