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There are scarce data on the optimal duration and prognostic impact of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents for left main coronary artery (LMCA) disease. The aim of this study was to investigate the practice pattern and long-term prognostic effect of DAPT duration in patients undergoing PCI with second-generation drug-eluting stents for LMCA disease.Using individual patient-level data from the IRIS-MAIN and KOMATE registries, 1827 patients undergoing PCI with second-generation drug-eluting stents for LMCA disease with valid information on DAPT duration were included. The efficacy outcome was major adverse cardiovascular events (MACE, a composite of cardiac death, myocardial infarction, and stent thrombosis) and the safety outcome was TIMI major bleeding.DAPT duration was6 months (n=273), 6 to 12 months (n=477), 12 to 24 months (n=637), and ≥ 24 months (n=440). The median follow-up duration was 3.9 [interquartile range, 3.01-5.00] years. Prolonged DAPT duration was associated with lower incidences of MACE. In multigroup propensity score analysis, adjusted HR for MACE were significantly higher for DAPT6 months and DAPT 6 to 12 months than for DAPT 12 to 24 months (HR, 4.51; 95%CI, 2.96-6.88 and HR 1.92; 95%CI, 1.23-3.00). There was no difference in HR for major bleeding among the assessed groups.DAPT duration following PCI for LMCA disease is highly variable. Although the duration of DAPT should be considered in the context of the clinical situation of each patient,12 months of DAPT was associated with higher incidence of MACE. Registration identifiers: NCT01341327; NCT03908463.

Ticagrelor-based dual antiplatelet therapy (TDAPT) provides potent antiplatelet inhibition but may increase the bleeding risk in Asian populations. We investigated the impact of the early use of low-dose TDAPT (l-TDAPT; 120 mg) on clinical outcomes in Korean patients undergoing percutaneous coronary intervention (PCI). A multicenter prospective clinical cohort study was conducted with patients on standard-dose TDAPT (s-TDAPT; 180 mg) after PCI for complex lesions. A major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, myocardial infarction, stroke, and repeat revascularization. A net clinical event (NCE) was defined as a composite of bleeding events and MACEs. Among the 772 patients on s-TDAPT, 115 (14.8%) switched to l-TDAPT within 6 months. Common reasons for the regimen changes were switching as planned (38.8%), dyspnea (25.5%), and bleeding (23.6%). A multivariate Cox proportional hazard model (CPH) showed that the risks of MACE, bleeding events, and NCE were not different between the l-TDAPT and s-TDAPT groups during the entire follow-up period and beyond 6 months after PCI. Multivariate time-varying CPH also showed similar results. De-escalation with low-dose ticagrelor within 6 months after PCI is feasible and safe even in patients with complex lesions harboring a high ischemic event risk.

PURPOSE We investigated whether the combination therapy of low-intensity rosuvastatin and ezetimibe is an useful alternative to moderate-intensity rosuvastatin monotherapy in patients requiring cholesterol-lowering therapy. METHODS This was a multicenter randomized, double-blind study to investigate the safety and efficacy of a fixed-dose combination of rosuvastatin 2.5 mg and ezetimibe 10 mg (R2.5+E10) compared to those of ezetimibe 10 mg monotherapy (E10), rosuvastatin 2.5 mg (R2.5), and rosuvastatin 5 mg monotherapy (R5) in patients with hypercholesterolemia. A total of 348 patients at 15 centers in Korea were screened, and 279 patients were randomized to different groups in the study. Clinical and laboratory examinations were performed at baseline and 4 and 8 weeks after intervention. The primary endpoint was the percentage change of low-density lipoprotein (LDL) cholesterol levels at the 8-week follow-up. FINDINGS Baseline characteristics were similar among the four groups. There were significant changes in lipid profiles at the 8-week follow-up. A greater decrease in the LDL cholesterol levels (primary endpoint) were found in the R2.5+E10 group (-45.7±18.6%) than in the E10 group (-16.7±14.7%, p

Diabetes mellitus (DM) is considered an independent risk factor for atrial fibrillation (AF). The excess risk in relation to the presence of proteinuria has not been well elucidated. Our aim was to determine the association between the incidence of AF and proteinuria in diabetic population. A total of 240,499 individuals aged ≥ 60 years from the Korea National Health Insurance Service-Senior cohort from 2004 to 2014 were included. 4.2% of individuals with DM and 3.7% of controls were diagnosed with AF during a median follow-up period of 7.2 years. Amongst controls (participants without proteinuria and DM), DM only, proteinuria only, and DM with proteinuria groups, the crude incidences of AF were 0.58, 0.70, 0.96, 1.24 per 100 person-years respectively. Compared with controls, the weighted risk of AF was increased by 11% (hazard ratio = 1.11, 95% confidence interval = 1.02–1.20, P = .001), 48% (hazard ratio = 1.48, 95% confidence interval = 1.30–1.69, P

BackgroundIn patients with suspected obstructive coronary artery disease (CAD), evaluation using a pre-test probability model is the key element for diagnosis; however, its accuracy is controversial. This study aimed to develop machine learning (ML) models using clinically relevant biomarkers to predict the presence of stable obstructive CAD and to compare ML models with an established pre-test probability of CAD models.MethodsEight machine learning models for prediction of obstructive CAD were trained on a cohort of 1,312 patients [randomly split into the training (80%) and internal validation sets (20%)]. Twelve clinical and blood biomarker features assessed on admission were used to inform the models. We compared the best-performing ML model and established the pre-test probability of CAD (updated Diamond-Forrester and CAD consortium) models.ResultsThe CatBoost algorithm model showed the best performance (area under the receiver operating characteristics, AUROC, 0.796, and 95% confidence interval, CI, 0.740–0.853; Matthews correlation coefficient, MCC, 0.448) compared to the seven other algorithms. The CatBoost algorithm model improved risk prediction compared with the CAD consortium clinical model (AUROC 0.727; 95% CI 0.664–0.789; MCC 0.313). The accuracy of the ML model was 74.6%. Age, sex, hypertension, high-sensitivity cardiac troponin T, hemoglobin A1c, triglyceride, and high-density lipoprotein cholesterol levels contributed most to obstructive CAD prediction.ConclusionThe ML models using clinically relevant biomarkers provided high accuracy for stable obstructive CAD prediction. In real-world practice, employing such an approach could improve discrimination of patients with suspected obstructive CAD and help select appropriate non-invasive testing for ischemia.

BackgroundThere is a paucity of information about mortality related to light-intensity physical activity (LPA) in the older population. We examine the associations between physical activity and mortality, focusing on the effect of light-intensity physical activity and the dose-response relationship between physical activity and mortality.MethodsWe analyzed a total of 58,537 participants aged ≥ 65 years (mean age, 73.9 ± 5.8 years; male, 36.0%) in the Korean National Health Insurance Service database between 2009 and 2012. The Date of the end of follow-up was December 31, 2013. Individuals were divided into four categories according to physical activity intensity: totally sedentary (43.3%), LPA only (35.8%), LPA and moderate- to vigorous-intensity physical activity (MVPA) (16.3%), MVPA only (4.5%). Physical activity was quantified using standardized self-reported questionnaires which composed of the duration and frequency of physical activity.ResultsDuring a mean follow-up of 39.6 ± 14.0 months, 5,651 (9.7%) deaths occurred. Compared with totally sedentary individuals, those in the LPA only, LPA and MVPA, and MVPA only groups showed 26% [hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.68–0.82], 27% (HR 0.73, 95% CI 0.63–0.84), and 34% (HR 0.66, 95% CI 0.54–0.79) lower all-cause mortality risk, showing an inverse relationship between physical activity intensity and mortality risk. In contrast, the LPA only, LPA and MVPA, and MVPA only groups represented a stronger inverse association with CV mortality (LPA: HR 0.76, 95% CI 0.62–0.92; LPA with MVPA: HR 0.74, 95% CI 0.55–0.999; MVPA, HR 0.57, 95% CI 0.37–0.87). Among participants performing LPA alone, participants performing less than the recommended dose of physical activity had lower all-cause mortality than those with sedentary activity (1–249 MET-min/week: HR 0.74, 95% CI 0.67–0.82, 250–499 MET-min/week: HR 0.65, 95% CI 0.59–0.72).ConclusionPhysical activity, even low doses of LPA, was associated with reduced mortality risk in the elderly population. This study may motivate sedentary individuals to engage in any physical activity for mortality benefits.

