Efficacy and safety of cilostazol-based triple antiplatelet therapy compared with clopidogrel-based dual antiplatelet therapy in patients with acute ST-elevation myocardial infarction undergoing percutaneous coronary intervention: A multicenter, randomized, open-label, phase 4 trial.

BACKGROUND: Previous studies reported that compared to conventional dual antiplatelet therapy (DAT; aspirin + clopidogrel), triple antiplatelet therapy (TAT), involving the addition of cilostazol to DAT, had better clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). However, the optimal duration of TAT is yet to be determined. METHODS: In total, 985 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) were prospectively enrolled in 15 PCI centers in South Korea and China. We randomly assigned patients into 3 groups: DAT (aspirin and clopidogrel for 12 months), TAT 1M (aspirin, clopidogrel, and cilostazol for 1 month), and TAT 6M (aspirin, clopidogrel, and cilostazol for 6 months). The primary endpoint was 1-year major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, recurrent myocardial infarction, stroke, or repeat revascularization. RESULTS: The primary endpoint did not differ among the 3 groups (8.8% in DAT, 11.0% in TAT 1M, and 11.6% in TAT 6M; hazard ratio for TAT 1M vs DAT, 1.302; 95% confidence interval [CI], 0.792-2.141; P = .297; hazard ratio for TAT 6M vs DAT, 1.358; 95% CI, 0.829-2.225; P = .225). With respect to in-hospital outcomes, more bleeding events occurred in the TAT group than in the DAT group (1.3% vs 4.7% vs 2.6%, P = .029), with no significant differences in major bleeding events. Additionally, the TAT group had a higher incidence of headaches (0% vs 1.6% vs 2.6%, P = .020). CONCLUSIONS: The addition of cilostazol to DAT did not reduce the incidence of 1-year MACEs compared with DAT alone. Instead, it may be associated with an increased risk of drug intolerance and side effects, including in-hospital bleeding and headaches.

Immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: results from a prematurely discontinued randomized multicenter trial.

BACKGROUND: We aimed to compare clinical outcomes between immediate and staged complete revascularization in primary percutaneous coronary intervention (PCI) for treating ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD). METHODS: A total of 248 patients were enrolled in a prospective, randomized, and multicenter registry. Immediate revascularization was defined as one-time PCI of culprit and non-culprit lesions at the initial procedure. Staged revascularization was defined as PCI of non-culprit lesions at a later date (mean, 4.4 days; interquartile range, 1-11.4), following initial culprit revascularization. The end points were major adverse cardiovascular events (MACE; composite of total death, recurrent myocardial infarction, and revascularization), any individual components of MACE, cardiac death, stent thrombosis, and stroke at 12 months. RESULTS: During a follow-up of 1 year, MACE occurred in 12 patients (11.6%) in the immediate revascularization group and in 8 patients (7.5%) in staged revascularization group (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.65-3.91). The incidence of total death was numerically higher in the immediate group than in the staged group (9.7% vs 2.8%, HR 3.53, 95% CI 0.97-12.84); There were no significant differences between the 2 groups in risks of any individual component of MACE, cardiac death, stroke, and in-hospital complications, such as need for transfusion, bleeding, acute renal failure, and acute heart failure. This study was prematurely terminated due to halt of production of everolimus-eluting stents (manufactured as PROMUS Element by Boston Scientific, Natick, Massachusetts). CONCLUSIONS: Due to its limited power, no definite conclusion can be drawn regarding complete revascularization strategy from the present study. Further large randomized clinical trials would be warranted to confirm optimal timing of complete revascularization for patients with STEMI and MVD.

Sialocele and Its Association with Hypercortisolism and Long-Term Glucocorticoid Treatment in Dogs: Retrospective Case-Control Study.

Dogs with sialocele often have concurrent hypercortisolism or are receiving long-term glucocorticoid treatment. However, their association has not been investigated. This retrospective matched case-control study investigated the association between hypercortisolism, long-term glucocorticoid treatment, and sialocele in dogs. We retrospectively reviewed the records from 1 January 2018 to 31 December 2022. Records of 19 dogs diagnosed with sialocele were investigated for hypercortisolism and long-term glucocorticoid treatment. Two age- and breed-matched controls for each sialocele dog (38 dogs) were investigated for the same concurrent diseases. Logistic regression analysis was used. The odds of sialocele in dogs with hypercortisolism were 15.56 times those of dogs without hypercortisolism (p = 0.02; 95% CI: 1.54-156.79). The odds of sialocele in dogs with long-term glucocorticoid treatment (median, 8 months; range, 5-13) were 7.78 times those of dogs without long-term glucocorticoid treatment (p = 0.03; 95% CI: 1.23-49.40). No associations were found between age, sex, body weight, and the presence of sialocele. The results indicate that sialocele was significantly associated with hypercortisolism and long-term glucocorticoid treatment in dogs. Therefore, dogs with hypercortisolism or receiving long-term glucocorticoid therapy should be screened for possible sialocele. Additionally, dogs with sialocele should be identified for concurrent hypercortisolism and prolonged glucocorticoid exposure.

