437 results on '"Chiung-Jen Wu"'
Search Results
2. The comparison of efficacy and safety between transradial and transfemoral approach for chronic total occlusions intervention: a meta-analysis
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Wei-Chieh Lee, Po-Jui Wu, Chih-Yuan Fang, Hsiu-Yu Fang, Chiung-Jen Wu, and Ping-Yen Liu
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Medicine ,Science - Abstract
Abstract This meta-analysis compared the outcomes of transradial access (TRA) and transfemoral access (TFA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent decades. We searched multiple databases for articles published between January 1, 2015, and December 31, 2020. Six observational studies with 11,736 patients were analyzed. Data included baseline demographics, Japan-chronic total occlusion (J-CTO) score, sheath size, PCI vessel, retrograde method, procedural time, fluoroscopy time, and contrast volume. The more prevalent target CTO vessel was the left coronary artery in the TRA group and the right coronary artery in the TFA group. Higher J-CTO score, longer procedural time, and more contrast volume were seen in the TFA group. In comparison, the TRA group had better procedural success rate (odds ratio (OR), 0.846; 95% confidence interval (CI) 0.749–0.956) and less vascular complications (OR, 0.323; 95% CI 0.203–0.515), but similar retrograde success rate (OR, 0.965; 95% CI 0.382–2.435). In-hospital death (OR, 0.527; 95% CI 0.187–1.489) and major adverse cardiovascular events (OR, 0.729; 95% CI 0.504–1.054) did not differ between the groups. Overall, fewer vascular complications and higher procedural success rates were noted in the TRA CTO PCI population. However, similar retrograde success rates and clinical outcomes were noted between the groups.
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- 2022
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3. Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access
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Cheng-Jui Lin, Wei-Chieh Lee, Chieh-Ho Lee, Wen-Jung Chung, Shu-Kai Hsueh, Chien-Jen Chen, Cheng-Hsu Yang, Hsiu-Yu Fang, Cheng-I Cheng, and Chiung-Jen Wu
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chronic total occlusion ,percutaneous coronary intervention ,distal transradial access ,snuffbox access ,vascular complication ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA).Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded.Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach.Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.
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- 2021
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4. Impact of electrocardiographic morphology on clinical outcomes in patients with non-ST elevation myocardial infarction receiving coronary angiography and intervention: a retrospective study
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Chiung-Jen Wu, Kuo-Ho Yeh, Hui-Ting Wang, Wen-Hao Liu, Huang-Chung Chen, Han-Tan Chai, Wen-Jung Chung, Shukai Hsueh, Chien-Jen Chen, Hsiu-Yu Fang, and Yung-Lung Chen
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Non-ST segment elevation myocardial infarction ,Electrocardiographic morphology ,ST depression ,Percutaneous coronary intervention ,Clinical outcomes ,Medicine ,Biology (General) ,QH301-705.5 - Abstract
Background The impact of electrocardiography (ECG) morphology on clinical outcomes in patients with non-ST segment elevation myocardial infarction (NSTEMI) receiving percutaneous coronary intervention (PCI) is unknown. This study investigated whether different ST morphologies had different clinical outcomes in patients with NSTEMI receiving PCI. Methods This retrospective study analyzed record-linked data of 362 patients who had received PCI for NSTEMI between January 2008 and December 2010. ECG revealed ST depression in 67 patients, inverted T wave in 91 patients, and no significant ST-T changes in 204 patients. The primary endpoint was long-term all-cause mortality. The secondary endpoint was long-term cardiac death and non-fatal major adverse cardiac events. Results Compared to those patients whose ECG showed an inverted T wave and non-specific ST-T changes, patients whose ECG showed ST depression had more diabetes mellitus, advanced chronic kidney disease (CKD) and left main artery disease, as well as more in-hospital mortality, cardiac death and pulmonary edema during hospitalization. Patients with ST depression had a significantly higher rate of long-term total mortality and cardiac death. Finally, multiple stepwise Cox regression analysis showed that an advanced Killip score, age, advanced CKD, prior percutaneous transluminal coronary angioplasty and ST depression were independent predictors of the primary endpoint. Conclusions Among NSTEMI patients undergoing coronary angiography, those with ST depression had more in-hospital mortality and cardiac death. Long-term follow-up of patients with ST depression consistently reveals poor outcomes.
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- 2020
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5. No correlation between body mass index and 30-day prognostic outcome in Asians with acute ST-elevation myocardial infarction undergoing primary coronary intervention
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Po-Jui Wu, Hui-Ting Wang, Pei-Hsun Sung, Meng-Shen Tong, Cheng-Hsu Yang, Chien-Jen Chen, Cheng-Jei Lin, Shu-Kai Hsueh, Sheng-Ying Chung, Wen-Jung Chung, Chi-Ling Hang, Chiung-Jen Wu, and Hon-Kan Yip
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Acute ST-segment elevation myocardial infarction ,Overweight ,Obesity ,Primary PCI ,30-day prognostic outcome ,Medicine (General) ,R5-920 ,Biology (General) ,QH301-705.5 - Abstract
Background: This study investigated whether body mass index (BMI) was a risk factor predictive of 30-day prognostic outcome in Asians with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Material and methods: Data regarding the impact of BMI on the prognostic outcome in Asian populations after acute STEMI is scarce. A number of 925 STEMI patients were divided into three groups according to the BMI: normal weight (
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- 2017
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6. Comparison of clinical outcomes after drug-eluting balloon and drug-eluting stent use for in-stent restenosis related acute myocardial infarction: a retrospective study
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Chih-Yuan Fang, Hsiu-Yu Fang, Chien-Jen Chen, Cheng-Hsu Yang, Chiung-Jen Wu, and Wei-Chieh Lee
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Drug-eluting stent ,Acute myocardial infarction ,Drug-eluting balloon ,In-stent restenosis ,Medicine ,Biology (General) ,QH301-705.5 - Abstract
Background Good results of drug-eluting balloon (DEB) use are achieved in in-stent restenosis (ISR) lesions, small vessel disease, long lesions, and bifurcations. However, few reports exist about DEB use in acute myocardial infarction (AMI) with ISR. This study’s aim was to evaluate the efficacy of DEB for AMI with ISR. Methods Between November 2011 and December 2015, 117 consecutive patients experienced AMI including ST-segment elevation MI, and non-ST-segment elevation MI due to ISR, and received percutaneous coronary intervention (PCI). We divided our patients into two groups: (1) PCI with further DEB, and (2) PCI with further drug-eluting stent (DES). Clinical outcomes such as target lesion revascularization, target vessel revascularization, recurrent MI, stroke, cardiovascular mortality, and all-cause mortality were analyzed. Results The patients’ average age was 68.37 ± 11.41 years; 69.2% were male. A total of 75 patients were enrolled in the DEB group, and 42 patients were enrolled in the DES group. The baseline characteristics between the two groups were the same without statistical differences except for gender. Peak levels of cardiac biomarker, pre- and post-PCI cardiac function were similar between two groups. The major adverse cardiac cerebral events rate (34.0% vs. 35.7%; p = 0.688) and cardiovascular mortality rate (11.7% vs. 12.8%; p = 1.000) were similar in both groups. Conclusions DEB is a reasonable strategy for AMI with ISR. Compared with DES, DEB is an alternative strategy which yielded acceptable short-term outcomes and similar 1-year clinical outcomes.
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- 2018
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7. Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters
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Huang-Chung Chen, Wei-Chieh Lee, Shu-Kai Hsueh, Cheng-I Cheng, Chien-Jen Chen, Cheng-Hsu Yang, Chih-Yuan Fang, Chi-Ling Hang, Hon-Kan Yip, Chiung-Jen Wu, and Hsiu-Yu Fang
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Transradial approach ,Percutaneous coronary intervention ,Chronic total occlusion ,Sheathless guiding catheter ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objectives: Our aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions using the sheathless technique with standard guiding catheters. Background: Transradial approach PCI was applied for CTO lesions. A major limitation of TRA CTO PCI is the inability to use large guiding catheters because of the relatively small size of the radial artery. Therefore, the sheathless technique for TRA PCI has been recently developed. However, reports on TRA CTO PCI using the sheathless technique are still lacking. Methods: Sixty-eight patients with CTO lesions were enrolled for TRA PCI using the sheathless technique with standard guiding catheters. The baseline characteristics, coronary angiographic characteristics and major procedure or access site related complications were compared between procedure success and procedure failure group to determine the predictors of success in sheathless CTO PCI. In-hospital and 30-day clinical outcomes were also evaluated in this study. Routine assessments of radial artery occlusion via Doppler ultrasound and pulse oximeter were recorded during one-year clinical follow-up. Results: The mean duration of CTO by history was 31.8 ± 42.3 months. The 7 Fr standard guiding catheter was used with the sheathless technique in 91.2%, and bilateral sheathless approach in 42.6% of the study patients. The procedure-related complications included coronary perforation needing covered stent deployment (2.9%), cardiac tamponade (2.9%), collateral perforation needing coil deployment (4.4%), and contrast induced nephropathy (2.9%). Only 2 patients (2.9%) experienced forearm ecchymosis at the radial artery access sites. In-hospital mortality and 30-day all-cause mortality were 2.9%, and 30-day MACEs were 1.5%. The rate of radial artery occlusion during one-year clinical follow-up was only 3.0%. Conclusions: It is feasible and safe to routinely use the sheathless technique with standard guiding catheters for TRA CTO PCI, with a low incidence of procedure-related complications and long-term radial artery occlusion.
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- 2015
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8. Predictors of 1-year outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry
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Fu-Tien Chiang, Kou-Gi Shyu, Chiung-Jen Wu, Guang-Yuan Mar, Charles Jia-Yin Hou, Ai-Hsien Li, Ming-Shien Wen, Wen-Ter Lai, Shing-Jong Lin, Chi-Tai Kuo, Chieh Kuo, Yi-Heng Li, and Juey-Jen Hwang
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acute coronary syndrome ,antiplatelet agents ,clopidogrel ,survival rates ,Taiwan ,Medicine (General) ,R5-920 - Abstract
Evidence-based guidelines have been formulated for optimal management of acute coronary syndrome (ACS). The Taiwan ACS Full Spectrum Registry aimed to evaluate the ACS management and identify the predictors of clinical outcomes of death/myocardial infarction/stroke 1 year post hospital discharge. Methods: Three thousand and eighty confirmed ACS patients enrolled in this registry were followed up for 1 year at 3-month intervals. Patient data on medical interventions as well as clinical events were recorded and analyzed by descriptive statistics. Results: One-year mortality among patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina was 6.1%, 10.1%, and 6.2%, respectively. Use of secondary preventive therapies was suboptimal throughout the follow-up phase, especially dual antiplatelet therapy, which fell from 74.8% patients at discharge to 24.9% patients at 1-year follow-up. The odds of an adverse incidence of death/myocardial infarction/stroke 1 year after discharge was significantly reduced in patients receiving aspirin and clopidogrel for ≥9 months and was consequently higher in patients in whom dual antiplatelet therapy was discontinued or prescribed for
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- 2014
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9. Anemia: A significant cardiovascular mortality risk after ST-segment elevation myocardial infarction complicated by the comorbidities of hypertension and kidney disease.
