Predictive Factors for Long-term Clinical Outcomes in Patients with Variant Angina / 대한내과학회지

BACKGROUND/AIMS: The incidence of variant angina (VA) is relatively high in Korea compared with western countries, but its long-term clinical outcomes are not well defined. METHODS: Patients who underwent ergonovine provocation tests at the cardiac catheterization laboratory of Chonnam National University Hospital between 1996 and 2011 were enrolled in this study (n = 1162). Of them, 686 patients with positive ergonovine provocation tests were divided into two groups: patients with cardiac events (Group I: 153 patients, 52.4 +/- 11.0 years, M: F = 103: 50) and those without (Group II: 533 patients, 51.6 +/- 10.7 years, M: F = 350: 183). The mean follow-up duration was 40.2 +/- 38.0 months. Cardiac events were defined as cardiac death, recurrent ischemia, rehospitalization, myocardial infarction, and follow-up angiography. Clinical findings, laboratory and coronary angiographic characteristics were compared between the groups. RESULTS: A history of smoking was more common in Group I than in Group II (45.8% vs. 36.3%, p = 0.037). The levels of low-density lipoprotein cholesterol (119.4 +/- 35.3 vs. 111.1 +/- 32.2 mg/dL, p = 0.010) were higher in Group I than in Group II. According to Cox proportional hazard regression analysis, the major predictive factor for cardiac events during clinical follow-up was smoking (HR 1.80, 95% CI 1.036-3.126, p = 0.037). CONCLUSIONS: A history of smoking was the only independent risk factor for cardiac events during a long-term clinical follow-up in Korean patients with variant angina.

Restenosis and Compliance with Self-Care Among Acute Coronary Syndrome Patients Undergoing Follow-up Angiograms

BACKGROUND: Compliance with self-care and lifestyle modification is recommended for all patients with acute coronary syndrome to prevent a secondary attack. Data is limited regarding the association between compliance with self-care and restenosis. This study was conducted to examine the association between compliance with self-care and restenosis and to determine the predicting factors for restenosis and low compliance with self-care. METHODS: A total of 166 acute coronary syndrome patients (64.2+/-10.8 years) hospitalized for an angiogram during routine follow-up or symptom management were conveniently recruited from a university hospital cardiovascular care unit. Self-administered questionnaires were used to evaluate the level of compliance with self-care and symptom-related satisfaction. RESULTS: In-stent restenosis was found in 40.4% of the subjects and 36.1% were persistently smoking. There was no significant relationship between low compliance with self-care and restensosis. A lower symptom-related satisfaction significantly predicted restenosis and low compliance with self-care. A longer period after initial diagnosis predicted restenosis and a shorter period after initial diagnosis predicted low compliance with self-care. Persistent smoking was independently associated with low compliance with self-care. CONCLUSIONS: Patients who continued to smoke and had lower symptom-related satisfaction with daily living showed a stronger tendency for lower compliance with self-care and lifestyle modification. Effective educational strategy focusing on smoking cessation is needed to increase compliance with self-care in patients with ACS, especially during admission with a first heart attack.

Predictive factor of the third coronary stent restenosis / 대한내과학회지

BACKGROUND: Percutaneous coronary intervention (PCI) has been established as one of the effective therapeutic methods in the treatment of ischemic heart disease. A coronary artery stent is the most promising device in PCI, however in-stent restenosis (ISR) remains a major problem to be overcome. METHODS: Follow-up coronary angiograms (CAG) three times after stenting were performed in 107 out of 3,816 stented patients at Chonnam National University Hospital between August 1992 and July 2004. The patients were divided into four groups: forty eight patients (Group I: 58.7+/-9.5 years, 35 Males) had no incident ISR on three follow-up CAG. Fourteen patients had three times of ISR and underwent four PCIs (Group II : 54.5+/-9.51 years, 12 Males), 15 had two times of ISR and underwent three PCIs (Group III : 53.9+/-5.9 years, 11 males), 30 had one time of ISR and underwent two PCIs (Group IV : 59.6+/-9.5 years, 27 males). Each group was analysed according to clinical characteristics, coronary angiographic findings, and therapeutic modalities for ISR. RESULTS: There was no differences in clinical diagnosis, lesion location, multi-vessel lesion and TIMI flow. Risk factors for atherosclerosis were not different except for diabetes mellitus. The incidence of diabetes mellitus was more common in Group II than in Group I (Group I: 22%, Group II: 57%, Group III: 46%, Group IV: 20%, Group I vs. Group II: p =0.023). Stent length and diameter were not different among four groups. CONCLUSION: The only predictor of recurrent coronary stent restenosis more than three times is diabetes mellitus.

