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Background: This study aimed to present the development process and characteristics of the Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers (KRAMI-RCC). Methods: We developed KRAMI-RCC, a web-based registry for patients with AMI. Patients from 14 RCCs were registered for more than three years from July 2016. It includes an automatic error-checking system, and user training and on-site monitoring are performed to manage data quality. Results: A total of 11,700 AMI patients were registered in KRAMI-RCC over three years (73.9% men). The proportions of patients with ST-elevation and non-ST-elevation myocardial infarction at discharge were 43.4% and 56.6%, respectively. Of the total three-year patients, 5.6% died in the hospital, and 4.4% died 12 months after discharge. The case fatality within 12 months was 9.7%. Pre-hospital care data showed delayed arrival time after onset of symptoms (median 153 min) and low transportation rate by public ambulance (25.2%). Post-hospital care data showed lower participation rate in the second rehabilitation program (16.8%). Conclusions: The recently developed KRAMI-RCC registry has been more focused on pre-hospital and post-hospital data, which will be helpful in understanding the current state of AMI disease management and in making policy decisions to reduce case fatality in Korea.

Background Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention. Methods Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138). Results During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, P = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, P = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) (P < 0.001). Conclusion In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention., Graphical Abstract

BACKGROUND AND OBJECTIVES This study was performed to describe clinical characteristics of patients with left ventriculars (LV) dysfunction and implantable cardioverter-defibrillator (ICD), and to evaluate the effect of ICD therapy on survival in Yeongnam province of Korea. SUBJECTS AND METHODS From a community-based device registry (9 centers, Yeongnam province, from November 1999 to September 2012), 146 patients with LV dysfunction and an ICD implanted for primary or secondary prophylaxis, were analyzed. The patients were divided into two groups, based on the etiology (73 with ischemic cardiomyopathy and 73 with non-ischemic cardiomyopathy), and indication for the device implantation (36 for primary prevention and 110 for secondary prevention). The cumulative first shock rate, all cause death, and type and mode of death, were determined according to the etiology and indication. RESULTS Over a mean follow-up of 3.5 years, the overall ICD shock rate was about 39.0%. ICD shock therapy was significantly more frequent in the secondary prevention group (46.4% vs. 16.7%, p=0.002). The cumulative probability of a first appropriate shock was higher in the secondary prevention group (p=0.015). There was no significant difference in the all-cause death, cardiac death, and mode of death between the groups according to the etiology and indication. CONCLUSION Studies from this multicenter regional registry data shows that in both ischemic and non-ischemic cardiomyopathy patients, the ICD shock therapy rate was higher in the secondary prevention group than primary prevention group.

Purpose Radiofrequency catheter ablation of the cavotricuspid isthmus (CTI) is effective in the treatment of typical atrial flutter (AFL) and atrial fibrillation (AF). AF and AFL often coexist. However, AF often occurs following successful ablation of CTI. The aim of this study was to investigate the predictors of concomitant AF following successful ablation of AFL. Methods We enrolled 122 patients [59.1 ± 11.3 years, male 100 (82.0%)] with typical AFL, who received successful ablation of the CTI. They were followed up at outpatient clinic (24.6 ± 25.7 months). Twelve-lead electrocardiogram and Holter monitoring were used to confirm the diagnosis of recurrent AFL or AF. We assessed prior history of AF, structural heart disease, left ventricular ejection fraction, left atrial diameter (LAD), left atrial volume index (LAVI), and AFL cycle length. Results Among the 122 ablated patients, 15 (12.3%) had recurrent AFL and 33 (27.0%) had recurrent AF. In univariate logistic analysis, LAD and LAVI could significantly predict the recurrence of AF after AFL ablation. However, multivariate logistic regression analysis found that the independent predictor of recurrent AF was LAVI. An LAVI of 42.6 mL may allow for the differentiation between only AFL and AFL with concomitant AF with 69.0% sensitivity and 69.8% specificity. Conclusions LAVI might be a useful predictor for occurrence of AF after ablation of typical AFL.

Objectives: Slow flow phenomenon is a serious complication of percutaneous coronary intervention (PCI) and is associated with a poor prognosis. We sought to evaluate the characteristics of lesions predisposing to the slow/no-reflow phenomenon during primary PCI in patients with acute myocardial infarction. Methods: The study subjects consisted of 57 consecutive patients (mean age 58.5 (SD 14.5) years, 45 males) who underwent primary PCI for acute myocardial infarction and intravascular ultrasound-virtual histology (IVUS-VH) examination. Slow flow was defined as ⩽ thrombolysis in myocardial infarction grade 2 after PCI. Results: Slow flow developed in 12 patients (eight males). Patients with slow flow were likely to be older (67.5 (13.8) years vs 56.2 (13.9) years, p = 0.015), had more cardiogenic shock (16.7% vs 2.2%, p = 0.046), larger fibrofatty volume over the entire lesion length (36.7 (25.5) mm 3 vs 18.0 (18.6) mm 3 , p = 0.006), higher remodelling index (1.10 (0.17) vs 0.99 (0.16), p = 0.043), larger plaque area (16.2 (5.4) mm 2 vs 12.5 (4.9) mm 2 , p = 0.025), fibrous area (8.0 (3.3) mm 2 vs 5.4 (3.0) mm 2 , p = 0.014) and fibrofatty area (2.7 (2.2) mm 2 vs 1.3 (1.6) mm 2 , p = 0.016) at the minimal lumen site than those without slow flow (37 males). Multivariate analysis revealed that the fibrofatty volume over the entire lesion length was the only independent factor (β = 0.359, 95% confidence interval 0.002 to 0.012, p = 0.006) for slow flow during primary PCI. Conclusions: This study suggests that slow flow may be dependent on the tissue characterisation (fibrofatty volume) of the underlying lesion at the time of the primary PCI for acute myocardial infarction.

