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The study compared the 2-year outcomes of patients diagnosed with acute myocardial infarction (AMI) triggered by coronary artery atherosclerosis and AMI caused by coronary artery spasm. A total of 36,797 patients in the Korea AMI Registry were grouped into 2 categories-(1) AMI due to coronary artery spasm without stenotic lesion (CAS-AMI, n = 484); and (2) AMI induced by coronary artery atherosclerosis (CAA-AMI, n = 36,313). The major clinical outcomes of the 2 groups were compared over a 2-year clinical follow-up period. Major adverse cardiac events (MACE) were defined as the composite of total death, nonfatal myocardial infarction, and repeat revascularization. The incidence of MACE (7.1% vs 11.1%; p = 0.007) and repeat revascularization (0.4% vs 4.2%; p <0.001) in the CAS-AMI group were significantly lower than in the CAA-AMI group at 2 years. However, the incidence of total death and nonfatal myocardial infarction was similar in both the groups. Aborted cardiac arrest was strongly associated with 2-year mortality in the CAS-AMI group (hazard ratios 13.5, 95% confidence interval 5.34 to 34.15, p <0.001) The incidence of MACE in CAS-AMI patients was significantly lower than in the CAA-AMI group of patients up to 2 years due to the relatively lower rate of repeat revascularization in CAS-AMI patients. However, the incidence of total death or nonfatal myocardial infarction in CAS-AMI patients was not different from that of patients with CAA-AMI., (Copyright © 2019 Elsevier Inc. All rights reserved.)

There is limited long-term comparative clinical outcome data concerning angiography- versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in non-complex left main coronary artery (LMCA) disease treated with the single stenting technique in the drug-eluting stent (DES) era.The aim of this study was to investigate whether angiography-guided stenting is comparable to IVUS-guided stenting during 3-year clinical follow-up periods in patients with non-complex LM disease treated with the single stenting technique.A total of 196 patients treated with either angiography-guided (n = 74) or IVUS-guided (n = 122) PCI were included. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR). To adjust for any potential confounders, propensity score (PS) adjusted analysis was performed.During 3-year follow-up, the PS adjusted Cox-proportional hazard ratio (HR) was not significantly different between the two groups for total death, cardiac death, and MI. Also, TLR and the combined rates of TVR and non-TVR were not significantly different. Finally, MACE was not significantly different between the two groups (HR: 0.63, 95% Confidence interval (CI): 0.33-1.17; P = 0.149).Angiography-guided PCI for non-complex LMCA diseases treated with the single stenting technique showed comparable results compared with IVUS-guided PCI in reducing clinical events during 3-year clinical follow-up in the DES era. Although IVUS guided PCI is the ideal strategy, angiography-guided PCI can be an option for LMCA PCI in some selected cases.

We report herein the optical coherence tomography (OCT) and stent boost imaging guided bioresorbable vascular scaffold (BVS) implantation for right coronary artery (RCA) chronic total occlusion (CTO) lesion. The gold standard for evaluating BVS expansion after percutaneous coronary intervention is OCT. However, stent boost imaging is a new technique that improves fluoroscopy-based assessments of stent overlapping, and the present case shows clinical usefulness of OCT and stent boost imaging guided 'overlapping' BVS implantation via antegrade approach for a typical RCA CTO lesion., Competing Interests: The authors have no financial conflicts of interest., (© Copyright: Yonsei University College of Medicine 2017.)

