The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience

Background and Objectives@#Although the shortage of donor is a common problem worldwide, a significant portion of unutilized hearts are classified as marginal donor (MD) hearts. However, research on the correlation between the MD and the prognosis of heart transplantation (HTx) is lacking. This study was conducted to investigate the clinical impact of MD in HTx. @*Methods@#Consecutive 73 HTxs during 2014 and 2021 in a tertiary hospital were analyzed.MD was defined as follows; a donor age >55 years, left ventricular ejection fraction 240 minutes, or significant cardiac structural problems. Preoperative characteristics and postoperative hemodynamic data, primary graft dysfunction (PGD), and the survival rate were analyzed. Risk stratification by Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was performed to examine the outcomes according to the recipient state. Each group was sub-divided into 2 risk groups according to the IMPACT score (low <10 vs. high ≥10). @*Results@#A total of 32 (43.8%) patients received an organ from MDs. Extracorporeal membrane oxygenation was more frequent in the non-MD group (34.4% vs. 70.7, p=0.007) There was no significant difference in PGD, 30-day mortality and long-term survival between groups. In the subgroup analysis, early outcomes did not differ between low- and high-risk groups. However, the long-term survival was better in the low-risk group (p=0.01). @*Conclusions@#The outcomes of MD group were not significantly different from non-MD group. Particularly, in low-risk recipient, the MD group showed excellent early and longterm outcomes. These results suggest the usability of selected MD hearts without increasing adverse events.

Prevalence and Characteristics of Atrial Tachycardia From Noncoronary Aortic Cusp During Atrial Fibrillation Catheter Ablation

Background and Objectives@#Atrial tachycardias (ATs) from noncoronary aortic cusp (NCC) uncovered after radiofrequency ablation for atrial fibrillation (AF) are rarely reported. This study was conducted to investigate the prevalence and clinical characteristics of NCC ATs detected during AF ablation and compare their characteristics with de novo NCC ATs without AF. @*Methods@#Consecutive patients who underwent radiofrequency catheter ablation for AF were reviewed from the multicenter AF ablation registry of 11 tertiary hospitals. The clinical and electrophysiological characteristics of NCC AT newly detected during AF ablation were compared with its comparators (de novo NCC AT ablation cases without AF). @*Results@#Among 10,178 AF cases, including 1,301 redo ablation cases, 8 (0.08%) NCC AT cases were discovered after pulmonary vein isolation (PVI; 0.07% in first ablation and 0.15% in redo ablation cases). All ATs were reproducibly inducible spontaneously or with programmed atrial stimulation without isoproterenol infusion. The P-wave morphological features of tachycardia were variable depending on the case, and most cases exhibited 1:1 atrioventricular conduction. AF recurrence rate after PVI and NCC AT successful ablation was 12.5% (1 of 8). Tachycardia cycle length was shorter than that of 17 de novo ATs from NCC (303 versus 378, p=0.012). No AV block occurred during and after successful AT ablation. @*Conclusions@#Uncommon NCC ATs (0.08% in AF ablation cases) uncovered after PVI, showing different characteristics compared to de-novo NCC ATs, should be suspected irrespective of P-wave morphologies when AT shows broad propagation from the anterior interatrial septum.

Sodium/glucose Co-Transporter 2 Inhibitor, Empagliflozin, Alleviated Transient Expression of SGLT2 after Myocardial Infarction

