Safety and Efficacy of Biodegradable Polymer-biolimus-eluting Stents (BP-BES) Compared with Durable Polymer-everolimus-eluting Stents (DP-EES) in Patients Undergoing Complex Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: There are no data comparing clinical outcomes of complex percutaneous coronary intervention (PCI) between biodegradable polymer-biolimus-eluting stents (BP-BES) and durable polymer-everolimus-eluting stents (DP-EES). We sought to evaluate the safety and efficacy of BP-BES compared with DP-EES in patients undergoing complex PCI. METHODS: Patients enrolled in the SMART-DESK registry were stratified into 2 categories based on the complexity of PCI. Complex PCI was defined as having at least one of the following features: unprotected left main lesion, ≥2 lesions treated, total stent length >40 mm, minimal stent diameter ≤2.5 mm, or bifurcation as target lesion. The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target vessel-related myocardial infarction (TV-MI), or target lesion revascularization (TLR) at 2 years of follow-up. RESULTS: Of 1,999 patients, 1,145 (57.3%) underwent complex PCI: 521 patients were treated with BP-BES and 624 with DP-EES. In propensity-score matching analysis (481 pairs), the risks of TLF (3.8% vs. 5.2%, adjusted hazard ratio [HR], 0.578; 95% confidence interval [CI], 0.246–1.359; p=0.209), cardiac death (2.5% vs. 2.5%, adjusted HR, 0.787; 95% CI, 0.244–2.539; p=0.689), TV-MI (0.5% vs. 0.4%, adjusted HR, 1.128; 95% CI, 0.157–8.093; p=0.905), and TLR (1.1% vs. 2.9%, adjusted HR, 0.390; 95% CI, 0.139–1.095; p=0.074) did not differ between 2 stent groups after complex PCI. CONCLUSIONS: Clinical outcomes of BP-BES were comparable to those of DP-EES at 2 years after complex PCI. Our data suggest that use of BP-BES is acceptable, even for complex PCI.

Safety and Efficacy of Biodegradable Polymer-biolimus-eluting Stents (BP-BES) Compared with Durable Polymer-everolimus-eluting Stents (DP-EES) in Patients Undergoing Complex Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES@#There are no data comparing clinical outcomes of complex percutaneous coronary intervention (PCI) between biodegradable polymer-biolimus-eluting stents (BP-BES) and durable polymer-everolimus-eluting stents (DP-EES). We sought to evaluate the safety and efficacy of BP-BES compared with DP-EES in patients undergoing complex PCI.@*METHODS@#Patients enrolled in the SMART-DESK registry were stratified into 2 categories based on the complexity of PCI. Complex PCI was defined as having at least one of the following features: unprotected left main lesion, ≥2 lesions treated, total stent length >40 mm, minimal stent diameter ≤2.5 mm, or bifurcation as target lesion. The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target vessel-related myocardial infarction (TV-MI), or target lesion revascularization (TLR) at 2 years of follow-up.@*RESULTS@#Of 1,999 patients, 1,145 (57.3%) underwent complex PCI: 521 patients were treated with BP-BES and 624 with DP-EES. In propensity-score matching analysis (481 pairs), the risks of TLF (3.8% vs. 5.2%, adjusted hazard ratio [HR], 0.578; 95% confidence interval [CI], 0.246–1.359; p=0.209), cardiac death (2.5% vs. 2.5%, adjusted HR, 0.787; 95% CI, 0.244–2.539; p=0.689), TV-MI (0.5% vs. 0.4%, adjusted HR, 1.128; 95% CI, 0.157–8.093; p=0.905), and TLR (1.1% vs. 2.9%, adjusted HR, 0.390; 95% CI, 0.139–1.095; p=0.074) did not differ between 2 stent groups after complex PCI.@*CONCLUSIONS@#Clinical outcomes of BP-BES were comparable to those of DP-EES at 2 years after complex PCI. Our data suggest that use of BP-BES is acceptable, even for complex PCI.

The Effects of Abciximab on Left Ventricular Remodeling in Patient with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVE: Abciximab has been shown to have beneficial effects beyond the improvement in the patency of an infarct-related artery and the microvascular integrity. However, it remains uncertain whether abciximab may lead to beneficial effects on the left ventricular remodeling in patients with an acute myocardial infarction, treated with primary percutaneous coronary intervention (PCI). Therefore, whether abciximab is effective in the left ventricular remodeling in patients with acute myocardial infarction, treated with primary PCI, was investigated. SUBJECTS AND METHODS: The study included 28 patients with an acute myocardial infarction (1 vessel disease) that had received either a primary PCI alone (group A, n=14) or an abciximab+primary PCI (group B, n=14). The baseline characteristics of the two groups were similar, with the exception of a thrombusburden lesion. All patients were examined by echocardiography within 72 hours, and at an average 11.7 months after the acute myocardial infarction. The change in the left ventricular end-diastolic volume index, end-systolic volume index and ejection fraction, between the two groups, were compared. RESULTS: At an average follow-up of 11.7 months, the left ventricular volume indices were smaller, and the left ventricular ejection fraction higher, compared with those at the baseline in each group. The change of the left ventricular end-diastolic volume index (-7+/-3 mL/m2 vs. -9+/-2 mL/m2, p=0.56), the left ventricular end-systolic volume index (-8+/-3 mL/m2 vs. -9+/-2 mL/m2, p=0.73) and the left ventricular ejection fraction (7+/-3% vs. 9+/-2%, p=0.49) did not show significant differences between groups A and B. CONCLUSION: These results suggest that abciximab does not improve the left ventricular remodeling in patient with an acute myocardial infarction, treated with primary PCI.

