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Drug-eluting stents (DES) significantly improved angiographic and clinical outcomes compared with bare-metal stents in patients with diabetes. The clinical effects of BioMime sirolimus-eluting stent (SES) in patients with diabetes have not been evaluated. Therefore, we compared the efficacy of BioMime DES in coronary artery disease (CAD) patients with versus without diabetes.This prospective analytical study compared angiographic in-segment late loss and clinical effectiveness of BioMime SES stents in treating patients with (patients: 77 and lesions: 83) versus without (patients: 154 and lesions: 162) diabetes. The purpose of this study was the comparison of angiographic in-segment late loss at 12 months. Major adverse cardiac events (MACEs) were also monitored as secondary outcomes 24 months after the index procedure.Of 231 patients enrolled in the study, the mean age was 63.3 years and 153 patients were male. Angiographic follow-up rate was 84.8% (patients: 196) and intravascular ultrasound (IVUS) follow-up rate was 67.9% (patients: 157) at 12 months. Diabetic patients were comparable to nondiabetic patients for 12-month in-segment late loss (0.01 ± 0.31 mm for the nondiabetes group versus 0.04 ± 0.11 mm for the diabetes group; P = 0.158; P 0.05). At 24 months, MACEs, including death, myocardial infarction and ischemic-driven target lesion revascularization were not statistically different between the two treatment groups.BioMime SES stents in treating patients with diabetes were comparable in reducing angiographic restenosis at 12 months and MACEs at 24 months compared to nondiabetic patients with CAD.

In patients with coronary artery disease who are being evaluated for percutaneous coronary intervention (PCI), procedures can be guided by fractional flow reserve (FFR) or intravascular ultrasonography (IVUS) for decision making regarding revascularization and stent implantation. However, the differences in clinical outcomes when only one method is used for both purposes are unclear.We randomly assigned 1682 patients who were being evaluated for PCI for the treatment of intermediate stenosis (40 to 70% occlusion by visual estimation on coronary angiography) in a 1:1 ratio to undergo either an FFR-guided or IVUS-guided procedure. FFR or IVUS was to be used to determine whether to perform PCI and to assess PCI success. In the FFR group, PCI was to be performed if the FFR was 0.80 or less. In the IVUS group, the criteria for PCI were a minimal lumen area measuring either 3 mmThe frequency of PCI was 44.4% among patients in the FFR group and 65.3% among those in the IVUS group. At 24 months, a primary-outcome event had occurred in 8.1% of the patients in the FFR group and in 8.5% of those in the IVUS group (absolute difference, -0.4 percentage points; upper boundary of the one-sided 97.5% confidence interval, 2.2 percentage points; P = 0.01 for noninferiority). Patient-reported outcomes as reported on the Seattle Angina Questionnaire were similar in the two groups.In patients with intermediate stenosis who were being evaluated for PCI, FFR guidance was noninferior to IVUS guidance with respect to the composite primary outcome of death, myocardial infarction, or revascularization at 24 months. (Funded by Boston Scientific; FLAVOUR ClinicalTrials.gov number, NCT02673424.).

In this study, we aimed to investigate the time course of new-onset complete atrioventricular block (CAVB) and its reversibility after transcatheter aortic valve implantation (TAVI). We analyzed 206 consecutive patients without baseline CAVB who underwent successful TAVI. The incidence of new-onset CAVB was determined to be 12.6% (26/206). Among these patients, 14 recovered from CAVB within 2 weeks (6.8%, 14/206), while the remaining 12 (5.8%, 12/206) underwent permanent pacemaker (PPM) insertion. Among the 12 patients who received the PPM, 4 were able to recover from CAVB within 4 months. Thus, only 8 among 206 patients (3.8%) showed persistent CAVB. Early-onset CAVB on the day of the procedure was the strongest predictor of PPM implantation (OR = 127). The electrocardiographic changes that occurred after TAVI were mostly recovered after 1 month. The most critical procedural factor that predicts CAVB and PPM insertion is the deep implantation (>4 mm) of a big valve (oversizing index >5.9%). In conclusion, the incidence of CAVB after TAVI was estimated to be at 12.6%. Two-thirds of these patients recovered from CAVB within 3 days, resulting in a final rate of persistent CAVB of 4%. To prevent CAVB, we have to implant an appropriate valve type with an optimal size and depth.