Background and Objectives@#Large clinical studies of sodium/glucose cotransporter 2 (SGLT2) inhibitors have shown a significant beneficial effect on heart failure-associated hospitalization and cardiovascular events. As SGLT2 is known to be absent in heart cells, improved cardiovascular outcomes are thought to be accounted for by the indirect effects of the drug. We sought to confirm whether such benefits were mediated through SGLT2 expressed in the heart using myocardial infarction (MI) model. @*Methods@#Mice pre-treated with empagliflozin (EMPA), an SGLT2 inhibitor, showed a significantly reduced infarct size compared with the vehicle group three days post-MI.Interestingly, we confirmed SGLT2 localized in the infarct zone. The sequential changes of SGLT2 expression after MI were also evaluated. @*Results@#One day after MI, SGLT2 transiently appeared in the ischemic areas in the vehicle group and increased until 72 hours. The appearance of SGLT2 was delayed and less in amount compared with the vehicle group. Additionally, there was a significant difference in metabolites, including glucose and amino acids in the 1 H nuclear magnetic resonance analysis between groups. @*Conclusions@#Our work demonstrates that SGLT2 is transiently expressed in heart tissue early after MI and EMPA may directly operate on SGLT2 to facilitate metabolic substrates shifts.

Sodium/glucose Co-Transporter 2 Inhibitor, Empagliflozin, Alleviated Transient Expression of SGLT2 after Myocardial Infarction

Background and Objectives@#Large clinical studies of sodium/glucose cotransporter 2 (SGLT2) inhibitors have shown a significant beneficial effect on heart failure-associated hospitalization and cardiovascular events. As SGLT2 is known to be absent in heart cells, improved cardiovascular outcomes are thought to be accounted for by the indirect effects of the drug. We sought to confirm whether such benefits were mediated through SGLT2 expressed in the heart using myocardial infarction (MI) model. @*Methods@#Mice pre-treated with empagliflozin (EMPA), an SGLT2 inhibitor, showed a significantly reduced infarct size compared with the vehicle group three days post-MI.Interestingly, we confirmed SGLT2 localized in the infarct zone. The sequential changes of SGLT2 expression after MI were also evaluated. @*Results@#One day after MI, SGLT2 transiently appeared in the ischemic areas in the vehicle group and increased until 72 hours. The appearance of SGLT2 was delayed and less in amount compared with the vehicle group. Additionally, there was a significant difference in metabolites, including glucose and amino acids in the 1 H nuclear magnetic resonance analysis between groups. @*Conclusions@#Our work demonstrates that SGLT2 is transiently expressed in heart tissue early after MI and EMPA may directly operate on SGLT2 to facilitate metabolic substrates shifts.

Long-term Clinical Outcomes of Radiofrequency Catheter Ablation versus Permanent Pacemaker Implantation in Patients with Tachycardia-Bradycardia Syndrome