The aim of this study was to investigate the practice pattern and long-term prognostic effect of dual antiplatelet therapy (DAPT) duration in patients undergoing percutaneous coronary intervention (PCI) with second-generation drug-eluting stent (DES) for left main coronary artery (LMCA) disease. Using individual patient-level data from the IRIS-MAIN and KOMATE registries, 1,827 patients undergoing PCI with second-generation DES for LMCA disease with valid information on the DAPT duration were included. The primary outcome was major adverse cardiovascular events (MACE, a composite of cardiac death, myocardial infarction, stent thrombosis) and the safety outcome was major bleeding. The DAPT duration was

Diabetes mellitus (DM) is considered an independent risk factor for atrial fibrillation (AF). The excess risk in relation to the presence of proteinuria has not been well elucidated. Our aim was to determine the association between the incidence of AF and proteinuria in diabetic population. A total of 240,499 individuals aged ≥ 60 years from the Korea National Health Insurance Service-Senior cohort from 2004 to 2014 were included. 4.2% of individuals with DM and 3.7% of controls were diagnosed with AF during a median follow-up period of 7.2 years. Amongst controls (participants without proteinuria and DM), DM only, proteinuria only, and DM with proteinuria groups, the crude incidences of AF were 0.58, 0.70, 0.96, 1.24 per 100 person-years respectively. Compared with controls, the weighted risk of AF was increased by 11% (hazard ratio = 1.11, 95% confidence interval = 1.02-1.20, P = .001), 48% (hazard ratio = 1.48, 95% confidence interval = 1.30-1.69, P .001), and 66% (hazard ratio = 1.66, 95% confidence interval = 1.26-2.18, P .001) in the DM only, proteinuria only, and DM with proteinuria groups, respectively (P for trend .001). Degree of proteinuria in diabetic patients was associated with a significantly higher rate of incident AF in dose dependent manner. Thus, assessing proteinuria by a simple urine dipstick test could provide a useful adjunct to risk assessment for AF in elderly population with DM.

Objectives The goal of this study was to evaluate whether the beneficial effect of use of intravascular ultrasound (IVUS) is sustained for long-term follow-up. Background The use of IVUS promoted favorable 1-year clinical outcome in the IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) trial. It is not known, however, whether this effect is sustained for long-term follow-up. Methods The IVUS-XPL trial randomized 1,400 patients with long coronary lesions (implanted stent length ≥28 mm) to receive IVUS-guided (n = 700) or angiography-guided (n = 700) everolimus-eluting stent implantation. Five-year clinical outcomes were investigated in patients who completed the original trial. The primary outcome was the composite of major adverse cardiac events, including cardiac death, target lesion–related myocardial infarction, or ischemia-driven target lesion revascularization at 5 years, analyzed by intention-to-treat. Results Five-year follow-up was completed in 1,183 patients (85%). Major adverse cardiac events at 5 years occurred in 36 patients (5.6%) receiving IVUS guidance and in 70 patients (10.7%) receiving angiographic guidance (hazard ratio: 0.50; 95% confidence interval: 0.34 to 0.75; p = 0.001). The difference was driven mainly by a lower risk for target lesion revascularization (31 [4.8%] vs. 55 [8.4%]; hazard ratio: 0.54; 95% confidence interval: 0.33 to 0.89; p = 0.007). By landmark analysis, major adverse cardiac events between 1 and 5 years occurred in 17 patients (2.8%) receiving IVUS guidance and in 31 patients (5.2%) receiving angiographic guidance (hazard ratio: 0.53; 95% confidence interval: 0.29 to 0.95; p = 0.031). Conclusions Compared with angiography-guided stent implantation, IVUS-guided stent implantation resulted in a significantly lower rate of major adverse cardiac events up to 5 years. Sustained 5-year clinical benefits resulted from both within 1 year and from 1 to 5 years post-implantation. (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions [IVUS-XPL Study]: Retrospective and Prospective Follow-Up Study; NCT03866486)

The aim of this study was to investigate the optimal strategy for antiplatelet therapy in patients with lower extremity peripheral artery disease (PAD) after endovascular revascularization.The optimal strategy for antiplatelet therapy in patients with PAD after endovascular revascularization has not been established.From March 2008 to February 2013, 693 patients with lower extremity PAD treated with different antiplatelet therapies, such as mono-antiplatelet therapy (MAPT) and dual-antiplatelet therapy (DAPT), of various durations after endovascular revascularization were analyzed. They were classified into 2 groups (DAPT 6 months or MAPT vs. DAPT ≥6 months). The primary outcomes were major adverse cardiovascular events and major adverse limb events. The safety outcome was major bleeding.During 5-year follow-up, major adverse cardiovascular events occurred less frequently in the DAPT ≥6-month group than the DAPT 6-month or MAPT group (17.3% vs. 31.3%; hazard ratio: 0.44; 95% confidence interval: 0.30 to 0.65; p 0.001). Major adverse limb events also occurred less frequently in the DAPT ≥6-month group than the DAPT 6-month or MAPT group (21.5% vs. 43.7%; hazard ratio: 0.42; 95% CI: 0.30 to 0.58; p 0.001). However, major bleeding events were infrequent, with no signal toward harm with DAPT ≥6 months. Results were consistent after inverse probability-weighted adjustment and propensity score matching.Following endovascular revascularization for lower extremity PAD, DAPT ≥6 months was associated with decreased 5-year major adverse cardiovascular events and major adverse limb events.

In 2010, Korea’s authorities announced foreign exchange-related macroprudential measures (MPMs) aimed at building resilience against external financial shocks. These measures have greatly contributed to limit systemic risk by curbing excessive capital inflows. Twelve years have passed since the global financial crisis started and ten years after the introduction of Korea’s FX-related macro-prudential policy measures. Accordingly, this study check the performance and effectiveness of these policies and discuss how to improve macroprudential measures in response to emerging external risks.

Background: Limited data are available regarding the role of angiotensin-II-receptor blockers (ARB) in the prevention of new-onset diabetes mellitus in patients with atherosclerotic cardiovascular disease (ASCVD) and hypertension requiring high-dose statin. This study aimed to compare the effects of telmisartan and amlodipine on glucose metabolism in hypertensive ASCVD patients with impaired fasting glucose (IFG) requiring high-intensity statin.Methods: A total of 99 patients with hypertensive ASCVD with impaired fasting glucose (100–125 mg/dL or HbA1c 5.7%–6.4%) were randomly assigned to two groups [telmisartan-statin group (n = 48) and amlodipine-statin group (n = 51)] as the add-on therapy to high-dose rosuvastatin therapy (20 mg). The primary endpoint was the value of the homeostatic model assessment for insulin resistance (HOMA-IR) at week 24, and the secondary endpoint was the change in the glucose metabolism indices from baseline to week 24. Results: The HOMA-IR at week 24 (2.4 [interquartile range, 1.8–3.8] versus 2.6 [1.7–3.7]; P = 0.809) and changes in the HOMA-IR from baseline to week 24 (−7.0 [−29.0 to 21.0] versus −2.3 [−53.3 to 27.3]; P = 0.539) were not significantly different between the telmisartan-statin group and the amlodipine-statin group. However, the fasting glucose level at week 24 was significantly lower in the telmisartan-statin group (107.7 ± 13.4 mg/dL) than in the amlodipine-statin group (113.3 ± 12.4 mg/dL; P = 0.039) and significantly decreased from the baseline in the telmisartan-statin group (−3.2% ± 8.6% versus 3.8% ± 13.2%; P = 0.003). The proportion of patients with IFG (71.1% versus 89.6%; P = 0.047) or hemoglobin A1c level >6.5% (4.2% versus 21.6%; P = 0.023) at week 24 was also significantly lower in the telmisartan-statin group than in the amlodipine-statin group.Conclusion: Compared to amlodipine, telmisartan did not decrease the HOMA-IR; rather, an improvement in glucose metabolism was noted during the follow-up in hypertensive ASCVD patients with IFG requiring high-dose statin, suggesting the potential role of ARB for reducing risks owing to high-intensity statin. Trial registration: clinicaltrials.gov, NCT03474562. Registered March 22, 2018, https://clinicaltrials.gov/ct2/show/NCT03474562

