Effect of body mass index and abdominal obesity on mortality after percutaneous coronary intervention: a nationwide, population-based study

Background/Aims@#We investigated the impact of obesity on the clinical outcomes following percutaneous coronary intervention (PCI). @*Methods@#We included South Koreans aged > 20 years who underwent the Korean National Health Screening assessment between 2009 and 2012. Obesity was defined using the body mass index (BMI), according to the World Health Organization’s recommendations. Abdominal obesity was defined using the waist circumference (WC), as defined by the Korean Society for Obesity. The odds and hazard ratios in all-cause mortality were calculated after adjustment for multiple covariates. Patients were followed up to the end of 2017. @*Results@#Among 130,490 subjects who underwent PCI, the mean age negatively correlated with BMI. WC, hypertension, diabetes, dyslipidemia, fasting glucose, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels correlated with the increased BMI. The mortality rates were higher in the lower BMI and WC groups than the higher BMI and WC groups. The non-obese with abdominal obesity group showed a mortality rate of 2.11 per 1,000 person-years. Obese with no abdominal obesity group had the lowest mortality rate (0.88 per 1,000 person-years). The mortality showed U-shaped curve with a cut-off value of 29 in case of BMI and 78 cm of WC. @*Conclusions@#The mortality showed U-shaped curve and the cut-off value of lowest mortality was 29 in case of BMI and 78 cm of WC. The abdominal obesity may be associated with poor prognosis in Korean patients who underwent PCI.

A Case of Acquired Coronary-Cameral Fistulae / 대한내과학회지

We report a rare case of acquired multiple coronary-cameral fistulae. A 46-year-old man presented to the cardiology department clinic complaining of recently aggravated exertional chest pain. He had been treated 10 years ago for an acute ST segment elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI). During revascularization, diffuse multiple fistulae from the left anterior descending (LAD) artery to the left ventricle (LV) had been observed. The current chest pain was evaluated by elective coronary angiography but no significant stenosis was observed. However, newly developed diffuse fistulae from the distal right coronary artery (RCA) to LV were found during angiography, as well as LAD-LV coronary fistulae. Multiple coronary-cameral fistulae were thought to be causing chest pain. A beta-blocker was prescribed and, after 3 months of follow-up, exertional chest pain had subsided without further complication.

Fluoroscopic Guided Fogarty Embolectomy for an Angio-Seal Embolism in the Popliteal Artery

The Angio-Seal is a widely used arterial closure device that helps achieve faster hemostasis and provide early ambulation to patients. However, it can cause various complications in clinical practice. We present the uncommon complication of popliteal artery occlusion following Angio-Seal deployment, and describe an effective interventional approach to its treatment. Because fluoroscopy-guided Fogarty embolectomy has the advantages of complete removal of the embolus without fragmentation, and clear visualization of the exact location of the embolus during the procedure, it is a suitable method for treating this complication.

Phantom Ischemia Mimicking ST Segment Elevation Myocardial Infarction in Fulminant Myocarditis / 이화의대지

A 30-year-old man visited the emergency room for chest pain, dyspnea and fever. Despite increased serum cardiac enzymes, ST segment elevation and inferior wall akinesis in electrocardiography and echocardiography, no atherosclerosis was evident in the coronary angiography. However, radionuclide myocardial perfusion image at day 2 showed a persistent perfusion defect in the left ventricular (LV) inferior wall. At day 3, prominent myocardial edema and severe LV systolic dysfunction developed with signs of heart failure. In this case, fulminant myocarditis seemed to originate from the right coronary artery territory and simulated a ST segment elevation myocardial infarction without coronary artery obstruction. The pathogenesis of the localized perfusion defect was unlcear.