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Wei-Chieh Lee, Hsiu-Yu Fang, Huang-Chung Chen, Chien-Jen Chen, Cheng-Hsu Yang, Chi-Ling Hang, Chiung-Jen Wu, and Chih-Yuan Fang
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Medicine ,Science - Abstract
The effect of anemia on patients with ST-segment elevation myocardial infarction (STEMI) remains a controversial issue. The aim of this study was to explore the effect of anemia on STEMI patients.From January 2005 to December 2014, 1751 patients experienced STEMI checked serum hemoglobin initially before any administration of fluids or IV medications. 1751 patients then received primary percutaneous intervention immediately. A total of 1388 patients were enrolled in the non-anemia group because their serum hemoglobin level was more than 13 g/L in males, and 12 g/L in females. A total of 363 patients were enrolled in the anemia group because their serum hemoglobin level was less than 13 g/L in males, and 12 g/L in females. Higher incidences of major adverse cerebral cardiac events (22.9% vs. 33.8%; p
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- 2017
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10. Liraglutide Inhibits Endothelial-to-Mesenchymal Transition and Attenuates Neointima Formation after Endovascular Injury in Streptozotocin-Induced Diabetic Mice
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Tzu-Hsien Tsai, Chien-Ho Lee, Cheng-I Cheng, Yen-Nan Fang, Sheng-Ying Chung, Shyh-Ming Chen, Cheng-Jei Lin, Chiung-Jen Wu, Chi-Ling Hang, and Wei-Yu Chen
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endothelial-mesenchymal transition ,hyperglycaemia ,liraglutide ,neointima formation ,Cytology ,QH573-671 - Abstract
Hyperglycaemia causes endothelial dysfunction, which is the initial process in the development of diabetic vascular complications. Upon injury, endothelial cells undergo an endothelial-to-mesenchymal transition (EndMT), lose their specific marker, and gain mesenchymal phenotypes. This study investigated the effect of liraglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist, on EndMT inhibition and neointima formation in diabetic mice induced by streptozotocin. The diabetic mice with a wire-induced vascular injury in the right carotid artery were treated with or without liraglutide for four weeks. The degree of neointima formation and re-endothelialisation was evaluated by histological assessments. Endothelial fate tracing revealed that endothelium-derived cells contribute to neointima formation through EndMT in vivo. In the diabetic mouse model, liraglutide attenuated wire injury-induced neointima formation and accelerated re-endothelialisation. In vitro, a high glucose condition (30 mmol/L) triggered morphological changes and mesenchymal marker expression in human umbilical vein endothelial cells (HUVECs), which were attenuated by liraglutide or Activin receptor-like 5 (ALK5) inhibitor SB431542. The inhibition of AMP-activated protein kinase (AMPK) signaling by Compound C diminished the liraglutide-mediated inhibitory effect on EndMT. Collectively, liraglutide was found to attenuate neointima formation in diabetic mice partially through EndMT inhibition, extending the potential therapeutic role of liraglutide.
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- 2019
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11. Impact of chronic obstructive pulmonary disease on patient with acute myocardial infarction undergoing primary percutaneous coronary intervention
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Pei-Hsun Sung, Sheng-Ying Chung, Cheuk-Kwan Sun, Cheng-Hsu Yang, Shyh-Ming Chen, Chi-Ling Hang, Chien-Jen Chen, Kuo-Ho Yeh, Yung-Lung Chen, Chiung-Jen Wu, Hsuen-wen Chang, Tzu-Hsien Tsai, and Hon-Kan Yip
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Acute myocardial infarction ,chronic obstructive lung disease ,clinical outcome ,Medicine (General) ,R5-920 ,Biology (General) ,QH301-705.5 - Abstract
Background: This study reported the incidence and prognostic outcome of chronic obstructive lung disease (COPD) patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: Between January 2002 and May 2011, totally 1554 consecutive patients who experienced STEMI undergoing primary PCI were enrolled into the study. Results: Of the 1554 patients, 124 (9.7%) with diagnosis of COPD and 1430 (90.3%) without COPD were categorized into group 1 and group 2. Although no difference in in-hospital mortality was noted between the two groups (p = 0.726). However, the hospitalization duration was notably longer (p = 0.003), the incidences of recurrent MI and re-hospitalization for congestive heart failure were significantly higher in group 1 than in group 2 (all p < 0.02). Although Kaplan-Meier analysis demonstrated that the incidence of freedom from one-year major adverse clinical outcome (MACO) (defined as recurrent MI, re-admission for congestive heart failure was significantly lower in group 1 than group 2 (p = 0.012), multivariate Cox regression analysis showed COPD was not an independent predictor of MACO-free time after adjusting traditional risk factors. Conclusion: COPD was not an independent predictor of short-term and medium-term MACO in patients with STEMI undergoing primary PCI.
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- 2013
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12. Long-term Outcomes of Carotid Artery Stenting for Radiation-Associated Stenosis
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Min-Ping Huang, Hsiu-Yu Fang, Chung-Yu Chen, Teng-Yeow Tan, Yeh-Lin Kuo, I-Chang Hsieh, Hon-Kan Yip, and Chiung-Jen Wu
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carotid artery stenosis ,carotid stenting ,radiotherapy ,Medicine (General) ,R5-920 ,Biology (General) ,QH301-705.5 - Abstract
Background: In Taiwan, the prevalence of head and neck cancer is relatively high. Because radiation-associated carotid stenosis is a significant risk factor for stroke, carotid artery stenting (CAS), instead of carotid endarterectomy, is indicated in patients with radiation-associated carotid stenosis. We sought to evaluate the effect of neck radiotherapy (XRT) on the long-term outcome of patients undergoing CAS. Methods: From March 2001 to November 2011, 147 CAS procedures were performed on 129 patients (n = 43 for XRT, n = 86 for non-XRT). Mean follow-up was 42.7 ± 20.5 months (median: 52 months; range: 1-60 months). Duplex velocity criterion for > 50% restenosis after CAS was defined as peak systolic velocity > 175 cm/s. Endpoints included 5-year freedom from mortality, ipsilateral recurrent stroke, and major adverse cardiovascular events (MACE). Results: The mean age of XRT patients was significantly lesser than that of non-XRT patients (61 ± 8 vs. 71 ± 8, p < 0.001). There was significantly less coronary artery disease and other cardiovascular co-morbidities in XRT patients. No significant differences were noted in the composite 30-day ipsilateral stroke/myocardial infarction/mortality (XRT: 8.6% vs. non-XRT: 6%, p > 0.05) and 5-year freedom from mortality, ipsilateral recurrent stroke, and MACE (p > 0.05) between the two groups. Intra-stent carotid restenosis > 50% was significantly higher in the XRT group on follow-up. Conclusion : Long-term outcomes of CAS for radiation-associated stenosis were not altered by a history of neck XRT, except for asymptomatic carotid restenosis.
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- 2013
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13. Assessment of reasons for not intensifying antihypertensive treatment in the Taiwanese population
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Chiung-Jen Wu, Kwo-Chuan Lin, Sien-Tsong Chen, Wen-Ter Lai, Chun-Peng Liu, Shou-Shan Chiang, Yu-Yao Huang, and Paolo Ferrari
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antihypertensives ,guidelines ,hypertension ,Taiwan ,therapeutic inertia ,Medicine (General) ,R5-920 - Abstract
Despite availability of effective antihypertensives, blood pressure (BP) control is usually inadequate. The Reasons for not Intensifying Antihypertensive Treatment (RIAT) registry evaluated the reasons behind not modifying treatment in an international, cross-sectional study in 16 countries. Methods and results: The Taiwanese cohort of RIAT consisted of 8922 patients with untreated/uncontrolled essential hypertension recruited from 22 centers in the country. At the first visit, physicians selected target BP and antihypertensive treatment, and at the next three visits they measured BP and modified treatment/provided justification for not modifying treatment. Mean target BP selected by physicians was 134.6/84.6 ± 5.1/5.0 mmHg, respectively. Patients’ individual risk stratification determined the BP goals. More patients achieved targets according to the physicians’ opinion than based on actual BP measurements: visit 2–50.6% vs. 48.6%; visit 3–58.4% vs. 55.2%; and visit 4–61.2% vs. 57.0%. At each visit, treatment remained unchanged for >60% patients not reaching target; the most common reason for this at visit 2 was the assumption that the time was too short to assess new drug therapy and at visits 3 and 4 was the assumption that target was reached/had almost been reached. Conclusion: About 40% Taiwanese hypertensive patients in RIAT did not reach BP targets after an average of 4 months’ follow-up. The most common reason for not modifying treatment was the assumption that the target had been reached or had almost been reached.
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- 2011
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14. Safety and feasibility of coronary stenting in unprotected left main coronary artery disease in the real world clinical practice--a single center experience.
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Wei-Chieh Lee, Tzu-Hsien Tsai, Yung-Lung Chen, Cheng-Hsu Yang, Shyh-Ming Chen, Chien-Jen Chen, Cheng-Jei Lin, Cheng-I Cheng, Chi-Ling Hang, Chiung-Jen Wu, and Hon-Kan Yip
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Medicine ,Science - Abstract
BACKGROUND: This study evaluated the feasibility, safety, and prognostic outcome in patients with significant unprotected left main coronary artery (ULMCA) disease undergoing stenting. METHOD AND RESULTS: Between January 2010 and December 2012, totally 309 patients, including those with stable angina [13.9% (43/309)], unstable angina [59.2% (183/309)], acute non-ST-segment elevation myocardial infarction (NSTEMI) [24.3% (75/309)], and post-STEMI angina (i.e., onset of STEMI50%) undergoing stenting using transradial arterial approach, were consecutively enrolled. The patients' mean age was 68.9±10.8 yrs. Incidences of advance congestive heart failure (CHF) (defined as ≥ NYHA Fc 3) and multi-vessel disease were 16.5% (51/309) and 80.6% (249/309), respectively. Mechanical supports, including IABP for critical patients (defined as LVEF
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- 2014
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15. Extracorporeal shock wave therapy reverses ischemia-related left ventricular dysfunction and remodeling: molecular-cellular and functional assessment.