Clinical Manifestation of Novel Stress-induced Cardiomyopathy Mimicking Acute Myocardial Infarction: Single Center Prospective Registry

BACKGROUND AND OBJECTIVES: The so-called 'stress-induced cardiomyopathy' or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI), has recently been reported, particularly in Japan. We prospectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. SUBJECTS AND METHODS: Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were: 1) no previous history of cardiac disease, 2) acute onset, 3) a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4) no significant stenosis in the coronary angiogram. RESULTS: The events preceding the condition included: emotional stress (N=7), acute illness (N=5), non-cardiac surgery or medical procedure (N=4) and accident (N=2). Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%). Pulmonary edema was demonstrated in 10 (56%), and cardiogenic shock in 4 (23%) of the patients. The peak creatinine kinase MB fraction was 69+/-136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF) was 38+/-8% on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. An intravascular ultrasonography showed no infarct-related plaques in the 4 patients examined. On a follow-up echocardiogram, the average LVEF was improved to 51+/-8%, and regional wall motion was normalized after 30+/-29 days following onset. CONCLUSION: We report, for the first time in a series of Korean patients, on a novel stress-induced cardiomyopathy with transient regional wall motion abnormality, mimicking AMI. The precise etiology remains to be elucidated in further studies.

Effect of Vigorous Preload Reduction on Mitral Annulus Velocity in Chronic Renal Failure

BACKGROUND AND OBJECTIVES: The pulsed wave Doppler echocardiography in the mitral inflow is used widely for the assessment of LV diastolic function. The echocardiographic index of LV diastolic function is known to be affected by several factors, such as the loading condition. In the Doppler tissue image (DTI), the mitral annulus velocity is known to be unaffected by the loading condition. The purpose of this study was to investigate the effect of the preload reduction on the mitral annulus velocity. SUBJECTS AND METHODS: We examined the transmitral and pulmonary venous flows, and the mitral annulus velocity in 30 patients with chronic renal failure, but a normal LV systolic function, by echocardiography, both before and after hemodialysis. The study patients were divided into two groups; Group I (preload reduction 2.0 kg, N=20). RESULTS: In the transmitral flow; the E velocity was changed, both before and after hemodialysis, in Group II. < Group I from 97+/-12 cm/s to 86+/-11 cm/s (NS), Group II from 85+/-5 cm/s to 63+/-5 cm/s (p=0.0001)<. The A velocity was also changed in Group II. In the mitral septal annulus velocity by DTI; The E' velocity was changed in both groups, but the A' velocity was only changed in Group II. In the mitral lateral annulus velocity by DTI; all indices remained unchanged in both groups. CONCLUSION: These results suggested that a vigorous preload reduction might change the echocardiographic indices, and either the transmitral flow pattern or the mitral septal annulus velocity. The mitral lateral annulus velocity indices, which are useful for the evaluation of the LV diastolic function, were unchanged by the preload reduction. The preload condition needs to be accounted for when evaluating the LV diastolic function with a Doppler echocardiography.

A Case of Primary Mediastinal Embryonal Carcinoma Arising in the Posterior Mediastinum / 결핵

Primary germ cell tumors of the mediastinum are rare, accounting 1-5% among all germ cell tumors and 10% of all neoplasms in this area. Approximately 85% of these tumors occur in men with a mean age 29 years. These tumors are mainly found in the anterior mediastinum and appear grossly as large lobulated masses. They are frequently invasive at the time of diagnosis and almost 90% of patients are symptomatic. Primary nonseminomatous germ cell tumor arising in the posterior mediastinum is very rare. We report a case of 37- year old male arising from the posterior mediastinum. Serum tumors markers including alpha-fetoprotein and beta-hCG which are usually elevated in germ cell tumor were not elevated. He was found to have a primary mediastinal embryonal carcinoma with pulmonary metastasis at open exploration. He was treated with debulking surgery and cisplatin-based chemotherapy, died of sepsis after 15 months postoperatively.

