Background/Aims : It is known that mortality increases with age for patients who suffer with acute myocardial infarction (AMI). Yet there isn’t much data on the clinical characteristics and long-term prognosis of young patients with AMI. Methods : We analyzed two groups of patients with AMI who underwent coronary angiogram : 108 patients younger than 40 years as group I and 64 patients over 70 years old as group II. We compared the baseline clinical characteristics, the echocardiographic and coronary angiographic findings, and the major adverse cardiac event (MACE). Results : Male gender (94.4% vs. 56.1%, respectively, p
Many preclinical studies show that electroacupuncture (EA) on PC6 and ST36 can reduce infarct size after ischemia-reperfusion (IR) injury. Yet studies to enhance the treatment effect size are limited. The purpose of this study was to explore whether EA has additional myocardial protective effects on an ischemia-reperfusion (IR) injury rat model when back-shu EA and moxibustion are added. SD rats were divided into several groups and treated with either EA only, EA + back-shu EA (B), or EA + B + moxibustion (M) for 5 consecutive days. Transthoracic echocardiography and molecular and immunohistochemical evaluations were performed. It was found that although myocardial infarct areas were significantly lower and cardiac function was also significantly preserved in the three treatment groups compared to the placebo group, there were no additional differences between the three treatment groups. In addition, HSP20 and HSP27 were expressed significantly more in the treatment groups. The results suggest that adding several treatments does not necessarily increase protection. Our study corroborates previous findings that more treatment, such as prolonging EA duration or increasing EA intensity, does not always lead to better results. Other methods of increasing treatment effect size should be explored.
Recently the incidence of coronary artery diseases in young patients has been increased in Korea, which may be related with the changes in dietary habits, stress and smoking.This report presents an 18-year-old male patient who suffered from acute non-ST elevation myocardial infarction. He had a history of 1.5 pack-years smoking, but no other risk factors. Depression of ST segments more than 3 mm in V1-6, I and aVL was documented on a twelve-lead electrocardiogram. Two-Dimensional echocardiography revealed hypokinetic anteroseptal wall motion, and myocardial SPECT demonstrated severe, reversible perfusion defects in the anteroseptal wall. A diagnostic coronary angiogram and an intravascular ultrasound revealed total occlusion in the proximal left anterior descending coronary artery due to heavy atheromatous plaque. The lesion was treated successfully by a coronary balloon and stent. He has no major adverse cardiovascular event on nine-month clinical follow-up after discharge.(Korean J Med 63:572-576, 2002)
Key Words : Myocardial infarction, Adolescence, Stents
A high serum triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been reported as an independent predictor for cardiovascular events in the general population. However, the prognostic value of this ratio in patients with renal dysfunction is unclear. We examined the association of the TG/HDL-C ratio with major adverse cardiovascular events (MACEs) according to renal function in patients with acute myocardial infarction (AMI).This study was based on the Korea Acute Myocardial Infarction Registry database. Of 13,897 patients who were diagnosed with AMI, the study population included the 7,016 patients with available TG/HDL-C ratio data. Patients were stratified into three groups according to their estimated glomerular filtration rate (eGFR), and the TG/HDL-C ratio was categorized into tertiles. We investigated 12-month MACEs, which included cardiac death, myocardial infarction, and repeated percutaneous coronary intervention or coronary artery bypass grafting.During the 12-month follow up period, 593 patients experienced MACEs. There was a significant association between the TG/HDL-C ratio and MACEs (p<0.001) in the entire study cohort. Having a TG/HDL-C ratio value in the highest tertile of TG/HDL-C ratio was an independent factor associated with increased risk of MACEs (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.26-1.93; p<0.001). Then we performed subgroup analyses according to renal function. In patients with normal renal function (eGFR ≥ 90 ml/min/1.73m2) and mild renal dysfunction (eGFR ≥ 60 to < 90ml/min/1.73m2), a higher TG/HDL-C ratio was significantly associated with increased risk of MACEs (HR, 1.64; 95% CI, 1.04-2.60; p = 0.035; and HR, 1.56; 95% CI, 1.14-2.12; p = 0.005, respectively). However, in patients with moderate renal dysfunction (eGFR < 60 ml/min/1.73m2), TG/HDL-C ratio lost its predictive value on the risk of MACEs (HR, 1.23; 95% CI, 0.82-1.83; p = 0.317).In patients with AMI, TG/HDL-C ratio is a useful independent predictor of 12-month MACEs. However, this ratio does not have predictive power in patients with moderate renal dysfunction.
The Fractional Flow Reserve and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea.