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Morgan Fu, Cheuk-Kwan Sun, Yu-Chun Lin, Ching-Jen Wang, Chiung-Jen Wu, Sheung-Fat Ko, Sarah Chua, Jiunn-Jye Sheu, Chiang-Hua Chiang, Pei-Lin Shao, Steve Leu, and Hon-Kan Yip
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Medicine ,Science - Abstract
An optimal treatment for patients with diffuse obstructive arterial disease unsuitable for catheter-based or surgical intervention is still pending. This study tested the hypothesis that extracorporeal shock wave (ECSW) therapy may be a therapeutic alternative under such clinical situation. Myocardial ischemia was induced in male mini-pigs through applying an ameroid constrictor over mid-left anterior descending artery (LAD). Twelve mini-pigs were equally randomized into group 1 (Constrictor over LAD only) and group 2 (Constrictor over LAD plus ECSW [800 impulses at 0.09 mJ/mm(2)] once 3 months after the procedure). Results showed that the parameters measured by echocardiography did not differ between two groups on days 0 and 90. However, echocardiography and left ventricular (LV) angiography showed higher LV ejection fraction and lower LV end-systolic dimension and volume in group 2 on day 180 (p
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- 2011
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16. One-Year Clinical Outcomes in Acute ST-Segment Elevation Myocardial Infarction Patients Undergoing Optical Coherence Tomography-Guided Primary Percutaneous Coronary Intervention: A Comparative Study.
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Yen-Nan Fang, Wei-Chieh Lee, Chien-Jen Chen, Chiung-Jen Wu, Chih-Yuan Fang, and Hsiu-Yu Fang
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- 2024
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17. Cutting Balloon Combined with Drug-Coated Balloon Angioplasty for the Treatment of In-Stent Restenosis
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Chien-Jen Chen, Wei-Chieh Lee, Chiung-Jen Wu, Cheng-Hsu Yang, Chih-Yuan Fang, Hsiu-Yu Fang, and You-Cheng Zheng
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Angiography ,Balloon ,Cohort Studies ,Coronary Restenosis ,Lesion ,Percutaneous Coronary Intervention ,Coated Materials, Biocompatible ,Restenosis ,Angioplasty ,Humans ,Medicine ,Registries ,Angioplasty, Balloon, Coronary ,Aged ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Surgery ,Conventional PCI ,Propensity score matching ,Female ,Stents ,Cutting balloon ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Drug-coated balloon (DCB) has emerged as an alternative therapeutic choice for in-stent restenosis (ISR) lesions. Cutting balloon angioplasty (CBA) is also a strategy utilized to treat tight stenotic lesions or ISR lesions. Few studies have focused on whether CBA plus DCB could achieve a better result in lowering the incidence of recurrent ISR. This study aimed to evaluate the efficacy of CBA plus DCB for ISR lesions.Between August 2011 and December 2017, 681 patients (937 lesions) were diagnosed with ISR and treated with DCBs in our hospital. The CBA plus DCB group comprised 90 patients who underwent PCI with further CBA plus DCB, and the DCB alone group comprised 591 patients who underwent percutaneous coronary intervention (PCI) with DCB alone.Baseline characteristics, the types of previous stents, lesion type, prevalence of ostial lesion and left main lesion, and pre-PCI and post-PCI stenotic percentage showed no significant difference between the two groups. Only post-PCI reference luminal diameter and size of DCB were larger in the CBA plus DCB group. During the one-year follow-up period, late loss and clinical outcomes did not differ between the two groups before and after propensity score matching. The incidence of subtotal/total occlusion with delay flow was lower in the CBA plus DCB group after propensity score matching (4.1% versus 10.9%; P = 0.030).In these patients with ISR lesions, the clinical outcomes and the incidence of repeat target lesion revascularization were similar after treatment with CBA plus DCB versus DCB alone. Further study is warranted, including prospective, randomized comparisons.
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- 2021
18. TCTAP C-122 A Challenging Case Report: Multiple Complications in Three Consecutive Sessions
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Chun-Ting Shih and Chiung-Jen Wu
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Cardiology and Cardiovascular Medicine - Published
- 2023
19. One-year Outcomes of XIENCE Skypoint 48-mm Drug-Eluting Stents in Long Coronary Lesions: The SPIRIT 48 Trial
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Ki E. Park, Chiung-Jen Wu, Bassem Chehab, Aziz Maksoud, Barry Bertolet, Shih-Wa Ying, Tiessa Simoes, Sandeep C. Pingle, and Chi-Jen Chang
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- 2023
20. Intra-Coronary Administration of Tacrolimus Improves Myocardial Perfusion and Left Ventricular Function in Patients with ST-Segment Elevation Myocardial Infarction (COAT-STEMI) Undergoing Primary Percutaneous Coronary Intervention
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Pei-Hsun, Sung, Wei-Chun, Huang, Ting-Hsing, Chao, Cheng-Han, Lee, Teng-Yao, Yang, Yu-Sheng, Lin, Rei-Yeuh, Chang, Jun-Ted, Chong, Cheng-Hsu, Yang, Chieh-Jen, Chen, Sheng-Ying, Chung, Shu-Kai, Hsueh, Chiung-Jen, Wu, and Hon-Kan, Yip
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surgical procedures, operative ,Original Article ,cardiovascular diseases - Abstract
BACKGROUND: Ischemia-reperfusion injury following acute ST-segment elevation myocardial infarction (STEMI) is strongly related to inflammation. However, whether intracoronary (IC) tacrolimus, an immunosuppressant, can improve myocardial perfusion is uncertain. METHODS: A multicenter double-blind randomized controlled trial was conducted in Taiwan from 2014 to 2017. Among 316 STEMI patients with Killip class ≤ 3 undergoing primary percutaneous coronary intervention (PCI), 151 were assigned to the study group treated with IC tacrolimus 2.5 mg to the culprit vessel before first balloon inflation, and the remaining 165 were assigned to the placebo group receiving IC saline only. The primary endpoint was percentage of post-PCI TIMI-3 flow. The primary composite endpoints included achievement of TIMI-3 flow, TIMI- myocardial perfusion (TMP) grade, or 90-min ST-segment resolution (STR). The secondary endpoints were left ventricular ejection fraction (LVEF) and 1-month/1-year major adverse cardio-cerebral vascular events (MACCEs) (defined as death, myocardial infarction, stroke, target-vessel revascularization or re-hospitalization for heart failure). RESULTS: Although post-PCI TIMI-3 epicardial flow and MACCE rate at 1 month and 1 year did not differ between the two groups, TMP grade (2.54 vs. 2.23, p < 0.001) and 90-min STR (67% vs. 61%, p < 0.001) were significantly higher in the tacrolimus-treated group than in the placebo group. The STEMI patients treated with tacrolimus also had significantly higher 3D LVEF and less grade 2 or 3 LV diastolic dysfunction at 9 months compared to those without. CONCLUSIONS: IC tacrolimus for STEMI improved coronary microcirculation and 9-month LV systolic and diastolic functions. However, the benefit of tacrolimus on clinical outcomes remains inconclusive due to insufficient patient enrollment.
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- 2021
21. Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access
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Wen-Jung Chung, Hsiu-Yu Fang, Cheng-I Cheng, Wei-Chieh Lee, Chiung-Jen Wu, Chieh-Ho Lee, Cheng-Hsu Yang, Cheng-Jui Lin, Chien-Jen Chen, and Shu-Kai Hsueh
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medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Cardiovascular Medicine ,Total occlusion ,vascular complication ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Occlusion ,medicine ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Radial artery ,chronic total occlusion ,Procedure time ,Original Research ,business.industry ,percutaneous coronary intervention ,Percutaneous coronary intervention ,Surgery ,Antegrade approach ,distal transradial access ,RC666-701 ,Conventional PCI ,snuffbox access ,Retrograde approach ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA).Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded.Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach.Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.
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- 2021
22. The effect of complete revascularization in patients with ST-segment elevation myocardial infarction with Killip class ≥ III
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Chien-Jen Chen, Cheng-Hsu Yang, Tien-Yu Chen, Chih-Yuan Fang, Wei-Chieh Lee, Chiung-Jen Wu, and Hsiu-Yu Fang
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Revascularization ,Severity of Illness Index ,Killip Class III ,Coronary artery disease ,03 medical and health sciences ,Killip class ≥ III ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Postoperative Complications ,cardiovascular mortality ,Internal medicine ,Cause of Death ,Medicine ,ST segment ,Humans ,030212 general & internal medicine ,Myocardial infarction ,cardiovascular diseases ,Mortality ,Killip class ,Aged ,business.industry ,complete revascularization ,Coronary Stenosis ,Percutaneous coronary intervention ,General Medicine ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Myocardial Infarction/Cardiogenic Shock ,ST-segment elevation myocardial infarction ,surgical procedures, operative ,Treatment Outcome ,Cardiovascular Diseases ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The effect of complete revascularization (CR) on high-risk patients with ST-segment elevation myocardial infarction (STEMI) has remains a controversial issue, especially on patients in a critical condition. The aim of this study was to explore the effect of CR on patients with STEMI with Killip class ≥ III. Methods From January 2008 to December 2014, 185 patients diagnosed with STEMI with Killip class ≥ III and multiple vessel coronary artery disease received primary percutaneous coronary intervention (PCI). Eighty-nine patients underwent culprit-only PCI, and the remaining 96 patients underwent immediate or staged PCI for CR. Out of the 96 patients in the CR group, 51 patients underwent immediate CR, and 45 patients underwent CR during the same hospitalization. Thirty-day and 1-year clinical outcomes were compared between the culprit-only PCI group and the CR group as well as between the immediate CR group and staged CR group. Results There was a trend toward a lower incidence of post-PCI acute kidney injury in the culprit-only PCI group when compared with the CR group (14.8% vs. 26.0%; P = 0.069). Thirty-day and 1-year cardiovascular mortality and all-cause mortality were similar between the culprit-only PCI group and CR group. Decreased 1-year cardiovascular mortality and all-cause mortality were noted in the staged CR group compared with the immediate CR group. Conclusion was associated a higher possibility of post-PCI acute kidney injury and did not seem to improve 30-day or 1-year clinical outcomes. Patients undergoing staged CR during the same hospitalization had better clinical outcomes.
