Consensus Statement on Coronary Intervention during the Coronavirus Disease 2019 (COVID-19) Pandemic: from the Korean Society of Interventional Cardiology (KSIC)

Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus-2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities;the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.

Consensus statement on coronary intervention during the coronavirus disease 19 pandemic: from the Korean Society of Interventional Cardiology

Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus 2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities; the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.

Early experience and favorable clinical outcomes of everolimus-eluting bioresorbable scaffolds for coronary artery disease in Korea

BACKGROUND/AIMS: Compared with metallic drug-eluting stents (DES), bioresorbable vascular scaffolds (BVS) may further improve long-term outcomes of percutaneous coronary intervention (PCI) in patients with coronary artery disease. We report our early experience with BVS in Korea. METHODS: We evaluated 105 consecutive patients with BVS implanted at Asan Medical Center, Korea between October 21, 2015 and June 3, 2016. Angiographic results, and in-hospital and 6-month clinical outcomes were assessed. RESULTS: A total of 134 BVS were implanted to treat 115 lesions. The mean age was 62 ± 10.5 years; 85 patients (81%) were males, 26 patients (25%) were presented with acute coronary syndrome. Among 115 lesions treated with BVS, 76 (66.1%) were B2/C type, 27 (23.5%) were bifurcation lesions, and four (3.5%) were chronic total occlusion. Pre-dilation and post-dilation using high-pressure non-compliant balloon was performed in 104 lesions (90.4%) and 113 lesions (98.2%), respectively. During the procedure, intravascular imaging was used for all patients (100%; intravascular ultrasound 89 and optical coherence tomography 40 patients). Device success rate was 100%. In-segment and in-scaffold acute again were 1.1 ± 0.6 and 1.3 ± 0.5 mm, respectively. Periprocedural myocardial infraction occurred in four patients (3.8%). No deaths, stent thrombosis, or urgent revascularizations occurred either during hospitalization or the follow-up period. CONCLUSIONS: In this single-center experience, implantation of BVS with intravascular imaging support was feasible and early clinical outcomes were excellent. Evaluation of long-term efficacy and safety of BVS and its feasibility in clinical use for a broader range of lesions is warranted.

Trends and Outcomes of Transcatheter Aortic Valve Implantation (TAVI) in Korea: the Results of the First Cohort of Korean TAVI Registry

BACKGROUND AND OBJECTIVES: There has been no nation-wide data on the outcomes of transcatheter aortic valve implantation (TAVI) after commercialization of TAVI in Korea. We report clinical features and outcomes of the first cohort of TAVI performed from Jun 2015 to Jun 2017 in Korea. METHODS: The first cohort of Korean-TAVI (K-TAVI) registry includes 576 consecutive patients with severe symptomatic aortic stenosis who underwent TAVI from 17 Korean hospitals for 2 years. RESULTS: Most of TAVI procedures were performed for septuagenarians and octogenarians (90.8%) through transfemoral approach (98.3%). The rate of device success was 92.5% and permanent pacemaker was implanted in 5.6%. In successive years, incidences of paravalvular leakage (PVL) and major bleeding declined. Society of Thoracic Surgeons (STS) score was 5.2 (3.0 to 9.0) and 34.7% of patients had high surgical risk (STS ≥8). One-year all-cause death occurred in 8.9% and was significantly lower in low to intermediate risk one than in high risk (5.4% vs. 15.5%, p < 0.001). The independent predictors of 1-year mortality were age (hazard ratio [HR], 1.087; 95% confidence interval [CI], 1.036–1.141; p=0.001), moderate or severe PVL (HR, 4.631; 95% CI, 1.624–13.203; p=0.004) and end-stage renal disease (HR, 5.785; 95% CI, 2.717–12.316; p < 0.001). CONCLUSIONS: K-TAVI registry showed favorable 1-year outcomes with decreasing complication rate over time in real-world Korean patients. Two-thirds of patients were low to intermediate surgical risk and showed a significantly lower mortality than the high-risk patients, suggesting the promising future on the expanded indications of TAVI.

Transseptal Transcatheter Mitral Valve-in-valve Replacement for a Failed Bioprosthetic Mitral Valve

No abstract available.