Additional postdilatation using noncompliant balloons after everolimus-eluting stent implantation: Results of the PRESS trial.

BACKGROUND: There are limited data on the clinical value of routine postdilatation using noncompliant balloons after contemporary drug-eluting stent implantation. HYPOTHESIS: Additional postdilatation using noncompliant balloons after everolimus-eluting stent implantation could provide better clinical outcomes. METHODS: We randomly assigned 1774 patients with coronary artery disease to undergo additional high-pressure postdilatation using noncompliant balloons and moderate-pressure dilatation using stent balloons after everolimus-eluting stent implantation. The primary endpoint was a composite of death, myocardial infarction (MI), stent thrombosis, and target vessel revascularization (TVR) 2 years after randomization. RESULTS: The study was discontinued early owing to slow enrollment. In total, 810 patients (406 patients in the high pressure group and 404 in the moderate pressure group) were finally enrolled. At 2 years, the primary endpoint occurred in 3.6% of patients in the high pressure group and in 4.4% of those in the moderate pressure group (P = .537). In addition, no significant differences were observed between the two groups in the occurrence of an individual end point of death (0.8% in the high pressure group vs 1.5% in the moderate group, P = .304), MI (0.2% vs 0.5%, P = .554), stent thrombosis (0% vs 0.2%, P = .316), or TVR (2.8% vs 2.6%, P = .880). CONCLUSIONS: The strategy of routine postdilatation using noncompliant balloons after everolimus-eluting stent implantation did not provide incremental clinical benefits.

High coronary calcium score and post-procedural CK-MB are noninvasive predictors of coronary stent restenosis.

PURPOSE: High coronary calcium score (CCS) and post-procedural cardiac enzyme may be related with poor outcomes in patients with coronary stent implantation. METHODS: A total of 1,072 patients (63.2% male, mean age: 61.7±10.3 years) who underwent coronary multi-detect computed tomography at index procedure and follow-up coronary angiography (CAG) after drug-eluting stent (DES) were divided into two groups: those with and without target lesion revascularization (TLR; >50% reduction in luminal stent diameter or angina symptoms on follow-up CAG). The CCSs for predicting stent revascularization were elucidated. RESULTS: There were no significant differences between the two groups with regard to risk factors. The initial CCS was significantly higher in the TLR group (1,102.4±743.7 vs 345.8±51.05, P=0.04). After adjustment of significant factors for TLR, only CCS and post-procedural creatine kinase MB form (CK-MB) elevation were significant predictors of coronary artery TLR. Receiver operation curve revealed that >800 in CCS had 69% in sensitivity and 88% in specificity about predicting the TLR. CONCLUSION: High CCS with post-procedural CK-MB might be the useful predictors for TLR after DES implantation.

Well-Tolerated and Undiscovered Common Atrium until Late Adulthood.

Common atrium is a rare congenital heart disease characterized by complete absence of the interatrial septum, and is commonly accompanied by malformation of the atrioventricular valve. Most patients with common atrium experience symptoms during childhood. Here, we describe a patient with common atrium who experienced his first obvious symptom at 48 years of age.

Electrical and mechanical properties as a processing condition in polyvinylchloride multi walled carbon nanotube composites.

We investigated the electrical conductivity (sigma) and mechanical property of polyvinylchloride/carbon nanotube composites as a function of the CNT content and processing time during a solid-state process of high speed vibration mixing (HSVM) and high energy ball milling (HEBM). Both processes were suggested to avoid high temperatures, solvents, chemical modification of carbon nanotubes. In this study, the percolation threshold (phi(c)) for electrical conduction is about 1 wt% CNT with a sigma value of 0.21 S/m, and the electrical conductivity is higher value than that reported by other researchers from melt mixing process or obtained from the other solid-state processes. We found that the dispersion of CNTs and morphology change from CNT breaking are closely related to sigma. Especially, a large morphology change in the CNTs was occurred at the specific processing time, and a significant decrease in the electrical conductivity of polyvinylchloride/carbon nanotube composite occurred in this condition. A meaningful increase of electrical properties and mechanical property is observed in the sample with about 1-2 wt% CNT contents sintered at 200 degrees C after the milling for 20 min by HEBM process. Our study indicates the proper process condition required to improve sigma of PVC/CNT composites.