Simultaneous Multi-Vessel Subacute Stent Thromboses in Zotarolimus-Eluting Stents

Despite its low incidence, stent thrombosis (ST) is one of the most dreaded complications of percutaneous coronary intervention. Endeavor (Medtronics Europe SA) is a new zotarolimus-eluting stent (ZES) with a favorable safety profile that was reported in early and ongoing trials. However, few lethal stent thromboses related to this new drug eluting stent (DES) have been reported. We experienced a case of simultaneous subacute ZES thromboses, 6 days after stent implantations in the proximal left anterior descending artery and the proximal right coronary artery (RCA).

Erratum

For the article: Park CG, Ahn JC, Hong SJ, et al. Efficacy of Irbesartan on Left Ventricular Mass and Arterial Stiffness in Hypertensive Patients. Korean J Intern Med 2006;21:103-108. The 6th author's name was misspelled as Sung Mi Park. The correct spelling is Seong Mi Park.

Efficacy of Irbesartan on Left Ventricular Mass and Arterial Stiffness in Hypertensive Patients

BACKGROUND: Increased aortic stiffness measured by pulse wave velocity (PWV) and left ventricular hypertrophy (LVH) are independent risk factors of cardiovascular events in hypertensive patients. We have conducted a prospective study to examine the effects of the angiotensin II receptor antagonist (irbesartan) on PWV and LVH in hypertensive patients. METHODS: A total of 52 untreated hypertensive patients (age:53.3+/-8.0 yrs) were enrolled; they had no evidence of associated cardiovascular complications. Blood pressure, heart rate, aortic PWV and left ventricular mass index (LVMI) by 2-D echocardiography were measured at baseline and after irbesartan treatment (150 mg or 300 mg/day) at 12 weeks and 24 weeks. RESULTS: Blood pressure was significantly decreased after 12 weeks and 24 weeks of treatment compared to baseline (SBP: 134.6+/-13.3 mmHg, 134.0+/-11.0 mmHg vs 163.7+/-13.8 mmHg p<0.001, DBP: 86.0+/-10 mmHg, 83.07 mmHg vs 102.4+/-9.6 mmHg p<0.001, respectively) without significant change in heart rate. LVMI decreased at 12 weeks and at 24 weeks after treatment compared to baseline (from 145.5+/-35.1 g/m2 at baseline to 137.5+/-35.4 g/m2 at 12 weeks, p=0.017 and 135.3+/-35.4 g/m2 at 24 weeks, p=0.008). Aortic PWV was decreased after irbesartan treatment at 12 weeks (from 9.6+/-2.8 m/sec to 8.7+/-3.1 m/sec at 12 weeks, p=0.064) and at 24 weeks (from 9.6+/-2.9 m/sec to 7.7+/-2.1 m/sec at 24 weeks, p=0.007). CONCLUSIONS: Long-term treatment with irbesartan may reduce arterial stiffness and regression of LVH in hypertensive patients. The pleiotropic effects of irbesartan, further decreasing PWV without change of BP between 12 and 24 weeks of treatment, may have favorable vascular effects on arterial stiffness and LVH.

The Source of Inflammatory Response and Platelet Activation in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Studies on the stability of atheromatous plaques, as a determinant of the cause of complications, have been reported. Among the functional features of plaques related with vulnerability, inflammation has emerged as a leading cause of clinical presentation. The purpose of this study was to find the source of the inflammatory response in the patients with acute myocardial infarction (AMI). SUBJECTS AND METHODS: Patients with AMI, whose lesion of in either the left anterior descending artery (LAD group, n=13) or the right coronary artery (RCA group, n=11), were selected. The levels of interleukin-6 (IL-6) and P-selectin were measured in blood from the aortic root (A), great cardiac vein (G) and peripheral vein (V). The control group (n=15) included patients with either stable or variant angina. RESULTS: The levels of IL-6 were 4.77+/-6.0 (A), 11.32+/-7.8 (G) and 4.39+/-5.0 pg/mL (V) in the LAD group, and 3.64+/-2.1 (A), 6.05+/-4.9 (G) and 3.84+/-3.2 pg/mL (V) in the RCA group. Unrelated to the infarction related artery, the level of IL-6 in the great cardiac vein was significantly increased in patients with AMI. The percentages of platelet expressed P-selectin were 6.03+/-7.0 (A), 8.14+/-8.1 (G) and 8.83+/-7.9 (V) in the LAD group and 6.46+/-8.4 (A), 5.80+/-6.0 (G) and 5.91+/-6.9 (V) in the RCA group. CONCLUSION: These findings suggest that the generalized inflammatory response is activated across the coronary vascular bed in patients with AMI, regardless of the infarction related artery site. Therefore, systemic therapy, as well as local management for vulnerable plaque, would be required.