Predictive Factors for the Mortality of Cardiovascular Patients at Coronary Care Unit / 대한구급학회지

BACKGROUND: Recently the incidence of coronary artery disease has been increased rapidly in Korea. After the introduction of coronary care unit, the mortality rate of cardiovascular patients has been decreased. The predictive factors for mortality in patients admitted at Coronary Care Unit (CCU) are important in the management of acutely ill cardiovascular patients. METHODS: One thousand one hundred and thirty patients (64.8+/-14.5 years), who were admitted at CCU from January 2002 to June 2003, were analyzed. The patients were divided into two groups according to mortality: the survived group (Group I: n=1055, 63.3+/-13.3 years) and the moribund group (Group II: n=75, 64.8+/-14.1 years). Clinical characteristics, risk factors, clinical diagnosis, laboratory, echocardiographic and coronary angiographic findings were compared between the two groups. RESULTS: The overall mortality at CCU was 6.6%, 75 out of 1130 patients. Age and sex were not different between both groups. Coronary artery disease was the most common cause of admission (886 out of 1130 patients) and death (46 out of 75 patients). Coronary angiographic findings were not different between the two groups. Left ventricular ejection fraction (LVEF) by echocardiogram was higher in Group I than in Group II (53.1+/-15.6% vs. 42.3+/-16.3%, p<0.05). Predictive factors for mortality by multiple logistic regression analysis were low LVEF (OR 11.4, 2.9-21.4 95%CI, p<0.001), no performance of percutaneous coronary intervention (PCI, OR 10.8, 2.5-17.8 95%CI, p<0.001) and clinical diagnosis of aortic dissection (OR 3.8, 1.3-9.8 95%CI, p=0.021). CONCLUSIONS: The predictive factors for mortality at CCU were low LVEF, no PCI and aortic dissection.

The Long-term Clinical Results of a Platelet Glycoprotein IIb/IIIa Receptor Blocker (Abciximab: ReoPro (R) ) Coated Stent in Patients with Coronary Artery Disease

BACKGROUND: Previously, the inhibition of coronary restenosis with Abciximab (ReoPro (R) ) -coated stent in a porcine model was reported. ReoPro (R) inhibits platelet aggregation, the proliferation of vascular smooth muscle cells and the inflammatory reaction. METHODS: A prospective randomized trial was performed to compare two types of stent for revascularization in the native coronary artery. The primary effective end points were major adverse coronary events (MACE) : cardiac death, acute myocardial infarction, target vessel revascularization (TVR) and restenosis at the 6-month clinical and angiographic follow-ups. RESULTS: One hundred and fifty-five patients were enrolled between August 2001 and June 2003. The mean ages (56.0 +/- 10.0 vs. 56.9 +/- 10.8 years), baseline diameter of stenosis and minimal luminal diameter were no different between the two groups. There was one myocardial infarction and revascularization during the hospital stay in control stent group. During the clinical follow-up there were two myocardial infarctions in control group. Follow-up coronary angiograms were performed in 62.3% (48/77) and 65.4% (51/78) of the coated and control groups, respectively. The diameter of stenosis and late loss were significantly less in the ReoPro (R) -coated stent group compared with the controls (16.4 +/- 5.8% vs. 34.3 +/- 6.1%, p=0.009; and 0.33 +/- 0.28 mm vs. 0.88 +/- 0.41 mm; p=0.002). The restenosis and TVR rates of the ReoPro (R) -coated stent were relatively lower compared with the control stent [14.6% (7/48) vs. 29.4% (15/51), p=0.062; and 9.2% (7/76) vs. 14.7% (11/75) ; p=0.327]. CONCLUSION: A ReoPro (R) -coated stent is safe, and may be effective in the prevention of coronary restenosis.