Trends and Outcomes of Transcatheter Aortic Valve Implantation (TAVI) in Korea: the Results of the First Cohort of Korean TAVI Registry

BACKGROUND AND OBJECTIVES@#There has been no nation-wide data on the outcomes of transcatheter aortic valve implantation (TAVI) after commercialization of TAVI in Korea. We report clinical features and outcomes of the first cohort of TAVI performed from Jun 2015 to Jun 2017 in Korea.@*METHODS@#The first cohort of Korean-TAVI (K-TAVI) registry includes 576 consecutive patients with severe symptomatic aortic stenosis who underwent TAVI from 17 Korean hospitals for 2 years.@*RESULTS@#Most of TAVI procedures were performed for septuagenarians and octogenarians (90.8%) through transfemoral approach (98.3%). The rate of device success was 92.5% and permanent pacemaker was implanted in 5.6%. In successive years, incidences of paravalvular leakage (PVL) and major bleeding declined. Society of Thoracic Surgeons (STS) score was 5.2 (3.0 to 9.0) and 34.7% of patients had high surgical risk (STS ≥8). One-year all-cause death occurred in 8.9% and was significantly lower in low to intermediate risk one than in high risk (5.4% vs. 15.5%, p < 0.001). The independent predictors of 1-year mortality were age (hazard ratio [HR], 1.087; 95% confidence interval [CI], 1.036–1.141; p=0.001), moderate or severe PVL (HR, 4.631; 95% CI, 1.624–13.203; p=0.004) and end-stage renal disease (HR, 5.785; 95% CI, 2.717–12.316; p < 0.001).@*CONCLUSIONS@#K-TAVI registry showed favorable 1-year outcomes with decreasing complication rate over time in real-world Korean patients. Two-thirds of patients were low to intermediate surgical risk and showed a significantly lower mortality than the high-risk patients, suggesting the promising future on the expanded indications of TAVI.

Coronary Artery Bypass Grafting vs. Drug-Eluting Stent Implantation for Multivessel Disease in Patients with Chronic Kidney Disease

BACKGROUND AND OBJECTIVES: There is currently a limited amount of data that demonstrate the optimal revascularization strategy for chronic kidney disease (CKD) patients with multivessel coronary artery disease (CAD). We compared the long-term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass graft surgery (CABG) for multivessel CAD in patients with CKD. SUBJECTS AND METHODS: We analyzed 2108 CKD patients (estimated glomerular filtration rate <60 mL/min/1.73 m²) with multivessel CAD that were treated with PCI with DES (n=1165) or CABG (n=943). The primary outcome was a composite of all causes of mortality, myocardial infarction, or stroke. The mean age was 66.9±9.1 years. RESULTS: Median follow-up duration was 41.4 (interquartile range 12.1-75.5) months. The primary outcome occurred in 307 (26.4%) patients in the PCI group compared with 304 (32.2%) patients in the CABG group (adjusted hazard ratio [HR], 0.941; 95% confidence interval [CI], 0.79–1.12; p=0.493). The two groups exhibited similar rates of all-cause mortality (adjusted HR, 0.91; 95% CI, 0.77–1.09; p=0.295), myocardial infarction (adjusted HR, 1.86; 95% CI, 0.85–4.07; p=0.120) and stroke (3.2% vs. 4.8%; HR, 0.93; 95% CI, 0.57–1.61; p=0.758). However, PCI was associated with significantly increased rates of repeat revascularization (adjusted HR, 4.72; 95% CI, 3.20–6.96; p<0.001). CONCLUSION: Among patients with CKD and multivessel CAD, PCI with DES when compared with CABG resulted in similar rates of composite outcome of mortality from any cause, MI, or stroke; however, a higher risk of repeat revascularization was observed.

Impact of Follow-Up Ischemia on Myocardial Perfusion Single-Photon Emission Computed Tomography in Patients with Coronary Artery Disease