Background and Objectives@#Pacemaker (PM) implantation is a well-accepted treatment option for patients with paroxysmal atrial fibrillation (AF) and related tachycardiabradycardia syndrome (TBS). Data on the long-term clinical outcomes after radiofrequency catheter ablation (RFCA) or PM implantation are sparse. @*Methods@#The medical records of 217 patients with TBS were retrospectively assessed.Outcomes in patients who underwent RFCA (n=108, 49.8%) were compared to those with PM implantation (n=109, 50.2%). The clinical outcomes were sinus rhythm maintenance, conversion to persistent AF, additional procedure or crossover, and the composite of cardiovascular hospitalization and death. @*Results@#During the follow-up period (mean 3.5±2.0 years), the RFCA group, compared to the PM group, showed better sinus rhythm maintenance (adjusted hazard ratio [aHR], 0.27;95% confidence interval [CI], 0.15–0.46; p=0.002) and less progression to persistent AF (aHR, 0.20; 95% CI, 0.06–0.63; p=0.006). Additional procedure or crossover did not differ significantly between the groups (aHR, 2.07; 95% CI, 0.71–6.06; p=0.185 and aHR, 0.69; 95% CI, 10.8–2.67; p=0.590, respectively). Most RFCA patients (92.6%) did not require pacemaker implantation during long term follow-up period (>3.5 years). The composite endpoint of cardiovascular rehospitalization and death was not significantly different between the groups (aHR, 0.92; 95% CI, 0.50–1.66; p=0.769).Background and Objectives: Pacemaker (PM) implantation is a well-accepted treatment option for patients with paroxysmal atrial fibrillation (AF) and related tachycardiabradycardia syndrome (TBS). Data on the long-term clinical outcomes after radiofrequency catheter ablation (RFCA) or PM implantation are sparse. @*Methods@#The medical records of 217 patients with TBS were retrospectively assessed.Outcomes in patients who underwent RFCA (n=108, 49.8%) were compared to those with PM implantation (n=109, 50.2%). The clinical outcomes were sinus rhythm maintenance, conversion to persistent AF, additional procedure or crossover, and the composite of cardiovascular hospitalization and death. @*Results@#During the follow-up period (mean 3.5±2.0 years), the RFCA group, compared to the PM group, showed better sinus rhythm maintenance (adjusted hazard ratio [aHR], 0.27;95% confidence interval [CI], 0.15–0.46; p=0.002) and less progression to persistent AF (aHR, 0.20; 95% CI, 0.06–0.63; p=0.006). Additional procedure or crossover did not differ significantly between the groups (aHR, 2.07; 95% CI, 0.71–6.06; p=0.185 and aHR, 0.69; 95% CI, 10.8–2.67; p=0.590, respectively). Most RFCA patients (92.6%) did not require pacemaker implantation during long term follow-up period (>3.5 years). The composite endpoint of cardiovascular rehospitalization and death was not significantly different between the groups (aHR, 0.92; 95% CI, 0.50–1.66; p=0.769). @*Conclusions@#RFCA is an effective alternative to PM implantation in patients with TBS.In these patients, successful RF ablation of AF is related to a higher rate of sinus rhythm maintenance compared to PM implantation, and the composite outcome of cardiovascular rehospitalization and death is similar.

Erratum: Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients

In the article, the 9th author's name was misspelled.

Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients

BACKGROUND AND OBJECTIVES: Right heart catheterization is traditionally performed using a femoral vein approach that involves admission, bed rest, and risks of bleeding and hematoma. Recent studies have confirmed safety of the use of forearm vein for right cardiac catheterization. In the present study, we evaluated the feasibility of right cardiac catheterization via the antecubital fossa vein in Korean patients. SUBJECTS AND METHODS: The medical records of all patients who underwent right heart catheterization at our hospital between January 2003 and December 2014 were reviewed retrospectively. Right cardiac catheterizations via the antecubital fossa vein and the femoral vein were compared in terms of demographic data (age, sex, weight, height, and body mass index), indications for right cardiac catheterization, and procedural and outcome data (initial success rate, procedure time, compression to ambulation time, and complications). RESULTS: We reviewed 132 cases (antecubital fossa vein approach, n=37; femoral vein approach, n=95). The demographic data, initial success rate (100% vs. 100%) and procedure time (21.6±16.8 min vs. 25.6±12.6 min, p=0.14) were similar in both groups. The antecubital fossa vein group had a shorter mean compression to ambulation time than the femoral vein group (0.0 min vs. 201.2±48.1 min, p<0.01). No complications were observed in either group. CONCLUSION: Our study indicated the ease of performance of right cardiac catheterization via the antecubital fossa vein. Thus, the antecubital fossa vein can be an alternative access site for right cardiac catheterization in Korean patients.

Extraction of a Fully Deployed Coronary Stent during Retrieval of Another Dislodged Stent

Coronary stent dislodgement is a rare and serious complication of percutaneous coronary intervention and is associated with major adverse cardiac events. Successful retrieval of the stent is recommended in this situation because it is important for the prognosis. Recently, a patient was referred to our hospital with a dislodged coronary stent. When attempting to percutaneously extract the dislodged stent, a challenging situation was encountered, as the stent was entrapped and tightly entangled with another fully deployed coronary stent. Extraction of a fully deployed stent is generally prohibited as it may result in severe complications. Nevertheless, we extracted both the dislodged stent and the fully deployed stent, as a last resort. Herein, we report about this case. Our case highlights if the operator had a thorough understanding of the surrounding circumstances regarding the fully deployed coronary stent, successful extraction of the fully deployed coronary stent without any complications could be possible.