Objective: The difference in the usefulness of routine angiographic follow-up (RAF) and clinical follow-up (CF) after a percutaneous coronary intervention (PCI) in multivessel coronary artery disease (MVD) patients has not been well clarified as yet., Patients and Methods: A total of 642 consecutive MVD patients who underwent PCI with drug-eluting stents (DES) were enrolled. RAF was performed at 6-9 months after the index PCI (n=374) and others were medically managed and clinically followed (n=268). Patients who experienced clinical events including death, myocardial infarction (MI), and ischemia-driven PCI before 1 year were excluded. To adjust for any potential confounders, a propensity scorematched analysis was carried out using the logistic regression model and two propensity-matched groups (193 pairs, n=386, C-statistic=0.744) were generated. Cumulative clinical outcomes up to 3 years were compared between the RAF group and the CF group., Results: During the 3-year follow-up period, the cumulative incidence of revascularization [target lesion revascularization: odds ratio (OR), 4.21; 95% confidence interval (CI), 1.67-10.6; P=0.001) and target vessel revascularization (TVR: OR, 4.69; 95% CI, 2.00-11.0; P<0.001, target vessel revascularization: OR, 4.69; 95% CI, 2.00-1011.0; P<0.001] and major adverse cardiovascular events (composite of death, repeat PCI and MI: OR, 2.96; 95% CI, 1.62-105.42, P<0.001) were significantly higher in the RAF group compared with the CF group. However, the 3-year incidence of death (OR, 1.41; 95% CI, 0.44-104.53; P=0.558) or MI (OR, 2.58; 95% CI, 0.79-108.37; P=0.102) was not different between the two groups. In MVD patients treated with second-generation DESs, the incidence of repeat revascularization (target lesion revascularization and target vessel revascularization) was not different between the two groups., Conclusion: Conclusion RAF following index PCI with DES in multivessel CAD patients was associated with increased incidence of revascularization and major adverse cardiovascular events. However, in MVD patients treated with second-generation DESs, repeat revascularization incidence was similar between two different follow-up strategies up to 3 years.

Background and Aims: The impact of vasomotion types on long-term clinical outcomes in patients with coronary artery spasm (CAS) induced by the acetylcholine provocation test (ACH-test) remains unclear., Methods: We evaluated 4644 consecutive patients with typical resting chest pain (CP), but no angiographically significant coronary artery lesion (<50% stenosis), who underwent an ACH-test. According to their vasomotor response, patients were categorized into four types: normal vasomotion (no CP, no ischemic electrocardiographic changes, and no vasoconstriction), microvascular spasm (CP with <75% vasoconstriction but with CP relief after nitroglycerin infusion), epicardial spasm (CP with ≥75% vasoconstriction), and ACH-test inconclusive (vasoconstriction and/or electrocardiographic changes, but no CP). We investigated CP recurrence requiring follow-up angiography and major adverse cardiovascular events (MACEs) during 5 years., Results: CP recurred in 7.9% of patients and was more frequent in abnormal vasomotion types (normal vasomotion, microvascular spasm, epicardial spasm, and inconclusive type: 5.4%, 9.8%, 10.9%, and 8.2%, respectively, log-rank p = 0.009). In multivariate analysis adjusted for medication use after the ACH-test, vasomotion subtype was not an independent predictor, whereas male sex, fixed lesion on baseline angiography, and medications including calcium channel blockers (CCBs), nitrates, and statins were independent positive predictors for recurrent CP. Alcohol consumption at the initial interview was a negative predictor. MACEs were observed in 1.6%, and the incidence was similar among subtypes (p = 0.421)., Conclusions: Recurrent CP and long-term outcomes are independent of vasomotion subtypes, but long-term use of CCBs, nitrates, and statins is a significant predictor for recurrent CP., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Critical limb ischemia (CLI) is associated with a high risk of cardiovascular ischemic events. We assessed the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty (PTA)., Methods: Of a total 286 consecutive CLI patients treated by PTA, 252 patients who underwent coronary angiography before or after PTA were enrolled. Coronary artery disease (CAD) was defined as angiographic stenosis ≥50% and significant CAD as ≥70% stenosis., Results: Of the 252 patients with CLI who underwent coronary angiography, a total of 167 patients (66.3%) had CAD and 85 patients (33.7%) did not have CAD. Patients in the CAD group were older, had a higher prevalence of diabetes and cerebrovascular disease, and had a lower mean ejection fraction. In the CAD group, of the 145 patients with significant CAD, percutaneous coronary intervention (PCI) was performed in 114 patients (78.6%). At 1 year, the CAD and non-CAD groups had no statistically significant differences in mortality (7.1% vs 4.7%; P=.45), myocardial infarction (1.1% vs 0%; P=.31), and PCI (4.7% vs 1.1%; P=.31). These outcomes were similar after the adjustment of baseline confounders. At 1 year, the CAD and non-CAD groups had similar rates of repeat PTA (16.7% vs 17.6%; P=.86), target lesion revascularization (13.7% vs 14.1%; P=.94), and amputation (19.1% vs 16.4%; P=.60)., Conclusion: A strategy of routine coronary angiography and coronary revascularization may be a reasonable treatment option for these patients who have high risk for severe CAD. A randomized trial is needed to determine if this is the preferred strategy for CLI patients.