Omega-3 fatty acids have been shown to be effective in lowering triglyceride (TG) levels; however, tolerability issues arise due to the large size of the pills. The purpose of this study was to examine the safety, compliance, and efficacy of Omethyl QTlet soft capsules (OQCs). This multi-center, prospective, observational study evaluated the safety, compliance, and efficacy of OQCs. Patients with hypertriglyceridemia with a history of omega-3 fatty acid intake were enrolled in this study and were prescribed OQCs (2 g–4 g/day) for eight weeks. All adverse events (AEs), adverse drug reactions (ADRs), and serious adverse events (SAEs) were recorded for safety evaluation. Adherence to treatment was assessed using questionnaires, and efficacy was assessed by changes in lipid and lipoprotein levels after eight weeks from baseline. The convenience of taking medication was analyzed for 580 patients, and the efficacy test was performed for 563 patients. The AE and ADR rates were 8.2% and 5.7%, respectively. There were only two SAEs. Of the patients, 55.8% responded that the OQC improved medication convenience, and mean changes in TG, total cholesterol, LDL-C, and non-HDL-C from baseline to eight weeks were −37.88 mg/dL, −11.56 mg/dL, −5.55 mg/dL, and −10.87 mg/dL, respectively (p-values < 0.001). In patients who had previously taken omega-3 fatty acids, OQCs showed safety and efficacy in lowering TG, and it was confirmed that compliance with medicine also improved compared to omega-3 fatty acids.

Background The ischemic/bleeding risk of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is still uncertain. We sought to develop a tool to predict ischemic and bleeding events in East Asians receiving 2nd generation drug-eluting stents (DESs) PCI. Methods A pooled cohort of 13,172 East Asian patients receiving PCI with 2nd generation DES (the Grand DES cohort) was analyzed to develop a scoring system. A net score was calculated by subtracting the bleeding score from the ischemic score. External validation was performed in the HOST-ASSURE and NIPPON trials. Results Among the total population, ischemic and bleeding events occurred in 195 patients (1.5%) and 166 patients (1.3%), respectively. The score to predict ischemic events included previous myocardial infarction (MI) or PCI, presentation as acute MI, anemia, stent diameter Conclusion We developed a tool to predict ischemic and bleeding events in East Asian patients received PCI with 2nd generation DES. This system can be used to assess clinical event risks, and to determine the adequate duration of DAPT in East Asians.

De-escalation of dual-antiplatelet therapy through dose reduction of prasugrel improved net adverse clinical events (NACEs) after acute coronary syndrome (ACS), mainly through the reduction of bleeding without an increase in ischemic outcomes. Whether the benefits of de-escalation are sustained in highly thrombotic conditions such as ST-elevation myocardial infarction (STEMI) is unknown. We aimed to assess the efficacy and safety of de-escalation therapy in patients with STEMI or non-ST-segment elevation ACS (NSTE-ACS).This is a pre-specified subgroup analysis of the HOST-REDUCE-POLYTECH-ACS trial. ACS patients were randomized to prasugrel de-escalation (5 mg daily) or conventional dose (10 mg daily) at 1-month post-percutaneous coronary intervention. The primary endpoint was a NACE, defined as a composite of all-cause death, non-fatal myocardial infarction, stent thrombosis, clinically driven revascularization, stroke, and bleeding events of grade ≥2 Bleeding Academic Research Consortium (BARC) criteria at 1 year.Among 2,338 patients included in the randomization, 326 patients were diagnosed with STEMI. In patients with NSTE-ACS, the risk of the primary endpoint was significantly reduced with de-escalation (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.48-0.89; p=0.006 for de-escalation vs. conventional), mainly driven by a reduced bleeding. However, in those with STEMI, there was no difference in the occurrence of the primary outcome (HR, 1.04; 95% CI, 0.48-2.26; p=0.915; p for interaction=0.271).Prasugrel dose de-escalation reduced the rate of NACE and bleeding, without increasing the rate of ischemic events in NSTE-ACS patients but not in STEMI patients.