The Korean chronic total occlusion (CTO) registry was collected prospectively from 26 cardiovascular centers since May 2007. The aim of this study is to investigate the impact of a successful staged percutaneous coronary intervention (PCI) of CTO lesions in acute myocardial infarction (AMI) patients on clinical outcomes.Among 2813 patients who underwent a staged PCI because of CTO lesions, 422 (15%) patients underwent primary PCI because of AMI. Among 422 patients, successful staged CTO-PCI was performed in 76%. The clinical outcomes were compared between the successful CTO-PCI group (n=321) and the failed CTO-PCI group (n=101). To adjust for potential confounders, a propensity score matching (PSM) analysis was carried out using the logistic regression model.After the PSM analysis, two propensity-matched groups (85 pairs, n=170) were generated and the baseline characteristics were balanced. The incidence of total death (P=0.029) and non-ST-segment elevation myocardial infarction (NSTEMI, P=0.043) at 1 year was higher in the failed CTO-PCI group. Multivariate regression showed that successful CTO-PCI was an independent predictor of preventing mortality (hazard ratio, 0.21, P=0.048). In the subgroup analysis, the Kaplan-Meier curve showed that successful CTO-PCI had a lower incidence of total death (log-rank=0.004) and cardiac death (log-rank=0.005) up to 1 year in NSTEMI patients. Cox-proportional analysis showed that successful CTO-PCI was beneficial in patients with NSTEMI, hypertension, and non-left-anterior descending artery lesion for preventing mortality.In this study, a staged successful CTO-PCI in AMI patients was associated with improved 1-year survival in the Korean population.

Background Reduced preprocedural thrombolysis in myocardial infarction (TIMI) flow in patients with ST-segment elevation myocardial infarction (STEMI) is known to be associated with increased mortality. However, clinical implications of reduced preprocedural TIMI flow in patients with non-ST-segment elevation myocardial infarction (NSTEMI) have not been fully elucidated as yet. The aim of the present study was to compare the clinical influence of reduced preprocedural TIMI flows between patients with STEMI and NSTEMI undergoing percutaneous coronary intervention (PCI). Methods From the Korea Acute Myocardial Infarction Registry, a total of 7336 AMI patients with angiographically confirmed reduced preprocedural TIMI flow (TIMI 0/1) during PCI were selected and divided into STEMI (n=4852) and NSTEMI (n=2484) groups. The 12-month composite of total death, nonfatal myocardial infarction, coronary artery bypass graft, and repeated PCI was compared between the two groups. Results After adjustment of baseline confounders by propensity score stratification, the NSTEMI group had lower incidences of major adverse cardiac events than the STEMI group (7.15 vs. 11.19%; hazard ratio: 0.63; 95% confidence interval: 0.47-0.84; P=0.001) at 12 months, which was largely attributable to the lower incidences of total deaths (2.43 vs. 3.99%; P=0.04) and repeated PCI (3.81 vs. 6.41%; P=0.01). Conclusion Among AMI patients with TIMI 0/1, patients with NSTEMI had better outcomes compared with those of patients with STEMI on the basis of the incidences of 12-month outcomes. This could be attributable to lower total death and repeated revascularization in patients with NSTEMI.

Background Acute mechanical circulatory support (aMCS) can be a lifesaving therapy for patients with refractory cardiogenic shock. As device safety and technology improve, so will the ability to extend aMCS to patients at remote hospitals. The Intermountain West is unique because of the large geographical area, making transport of critically ill patients a logistical challenge. Methods We reviewed our experience of transporting patients in cardiogenic shock over long distances who had already been placed on aMCS: Impella and extracorporeal membrane oxygenator devices. Survival data was compared to international benchmark data published by the Extracorporeal Life Support Organization. Results A total of 11 patients (91% male; mean age 56 ± 5.4 y) were transported via fixed-wing aircraft to our center. The etiology of cardiogenic shock was ST-elevation myocardial infarction ( n = 4), acutely decompensated chronic systolic heart failure ( n = 4), postcardiotomy shock ( n = 2), and acute myocarditis ( n = 1). Average transport distance was 364 ± 139 miles (585 ± 264 km) and flight time was 170 ± 29 min. All patients were safely transported with no in-transit adverse events. The average duration of aMCS was 6.4 ± 3.3 d. Six patients (54.5%) survived to device explantation and 3 (27.2%) survived to hospital discharge. For comparison, Extracorporeal Life Support Organization benchmark data for adult cardiogenic shock patients report 56% survival to device explantation and 41% to hospital discharge. Conclusions Patient transport with aMCS over long distances can be done safely without serious adverse events using good protocols and well-trained personnel. Although survival data are slightly below benchmark data, they appear reasonable, given the severity of illness and challenges of transferring critically ill patients to an expert center.

We discuss the macroeconomic effects of asset-based reserve requirements (ABRR) in a dynamic stochastic general equilibrium model. In contrast to the conventional reserve requirement system, ABRR impose reserve requirements on financial institutions’ asset holdings. The policy can be used for macro prudential purposes to reduce pro-cyclicality of financial institutions. Using a financial friction New Keynesian model based on Meh and Moran ( 2010 ), we show that ABRR can be a more effective instrument in the presence of sector-specific shocks than the Basel-III type countercyclical capital buffer. The reason is that the former policy can adjust the asset return of the specific sector hit by the shock, whereas the latter does not have such sector-specific treatment.

Background: Despite advances in reperfusion times, patients presenting with acute myocardial infarction carry an unacceptably high rate of mortality and morbidity. Mechanical unloading of the left ventricle (LV) has been suggested to reduce infarct size after acute myocardial infarction. Although prior studies have investigated LV unloading during ischemia with a delay in reperfusion, little is known about the optimal timing for LV unloading in the setting of acute myocardial infarction. Methods: Studies were conducted in 17 adult Yorkshire swine weighing 67±5 kg. A coronary balloon was inflated in the mid left anterior descending for 60 minutes to induce a myocardial infarction. The coronary balloon was then deflated for 120 minutes (reperfusion). The animals were stratified into 3 groups: group 1 (control, reperfusion with no LV unloading, n=5), group 2 (LV unloading during ischemia with delayed reperfusion, n=6), and group 3 (simultaneous LV unloading and reperfusion, n=6). Staining the hearts with Evans blue and 2,3,5-triphenyltetrazolium chloride was used to identify the area at risk and the infarct area respectively. Infarct percent size was defined as the area of infarcted myocardium divided by the area at risk. Results: Of the 3 groups, group 3 demonstrated significantly smaller infarct percent size compared with controls (54.7±20.3% versus 22.2±13.4%; P =0.03). Comparison between group 1 and group 2 did not reveal significant difference (54.7±20.3% versus 43.3±24.6%; P =0.19). Conclusions: In our large animal experimental model, simultaneous reperfusion and mechanical LV unloading yielded the smallest infarct size compared with no LV unloading or LV unloading with delayed reperfusion. In the context of prior studies showing benefit to unloading before reperfusion, these findings raise questions about how this strategy may be translated to humans.