Objective: The objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk score., Design: A prospective cohort study within a national insurance system., Setting: 18 health promotion centres nationwide between 1996 and 2001 in Korea., Participants: 268 315 Koreans between the ages of 30 and 74 years without CHD at baseline., Outcome Measure: Non-fatal or fatal CHD events between 1997 and 2011. During an 11.6-year median follow-up, 2596 CHD events (1903 non-fatal and 693 fatal) occurred in the cohort. The optimal CHD model was created by adding high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides to the basic CHD model, evaluating using the area under the receiver operating characteristic curve (ROC) and continuous net reclassification index (NRI)., Results: The optimal CHD models for men and women included HDL-cholesterol (NRI=0.284) and triglycerides (NRI=0.207) from the basic CHD model, respectively. The discrimination using the CHD model in the Korean cohort was high: the areas under ROC were 0.764 (95% CI 0.752 to 0.774) for men and 0.815 (95% CI 0.795 to 0.835) for women. The Framingham risk function predicted 3-6 times as many CHD events than observed. Recalibration of the Framingham function using the mean values of risk factors and mean CHD incidence rates of the KHS cohort substantially improved the performance of the Framingham functions in the KHS cohort., Conclusions: The present study provides the first evidence that the Framingham risk function overestimates the risk of CHD in the Korean population where CHD incidence is low. The Korean CHD risk model is well-calculated alternations which can be used to predict an individual's risk of CHD and provides a useful guide to identify the groups at high risk for CHD among Koreans., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: The gold standard for evaluating stent expansion after percutaneous coronary intervention (PCI) is intravascular ultrasound (IVUS). However, the routine use of this modality is costly and time consuming. StentBoost is a new imaging technique that improves fluoroscopy-based assessments of stent expansion. The purpose of this study was to evaluate the effect of StentBoost imaging-guided PCI on mid-term angiographic and clinical outcomes., Methods and Results: A total of 870 consecutive patients were recruited (mean age: 64.34 ± 11.61; men: 64.5%), all of whom underwent PCI with drug-eluting stents (DESs). The subjects were divided into a no StentBoost group (n=569 patients) and a StentBoost group (n=301 patients). The 6-month angiographic and 12-month clinical outcomes were compared between the two groups. At 1 month, clinical outcomes were similar between the two groups. At 6 months, the StentBoost group had significantly lower rates of late loss (0.32 ± 0.40 vs. 0.48 ± 0.59; p=0.005) and binary restenosis (1.2% vs. 8.3%; p=0.029) compared with the no-StentBoost group. At 12 months, StentBoost group had significantly lower the incidence of target lesion revascularization (TLR) (1.7% vs. 7%; p=0.034) and TLR-major adverse cardiac events (6% vs. 13.2%; p=0.037) compared with the no-StentBoost group., Conclusion: We conclude that the routine clinical use of StentBoost during PCI can be useful, and results in better medium-term angiographic and clinical outcomes., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Insulin resistance (IR) is known to be a risk factor for coronary artery disease (CAD). We aimed to evaluate the impact of IR on 1-year clinical outcomes in non-diabetic CAD patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DESs)., Methods and Results: A total of 229 consecutive non-diabetic CAD patients treated with DESs were enrolled. Study population was divided into IR group [homeostasis model assessment (HOMA) index ≥ 2.5, n=54] and non-IR group (HOMA index<2.5, n=175). Baseline clinical and procedural characteristics were similar between the groups except higher incidence of high-sensitivity C-reactive protein and lower incidence of multivessel disease as the target vessel in the non-IR group. There was a trend toward longer restenosis lesion length in the IR group at 6 months angiographic follow up but composite major clinical outcomes up to 1 year were similar between the two groups., Conclusions: Despite worse trend in angiographic outcomes in the IR group (HOMA index ≥ 2.5), it was not translated into worse 1-year major clinical outcomes following PCI with DESs as compared to the non-IR group., (Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Background: The association of emerging biomarkers such as high-sensitivity C-reactive protein (hs-CRP), homocysteine and fibrinogen with the risk of coronary artery disease (CAD) is still uncertain in Asian population including Koreans and little is known about the combined effect of biomarkers on the risk of CAD., Methods: A total of 10 650 subjects (6538 men and 4112 women) were enrolled in this study. A 10-year CAD risk was calculated using Framingham risk score modified by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and levels of circulating hs-CRP, homocysteine and fibrinogen were measured using validated assays., Results: The 10-year CAD risk gradually augmented with increase in the circulating levels of hs-CRP, homocysteine and fibrinogen. For the highest quartile of hs-CRP, odds ratio (OR) of high-risk for CAD (10-year risk ≥ 20%) compared with the lowest quartile was 3.97 (95%CI: 2.51 - 6.29). For homocysteine and fibrinogen, ORs in the highest quartile compared to the lowest quartile were 5.10 (95%CI: 3.05 - 8.53, P < 0.001) and 1.46 (95%CI: 0.69 - 3.11, P = 0.325), respectively. OR of high-risk for CAD in both the highest quartile of hs-CRP and homocysteine was 9.05 (95%CI: 5.30 - 15.45) compared with the below median of hs-CRP and homocysteine., Conclusions: The present study demonstrated that hs-CRP and homocysteine are well associated with the 10-year CAD risk estimated using NCEP ATP III in Koreans and combination of hs-CRP and homocysteine can have strong synergy in predicting the development of CAD.