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- 2019
23. Impact of Chronic Kidney Disease on Chronic Total Occlusion Revascularization Outcomes: A Meta-Analysis
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Hsiu-Yu Fang, Huang-Chung Chen, Po-Jui Wu, Chih-Yuan Fang, Wei-Chieh Lee, and Chiung-Jen Wu
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Revascularization ,urologic and male genital diseases ,Article ,Nephropathy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,education ,chronic total occlusion ,education.field_of_study ,business.industry ,Mortality rate ,Incidence (epidemiology) ,percutaneous coronary intervention ,lcsh:R ,Percutaneous coronary intervention ,General Medicine ,Odds ratio ,medicine.disease ,female genital diseases and pregnancy complications ,revascularization ,business ,chronic kidney disease ,Kidney disease - Abstract
Objectives: To examine the impact of revascularization and associated clinical outcomes of chronic kidney disease (CKD) chronic total occlusion (CTO) and non-CKD CTO groups. Background: The influence of CKD on clinical outcomes after percutaneous coronary intervention (PCI) for CTO lesions is unknown, and there is no systemic review of this topic to date. Methods: We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials Databases for articles published between 1 January 2010 and 31 March 2020. CKD was defined as estimated glomerular filtration rate of <, 60 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease formula. Data included demographics, lesion distributions, incidence of contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural success rate, mortality, and target lesion revascularization (TLR)/target vessel revascularization (TVR). Results: Six studies were ultimately included in this systematic review. A high prevalence (25.5%, range, 19.6&ndash, 37.9%) of CKD was noted in the CTO population. In the non-CKD group, outcomes were better: less incidence of CIN or AKI (odds ratio (OR), 2.860, 95% confidence interval (CI), 1.775&ndash, 4.608), higher procedural success rate (OR, 1.382, 95% CI, 1.036&ndash, 1.843), and lower long-term mortality (OR, 4.502, 95% CI, 3.561&ndash, 5.693). The incidence of TLR/TVR (OR, 1.118, 95% CI, 0.888&ndash, 1.407) did not differ between groups. Conclusions: In the CKD CTO PCI population, a lower procedural success rate, a higher incidence of CIN or AKI, and higher in-hospital and long-term mortality rate were noted due to more complex lesions and more comorbidities. However, the incidence of TLR/TVR did not differ between groups.
- Published
- 2021
24. Impact of high triglyceride/high-density lipoprotein cholesterol ratio (insulin resistance) in ST-segment elevation myocardial infarction
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Chien-Jen Chen, Cheng-Hsu Yang, Huang-Chung Chen, Chih-Yuan Fang, Chiung-Jen Wu, Hsiu-Yu Fang, and Wei-Chieh Lee
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Observational Study ,Coronary artery disease ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Insulin resistance ,High-density lipoprotein ,cardiovascular mortality ,Diabetes mellitus ,Internal medicine ,insulin resistance ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Hazard ratio ,Cholesterol, HDL ,Case-control study ,Percutaneous coronary intervention ,nutritional and metabolic diseases ,General Medicine ,Middle Aged ,medicine.disease ,high triglyceride/high-density lipoprotein cholesterol ratio ,ST-segment elevation myocardial infarction ,chemistry ,030220 oncology & carcinogenesis ,Case-Control Studies ,diabetes mellitus ,Cardiology ,ST Elevation Myocardial Infarction ,lipids (amino acids, peptides, and proteins) ,Female ,business ,Biomarkers ,Research Article - Abstract
The ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) has been proposed as an easily obtainable atherogenic marker and high TG/HDL-C ratio is associated with insulin resistance. This study investigated the associated between a high TG/HDL-C ratio and cardiovascular mortality in patients with ST-segment elevation myocardial infarction (STEMI), with or without diabetes mellitus (DM). Between January 2005 and December 2014, 1661 patients with STEMI underwent primary percutaneous coronary intervention in our hospital. Of these, 289 were classified into group 1 (with both DM and a high TG/HDL-C ratio), 295 into group 2 (with DM, but without a high TG/HDL-C ratio), 501 into group 3 (without DM, but a high TG/HDL-C ratio), and 576 into group 4 (without DM or a high TG/HDL-C ratio). Older age, longer chest pain to reperfusion time, poor hemodynamic condition, and higher prevalence of multiple vessel coronary artery disease were noted in those with DM. Poor outcomes including higher 30-day and 1-year cardiovascular mortality and all-cause mortality rates were noted in those with DM but without a high TG/HDL-C ratio. Patients with DM but without a high TG/HDL-C ratio had a Hazard ratio of 3.637 for cardiovascular mortality relative to those without DM, but without a high TG/HDL-C ratio. Even though a high TG/HDL-C ratio is associated with insulin resistance, patients with or without DM, but with a high TG/HDL-C ratio had better 30-day and 1-year outcomes.
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- 2020
25. Impact of electrocardiographic morphology on clinical outcomes in patients with non-ST elevation myocardial infarction receiving coronary angiography and intervention: a retrospective study
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Kuo-Ho Yeh, Huang-Chung Chen, Yung-Lung Chen, Chiung-Jen Wu, Hui-Ting Wang, Hsiu-Yu Fang, Shu-Kai Hsueh, Wen-Jung Chung, Chien-Jen Chen, Wen-Hao Liu, and Han-Tan Chai
- Subjects
medicine.medical_specialty ,Epidemiology ,medicine.medical_treatment ,Surgery and Surgical Specialties ,Cardiology ,lcsh:Medicine ,030204 cardiovascular system & hematology ,General Biochemistry, Genetics and Molecular Biology ,Percutaneous coronary intervention ,03 medical and health sciences ,0302 clinical medicine ,T wave ,Internal medicine ,Clinical outcomes ,Internal Medicine ,Clinical endpoint ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,ST depression ,Non-ST segment elevation myocardial infarction ,medicine.diagnostic_test ,business.industry ,General Neuroscience ,lcsh:R ,General Medicine ,medicine.disease ,Electrocardiographic morphology ,Conventional PCI ,medicine.symptom ,General Agricultural and Biological Sciences ,business ,Electrocardiography ,Kidney disease - Abstract
Background The impact of electrocardiography (ECG) morphology on clinical outcomes in patients with non-ST segment elevation myocardial infarction (NSTEMI) receiving percutaneous coronary intervention (PCI) is unknown. This study investigated whether different ST morphologies had different clinical outcomes in patients with NSTEMI receiving PCI. Methods This retrospective study analyzed record-linked data of 362 patients who had received PCI for NSTEMI between January 2008 and December 2010. ECG revealed ST depression in 67 patients, inverted T wave in 91 patients, and no significant ST-T changes in 204 patients. The primary endpoint was long-term all-cause mortality. The secondary endpoint was long-term cardiac death and non-fatal major adverse cardiac events. Results Compared to those patients whose ECG showed an inverted T wave and non-specific ST-T changes, patients whose ECG showed ST depression had more diabetes mellitus, advanced chronic kidney disease (CKD) and left main artery disease, as well as more in-hospital mortality, cardiac death and pulmonary edema during hospitalization. Patients with ST depression had a significantly higher rate of long-term total mortality and cardiac death. Finally, multiple stepwise Cox regression analysis showed that an advanced Killip score, age, advanced CKD, prior percutaneous transluminal coronary angioplasty and ST depression were independent predictors of the primary endpoint. Conclusions Among NSTEMI patients undergoing coronary angiography, those with ST depression had more in-hospital mortality and cardiac death. Long-term follow-up of patients with ST depression consistently reveals poor outcomes.
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- 2020
26. The Comparison of Clinical Outcomes After Drug-Eluting Balloon and Drug-Eluting Stent Use for Left Main Bifurcation In-Stent Restenosis
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Chien-Jen Chen, Chiung-Jen Wu, Hsiu-Yu Fang, Cheng-Hsu Yang, Chih-Yuan Fang, Shu-Kai Hsueh, and Wei-Chieh Lee
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Balloon ,Coronary Restenosis ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Restenosis ,Recurrence ,Internal medicine ,Myocardial Revascularization ,medicine ,Humans ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,Aged ,Retrospective Studies ,Cardiovascular mortality ,business.industry ,Mortality rate ,Percutaneous coronary intervention ,Stent ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,medicine.disease ,Coronary Vessels ,Treatment Outcome ,Drug-eluting stent ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Increasing evidence is available for the use of percutaneous coronary intervention (PCI) in selected patients with unprotected left main (LM) bifurcation coronary lesions. However, little data have been reported on recurrent in-stent restenosis (ISR) for LM bifurcation lesions. The aim of this study was to evaluate the efficacy of a drug-eluting balloon (DEB) for LM bifurcation ISR compared with that of a drug-eluting stent (DES).Between December 2011 and December 2015, 104 patients who underwent PCI for unprotected LM bifurcation ISR were enrolled. We separated the patients into 2 groups: (1) those underwent PCI with further DEB and (2) those underwent PCI with further DES. Clinical outcomes were analyzed.Patients' average age was 67.14 ± 7.65 years, and the percentage of male patients was 76.0%. A total of 75 patients were enrolled in the DEB group, and another 29 patients were enrolled in the DES group. Similar target lesion revascularization (TLR) rate and recurrent myocardial infarction (MI) rate were noted for both groups. A significantly higher cardiovascular mortality rate was found in the DES group (10.7% versus 0%, P = 0.020), and a higher all-cause mortality rate was noted in the DES group (21.4% versus 6.8%, P = 0.067).It is feasible to use DEB for LM bifurcation ISR. When comparing DEB with DES, similar TLR rates were found, but lower recurrent MI and lower cardiovascular death were noted for DEB treatment.
- Published
- 2018
27. Acute Inferior Wall ST Segment Elevation Myocardial Infarction Caused Atrial Lead Dysfunction Reversed by Primary Percutaneous Coronary Intervention
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Hui-Ting Wang, Yung-Lung Chen, and Chiung-Jen Wu
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Pacemaker, Artificial ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Sick sinus syndrome ,Coronary Restenosis ,Electrocardiography ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,ST segment ,In patient ,Heart Atria ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Sick Sinus Syndrome ,business.industry ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Coronary Vessels ,Atrial Lead ,cardiovascular system ,Inferior wall ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Atrioventricular block - Abstract
The mechanism of atrial lead dysfunction varies in patients receiving pacemaker implantation and this needs to be investigated, especially when the causes are reversible. We report and discuss a 76-year-old female who had atrial lead dysfunction caused by acute myocardial infarction and who was recovered after primary percutaneous coronary intervention. The sequential electrocardiographic changes were demonstrated and the possible mechanisms were discussed.