Since the global financial crisis, low interest rates have continued throughout the world. However, financial imbalance has deepened as much of the expanded investment during low interest rates did not lead to increased productivity. This study focused on the increase of marginal firms as a result of the adverse effects of financial imbalances on firms. The marginal firms were identified based on the company's financial statement, and the share of marginal firms by country was compared and analyzed using Worldscope data. As a detailed analysis on the marginal firms, the impact of borrowing interest rate on the possibility of becoming a marginal company was analyzed in the case of Korea with KED data. According to the international comparison, East Asia including Korea, China and Japan has shown a lower share of marginal companies than Europe, South Asia and Latin America. Empirical results through Panel Logit with Sector Fixed Effect Model show that the borrowing rate has a negative correlation with the probability the company will become a marginal company in the case of Korea. However, the impact of an increase in borrowing rates on the likelihood of becoming a marginal company depends on the degree of financial vulnerability. Specifically, an increase in the borrowing rate has a greater impact on the possibility to become ICR

Background There are limited data comparing long-term clinical outcomes between first-generation (1G) and second-generation (2G) drug-eluting stents (DESs) in patients who underwent successful percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) lesion. Methods A total of 840 consecutive patients who underwent PCI with DESs for CTO lesion from January 2004 to November 2015 were enrolled. Finally, a total of 324 eligible CTO patients received 1G-DES (Paclitaxel-eluting stent or Sirolimus-eluting stent, n = 157) or 2G-DES (Zotarolimus-eluting stent or Everolimus-eluting stent, n = 167) were enrolled. The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total repeat revascularization [target lesion revascularization (TLR), target vessel revascularization (TVR), and non-TVR]. We investigated the 5-year major clinical outcomes between 1G-DES and 2G-DES in patient who underwent successful CTO PCI. Results After propensity score matched (PSM) analysis, two well-balanced groups (111 pairs, n = 222, C-statistic = 0.718) were generated. Up to the 5-year follow-up period, the cumulative incidence of all-cause death, re-MI, TLR, TVR and non-TVR were not significantly different between the two groups. Finally, MACE was also similar between the two groups (HR = 1.557, 95% CI: 0.820–2.959, P = 0.176) after PSM. Conclusions In this study, 2G-DES was not associated with reduced long-term MACE compared with 1G-DES following successful CTO revascularization up to five years.

The goal of this study was to evaluate whether the beneficial effect of use of intravascular ultrasound (IVUS) is sustained for long-term follow-up.The use of IVUS promoted favorable 1-year clinical outcome in the IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) trial. It is not known, however, whether this effect is sustained for long-term follow-up.The IVUS-XPL trial randomized 1,400 patients with long coronary lesions (implanted stent length ≥28 mm) to receive IVUS-guided (n = 700) or angiography-guided (n = 700) everolimus-eluting stent implantation. Five-year clinical outcomes were investigated in patients who completed the original trial. The primary outcome was the composite of major adverse cardiac events, including cardiac death, target lesion-related myocardial infarction, or ischemia-driven target lesion revascularization at 5 years, analyzed by intention-to-treat.Five-year follow-up was completed in 1,183 patients (85%). Major adverse cardiac events at 5 years occurred in 36 patients (5.6%) receiving IVUS guidance and in 70 patients (10.7%) receiving angiographic guidance (hazard ratio: 0.50; 95% confidence interval: 0.34 to 0.75; p = 0.001). The difference was driven mainly by a lower risk for target lesion revascularization (31 [4.8%] vs. 55 [8.4%]; hazard ratio: 0.54; 95% confidence interval: 0.33 to 0.89; p = 0.007). By landmark analysis, major adverse cardiac events between 1 and 5 years occurred in 17 patients (2.8%) receiving IVUS guidance and in 31 patients (5.2%) receiving angiographic guidance (hazard ratio: 0.53; 95% confidence interval: 0.29 to 0.95; p = 0.031).Compared with angiography-guided stent implantation, IVUS-guided stent implantation resulted in a significantly lower rate of major adverse cardiac events up to 5 years. Sustained 5-year clinical benefits resulted from both within 1 year and from 1 to 5 years post-implantation. (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions [IVUS-XPL Study]: Retrospective and Prospective Follow-Up Study; NCT03866486).

Limited data exist on the long-term efficacy of extended dual antiplatelet therapy (DAPT) after left main coronary artery (LMCA) bifurcation stenting. This study investigated the long-term clinical outcomes associated with long-term DAPT after LMCA bifurcation stenting. Using data from the multicenter KOMATE and COBIS registries, we analyzed 1,142 patients who received a drug-eluting stent for a LMCA bifurcation lesion and who experienced no adverse events for 12 months after the index procedure. Patients were divided into 2 groups: DAPT >12 months (n = 769) and DAPT ≤12 months (n = 373). The primary end point was major adverse cardiovascular events (MACEs), as a composite of cardiac death, myocardial infarction, stroke, and stent thrombosis, over 5 years of follow-up. We further performed propensity score adjustment for clinical outcomes. DAPT >12 months afforded a lower MACE rate than DAPT ≤12 months (2.3% vs 5.4%, adjusted hazard ratio [HR] 0.37; 95% confidence interval [CI] 0.19 to 0.71; p = 0.003). The use of DAPT for >12 months was an independent predictor of a reduced likelihood of MACEs (HR 0.34; 95% CI 0.17 to 0.67; p = 0.002). A DAPT score ≥2, chronic kidney disease, and age >75 years were significant independent predictors of MACEs. In subgroup analysis, the use of DAPT for >12 months consistently resulted in better clinical outcomes across all subgroups, especially among patients with ACS, compared with the use of DAPT for ≤12 months. In conclusion, an extended duration of DAPT reduces MACE rates after LMCA bifurcation stenting.

Most previous studies have shown that push factors have had a greater impact on capital outflows in emerging economies than pull factors. Meanwhile, in May 2018, the US Federal Reserve Chairman Jerome Powell addressed the controversy over capital movements to emerging economies after the global financial crisis. Powell said the inflows of capital into emerging economies are unlikely to have been caused by the Fed's interest rate policy. Powell's speech contains "implied" warnings that the US monetary policy is not a triggering force of a capital outflow in emerging economies. This is why Powell’s speech is adding to the difficulty of policy responses in emerging countries. This, in turn, suggests that it is necessary to check the determinants of global capital flows. In addition, the impact of US monetary policy on Korea's financial markets and capital outflows needs to be analyzed in depth. In this paper, the discussion of push (external) vs. pull (internal) factors of capital flow is examined using panel data of 47 countries. Our empirical results show that the push and pull factors determining capital flows to advanced economies and emerging market economies are different. This study also analyzes the impact of the normalization of US monetary policy on the domestic financial market and foreign exchange market by using the TVP-VAR model. Our analysis shows that US credit spread shock, which is an indicator of uncertainty in international financial markets, has had a negative impact on domestic financial markets and capital inflows. On the other hand, the impact of the US policy rate hike after 2015 was limited.