Effect of Human Bcl-2 Gene Expression on the Peripheral Atherosclerotic Lesions of Apolipoprotein E-Deficient Mouse

BACKGROUND AND OBJECTIVES: Bcl-2 protein is related to the inhibition of apoptosis via the mitochondrial pathway and Bcl-2's anti-oxidant effect. During the development of atherosclerosis, apoptosis is known to play an important role in the pathophysiologic behavior of atherosclerotic vascular disease in the medium-sized arteries. Apoptosis may be a compensatory reaction to regulate the cellular density of various tissues during the cellular proliferation process such as happens with tissue injury and during the development of atherosclerosis. The consequences of apoptosis in atherosclerosis may be related to the formation of an acellular lipid core, plaque instability and the loss of vascular wall integrity and remodeling. We sought to determine the effect of Bcl-2 gene expression on the development of primary atherosclerosis in apolipoprotein E deficient mouse, which is one of the typical animal models that are used for the development of peripheral atherosclerosis. MATERIALS AND METHODS: Bcl-2 transgenic mice were cross hybridized with apolipoprotein E deficient mice. Systemic analysis of the distribution and severity of their atherosclerotic lesions was done by dissecting microscopy, and the histological characteristics of the lesions were evaluated in normal chow-fed, 9-month-old apolipoprotein-E deficient/Bcl-2 transgenic mice (n=6) and apolipoprotein-E deficient mice (n=6). RESULTS: The distribution and severity of atherosclerotic lesions at the peripheral arteries were less in the apolipoprotein-E deficient/Bcl-2 transgenic mice. Acellular lipid core formation, destruction of the smooth muscle cell layers in the media and infiltration of inflammatory cells in the adventitia were much less in the apolipoprotein-E deficient/Bcl-2 transgenic mice. The lipid profile was similar in both groups. CONCLUSION: The effect of Bcl-2 gene expression on the peripheral atherosclerosis was related with the inhibition or the delay of atherosclerotic lesion progression, such as the reduction of amount of the acellular lipid core, maintenance of vascular smooth muscle cell integrity and the reduction of adventitial inflammation, and this was achieved regardless of serum cholesterol level.

Early Assessment of Myocardial Contractility by Contrast-Enhanced Magnetic Resonance (ceMRI) Imaging after Revascularization in Acute Myocardial Infarction (AMI)

BACKGROUND: Recent studies have demonstrated that the size and shape of the hyperenhanced areas on contrast-enhanced magnetic resonance imaging (ceMRI) were nearly identical to areas of irreversible injury, as defined by histochemical staining. We compared the transmural extent of infarct (TEI), as defined by ceMRI, to the initial ECG findings for acute myocardial infarction (AMI), and we also assessed functional contractility according to TEI. METHODS: 12 patients who presented with their first myocardial infarction underwent cine and ceMRI 4 weeks later after their successful revascularization. TEI and wall thickening were determined by using a 30-segment model. RESULTS: Infarction was observed in 81 (23.9%) segments, of which 46 segments (56.8%) had abnormal wall motion and 35 segments (43.2%) had normal wall motion. Of the 35 segments, 33 (94.3%) had subendocardial infarction. 17 segments had infarct of less than 25% of the wall thickness, and all of them had normal wall motion. On the other hand, 11 segments had infarct of more than 75% of wall thickness, of which 11 (100%) had abnormal wall motion. None of segments with nearly transmural infarction were observed in non ST-elevation AMI. The majority of the segments with infarct had non-transmural infarction (87.5%), even if the segments were in ST-elevation AMI (76.1%). Infarct size, as defined by ceMRI, was strongly correlated with peak CK-MB and Troponin-T (r=0.96, p< 0.001, r=0.91, p< 0.001, respectively). CONCLUSION: TEI defined by ceMRI is inversely related to the contractility after revascularization in AMI. We were able to predict the future contractile function of segments with infarction using ceMRI before revascularization.