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- 2018
28. The Five-Year Clinical and Angiographic Follow-Up Outcomes of Intracoronary Transfusion of Circulation-Derived CD34+ Cells for Patients With End-Stage Diffuse Coronary Artery Disease Unsuitable for Coronary Intervention—Phase I Clinical Trial
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Fan-Yen Lee, Pei-Hsun Sung, John Y. Chiang, Sung-Nan Pei, Mel S. Lee, Hon-Kan Yip, Yung-Lung Chen, Yi-Chen Li, Meng-Shen Tong, Chiung-Jen Wu, Ming-Chun Ma, and Jiunn-Jye Sheu
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,Antigens, CD34 ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Critical Care and Intensive Care Medicine ,law.invention ,Coronary artery disease ,Angina ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Ventricular remodeling ,Survival rate ,Aged ,Endothelial Progenitor Cells ,Ejection fraction ,business.industry ,Hematopoietic Stem Cell Transplantation ,Middle Aged ,Flow Cytometry ,medicine.disease ,Clinical trial ,Treatment Outcome ,030104 developmental biology ,Heart failure ,Cardiology ,Female ,business - Abstract
OBJECTIVES This study investigated the clinical and angiographic long-term outcomes of intracoronary transfusion of circulation-derived CD34+ cells for patients with end-stage diffuse coronary artery disease unsuitable for coronary intervention. DESIGN AND SETTING A single-center prospective randomized double-blinded phase I clinical trial. Thirty-eight patients undergoing CD34+ cell therapy were allocated into groups 1 (1.0 × 10 cells/each vessel; n = 18) and 2 (3.0 × 10 cells/each vessel; n = 20). PATIENTS Those with end-stage diffuse coronary artery disease were unsuitable for percutaneous and surgical coronary revascularization. INTERVENTIONS Intracoronary delivery of circulation-derived CD34+ cells. MEASUREMENTS AND MAIN RESULTS We prospectively evaluated long-term clinical and echocardiographic/angiographic outcomes between survivors and nonsurvivors. By the end of 5-year follow-up, the survival rate and major adverse cardio/cerebrovascular event were 78.9% (30/38) and 36.8% (14/38), respectively. During follow-up period, 31.6% patients (12/38) received coronary stenting for reason of sufficient target vessel size grown-up after the treatment. Endothelial function was significantly reduced in the nonsurvivors than the survivors (p = 0.039). Wimasis image analysis of angiographic findings showed that the angiogenesis was significantly and progressively increased from baseline to 1 and 5 years (all p < 0.001). The 3D echocardiography showed left ventricular ejection fraction increased from baseline to 1 year and then remained stable up to 5 years, whereas left ventricular chamber diameter exhibited an opposite pattern to left ventricular ejection fraction among the survivors. The clinical scores for angina and heart failure were significantly progressively reduced from baseline to 1 and 5 years (all p < 0.001). CONCLUSIONS CD34+ cell therapy for end-stage diffuse coronary artery disease patients might contribute to persistently long-term effects on improvement of left ventricular function, angina/heart failure, and amelioration of left ventricular remodeling.
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- 2018
29. Gender differences in patients undergoing coronary stenting in current stent era
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Woo, Max, Chang-qing, FAN, Yung-Lung, Chen, Husein, Hesham, Hsiu-Yu, Fang, Cheng-Jui, Lin, and Chiung-Jen, Wu
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- 2011
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30. Influence about the flow of distal branch after intervention of the right coronary artery chronic total occlusion
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Chih-Yuan Fang, Wei-Chieh Lee, Chiung-Jen Wu, and Hsiu-Yu Fang
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Ventricular Function, Left ,End stage renal disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Retrospective Studies ,Aged, 80 and over ,Ejection fraction ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Thrombolysis ,medicine.disease ,Surgery ,Treatment Outcome ,Coronary Occlusion ,Right coronary artery ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,TIMI - Abstract
Limited data are available for the clinical outcomes after the recanalization of right coronary artery (RCA) chronic total occlusion (CTO). The study aims to assess the clinical outcomes in the antegrade flow of the distal branch after successful RCA CTO percutaneous coronary intervention (PCI).Between January 2002 and December 2012, 538 patients who underwent RCA CTO PCI were enrolled. The clinical outcomes as myocardial infarction (MI), target vessel revascularization, cardiac death, major adverse cardiac events, and all-cause mortality, were compared to the antegrade flow of distal branch after successful RCA CTO PCI.The CTOs were located in proximal segments (57.6%), mid segments (27.5%) and distal segments (14.9%). The average Syntax score was 18.4±9.6 and 47.8% patients had a Syntax score greater than 27.5. A total of 62.8% patients had final thrombolysis of myocardial infarction (TIMI)-3 flow of distal branch, 16.9% patients had final TIMI-3 flow of only one major branch, 11.3% patients had TIMI-1-2 flow, and 8.9% patients had no antegrade flow. The incidence of periprocedural MI was lower in both side branches were preserved (13.9% vs. 23.0% and 18.8%, p=0.01). The clinical outcomes were similar between the groups with and without good antegrade flow of distal side branch. End stage renal disease (ESRD) and left ventricular ejection fraction (LVEF)40% predicted three-year cardiac death.There is no significant difference of clinical outcomes when distal side branches of RCA are recanalized successfully. ESRD and LVEF40% were the predictors for three-year cardiac death.
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- 2017
31. Feasibility and Safety of Transulnar Catheterization in Ipsilateral Radial Artery Occlusion
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Chih-Yuan Fang, Cheng-Hsu Yang, Wen-Jung Chung, Hsiu-Yu Fang, Wen-Hao Liu, Chiung-Jen Wu, Mostafa Mohammad Omran, Chien-Jen Chen, Cheng-I Cheng, and Shu-Kai Hsueh
- Subjects
Male ,medicine.medical_specialty ,Ischemia ,Arterial Occlusive Diseases ,030204 cardiovascular system & hematology ,Ulnar Artery ,03 medical and health sciences ,0302 clinical medicine ,Forearm ,medicine.artery ,Catheterization, Peripheral ,Occlusion ,medicine ,Humans ,030212 general & internal medicine ,Radial artery ,Ulnar artery ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Angiography ,Ultrasonography, Doppler ,General Medicine ,medicine.disease ,Surgery ,Pulse oximetry ,Treatment Outcome ,medicine.anatomical_structure ,Radial Artery ,Feasibility Studies ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
To investigate the postprocedural cardiovascular events and vascular outcomes, including hand ischemia and neurological compromise, after transulnar (TU) catheterization in ipsilateral radial artery occlusion.Previous randomized trials have shown that the transulnar (TU) approach for coronary angiogram and intervention has safety and outcomes similar to those of the transradial (TR) approach. However, the safety of the TU procedure when ipsilateral radial artery occlusion occurs is unknown.We retrospectively reviewed 87 TU cases with ipsilateral radial artery occlusion confirmed by a forearm angiogram. Eighty percent of these patients had a history of ipsilateral radial artery cannulation or surgery. We avoided the use of over-sized sheaths or applied a sheathless approach during surgery.No ulnar artery occlusion was observed by subsequent Doppler ultrasound or pulse oximetry. No patient developed hand ischemia or serious complications requiring surgery or blood transfusion during the follow-up period of 32.2 ± 24.0 months. Review of the preprocedural forearm angiograms showed that 95.7% of the patients possessed significant collaterals supplying flow from the interosseous artery to the occluded radial artery remnant. Thus, the blood circulation to the palmar arch and digital vessels was maintained even when the ulnar artery was temporarily occluded by an in-dwelling ulnar arterial sheath.TU catheterization was safe in patients with coexisting ipsilateral radial artery occlusions and feasible for use in complex intervention procedures. Cautious manipulation of ulnar artery cannulation and hemostasis helped decrease the risk of hand ischemia.
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- 2017
32. Short-term and long-term prognostic outcomes of patients with ST-segment elevation myocardial infarction complicated by profound cardiogenic shock undergoing early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention
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Fan-Yen Lee, Meng-Shen Tong, Chiung-Jen Wu, Chien-Jen Chen, Hon-Kan Yip, Sheng-Ying Chung, Jiunn-Jye Sheu, Cheng-Hsu Yang, and Pei-Hsun Sung
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Shock, Cardiogenic ,Taiwan ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,ST segment ,030212 general & internal medicine ,Myocardial infarction ,Survival rate ,Retrospective Studies ,business.industry ,Mortality rate ,Cardiogenic shock ,Percutaneous coronary intervention ,Middle Aged ,Prognosis ,medicine.disease ,Survival Rate ,surgical procedures, operative ,Respiratory failure ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
This study investigated the 30-day and long-term prognostic outcomes in patients with ST-segment elevation myocardial infarction (STEMI) complicated with profound cardiogenic shock (CS) undergoing early routine extracorporeal membrane oxygenator (ECMO)-assisted primary percutaneous coronary intervention (PCI).Between December 2005 and December 2014, 65 consecutive STEMI patients with profound CS underwent routine ECMO-supported primary PCI.The incidences of acute pulmonary edema, respiratory failure with requirement of mechanical ventilatory support upon presentation, and 30-day mortality rate were 100%, 95.4%, and 43.1%, respectively. The duration of hospitalization, mean long-term follow-up, and survival rate were 32.1±53.1 (days), 733.6±986.7 (days), and 32.3%, respectively. The mean APACHE score (32.6±8.3 vs. 28.5±7.5), peak serum creatinine level (4.3±2.4 vs. 1.7±1.2mg/dL), incidences of failed ECMO weaning (57.1% vs. 0%), successful ECMO weaning but in-hospital death (40.0% vs. 0%) were significantly lower in 30-day survivors than those in non-survivors (all p0.05), whereas final thrombolysis in myocardial infarction (TIMI)-3 flow [53.6% vs. 91.9%] showed an opposite pattern compared to that of APACHE score in the two groups (p0.02). Multivariate analysis demonstrated that unsuccessful reperfusion, failed ECMO weaning, and peak creatinine level were independent predictors of 30-day mortality (all p0.01).Early ECMO-supported primary PCI in STEMI patients with profound CS was feasible as a life-saving strategy with acceptable 30-day and long-term prognostic outcomes.
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- 2016
33. Associations with 30-day survival following extracorporeal membrane oxygenation in patients with acute ST segment elevation myocardial infarction and profound cardiogenic shock
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Hsiu-Yu Fang, Chiung-Jen Wu, Chi-Ling Hang, Wei-Chieh Lee, Chih-Yuan Fang, Hon-Kan Yip, Chien-Jen Chen, Huang-Chung Chen, and Cheng-Hsu Yang
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Percutaneous ,medicine.medical_treatment ,Shock, Cardiogenic ,Taiwan ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Balloon ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,ST segment ,030212 general & internal medicine ,Myocardial infarction ,Blood urea nitrogen ,Retrospective Studies ,business.industry ,Cardiogenic shock ,Middle Aged ,Prognosis ,medicine.disease ,Survival Rate ,surgical procedures, operative ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Follow-Up Studies - Abstract
Background Limited data are available regarding the role of percutaneous cardiopulmonary support for the treatment of ST segment elevation myocardial infarction (STEMI) with profound cardiogenic shock (CS). The aim of this study is to identify the determinant factors for survival of patients with STEMI who underwent extracorporeal membrane oxygenation (ECMO) support. Method From January 2005 to December 2013, 192 patients experienced STEMI with CS needed intra-aortic balloon pumping and support with vasoactive agents at our hospital. Among them, 51 patients experienced profound CS and needed ECMO support. Results Higher body mass index (BMI) level, longer door-to-balloon time, higher serum blood urea nitrogen (BUN) level, and lower 24 h lactic acid clearance were associated with 30-day mortality post-ECMO. Conclusions Longer door-to-balloon time, higher BMI, higher serum BUN level, and poorer lactic acid clearance following ECMO placement for patients with STEMI and profound CS could predict 30-day clinical outcomes.