BACKGROUND Dipeptidyl peptidase-4 (DPP4) inhibitors are widely used to treat type 2 diabetes mellitus (T2DM). In a previous study, we demonstrated a plausible mechanism how DPP4 inhibitors may cause accumulation of stroma derived factor-1 (SDF1) in ischemic retina, leading to vascular permeability and diabetic retinopathy (DR). We sought to investigate the association of DPP4 inhibitors with DR in patients using the Korean National Health Insurance Service (NHIS) data. METHODS This was a retrospective, population-based cohort study using the Korean NHIS database. The Korean NHIS is a government-run, mandatory medical insurance service and keeps records of patient sociodemographic data, inpatient and outpatient medical services and prescriptions. The database consists of records from the entire Korean, totaling 51 million people, regardless of the medical institution from which they received service. RESULTS Among the total study population, 26.0% (152,149 of 585,191) received prescriptions of DPP4 inhibitors. The incidence of DR in the DPP4 inhibitor group was 55.03 per 1,000 person-years (PPY), compared to 50.17 PPY in the non-DPP4 group (P P

Background: The role of immediate percutaneous coronary intervention (PCI; door-to-balloon time ≤90 minutes) in patients with ST-segment–elevation myocardial infarction who present ≥12 hours after symptom onset is still obscure. We sought to explore the clinical outcomes of immediate PCI in patients with ST-segment–elevation myocardial infarction depending on presentation time. Methods: Using the Korea Acute Myocardial Infarction Registry, a nationwide prospective multicenter registry in the Republic of Korea, we analyzed data from 5968 patients with ST-segment–elevation myocardial infarction. These patients were classified into the following groups: early presenters (n=5104 with symptom onset-to-door time Results: In early presenters, immediate PCI was significantly associated with a lower rate of major adverse cardiac events compared with delayed PCI (door-to-balloon time >90 minutes; immediate versus delayed PCI, 8.6% versus 17.9%; inverse probability weighting adjusted hazard ratio, 0.63 [95% CI, 0.56–0.71]). In late presenters, immediate PCI was not associated with better major adverse cardiac events outcomes (13.0% versus 14.8%; inverse probability weighting adjusted hazard ratio, 1.05 [95% CI, 0.77–1.44]). The same trend was found for cardiac death (early presenters: immediate versus delayed PCI, 5.6% versus 14.3%; inverse probability weighting adjusted hazard ratio, 0.55 [95% CI, 0.48–0.64]; late presenters: 9.9% versus 9.8%; inverse probability weighting adjusted hazard ratio, 1.25 [95% CI, 0.86–1.82]). Very late presenters also showed the same trends as late presenters. Immediate PCI was an independent predictor of major adverse cardiac events in early presenters but not in late presenters. Conclusions: Immediate PCI, defined by time door-to-balloon time ≤90 minutes, for patients with ST-segment–elevation myocardial infarction who present ≥12 hours after symptom onset is not associated with improved long-term clinical outcomes as compared with delayed PCI (door-to-balloon time >90 minutes).