The long-term clinical results of a platelet glycoprotein IIb/IIIa receptor blocker (Abciximab: ReoPro(R)) coated stent in patients with coronary artery disease / 대한내과학회지

BACKGROUND: Previously we reported the inhibition of coronary restenosis with Abciximab (ReoPro(R))-coated stent in a porcine model. ReoPro(R) inhibits platelet aggregation, the proliferation of vascular smooth muscle cells and inflammatory reaction. METHODS: We performed a prospective randomized trial to compare two types of stents for the revascularization in native coronary artery. The primary effective end points were major adverse coronary events (MACE): cardiac death, acute myocardial infarction, target vessel revascularization (TVR), restenosis at 6-month clinical and angiographic follow-up. RESULTS: One hundred fifty-five patients were enrolled between Aug, 2001 and Jun, 2003. Mean ages (56.0 +/- 10.0 vs. 56.9 +/- 10.8 years), baseline diameter stenosis and minimal luminal diameter were not different between the two groups. There was one myocardial infarction and revascularization during hospital stay in control stent group. During clinical follow-up, there were two myocardial infarctions in control group. Follow-up coronary angiogram was done 62.3% (48/77) in coated and 65.4% (51/78) in control groups. Diameter stenosis and late loss were significantly less in the ReoPro(R)-coated stent group compared with controls (16.4 +/- 5.8% vs. 34.3 +/- 6.1%, p=0.009; and 0.33 +/- 0.28 mm vs. 0.88 +/- 0.41 mm; p=0.002). The restenosis and TVR rates of ReoPro-coated stent were relatively lower compared with control stent [14.6% (7/48) vs. 29.4% (15/51), p=0.062; and 9.2% (7/76) vs. 14.7% (11/75); p=0.327]. CONCLUSION: A ReoPro(R)-coated stent is safe and may be effective in the prevention of coronary restenosis.

Predictive factors of restenosis after stenting in proximal left anterior descending coronary artery / 대한내과학회지

BACKGROUND: A proximal Left anterior descending coronary artery (LAD) is one of the most important arterial segment due to its wide area of myocardial blood supply and high incidence of restenosis after percutaneous coronary intervention. This study was aimed to predict the risk factor after stenting in proximal LAD. METHODS: A total of 412 patients with proximal LAD stent implantation, who underwent follow-up coronary angiogram except for the LAD ostial lesion between 1996 and 2001 at Chonnam National University Hospital, were divided into two groups: Restenosis group (n=144 : 57.5 +/- 10.2 years, 78.8% male) and no restenosis group (n=268 : 57.4 +/- 10.0 years, 76.8% male). Restenosis rate, complications and predictive factors after proximal LAD stenting were analyzed. RESULTS: There were no differences in baseline clinical characteristics of sex, age, risk factors of atherosclerosis, lipid profile, clinical diagnosis, type and number of lesion coronary artery, Thrombolysis In Myocardial Infarction flow between the two groups. The restenosis rate after proximal LAD stenting was 35.0%. The complications during the follow up period after stenting were one transient ischemic attack in restesnosis group and one non-hemorrhagic stroke in both groups. There were no differences in major advanced cardiac event until the 12th month clinical follow up. There were no differences in lesion length, reference diameter, minimal luminal diameter, diameter stenosis and stent diameter, but the stent length were longer (20.7 +/- 6.92 mm) in restenosis group compared with no restenosis group (18.8 +/- 6.18 mm, p=0.006). CONCLUSION: The restenosis rate after proximal LAD stenting is relatively high and the only predictive factor for restenosis is stent length.