PURPOSE: Few studies have reported on predicting prognosis using myocardial perfusion single-photon emission computed tomography (SPECT) during coronary artery disease (CAD) treatment. Therefore, we aimed to assess the clinical implications of myocardial perfusion SPECT during follow-up for CAD treatment. MATERIALS AND METHODS: We enrolled 1153 patients who had abnormal results at index SPECT and underwent follow-up SPECT at intervals ≥6 months. Major adverse cardiac events (MACE) were compared in overall and 346 patient pairs after propensity-score (PS) matching. RESULTS: Abnormal SPECT was associated with a significantly higher risk of MACE in comparison with normal SPECT over the median of 6.3 years (32.3% vs. 19.8%; unadjusted p<0.001). After PS matching, abnormal SPECT posed a higher risk of MACE [32.1% vs. 19.1%; adjusted hazard ratio (HR)=1.73; 95% confidence interval (CI)=1.27–2.34; p<0.001] than normal SPECT. After PS matching, the risk of MACE was still higher in patients with abnormal follow-up SPECT in the revascularization group (30.2% vs. 17.9%; adjusted HR=1.73; 95% CI=1.15–2.59; p=0.008). Low ejection fraction [odds ratio (OR)=5.33; 95% CI=3.39–8.37; p<0.001] and medical treatment (OR=2.68; 95% CI=1.93–3.72; p<0.001) were independent clinical predictors of having an abnormal result on follow-up SPECT. CONCLUSION: Abnormal follow-up SPECT appears to be associated with a high risk of MACE during CAD treatment. Follow-up SPECT may play a potential role in identifying patients at high cardiovascular risk.

Sarcopenia Is Not Associated with Depression in Korean Adults: Results from the 2010-2011 Korean National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: Sarcopenia is associated with metabolic disorders, cardiovascular disease, and mortality; however, its association with depression in the general population remains unknown. Therefore, we investigated this association in Korea. METHODS: This study included 8,958 and 8,518 subjects from the 2010-2011 Korean National Health and Nutrition Examination Survey V-1, 2. The study was restricted to participants > or =20 years of age who had completed the survey, including whole-body dual-energy X-ray absorptiometry scans. After exclusion, 7,364 subjects were included in our final analysis. Age was categorized into three groups (20-39, 40-59, and > or =60 years), and subjects were categorized according to their sarcopenic and obesity status. Depression was categorized into three groups (not depressed, depressed, and depression). RESULTS: The sarcopenia group did not have a higher prevalence of depression or depressive symptoms compared to the nonsarcopenia group; the same was true even when obesity was considered. All age groups showed non-significant associations between sarcopenia and depression. In multivariate logistic regression models, no significant associations were observed between sarcopenia and prevalence of depression or depressed symptoms in men and women. CONCLUSION: We found no associations between sarcopenia and the prevalence of depression or depressed symptoms in Korean adults. Future large prospective studies and randomized controlled trials are needed to further assess this relationship.

A Case of Hepaticoduodenal Fistula Development after Transarterial Chemoembolization in Patient with Hepatocellular Carcinoma / 대한소화기학회지

Transarterial chemoembolization (TACE) is recommended as one of the first line therapy for unresectable hepatocellular carcinoma (HCC). Rupture of HCC following TACE is a rare and potentially fatal complication. We report a case of hepaticoduodenal fistula with ruptured HCC and liver abscess complicated by TACE. A 52-year-old male was treated by TACE three times, followed by radiation therapy and systemic chemotherapy. 30 days after the last TACE, right upper quadrant pain of abdomen was developed. About 1 month later, computed tomography of abdomen showed ruptured HCC with debris containing liver abscess and hepaticoduodenal fistula. Esophagogastroduodenoscopy revealed hepaticoduodenal fistula and hepatic parenchyme covered with exudate. The patient was managed with supportive care, but the hepaticoduodenal fistula persisted.

A Case of Chronic Pyothorax-Associated Lymphoma / 대한내과학회지

Pyothorax-associated lymphoma is a distinct type of malignant lymphoma composed of lymphocytes, mostly of a B-cell nature. It occurs in patients with a long history of pyothorax and is strongly associated with Epstein-Barr virus infection. We experienced a case of pyothorax-associated lymphoma in a 66-year-old male. The patient had chronic pyothorax after tuberculous pleurisy was treated about 37 years earlier and was hospitalized for a recently occurring chest wall mass. A core needle biopsy of the chest wall mass led to a diagnosis of diffuse large B-cell lymphoma. Pyothorax-associated lymphoma is rare in Korea, but should be considered in patients with chronic pyothorax and a recently occurring pleural mass.

A Case of Chronic Pyothorax-Associated Lymphoma / 대한내과학회지

Pyothorax-associated lymphoma is a distinct type of malignant lymphoma composed of lymphocytes, mostly of a B-cell nature. It occurs in patients with a long history of pyothorax and is strongly associated with Epstein-Barr virus infection. We experienced a case of pyothorax-associated lymphoma in a 66-year-old male. The patient had chronic pyothorax after tuberculous pleurisy was treated about 37 years earlier and was hospitalized for a recently occurring chest wall mass. A core needle biopsy of the chest wall mass led to a diagnosis of diffuse large B-cell lymphoma. Pyothorax-associated lymphoma is rare in Korea, but should be considered in patients with chronic pyothorax and a recently occurring pleural mass.