OBJECTIVES We investigated whether the dual antiplatelet therapy (DAPT) score (DS) predicts clinical outcome in an East-Asian population that received exclusively second generation drug-eluting stent (DES). BACKGROUNDS It is uncertain whether the DS could adequately risk stratify patients exclusively receiving second generation DES. METHODS From the Grand-DES registry, we evaluated patients who were treated with DAPT for at least 12 months and were event-free at 12 months after DES implantation. Patients were classified into two categories: high DS (≧2) (n = 3,157); and low DS (

Background: β-Blockers can improve prognosis after acute myocardial infarction. However, it remains unclear how long β-blockers should be prescribed. Methods: We included patients from the prospective, nationwide Korea Acute Myocardial Infarction Registry-National Institutes of Health registry and collected data on β-blockers and left ventricular ejection fraction (LVEF) at 1-year follow-up. Patients were stratified into 2 groups: 1001 patients with a 1-year LVEF Results: A total of 3177 patients received β-blockers at 1 year, and 151 patients died during the 2-year follow-up from 1 year after index hospitalization. β-Blockers showed survival benefits in patients with a 1-year LVEFP =0.001) but not in those with a 1-year LVEF≥50% (log-rank P =0.311). After adjusting covariates, β-blockers were associated with a 51% reduction in mortality in patients with a 1-year LVEFP =0.020) but not in their counterparts ( P =0.322). Indeed, there was a prognostic interaction between the use of β-blockers at 1 year and 1-year LVEF ( P for interaction=0.004). Conclusions: Use of β-blockers at 1-year follow-up after acute MI was associated with improved outcomes in patients with an LVEF50% at 1 year. This study provides valuable information about differential responsiveness to β-blockers according to 1-year LVEF and might suggest the proper duration of β-blockers after acute MI. Registration: URL: http://cris.nih.go.kr/cris/en/ ; Unique identifier: KCT0000863.

Background: The clinical outcome after percutaneous coronary intervention (PCI) is affected by various clinical and procedural risk factors. We investigated the relative impact of clinical and procedural risks on clinical outcomes after PCI. Methods: A total of 13 172 patients were enrolled from the Grand-DES registry. The population was grouped into tertiles (high-, intermediate-, low-risk) according to the number of prespecified clinical and procedural risk factors, respectively. The primary end point was major adverse cardiac and cerebrovascular events (MACCE) at 3 years post-PCI. Results: MACCE occurred in 1109 (8.4%) patients during the follow-up period (median duration: 1126 days). Compared with procedural risk, clinical risk showed superior predictive power (area under the curve: 0.678 versus 0.570, P P P Conclusions: Clinical and procedural risks were both significant predictors for ischemic clinical events in patients undergoing PCI. However, clinical risk had a greater and more prolonged effect on outcomes than procedural risk. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03507205.

OBJECTIVES This study aimed to investigate the effects of procedural optimization on the clinical outcomes of using the drug-coated balloon (DCB) in the treatment of coronary artery disease. BACKGROUNDS Procedural optimization is considered an essential step in DCB treatment. METHODS Data of consecutive patients who underwent DCB treatment at the Seoul National University Hospital were collected. The primary outcome was target lesion failure (TLF) at 2 years. RESULTS Among 259 patients (309 lesions), TLF was observed in 31 (12.0%) patients. The following were modifiable procedural factors: residual percent diameter stenosis (%DS) after lesion preparation; DCB-to-vessel/stent ratio; time-delay to inflation; and total DCB inflation time. The best cutoff values for these parameters were 20%, 0.95, 25, and 60 s, respectively. The patients were classified based on the number of procedural factors that satisfied adequate criteria. TLF was observed in 7.3% in the fully optimized group, 9.1% in the partially optimized group, and 34.1% in the nonoptimized group over 2 years (p

Paravalvular leak (PVL) is an important complication of transcatheter aortic valve implantation (TAVI) and is associated with poor prognosis. We aimed to identify the risk factors for PVL after TAVI including patient (calcium amount or location), device (leakage-proof or not), and procedural (oversizing index (OI)) factors. The primary outcome was mild or greater PVL at 1-month follow-up echocardiography. Overall, 238 patients who underwent TAVI using eight types of valves (Edwards Sapien, Sapien XT, Sapien 3, CoreValve, Evolut R, Evolut PRO, Lotus, and Lotus Edge) were included. The incidence of significant PVL (&ge, mild PVL) was 24.4%. Although patient factors (calcification of valve) were not predictors of PVL, valve without leakage-proof function (Edwards Sapien, Sapien XT, and CoreValve) was a significant predictor of PVL (adjusted odds ratio, 3.194, 95% CI, 1.620&ndash, 6.299). Furthermore, OI has a significant protective role against PVL (PVL increased by 45% when OI decreased by 5%). The best cutoff value of OI to predict the absence of PVL was &ge, 17.6% for the Evolut system and &ge, 10.2% for the Sapien system. The predictors of PVL after TAVI included factors from the device (valve without leakage-proof function) and procedure (under-sizing). In patients with a high risk of PVL, the procedure should be optimized using valves with leakage-proof function and adequate OI.