Rapidly Growing Right Ventricular Outflow Tract Mass in Patient with Sarcomatoid Renal Cell Carcinoma

Cardiac metastasis from renal cell carcinoma (RCC) without inferior vena cava (IVC) involvements is extremely rare with few reported cases. Sarcomatoid RCC with rhabdoid feature is a rare pathologic type of RCC having aggressive behavior due to great metastatic potential. Here, we report a case of rapidly growing cardiac metastasis of RCC which brought on right ventricular outflow tract (RVOT) obstruction without IVC and right atrial involvement in a 61-year-old woman. Cardiac arrest occurred during radical nephrectomy and echocardiography revealed mass nearly obstructing the RVOT which was not recognized by preoperative echocardiography 1 month ago. Postoperative immunohistochemical evaluation of renal mass revealed sarcomatoid RCC with rhabdoid feature.

Radiation Exposure in Coronary Angiography: A Comparison of Cineangiography and Fluorography

BACKGROUND AND OBJECTIVES: Coronary angiography (CAG) is the gold standard for diagnosing coronary artery disease. However, exposure to ionizing radiation delivered during CAG has various negative biological effects on humans. In this study, there was an evaluation of whether fluorography resulted in decreased radiation exposure, as compared with cineangiography. SUBJECTS AND METHODS: Fifty-five patients were prospectively enrolled and divided into two CAG groups, in accordance with the operator's professional discretion: a conventional cineangiography group versus a fluorography group. Fluorography refers to the photography of fluoroscopic images that are retrospectively stored, e.g., using the "Store fluoro" function of the Siemens cardiac angiography system. The primary outcomes included the air kinetic energy released per unit mass {air kerma (AK) mGy} and the dose (kerma)-area product (DAP; microGy . m2), both measured using built-in software in the Siemens system. The secondary outcomes included the total procedure time and amount of contrast agent used with each CAG method. RESULTS: The total AK and DAP were significantly lower in the fluorography group (159.3+/-64.9 mGy and 1337.9+/-629.6 microGy . m2, respectively) than in the cineangiography group (326.9+/-107.5 mGy and 2341.1+/-849.9 microGy . m2, respectively; p=0.000 for both). The total procedure time (cineangiography vs. fluorography, 12.8+/-4.7 vs. 12.5+/-2.9 min; p=0.779) and contrast agent amount (136.1+/-28.3 vs. 126.3+/-25.7, p=0.214) were comparable between the two groups. CONCLUSION: Fluorography is a useful method to decrease the radiation exposure in selected patients requiring CAG.

Changes in Carotid Intima-media Thickness and Left Ventricular Mass by Control of Blood Pressure and Hyperlipidemia in Hypertensive Patients

BACKGROUND: Hypertensive patients often present with carotid atherosclerosis, and especially those with left ventricular hypertrophy (LVH) are known to have twice the prevalence of carotid atheroma. The aims of this study were to evaluate the changes in the severity of carotid atherosclerosis and left ventricular (LV) mass by control of blood pressure (BP) and hyperlipidemia in hypertensive patients. METHODS: A total of 87 treated hypertensive patients who had been diagnosed as stage 2 hypertension on Joint National Committee 7 classification in past 1 year or LVH on electrocardiographic criteria were enrolled. Both at baseline and the end of study, repetitive measurements of carotid intima-media thickness (IMT) and LV mass indexed by body surface area were performed. Measurement of carotid IMT was conducted at bilateral sides of distal common carotid artery. RESULTS: After the follow-up period of mean 16-months, there were significant lowering in systolic and diastolic BP, respectively (144.6 +/- 19.2 to 131.3 +/- 13.6 mm Hg, p < 0.001; 87.5 +/- 11.3 to 79.6 +/- 9.4 mm Hg, p < 0.001). Carotid IMT showed no significant change (0.75 +/- 0.18 to 0.76 +/- 0.18 mm, p = 0.310). Although there was significant reduction in LV mass index (107.9 +/- 22.0 to 101.0 +/- 18.4 g/m2, p < 0.001), it was not correlated with the changes in carotid IMT (r = 0.141, p = 0.197). CONCLUSIONS: Anti-hypertensive therapy combined with statin if indicated did not show significant reduction in atherosclerotic burden of carotid artery, but it seemed to prevent further progression in hypertensive patients. Decrement in LV mass achieved by BP control was not correlated with changes in carotid IMT.