The absence of coronary artery calcification (CAC) has been used to as an indication to rule out significant coronary artery disease (CAD). However, diagnostic usefulness of 'zero calcium score criteria' as a decision-making strategy to rule out significant CAD as the etiology of acute chest pain has not been studied in depth, especially in Asian ethnicity. We prospectively enrolled 136 Korean patients (58% men, 56 ± 13 years) who presented to the emergency department (ED) with acute chest pain and non-diagnostic ECG. All patients underwent 64-slice CT for calcium scoring and coronary CT angiography (cCTA). We investigated the association of CAC with the presence of ≥50% CAD on cCTA and with a final diagnosis of an acute coronary syndrome (ACS). Ninety-two patients out of 136 (68%) did not show detectable CAC, and 14 out of these 92 without CAC (15%) had ≥50% CAD on cCTA. Sensitivity, specificity, positive predictive value and negative predictive value of zero calcium score criteria for the detection of ≥50% CAD were 0.66 (95% confidence interval, 0.50-0.80), 0.83 (0.74-0.90), 0.64 (0.48-0.77), 0.85 (0.75-0.91), respectively. Patients who had ≥50% CAD without detectable CAC were younger (P = 0.001), and had a higher prevalence of smoking (P = 0.048) as compared to patients with a degree of CAC. Most of the patients with ≥50% CAD of non-calcified plaque were younger than 60 years of age (79%, 11/14), however, 3 of them were older than 60 years of age. Forty-five patients (33%) were subsequently diagnosed as having ACS, and 38% (17/45) of them had no CAC. Zero calcium score did not necessarily guarantee the absence of significant CAD, even in patients older than 60 years, in Asian ethnicity presenting to the ED with chest pain.

Background: Coronary artery calcification (CAC) is correlated with aortic calcification (AC) and predicts coronary atherosclerosis as well as obstructive coronary artery disease (OCAD). This study aims to investigate whether AC predicts OCAD independent of CAC and its incremental value in predicting OCAD with CAC., Methods: Among the consecutive patients who underwent 64-slice multidetector CT (MDCT), we enrolled 120 stable OCAD (luminal narrowing ≥ 50%) patients and 120 controls without OCAD, matched for cardiovascular risk factors. CAC, thoracic AC, and OCAD were determined by MDCT., Results: The prevalence of AC and CAC were significantly higher in OCAD patients than in controls (64% vs. 48%, p = 0.019; 57% vs. 32%, p < 0.001, respectively). There is a significant correlation between AC and CAC scores in the overall study population (r = 0.528, p < 0.001). In univariate analysis, the odds ratios (ORs) of AC and CAC in predicting OCAD were 1.91 (95% CI, 1.14-3.21) and 2.82 (95% CI, 1.67-4.78), respectively. When an adjustment was made for each other, AC did not maintain a significant association with OCAD, whereas CAC persisted the association (OR, 2.52; 95% CI, 1.42-4.47). Both AC and CAC present as compared to both absent was found to be a more potent predictor for OCAD (OR, 3.37; 95% CI 1.78-6.36, p < 0.001) than CAC alone., Conclusions: The presence of AC was associated with stable OCAD independently from cardiovascular risk factors, but the association seemed to be based on the close correlation between AC and CAC. However, AC might have an incremental value with CAC for predicting OCAD., (Copyright © 2010. Published by Elsevier Ireland Ltd.)