Capital market integration contributes to economic growth and it can be more beneficial for emerging market economies (EMEs, hereafter) at their early stages of development where the capital is relatively insufficient. An open capital market also enables investor to share the country-specific risks by holding foreign assets. However, there are also some negative side effects of capital market integration. Financial shocks originating in the center country can be quickly propagated through the integrated financial market. The Global Financial Crisis (GFC, hereafter) is a good example of the contagion of the financial crisis. Volatile cross-border capital inflows and outflows negatively affect financial stability, which eventually lowers economic growth by causing financial crises. Despite of these negative side effects, capital market integration has been an inevitable long-term trend for many EMEs over the past few decades (Aizenman et al. 2010). There have been continuous capital flows to EMEs, which started even before GFC and this trend has been more pronounced during the U.S. zero-interest rate period (Ahmed and Zlate 2014). Though some monetary authorities in EMEs tried to moderate the procyclicality of credit flows by implementing policy instruments such as capital controls or macro-prudential policy measures after GFC (Kim and Mehrotra 2018), the common factors in the global financial market still play a crucial role in determining capital inflows to EMEs. The relationship between the global financial condition and its impact on capital inflows to EMEs, has been a long-debated issue. This issue concerns whether push or pull factors are the major determinant of capital flows. The push factor represents the common factor that exists in the global financial market or center countries, which influences capital inflows to peripheral countries. These factors are interest rates and GDP growth rates of advanced economies (AEs, hereafter), global risk factors such as VIX (S&P 500 Volatility Index), and the commodity price index. The pull factor denotes domestic factors that attract funds from the global financial market to domestic financial markets. These factors are domestic interest rates, domestic GDP growth rates, and other country-specific characteristics such as exchange rate regime, degree of the capital account openness, institutional quality, and stages of economic development. In previous literature, many scholars have found strong evidence for push factors being the major determinant of capital movement. The interest rates of mature economies and VIX are significant determinants of capital inflows to EMEs. However, there is only some evidence that higher domestic interest rates and higher domestic GDP growth rates pull capital from the center countries to individual EMEs (Koepke 2015). Related to this long-debated issue in academia, the Chairman of the Federal Reserve, Jerome H. Powell recently stated, "... I will argue that, while global factors play an important role in influencing domestic financial conditions, the role of U.S. monetary policy is often exaggerated." With this statement, he also pointed out that the slowdown in capital inflows to EMEs which has been happening ever since 2011 has been mainly due to the narrowing of GDP gaps between AEs and EMEs, i.e., the recent decrease in capital in-flows to EMEs can be attributed to the decline in EMEs' GDP growth rates given the fact that the U.S. GDP growth rate has picked up. In this paper, we revisit this issue of push and pull factors of capital inflows. To this end, we consider the heterogeneity that exists in EMEs by dividing them into four subgroups. We investigate which is the main driver of capital inflows between push and pull factors across country groups. Categorizing subgroups is important for two reasons. First, EMEs are so heterogeneous that we make subgroups which share similar economic fundamentals by regions. Second, making subgroups across EMEs is an effective way to indirectly consider the regional contagion effect. With this cross-country analysis, we can figure out the differing effects of push and pull factors across country groups, and this can eventually lead to the development and implementation of appropriate policy instruments. Our empirical finding shows that the push and pull factors play a different role in determining capital inflows to AEs and EMEs. The major drivers of capital inflows to AEs are both push and pull factors, but push factors turn out to be the main determinant of capital inflows to EMEs. When EMEs are divided into four subgroups, we find sizable heterogeneity across subgroups. In Asian countries, both push and pull factors are significant, which is similar to AEs, but only U.S. interest rate plays a major role in Eastern Europe. Some pull factors are important in Latin American countries and other EMEs, but these are not robust to alternative empirical models and measures.