- Published
- 2016
34. Liraglutide Inhibits Endothelial-to-Mesenchymal Transition and Attenuates Neointima Formation after Endovascular Injury in Streptozotocin-Induced Diabetic Mice
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Chiung-Jen Wu, Yen-Nan Fang, Wei-Yu Chen, Chi-Ling Hang, Chien-Ho Lee, Cheng-I Cheng, Cheng-Jei Lin, Sheng-Ying Chung, Tzu-Hsien Tsai, and Shyh-Ming Chen
- Subjects
0301 basic medicine ,Interleukin-1beta ,Smad2 Protein ,030204 cardiovascular system & hematology ,Umbilical vein ,Mesoderm ,0302 clinical medicine ,Glucagon-Like Peptide 1 ,Endothelial dysfunction ,Receptor ,lcsh:QH301-705.5 ,liraglutide ,General Medicine ,Arteries ,cardiovascular system ,neointima formation ,medicine.drug ,Signal Transduction ,Neointima ,medicine.medical_specialty ,Mice, Transgenic ,Article ,Streptozocin ,Diabetes Mellitus, Experimental ,03 medical and health sciences ,Internal medicine ,medicine ,Human Umbilical Vein Endothelial Cells ,endothelial-mesenchymal transition ,Animals ,Humans ,Endothelium ,RNA, Messenger ,business.industry ,Liraglutide ,Mesenchymal stem cell ,Adenylate Kinase ,AMPK ,Streptozotocin ,medicine.disease ,Mice, Inbred C57BL ,030104 developmental biology ,Endocrinology ,Glucose ,lcsh:Biology (General) ,Snail Family Transcription Factors ,business ,Biomarkers ,hyperglycaemia - Abstract
Hyperglycaemia causes endothelial dysfunction, which is the initial process in the development of diabetic vascular complications. Upon injury, endothelial cells undergo an endothelial-to-mesenchymal transition (EndMT), lose their specific marker, and gain mesenchymal phenotypes. This study investigated the effect of liraglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist, on EndMT inhibition and neointima formation in diabetic mice induced by streptozotocin. The diabetic mice with a wire-induced vascular injury in the right carotid artery were treated with or without liraglutide for four weeks. The degree of neointima formation and re-endothelialisation was evaluated by histological assessments. Endothelial fate tracing revealed that endothelium-derived cells contribute to neointima formation through EndMT in vivo. In the diabetic mouse model, liraglutide attenuated wire injury-induced neointima formation and accelerated re-endothelialisation. In vitro, a high glucose condition (30 mmol/L) triggered morphological changes and mesenchymal marker expression in human umbilical vein endothelial cells (HUVECs), which were attenuated by liraglutide or Activin receptor-like 5 (ALK5) inhibitor SB431542. The inhibition of AMP-activated protein kinase (AMPK) signaling by Compound C diminished the liraglutide-mediated inhibitory effect on EndMT. Collectively, liraglutide was found to attenuate neointima formation in diabetic mice partially through EndMT inhibition, extending the potential therapeutic role of liraglutide.
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- 2019
35. Evaluation of Bleeding Risk in Patients with Acute Myocardial Infarction Undergoing Transradial Percutaneous Coronary Intervention
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Tzu-Hsien Tsai, Wen-Jung Chung, Shu-Kai Hsueh, Tien-Yu Chen, Cheng-I Cheng, Chiung-Jen Wu, Chien-Ho Lee, Po-Jui Wu, and Chien-Jen Chen
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hemorrhage ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Non-ST Elevated Myocardial Infarction ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Area under the curve ,Percutaneous coronary intervention ,General Medicine ,Thrombolysis ,Middle Aged ,medicine.disease ,Blood pressure ,ROC Curve ,Heart failure ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,TIMI - Abstract
We investigated the accuracy of various bleeding risk scores to estimate the bleeding risk in patients with acute myocardial infarction (AMI) managed with percutaneous coronary intervention (PCI) access via the radial artery.We retrospectively enrolled 1,651 patients who were definitively diagnosed with ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI). We assessed the predictive validities of 30-day bleeding events in various scoring systems using receiver operating characteristic curves.Overall, ACUITY-HORIZONS exhibited the highest area under the curve to predict 30-day bleeding, followed by ACTION and CRUSADE; HAS-BLED displayed the lowest score. With a cut-off of 17, ACUITY-HORIZONS demonstrated the best discrimination for the Thrombolysis in Myocardial Infarction (TIMI) 30-day serious bleeding rate. We observed significant differences among all-cause death, cardiovascular death, and major adverse cardiac events between the ACUITY-HORIZONS groups with a score of ≤ 17 and > 17. ACUITY-HORIZONS score > 17, initial systolic blood pressure (SBP) < 90 mmHg, and Killip III and IV upon admission positively predicted the 30-day bleeding risk, whereas myocardial infarction (MI) and TIMI major bleeding within 30 days, heart failure at admission, and initial SBP < 90 mmHg positively predicted the 30-day mortality.Comparatively, ACUITY-HORIZON is the most reliable system in predicting 30-day bleeding for patients with AMI via transradial PCI. In the transradial scenario, bleeding and MI within 30 days are substantially related to 30-day mortality.
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- 2019
36. A subanalysis of Taiwanese patients from ODYSSEY South Korea and Taiwan study evaluating the efficacy and safety of alirocumab
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Fu-Tien Chiang, Ching Pei Chen, Chiung Jen Wu, Chern En Chiang, Pi-Jung Hsiao, Ming En Liu, Tsong Hai Lee, Hung I. Yeh, Zhih Cherng Chen, and Ting-Hsing Chao
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Male ,medicine.medical_specialty ,Hypercholesterolemia ,MEDLINE ,Subgroup analysis ,030204 cardiovascular system & hematology ,Antibodies, Monoclonal, Humanized ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Medicine ,Humans ,Lipoprotein cholesterol ,Alirocumab ,Aged ,business.industry ,Cholesterol ,PCSK9 Inhibitors ,General Medicine ,Cholesterol, LDL ,Middle Aged ,chemistry ,030220 oncology & carcinogenesis ,lipids (amino acids, peptides, and proteins) ,Female ,business - Abstract
Alirocumab can provide significant reductions in low-density lipoprotein cholesterol (LDL-C). However, data regarding its efficacy and safety in Asians are limited.A subgroup analysis of Taiwanese patients (n = 116) in a randomized trial evaluating the efficacy and safety of alirocumab in South Korea and Taiwan (ODYSSEY KT, clinicaltrials.gov Identifier: NCT02289963) was performed. Patients with hypercholesterolemia at high cardiovascular risk on maximally tolerated statin were randomized to alirocumab (75 mg every 2 weeks; with dose increased to 150 mg at Week 12 if LDL-C ≥ 70 mg/dL at Week 8) or placebo for 24 weeks. The primary efficacy endpoint was the percent change in LDL-C from baseline to Week 24. Safety was assessed for a total of 32 weeks.At Week 24, the percent change in calculated LDL-C in the alirocumab group (n = 57) was -51%, whereas that in the placebo group (n = 59) was 2.5%. Alirocumab significantly improved other lipid parameters, including non-high-density lipoprotein cholesterol, apolipoprotein B and A1, lipoprotein (a), high-density lipoprotein cholesterol, and total cholesterol. A significantly higher proportion of patients in the alirocumab group reached an LDL-C target below 70 mg/dL than those in the placebo group (81.3% vs 15.4%). The incidence of treatment-emergent adverse events was comparable between both groups.Alirocumab treatment provided a favorable effect on LDL-C levels and other lipid parameters, and was generally well-tolerated in patients from Taiwan. The results of current analysis were consistent with the overall ODYSSEY phase 3 program.
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- 2019
37. Percutaneous Coronary Intervention for Tortuous Left Anterior Descending Artery with Bioresorbable Vascular Scaffold via the Transradial Approach
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Wei-Chieh, Lee, Hsiu-Yu, Fang, and Chiung-Jen, Wu
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Letter to the Editor - Published
- 2018
38. TCTAP A-026 Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access in the Anatomical Snuffbox
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Shaur Zheng Chong, Chiung-Jen Wu, and Wei-Chieh Lee
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medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,medicine.medical_treatment ,medicine ,Percutaneous coronary intervention ,Cardiology and Cardiovascular Medicine ,business ,Total occlusion ,Anatomical snuffbox ,Surgery - Published
- 2021
39. Clinical Outcomes Following Covered Stent for the Treatment of Coronary Artery Perforation
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Chiung-Jen Wu, Hsiu-Yu Fang, Shu-Kai Hsueh, Wei-Chieh Lee, Chi-Ling Hang, and Chih-Yuan Fang
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Perforation (oil well) ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,Coronary arteries ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Pericardiocentesis ,Cardiac tamponade ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Coronary Artery Perforation ,Target lesion revascularization ,Covered stent - Abstract
Background This study aimed to evaluate short- and long-term outcomes of polytetrafluoroethylene covered stent for patients with coronary artery perforation. Methods During April 2004 and February 2016, a total 48 patients underwent implantation using polytetrafluoroethylene-covered JOSTENT GraftMaster stents (Abbott Vascular, Santa Clara, CA) in the native coronary arteries implantation for coronary artery perforation. Clinical outcomes such as target lesion revascularization (TLR), myocardial infarction (MI), definite or possible stent thrombosis, cardiovascular mortality, and all-cause mortality were analyzed. Results The average age of study patients was 68.02 ± 13.49 years, and the majorities were men (76.6%). The most frequent devices cause of perforation were stents (37.5%). Eighteen patients (37.5%) experienced cardiac tamponade and 20 patients (41.7%) underwent emergent pericardiocentesis. Only 1 patient (2.1%) experienced emergent surgical repair after covered stent. At the 30-day follow-up, the rate of all-cause mortality was 16.7% and cardiovascular mortality was 13.0%. At the 1-year follow-up, the rate of MI was 6.1%, the rate of TLR was 21.9%, the rate of definite or possible stent thrombosis was 15.6%, the rate of cardiovascular mortality was 22.0%, and the rate of all-cause mortality was 26.2%. Between the patients with and without cardiac tamponade, patients with cardiac tamponade had higher cardiovascular mortality in 30-day and also higher all-cause mortality in 30-day and 1-year follow-up. Conclusion The covered stent could solve emergent condition for patients with coronary artery perforation with high TLR and stent thrombosis rate at long-term follow-up. The patients with cardiac tamponade had worse clinical outcomes in 30-day and 1-year follow-up.