The long-term clinical effect of cutting ballon angioplasty for coronary in-stent restenosis / 대한내과학회지

BACKGROUND: Coronary stent implantation reduced the restenosis rate after percutaneous coronary intervention (PCI) but, still coronary in-stent restenosis (ISR) remains the major problem after PCI. Cutting balloon angioplasty is one of the method for ISR treatment. The purpose of this study is prospectively comparing the effect of cutting balloon angioplasty (CBA) with plain old balloon angioplasty (POBA) for the ISR. METHODS: A total of 50 patients with ISR, who underwent PCI (randomized CBA or POBA for ISR) from January to December 2001 at Chonnam National University Hospital, were divided into two groups: Group I (n=25: 58.4+/-7.9 years, male 88%) with CBA and Group II (n=25: 58.1+/-8.7 years, male 92%) with POBA. The early luminal gain, late luminal loss, major adverse cardiac event and angiographic restenosis rate were compared. RESULTS: There were no differences in baseline clinical characteristics of sex, age, ejection fraction, cardiac enzyme, risk factors of atherosclerosis, number of coronary artery lesions, and type of ISR between the groups. The minimal luminal diameters of before and after PCI were 0.83+/-0.34 mm, 2.10+/-0.55 mm in group I and 0.93+/-0.58 mm, 2.08+/-0.79 mm in group II. There were no differences in early luminal gain. All patients underwent follow-up coronary angiogram and the restenosis rate was 32% (8/25) in group I and 28% (7/25) in group II, and late luminal loss were 0.60+/-0.40 mm in group I and 0.65+/-0.61 in group II (p=NS). The major adverse cardiac events during 6-month follow-up developed in 3 cases of group I and 4 cases of group II (p=NS). CONCLUSION: There were no differences in early and long-term clinical effects after CBA and POBA for the treatment of ISR.

The Inhibitory Effects of Platelet Glycoprotein IIb/IIIa Receptor Blocker-Coated Stent on Neointima Formation and Inflammatory Response in Porcine Coronary Stent Restenosis

BACKGROUND AND OBJECTIVES: Previously, we reported that Abciximab (ReoPro(r))-coated stent inhibited in-stent neointimal hyperplasia. ReoPro(r) is known to suppress vascular inflammation through CD 11b/18 (macrophage-1 receptor). We observed inhibitory effects of neointima formation and inflammatory reaction after stenting in a porcine model. MATERIALS AND METHODS: The surface of the stent was coated with ReoPro(r) by means of plasma polymerization followed by chemical grafting. Stent overdilation injury was performed with control bare stent (Group I, n=13) and ReoPro(r)-coated stents (Group II, n=13) in 26 porcine coronary arteries. Follow-up coronary angiogram and the histopathologic assessments of stented porcine coronary were performed on day 14 (Group I:n=6, Group II:n=6) and day 28 (Group I:n=7, Group II:n=7) after stenting. RESULTS: Pathologic area stenosis was 19.7+/-5.3% in Group I and 15.9+/-3.3% in Group II at day 14, and 33.6+/-27.7% and 22.6+/-6.6%, respectively, at day 28 (p<0.05 at day 28). The ratio of inflammatory cells out of the number of total cells in the neointima was 21.8+/-6.5% in Group I and 22.5+/-11.6% in Group II at day 14, and 27.3+/-18.3% in Group I and 28.6+/-10.7% in Group II at day 28 post stenting (p=NS). And those of the media were 2.89+/-1.13% in Group I and 1.36+/-1.27% in Group II at day 14, and 6.61+/-5.61% and 6.26+/-4.51% at day 28 (p=NS). Fibrinoid materials associated with inflammatory reaction were observed in both groups at days 14 and 28. CONCLUSION: An inflammatory reaction was not suppressed with the use of ReoPro(r)-coated stenting in a porcine stent restenosis model.