Korean Abstract: 2011년 이후 우리나라에서 거주자의 해외투자가 주식 및 채권을 중심으로 가파르게 증가하고 있다. 2010년경 1,000억 달러 수준이던 거주자 해외증권 투자는 2019년 3월 말 현재 4,984억 달러로 급증하였다. 이러한 추세는 거시경제 여건(저금리, 은퇴 대비 저축 확대 등), 정부정책 변화(해외투자 활성화, 해외투자 관련 규제 완화 등), 제도 변화(보험업종에서의 IFRS 도입 등)로 향후에도 지속될 전망이다. 이는 여러 경로를 통해 대외충격에 민감한 우리나라 금융시장에 다양한 영향을 미칠 것이다. 특히 외환ㆍ외화자금시장과 단기외채 등 대외부문 거시건전성(macro-prudential)에 영향을 미칠 가능성이 높아 그 영향을 분석하고 리스크에 대해서는 미리 대비책을 마련할 필요가 있다. 그래서 본 연구는 거주자의 해외증권투자가 스왑레이트(swap rate) 및 환율에 미치는 영향에 대한 실증분석, 과거 국내 해외증권투자 확대 시기의 사례분석 및 금융회사 전문가 심층 인터뷰를 통해 외환 및 외화자금시장 안정화 방안을 위한 정책적 시사점을 제시하고자 한다.제2장에서는 거주자의 해외증권투자(채권/주식)가 스왑레이트와 환율(exchange rate)에 어떠한 영향을 미치는지 분석하였다. 스왑레이트 및 환율에 영향을 미치는 다른 변수를 계량모형에 포함하여 통제하였으며, 내생성의 문제를 효과적으로 완화할 수 있는 연립방정식 모형(Simultaneous Equations Model, 이하 SEM으로 표기)을 사용하였다. 한국을 포함한 18개국, 2000년부터 2017년까지의 국가패널을 사용한 연립방정식 실증분석 결과 거주자의 해외채권투자와 주식투자가 스왑레이트 및 환율에 미치는 효과가 상이한 것을 확인할 수 있었다. 거주자의 해외채권투자는 스왑레이트를 낮추는 반면 거주자의 해외주식투자는 스왑레이트에 미치는 영향이 통계적으로 유의하지 않았다. 반면 환율과 의 관련성에서는 반대의 효과가 나타났다. 즉 거주자의 해외채권투자는 환율에 미치는 영향이 통계적으로 유의하지 않은 반면, 거주자의 해외주식투자는 자국통화가치의 평가절하와 관련되어 있는 것으로 분석되었다. 거주자 해외채권투자의 확대가 스왑레이트를 감소시키는 효과는 주로 신흥국에서 두드러졌다. 이러한 실증분석 결과는 채권과 주식의 상이한 환리스크(exchange risk) 헤지(hedge) 관행이 설명할 수 있다. 일반적으로 채권투자에서는 환리스크를 헤지하기 위해 외화자금시장을 이용하게 되면서 스왑레이트를 낮추게 되지만, 주식투자에서는 주로 현물환 시장에서 자국통화를 투자국통화로 교환한 후 해외주식투자가 이루어진다. 이러한 과정에서 자국통화의 가치가 절하되는 것이다. 이러한 실증분석 결과는 한국의 월별 자료를 사용한 VAR 분석 결과에서도 나타나는 강건한 결과임을 확인하였다. 제3장에서는 국내에서 거주자의 해외증권투자가 확대되었던 과거 시기와 최근 시기를 비교ㆍ분석하였다. 2000년대 중반 시기, 2010년 이후부터 최근 시기 등 두 시기의 해외증권투자 확대 배경, 투자 주체 및 방식, 영향 등에 대해 그 특징을 살펴보았다. 해외증권투자 확대 배경 측면에서는 두 시기 모두 공통적으로 국내 경상수지 흑자 및 외국인 자금 유입 지속, 저금리 지속, 정부의 해외투자 활성화 정책 요인이 크게 작용하였다. 즉 국내 경상수지 흑자 및 외국인 자금 유입 지속으로 외화 유동성이 풍부해지고 저금리 기조의 장기화로 원화 유동성도 풍부해져 국내에서 해외 고수익 투자 수요가 크게 확대되었다. 이러한 상황에서 정부는 국내의 풍부한 외화 유동성을 조절하고 원화 강세압력을 완화하기 위해 해외투자 활성화 정책을 추진하였다. 투자 주체 및 방식 측면에서는 두 시기가 차이점을 보였다. 투자 주체의 경우 2000년대 중반에는 자산운용사를 중심으로 해외주식투자가 확대된 반면, 최근 시기에는 보험사를 중심으로 해외채권투자가 크게 확대되었다. 해외투자방식의 경우도 두 시기가 차이점을 보였다. 2000년대 중반에는 해외증권투자 시 주식 및 채권을 불문하고 100% 환위험을 헤지한 반면, 최근 시기에는 채권에 대해서는 100% 환위험을 헤지하고, 주식에 대해서는 일정 비율 환위험을 헤지하지 않고 있다. 해외증권투자 확대의 영향 측면에서는 두 시기에 공통점과 차이점이 혼재한다. 2000년대 중반의 경우 해외증권투자는 100% 환위험 헤지로 원화강세 압력을 완화시키지 못한 반면, 스왑레이트 하락과 단기 외화차입 증대를 초래하였다. 스왑레이트 하락에 따른 재정거래차익 기회 확대로 외은지점 등 은행의 단기성 외화 차입이 늘어났다, 이는 우리나라의 국가신용도에 부정적인 영향을 미쳤다. 최근 시기에는 2000년 중반에 비해 환위험 헤지 비율이 낮아졌지만 여전히 보험사를 중심으로 한 높은 환헤지 비율이 지속되고 있다. 이로 인해 해외투자가 환율에 미치는 영향은 제한적이지만 스왑레이트에는 하락 압력요인으로 작용하고 있다. 끝으로 실증분석 결과, 사례분석 및 전문가 심층 면담 결과를 바탕으로 외환 및 외화자금시장 안정화를 위해 미헤지 외화증권투자에 대한 인센티브 확대 강구, 환헤지 규제 관련 정부 내 거버넌스 구조(governance framework) 필요, 보험사 회계기준 및 자본 적정성 규제 변경에 따른 리스크 대응 강화, 외화표시 보험 판매 활성화 유도, RBC 비율 규제 개선 등 정책적 시사점을 제시하였다. English Abstract: Since 2011, the overseas financial investment of residents in Korea has been increasing rapidly, mainly in stocks and bonds. Residents‘ portfolio investment, which was about 100 billion USD in 2010, has surged to 498 billion USD as of end-March 2019. This trend is expected to continue in the future due to macroeconomic conditions (low interest rates, expansion of savings over retirement), changes in government policies (activation of foreign investment, deregulation related to overseas investment), and institutional changes (introduction of IFRS in the insurance industry). This will have an influence on the Korean financial market through various channels. In particular, it is likely to affect the FX market, FX money market and the external macro-prudential elements such as short term external debt, meaning it will be necessary to analyze these effects and prepare for risks in advance. Therefore, this study is aimed at presenting policy implications for stabilizing the FX market and FX money market through empirical analysis, comparative analysis of the past and recent expansion period of overseas portfolio investment, and in-depth interviews with financial experts. In Chapter 2, we examine the impact of the residents' foreign portfolio investments(bonds/equity) on swap rates and exchange rates. We use the Simultaneous Equations Model (SEM), which can effectively mitigate the endogeneity problem under the control of other factors that might affect swap rates and exchange rates. The empirical results of the SEM using the panel data show that the effect of residents’ foreign bond investment and foreign equity investment on swap rates and exchange rates are different. Residents’ foreign bond investment lowers the swap rates, while the residents' foreign equity investment has no impact on the swap rates. On the other hand, the effect on the exchange rates is opposite. The effect of residents’ foreign bond investments on exchange rates are statistically insignificant but, residents’ foreign equity investments are closely related to the depreciation of the Korean won. The notable result is that the effect of residents’ foreign bond investment on swap rates is more pronounced in emerging market economies. These empirical results can be explained by the different hedge practices of foreign bond and equity investment to deal with the exchange risk. In general, residents’ foreign bond investment lowers the swap rate by utilizing the swap market to hedge exchange risk. However, investors in foreign equity investment normally exchange their local currency to foreign currency in the spot exchange market. In this process, the value of the local currency is depreciated. These empirical results are consistent with the results from our VAR model using Korean monthly data. In Chapter 3, we conduct a comparative analysis between the past and recent periods when residents’ overseas securities investment expanded. This study examines the background, investor, investment method, and impact of overseas portfolio investment expansion in the mid-2000s and from 2010 to the latest. The expansion of overseas portfolio investment in both periods was mainly caused by current account surplus, continued inflow of foreign funds, low interest rate, and government policy to revitalize overseas investment. In other words, as foreign currency liquidity and won-denominated liquidity are abundant due to the current account surplus, the inflow of foreign funds, and the prolonged low interest rate, the seeking for high-yield overseas investments has expanded greatly in Korea. Against this backdrop, the Korean government has promoted overseas investment in order to reduce the abundance of foreign currency liquidity and to ease the pressure on the strong won. The two periods show differences in terms of investor and FX risk hedge pattern. In the case of the investor, overseas equity investment was expanded mainly by asset management companies in the mid-2000s, while foreign bond investment was largely expanded by insurance companies in recent years. In the case of FX risk hedge pattern, in the mid-2000s, FX risk was fully hedged when investing overseas securities, regardless of stocks and bonds. However in recent years, FX risk is not fully hedged when investing in overseas stocks, while 100% hedged when investing in overseas bonds. In terms of the impact of overseas securities investments, there are commonalities and differences between the two periods. In the mid-2000s, foreign securities investment failed to alleviate the won's appreciation pressure due to a 100% hedge of FX risks, while causing a drop in swap rates and an increase in short-term external debts. Banks’ short-term external debts, including at branches of foreign banks, have increased thanks to increased opportunities for arbitrage transaction gains due to a drop in swap rates. The increase in short-term foreign debt has contributed to the decline in Korea's national credibility. In recent years, the rate of exchange risk hedging has been lower than in the mid-2000s. However, major overseas investors, especially insurers, still maintain high FX risk hedging rates. As a result, the impact of foreign investment on the exchange rate is limited, but instead, it acts as a factor to lower the swap rate. Finally, based on the results of empirical analysis, case analysis and in-depth interviews with experts, we suggest the policy implications for stabilizing the FX markets and FX money markets. These include: increased incentives for unhedged foreign currency investments, the need for a governance framework to reconcile differences between macroeconomic and financial regulators, stronger risk responses to changes in accounting standards and capital adequacy regulations, more active foreign currency denominated insurance sales, and improvements made in risk-based capital (RBC) ratio regulation.

This report looks at the current state of foreign currency deposits (FCDs) in Korea and identifies determinants of the foreign currency deposits and the relationship between foreign currency deposit and exchange rate stability. Based on empirical analysis and surveys of experts, this paper proposes a scheme to activate foreign currency deposits. Korea's foreign currency deposits have increased significantly since the global financial crisis, thanks to the continuation of the current account surplus. At the end of 2010, FCDs were $24 billion, and as of the end of 2017, FCDs increased to $87 billion. Accordingly, the role of FCDs as a source of foreign currency funds for domestic banks has increased significantly. In 2010–18, when looking at changes in the composition of foreign currency liabilities of domestic banks, the share of foreign borrowing decreased from 40.7% to 24.8%, while the reliance on FCDs rose from 20.1% to 35.3%. However, as corporations’ share of FCDs account for about 80%, Korea's FCDs are highly volatile depending on the size of imports and exports, exchange rate fluctuations, etc. In fact, during March–April 2019, the size of FCDs decreased sharply due to an increase in the exchange rate. In order to identify the determining factors of Korea’s FCDs, a structural VAR (vector autoregressive) model was used. When analyzed for the entire period, FCDs were found to respond significantly to the exchange rate shock, but were not significantly affected by the current account shocks. However, the impact of the two variables on FCDs varied significantly before and after the global financial crisis. Before the global financial crisis, while the effect of currency shocks on FCDs was not statistically significant, the impact of the current account balance on FCDs was significant. However, since the global financial crisis, the effect of commercial accounts on FCDs has been greatly weakened, while exchange rates have played an important role as a variable affecting FCDs. In addition, the report found that increased FCDs have a positive effect on exchange rate stability, thus increasing the legitimacy of policy efforts to expand FCDs. Using panel data from 21 countries, the impact of foreign exchange reserves and foreign currency deposits on exchange rate stability was demonstrated. It was confirmed that an increase in foreign currency deposits in countries or periods where foreign exchange reserves are relatively low reduces exchange rate volatility. Based on empirical findings and interviews with commercial bank officials and experts, the report provides several suggestions on how to raise FCDs. In order for FCDs to function as a stable source of foreign currency liquidity, banks must be given incentives in their management and procurement of FCDs. First of all, the current system where sell and buy transactions in the swap market lead to a reduction in foreign currency liquidity coverage ratio (LCR) should be improved. We suggest measures such as regarding foreign currencies that will be returned to the bank within a few days after a sell and buy transaction as cash inflows when conducting 3-month stress test calculations. In regard to the foreign currency LCR and three-month stress test, it will be necessary to check whether regulatory effects are overlapping with existing measures such as the foreign exchange stability levy or regulations on foreign exchange derivatives position, etc. In terms of foreign currency funding, we propose an improvement of the return on foreign currency deposits and the strengthening of global money management services. Should the current account surplus flow be disrupted, it will be difficult for the authorities to pursue the expansion of foreign currency deposits. However, based on the understanding of the incentive structure of the FCDs stakeholders analyzed in this report, it is necessary to promote the expansion of FCDs in a way that increases the attractiveness of FCDs as a financial product.