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- 2016
40. Comparison of Clinical Results Following the Use of Drug-Eluting Balloons for a Bare-Metal Stent and Drug-Eluting Stent Instent Restenosis
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Wei-Chieh Lee, Chien-Jen Chen, Hsiu-Yu Fang, Chih-Yuan Fang, Cheng-Hsu Yang, Chiung-Jen Wu, Hon-Kan Yip, Yen-Nan Fang, and F.A.C.C. Chi-Ling Hang M.D.
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Bare-metal stent ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Stent ,030204 cardiovascular system & hematology ,medicine.disease ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Restenosis ,Drug-eluting stent ,Angioplasty ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Background Drug-eluting balloons (DEBs) have emerged as a potential alternative to current treatments of instent restenosis (ISR). The study aims to investigate the clinical outcomes of a DEB angioplasty to treat bare-metal stent (BMS) ISR and drug-eluting stent (DES) ISR at 1-year clinical follow-up period. Methods Between November 2011 and December 2014, 312 patients were diagnosed with coronary artery ISR at our hospital. A total of 426 coronary ISR lesions were treated with DEBs. The clinical outcomes, including target lesion revascularization (TLR), myocardial infarction, stroke, cardiovascular mortality, and all-cause mortality were compared between the BMS-ISR group and DES-ISR group. Propensity score matched analysis was used to minimize bias. Results The average age of the patients was 64.99 ± 10.35 years, and 76.9% of the patients were male. After multivariate Cox regression analyses about 1-year recurrent restenosis in DES-ISR group, only end stage renal disease (ESRD) (P = 0.047) and previous DEB failure (P
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- 2016
41. Comparison of a Sheathless Transradial Access With Looping Technique and Transbrachial Access for Carotid Artery Stenting
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Chiung-Jen Wu, Wei-Chieh Lee, Chih-Yuan Fang, Huang-Chung Chen, Hon-Kan Yip, Shu-Kai Hsueh, Chien-Jen Chen, and Hsiu-Yu Fang
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Male ,medicine.medical_specialty ,Time Factors ,Brachial Artery ,Carotid arteries ,medicine.medical_treatment ,Taiwan ,Punctures ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,Angioplasty ,Catheterization, Peripheral ,Occlusion ,medicine ,Humans ,Vascular Patency ,Carotid Stenosis ,Radiology, Nuclear Medicine and imaging ,Major complication ,Radial artery ,Brachial artery ,Aged ,Ultrasonography, Doppler, Duplex ,medicine.diagnostic_test ,business.industry ,Angiography ,Middle Aged ,Surgery ,Stroke ,Treatment Outcome ,Ischemic Attack, Transient ,Radial Artery ,embryonic structures ,Cardiology ,Feasibility Studies ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Carotid Artery, Internal ,030217 neurology & neurosurgery - Abstract
Purpose: To evaluate the feasibility and safety of sheathless transradial access (TRA) with the looping technique for carotid artery stenting (CAS) compared with the transbrachial approach (TBA). Methods: Among 99 symptomatic patients with a history of transient ischemic attack (TIA) or stroke, 38 patients (mean age 69±10 years; 28 men) with documented internal carotid artery stenosis were selected for CAS via a sheathless TRA and compared with 61 patients who received CAS via the brachial artery. Routine assessments of radial artery patency using duplex ultrasound and clinical follow-up were performed at 1, 6, and 12 months. Results: The sheathless TRA technique offered 100% procedure success; only 1 patient in the sheathless TRA group and 2 patients in the TBA group experienced TIAs during the procedure. There were no major complications (major stroke or 30 day in-hospital death) in either group or radial access site complications. The incidence of radial artery occlusion in the sheathless TRA CAS group was 9% (3/33) at 1 year (5 patients died unrelated to the procedure). Conclusion: The sheathless TRA with looping technique may be an alternative to transbrachial access for CAS in patients who have small radial arteries and are unsuitable for the transfemoral approach.
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- 2016
42. One-year outcomes following drug-eluting balloon use for coronary ostial restenosis
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Chien-Jen Chen, Cheng-Hsu Yang, Wei-Chieh Lee, Chih-Yuan Fang, Hon-Kan Yip, Chi-Ling Hang, Hsiu-Yu Fang, Shu-Kai Hsueh, Wen-Jung Chung, and Chiung-Jen Wu
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Restenosis ,Diabetes mellitus ,Internal medicine ,medicine.artery ,Drug-eluting balloons ,Medicine ,030212 general & internal medicine ,Coronary ostial intervention ,Target lesion revascularization ,business.industry ,Percutaneous coronary intervention ,medicine.disease ,medicine.anatomical_structure ,Right coronary artery ,Conventional PCI ,Cardiology ,Coronary ostial instent restenosis ,Cardiology and Cardiovascular Medicine ,business ,Drug eluting balloon ,Artery - Abstract
Aims The management of ostial lesions is one of the challenges of percutaneous coronary intervention (PCI) in recent medicine. Although stent implantation has increased the accuracy of the results and improved long-term outcomes, in-stent restenosis (ISR) occurs more frequency following the treatment of ostial lesions than the treatment of non-ostial lesions. When additional stenting is not desirable, PCI with drug-eluting balloons (DEBs) has emerged as an adjunctive strategy. However, little data regarding the effects of DEBs in ostial ISR lesions are available. Our study aimed to assess the efficacy of the use of DEBs in coronary ostial instent restenotic lesions. Methods and results From November of 2011 to May of 2014, 85 patients were diagnosed with coronary ostial ISR in our hospital. A total of 93 coronary ostial ISR lesions were treated with DEBs. More than half of the study patients had comorbidities, including hypertension, diabetes, and hyperlipidemia, 77.6% of the study patients had triple vessel coronary artery disease, and 54.1% of the study patients had left main coronary artery disease. In our study, target lesion revascularization were performed in 19.2% in all groups; 11.5% were in the ostial left anterior descending artery, 29.0% were in the ostial left circumflex artery, and 21.4% were in the ostial right coronary artery. Across all of the groups, 24.4% of the patients experienced major adverse cardiac cerebral events. Conclusion Percutaneous coronary intervention with drug-eluting balloons is an alternative strategy for coronary ostial instent restenosis when additional stenting is not desirable.
- Published
- 2016
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43. Timing of Staged Percutaneous Coronary Intervention for a Non-Culprit Lesion in Patients With Anterior Wall ST Segment Elevation Myocardial Infarction With Multiple Vessel Disease
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Wei-Chieh Lee, Chiung-Jen Wu, Bo-Jui Wu, Hsiu-Yu Fang, Chih-Yuan Fang, Chi-Ling Hang, Hon-Kan Yip, Cheng-Hsu Yang, and Chien-Jen Chen
- Subjects
Staged Percutaneous Coronary Intervention ,medicine.medical_specialty ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Culprit ,Body Mass Index ,Angina ,Electrocardiography ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Heart Conduction System ,Risk Factors ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Anterior Wall Myocardial Infarction ,Aged ,Retrospective Studies ,Inpatients ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,surgical procedures, operative ,Heart failure ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
The optimal timing of a staged percutaneous coronary intervention (PCI) for non-culprit lesions in patients with STsegment elevation myocardial infarction (STEMI) patients with multi-vessel disease (MVD) remains controversial. We focused on patients with anterior wall STEMI with MVD and determined the clinical effects for timing of staged PCI.From November 2005 to December 2014, 258 patients were diagnosed with anterior wall STEMI with MVD in our hospital. Among them, 37 patients received staged PCI within 3 weeks, 50 patients received staged PCI during 3 weeks to one year, and 167 patients received only primary PCI for culprit lesions. Clinical outcomes such as admission for angina or heart failure, target vessel revascularization, myocardial infarction, stroke, cardiovascular mortality, and allcause mortality were compared among the 3 groups.Acute kidney injury (AKI) after PCI occurred in 18.9% of the 3-week group, 0% of the one-year group, and 7.6% of the control group (P = 0.005). Of the one-year and 3-year clinical outcomes, the one-year group had better results, such as fewer major adverse cardiac cerebral events (P = 0.028, P = 0.023), and lower recurrent MI (P = 0.065; P = 0.018), cardiovascular mortality (P = 0.043; P = 0.020), and all-cause mortality (P = 0.047; P = 0.005).In patients with anterior wall STEMI with MVD, staged PCI for a non-culprit lesion over 3 weeks to one year had a better clinical outcome. Staged PCI for a non-culprit lesion within 3 weeks may be related to the occurrence of AKI, may lead to worse clinical outcomes, and did not decrease the occurrence of angina or post-MI heart failure.
- Published
- 2016
44. The predictors of dislodgement and outcomes of transcatheter closure of complex atrial septal defects in adolescents and adults
- Author
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Hsiu-Yu Fang, Chien-Fu Huang, Chiung-Jen Wu, Chih-Yuan Fang, Wei-Chieh Lee, and Ying-Jui Lin
- Subjects
medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,genetic structures ,Population ,Septum secundum ,Atrial septal occluder ,Hemodynamics ,behavioral disciplines and activities ,Atrial septal defects ,Internal medicine ,mental disorders ,medicine ,Transcatheter closure ,Closure (psychology) ,education ,education.field_of_study ,ASO dislodgement ,business.industry ,medicine.disease ,Pulmonary hypertension ,Complex atrial septal defect ,Atrial septum ,Surgery ,Catheter ,lcsh:RC666-701 ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Technical difficulties still exist for the catheter closure of atrial septal defects (ASD) in some of the morphological features of defects, or hemodynamic features in the population. The morphological or hemodynamic features are (1) large ASD, (2) wide rim deficiency, (3) multiple defects, (4) severe pulmonary hypertension, (5) ventricular dysfunction, and (6) restrictive left ventricular compliance. Our study aimed to assess the efficacy of transcatheter closure of complex ASDs under transesophageal echocardiography (TEE) guidance in adolescents and adults, and figured out the predictors of atrial septum occluder (ASO) dislodgement. Methods From June 2003 to June 2014, 125 adults and 12 adolescents were diagnosed with secundum ASD and underwent a transcatheter closure of defects using an ASO. Among the above patients, 63 patients had morphological or hemodynamic features that made ASD closure difficult. Results No ASO dislodgement occurred in the non-complex ASD closure group, and an 88.9% success rate was observed in the complex ASD closure group. Higher Qp/Qs ratio, higher incidence of multiple ASDs, and larger ASD size in the complex ASD closure group were noted. 50.8% patients in complex ASD closure group had ASD ≧ 30 mm. Multivariate analysis demonstrated that an occurrence of eroded and IAS or aneurysm formation and arrhythmia during implantation were independent predictors for ASO dislodgement in complex ASD closure (p = 0.005; p = 0.037). Conclusion Eroded and floppy IAS or aneurysm formation post ASO implantation and peri-procedure arrhythmia could predict ASO dislodgement in complex ASD closure. Transcatheter closure of ASDs under TEE guidance is feasible in complex cases.