Gamma-glutamyltransferase (GGT) is a novel coronary artery disease (CAD) risk factor, but its use as an independent factor for CAD risk prediction remains unclear in Asian population. This study examined the association between serum GGT concentration and Framingham risk score (FRS) in the Korean population. This cross-sectional study was performed on 30,710 Koreans. Besides FRS, body mass index, fasting blood glucose, liver enzymes, lipid profile, uric acid and high sensitive C-reactive protein data were used. The study subjects were grouped into quartiles according to the levels of GGT. Analyses relating GGT to FRS ≥ 20% utilized multiple confounders adjusted logistic regression. Positive correlations were established between log-transformed GGT concentration and FRS (r = 0.38; P < 0.001). Increasing the quartile of serum GGT concentration was significantly associated with linear increasing trends in FRS (P-trend < 0.001). Compared to the lowest baseline GGT category, age-gender adjusted odd ratios for FRS ≥ 20% were significantly increased from the lowest to highest GGT quartiles; these results remained significantly after adjustments for multiple confounders. Increased GGT concentration is associated with the increase in FRS. Serum GGT may be helpful to predict the future risk of CAD.

Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis (%DS) was 58 ± 13%. Of the 50 lesions, 20 (40%) were deferred without additional intervention. The FFR and %DS had a negative correlation (r = -0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r = -0.56, p = 0.12). Although most lesions (89%) with a %DS of ≥70 had significant functional ischemia, among 41 lesions with a %DS <70, only 20 (49%) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0% (23.3% in the FFR <0.80 group and 10.0% in FFR ≥0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic %DS, in particular, in moderate- or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Increasing coronary artery calcium scores (CACS) are independently associated with cardiac events. Recent advents in coronary computed tomography angiography (CCTA) have allowed us to better characterize individual plaque. Currently, it is unknown if higher CACS are likely to be associated with more calcified or mixed and heterogeneous plaque burden on CCTA. The study population consisted of 1,043 South Korean asymptomatic subjects (49 ± 10 years, 62% men) who underwent CCTA (64-slice MDCT). Plaques were classified on contrast-enhanced CCTA as non-calcified, mixed, and calcified on a per-segment basis according to the modified American Heart Association classification. The majority of the study participants had no coronary calcification (n = 866, 83%), whereas CACS> 0 was observed in 177 participants (17%). Only 40 (5%) participants in absence of CACS had exclusively non-calcified plaque, whereas 10 (1.2%) had significant coronary artery disease. With increasing CACS, study participants were more likely to have exclusively mixed or combination atherosclerotic plaques (P = 0.001). Among individuals with CACS 1-10, the prevalence of at least two coronary segments with mixed plaques was 4%, increasing up to 18 and 41% with CACS of 11-100 and >100. The respective prevalence of ≥2 coronary segments (calcified plaques) with increasing CACS were 6%, 16 and 26% (P = 0.01) and of non-calcified plaques were 6%, 6 and 11% (P = 0.71). In multivariable adjusted analyses, those with CACS >100 were 7.17 times (95% CI: 1.36-37.68) more likely to have ≥2 coronary segments with calcified plaque comparing with CACS 1-10. On the other hand the respective risk was higher for presence of ≥2 segments with mixed plaques (odds ratio: 15.81, 95% CI: 3.14-79.58). Absence of CAC is associated with a negligible presence of any atherosclerotic disease as detected by CCTA in asymptomatic population. A higher CACS is more likely to be associated with heterogeneous coronary plaque (combination of calcified, non-calcified, and mixed plaques), and appears to be more strongly associated with a higher burden of mixed plaque.