Independent determinants for presence and degree of left ventricular systolic dyssynchrony in treatment-naive patients with hypertension.

OBJECTIVE: Prevalence of left ventricular systolic dyssynchrony (LVSD) is over 40% in treatment-naive patients with hypertension and it improves after chronic antihypertensive treatment. These findings might support the hypothesis that blood pressure (BP), BP-derived parameters, central BP, or arterial stiffness would contribute to LVSD. Therefore, we aimed to investigate possible factors associated with LVSD in treatment-naive patients with hypertension. METHODS: The study groups consisted of 266 treatment-naive hypertensive patients who underwent anthropometric, clinical, laboratory, echocardiographic, arterial stiffness, central blood pressure, and 24-h ambulatory blood pressure monitoring evaluations. Echocardiographic measurement was recorded as follows: peak systolic velocity (Sa, subclinical left ventricular systolic function), peak early diastolic and late diastolic velocity at the mitral annulus (Ea and Aa, respectively), mitral E/Ea ratio (subclinical left ventricular diastolic function), standard deviation of time from ECG Q to systolic peak velocity of 12 left ventricular segments (Ts-SD12), and maximal difference between peak systolic velocities of any 2 of the 12 segments (Ts-Max). A Ts-SD12 at least 33 or Ts-Max at least 100 ms was regarded as presence of LVSD. RESULTS: Patients were divided into those without LVSD (group 1, n = 151, 56.8%) and those with LVSD (group 2, n = 115, 43.2%). Group 2 had higher E/Ea and high-density lipoprotein and lower Sa and triglyceride than group 1. On multivariate analysis, Sa was independently and inversely associated with the presence of LVSD [odds ratio (OR) 0.67, 95% confidence interval (CI) 0.48-0.93, P = 0.018]. The linear relationship between variables and degree of LVSD showed that serum potassium levels, E/Ea, and Sa remained significant after multivariate analysis (potassium, ß = 0.199, P = 0.006; E/Ea, ß = 0.211, P = 0.017; Sa, ß = -0.301, P < 0.001 in Ts-SD12 and potassium, ß=0.187, P = 0.010; E/Ea, ß = 0.234, P = 0.008; Sa, ß = -0.322, P < 0.001 in Ts-Max, respectively). CONCLUSION: Subclinical left ventricular systolic function is independently associated with both the presence and degree of LVSD in treatment-naive hypertensive patients. Subclinical left ventricular diastolic function and serum potassium levels are independently associated with the degree of LVSD. However, arterial stiffness and BP parameters are not determinants.

Three-dimensional heterostructure of metallic nanoparticles and carbon nanotubes as potential nanofiller.

The effect of the dimensionality of metallic nanoparticle-and carbon nanotube-based fillers on the mechanical properties of an acrylonitrile butadiene styrene (ABS) polymer matrix was examined. ABS composite films, reinforced with low dimensional metallic nanoparticles (MNPs, 0-D) and carbon nanotubes (CNTs, 1-D) as nanofillers, were fabricated by a combination of wet phase inversion and hot pressing. The tensile strength and elongation of the ABS composite were increased by 39% and 6%, respectively, by adding a mixture of MNPs and CNTs with a total concentration of 2 wt%. However, the tensile strength and elongation of the ABS composite were found to be significantly increased by 62% and 55%, respectively, upon addition of 3-D heterostructures with a total concentration of 2 wt%. The 3-D heterostructures were composed of multiple CNTs grown radially on the surface of MNP cores, resembling a sea urchin. The mechanical properties of the ABS/3-D heterostructured nanofiller composite films were much improved compared to those of an ABS/mixture of 0-D and 1-D nanofillers composite films at various filler concentrations. This suggests that the 3-D heterostructure of the MNPs and CNTs plays a key role as a strong reinforcing agent in supporting the polymer matrix and simultaneously serves as a discrete force-transfer medium to transfer the loaded tension throughout the polymer matrix.

Safety of dental extractions in coronary drug-eluting stenting patients without stopping multiple antiplatelet agents.