Background and Objectives:The head-up tilt test (HUT) is widely used for the diagnosis of vasovagal syncope. To improve the sensitivity of the test, provocation with isoproterenol is frequently used. The aim of this study was to evaluate the values of isosorbide dinitrate spray as a provocation drug in the HUT. Subjects and Methods: Two hundred patients, undergoing baseline HUT (60°for 20 minutes) for suspected vasovagal syncope or presyncope and unexplained dizziness, were enrolled. If the baseline HUT was negative, isosorbide dinitrate (2.5 mg) spray was applied sublingually (group I, n=93), or isoproterenol (3 μg/min) infused (group II, n=93), in a randomized fashion. The values of isosorbide dinitrate and isoproterenol were compared in those patients that developed a positive vasovagal response or who completed the drug-provocative HUT. Results:Syncope was similarly reproduced in both groups (47.7 vs. 41.9%, p>0.05). Type I responses were most common in both groups, and types I and II responses were more common in group I than group II (78.0 vs. 55.6% and 12.2 vs. 5.6%, p<0.05, respectively). The average time to a positive response was longer in group I than group II (8.5±3.4 vs. 6.1±3.6 minutes, p<0.01). The sensitivity and specificity of the drug-provocative HUT were significantly higher in group I than group II (73.5 and 87.5% vs. 58.5 and 71.1%; respectively, p<0.01). The incidence of minor adverse effects were similar in both groups, but serious cardiac side effects were significantly more common in group II than group I (4.3 vs. 0%, p<0.05). Conclusion:Sublingual isosorbide dinitrate spray may be used as a simple, effective and well tolerated provocative drug during HUT. (Korean Circulation J 2005;35:690-695)
Curcumin, a yellow pigment of turmeric in curry, is reported to interfere with nuclear factor (NF)-κB. This study was designed to investigate the underlying pathway of antiinflammation of curcumin on endothelial cells. Human umbilical vein endothelial cells (HUVECs) were stimulated with 10 ng/mL tumor necrosis factor (TNF)-α. Curcumin blocked the activation of NF-κB by TNF-α. Curcumin also reduced the intracellular reactive oxygen species (ROS), monocyte adhesion, phosphorylation of c-Jun N-terminal kinase (JNK), p38, and signal transducer and activator of transcription (STAT)-3 in TNF-α-stimulated HUVECs. The expression of intracellular cell adhesion molecule (ICAM)-1, monocyte chemoattractant protein (MCP)-1, and interleukin (IL)-8 were attenuated by curcumin at both mRNA and protein level. Curcumin, however, did not affect the expression of TNF receptor I and II in TNF-α-stimulated HUVECs. We suggest that curcumin could contribute to protection against the adverse vascular effect of the proinflammatory response through the modulation of p38 and STAT-3 in addition to NF-κB and JNK in endothelial cells.
Background and Objectives:The level of cardiac specific troponin (cTn) may be important in patients with acute coronary syndrome (ACS), but with normal electrocardiography (ECG). Subjects and Methods:Three hundred and nineteen patients (61±11 years, M:F=212:107), with ACS and normal ECG, who underwent a diagnostic coronary angiogram (CAG), between July 2000 and June 2001, were analyzed according to their cTn level. The clinical characteristics, initial CAG findings and major adverse cardiac events (MACE), during a oneyear clinical follow-up, were compared between positive and negative cTn groups. Results:Of the enrolled patients, 191 had a negative cTn (group A, 61±10 years, M:F=131:60), and 128 a positive cTn (group B, 60±11 years, M:F=81:47), and 176 (55.2%) were shown to have significant coronary artery stenosis on CAG. There were no significant differences in risk factors between the two groups. The mean left ventricular ejection fraction was 64±9%, and was lower in group B than in group A (59±10% vs. 67±7%, p<0.05). cTn positivity was associated with the percentage of significant coronary artery stenosis present (88% vs. 32%, p<0.05), a smaller minimal luminal diameter (1.09±0.44 mm vs. 2.68±0.33 mm, p<0.05) and a larger diameter of stenosis (68± 6% vs. 44±6%, p<0.05). A multi-vessel lesion was more common in group B than in group A (58.3% vs. 30.3%, p<0.05). During the one-year follow-up period, 36 patients developed MACE, resulting in 3 deaths, 7 acute myocardial infarctions and 34 patients with restenosis. MACE was observed in 9 patients of group A and in 27 of group B (4.7% vs. 21.1%, p<0.05). Conclusion:The troponin levels are valuable for the early diagnosis, and prediction of the long-term prognosis, in patients with ACS and a normal ECG. (Korean Circulation J 2003;33 (5):385-392)
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