Background There are many studies on emphasizing the importance of quitting smoking, but the smoking status was based on baseline status without subsequent status. Since a significant percentage of patients who have received coronary revascularization change their smoking status, it is necessary to confirm the clinical consequences of smoking status after revascularization. Purpose In this study, we aimed to investigate the impact of smoking status after revascularization on long-term clinical outcomes, using large population based study from the Korean National Health Insurance System. Methods Among 74,004 patients who received coronary revascularization (PCI or CABG) from 1 January 2007 to 21 December 2013 and underwent regular health check-up within 2 years after index PCI, examined for death, MI, revascularization and stroke. Results Within patients who underwent revascularization, 33,800 (45.7%) of patients were self-reported non-smoker, 28,603 (38.7%) were ex-smoker, 11601 (15.6%) were current smokers at first regular health check-up after revascularization. Current smokers were associated with higher risks for death (HR: 1.497; 95% CI: 1.366–1.641), MI (HR: 1.498; 95% CI: 1.302–1.723) and revascularization (HR: 1.088; 95% CI: 1.018–1.164) than non-smokers. Compared with non-smokers, more than 30PY ex-smokers and current smokers showed higher incidence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of death, MI, revascularization and stroke. Regarding smoking tendency, maintaining non-smokers were lower risk for MACCE than maintaining smokers (Figure 1). Quitters tended to lower MACCE compared to patients who continued to smoke (HR: 0.823; 95% CI: 0.762–0.888). Especially, maintaining non-smokers and quitters significantly showed lower mortality than patients who continued to smoke. Conclusion Smoking is associated with poor clinical outcomes after coronary revascularization especially more than 30PY ex-smokers and current smokers. These results also emphasized that smoking cessation after revascularization also important for mortality benefit. Figure 1 Funding Acknowledgement Type of funding source: None

To demonstrate the association of the serum creatinine/serum cystatin C ratio (sarcopenia index, SI) with clinical outcomes including cardiovascular and bleeding risk in older patients who underwent percutaneous coronary intervention (PCI), we analyzed a multicenter nation-wide pooled registry. A total of 1086 older patients (65 years or older) who underwent PCI with second-generation drug-eluting stents (DES) were enrolled. The total population was divided into quartiles according to the SI, stratified by sex. The primary clinical outcomes were major adverse cardiovascular events (MACE, all-cause death, myocardial infarction and target lesion revascularization) and thrombolysis in myocardial infarction major and minor bleeding during a 3-year follow-up period. In the total population, MACE occurred within 3 years in 154 (14.2%) patients. The lowest SI quartile group (Q1) had a significantly higher 3-year MACE rate (Q1 vs. Q2&ndash, 4, 23.1% vs. 11.2%, p &lt, 0.001), while bleeding event rates were similar between the groups (Q1 vs. Q2&ndash, 2.6% vs. 2.2%, p = 0.656). The Cox proportional hazard model showed that lower SI is an independent predictor for MACE events (HR 2.23, 95% CI 1.62&ndash, 3.07, p &lt, 0.001). The SI, a surrogate for the degree of muscle mass, is associated with cardiovascular and non-cardiovascular death, but not with bleeding in older patients who underwent PCI.

