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안성균,탁승재,최정현,유상용,정진국,최병주,최태영,최소연,윤명호,황교승,신준한 대한심장학회 2005 Korean Circulation Journal Vol.35 No.3
Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial ischemia, which frequently presents as sudden death. The pathophysiology and treatment of SCAD have not been fully determined. Herein, a case of SCAD, manifesting as variant angina, which rapidly progressed during an ergonovine test, in which 3 drug-eluting stents were deployed using intravascular an ultrasound guidance, with an excellent imediate result, is reported.
안성균,최경훈,김장영,이승환,안민수,유병수,윤정한,성중경,이지현,이준원,윤영진 대한심장학회 2013 Korean Circulation Journal Vol.43 No.4
Background and Objectives: Stented segment length is a predictive factor for restenosis and stent thrombosis still in the drug-eluting stent (DES) era, and the benefit of routine intravascular ultrasound (IVUS) is still unclear. The aim of the present study was to investigate whether IVUS-guided percutaneous coronary intervention (PCI) improved the vascular outcomes as compared with conventional PCI in the treatment of diffuse coronary artery disease. Subjects and Methods: From our registry database from January 2006 to May 2009, we identified 85 consecutive patients with de novo coronary lesions treated with at least 64 mm of multiple, overlapping DES. The 2-year rate of major adverse cardiovascular events (MACE),defined as the composite of cardiovascular death, non-fatal myocardial infarction, target lesion revascularization (TLR), or stent thrombo -sis, was compared according to the use of IVUS. Results: The 2-year MACE rate was lower in the IVUS-guided group than that of the angiography-guided group (8% vs. 33.3%, p=0.005). The incidence of TLR was lower in patients with IVUS use than in those without IVUS use (0% vs. 27.8%, p<0.001). On Cox proportional hazard analysis, no IVUS use {hazard ratio (HR) 5.917, 95% confidence interval (CI) 1.037-33.770, p=0.045 } and age (HR 1.097, 95% CI 1.006-1.138, p=0.032) were unfavorable predictors for the 2-year MACE. Conclusion: The use of IVUS may improve the effectiveness and safety of multiple overlapping drug-eluting stenting for long, diffuse coronary lesions.
안성균,윤정한,김장영,어영,유병수,이승환,안민수,김주원,김경민,이지현,이준원,탁승제,최경훈,윤영진 대한심장학회 2013 Korean Circulation Journal Vol.43 No.8
Background and Objectives: We evaluated the effectiveness of genotype- and phenotype-directed individualization of P2Y 12 inhibitors to decrease high on-treatment platelet reactivity (HOPR). Subjects and Methods: Sixty-five patients undergoing percutaneous coronary intervention for non-ST elevation acute coronary syn -dromes were randomly assigned to genotype- or phenotype-directed treatment. All patients were screened for CYP2C19*2, *3, or *17 al-leles by using the Verigene CLO assay (Nanosphere, Northbrook, IL, USA). The P2Y 12 reaction unit (PRU) was measured using the VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA). 21 CYP2C19 *2 or *3 carriers (65.6%) and 11 patients with HOPR (33.3%), defined as a PRU value ≥230, were given 90 mg ticagrelor twice daily; non-carriers and patients without HOPR were given 75 mg clopidogrel daily. The primary endpoint was the percentage of patients with HOPR after 30 days of treatment. Results: PRU decreased following both genotype- and phenotype-directed therapies (242±83 vs. 109±90, p<0.001 in the genotype-di-rected group; 216±74 vs. 109±90, p=0.001 in the phenotype-directed group). Five subjects (16.2%) in the genotype-directed group and one (3.3%) in the phenotype-directed group had HOPR at day 30 (p=0.086). All patients with HOPR at the baseline who received ticagrelor had a PRU value of <230 after 30 days of treatment. Conversely, clopidogrel did not lower the number of patients with HOPR at the baseline. Conclusion: Tailored antiplatelet therapy according to point-of-care genetic and phenotypic testing may be effective in decreasing HOPR after 30 days.
안성균,이승환,이지현,이준원,윤영진,안민수,김장영,유병수,윤정한,최경훈,탁승제 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.3
Purpose: We aimed to investigate whether combination therapy using intracoronary(IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusioncompared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: We enrolled 40 patients with STEMI, who presentedwithin 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5. Results:IMR was lower in the combination group than in the IC abciximab group (23.5±7.4 U vs. 66.9±48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5±7.4 U vs. 37.2±26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximabgroup (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9±48.7 U vs. 37.2±26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively). Conclusion: Combination treatment using IC abciximab and AT may synergisticallyimprove myocardial perfusion in patients with STEMI undergoing primaryPCI (Trial Registration: clinicaltrials. gov Identifier: NCT01404507).