Background The long-term clinical efficacy of intracoronary stenting is limited by restenosis and delivery by the stent of agents inhibiting cell cycle progression should prevent in-stent neointimal hyperplasia. Carvedilol is an antioxidant that inhibits smooth muscle cell proliferation and migration, whereas probucol is a vascular protectant and reduces stent restenosis by improving the lumen dimension at the stent placement site. Methods and Results BiodivYsio® phosphorylcholine-coated stents were dip-coated with carvedilol (5 mg/ml) or probucol (50 mg/ml) by immersion in respective methanol solutions. Twenty-four stents (carvedilol =8, probucol =8, control =8) were placed in 12 pigs and histopathologic analysis was done 4 weeks later. Histomorphometry of the carvedilol-coated stent group compared with the control groups showed that the neointimal area decreased by 42% (1.12±0.55 mm2 in the carvedilol group vs 1.9240.52 mm2 in the control, p=0.004) and the lumen area increased by 20% (5.1540.90 mm2 vs 4.1740.87 mm2, p=0.008), resulting in a 43% reduction of the percent area stenosis (18.2249.6% vs 31.949.2%, p=0.002). In the probucol-coated stent group, the lumen area, neointimal area, and %area stenosis did not different significantly from the control group. There were 7.742.97% proliferating nuclear cell antigen-positive cells in the carvedilol-coated stent group compared with 17.841.45% in the control group (p=0.0001) and 15.941.91% in the probucol group (vs control, p=NS). Conclusions The carvedilol-coated stent, but not the probucol-coated one, inhibited neointimal hyperplasia in a porcine stent restenosis model. (Circ J 2005; 69: 101 - 106)

Background Patterns of arterial remodeling during the course of plaque development have been shown to play an important role in both the progression of de novo atherosclerosis and in the restenotic process following coronary intervention. The aim of the present prospective study was to evaluate the effect of pre-interventional arterial remodeling on in-stent neointimal hyperplasia (NIH) and in-stent restenosis (ISR) after stenting. Methods and Results Pre-interventional arterial remodeling was assessed in 85 native coronary lesions by using intravascular ultrasound (IVUS). The remodeling index (RI) was 1.09±0.20 in the positive remodeling (PR)/intermediate remodeling (IR) group and 0.84±0.12 in the negative remodeling (NR) group. The plaque plus media cross sectional area (PM p=0.001, p=0.001, respectively). On 3-dimensional analysis of IVUS images at follow-up, the lumen volume was significantly smaller in the PR/IR group than that in the NR group (62±15 mm3 vs 75 ±20 mm3; p=0.001), and neointima hyperplasia volume was significantly larger in the PR/IR group than that in the NR group (46±15 mm3 vs 26±10 mm3; p=0.001). A significant positive correlation was found between pre-interventional RI and follow-up NIH CSA (r=0.25, p=0.022). The incidence of ISR and repeat intervention was significantly higher in the PR/IR group (30.8% vs 18.2%, 28.8% vs 15.2%; p=0.032, 0.035, respectively). Conclusion Measuring pre-interventional arterial remodeling patterns by IVUS may be helpful to stratify lesions at high-risk of ISR. (Circ J 2005; 69: 414 - 419)

Background and Objectives: Coronary lesions with mismatched functional and anatomical significance are not uncommon. We as sessed the accuracy and predictors of mismatch between fractional flow reserve (FFR) and quantitative coronary angiography (QCA) analy ses in patients with coronary lesions. Subjects and Methods: A total of 643 lesions with pre-interventional FFR and QCA measurements were consecutively enrolled and divided into four groups using FFR ≤0.80 and percent diameter stenosis (%DS) ≥50% as cutoffs for functional and anatomical significance, respectively. Accordingly, FFR >0.80 and DS ≥50%, and FFR ≤0.80 and DS

We report a case of giant coronary aneurysm presenting with cardiac tamponade, which was well documented with coronary angiography.

Protein C and S are plasma proteins that inhibit the anticoagulation system. Activated protein C in the presence of protein S (a cofactor) inhibits activated factor V and VIII. These protein deficiencies have been commonly associated with venous thromboembolism and occasionally with pulmonary thromboembolism by inducing a systemic hypercoagulability. However cardiac involvement alone is very rare. We report here on a case of intracardiac multichamber thrombi with combined protein S and C deficiencies.