BACKGROUND: The risk of excessive bleeding prompts physicians to stop multiple antiplatelet agents before minor surgery, which puts coronary stenting patients at risk for adverse thrombotic events. HYPOTHESIS: We hypothesized that most dental extractions can be carried out safely without stopping multiple antiplatelet agents. METHODS: All dental extraction patients who had undergone coronary stenting and who were also on oral multiple antiplatelet agents therapy were enrolled. One hundred patients underwent dental procedures without stopping antiplatelet agents. All wounds were sutured and followed up at 24 hours, 1 week, and 1 month after the procedure. There were 2233 patients who had not taken oral antiplatelet agents from a health promotion center and had teeth extracted by the same method. After performing propensity-score matching for the entire population, a total of 100 matched pairs of patients were created. The primary outcome was a composite of excessive intraextraction blood loss, transfusion, and rehospitalization for bleeding, and the secondary outcome was a composite of death, nonfatal myocardial infarction, target lesion revascularization, and stent thrombosis within 1 month after the procedure. RESULTS: There were 2 excessive intraextraction bleeding cases that continued at the extraction site for 4 and 5 hours, respectively, in the coronary stenting patients, and 1 excessive intraextraction bleeding case that continued for 3 hours in the control patients. There were no cases of transfusion, rehospitalization for bleeding, or major cardiovascular events for the 2 propensity-matched groups. CONCLUSIONS: We found that most dental extractions in coronary stenting patients can be carried out safely without stopping multiple antiplatelet agents.

Change of coronary flow velocity during the cold pressor test is related to endothelial markers in subjects with chest pain and a normal coronary angiogram.

BACKGROUND: Several studies demonstrated that endothelial or atherosclerotic biomarkers, including plasma free insulin-like growth factor-I(IGF-I), soluble CD40 ligand (sCD40L), adiponectin, and leptin have an influence on coronary endothelial function. HYPOTHESIS: The aim of the present study was to investigate whether change of coronary flow velocity of the distal left anterior descending artery (LAD) during the cold pressor test (CPT) with transthoracic Doppler echocardiography (TTE) was associated with these biomarkers in subjects with chest pain and a normal coronary angiogram. METHODS: In 190 subjects (mean age, 54±11 years; male:female, 113:77) with chest pain and a normal coronary angiogram, peak diastolic velocity (PDV) of the distal LAD during the CPT with TTE was assessed. Acetylcholine provocation test was performed in 58 subjects (mean age, 51±10 years) who were clinically suspected of vasospasm. CPT%PDV was defined as the percent change in PDV during the CPT. Associations between CPT%PDV and clinical parameters were analyzed. RESULTS: According to multiple regression analysis, CPT%PDV was associated with plasma free IGF-I in the entire study population (ß=0.295, P<0.001 in all subjects; ß=0.341, P=0.001 in males; ß=0.243, P=0.037 in females; ß=0.303, P=0.002 in nonsmokers; and ß=0.256, P=0.047 in smokers), and sCD40L in males (ß=-0.269, P=0.008)and smokers (ß=-0.261, P=0.046). Subjects with vasospasm to intracoronary acetylcholine had lower plasma free IGF-I(6.9±3.3 vs 8.9±3.4, P=0.026) and CPT%PDV (8.8±24.9 vs 52.7±26.0, P<0.001) than the others. Plasma adiponectin and leptin were not associated with CPT%PDV. CONCLUSIONS: Change of coronary flow velocity assessed using the CPT with TTE may be related to endothelial markers, especially plasma free IGF-I.

Association between plaque thickness of the thoracic aorta and recurrence of atrial fibrillation after ablation.

BACKGROUND AND OBJECTIVES: Several predictors of recurrence of atrial fibrillation (AF) after ablation have been identified, including age, type of AF, hypertension, left atrial diameter and impaired left ventricular ejection fraction. The aim of this study was to investigate whether the atherosclerotic plaque thickness of the thoracic aorta is associated with a recurrence of AF after circumferential pulmonary vein ablation (CPVA). SUBJECTS AND METHODS: Among patients with drug-refractory paroxysmal or persistent AF, 105 consecutive (mean age 58±11 years, male : female=76 : 29) patients who underwent transesophageal echocardiography and CPVA were studied. The relationships between the recurrence of AF and variables, including clinical characteristics, plaque thickness of the thoracic aorta, laboratory findings and echocardiographic parameters were evaluated. RESULTS: A univariate analysis showed that the presence of diabetes {hazard ratio (HR)=3.425; 95% confidence interval (CI), 1.422-8.249, p=0.006}, ischemic heart disease (HR=4.549; 95% CI, 1.679-12.322, p=0.003), duration of AF (HR=1.010; 95% CI, 1.001-1.018, p=0.025), type of AF (HR=2.412, 95% CI=1.042-5.584, p=0.040) and aortic plaque thickness with ≥4 mm (HR=9.514; 95% CI, 3.419-26.105, p<0.001) were significantly associated with the recurrence of AF after ablation. In Cox multivariate regression analysis, only the aortic plaque thickness (with ≥4 mm) was an independent predictor of recurrence of AF after ablation (HR=7.250, 95% CI=1.906-27.580, p=0.004). CONCLUSION: Significantly increased aortic plaque thickness can be a predictable marker of recurrence of AF after CPVA.