Effects of Cilostazol on Platelet Activation in Coronary Stenting Patients Who Already Treated with Aspirin and Clopidogrel

BACKGROUND: A recent study has shown that triple anti-platelet therapy (cilostazol+clopidogrel+aspirin) resulted in a significantly lower restenosis rate after coronary stenting than did conventional therapy (clopidogrel+aspirin). However, the anti-platelet effects of cilostazol, when combined with clopidogrel and aspirin, have not been evaluated. METHODS: Low dose cilostazol (50 mg/BID) was given to 47 patients who had already been taking clopidogrel (75 mg/day) and aspirin (100 mg/day) for more than 1 month subsequent to coronary stenting due to AMI and unstable angina. Markers of platelet activation, P-selectin and activated GPIIb/IIIa on platelets, were measured at baseline and 2 weeks after cilostazol treatment. We empirically divided patients into tertiles (low, n=16; moderate, n=14; high group, n=17), according to the baseline P-selectin expression. We then performed a comparative assessment of the anti-platelet effects of cilostazol at baseline and after 2 weeks of cilosatzol administration. RESULTS: P-selectin was significantly decreased after 2 weeks of cilostazol treatment in total patients (n=47, 3.2 +/- 2.4% to 2.0 +/- 1.9%, p=0.03). This inhibition of P-selectin expression was mainly achieved in the moderate and high P-selectin groups (low group; 1.4 +/- 0.5 to 1.9 +/- 1.3%, p> 0.05, moderate group; 2.5 +/- 0.3 to 1.3 +/- 0.3%, p 0.05). Underlying disease, cardiovascular risk factors, concomitant medication including statin, and hsCRP were not related to the degree of P-selectin expression. CONCLUSION: Our data demonstrated that cilostazol treatment in addition to conventional anti-platelet therapy provides more effective suppression of platelet P-selectin expression in patients with relatively high platelet activity.

Relation between Pulse Wave Velocity, Left Ventricular Diastolic Function, and Circadian Variation of Blood Pressure in Patients with Never Treated Essential Hypertension

BACKGROUND AND OBJECTIVES: An increased pulse wave velocity (PWV) and a non-dipping pattern in hypertensive patients have been shown to be associated with an excess of target organ damage. The relationship between the PWV and circadian variation of blood pressure (BP) (dipper or nondipper) were sought, and also the LV diastolic function between dipper and nondipper patients compared. SUBJECTS AND METHODS: 44 hypertensive subjects, who had never been treated, were enrolled (mean age: 48+/-12 yrs, men: 29). The following procedures were undertaken. 1) 24 hour ambulatory BP monitoring; 2) echocardiography for LV geometry, LV mass index (LVMI), LV systolic and diastolic functions, including tissue Doppler and aortic PWV. The patients were divided into two groups with respect to their ambulatory BP profiles, i.e., dipper and nondipper. The PWV, LV geometry and diastolic functions were compared between dipper and nondipper patients, and the relationship between the PWV and diastolic function analyzed in all patients. RESULTS: Twenty (45%) were nondipper patients. There were no significant differences in the LV geometry, LVMI and PWV between dipper and nondipper patients (PWV; 8.8+/-3.1 vs. 8.6+/-3.3 m/sec, p>0.05). In all patients, the PWV was related to the deceleration time (r=0.34, p=0.03) and the mitral E/A (r=-0.31, p=0.02) and mitral Em/Am ratios obtained by the tissue Doppler echocardiography (r=-0.31, p=0.03). The proportion with diastolic dysfunction was higher in the nondipper than the dipper patients (21 vs. 50%, p<0.01). There was a significant relation between the PWV and Em (r=-0.45, p=0.047) in the nondipper, but not in the dipper. CONCLUSION: Prolonged exposure to high BP (nondipper) was not related with increased aortic stiffness in never treated hypertensive patients. The PWV was closely related with LV diastolic dysfunction in nondipper patients.