Procedure-Induced Acute Common Carotid Artery Perforation Presenting With Airway Obstruction and Successful Treatment by Endovascular Stent Graft

A 63-year-old female was admitted to our hospital for catheter ablation during atrial fibrillation. After catheter ablation, the patient was transferred to the cardiac care unit and mechanically ventilated due to dyspnea and hypotension. Imaging showed active bleeding from the right common carotid artery (CCA) with extensive hematoma into the mediastinum. She was successfully treated with a stent graft at the CCA. Further bleeding or neurologic sequel did not occur after treatment.

The Effect of Intra-coronary Nicorandil Prior to Reperfusion in Acute ST Segment Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: Intravenous nicorandil infusion with percutaneous coronary intervention (PCI) has been reported to reduce reperfusion injury events and to improve cardiac function in patients with an acute myocardial infarction. However, there is limited information on the use of intra-coronary nicorandil. A prospective randomized single center study was designed to evaluate the efficacy of the use of intra-coronary nicorandil. SUBJECTS AND METHODS: Seventy-three patients with an acute ST segment elevation myocardial infarction were randomly assigned to the nicorandil group (n=37) or a control group (n=36); all patients received a PCI. In the nicorandil group of patients, 4 mg of intra-coronary nicorandil was infused directly into the infarct area prior to reperfusion (2 mg before ballooning, 2 mg before stenting). The composite endpoint was the incidence of ventricular arrhythmia, no-reflow and slow flow. We estimated the post thrombolysis in myocardial infarction (TIMI) grade, the myocardial perfusion grade after PCI and the short-term clinical outcome. RESULTS: The baseline characteristics were similar in both groups of patients. A significant difference was observed in the composite endpoint in the nicorandil group of patients as compared to the control group of patients (p=0.037). The achievement rate of post TIMI grade 3 was significantly higher in the nicorandil group of patients (p=0.019). The myocardial perfusion grade 1 was not observed in the nicorandil group of patients; however, it was observed in five patients in the control group (p=0.019). Major adverse cardiac events in hospital and in 30 days were similar between the two groups. CONCLUSION: Intra-coronary nicorandil infusion reduced the occurrence of no-reflow, slow reflow, reperfusion arrhythmia and improved the myocardial perfusion grade and TIMI flow during PCI. The results of this study showed that the use of intracoronary nicorandil improved the clinical outcome in patients with an acute myocardial infarction.

A Case of Late Recurrent Vasospasm After Sirolimus-Eluting Stent Implantation

A 67-year-old male with stable angina was admitted to our cardiovascular center. He had neither any history of smoking, diabetes mellitus, hypertension, cerebrovascular accident nor family history of coronary artery disease. Coronary angiography showed a 90% tubular eccentric luminal narrowing at the mid left anterior descending artery (m-LAD). A sirolimus-eluting stent (SES) was implanted in the m-LAD. Coronary angiography performed after 9 months did not reveal restenosis or recurrent coronary artery disease. However, the patient returned to the emergency room with severe chest pain after 17 months. Coronary angiography showed severe diffuse vasospasm distal to the m-LAD stent site. After 20 days, vasospastic myocardial infarction developed. A zotarolimus-eluting stent with a phosphorylcholine polymer was implanted distal to the m-LAD stent. The zotarolimus-eluting stent was used because the polymer in the SES or sirolimus was considered a possible cause for the recurrent vasospasm. The patient had no further chest pain during the 9 months after zotarolimus-eluting stent implantation. We suspect that the polymer in the SES or sirolimus might have caused endothelial dysfunction and provoked the late vasospasm. Here, we describe this case of late recurrent vasospasm after SES implantation.