The Long-Term Clinical Effects of Heparin-Coated Coronary Stent

BACKGROUND AND OBJECTIVES: A heparin-coated stent has been reported to be effective in the prevention of restenosis in a porcine model. The aim of this study was to compare the long term effects of heparin-coated and bare stents in patients who underwent percutaneous coronary intervention (PCI), with regard to the clinical and angiographic outcomes. SUBJECTS AND METHODS: Thirty patients who underwent PCI at Chonnam National University Hospital between July 1999 and December 2000 were randomly assigned into two groups; Group I had control bare stents (n=15, 15 lesions, 59+/-12 years, 13 males) and Group II heparin coated stents (n=15, 15 lesions, 59+/-11 years, 14 males). Six months following stenting, follow-up coronary angiograms were performed in 24 (80%) patients. The average follow-up period was 22+/-6 months. RESULTS: The initial clinical and angiographic characteristics were no different between the two groups. The reference diameters (Group I; 2.84+/-0.57 mm, II; 3.34+/-0.57 mm), minimal luminal (Group I; 2.37+/-0.60 mm, II; 2.60+/-0.59 mm) and diameter stenosis (Group I; 16.8+/-8.8%, II; 22.6+/-8.6%) following stenting, were no different between the two groups. Subacute stent thrombosis was observed in 1 patient (6.7%) of Group I. On follow-up coronary angiograms, the reference (group I; 2.46+/-0.34 mm, group II; 2.70+/-0.43 mm), minimal luminal diameters (group I; 1.47+/-0.59 mm, group II; 1.64+/-0.80 mm) and diameter stenosis (group I; 39.4+/-25.1%, group II; 40.8+/-26.1%) diameters were also no different, and restenosis was observed in 3 (25%) patients of each group. One cardiac death and 3 target vessel revascularizations were observed in each group during follow-up. CONCLUSION: The heparin-coated coronary stents were not effective in the prevention of coronary stent restenosis.

The Effect of Gender on Short- and Long-term Clinical Outcomes of Percutaneous Coronary Intervention in Korean Octogenarians

BACKGROUND AND OBJECTIVES: Previous studies examining the gender differences in patients undergoing percutaneous coronary intervention (PCI) have reported that women have a higher in-hospital mortality rate, and are at an increased risk for adverse outcomes compared to men. The aim of this study was to determine whether or not Korean women undergoing contemporary PCI have a higher risk than men. SUBJECTS AND METHODS:Seventy eight elderly patients with 105 lesions, including 33 women (47 lesions, 81.9+/-1.97 year-old) and 45 men (58 lesions, 81.6+/-1.74 year-old) who underwent PCI from Jan 1996 to Apr 2001 were enrolled in this study. The demographics, angiographic findings and the clinical outcomes of each gender were compared. RESULTS: Clinical diagnosis and risk factors for atherosclerosis for males and females were similar with the exception of their smoking status (36.7% vs. 14.8%, p=0.002) and stroke history (9.1% vs. 0%, p=0.038). There were no differences in the major in-hospital complications including cardiac death (12.1% vs 15.6%, p=0.75), acute myocardial infarction (AMI:3% vs. 0%, p=0.42), rescue PCI (3% vs. 0%, p=0.42) and emergent coronary artery bypass grafts (CABG:6.1% vs. 11.1%. p=0.44) between the two groups. A twelve-month clinical follow-up showed that the major adverse cardiac events including cardiac death (17.8% vs 28.9%, p=0.27), AMI (0% vs. 5.3%, p=0.5) and repeated revascularization (20.7% vs. 15.8%, p=0.6) in males and females were also similar. CONCLUSION: PCI in Korean female patients older than 80 years can be performed with a comparable procedural success rate and clinical outcomes to those of elderly male patients.

The clinical effects of the BiodivYsio Phosphorylcholine-coated Stent in patients with small coronary artery diseases / 대한내과학회지

BACKGROUND: The BiodivYsio stent is a balloon-expandable stent coated with phosphorylcholine designed to reduce the formation of thrombus and the risk of restenosis. METHODS: We prospectively studied 20 patients who underwent implantation of BiodivYsio stent (group I; 60.8+/-9.3 years, male 60.0%) and compared to 20 patients who underwent balloon angioplasty alone (group II; 60.3+/-7.9 years, male 45.0%) for small coronary arterial lesions (target arterial diameter was between 2.0 mm and 2.8 mm) between February 2001 and October 2001. Major adverse cardiac events such as acute myocardial infarction, target vessel revascularization and death were evaluated during hospital admission and at 6-months after percutaneous coronary intervention (PCI). RESULTS: During hospitalization, the incidence of acute myocardial infarction, target vessel revascularization and death was not different between the two groups. At follow-up coronary angiography 6 months after PCI, the incidence of restenosis was lower in group I than in group II (Group I; 3/20, 15.0% vs Group II; 9/20, 45.0%, p=0.032) and the incidence of target vessel revascularization (TLR) was lower in group I than in group II (Group I; 3/20, 15.0% vs Group II; 8/20, 40.0%, p=0.041). CONCLUSION: Coronary BiodivYsio stenting in small coronary artery leads to excellent short- and mid-term clinical outcomes.

