Predictors of total occlusion of the infarct-related artery in patients with acute Non-ST elevation myocardial infarction / 대한내과학회지

BACKGROUND/AIMS: Some patients with non-ST elevation myocardial infarction (NSTEMI) have total occlusion of the infarct related artery (IRA) and may benefit from early invasive treatments. The aim of this study was to investigate the predictors of total occlusion of the IRA in patients with NSTEMI before coronary angiography. METHODS: A total of 205 consecutive patients with NSTEMI (63.3+/-10.5 years, 123 males) who were admitted and underwent coronary angiogram from April 2005 to December 2006 at Chonnam National University Hospital were divided into two groups: group I (total occlusion of IRA: n=62, 61.1+/-13.3 years, 42 males) and group II (patent IRA: n=143, 64.2+/-11.3 years, 81 males). Clinical, biochemical and echocardiographic parameters on admission were compared between the groups. RESULTS: A total occlusion of the IRA in patients with NSTEMI was observed in 62 (30.2%) patients most frequently in the left circumflex coronary artery. The predictive factors for total occlusion, according to the multivariate analysis, were prolonged duration of continuous chest pain (OR:9.67, 95% CI:1.59~80.6, p=0.03), a higher level of the creatine kinase-MB fraction (CK-MB) (OR:5.35, 95% CI:1.31~90.0, p=0.035) and fibrinogen (OR:6.73, 95% CI:1.48~50.2, p=0.043), and multiple leads with ST depression on the ECG (OR:4.78, 95% CI:1.22~41.9, p=0.048). CONCLUSIONS: Total occlusion of the IRA in patients with acute NSEMI is associated with a long duration of chest pain, high levels of CK-MB and fibrinogen, and ST changes in multiple ECG leads.

The Comparative Clinical Effects of Valsartan and Ramipril in Patients With Heart Failure

BACKGROUND AND OBJECTIVES: Angiotensin II receptor blocker (ARB) has emerged as an alternative to angiotensin converting enzyme inhibitor (ACEI) for the treatment of heart failure. This study aimed at comparing the effectiveness and safety of valsartan with ramipril in patients with heart failure, and these patients were hospitalized at Chonnam National University Hospital, Wonkwang University Hospital, Gunsan Medical Center, Presbyterian Medical Center, Seonam University Hospital and Gwangju Christian Hospital. SUBJECTS AND METHODS: Between March 2005 and March 2007, 82 patients (60.5+/-12.4 years, 59 males) who complained of class II to IV dyspnea, according to the New York Heart Association (NYHA) classification, and who had low left ventricular ejection fraction (LVEF) less than 50% were randomly allocated to valsartan or ramipril. After 6 months, the clinical symptoms, vital signs, biochemical tests and echocardiography were compared between the two groups. RESULTS: The NYHA class was improved in both groups (the valsartan group: 2.31+/-0.51 vs. 1.46+/-0.58, p<0.001; the ramipril group: 2.21+/-0.55 vs. 1.61+/-0.50, p<0.001). The incidence of cough, as measured by the cough index, was significantly lower in the valsartan group than in the ramipril group (p=0.045). The LVEF was improved in both groups (the valsartan group: 36.4+/-8.5% vs. 46.9+/-12.9%, p<0.001; the ramipril group: 35.1+/-8.5% vs. 45.3+/-11.2%, p<0.001). The improvements of the left ventricular end-systolic dimension (p=0.754) and end-diastolic dimension (p=0.998) were not different between the two groups. N-terminal Pro-B-type natriuretic peptide level was improved in both groups (the valsartan group: 2619.6+/-4213.5 vs. 995.4+/-2186.0 pg/mL, p=0.012; the ramipril group: 3267.9+/-4320.0 vs. 828.1+/-1232.8 pg/mL, p=0.009), and there was no difference between the groups (p=0.877). CONCLUSION: Both valsartan and ramipril were effective treatments, with relatively low adverse events, in patients with heart failure.

New risk factors for thromboembolic complications in atrial fibrillation / 대한내과학회지

BACKGROUND: Atrial fibrillation (AF) is the most common cause of embolic cerebral infarction. This study was performed to determine new risk factors and the mechanism underlying thromboembolism (TE) in patients with AF. METHODS: 192 patients (M:F=137:55, 61+/-11 years) with AF were randomly selected and divided into a TE (n=95) and non-TE group (n=97). Another 71 patients with AF (M:F=38:33, 55+/-14) were studied for endothelial function by measuring the level of von Willebrand factor (vWF; factor 8 related antigen), inflammation by WBC, ESR, and high sensitive CRP and coagulation system by fibrinogen, fibrinogen degradation product and fibrin d-dimer; the results were compared with 25 patients with normal sinus rhythm. RESULTS: The TE group was older than non-TE group. Hypertension (HTN), diabetes mellitus (DM), hypercholesterolemia, smoking and fine AF (AF wave amplitude <1 mm) were more frequent in the TE group. Mitral valvular disease, an ejection fraction <40% and dilated cardiomyopathy were more frequent in the TE group and the left atrial (LA) dimension was greater in the TE group. The use of anticoagulants, an angiotensin-II receptor blocker and statins were less frequently observed in the TE group. The vWF-factor 8 related antigen was higher in patients with advanced age, LV dysfunction, HTN, DM, mitral stenosis and positively correlated with age, LA dimension, LV end-diastolic and end-systolic dimension, ejection fraction, NYHA class and AF duration. The fibrinogen level was positively correlated with age, NYHA class, LA dimension and d-dimer with NYHA class. Markers for inflammation or coagulation were not significantly different in the atrial fibrillation and the sinus rhythm group. CONCLUSIONS: No use of an angiotensin-II receptor blocker or statin and fine AF may be new risk factors for TE in patients with AF. The TE risk factors are thought to increase TE by impairing endothelial function.