Machine learning (ML) might be useful to analysis various clinical information to make more accurate predictions. We sought to develop a ML model, utilizing clinical variables to predict the presence of stable obstructive coronary artery disease (CAD). We retrospectively analyzed 4906 patients who

Background There were limited data comparing the major clinical outcomes between first-generation (1G)-drug eluting stents (DES) and second-generation (2G)-DES in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) during very long follow-up periods. We thought to investigate the comparative efficacy and safety of 2G-DES compared with 1G-DES in AMI patients during 5-year follow-up periods. Method A total of 1016 eligible AMI patients who underwent PCI with 1G-DES [paclitaxel-, sirolimus-, 1G-zotarolimus-eluting stent (endeavor® or endeavor sprint®), n = 554] or 2G-DES [2G-zotarolimus (endeavor resolute®)- or everolimus-eluting stent, n = 462] were enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-target vessel revascularization (Non-TVR) and the secondary endpoint was stent thrombosis (ST) at 5 years. Results Two propensity score-matched (PSM) groups (232 pairs, n = 464, C-statistic = 0.802) were generated. During the 5-year follow-up period, the cumulative incidence of TLR [hazard ratio (HR): 3.133; 95% confidence interval (CI): 1.539–6.376; P = 0.002], TVR (HR: 3.144; 95% CI: 1.596–6.192; P = 0.001) and total revascularization rate (HR: 1.874; 95% CI: 1.086–3.140; P = 0.023) were significantly higher in 1G-DES compared with 2G-DES after PSM. However, the incidence of total death, non-fatal MI and ST were similar between the two groups. Conclusion In this single-center and all-comers registry, 2G-DES's superiorities for TLR, TVR and total revascularization in AMI patients suggested during 5-year clinical follow-up periods.

Acute myocardial infarction (AMI) is a progressive disease in Korea and active treatment strategies can improve the clinical outcomes. In the CADILLAC trial, anemia on admission was associated strongly with adverse outcomes and increased mortality in AMI. However, it remains controversial whether anemia on admission is an independent poor prognostic factor of long-term clinical outcomes in AMI patients undergoing a percutaneous coronary intervention with a drug-eluting stent in Koreans.A total of 1143 AMI patients undergoing percutaneous coronary intervention with drug-eluting stent at Korea University Guro Hospital between 2005 and 2015 were enrolled. Anemia on admission was defined as hemoglobin levels of less than 13 g/dl in men and less than 12 g/dl in women using the WHO's criteria. Patients were divided into two groups (472 patients with anemia and 671 patients without anemia). The primary endpoint was major adverse cardiac events (MACE) up to 5 years including death, myocardial infarction, and revascularization.To adjust for confounding factors, we carried out a propensity score matching analysis. Two matched groups (300 pairs, n=600 patients) were generated and their baseline characteristics were balanced. During the 5-year clinical follow-up, patients with anemia had a higher incidence of MI [hazard ratio (HR): 2.137, 95% confidence interval (CI): 1.074-4.254], target vessel revascularization (HR: 1.641, 95% CI: 1.004-2.682), and total MACE (HR: 1.427, 95% CI: 1.012-2.614).AMI patients with anemia on admission had higher incidence of MI, target vessel revascularization, and total MACE over the 5-year follow-up.

Background and objectives Extracorporeal membrane oxygenation (ECMO) support is increasingly used in primary percutaneous coronary intervention (PCI) during cardiopulmonary resuscitation (CPR) to treat acute myocardial infarction (AMI) patients who experienced cardiogenic shock. However, to date, there have been no studies on the relationship between clinical outcomes and CPR time in such patients with AMI treated by ECMO-assisted primary PCI. Methods From July 2008 to March 2016, we analyzed data from 42 AMI with cardiogenic shock patients who underwent CPR and were treated by ECMO-assisted primary PCI. The primary outcome was 30-day in-hospital mortality after primary PCI. The predictors of mortality were determined using a Cox proportional hazards model. Results Thirty-day in-hospital mortality was observed for 33 patients (78.6%). The mean CPR time was 37.0±37.3 minutes. The best cut-off CPR time value associated with clinical outcome was calculated to be 12.5 minutes using receiver operating characteristic curve analysis. Multivariate analysis revealed that CPR time of >12.5 minutes was an independent predictor of 30-day mortality (adjusted hazard ratio, 4.71; 95% confidence interval, 1.30-17.406; p=0.018). Conclusions Despite ECMO support, the clinical outcomes of AMI patients with a complication of cardiogenic shock remain poor. Prolonged CPR time is associated with a poor prognosis in patients with AMI treated by ECMO-assisted primary PCI.

The aim of this study was to evaluate the extent of neointimal response after the implantation of a second-generation drug-eluting stent, zotarolimus-eluting stent (ZES-ER, Endeavor Resolute) or everolimus-eluting stent (EES, Xience V), using intravascular ultrasound (IVUS) in diabetic patients.In all, 154 diabetic patients with de-novo coronary lesions were randomized to be implanted with a ZES-ER or EES, and the angiographic follow-up at 9 months combined with a complete IVUS study was available for 96 patients with 101 lesions.Baseline demographic and lesion parameters were similar in both groups at index percutaneous coronary intervention. On follow-up angiography, in-stent late lumen loss and minimal lumen diameter were not different between the two groups. On IVUS study, neointimal hyperplasia volume [median (interquartile range): ZES-ER vs. EES; 2.25 mm (0.57-6.25) vs. 1.59 mm (0.45-8.37), P=0.615] and in-stent percentage of volume obstruction [median (interquartile range): ZES-ER vs. EES; 1.16% (0.33-3.61) vs. 0.77% (0.29-4.01), P=0.615] showed similar results between the two groups.In diabetic patients, the second-generation drug-eluting stents, ZES-ER and EES, were comparable in inhibiting neointimal proliferation.