The clinical effects of the BiodivYsio Phosphorylcholine-coated Stent in patients with small coronary artery diseases / 대한내과학회지

BACKGROUND: The BiodivYsio stent is a balloon-expandable stent coated with phosphorylcholine designed to reduce the formation of thrombus and the risk of restenosis. METHODS: We prospectively studied 20 patients who underwent implantation of BiodivYsio stent (group I; 60.8+/-9.3 years, male 60.0%) and compared to 20 patients who underwent balloon angioplasty alone (group II; 60.3+/-7.9 years, male 45.0%) for small coronary arterial lesions (target arterial diameter was between 2.0 mm and 2.8 mm) between February 2001 and October 2001. Major adverse cardiac events such as acute myocardial infarction, target vessel revascularization and death were evaluated during hospital admission and at 6-months after percutaneous coronary intervention (PCI). RESULTS: During hospitalization, the incidence of acute myocardial infarction, target vessel revascularization and death was not different between the two groups. At follow-up coronary angiography 6 months after PCI, the incidence of restenosis was lower in group I than in group II (Group I; 3/20, 15.0% vs Group II; 9/20, 45.0%, p=0.032) and the incidence of target vessel revascularization (TLR) was lower in group I than in group II (Group I; 3/20, 15.0% vs Group II; 8/20, 40.0%, p=0.041). CONCLUSION: Coronary BiodivYsio stenting in small coronary artery leads to excellent short- and mid-term clinical outcomes.

The Effects of Beta-Radiation Using a Holmium-166 Coated Balloon on Neointimal Hyperplasia in a Porcine Coronary Stent Restenosis Model

BACKGROUND AND OBJECTIVES: Brachytherapy is a promising method in the prevention and treatment of coronary stent restenosis. We sought to observe the therapeutic effects of a radioactive balloon loaded with Holmium-166 (166Ho) in a porcine coronary stent restenosis model. Materials and Methods: A radioisotope of (166Ho) was coated on the balloon surface using a polyurethane coating (20 Gy in 0.5 mm depth). Stent overdilation injuries were performed in two coronary arteries in 8 pigs. Four weeks after the stent overdilation injury, radiation therapies were performed using a control balloon dilation in one coronary artery (Group I:n = 8) and a 166Ho-coated balloon in the other coronary artery in each pig (Group II:n = 8). Follow-up coronary angiogram and histopathologic assessment were performed at 4 weeks after the therepy was administered. RESULTS: Laboratory findings did not differ significantly between the pre-treatment baseline and the measurements taken after radiation. On quantitative coronary angiogram, the coronary artery diameters were not significantly different between the two groups before stenting or at 4 and 8 weeks after stenting. On histopathologic analysis, injury score, internal elastic lamina area and lumen area did not differ significantly between the two groups. The neointimal area was 1.78 +/- 0.11 mm2 in group I and 1.36 +/- 0.12 mm2 in group II (p=0.017), and the histopathologic area of stenosis was 35.1 +/- 1.6% in Group I, 27.6 +/- 1.9% in Group II (p=0.005). CONCLUSION: A treatment of beta-radiation in a stented porcine coronary artery using radioactive Ho-166 coated balloon inhibits stent restenosis without any side effects.

A Huge Left Ventricular Pseudoaneurysm after Acute Inferior Myocardial Infarction

No abstract available.