Toad toxin has digitalis-like cardioactive effects that include bradycardia, varying degrees of atrioventricular block, ventricular tachycardia, ventricular fibrillation and sudden cardiac death. We report here on a 54-year-old man who had varying degrees of atrioventricular block and nonsustained ventricular tachycardia two hours after he ate a bowl of toad soup. (Korean Circulation J 2007;37:283-286)

Background and Objectives：Serum uric acid has been reported to be an independent risk factor for coronary artery disease (CAD) and a predictor of mortality in patients with CAD. Yet there is gender difference for the serum uric acid levels. We evaluated the influence of the uric acid levels on major adverse cardiovascular events (MACEs) in patients with CAD according to their gender. Subjects and Methods：Of the 777 patients with angiographically proven CAD, 660 patients (378 males, 57.3%) were followed up a median of 18 month (maximum: 61 month). The MACEs included acute myocardial infarction, cerebral infarction, coronary artery bypass graft, percutaneous coronary intervention due to de novo lesion during follow up, new onset congestive heart failure and sudden cardiac death. Results：MACEs in men were associated with acute coronary syndrome (ACS)(odds ratio (OR): 2.03, 95% confidence intervals (CI): 1.01 to 3.96, p=0.038), multi-vessel disease (OR: 3.68, 95% CI: 1.82 to 7.47, p=0.000) and the serum uric acid levels (OR: 1.23, 95% CI: 1.01 to 1.50, p=0.044), according to multivariate Cox regression analysis. For women, MACEs were associated with multi-vessel disease (OR: 2.43, 95% CI: 1.15 to 5.13, p=0.020) and the highest uric acid quartile (OR: 2.64, 95% CI: 1.31 to 5.30, p=0.006) according to multivariate Cox regression analysis. For all patients, the highest uric acid quartile was associated with an increased risk of MACE (p=0.000), and CHF was the major contributor to the observed MACEs (p=0.004). Conclusion：In male patients with CAD, the serum uric acid level is a predictor of cardiovascular events, and the highest uric acid quartile is a predictor of cardiovascular events in women. (Korean Circulation J 2007;37:196-201)

Background and Objectives: Nitroglycerin-mediated arterial dilation (NMD) was shown to be preserved in most previous studies, and this is possibly due to using a single high dose of nitroglycerin (NTG), which causes maximal arterial dilation. We sought to evaluate the clinical factors of flow-mediated dilation (FMD) and NMD at different doses of NTG in the patients with coronary artery disease (CAD). Subjects and Methods: Thirty-two consecutive patients (mean age: 61 years old, 18 males) with angiographically proven CAD underwent FMD and NMD at total cumulative doses of 25μg, 175μg and 325μg with using high-resolution ultrasound for the imaging. Results: The FMD, NMD (25μg), NMD (175μg) and NMD (325μg) were 4.72±1.82%, 7.08±3.02%, 13.33±6.14% and 15.89±7.24%, respectively (p

Background and Objectives：Rupture-prone plaque, characterized by a large necrotic core, thin fibrous cap and large number of inflammatory cells, is known to be associated with acute coronary syndrome (ACS) from several autopsy and animal studies. We sought to assess in-vivo lesion characteristics of culprit lesions in patients with ACS. Subjects and Methods：One hundred consecutive patients (mean age 60.4 years, 70 males), who underwent percutaneous coronary intervention, were analyzed for intravascular ultrasound (IVUS) radiofrequency information using IVUS-virtual histology (VH) software. Results：Patients with ACS (n=44, mean 59.7 years, 34 males) had a lower prevalence of hypertension (45.5% vs. 67.9%, p=0.024), higher level of high-sensitivity C-reactive protein (0.36±0.36 mg/dL vs. 0.22±0.27, p=0.043), longer lesion length (22.6±8.6 mm vs. 19.3±6.9 mm, p=0.036), and more plaque rupture (63.6% vs. 10.7%, p

Background and Objectives:Whether uric acid is a predictor of cardiovascular events remains controversial. We sought to evaluate the effects of the serum uric acid levels on major adverse cardiovascular events (MACEs) in the patients with coronary artery disease (CAD). Subjects and Methods:The study population consisted of 660 consecutive patients with CAD, and they were followed up for a mean of 27 months (maximum: 62 months). The recorded MACEs included acute myocardial infarction (AMI), stroke, coronary artery bypass graft, percutaneous coronary intervention (PCI) due to de novo lesion during follow up, congestive heart failure (CHF) and sudden cardiac death. Results:In the CAD patients with a uric acid level ≤3.88 mg/dL (the lowest quartile), as compared with those CAD patients with uric acid levels >5.74 mg/dL (the highest quartile), the MACE rate increased from 7.2% to 20.1%. On univariate Cox regression analysis, the highest uric acid quartile was a predictor of AMI, CHF and MACE. The absolute serum uric acid level was predictive of PCI, CHF and MACE. Multivariate Cox regression analysis showed that the independent predictors of MACE were presentation with acute coronary syndrome (HR 1.70, 95% CI: 1.04 to 2.78, p=0.033), multi-vessel disease (HR 2.43, 95% CI: 1.44 to 4.12, p=0.001), and the uric acid levels (HR 1.22, 95% CI: 1.05 to 1.43, p=0.010), and the highest uric acid quartile (HR 2.54, 95% CI: 1.58 to 4.10, p