Metabolic Syndrome and Risk of In-Stent Restenosis: Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Patients with metabolic syndrome (MS) have an increased risk of cardiovascular events. However, only limited studies are available on the effect of MS on restenosis and on the clinical outcome of patients undergoing percutaneous coronary intervention (PCI). The aim of this study is to assess the role of MS in the development of restenosis, and risk of a 6-month major adverse cardiac event (MACE) and a 12-month MACE, as well as the difference of outcome between the use of bare metal stents (BMSs) and the use of drug eluting stents (DESs). SUBJECTS AND METHODS: This is a one center, retrospective study. The study population comprised 151 patients undergoing percutaneous coronary intervention (PCI) with BMSs and 200 patients undergoing PCI with DESs. The study population was classified into two groups of patients with MS and patients without MS. RESULTS: The baseline clinical characteristics were similar in the two groups (with or without MS) except for hypertension, diabetes, body mass index, triglyceride level and high-density lipoprotein level. The frequency of in-stent restenosis of the patients that were implanted with BMSs or DESs was not different between two groups, based on a 6 month follow-up quantitative coronary angiographic analysis (BMSs: 30% vs 22.2%, p= 0.352; DES: 3.3% vs 2.2%, p=0.76; for patients with and without MS, respectively). The percent of patients with a 6-month MACE for patients implanted with BMSs was not statistically different for patients with or without MS (30% vs 22.2%, p=0.352) but the percent of patients with a 12-month MACE showed a statistically significant higher level for the MS group (38.6% vs 23.5%, p=0.044). The percent of patients with a 6-month MACE for patients implanted with DESs was also not statistically different between two groups (5.8% vs 1.7%, p= 0.123). CONCLUSION: Patients with MS undergoing BMSs or DESs implantation do not show higher levels of in-stent restenosis and levels of a 6-month MACE. The number of 12-month MACEs of patients implanted with BMSs is statistically higher, but the number of 6-month MACEs of patients implanted with DESs is not different for the MS group. We conclude that MS is not risk factor of in-stent restenosis in PCI but MS may influence the long-term clinical outcome in patients undergoing PCI.

Experience of Rituximab Treatment in Two Patients with Severe Systemic Lupus Erythematosus / 대한류마티스학회지

Rituximab is a chimeric monoclonal antibody for human B lymphocyte subset CD20 and has recently been used for treatment of autoimmune disease such as rheumatoid arthritis and systemic lupus erythematosus (SLE). We report the experiences of rituximab treatment in two patients with severe SLE. The first case is 16-year-old female patient with hemolytic anemia, thrombocytopenia and acute renal failure due to aggravation of lupus nephritis, and the second case is 30-year-old female pregnant patient with diffuse alveolar hemorrhage after preterm premature rupture of fetal membranes. All two patients responded to rituximab and maintained symptom free state.

A Case of Endoscopic Management of Dieulafoy's Lesion in the Ampulla of Vater / 대한소화기내시경학회지

Dieulafoy's lesion is an uncommon but important cause of massive upper gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction but extragastric locations of Dieulafoy's lesion are rare. In this study, diagnosis of Dieulafoy's lesion was frequently made by endoscopy instead of surgery. Hemostasis was achieved by endoscopic treatment in more than 90% of patients. We report the successful application of endoscopic hemoclipping for treatment of active bleeding from Dieulafoy's lesion in the ampulla of Vater of the duodenum.