- Published
- 2015
45. Comparison of different strategies for acute ST-segment elevation myocardial infarction with high thrombus burden in clinical practice: Symptom-free outcome at one year
- Author
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Chih-Yuan Fang, Hon-Kan Yip, Hsiu-Yu Fang, Wei-Chieh Lee, Chiung-Jen Wu, Chien-Jen Chen, Cheng-Hsu Yang, Chi-Ling Hang, Huang-Chung Chen, and Shu-Kai Hsueh
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Acute ST segment elevation myocardial infarction ,Myocardial Infarction ,Platelet Glycoprotein GPIIb-IIIa Complex ,Critical Care and Intensive Care Medicine ,Electrocardiography ,Percutaneous Coronary Intervention ,Coronary thrombosis ,St elevation myocardial infarction ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Aged ,Aged, 80 and over ,Dose-Response Relationship, Drug ,medicine.diagnostic_test ,business.industry ,Coronary Thrombosis ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Injections, Intra-Arterial ,Tirofiban ,Conventional PCI ,Cardiology ,Tyrosine ,Platelet aggregation inhibitor ,Female ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
Objective The aim of this study was to evaluate the clinical effects of different strategies for preventing coronary microvascular obstruction in ST elevation myocardial infarction (STEMI) patients with a high thrombus-burden plaque. Methods Between January, 2007 and December, 2012, 354 patients suffering from STEMI with high thrombus-burden were enrolled and divided into three groups as the first group received a GP IIb/IIIa inhibitor, and the second group received a distal protective device, and the third group was treated with primary PCI alone. Results A high percentage of patients in the GP IIb/IIIa inhibitor (96.8% and 90.5%), distal protective device (99.3% and 87.6%) had better thirty-day and one-year symptom-free outcomes when compared with PCI only group (91.6% and 65.6%) ( P = 0.008 and P Conclusions Treatment with intracoronary GP IIb/IIIa inhibitor injection or distal protection device to prevent coronary microvascular obstruction was demonstrated to increase the occurrences of thirty-day and one-year symptom-free outcomes; thus, these treatments can help decrease post-MI medical care costs.
- Published
- 2015
46. COMPARISON OF DISTAL RADIAL IN THE ANATOMICAL SNUFFBOX VERSUS CONVENTIONAL TRANSRADIAL ACCESS FOR CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION (TWO CENTERS EXPERIENCE)
- Author
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Mohamed Ossama, Mohamed Elbayoumi, Hatem Khairy, Mohamed A. Oraby, Yousry Kamel, Islam Ghanem, Mohamed Magdy, Mohamed Magdy F. Mansour, Amr Imam, and Chiung-Jen Wu
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Femoral artery ,Total occlusion ,Anatomical snuffbox ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,medicine.artery ,Conventional PCI ,medicine ,cardiovascular diseases ,Radial artery ,Cardiology and Cardiovascular Medicine ,business - Abstract
The radial artery (RA) access has been used to perform chronic total occlusion percutaneous coronary intervention (CTO PCI) with similar success and safety to CTO PCI using the common femoral artery (CFA) access. Distal transradial access in the anatomical snuffbox is a challenging new access with
- Published
- 2020
47. Associations with the In-Hospital Survival Following Extracorporeal Membrane Oxygenation in Adult Acute Fulminant Myocarditis
- Author
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Hon-Kan Yip, Huang-Chung Chen, Chien-Jen Chen, Chiung-Jen Wu, Chi-Ling Hang, Hsiu-Yu Fang, Cheng-Hsu Yang, Shaur-Zheng Chong, Chih-Yuan Fang, and Wei-Chieh Lee
- Subjects
medicine.medical_specialty ,Myocarditis ,medicine.medical_treatment ,Fulminant ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,acute fulminant myocarditis ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,030212 general & internal medicine ,Survival rate ,business.industry ,Cardiogenic shock ,lcsh:R ,cardiogenic shock ,technology, industry, and agriculture ,Acute kidney injury ,decompensated heart failure ,General Medicine ,extracorporeal membrane oxygenation ,medicine.disease ,Heart failure ,Cardiology ,Hemodialysis ,business ,in-hospital mortality - Abstract
Background: Acute fulminant myocarditis (AFM) is a serious disease that progresses rapidly, and leads to failing respiratory and circulatory systems. When medications fail to reverse the patient&rsquo, s clinical course, extracorporeal membrane oxygenation (ECMO) is considered the most effective, supportive and adjunct strategy. In this paper we analyzed our experience in managing AFM with ECMO support. Methods: During October 2003 and February 2017, a total of 35 patients (&ge, 18 years) were enrolled in the study. Twenty patients survived, and another 15 patients expired. General demographics, the hemodynamic condition, timing of ECMO intervention, and laboratory data were compared for the survival and non-survival groups. Univariate and multivariate Cox regression analyses were performed to identify the associations with in-hospital mortality following ECMO use in this situation. Results: The survival rate was 57.1% during the in-hospital period. The average age, gender, severity of the hemodynamic condition, and cardiac rhythm were similar between the survival and non-survival groups. Higher serum lactic acid (initial and 24 h later), higher peak cardiac biomarkers, higher incidence of acute kidney injury and the need for hemodialysis were noted in the non-survival group. Higher 24-h lactic acid levels and higher peak troponin-I levels were associated with in-hospital mortality. Conclusions: When ECMO was used for AFM, related cardiogenic shock and decompensated heart failure, higher peak serum troponin-I levels and 24-h serum lactic acid levels following ECMO use were independently associated with in-hospital mortality.
- Published
- 2018
48. The Clinical Outcomes Based on the Achievement of Low-Density Lipoprotein Cholesterol Targets after ST Elevation Myocardial Infarction
- Author
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Hsiu-Yu Fang, Wei-Chieh Lee, Chien-Jen Chen, Cheng-Hsu Yang, Chih-Yuan Fang, and Chiung-Jen Wu
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Article ,Angina ,03 medical and health sciences ,0302 clinical medicine ,St elevation myocardial infarction ,Internal medicine ,Diabetes mellitus ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,low-density lipoprotein cholesterol ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,lcsh:R ,Percutaneous coronary intervention ,left main coronary artery disease ,General Medicine ,medicine.disease ,clinical outcomes ,Stenosis ,surgical procedures, operative ,ST elevation myocardial infarction ,Conventional PCI ,Cardiology ,lipids (amino acids, peptides, and proteins) ,Lipid profile ,business - Abstract
The clinical outcome of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), with or without achievement of low-density lipoprotein cholesterol (LDL-C) targets, has rarely been investigated. This study was performed to investigate the comparison of clinical outcome in STEMI patients with or without achievement LDL-C targets (below 70 mg/dL and/or &ge, 50% reduction). Between November 2013 and December 2016, 689 STEMI patients underwent primary PCI in our hospital. Patients who were deceased, lost to follow-up, had no follow-up lipid profile, or had no side effects after statin use were excluded. A total of 343 patients were classified into group 1 (with LDL-C target achievement) and 172 patients were classified into group 2 (without LDL-C target achievement). Between the two groups, a higher prevalence of left main coronary artery disease, smaller pre-PCI stenosis, and a larger pre-PCI minimal luminal diameter were noted in group 2. The incidence of post-MI angina (8.7% vs. 6.4%, p = 0.393), target vessel revascularization (2.3% vs. 3.5%, p = 0.566), and recurrent MI (1.5% vs. 1.2%, p = 1.000), showed similar results between the two groups during a one-year follow-up period. Initial LDL-C levels &ge, 130 mg/dL, left main coronary artery disease, and absence of diabetes mellitus were positively associated with non-achievement of LDL-C targets. After STEMI, 66.6% of patients could achieve LDL-C targets one year later. However, such patients did not show better clinical outcomes. Non-DM, initial LDL-C levels &ge, 130 mg/dL, and left main coronary artery disease were related to non-achievement of LDL-C targets.
- Published
- 2019
49. P3427Intra-coronary administration of tacrolimus improves myocardial perfusion and LV function in patients with ST-segment elevation myocardial infarction undergoing primary coronary intervention
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Pei-Hsun Sung, Hon-Kan Yip, W C Huang, and Chiung Jen Wu
- Subjects
Lv function ,medicine.medical_specialty ,business.industry ,medicine.disease ,Tacrolimus ,Internal medicine ,Cardiology ,Medicine ,ST segment ,In patient ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Published
- 2018
50. Assessment of CHA2DS2-VASc score for predicting cardiovascular and cerebrovascular outcomes in acute myocardial infarction patients
- Author
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Chien-Ho Lee, Cheng-Jui Lin, Cheng-I Cheng, Shu-Kai Hsueh, Chen-Yu Li, Wen-Jung Chung, Chee-Jen Chang, Chiung-Jen Wu, and Tzu-Hsien Tsai
- Subjects
Research design ,Male ,medicine.medical_specialty ,China ,CHA2DS2-VASc score ,Myocardial Infarction ,Observational Study ,acute myocardial infarction ,Disease ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,atrial fibrillation ,030212 general & internal medicine ,Myocardial infarction ,Mortality ,Stroke ,Aged ,business.industry ,Incidence (epidemiology) ,Incidence ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Cerebrovascular Disorders ,Cardiovascular Diseases ,Research Design ,CHA2DS2–VASc score ,Cardiology ,Myocardial infarction complications ,Female ,Myocardial infarction diagnosis ,business ,Research Article - Abstract
Although established guidelines currently recommend the use of the CHA2DS2-VASc score for evaluating embolic risk in AF patients, few studies have evaluated the use of the CHA2DS2-VASc score for predicting cardiovascular outcomes in patients with acute myocardial infarction (AMI). The aim of this study was to determine whether CHA2DS2-VASc score is a predictor of a major adverse cardiocerebral vascular event (MACCE) in AMI patients. This study analyzed data in the Taiwan National Health Insurance Research Database from January 2008 to December 2012. Cardiovascular outcomes were analyzed according to the baseline characteristics, presence of AF, and CHA2DS2-VASc score. Twenty nine thousand four hundred fifty-two patients with non-fatal AMI, 1171 patients (8.3%) were with AF. The Cox regress model showed with the exception of women sex and peripheral artery disease, all the baseline characteristics considered risks in CHA2DS2-VASc scores were independently associated with the increased incidence of MACCE within 1 year after AMI. A CHA2DS2-VASc score of
- Published
- 2018
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