We investigated whether intensive glucose control after percutaneous coronary intervention (PCI) improves clinical outcomes in diabetic patients. From the Grand-DES registry, we analyzed 2576 diabetic patients (median age 66 years, male 65.6%) who underwent PCI and had at least 2 records of HbA1c during the follow-up. Patients were categorized according to the mean HbA1c (&ge, 7% or &lt, 7%). Primary outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and any revascularization. During a median follow-up of 33.6 months, MACE occurred in 335 (13.0%) patients. Intensive glucose control with follow-up mean HbA1c &lt, 7.0% (42.2%, n = 1087) was not associated with lower risk of MACE, compared to control with mean HbA1c &ge, 7.0% (adjusted hazard ratio [aHR] [95% confidence interval] 1.06 [0.82&ndash, 1.37], p = 0.672). In subgroup analysis, patients with sustained HbA1c of &lt, 7.0% throughout the follow-up were not associated with a lower risk of MACE compared to those with sustained HbA1c of &ge, 7.0% (aHR 1.15 [0.71&ndash, 1.89], p = 0.566). More intensive glucose control with mean HbA1c &le, 6.5% was not associated with lower risk of MACE, compared to loose control with a mean HbA1c &ge, 8.0% (aHR 1.15 [0.71&ndash, 1.86], p = 0.583). Intensive glucose control after PCI was not associated with better clinical outcomes in diabetic patients undergoing PCI than lenient control.

BACKGROUND Aortic knob width (AKW), which can be measured easily in simple radiography, is associated with the degree of dilatation and tortuosity of the aortic arch. Pulsatile stress influences aortic geometry. This study was carried out to investigate whether AKW can represent invasively measured aortic pulse pressure (APP). METHODS A total of 252 patients who underwent invasive coronary angiography (ICA) for the evaluation of coronary artery disease were enrolled. AKW was defined as the perpendicular length from the lateral margin of the main bronchus to the most prominent edge of the aortic knob on chest radiography. APP was measured at the ascending aorta using a pigtail catheter immediately before ICA. RESULTS When patients were divided into two groups according to the median value of APP (69 mmHg), AKW was significantly greater in patients with higher APP (≥69 mmHg) than in those with lower APP (

While dual antiplatelet therapy (DAPT) is essential after percutaneous coronary intervention (PCI), the optimal duration is affected by various factors. However, the effect of ethnicity on DAPT duration has not been fully evaluated. In this study, we evaluated the different effect of DAPT duration by ethnicity. We searched Pubmed, Embase, Cochrane library, and relevant websites to search for randomized clinical trials (RCT) assessing the clinical impact of long term DAPT (L-DAPT) and short term DAPT (S-DAPT). Studies were divided by ethnicity, and we compared the efficacy and safety of DAPT duration in each ethnic group. Thirteen RCTs including 38,255 patients (five East Asian studies and eight non&ndash, East Asian studies) were eligible for analysis. For the primary outcome, L-DAPT showed a significantly lower rate of primary outcome only in non&ndash, East Asians (S-DAPT vs. L-DAPT, odds ratio (OR) = 1.16, 95% confidence interval (CI): 1.02&ndash, 1.32, p = 0.02), while in East Asians, the effect of S-DAPT and L-DAPT were comparable. S-DAPT significantly increased ischemic events only in non&ndash, East Asians (S-DAPT vs. L-DAPT, OR = 1.24, 95% CI: 1.09&ndash, 1.42, p &lt, 0.01), while bleeding events were decreased by S-DAPT in both ethnicities. These results demonstrate that the adequate DAPT duration after PCI may be different in East Asians.