The percutaneous coronary intervention in elderly women over 70 years of age / 대한내과학회지

BACKGROUND: Previous reports have mentioned the increased mortality of percutaneous coronary intervention (PCI) in elderly female patients compared with elderly male. The purpose of this study was to evaluate the clinical characteristics, coronary lesion, characteristics and differences of success rate of PCI between male and female elderly patients. METHODS: Three hundred sixty six elderly patients (454 lesions), including 210 male (255 cases, 73.4+/-2.45 year-old) and 156 female (199 cases, 73.5+/-2.55 year-old) who underwent PCI at Chonnam National University Hospital between Jan '96 and Dec '98 (out of 3,030 patients during same period). We compared clinical characteristic, coronary artery lesion morphology, success and complication rates of PCI in elderly male and female patients. RESULTS: Clinical diagnosis and risk factors for atherosclerosis were not different between two groups. Right coronary lesions were more common in female and left circumflex artery lesion less common in female patients. The success rate of balloon angioplasty was 93.2% (110/118) in male and 93.3% in (98/105) in female patients, and the success rates of stenting were 99.2% (136/137) in male and 100% (94/94) in female. Success rates of PCI were not different between two groups. Procedure-related mortality was one cardiac death (1/255, 0.39%) in male group only. Complications of elderly male were two occlusive dissection (OD: 2/255, 0.8%), three thrombotic occlusion (TO: 3/255, 1.2%) and two ventricular arrhythmia (VA) with shock (2/255, 0.8%). In 199 female patients, three OD (3/199, 1.5%), three TO (3/199, 1.5%) and two VA (2/199, 1.0%) developed. The complications rates were not different two groups. CONCLUSION: PCI in female patients older than 70 years can be performed with comparable success and complication rates to those of elderly male patients.

The percutaneous coronary intervention in elderly women over 70 years of age / 대한내과학회지

BACKGROUND: Previous reports have mentioned the increased mortality of percutaneous coronary intervention (PCI) in elderly female patients compared with elderly male. The purpose of this study was to evaluate the clinical characteristics, coronary lesion, characteristics and differences of success rate of PCI between male and female elderly patients. METHODS: Three hundred sixty six elderly patients (454 lesions), including 210 male (255 cases, 73.4+/-2.45 year-old) and 156 female (199 cases, 73.5+/-2.55 year-old) who underwent PCI at Chonnam National University Hospital between Jan '96 and Dec '98 (out of 3,030 patients during same period). We compared clinical characteristic, coronary artery lesion morphology, success and complication rates of PCI in elderly male and female patients. RESULTS: Clinical diagnosis and risk factors for atherosclerosis were not different between two groups. Right coronary lesions were more common in female and left circumflex artery lesion less common in female patients. The success rate of balloon angioplasty was 93.2% (110/118) in male and 93.3% in (98/105) in female patients, and the success rates of stenting were 99.2% (136/137) in male and 100% (94/94) in female. Success rates of PCI were not different between two groups. Procedure-related mortality was one cardiac death (1/255, 0.39%) in male group only. Complications of elderly male were two occlusive dissection (OD: 2/255, 0.8%), three thrombotic occlusion (TO: 3/255, 1.2%) and two ventricular arrhythmia (VA) with shock (2/255, 0.8%). In 199 female patients, three OD (3/199, 1.5%), three TO (3/199, 1.5%) and two VA (2/199, 1.0%) developed. The complications rates were not different two groups. CONCLUSION: PCI in female patients older than 70 years can be performed with comparable success and complication rates to those of elderly male patients.

The inhibitory effect of platelet glycoprotein IIb/IIIa receptor blocker-coated stent on porcine coronary stent restenosis / 대한내과학회지