Korean Abstract: 본 연구는 글로벌 자본유출입 결정요인 및 미국 통화정책이 국내 금융시장에 미치는 영향을 분석하였다. 실증분석 결과 신흥국의 자본유출입은 주로 대외요인에 의해 영향을 받았으나, 국가별로 자본유출입 결정요인이 상당히 상이한 것으로 나타났다. 미 연준 통화정책 정상화가 국내 금융시장, 외환시장에 미치는 파급영향을 분석한 결과 미 정책금리, 기간프리미엄, 신용스프레드 등이 높아지면 국내 신용스프레드 확대 및 원/달러 환율 상승(원화 약세) 등을 초래하여다. 아울러 내국인 해외투자자금이 회수되면서 외국인 국내투자자금 이탈을 상쇄시키는 모습을 보였다. 그동안 내외금리 차 확대가 곧바로 자본유출로 이어진다는 우려가 컸다. 하지만 2014년 이후 '내국인 해외 증권투자자산 > 외국인 국내 증권투자' 구조 정착 및 내국인 해외투자자금의 환류 가능성 상승 등으로 '내외금리차 확대 → 자본유출 증가' 리스크가 과거보다 줄어들었다는 점을 시사한다. English Abstract: During the global financial crisis, the US monetary authority (Fed) reduced the benchmark interest rate to 0% and provided massive liquidity through three quantitative easing measures. As a result, the US Fed balance sheet expanded five times ($ 4.5 trillion) from September 2008 ($ 0.9 trillion). Much of the increased global liquidity flowed into emerging economies. The influx of capital contributed to the growth of emerging economies, leading to new credit increases such as bank loans. Emerging markets, which supported 63% of global GDP, served as an engine of the global economy at a time when the growth in the US and Europe were subdued. While capital inflows have a supporting role in contributing to economic growth, they have also been a potential prompting factors to systemic risk in emerging countries and Korea. Emerging economies actively responded to systemic risks from foreign capital inflows. With the introduction of macro-prudential policy measures, emerging economies have been striving to maintain an external balance by responding to the surge in domestic credit and restraining excessive capital inflows. In order for emerging countries to adopt measures to curb inflows of capital, persuasiveness and legitimacy are secured only if external influences are triggered by external factors. Most previous studies have shown that push factors have had a greater impact on capital outflows in emerging economies than in pull factors. Raghuram Rajan, former central bank governor of India, has pointed out that the monetary policy impact of the US Fed and the developed country central bank is a major external factor (push factor). Meanwhile, in May 2018, the US Federal Reserve Chairman Jerome Powell addressed the controversy over capital movements to emerging economies after the global financial crisis. Powell said the inflows of capital into emerging economies is unlikely to have been caused by the Fed’s interest rate policy. According to the study, the US Fed’s quantitative easing has had the effect of lowering the Fed base rate by a further 4%. This means that normalization of the quantitative easing policy will lead to a policy rate hike of 4 percentage points. This is the reason why the normalization of US monetary policy will have a negative impact on the global economy. At the same time, the squeezing on capital outflows in emerging economies is increasing. Powell’s speech contains “implied” warnings that the US monetary policy is not a triggering force of a capital outflow in emerging economies. That’s why Powell’s speech is adding to the difficulty of policy responses in emerging countries. This suggests that it is necessary to check the determinants of global capital flows. In addition, the impact of US monetary policy on Korea's financial markets and capital outflows needs to be analyzed in depth.

This study sought to investigate the long-term clinical effects of stent generation and stent strategy for left main coronary artery (LMCA) bifurcation lesion treatment.Limited data are available to assess long-term clinical outcomes after stenting, including use of current-generation drug-eluting stent (C-DES) for treatment of LMCA bifurcation lesions.A total of 1,353 patients who were recorded in 2 multicenter real-world registries were treated by either early-generation drug-eluting stent (E-DES) (n = 889) or C-DES (n = 464). Primary endpoint was major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization rates during 3-year follow-up. The authors further performed propensity-score adjustment for clinical outcomes.During 3-year follow-up, the overall MACE rate was 8.7%. Use of a 1-stent strategy resulted in better clinical outcomes than use of a 2-stent strategy (4.7% vs. 18.6%, hazard ratio [HR]: 3.71; 95% confidence interval [CI]: 2.55 to 5.39; p 0.001). Use of C-DES resulted in a lower MACE rate compared with using E-DES (4.6% vs. 10.9%, HR: 0.55; 95% CI: 0.34 to 0.89; p = 0.014), especially for the 2-stent strategy. For patients with C-DES, the presence of chronic kidney disease and pre-intervention side branch diameter stenosis ≥50% were significant independent predictors of MACE.Intervention of LMCA bifurcation lesions using DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES patients. Use of a 1-stent strategy resulted in better clinical benefits than using a 2-stent strategy.

AIMS There are few randomised studies concerning the optimal duration of dual antiplatelet therapy (DAPT) for patients who receive a second-generation drug-eluting stent (DES). This trial aimed to investigate the safety of six-month compared with 12-month DAPT maintenance after second-generation DES implantation. METHODS AND RESULTS A prospective, randomised, multicentre trial was performed at 10 medical centres. The 1,368 patients included in the study received a biolimus-eluting stent (BES) or a zotarolimus-eluting stent (ZES). The primary outcome measured was the composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), or ischaemia-driven target lesion revascularisation at the 12-month follow-up. The secondary outcome was the percentage of uncovered struts at six months in 60 patients (30 ZES, 30 BES) using optical coherence tomography (OCT) assessment. Each patient was randomly assigned to six-month (n=684) or 12-month DAPT (n=684). Major adverse cardiac events at 12 months occurred in eight patients (1.2%) in the six-month DAPT group and in four patients (0.6%) in the 12-month DAPT group (risk difference 0.6%; 95% confidence interval [CI]: -0.4-1.6%; p=0.24). The upper 95% CI limit was lower than the pre-specified limit of 4% non-inferiority (p for non-inferiority

The role of infectious agents in the etiology of inflammatory diseases once believed to be non-infectious is increasingly being recognized. Many bacterial components in the indoor dust can evoke inflammatory lung diseases. Bacteria secrete nanometer-sized vesicles into the extracellular milieu, so-called extracellular vesicles (EV). which are pathophysiologically related to inflammatory diseases. Microbiota compositions in the indoor dust revealed the presence of both Gram-negative and Gram-positive bacteria. Escherichia coli is a model organism of Gram-negative Enterobacteriaceae. The repeated inhalation of E. coli-derived EVs caused neutrophilic inflammation and emphysema in a dose-dependent manner. The emphysema induced by E. coli-derived EVs was partially eliminated by the absence of Interferon-gamma or interleukin-17, suggesting that Th1 and/or Th17 cell responses are important in the emphysema development. Meanwhile, the repeated inhalation of Staphylococcus aureus-derived EVs did not induce emphysema, although they induced neutrophilic inflammation in the lung. In terms of microbial EV compositions in the indoor dust, genera Pseudomonas, Acinetobacter, Enterobacter, and Staphylococcus were dominant. As for the clinical significance of sensitization to EVs in the indoor dust, EV sensitization was closely associated with asthma, chronic obstructive pulmonary disorder (COPD), and lung cancer. These data indicate that biological ultrafine particles in the indoor dust, which are mainly composed of microbial EVs, are important in the pathogenesis of chronic lung diseases associated with neutrophilic inflammation. Taken together, microbial EVs in the indoor dust are an important diagnostic and therapeutic target for the control of chronic lung diseases, such as asthma, COPD, and lung cancer.

Purpose Although current guidelines recommend the administration of dual antiplatelet therapy (DAPT) for up to 12 months after the implantation of a drug-eluting stent (DES), extended DAPT is frequently used in real-world practice. Materials and Methods From the Korean Multicenter Angioplasty Team registry, we identified a total of 1414 patients who used DAPT for >3 years after DES implantation (extended-DAPT group) and conducted a landmark analysis at 36 months after the index procedure. We evaluated the determinants for and long-term outcomes of extended DAPT and compared the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as the composite of all-cause death, myocardial infarction, stent thrombosis, and stroke, between the extended-DAPT group and the guideline-DAPT group [DAPT

Limited data exist on the long-term efficacy of extended dual antiplatelet therapy (DAPT) after left main coronary artery (LMCA) bifurcation stenting. This study investigated the long-term clinical outcomes associated with long-term DAPT after LMCA bifurcation stenting. Using data from the