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Background and Objectives:Primary (idiopathic) pulmonary hypertension is a rare, progressive and fatal dise- ase. It has been defined, by the World Health Organization, as a mean pulmonary arterial pressure greater than 25 mmHg at rest, or greater than 30 mmHg during exercise, without the apparent cause of secondary pulmonary hypertension. This study was performed to better understanding the clinical presentation, natural history and prognosis of primary pulmonary hypertension. Subjects and Methods:A total of 18 patients, who were diagno- sed as primary pulmonary hypertension, at three University Hospitals, were retrospectively reviewed. All patients had undergone echocardiography and cardiac catheterization. Results:With the patients there was a male: female ratio of 1:8, ranging in age between 10 and 50 years. The most common presenting symptom was dysp- nea on exertion, with other symptoms comprising of fatigue in 11, chest pain in 5, syncope in 3 and hemoptysis in 2. The ECG & echocardiography reflected the presence of right-sided heart enlargement. The average right ventricular systolic pressure, from Doppler echocardiography, was 73.6±18.8 mmHg. The mean pulmonary ar- tery pressure and pulmonary capillary wedge pressure were 52.9±18.4 and 9.2±3.1 mmHg, respectively. The survival times were within 30 and 21 to 60 months in 9 and the remaining patients, respectively. Conclusion: We conclude that primary pulmonary hypertension is common in female patients in their third to fifth decades. This study also showed a poor prognosis, as in other reports. (Korean Circulation J 2003;33 (6):507-512)

Background and Objectives:The optimal treatment for in-stent restenosis (ISR) is controversial, although intracoronary radiation therapy (ICRT) has provided the most consistent results to date. This study was designed to assess the early and late angiographic results, and to find independent predictors of recurrent restenosis, following cutting balloon angioplasty (CBA) for ISR. Subjects and Methods:Eighty patients (87 lesions) with first time ISR underwent CBA and systematic follow-up (FU) angiography. A conventional balloon was used before, or after, the CBA, if required. ICRT was used in 18 lesions (21%). A multivariate logistic regression analysis was performed. (Why?) Results:The ISR was focal (n=32, 37%), diffuse or proliferative (n=51, 58%) and occlusive (n=4, 5%). Procedural success was achieved in all 87 lesions (100%). No significant edge dissection occurred. The preand post-procedural diameter stenoses (DS) were 81.5±10.8% and 6.7±6.0%, respectively, and the preand post-procedural MLD (Define MLD?) 0.71±0.44 mm and 2.85±0.32 mm, respectively, with 2.14±0.44 mm of acute gain. A FU angiography was performed in 54 (78%) of the 69 lesions treated with CBA alone. The overall angiographic restenosis rate was 24% (13/54), with 9% (2/22) in the focal ISR and 34% (11/32) in the diffuse or occlusive ISR. The FU DS and MLD were 32.0±23.4% and 2.1±0.7 mm, respectively, with 0.79±0.69 mm of late loss. The length of a restenotic lesion (OR 12.2, 95% CI:1.3115.2, p=0.0286) was an independent predictor of recurrent restenosis. Conclusion:CBA is a simple and efficient first line treatment for ISR, with an acceptable restenosis rate, and the length of a restenotic lesion is an independent predictor of recurrent restenosis. In diffuse or occlusive ISR, more definite treatment modalities, such as ICRT combined with CBA or debulking techniques, might be required to reduce recurrent restenosis. (Korean Circulation J 2003;33 (3):196-204)

Background:Percutaneous transluminal coronary angioplasty (PTCA) is a widely acceptable treatment for ischemic heart disease. However, restenosis after successful PTCA, which develops in 20-30% of all patients, remains a serious late complication. This study was performed to compare the efficacy of cilostazol with that of ticlopidine for the prevention of stent restenosis. Materials and Methods:Fifty three patients who had undergone coronary stent implantation were divided into group A (n=25) receiving 100 mg aspirin and 200 mg cilostazol and group B (n=28) receiving 100 mg aspirin and 500 mg ticlopidine, between Sep 1998 and Feb 1999 at Pusan Paik Hospital, Inje University. Clinical and laboratory evaluations were preformed at regular intervals. Results:There were no differences in baseline characteristics between the two groups. Coronary artery restenosis was observed in 5 (20.8%) patients of group A and 8 (26%) of group B, a difference which was not statistically significant (p=NS). The minimal luminal diameter was 2.10±0.89 mm in group A and 1.93±0.65 mm in group B (p=NS). Two patients in group A complained of headaches, while 6 (21. 4%) patients of group B developed side effects including thrombocytopenia in 2 patients, and skin rash in 2 patients (Edwhat of the remaining 2 patients with side effects in group B?). No instances of cardiac death occurred during the follow-up period. Conclusion:The findings of this study suggest that aspirin plus cilostazol may be a safer as well as an qually antithrombotic regimen, compared to that of aspirin plus ticolpidine, for recovery after elective coronary stent implantation.(Korean Circulation J 2001;31(8):780-787)