High Aortic Stiffness Assessed by Pulse Wave Velocity is an Independent Predictor of Coronary Artery Calcification and Stenosis in Suspected Coronary Artery Disease Patients

BACKGROUND AND OBJECTIVES: Aortic stiffness is an independent predictor of cardiovascular mortality and of all other causes in hypertensive patients. The object of this study was to investigate whether aortic stiffness, measured by pulse wave velocity (PWV), could be used as an independent predictor for detecting coronary artery atherosclerosis. SUBJECTS AND METHODS: PWV was measured by an invasive method. All patients (n=187, M/F= 77/110) were suspected as having the coronary artery disease (CAD) and underwent coronary angiography. CAD was classified as that with or without calcification and stenosis and was classified by the calcification segments and stenotic vessel numbers. RESULTS: Coronary artery calcification was significantly associated with diabetes mellitus (p<0.001), the waist/hip circumference ratio (p=0.012), hypertension (p=0.002), age (p<0.001) and PWV (p<0.001). Multiple logistic regression analysis revealed that coronary artery calcification was highly associated with age (OR=1.052, p=0.023) and PWV (OR=1.213, p<0.001). Significant coronary artery stenosis was associated with hypertension (p=0.002), diabetes mellitus (p=0.015), age (p=0.004), waist/hip circumference ratio (p=0.019), systolic blood pressure (p=0.007), pulse pressure (p=0.016), low density lipoprotein levels (p=0.004) and PWV (p<0.001). Multivariate analysis showed that PWV (OR=1.370, p<0.001) and low density lipoprotein levels (OR=1.022, p=0.006) were the best predictors of coronary artery stenosis. Patients with severe coronary atheosclerosis exhibited a greater increased aortic PWV. CONCLUSION: A high aortic PWV is an independent marker for coronary artery stenosis and calcification in suspected CAD patients. The aortic PWV could be used as an independent predictor for ischemic heart disease in patients with suspected CAD.

The Comparison of Serum Lipid Levels and Risk Factors according to the Status of Coronary Atherosclerosis in Koreans

BACKGROUND AND OBJECTIVES: The aims of this study were to compare the lipid distributions and risk factors in an angiographically normal coronary artery group to those of microvascular and coronary artery diseased groups of Koreans, and to find the effects of the variable risk factors on the serum lipid levels according to the coronary atherosclerosis status. SUBJECTS AND METHODS: A total of 1,198 patients (563 males and 635 females), having undergone a coronary angiography (CAG) using Judkins method, were included. According to their coronary angiographic findings, they were divided into normal CAG (n=568), microvascular disease (n=230) and coronary atherosclerosis (n=400) groups. RESULTS: The mean value of the total cholesterol in the patients with normal coronary artery was 175 mg/dl, which progressively increased to 182 mg/dl and 198 mg/dl in the patients with microvascular disease and coronary atherosclerosis, respectively. The frequencies of the risk factors for coronary atherosclerosis also progressively increased in the patients with microvascular disease and coronary atherosclerosis. The mean values of the serum total cholesterol, LDL-cholesterol and lipoprotein(a), progressively increased from the patients with normal angiographic findings to those with microvascular disease and coronary atherosclerosis, and the results were statistically significant. The results for the patients with microvascular disease were in between those of the patients with normal angiographic findings and those with coronary atherosclerosis. CONCLUSION: The correlation between coronary atherosclerosis and the serum cholesterol levels has, until now, been studied epidemiologically, and this is the first study to angiographically elucidate the positive relationship between coronary artery disease and the serum cholesterol levels. Our data showed lower ranges of lipid distributions compared to those of the ATP III guideline.