A Case of Hemobilia Associated with Spontaneous Gallbladder Hemorrhage / 대한소화기내시경학회지

Hemobilia is a hemorrhage into the biliary tract that may follow trauma (including surgical and percutaneous techniques in hepatobiliary system), aneurysms of the hepatic artery (and its branch), tumors of the biliary tract, hepatoma, inflammation, liver abscess, and gallstone disease. But, a case has not been reported involving of hemobilia associated with gallbladder hemorrhage without obvious predisposing factors or causes. A 62-year-old woman was admitted to Kyunghee Medical Center due to intermittent nausea, and right upper quadrant pain for 2 days before admission. She had no history of abdominal trauma. On the second and third day of her stay, she experienced melena of which the amount was about 300 ml. Abdominal ultrasonography revealed a gallbladder with a 8 mm sized cystic lesion attached to the fundus. Computed tomographic (CT) evaluation of the abdomen demonstrated a highly enhanced 7~8 mm sized nodular mass in the lumen of the gallbladder. The gallbladder, cystic duct, and CBD were dilated due to the filling of blood clots or sludge material. An ERCP was performed and bleeding from the papilla of Vater was confirmed. Subsequently, emergent laparoscopic cholecystectomy was conducted. Pathologic evaluation revealed a grayish-red gallbladder that had a ruptured vessel. The ruptured vessel showed a severe hypertrophic state but there was no evidence of vasculitis, aneurysm, arterio-venous malformation, or malignancy. The case is here in reported of hemobilia associated with spontaneous gallbladder hemorrhage.

The Effect of Slow Release Lanreotide in Korean Acromegalic Ratients / 대한내분비학회지

BACKGROUND: Previous studies have shown that somatostatin analogues such as octreotide are effective in suppressing GH and IGF-I levels in acromegaly. The recent availability of slow release lanreotide could avoid the inconveniences associated with either repeated subcutaneous injections or continuous infusions. We investigated the effects of the SR-lanreotide on clinical, biochemical and safety responses in five patients with acromegaly. And we investigated whether the response of the GH level to acute adrninistration of octreotide predicts the response after 12 weeks of treatment with the SR-lanreotide and whether the identification of gsp oncogene could be used as a therapeutic and prognostic clue in treatment with the SR-lanreotide. METHODS: We studied the effects of SR-lanreotide 30 mg administered intramuscularly biweekly for 12 weeks in five Korean acromegalic patients. Subjective improvements in the clinical symptoms of acromegaly and adverse reactions were recorded. During SR-lanreotide treatment, serum GH, IGF-I and IGFBP-3 concentrations were evaluated just before the next injection of the SR-lanreotide. Before the start of SR-lanreotide therapy the sensitivity of GH secretion to the octreotide was tested by measuring the effect of the acute response to 0.1 mg intravenously on plasma GH levels followed until 6 hours after administration of octreotide. Direct polymerase chain reaction sequencing of the gsp oncogene were performed. We compared the responses to SR-lanreotide in patients harboring gsp-positive and gsp-negative somatotroph adenomas. RESULTS: The treatment with SR-lanreotide for 12 weeks could suppress the GH level by more than 50% in four of five patients and normalize the IGF-I in two patients. No correlation was found between the GH level and IGF-I level at the end of the study. The IGFBP-3 level correlated with the IGF-I level in three of five patients. Although the initial GH response to octreotide tended to correlate with the IGF-I response after SR-lanreotide treatment, the results were statistically insignificant. The patients with gsp-positive tumor tended to show a better response to SR-lanreotide. During treatment, there was a reduction in the percentage of patients complaining of joint pain, fatigue, digital paresthesia, and hyperhydrosis. Changes in soft tissue swelling were documented by decreases in finger circumference. The common adverse events were abdominal discomfort, loose stool, and diarrhea. These events were decreased progressively. No patients discontinued the treatment of SR-lanreotide due to adverse events. CONCLUSION: This study showed that SR-lanreotide is effective in controlling acromegalic symptoms as well as GH and IGF-I hypersecretion. This treatment was well tolerated and more convenient for the patients. Further studies are required for clinical outcome of long-term SR-lanreotide treatment and cost-effective analysis.

Significance of Left Ventricle Chamber Obliteration in Dobutamine Stress Echocardiography

BACKGROUND: LV chamber obliteration(COB) during dobutamine stress echocardiography indicates a vigorous inotropic response to dobutamine stress. This may suggest the absence of coronary artery disease, but a small LV cavity may also preclude recognition of wall motion abnormalities. METHODS: Chamber obliteration was defined by contact of the opposite walls in the apical 4 chamber views during dobutamine stress echocardiography. To detect of chamber obliteration and coronary artery disease, dobutamine stress echocardiography was performed in 132 patients with chest pain. To confirm of coronary artery disease, coronary angiography was performed in 64 patients among 132 patients. RESULTS: 1) Chamber obliteration during dobutamine stress echocardiography occurred in 37 patients(28%) among 132 patients. 2) Chamber obliteration during dobutamine stress echocardiography was more common in patients with hypertension(p<0.05) and left ventricular hypertrophy during baseline echocardiography(p<0.005). 3) Coronary angiography was performed in 64 patients(48 patients without chamber obliteration, 16 patients with chamber obliteration). The sensitivity of dobutamine stress echocardiography in the diagnosis of coronary artery disease was 88% in patients without chamber obliteration, 71% in patients with chamber obliteration. But, the difference of sensitivity of both groups was not significant. CONCLUSION: These results suggest that chamber obliteration during dobutamine stress echocardiography will not affect results of the sensitivity of dobutamine stress echocardiography in the diagnosis of coronary artery disease.