Background and Objectives：While the clinical significance of descending thoracic aorta intima-media thickness (DTA-IMT) remains unclear, common carotid IMT (CIMT) is known to be associated with major adverse cardiovascular events (MACE) in patients with atherosclerotic disease. Subjects and Methods：A total of 104 patients (mean age, 59 yrs; 69 male) with angiographically proven coronary atherosclerosis underwent transesophageal echocardiography (TEE) for DTA-IMT measurement and carotid scanning for CIMT measurement. The patients were divided into two groups based on the median IMT value, and they were followed up for cardiovascular events and all-cause mortality for a period of 50±21 months. Results：Patients having a higher DTA-IMT value (n=44, >2.1 mm) had a higher chance of stroke (6.7% vs. 2.8%, p=0.04), peripheral vascular disease (6.7% vs. 1.9%, p=0.02), and death (2.9% vs. 0%, p=0.04) than those who had lower DTA-IMT values (n=60, ≤2.1 mm). The patients who had higher CIMT values (n=49, >0.089 mm) had a higher chance of peripheral vascular disease (16% vs 2%, p= 0.009) than those having lower IMT values (n=55, ≤0.089 mm). However, there was no significant difference between the groups in terms of recurrent chest pain, heart failure, syncope, myocardial infarction or chronic kidney disease during the follow-up period. Multivariate Cox regression analysis revealed that increased DTA-IMT was associated with stroke (OR, 4.29; 95% CI, 1.076-17.181; p=0.039) and peripheral vascular disease (OR, 9.37; 95% CI, 1.571-55.499; p=0.014), whereas increased CIMT was associated with peripheral vascular disease (OR, 14.365; 95% CI, 1.050-196.540; p=0.046). Conclusion：This study suggests that descending thoracic aorta IMT is more closely associated with prognosis in patients with coronary atherosclerosis than CIMT. (Korean Circulation J 2007; 37:365-372)

Background and Objectives: A prolonged heart rate-corrected QT interval (QTc) is known to be related to an increased risk of coronary artery disease (CAD) and sudden cardiac death, while the carotid intima-media thickness (IMT) is related to CAD. We sought to evaluate the relationship among the QTc, the carotid IMT and the severity of CAD. Subjects and Methods: The QTc and the carotid IMT were measured in 165 consecutive patients who underwent coronary angiography. The measurement of the QTc was done automatically by a digital QT Guard TM system (GE Marquette Medical System, Milwaukee, USA) and the carotid IMT was measured by M’ATH software (METRIS Co., Argenteuil, France). The severity of CAD was divided into minimal disease (90, 54.5%), one-vessel disease (32, 19.4%), and multi-vessel disease (43, 26.1%), according to the number of vessels that were narrowed by more than 50%. Results: The mean values of the QTc were 415.1±20.5 msec in the minimal disease group, 411.7±17.0 msec in the one-vessel disease group and 434.2±46.1 msec in the multi-vessel disease group. The QTc was correlated with age (r=0.236, p=0.002), HDL cholesterol (r=-0.160, p=.043), the right carotid IMT (r=0.17, p=0.026), the left carotid IMT (r=0.178, p=0.022) and the severity of CAD (r=0.243, p=0.002). On the multiple linear regression analysis after adjustment for age and HDL cholesterol, the QTc was an independent factor for the severity of CAD. Conclusion: These results suggest that repolarization abnormalities are associated with the severity of CAD and they may reflect the severity of the morphologic atherosclerotic surrogates. (Korean Circ J 2007;37:538-542)

Background and Objectives:It’s not clear whether the serum lipid level is associated with the individual carotid arterial wall thickness for patients suffering with coronary atherosclerosis, although hypercholesterolemia is associated with an increased carotid IMT. We sought to evaluate the association between the serum lipid level and the individual carotid arterial wall thickness (intimal thickness (IT) and medial thickness (MT)) as well as the carotid intima-media thickness (IMT) for patients with coronary atherosclerosis. Subjects and Methods:The carotid arterial wall thickness was measured using high-resolution B-mode ultrasound in 139 consecutive patients (58±11 years old, 75 males) with coronary atherosclerosis by performing coronary angiography. Results: Measurement of the individual arterial wall thickness was possible in 126 patients (90.6%) out of all the study subjects. The carotid IMT was correlated with the total cholesterol (r=0.207, p=0.015) and low-density lipoprotein (LDL) cholesterol (r=0.237, p=0.006). The carotid IT was correlated with the total cholesterol (r=0.210, p= 0.020), triglyceride (r=0.212, p=0.018), and LDL-cholesterol (r=0.246, p=0.006), whereas the MT did not show any significant correlation with the serum lipid level. Multivariate analysis disclosed that the serum LDL cholesterol level was associated with the carotid IMT and IT for the patients with coronary atherosclerosis, but it was not correlated with the MT. Conclusion:This study suggests that the serum LDL cholesterol level is more closely associated with the carotid IT than the IMT for patients with coronary atherosclerosis, and each carotid arterial wall has a different response to the serum lipid level. (Korean Circulation J 2007;37:380-384)