Structural and Functional Changes of Heart after Cardioversion of Atrial Fibrillation

BACKGROUND AND OBJECTIVES: Chronic atrial fibrillation (AF) causes atrial enlargement and impairs cardiac function. It is known that restoration of sinus rhythm reduces left atrial size and improves left ventricular ejection fraction (EF). However, it's unclear whether the restoration of sinus rhythm is more beneficial than controlling the ventricular rate. This study was designed to compare the effects of two treatment strategies on structural and functional changes of the heart in patients with AF. SUBJECTS AND METHODS: Thirty-seven AF patients who initially cardioverted to sinus rhythm were studied. At 6 months after cardioversion, 17 patients (Group I) maintained normal sinus rhythm (NSR) and 20 (Group II) experienced AF recurrence. Initial and follow-up echocardiography were evaluated in each patient and compared between the two groups. RESULTS: Baseline clinical and echocardiographic findings were similar between the two groups except that the left atrial length was longer in Group II than in Group I. Compared to baseline, left atrial dimension (LAD) and left ventricular mass index (LVMI) measured by M-mode were significantly reduced in group I at follow-up (p<0.05); however, these changes were not observed in group II. The reduction of LAD and LVMI was observed only in patients with less than 50% EF and/or dilated left atrium at baseline (p<0.05). CONCLUSION: In patients with AF, maintenance of NSR after cardioversion significantly reduces LAD and LVMI, especially in cases of left ventricular dysfunction or dilated left atrium. Even after adjustment of baseline LAD, LVMI and EF, maintenance of NSR remains the independent factor that reduces LAD at follow-up (p=0.001).

The Relationship between Serum Adiponectin, Essential Hypertension, LV Mass Index, and LV Diastolic Function

BACKGROUND AND OBJECTIVES: Adiponectin is known for its anti-inflammatory and anti-atherogenic effects. The purpose of this study is to characterize the relationships among serum adiponectin, essential hypertension (EH), left ventricular mass index (LVMI), and LV diastolic function. SUBJECTS AND METHODS: Serum adiponectin by RIA and body mass index were measured in 275 patients (M: F=137: 138). We calculated LVMI, E/A ratio, deceleration time (DT), and isovolumetric relaxation time (IVRT) by using echocardiograms. RESULTS: The serum adiponectin level of the hypertensive group was significantly lower than that of the non-hypertensive group (9.9+/-9.8 ug/mL vs. 12.9+/-9.5 ug/mL, p<0.05). Plasma adiponectin was negatively correlated with LVMI (r=-0.329, p<0.001), BMI (r=-0.290, p<0.001), and IVRT (r=-0.485, p<0.05), but was positively correlated with E/A (r=+0.359, p<0.001). CONCLUSION: These results suggest that a decrease in serum adiponectin is associated with an increase in blood pressure and BMI, progress of LVH, and decrease in LV diastolic function.

A Case of Coronary Arteriovenous Fistula from Diagonal Branch of Left Anterior Descending Coronary Artery to Left Ventricle

Most coronary arteriovenous fistula (CAVF) drain into the pulmonary artery or the right heart chamber. CAVF between the left coronary artery and left ventricle is very uncommon. Moreover, a case of CAVF from a diagonal branch of the LAD to the LV has not been reported so far. We report a case of a 79-year-old man, complaining of intermittent chest pain and dyspnea on exertion for apprioximately 2 months. CAVF from the diagonal branch of the LAD to the LV was confirmed by selective coronary angiography.