Uptake of F-18 FDG and ultrasound analysis of carotid plaque.

OBJECTIVES: To elucidate the relation between the echolucent plaque on carotid ultrasound and acute inflammation on F-18 FDG carotid PET/CT. METHODS: Thirty nine patients (M:F ratio = 23:16, mean age = 63 ± 11 years) that underwent coronary angiography and carotid ultrasound were divided into three groups-echolucent plaque (n = 22), calcified (n = 10), and no plaque(n = 7). All the patients underwent F-18 FDG carotid PET/CT. The mean standardized uptake values (SUV), namely target to background ratio (TBR) on 180 minutes delayed F-18 FDG carotid PET/CT images were compared with levels of serum inflammatory markers and lipid profiles, and in terms of the presence of carotid plaque on carotid US. RESULTS: 180 minutes TBR of carotid arterial wall at echolucent plaque, calcified plaque, and no plaque were 1.40 ± 0.05, 1.23 ± 0.03, 1.17 ± 0.03 in both carotid artery. TBR of carotid arterial walls for echolucent plaque were significantly larger than TBR for calcified, and no plaque respectively at the both side of carotid artery (P < .05). Serum HDL levels were found to be inversely correlated with F-18 FDG uptake at both carotid arteries (r = -0.43, P = .005) on 180 minutes delayed phase images. Also serum hs-CRP levels were found to be correlated with F-18 FDG TBR values of right carotid arteries (r = 0.41, P = .04). CONCLUSIONS: Our results show that F-18 FDG carotid PET/CT can depict metabolically active atherosclerotic plaques, and suggest that F-18 FDG carotid PET/CT can be used as a noninvasive imaging modality for functional evaluation of atherosclerosis.

Valsalva maneuver to predict dynamic intraventricular obstruction during dobutamine stress echocardiography in patients with hypertension.

BACKGROUND: We were to evaluate the effect of Valsalva maneuver with comparison to preload reduction by nitroglycerin (NTG) to predict intraventricular obstruction (IVO) during dobutamine stress echocardiography (DSE) in patients with hypertension. METHODS: A total of 38 hypertensive patients (mean age 66.0±9.9 years; 32% male) were prospectively enrolled. The patients with positive exercise electrocardiography, transmural infarction, significant valvular heart disease, atrial fibrillation, beta-blocker therapy, and induced ischemia during DSE were excluded. The development of an IVO during DSE was defined as a late-peaking intraventricular pressure gradient (IVPG) >30 mmHg. RESULTS: The patients were divided into 2 groups, without IVO (n=11, non-IVO) and with IVO (n=27). IVO group had smaller left ventricular (LV) cavity and LV end-diastolic volume, and more increased interventricular septum thickness and higher basal septal thickness than non-IVO group. At rest, after Valsalva maneuver, during peak dose of dobutamine, and after NTG, IVPG was higher in IVO-group. To predict IVO during DSE, IVPG ≥5 mmHg after Valsalva maneuver had a sensitivity of 70.4% and specificity of 90.9%. and IVPG ≥4.5 mmHg after NTG had a sensitivity of 33.3% and specificity of 90.9%. CONCLUSIONS: Simple and safe Valsalva maneuver plays an effective role to predict dynamic IVO in patients with hypertension who might be good candidate for beta-blocker therapy and is even more sensitive than preload reduction by NTG.

Evaluation of a new third-generation ELISA for the detection of HIV infection.

The purpose of this study was to assess whether the LG Anti-HIV 1/2 Plus ELISA (LG Life Sciences, Seoul, Korea), a new third-generation enzyme-linked immunosorbent assay for the detection of HIV infection, has improved sensitivity and specificity in comparison to the other licensed third-generation assays. The sensitivity of the LG Anti-HIV 1/2 Plus ELISA was comparable to the Enzygnost Anti-HIV 1/2 Plus ELISA (Dade Behring, Marburg, Germany) (100% vs 100%), and it was capable of detecting highly divergent subtypes including HIV-1 group O. The specificity of the LG Anti-HIV 1/2 Plus ELISA was 100%. The concordance of the LG Anti-HIV 1/2 Plus ELISA and the Enzygnost Anti-HIV 1/2 Plus was found to be 1. The LG Anti-HIV 1/2 Plus ELISA has a short window period among the third-generation ELISA assays and this test showed satisfactory reproducibility.