A Case Report of Rapidly Progressive Empyema Caused by Pulmonary Actinomycosis: A Case Report / 대한구급학회지

Pulmonary actinomycosis is an indolent and slowly progressive infectious disease, accompanied by pleural effusion and empyema in about 50% of cases. The size of the effusion is usually small, though, and it responds to appropriate antibiotics. We report a case of rapidly progressing, severe empyema leading to respiratory failure that was caused by pulmonary actinomycosis. A 57-year-old man presented with pleuritic chest pain for 5 days. The initial plain chest radiograph and CT scan showed pleural effusion. Gross pus was observed during the thoracentesis and laboratory test of pleural effusion revealed empyema. In spite of empirical antibiotics and chest tube drainage, the empyema rapidly progressed and the patient reached respiratory failure. Mechanical ventilation applied and decortication via video-assisted thoracotomy was performed. Microscopic examination of both the pleural and adjacent lung biopsy specimen revealed actinomycosis.

A Case of Mycobacterium abscessus Lung Disease in a Patient with H1N1 Influenza Pneumonia / 결핵및호흡기질환

Novel influenza A (H1N1) virus is a common pathogen of febrile respiratory infection recently. Here, we report the case of a 63-year-old male patient who presented with 3 days' ongoing cough and fever. He was diagnosed with novel influenza A (H1N1) pneumonia by real-time reverse-transcriptase-polymerase-chain-reaction (rRT-PCR). During treatment for novel influenza A (H1N1), his symptoms and radiologic findings improved initially, but multiple lung nodules developed subsequently and found on chest x-ray (on the 5th hospital day). Mycobacterium abscessus was isolated repeatedly from sputum and bronchoalveolar lavage fluid. To our knowledge, this is the first reported case of Mycobacterium abscessus lung disease in a patient with H1N1 influenza pneumonia.

A Case of Mycobacterium abscessus Lung Disease in a Patient with H1N1 Influenza Pneumonia / 결핵및호흡기질환

Novel influenza A (H1N1) virus is a common pathogen of febrile respiratory infection recently. Here, we report the case of a 63-year-old male patient who presented with 3 days' ongoing cough and fever. He was diagnosed with novel influenza A (H1N1) pneumonia by real-time reverse-transcriptase-polymerase-chain-reaction (rRT-PCR). During treatment for novel influenza A (H1N1), his symptoms and radiologic findings improved initially, but multiple lung nodules developed subsequently and found on chest x-ray (on the 5th hospital day). Mycobacterium abscessus was isolated repeatedly from sputum and bronchoalveolar lavage fluid. To our knowledge, this is the first reported case of Mycobacterium abscessus lung disease in a patient with H1N1 influenza pneumonia.

Relationship between clinical course and measures of atherosclerosis in diabetic foot / 대한내과학회지

BACKGROUND: Although various factors may influence the outcome of diabetic foot ulcers in diabetic subjects, the severity of peripheral vascular disease (PVD) is the main independent risk factor for amputation. The carotid intima-medial thickness (IMT), ankle brachial pressure index (ABPI) and pulse wave velocity (PWV) have been used as noninvasive markers of PVD. The present study aims to examine the association of carotid IMT, ABPI and PWV with the risk of lower extremity amputation in diabetic foot patients. METHODS: Total 114 diabetic patients (39 diabetic foot patients and 75 patients who didn't have diabetic foot) were participated for the study. Twenty four of diabetic foot patients underwent lower extremity amputation. Informations about past history, social habit and courses of diabetic foot were collected from the patients by means of a structured interview. We measured carotid IMT, ABPI and PWV. RESULTS: The following characteristics were significantly related to the development of diabetic foot ulcers: male, smoker, alcohol drinker, longer diabetes duration, presence of diabetic chronic complications, lower ABPI (0.8 mm), increased PWV. Patients with amputation had lower HDL cholesterol, higher incidence of osteomyelitis and older age, compared with patients without amputation. We observed a significant association between mean carotid IMT and the rate of amputation in diabetic foot patients [odd ratio, 11.42 (95% confidence interval, 1.03~127.19)]. CONCLUSIONS: This study suggests that measurement of carotid IMT as noninvasive index of atherosclerosis may be a useful indirect method in identifying diabetic foot patients who may have lower extremity amputation.