Background and Objectives：Increased carotid intima-media thickness (IMT) is known to be associated with adverse cardiovascular events in the patients with risk factors or established atherosclerosis. However, the prognostic importance of carotid IMT is uncertain in the patients who underwent percutaneous coronary intervention (PCI). We sought to evaluate the association of carotid IMT with major adverse cardiovascular events (MACE) and restenosis in the patients who underwent PCI. Subjects and Methods：The study population consisted of 308 consecutive patients who underwent PCI, and they were followed up for mean of 30.6±13.3 months. Base on the median values of carotid IMT, which was measured in the right common carotid artery at the time of PCI with using high-resolution ultrasound and a semiautomatic method, the subjects were divided into the thick (n=156, 1.003±0.14 mm) and thin IMT (n=152, 0.748±0.07 mm) groups, and they were followed up for at least 1 year. Results：Patients with thick carotid IMT were older (61±9 years vs. 57±10 years, respectively, p=0.001), had a higher body mass index (25.0±3.0 vs. 23.9±4.0, respectively, p=0.017), a history of previous myocardial infarction (20% vs. 9%, respectively, p=0.008), more multivessel disease and more restenosis (34.6% vs. 23.0%, respectively, p=0.025) than those patients with a thin carotid IMT. However other MACEs such as death, myocardial infarction, stroke, heart failure and target lesion revascularization did not show any significant differences between the two groups. Multivariate Cox regression analysis showed that carotid IMT was an independent predictor of restenosis (odds ratio: 1.754, 95% confidence interval: 1.1296 to 2.726, p=0.012). Conclusion：An increased carotid IMT is associated with restenosis, but it does not have clinical prognostic importance for the patients who underwent PCI during a mean follow up period of 31 months. (Korean Circulation J 2007;37:103-107)

Electrical injury may lead to a conduction disorder of the heart. We report here on a 36-year-old man, who was treated with a permanent pacemaker, after an electrical injury induced high-degree atrioventricular block and clinical manifestations (dizziness and dyspnea). (Korean Circulation J 2006;36:767-770)

Background and Objectives:There is little clinical data on the results of using Sirolimus-Eluting Stent (SES) for treating In-Stent Restenosis (ISR). We performed this study to evaluate the clinical outcomes for implanting SES for treating ISR in a real world hospital environment. Subjects and Methods:A total of 30 patients with 32 ISRs (males: 73.3%, mean age: 60.2) (focal lesions: 21.9%, diffuse intra-stent lesions: 34.4%, proliferative lesions: 21.9%, total occlusions: 21.9%) were treated with SES after balloon predilation was performed. We evaluated the clinical results and the performed coronary angiography after 6 months. Results:All the procedures were successful. The mean SES diameter and length were 3.0±0.3 mm and 27.1±5.5 mm, respectively, and the mean acute gain was 2.42±0.38 mm. No in-hospital major adverse cardiac events (MACE) were observed. Twenty five patients with 27 lesions (84.4%) underwent coronary angiography at their 6 month follow-up. The late loss and loss index were 0.41±0.56 mm and 0.18±0.22, respectively. The binary restenosis rate was 7.4% (2/27 lesions). The rate of target lesion revascularization was 3.7% (1/27 lesion). The incidence of MACE at 6 months was 3.3% (1/30 patient). Conclusion:Treating ISR with SES is a safe and effective procedure for reducing ISR without the occurrence of acute or sub-acute thrombosis. (Korean Circulation J 2006;36:121-125)

Background and Objectives：It has been reported that the common carotid artery (CCA) intima-media thickness (IMT) correlates to angiographically determined coronary artery stenosis. The aim of this study was to evaluate the correlation between the carotid IMT and left main (LM) plaque using ultrasonography. Subjects and Methods：In fifty patients (mean age 59.6±9.9, males 35 (70%)) with coronary artery disease (CAD), the risk factors of atherosclerosis were evaluated and coronary angiographs obtained. The carotid IMT was measured in the far wall of both CCAs, with a 10 MHz linear probe, and the value of the IMT was automatically calculated using programmed software (M’ATH, METRIS Co., Argenteuil, France). The LM plaque was measured by intravascular ultrasound. The maximal thickness, ratio of the maximal thickness, cross-sectional area (CSA) and burden of the plaque were measured at 2 mm intervals, and the average values calculated. Results：In the right common carotid artery, the maximal IMT significantly correlated with the mean plaque CSA and plaque burden of the LM (r=0.375. p=0.007, r=0.408. p=0.003, respectively). The mean IMT significantly correlated with the plaque burden of the LM, but not with the mean plaque CSA of the LM (r=0.357. p=0.011, r=0.264. p=0.063, respectively). In the left common carotid artery, the maximal IMT was not significantly correlated with the mean plaque CSA and plaque burden of the LM (p=0.251, p=0.218, respectively). The mean IMT was not correlated with the mean plaque CSA and plaque burden of the LM (p=0.249, p=0.078, respectively). Conclusion：There was a significant correlation between the right CCA IMT and plaque burden of the LM in patients with CAD. (Korean Circulation J 2005;35:795-800)