In an observational study, we examined the effect of statins on low-density-lipoprotein (LDL) subfractions.Using density-gradient ultracentrifugation, we measured small, dense LDL density in 612 patients (mean age, 61.7 ± 12.6 yr), some with and some without coronary artery disease, who were placed in a statin-treated group (n=172) or a control group (n=440) and subdivided on the basis of coronary artery disease status.Total cholesterol, LDL cholesterol, apolipoprotein B, and the LDL cholesterol/apolipoprotein B ratio were significantly lower in the statin group. However, the proportion of small, dense LDL was higher in the statin group (42.9% ± 9.5% vs 41.3% ± 8.5%; P=0.046) and the proportion of large, buoyant LDL was lower (23.6% ± 7.5% vs 25.4% ± 7.9%; P=0.011). In the statin group, persons without coronary artery disease had higher proportions of small, dense LDL, and persons with coronary artery disease tended to have higher proportions of small, dense LDL.Our study suggests that statin therapy--whether or not recipients have coronary artery disease--does not decrease the proportion of small, dense LDL among total LDL particles, but in fact increases it, while predictably reducing total LDL cholesterol, absolute amounts of small, dense LDL, and absolute amounts of large, buoyant LDL. If and when our observation proves to be reproducible in subsequent large-scale studies, it should provide new insights into small, dense LDL and its actual role in atherogenesis or the progression of atherosclerosis.

Introduction/objectives: Cardiovascular disease is the leading cause of death for individuals with diabetes mellitus. Controversy exists regarding the screening of asymptomatic diabetics for occult coronary artery disease (CAD). The purpose of this study is to describe the prevalence of occult CAD in a group of asymptomatic subjects with diabetes using non-invasive coronary angiography, as well as to investigate the predictive accuracy of current guidelines with regards to their recommended criteria for further cardiac diagnostic testing in this patient population., Methods: We prospectively enrolled 217 asymptomatic Korean outpatients with type 2 diabetes who had no prior history of CAD. All underwent non-invasive coronary angiography using a 64-slice multi-detector computed tomography scanner., Results: The mean age of the study participants was 59+/-8 years; 66% were men. Diabetes duration was 7+/-7 years, mean Framingham risk score was 13%, and mean hemoglobin A1C level was 7%. Of the 217 outpatients, 138 (64%) had occult CAD based on cardiac computed tomography angiography (CCTA) findings. Thirty-six (36/138; 26%) had a significant stenosis on CCTA. Nearly half of the individuals (62/138; 45%) had a combination of non-calcified and calcified plaques. Only 5 out of 217 (2%) individuals with significant stenosis would have been missed using the American Diabetes Association (ADA) criteria for further cardiac testing., Conclusion: Almost two thirds of asymptomatic diabetics have occult CAD, including obstructive disease. Based on CCTA findings, the ADA criteria for further cardiac diagnostic testing would identify most individuals who have a significant coronary stenosis.

Objectives: The purpose of this study was to evaluate the prevalence of occult coronary artery disease (CAD) with coronary computed tomography angiography (CTA) to characterize plaque composition and to evaluate the potential of this new technology to impact risk stratification in asymptomatic middle-aged subjects., Background: There is a paucity of information regarding the role of CTA for the detection of occult CAD in asymptomatic individuals., Methods: We consecutively enrolled 1,000 middle-aged asymptomatic subjects (age 50 +/- 9 years, 63% men) who underwent CTA (64-slice multidetector row computed tomography) as part of a general health evaluation., Results: Atherosclerotic plaques were identified in 215 (22%, 2 +/- 1 segments/subject) individuals; 40 individuals (4%) had only noncalcified plaques. Fifty-two (5%) subjects had significant (>or=50%) diameter stenosis and 21 (2%) had severe (>or=75%) stenosis. Thirteen (25%) and 30 (58%) subjects with significant stenosis were classified into National Cholesterol Education Program low-risk and mild coronary calcification (coronary artery calcium scores <100), respectively. Midterm follow-up (17 +/- 2 months) revealed 15 cardiac events only in those with CAD on CTA: 1 unstable angina requiring hospital stay and 14 revascularization procedures. Most (87%) events occurred within 90 days of index CTA., Conclusions: The prevalence of occult CAD in apparently healthy individuals was not negligible, although their midterm prognosis was good. CTA has a potential to provide a better insight about the occult CAD in this population. However, on the basis of our results and considering present radiation exposure data, we cannot recommend that CTA be used as a screening tool for this population at this point.