Objectives. The aim of this study was to assess the clinical impact of 3 bifurcation angles in left main (LM) bifurcation treated with the 2-stent technique. Background. Data are limited regarding the impact of bifurcation angles after LM percutaneous coronary intervention (PCI). Methods. Using patient-level 4 multicenter registries in Korea, 462 patients undergoing LM bifurcation PCI with the 2-stent technique were identified (181 crush, 167 T-stenting; 63% 1st generation drug-eluting stent (DES), 37% 2nd generation DES). Three bifurcation angles, between the LM and left anterior descending (LAD), the LM and left circumflex (LCX), and the LAD and LCX, were measured. The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). Results. In patients treated with the crush technique, the best cutoff value (BCV) to predict TLF was 152° of the LM-LAD angle. In the crush group, a significantly higher TLF rate, mostly driven by TLR, was observed in the LM-LAD angle ≥152° group compared with the Conclusions. In LM bifurcation PCI using the 2-stent technique, wide LM-LAD angle (≥152°) was associated with a greater risk of TLF in the crush, whereas none of the bifurcation angles affected T-stenting outcomes.

Background Although some strategies are used for prophylaxis of contrast induced nephropathy, their efficacy is not fully established. Sarpogrelate can relieve vasospasm and have anti-inflammatory action. This study examined whether sarpogrelate reduces the incidence of contrast induced nephropathy (CIN) or subsequent renal impairment during four weeks after coronary angiography compared with a control group. Methods Seventy-four participants with chronic renal failure were randomly assigned to the sarpogrelate or control group. Patients assigned to the sarpogrelate group received oral saporogelate from 24 hours before contrast exposure up to one month after contrast exposure. The primary outcome of this study was the incidence of CIN within 48 hours after exposure to the contrast agent. Results Thirty-one subjects in the control group and 35 subjects in the sarpogrelate group were used for the analysis. Cumulative CIN occurred numerically more at 48 hours in the sarpogrelate group and less at one month without statistical significance (11.4% vs. 6.5% at 48 hours and 11.4% vs. 16.1% at one month, respectively). Baseline renal function was similar in both groups, but the estimated glomerular filtration rate (eGFR) was lower in the sarpogrelate group at 12 and 48 hours compared with the control group (45.6 vs. 54.7 mL/min/1.73m2; P = 0.023 and 39.9 vs. 50.6 mL/min/1.73m2; P = 0.020, respectively). At one month, the eGFR became comparable between the two groups because the eGFR was aggravated in the control group and maintained in the sarpogrelate group. Conclusion This study failed to demonstrate that sarpogrelate has a renoprotective effect against contrast induced acute kidney injury. Trial Registration ClinicalTrials.gov Identifier: NCT01165567, Graphical Abstract

The application of a simple blood test to predict prognosis in acute heart failure (AHF) patients is not well established. Neutrophil-lymphocyte ratio (NLR) is inexpensive and easy to obtain in hospitalized patients using a routine blood test. We evaluate the prognostic implications of NLR as an independent predictor of in-hospital and long-term mortality in AHF patients. Among 5625 patients enrolled in the Korean Acute Heart Failure registry, 5580 patients were classified into quartiles by their NLR level, and analyzed for in-hospital and post-discharge three-year mortality. Patients in the highest NLR quartile had the highest in-hospital and post-discharge three-year mortality. The same results were seen by dividing the aggravating factor into the infection or ischemia group and the non-infection or non-ischemia group. For patients aggravated from infection or ischemia, a cut-off NLR value was 7.0 that increase the risk of in-hospital and post-discharge three-year mortality. In subgroups of patients not aggravated from infection or ischemia, a cut-off NLR value was 5.0 that increase the risk of in-hospital and post discharge three-year mortality. Elevated NLR in AHF patients at the index hospitalization is an independent predictor for in-hospital and post-discharge three-year mortality. Taken together, NLR is a marker for risk assessment of AHF patients.