We report a case of in-stent restenosis due to the fracture of a sirolimus-eluting stent, which was confirmed by intravascular ultrasound. It can be suggested that a stent fracture is an important cause of restenosis in this era of drug-eluting stents. (Korean Circulation J 2005;35:787-789)

Background and Objectives:From a clinical standpoint, coronary artery disease in blood vessels measuring 2.5 mm to 2.75 mm, as accessed by quantitative coronary angiography (QCA), has been classified as a small vessel disease, and it is treated with percutaneous coronary intervention (PCI). The aim of this study was to evaluate the discrepancy of vessel size between intravascular ultrasound (IVUS) and QCA, and its late outcome before and after stent implantation in patients with small coronary artery disease (2.5-2.75 mm). Subjects and Methods:We enrolled 135 patients having 143 lesions who underwent IVUS-guided PCI. Twenty-three patients (26 lesions) were in the small vessel (SV, ≤2.75 mm) group and 112 patients (128 lesions) were in the large vessel (LV, >2.75 mm) group. We evaluated the IVUS and QCA parameters’ association with mortality, acute myocardial infarction (AMI) and target vessel revascularization (TVR) at the 1 year follow-up. Results:On QCA, the pre-interventional reference vessel diameters and post-stent minimal lumen diameters in the SV group were smaller than those in the LV group. The discrepancy of vessel size between IVUS and QCA at the reference site was larger in the SV group than that in the LV group (1.44 mm vs. 0.92 mm, respectively p

Background and Objectives：This study was performed to evaluate the clinical usefulness of the carotid intimamedia thickness (IMT) as a screening test for coronary artery disease (CAD), and evaluate the differences in the carotid IMT in CAD patients with age- and sex-matched healthy subjects and hyperlipidemic hypertensive patients. Subjects and Methods：The study was conducted on a total of 609 subjects; 229 patients with CAD (mean age; 53 yrs, 148 males), 207 age- and sex-matched hyperlipidemic hypertensive patients (mean age; 52 yrs, 115 males) and 173 age and sex matched healthy subjects (mean age; 52 yrs, 100 males). The carotid IMT was semi-automatically measured using high-resolution ultrasound. The clinical variables and carotid IMT in the study subjects were compared, and the data analyzed. Results：The mean carotid IMT in patients with CAD (0.87±0.19 mm) was significantly higher than that in hyperlipidemic hypertensive patients (0.72±0.14 mm, p

Background and Objectives:We performed this study to evaluate the feasibility and accuracy of the newly developed Korean software (KS) for measurement of the carotid intima-media thickness (IMT), which was compared with the commercial software. Subjects and Methods:The study population consisted of 60 consecutive patients (mean of 59 years old, 27 males) undergoing transthoracic echocardiography. We measured the carotid IMT using both software packages, and also measured the intima thickness (IT) and media thickness (MT), separately, using the KS package. Results:Measurement of the IMT was possible in all the study subjects with both software packages, but the separate measurements of the IT and MT was possible in only 24 patients using the KS package. The mean IMT using the commercial and KS packages were 0.727±0.157 and 0.733±0.156 mm, respectively, which were found to correlate (r=0.985, p=0.000). The mean IMT, IT and MT of the 24 patients were 0.841±0.138, 0.340±0.033 and 0.505±0.124 mm, respectively. The carotid IMT was correlated with the IT and MT and also with the IT/IMT, MT/IMT and IT/MT ratios (r=0.562, p=0.004; r=0.934, p=0.000; r= -0.809, p=0.000; r=0.591, p=0.002; r=-0.754, p=0.000, respectively). The IT was found not to correlate with the MT (r=0.369, p=0.076). Age was found to correlate with the IMT using both the commercial and KS packages (r=0.616, p=0.000; r=0.583, p=0.000, respectively), and with the MT and IT/IMT and IT/MT ratios (r=0.504, p=0.012; r=-0.538, p=0.007; r=-0.428, p=0.037), but not with the IT (r=0.300, p=0.154). Conclusion:The newly developed KS was feasible and accurate in measuring the carotid IMT, which can also be used to separately measure the IT and MT. (Korean Circulation J 2005;35:625-632)