Background:Bevantolol HCl was developed as the first antihypertensive agent that has selective β1 and α 1 blocking effects with an additional calcium antagonistic activity. It's expected that antihypertensive effect is comparable to other beta-blockers without any significant adverse effect on lipid and glucose metabolism observed in other drugs, and It has less negative inotropic effect due to peripheral vasodilatation mediated through α1 and calcium channel blocking effects. To evaluate the antihypertensive effect and safety of bevantolol HCl, we investigated 73 patients with mild to moderately severe essential hypertension. Methods: Patients who showed either systolic blood pressure 150-209 mmHg or diastolic pressure 95- 119 mmHg, were enrolled in this study. Following placebo period of 2weeks, bevantolol HCl was administered in daily dose of 100-200 mg for 12 weeks. Results:Of the 73 patients, 55 patients who were able to receive bevantolol HCl were observed for the safety and 45 patients who completed this study were evaluated for the antihypertensive effect of the drug. 1 Antihypertensive effect:The mean systolic and diastolic blood pressure significantly decreased from 156.7±11.7 mmHg to 144.0±16.7 mmHg and from 101.6±6.4 mmHg to 93.2±9.7 mmHg in two weeks of observation in 37/45 patients (82.2% and was consistently effective for 12 weeks (p

ObjectivesThe aim of this study was to determine which drug-eluting stent (DES) is preferable for the treatment of ST-segment elevation myocardial infarction (STEMI) and to elucidate the impact of diabetes mellitus on the outcome of each DES.BackgroundRecent studies have shown the benefit of DES in patients with STEMI. Diabetes mellitus might differentially affect outcomes of each DES.MethodsWe analyzed the large-scale, prospective, observational KAMIR (Korea Acute Myocardial Infarction Registry) study, which enrolled 4,416 STEMI patients (26% with diabetes) treated with paclitaxel-eluting stent (PES) or sirolimus-eluting stent (SES). Primary outcome was major adverse cardiac event (MACE), defined as a composite of mortality, nonfatal myocardial infarction, and target lesion revascularization (TLR).ResultsIn the overall population, the MACE rate at 1 year was significantly higher in the PES than the SES group (11.6% vs. 8.6%, p = 0.014), which was mainly due to increased TLR (3.7% vs. 1.8%, p < 0.001). In the diabetic subgroup, however, the MACE rate was not significantly different between PES and SES (14.5% vs. 12.3%, p = 0.217), in contrast to the nondiabetic subgroup, where PES was inferior to SES as in the overall population. Matching by propensity-score did not significantly alter these results. For TLR, there was interaction between the type of stents and diabetes mellitus (unadjusted: p = 0.052; after propensity-score matching: p = 0.035).ConclusionsThe PES was inferior to the SES in the overall population, with regard to the occurrence of MACE and TLR. However, subgroup analysis for diabetic subjects showed no differences in clinical outcomes between PES and SES. These results suggest that diabetes differentially affects the outcome of first-generation DES.

Background Previous randomized trials have showed the superiority of Paclitaxel-eluting stent over bare metal stent in angiographic and clinical outcomes. Coroflex Please™ stent is a newly developed drug eluting stent using the Coroflex™ stent platform combined with the drug paclitaxel contained in a polymer coating. PECOPS I trial, one-arm observational study, showed that the clinical and angiographic outcomes of Coroflex Please™ stent were within the range of those of Taxus, the 1st generation paclitaxel-eluting stent (PES). However, there have been no studies directly comparing the Coroflex Please™ stent with the Taxus Liberte™ stent that is the newest version of Taxus. Therefore, prospective, randomized trial is required to demonstrate the non-inferiority of Coroflex Please™ stent compared with Taxus Liberte™ stent in a head-to-head manner. Methods In the comparison of Efficacy between COroflex PLEASe™ ANd Taxus™ stent(ECO-PLEASANT) trial, approximately 900 patients are being prospectively and randomly assigned to the either type of Coroflex Please™ stent and Taxus Liberte™ stent via web-based randomization. The primary endpoint is clinically driven target vessel revascularization at 9 months. The secondary endpoints include major cardiac adverse events, target vessel failure, stent thrombosis and angiographic efficacy endpoints. Discussion The ECO-PLEASANT trial is the study not yet performed to directly compare the efficacy and safety of the Coroflex Please™ versus Taxus Liberte™ stent. On the basis of this trial, we will be able to find out whether the Coroflex Please™ stent is non-inferior to Taxus Liberte™ stent or not. Trial registration ClinicalTrials.gov number, NCT00699543.

Patient initials or identifier number LSW ### Relevant clinical history and physical exam A 51 year-old male was presented with dyspnea on exertion for 4 months. He was a smoker and had hypertension with medication for 10 years. His clinical presentation was unstable angina. Physical

Stenting of small vessels might be associated with higher rates of adverse events. The relationship between stent strut thickness and adverse clinical events remains particularly evident in smaller vessels. Recently published trial showed biolimus A9-eluting stent (BES) was non-inferior with