BACKGROUND: The problems of coronary stent thrombosis and restenosis still remain to be solved.The glycoprotein IIb/IIIa receptor blocker, Abciximab (ReoPro), plays important roles in the treatment of high-risk patient with acute platelet-rich thrombus and in the inhibition of smooth muscle cell proliferation. The aim of this study was to determine whether the use of ReoPro-coated stents could reduce the neointimal formation in a porcine coronary stent restenosis model. METHODS: ReoPro was coated on the surface of stent by means of plasma polymerization followed by chemical grafting. Stent overdilation injury was performed with control bare stent (Group I, n=13), and ReoPro-coated stents (Group II, n=14). Follow-up quantitative coronary angiogram was performed at 4 weeks after stenting and histopathologic assessment were compared in both groups. RESULTS: The diameter stenosis by QCA between two groups was significantly higher in Group I (23+/-5 % vs. 15+/-7 %, p=0.003). On histopathologic examination, no in-stent thrombus was observed. The percent area stenosis was significantly higher in Group I than in Group II (48+/-17 % vs. 30+/-16 %, p=0.01). The area of neoinima was larger in Group I than in Group II (3.2+/-1.2 mm2 vs. 2.0+/-1.0 mm2, p=0.01). By immunocytochemistry, proliferation cell nuclear antigen indices were higher in Group I (4.2+/-2.1 %, vs 2.4+/-1.8 % p=0.03). CONCLUSION: The ReoPro-coated stent is safe and effective in the prevention of in-stent thrombus and restenosis, which may be related with the inhibition of platelet thrombus and neointimal cell proliferation.

Risk Factors for the Second Restenosis after Coronary Interventions

BACKGROUND AND OBJECTIVES: One of the major limitations in coronary intervention is restenosis. This study was aimed to identify clinical, angiographic and procedural factors, which may be related to the second restenosis (SR). MATERIALS AND METHOD: We studied 101 patients who underwent more than two follow-up coronary angiograms after two coronary interventions between Jan 1996 and Dec 1998 in Chonnam University Hospital (out of 4092 total coronary interventions in 3030 patients during the same period). The patients were divided into two groups according to the evidence of second restenosis (SR). Fifty two patients (Group A: 56.6+/-9.9 year, M: F=44:8) who had SR, and the other 49 patients (Group B: 53.8+/-8.5 year, M: F=44: 5) were analyzed. Clinical features, angiographic characteristics, coronary interventional procedures, and other risk factors were compared between two groups by univariate analysis and multivariate stepwise logistic regression analysis for the predictive factors of second restenosis. RESULTS: 1) The clinical variables of age, sex, clinical diagnosis, and risk factors were not different between two groups. 2) The lesion types severer than B2 by AHA/ACC classification were associated with SR (p<0.05). 3) Recurrent angina as an indication for follow up angiography was associated with SR (p<0.01). CONCLUSION: The predictive factors associated with SR were patient's subjective symptom and lesion severer than type B2 according to AHA/ACC classification.

Clinical Characteristics of Coronary Interventions in Old Aged Patients

BACKGROUND: Coronary intervention is one of well established therapeutic modalities for patients with ischemic heart diseases. With the prolonged life expectancy and changes in dietary habits in Korea, the number and percentage of elderly patients with ischemic heart disease have increased in interventional coronary therapies. METHOD: There were 1762 patients (age> or = 70 years : 253, age<70 years: 1509) who underwent diagnostic coronary angiogram at Chonnam University Hospital between Jan '96 and Jun '97. We compared clinical characteristics, coronary lesion morphology, success rates and complications of coronary interventions in control and aged groups. RESULTS: 1) Female patients were more prevalent in aged group (43 %; 145 male, 108 female) than in the control group (35%; 982 male, 527 female, p<0.05). 2) The diagnostic sensitivity of coronary angiogram was higher in the aged (169/253, 67 %) than in control group (738/1509, 49 %, p<0.05). Multivessel diseases were more prevalent in the aged (65 %) than in the control groups (49%). 3) Coronary interventions were performed less frequently in the aged group (119/169, 70 %) than in the control group (605/738, 82%, p<0.05). The success rates of PTCA were not different between in the aged (89%) and control (93%) groups, and the success rates in stenting was also not different between the aged (98%) and control (99%) groups. 4) Procedure-related complications (4.6 vs. 7.6 %) and mortalities (0.5 vs 0.8 %) during and after coronary interventions were not different in control and elderly groups. CONCLUSION: Coronary interventions in patients older than 70 years can be performed with high success and low complication rates ; the results do not differ from those of younger patients.