Background and Objectives:An elevated serum homocysteine level is a risk factor of atherosclerosis. The relationship between homocysteine and antioxidant vitamins, and other cardiovascular risk factors, and between cardiovascular patients and controls, were evaluated. Subjects and Methods:The study population consisted of 146 patients, with objectively first diagnosed ischemic heart disease, and 146 healthy sex and age matched controls. The serum levels of homocysteine, folate, vitamin B12 and vitamin B6 were measured. The correlation between the serum levels of homocysteine and those of folate, vitamin B6 and vitamin B12 were also evaluated. Results:The serum homocysteine concentrations were significantly higher in the cardiovascular patients than in the matched controls (13.35±0.51 mmol/l vs. 11.43±0.37 mmol/l, p=0.003). However, there was no significant difference between the stable angina, unstable angina and myocardial infarction subgroups. From a multivariate analysis, the elevated homocysteine level was still associated with a low folate level (patient group;r=-0.380, p=0.000, control group;r=-0.229, p=0.000). The measured vitamin B12 level showed no correlation with the homocysteine level in the cardiovascular patients, but did in the controls (R=0.066, p

Background and Objectives:Adiponectin is an adipocyte derived plasma protein that is known to have an anti-atherogenic effect. Low plasma adiponectin concentrations are found in obesity, diabetes and coronary artery disease. The measurement of the plasma adiponectin level is helpful in the assessment of the risk for coronary artery disease. The intercellular adhesion molecule (ICAM)-1 is associated with the atherosclerotic inflammatory response. An elevated ICAM-1 concentration is associated with increased risk of future coronary events, independent of other risk factors. The relationships between serum adiponectin and ICAM-1 levels and the progression of coronary artery stenosis with instent restenosis of previous stent sites were analyzed. Subjects and Methods:83 patients who had percutaneous transluminal coronary angioplasty and stent insertion were enrolled. The initial angiographic finding was compared with that at the 6 month follow up. The serum adiponectin and ICAM-1 level were measured with the plasma lipid profiles prior to percutaneous coronary intervention. These biochemical parameters were analyzed according to the progression of coronary artery stenosis (≥10%) and instent restenosis (≥50%). Results:In the coronary artery stenosis progression group, there were significantly lower adiponectin (3.91±1.24 μg/mL vs. 4.66±1.36 μg/mL, p=0.03) and higher ICAM-1 levels (199.16±79.13 ng/mL vs. 150.54±63.65 ng/mL, p=0.03). The instent restenosis group also showed lower adiponectin (3.99±1.22 μg/mL vs. 4.33±1.38 μg/mL) and higher ICAM-1 (195.17±68.45 ng/mL vs. 171.47±80.48 ng/mL) levels, but without statistical significance. Conclusion:The serum adiponectin and ICAM-1 levels are related to the progression of coronary artery stenosis. However, further study will be required to confirm the relationships between the serum adiponectin and ICAM-1 levels and instent restenosis. (Korean Circulation J 2004; 34(9):837-844)

Background and Objectives:In dialysis patients, the cardiovascular mortality is 10 to 20 times higher than that in the general population. The increased arterial stiffness in patients with end-stage renal disease (ESRD) is an independent predictor of all-cause mortality. The arterial stiffness and atherosclerotic markers were evaluated in patients with ESRD treated with and without hemodialysis (HD) or peritoneal dialysis (PD). Subjects and Methods:14 hemodialysis (mean dialysis duration 19.6 months), 14 peritoneal dialysis (mean dialysis duration 26.1 months) and 14 patients with ESRD prior to initiation of dialysis, and 27 age-sex matched controls were enrolled. The calculated central pulse pressure, plasma homocysteine, serum C-reactive protein, left ventricular mass index and aortic pulse wave velocity (PWV) were measured. Results:Patients with ESRD treated with and without dialysis had greater increases in their arterial stiffness and advanced atherosclerosis compared with the controls. However, there was no difference in the arterial stiffness and atherosclerotic markers before and after the dialysis treatment, or in the dialysis modality (HD, PD) of patients with ESRD. In a multiple regression model, PWV in patients with ESRD was explained by the level of plasma homocysteine (β=0.396;p=0.027). Conclusion:Atherosclerosis and arterial stiffness in patients with ESRD may not be affected by dialysis treatment or modality. In patients with ESRD, the level of plasma homocysteine is independently associated with arterial stiffness. (Korean Circulation J 2004;34(9):865-873)

Background and Objectives:Congenital long QT syndrome (LQTS) is a genetic disease that brings prolongation of the QT interval on an electrocardiogram and leads to syncope and sudden death by a fatal ventricular arrhythmia. In Korea, there have been studies about the clinical characteristics and treatment of LQTS, but there are no studies for the molecular and biological evaluation of its genetic mutation. Subjects and Methods:Six nationwide university hospitals and laboratories segregated DNA from the blood of 10 patientsdiagnosed with LQTS to analyze the genetic mutation. Results:Nine out of ten individuals were female. Eight showed genetic mutations. Three had an abnormality in the KvLQT1, 6 in the HERG and 2 had abnormalities in both KvLQT1 and HERG. None had abnormalities in KCNE1 and 2 showed no abnormalities in KvLQT1, HERG or KCNE1. Conclusion:Congenital LQTS shows various genetic mutations, and this indicates the necessity for further organized study in more individuals for confirmation of the relationship between the results of clinical diagnosis and genetic analysis. (Korean Circulation J 2004;34(8):813-819)