The Safety of Tirofiban Therapy in Patients with Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Recent randomized studies have shown a significant reduction in the rate of recurrent cardiac events with adjunctive pharmacotherapy, using Glycoprotein IIb/IIIa inhibitors (GPI), in patients undergoing percutaneous coronary intervention (PCI) procedures. However, in Korea, there is a paucity of data concerning complications of tirofiban therapy in patients with acute coronary syndrome (ACS). Therefore, this study was performed to evaluate the safety of tirofiban therapy. SUBJECTS AND METHODS: ACS patients who underwent tirofiban administration between May 2002 and October 2003 were reviewed. The rates of bleeding, transfusion, and thrombocytopenia were analyzed, and the rates of complications by ages, gender and PCI compared with medical treatment, renal function and vascular access route. RESULTS: A total of 261 ACS patients (male/female=150/111) underwent tirofiban therapy. The mean ages of the subjects was 64.5 years, the rates of minor bleeding, major bleeding, transfusion and thrombocytopenia were 8.1% (n=21), 2.3% (n=6), 4.6% (n=12) and 1.2% (n=3), respectively. Minor bleeding occurred at similar rates in both sexes (8 vs. 8.1%) and to a greater extent in old age (> or =65) (12.5 vs. 2.6%, p=0.093), but major bleeding occurred to a greater extent in females and old age (5.4 vs. 0% and 4.2 vs. 0%, p=0.25 and 0.093, respectively). The rates of thrombocytopenia and transfusion were greater in old age (2.1 vs. 0% and 8.3 vs. 0%, p=0.052 and 0.087, respectively). In-hospital days were greater in old age (14.7+/-9.5 vs. 11.9+/-4.4 days, p=0.065). The rates of complications were similar in both groups when compared by PCI or medical treatment and vascular access route. The serum creatinine was 3.3 mg/dL in those with major bleeding, which was higher than in the other groups (p=0.000). CONCLUSION: The tirofiban therapy in patients with ACS did not induce an increase in the bleeding rates, in-hospital days and it was safe and well tolerated in old age.

Incidence of and Risk Factors for Bundle Branch Block in Adults older than 40 years

BACKGROUND: In the general population, the incidence of bundle branch block (BBB) is relatively low, and its effects on long-term prognosis have not been established. Previous studies on the incidence and correlation of BBB to clinical factors have produced conflicting results. However, the incidence of BBB was strongly related to age. This study aimed to describe the incidence of and risk factors for BBB in Korea. METHODS: In this study, 14, 540 adults (male 6, 573/female 7, 967) > or=40 years old received screening tests for general health between April and December 2000. Participants answered questionnaires and underwent examinations, which included blood pressure, electrocardiogram (ECG), total cholesterol and fasting glucose. The data analysis was performed using SPSS 10.0 for windows. RESULTS: The incidences of complete right bundle branch block (CRBBB) were 1.5 and 2.9% in people older than 40 and 65 years, respectively. Approximately 38.0% of individuals with CRBBB were older than 65 years. The incidence of CRBBB was higher in men than women at all age groups was highest in those aged 75-79 years. Males, advancing age (> or=65 years), hypertension and diabetes mellitus (DM) were associated with an increased risk of CRBBB. The incidences of complete left bundle branch block (LBBB) and bifascicular bundle branch block (BBBB) were 0.1 and 0.08% and 0.3 and 0.2% in those older than 40 and 65 years, respectively. Approximately 71.4 and 58.3% of individuals with LBBB and BBBB, respectively, were older than 65 years. Advancing age and cardiac disease were associated with an increased risk of LBBB. Advancing age was associated with an increased risk of BBBB. The most potent risk factor for BBB in this study was advancing age. CONCLUSION: The incidences of BBB were 1.7 and 3.4% in those older than 40 and 65 years respectively. Bundle branch block correlates strongly with age, and is common in the older ages groups. These findings support the theory that bundle branch block is a marker of slowly progressing degenerative diseases.