Computational fluid dynamics (CFD) is novel noninvasive technology that can provide information of coronary hemodynamics. This study attempted to determine whether the wall shear stress (WSS) evaluated by CFD is related to the adverse plaque characteristics (APC). We retrospectively enrolled 296

Drug coated balloon (DCB) angioplasty is recommended as a reasonable option for drug-eluting stent (DES) in-stent restenosis (ISR). Currently, procedural optimization is regarded as essential to maximize the clinical outcomes. We investigated the impact of optimizing procedure-related factors during

Background Endothelium has a function to regulate vascular tone by releasing mediators either vasodilating or vasoconstricting blood vessels. Endothelial dysfunction can be measured conveniently by Reactive Hyperemia Index (RHI) with a peripheral arterial tonometry. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II (AT II) receptor blockers (ARBs) are considered to have beneficial effects on endothelium through inhibition of AT II. This study was performed to compare the effect of ACEIs or ARBs on endothelial function estimated by RHI in hypertensive patients. Methods Twenty consecutive patients with hypertension (57.9 ± 11.3 years, 60% men) were assigned to receive treatment with ramipril or telmisartan for eight weeks (n = 10 per group). Blood pressure (BP) and RHI were measured at baseline and after eight weeks treatment. Results The two groups were similar in terms of demographic and laboratory characteristics. But baseline systolic BP and pulse pressure (PP) were higher in telmisartan group than ramipril group (systolic BP, 159 ± 6.83 vs 150 ± 7.49, p = 0.028; PP, 75.0 ± 14.0 vs 60.3 ± 12.4, p = 0.034). In both groups, systolic and diastolic BP decreased significantly after eight weeks treatment (p

Background: Atrial ischemia is a known risk factor of non-valvular atrial fibrillation (AF). However, relationship between coronary vasospasm and AF has not yet been determined. Methods: We investigated consecutive patients with normal sinus rhythm without AF history who underwent coronary angiography with ergonovine provocation test to evaluate vasospastic angina (VA). Patients with spasms over 50% and either typical chest pain or electrocardiogram changes during provocation test were diagnosed as vasospastic angina (VA group). Results: Out of total 683 patients investigated, nine (4.6%) patients in VA group (n=195) and seven (1.4%) patients in control group (n=488) developed new-onset AF (follow-up duration, median 56 months; range, 6-263 months). Annual AF incidence rate was higher in VA group (0.63%/y) than in control group (0.23%/y). In univariate and multivariate analysis adjusted for age, VA was an independent predictor of AF (HR 2.93, p=0.021). In subgroup analysis of 195 patients with VA, there were no cases of AF in patients with spasm observed only in the left anterior descending artery. All nine patients with new onset AF had spasm in the right coronary artery or left circumflex artery. Conclusions: Vasospastic angina could be an independent predictor of new-onset AF.

BACKGROUND The gender-related change in aortic morphology by arterial stiffness has not been well studied. This study was performed to investigate the association between brachial-ankle pulse wave velocity (baPWV) and aortic root size according to gender. METHODS A total of 263 consecutive subjects (63.2 ± 10.6 years, 71.1% men) without overt cardiovascular disease who underwent both baPWV measurement and transthoracic echocardiography on the same day were retrospectively analyzed. The diameters of the aortic annulus (AN), sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AA) were measured using 2-dimensional echocardiography. RESULTS The body surface area (BSA)-corrected diameters of AN, SV, STJ, and AA were significantly higher in women than in men. Univariable analyses showed that baPWV was significantly correlated with SV/BSA and STJ/BSA in men, and with SV/BSA, STJ/BSA, and AA/BSA in women (p < 0.05 for each). In men, however, these associations disappeared in multiple linear regression models after controlling for potential confounders (p > 0.05 for each). In women, the associations of baPWV with diameters of STJ/BSA (β = 0.407, p < 0.001) and AA/BSA (β = 0.391, p = 0.005) remained significant in the same multivariate models. Women-specific correlation between aortic root size and baPWV was also similarly demonstrated in age-matched analyses (n = 61 in each gender). CONCLUSIONS Among Korean adult without overt cardiovascular disease, the association between increased arterial stiffness and aortic root dilatation is stronger in women than in men.

Current guidelines recommend percutaneous coronary intervention (PCI) for noninfarct arteries in ST-segment elevation myocardial infarction (STEMI) patients, who are hemodynamically stable. However, evidence is limited in high risk patients, such as those with left ventricular (LV) dysfunction. A