Long-Term Outcomes of Complete Versus Incomplete Revascularization for Patients with Multivessel Coronary Artery Disease and Left Ventricular Systolic Dysfunction in Drug-Eluting Stent Era

We aimed to investigate that complete revascularization (CR) would be associated with a decreased mortality in patients with multivessel disease (MVD) and reduced left ventricular ejection fraction (LVEF). We enrolled a total of 263 patients with MVD and LVEF <50% who had undergone percutaneous coronary intervention with drug-eluting stent between March 2003 and December 2010. We compared major adverse cardiac and cerebrovascular accident (MACCE) including all-cause death, myocardial infarction, any revascularization, and cerebrovascular accident between CR and incomplete revascularization (IR). CR was achieved in 150 patients. During median follow-up of 40 months, MACCE occurred in 52 (34.7%) patients in the CR group versus 51 (45.1%) patients in the IR group (P=0.06). After a Cox regression model with inverse-probability-of-treatment-weighting using propensity score, the incidence of MACCE of the CR group were lower than those of the IR group (34.7% vs. 45.1%; adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.44-0.95, P=0.03). The rate of all-cause death was significantly lower in patients with CR than in those with IR (adjusted HR, 0.48; 95% CI, 0.29-0.80, P<0.01). In conclusion, the achievement of CR with drug-eluting stent reduces long-term MACCE in patients with MVD and reduced LVEF.

Abdominal and Pericardial Fat in Patients with and without Coronary Artery Disease: Computed Tomography Study

OBJECTIVE: There has been a limited investigation looking into the correlation between pericardial fat and abdominal fat with coronary artery disease (CAD) as measured by coronary computed tomographic angiography (CCTA). We proposed that the volume of pericardial fat is larger in patients with CAD than in patients without CAD, and sought to determine which abdominal adiposity index best correlated with pericardial fat volume. METHODS: Participants were examined using CCTA between October 2007 and January 2008. All participants had no previous history of CAD. Pericardial adipose tissue (PAT) volume, abdominal total adipose tissue volume, abdominal subcutaneous adipose tissue volume, and abdominal visceral adipose tissue (AVAT) volume were measured using CCTA. RESULTS: Fifty patients (26.5%) demonstrated CAD, and 139 patients did not demonstrate CAD by CCTA. PAT volume in patients with CAD was larger than that of patients without CAD (173.2+/-64.2 cm3 vs. 147.6+/-50.4 cm3, p<0.01). However, indices of abdominal adiposity were not significantly different between the two groups. Using multivariable analysis, independent predictors of CAD were PAT volume (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.00-1.02, p=0.04), coronary artery calcium score (OR 1.01, 95% CI 1.00-1.01, p<0.01), and typical chest pain (OR 4.88, 95% CI 1.47-16.21, p=0.01). AVAT volume showed a linear correlation with PAT volume. CONCLUSION: PAT volume was an independent predictor of CAD as measured by CCTA. PAT volume was also well correlated with the AVAT volume among the indices of abdominal adiposity.

A case of Rhizobium radiobacter bacteremia in a patient with lymphoma / 대한내과학회지

Rhizobium species, aerobic Gram-negative rods found in soils worldwide, are well-known tumor-inducing pathogens in plants. Since 1980, when the first case of prosthetic valve endocarditis caused by Rhizobium radiobacter was reported, R. radiobacter has been recognized as an opportunistic human pathogen. In Korea, three cases of infection by this organism have been reported. Recently, we experienced a case of R. radiobacter bacteremia in a patient who underwent chemotherapy for lymphoma. Here, we report the case with a review of the literature.

The Incidence and Predictors of Postoperative Atrial Fibrillation After Noncardiothoracic Surgery

BACKGROUND AND OBJECTIVES: The incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery. SUBJECTS AND METHODS: Patients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded. RESULTS: Between January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage. CONCLUSION: Postoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates.

Drug-induced hepatitis complicated by pure red cell aplasia and autoimmune hemolytic anemia: a case report / 대한내과학회지

Pure red cell aplasia is a rare hematopoietic complication of drug-induced hepatitis, with only five cases reported worldwide. Moreover, pure red cell aplasia associated with autoimmune hemolytic anemia in the setting of drug-induced hepatitis is exceedingly rare. We recently experienced a case of drug-induced hepatitis complicated by pure red cell aplasia and autoimmune hemolytic anemia without parvovirus B19 infection. Here, we report the case and review the literature.

A Case of Right Coronary Artery Hematoma Detected by Echocardiography after Percutaneous Coronary Intervention

A 69-year-old man was admitted to undergo percutaneous coronary intervention (PCI) for chronic total occlusion of right coronary artery. He had diabetes mellitus, stable angina pectoris. Diagnostic coronary angiography demonstrated proximal total occlusion of right coronary artery. PCI was failed due to failure of balloon passage. Echocardiography was performed after PCI and thickened epicardial tissue at right atrioventricular groove was noted. It was highly echogenic and localized along the course of mid right coronary artery. In following echocardiogram after 12 days, the size of echogenic mass was decreased from 3.4 cmx2.6 cm to 1.7 cmx0.7 cm and we could conclude it was right coronary artery hematoma associated with PCI.

A Case of Coarctation of Aorta with Left Isomerism Associated with Inferior Vena Cava Interruption and Polysplenia

A 27-year-old female visited outpatient clinic for the evaluation of palpitation and dyspnea on exertion. Echocardiographic examination including transthoracic and transesophageal echocardiography revealed coarctation of aorta, bicuspid aortic valve, mitral valve prolapse, and sealed-up ventricular septal defect. Further evaluation with computed tomography angiography revealed another combined congenital anomaly of left isomerism with polysplenism and interrupted inferior vena cava and pulmonary embolism with deep vein thrombosis. After corrective surgery for the coarctation, she received anticoagulation therapy for the treatment and the secondary prevention of pulmonary embolism.