Background: Data regarding the efficacy of adjunctive balloon postdilation (ABP) at the site of two or more overlapping drug-eluting stent (DES) implantation in diffuse long lesion angioplasty are limited. This study was aimed to evaluate the efficacy of routine ABP to the overlapping DES sites in terms of clinical and angiographic outcomes., Methods: We enrolled 88 patients (55 men, mean age 63.51+/-10.24 years), and 93 lesions with diffuse long lesion were treated with DES. The clinical and angiographic outcomes up to 6 months of 35 patients in the without routine ABP group were compared with those of 53 patients in the with ABP group., Results: Baseline clinical characteristics, procedural characteristics, angiographic lesion length, lesion type and DES type were similar between the two groups. Late loss and binary restenosis at 6 months were similar between the two groups. The death, Q-wave myocardial infarction and the major adverse cardiac events were similar between the two groups (7.9 vs. 9.1% in ABP group, P=NS), but there was a trend toward lesser target lesion and vessel revascularization in no ABP group (2.6 vs. 9.0% in no ABP group, P=0.09)., Conclusion: The routine ABP at the overlapping site of DES implantations in a diffuse long coronary lesion showed no significant benefits in terms of angiographic and clinical outcomes compared with those of patients without routine ABP.

Objective: This study compared the efficacy of the sirolimus-eluting stent (SES), the paclitaxel-eluting stent (PES), and the bare metal stent (BMS) for long coronary lesions., Background: The outcome of drug-eluting stent (DES) implantation in long coronary lesions remains unclear., Methods: The study involved 527 patients with de novo long coronary lesions (> or = 24 mm), which were treated with long (> or = 28 mm) SESs (223 lesions), PESs (194 lesions), or BMSs (201 lesions)., Results: Lesions in the SES (36.0 +/- 14.9 mm, P < 0.001) and PES (36.3 +/- 14.5 mm, P < 0.001) groups were longer than those in the BMS group (32.0 +/- 12.3 mm), meaning the two DES groups had longer stented segments than did the BMS group. Six-month angiographic follow-up showed the SES (9.3%, P < 0.001) and PES (21.3%, P < 0.001) groups had lower in-segment restenosis rates than that of the BMS group (42.5%). The rate of major adverse cardiac events (MACE) including death, myocardial infarction, and target lesion revascularization at 9 months was higher in the BMS group (26.6%) than that in the SES (13.0%, P < 0.001) and PES (15.7%, P < 0.001) groups. Posthoc analysis of the two DES groups showed that the in-segment restenosis rate was lower for the SES than that for the PES group (P = 0.002), while the MACE rate was similar., Conclusions: The use of DESs for long coronary lesions appears to be safe and more effective than the use of BMSs in terms of restenosis and adverse clinical events. SES use was associated with lower late luminal loss and a lower angiographic restenosis rate compared with PES use., (2006 Wiley-Liss, Inc.)

Background: Arterial stiffness has been known as a major contributory factor to cardiovascular (CV) morbidity and mortality in patients with hypertension. Pulse wave velocity (PWV), a surrogate measurement of large artery damage, has not been ascertained as an independent risk factor of coronary artery disease (CAD). The aim of this study was to assess whether PWV is associated with CV risk., Methods and Results: We prospectively enrolled 326 consecutive patients undergoing coronary angiography for the assessment of suspected CAD. Arterial stiffness was assessed through aorto-femoral PWV using fluid-filled system. PWV was higher in patients with CAD than those without CAD (12.5 +/- 5.1 vs 10.2 +/- 3.1 m/s, p < 0.001). In multivariate logistic regression analysis, after entering for age, diabetes and other CV risk factors, PWV remained the significant independent variable for CAD (p = 0.050). When the severity of CAD was expressed as one-, two- or three-vessel disease, PWV was a significantly associated with the severity of CAD (p < 0.001)., Conclusion: Our findings suggest that PWV is an independent risk marker for CAD, as well as strongly associated with the severity of CAD.