Vessel Size and Long-Term Clinical and Angiographic Outcome after Primary Stenting in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The role of coronary stenting in the treatment of patients with small vessels ( or =3.0 mm. The primary end points were the major adverse cardiac events including death, recurrent myocardial infarction, or target vessel revascularization at follow-up. The incidence of angiographic restenosis (> or = 50% of diameter stenosis) was assessed as a secondary end point. Event-free survival in the small vessel group (less than 3mm of reference vessel diameter) was 62.5% at 23.7+/-13.0 months and 76% in the large vessel group (p<0.001) at 23.5+/-12.0 months. The follow-up angiographic restenosis rate was significantly higher in the small vessel group (61% vs. 32% in the small and large vessel groups, respectively, p=026). CONCLUSION: Acute myocardial infarction patients with small vessels present a higher risk for an adverse outcome following primary stenting.

Vascular Remodeling by a Guidewire Insertion in the Normal Rabbit Iliac Artery

BACHGROUND AND OBJECTIVE: The behavior of vascular remodeling is not exactly known to occur in the normal vessel, athough adaptive and pathologic remodeling occurs in atherosclerosis. We examined the behavior of vascular remodeling with an abrupt reduction of luminal area by indwelling a guidewire within an iliac artery in a normal rabbit. MATERIALS AND METHODS: New Zealand white rabbits (n=17, body weight =3.2+/-0.2kg) were dissected to expose the left femoral artery and indwelling a guidewire(diameter=0.035") was inserted toward the aorta in order to induce the acute irreversible luminal thrombus within the left iliac artery. Four weeks later, the manipulated iliac arteries were harvested. RESULTS: All iliac arteries were patent. There were three patterns of vascular remodeling in microscopic examination. In the first group(n=8), a simple concentric luminal dilatation with centrally organized thrombus was shown. The arterial wall showed increased wall thickness and a number of medial smooth muscle cell(SMC). The second group(n=8) showed luminal thrombus with neointimal hyperplasia, which consisted of migration and proliferation of medial SMC, and regression of the original medial layer. Vascular lumen was markedly enlarged. It appeared as wide lumen with extrusion of the guidewire toward outside of the new lumen and a transition from an old medial smooth muscle layer which had the original SMC in structure to a new layer consisting of linear SMC proliferation in intimal hyperplasia. Finally, sinusoidal plexus formation was seen within a thrombus in only one case. This sinusoidal vascular structure contained SMC with an extracellular matrix. CONCLUSION: We observe the pluripotent capability of vascular remodeling following acute luminal loss by a guidewire insertion in the normal rabbit iliac artery.

Safety and cost-effectiveness of early discharge after primary coronary stenting in acute myocardial infarction / 대한내과학회지

BACKGROUND: Primary coronary stenting results in reduced rates of reinfarction, recurrent ischemia, stroke and in-hospital mortality and may allow earlier hospital discharge compared with primary angioplasty for acute myocardial infarction(AMI). This study evaluated the hypothesis that primary coronary stenting, with subsequent discharge within 4 days after admission, is safe and cost-effective in low risk patients for AMI, prospectively. METHODS: The study group consisted of low risk patients after susccessful primary stenting with conventional transfemoral intervention for AMI. Low risk status required be met all the following criteria : age or =5 days), N=16}. Their demographic and angiographic characteristics, the rate of major adverse cardiac events, ejection fraction during 3 months, and total medical costs were analyzed. RESULTS: The 25 patients(61%) were discharged on day 3 or 4. The peak level of CK-MB were not significantly lower in early discharge group than conventional discharge group(ED/CD;112.4+/-67.3/153.3+/-76.9 U/L, p=0.089). Comparing to conventional discharge group, in-hospital costs were significantly lower in patients of early dicharge group(ED/CD;7,109,118+/-1,068,861/8,766,336+/-1,688,707, p=0.001). Major adverse cardiac events were similar in both group(ED/CD;16/25%, p=0.329). CONCLUSION: Early identificaton of low risk patients after successful primary stenting by transfemoral intervention for AMI allowed safe omission of the intensive care phase and noninvasive testing, and early hospital discharge, resulting in substantial costs savings.