Background and Objectives:In radiofrequency catheter ablation (RFCA), it is an essential point to understand the characteristics of local electrograms at arrhythmic focus. However controversy exists as whether the unipolar or bipolar electrogram is superior in detecting arrhythmic focus. Subjects and Methods:We evaluated the characteristics of unipolar and bipolar electrograms at ventricular tachycardia (VT) origin. Electroanatomical mapping and RFCA were performed in 6 patients with idiopathic VT. 22 sites were enrolled and 6 of them were successful sites. We analyzed the relationship between surface and local electrograms in accordance with success or failure. We also analyzed the morphology of local electrograms. Results:At successful sites of RFCA, point of unipolar onset (22.86±10.82 msec vs 5.47±26.31 msec, p

Commotio cordis is sudden death due to a non-penetrating chest wall impact in the absence of structural injury to the heart and chest wall. It usually occurs during sports games, like baseball, ice-hockey and soft balls, in young children. When objects (baseball, hockey puck, etc) strike the chest, a fatal arrhythmia like ventricular fibrillation can occur. We report a case of ventricular fibrillation that occurred after a light blunt trauma to the chest wall. (Korean

A single coronary artery is a rare congenital anomaly. The right coronary artery, originating from distal left circumflex, is an extremely rare variety of a single coronary artery. Our report is accompanied by a brief review of the literature.

Numerous central nervous system disorders can produce various electrocardiographic abnormalities due to vagal stimulation. These common abnormalities may include:QT prolongation, a large and inverted T wave and a prominent U wave etc. Sinus bradycardia and atrioventricular block have rarely been reported. We experienced a case of sick sinus syndrome, which was associated with a subarachnoid hemorrhage and subdural hematoma following a head trauma. (Korean Circulation J 2003;33 (12):1151-1154)

Background and Objectives:The change in QT dispersion (QTd) immediately after balloon angioplasty refl- ects the immediate impact of ischemia. We intended to analyze the immediate impact of ischemia on myocardial repolarization. Subjects and Methods:Forty-six patients who underwent percutaneous coronary intervention were enrolled. The standard 12-lead electrocardiogram (ECG) was recorded just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning. QTd was determined by the difference between the maximum and mi- nimum QT interval (QTi). We then calculated the corrected QTi (QTc) using Bazett's formula. QTd and QTi were compared according to the site of the ballooned vessel, number of ballooned vessels and history of acute myocardial infarction. Results:QTd just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning were 35.21±10.36 msec, 54.56±16.89 msec, 50.91±14.20 msec, 45.52±9.6 msec and 38.56±10.89 msec, respectively. QTd increased markedly during ballooning, but after myocardial ischemia was relieved, decreased rapidly. Ten minutes after ballooning, QTd was reduced to a similar level as that of baseline. There were no signi- ficant differences between the AMI and non-myocardial infarction groups, single-vessel and multi-vessel groups, and the location of the stenosed artery. There was no significant difference in QTi according to different stenosed vessel. Conclusion:QT (QTc) dispersion increased rapidly with myocardial ischemia and reduced rapidly after the myocardial ischemia was resolved. Therefore, increased QTd can be used as an early clue of myocardial

Background:Coronary sinus catheterization is important in electrophysiological studies. However the morphologic feature of the coronary sinus and its significance in patients with supraventricular tachycardia (SVT) have not been determined. During diagnostic electrophysiological studies, coronary sinus catheterization was easier in patients with atrioventricular nodal reentry tachycardia (AVNRT) than in patients with atrioventricular reentry tachycardia (AVRT). Therefore, we studied coronary sinus morphology in patients with SVT and compared AVNRT and AVRT patients. Methods:The size and shape of the coronary sinus were measured in 13 patients who underwent retrograde coronary sinus venogram during electrophysiologic study between May and June 1996. The diagnosis was 7 cases of AVNRT, 2 of Wolff-Parkinson-White syndrome and 4 of concealed bypass tracts (mean age, 40 years:male vs female, 1:1.2). Results:The mean coronary sinus ostial diameter was 10.4±2.0 mm;for AVNRT, it was 11.4±2.2 mm, and for AVRT it was 9.3±1.0 mm in left anterior oblique projection (p=0.031). The mean coronary sinus-to-spine angle was 82.6±17.4°:AVNRT 95.4±24.4° and AVRT 67.7±15.2° in anterior posterior projection (p=0.035). Conclusion:The coronary sinus ostial diameter of AVNRT patients was significantly larger than that of AVRT patients. This finding may have important implications for arrythmia pathogenesis in such patients. (Korean Circulation J 1998;28(4):620-625)

Background:Recently, the incidence of acute myocardial infarction (AMI) rapidly increased with prolongation of life spans, improvements of food and life styles in Korea. The mortality rate of AMI is higher than other disease. The purpose of this study is to evaluate which factors can affect the early outcome of AMI in Korean. Methods:A retrospective clinical study was done on 555 consecutive patients{Male:Female=387 (69.7%): 168 (30.3%), mean age 61.3 years} with AMI who had been admitted to Dong-San Medical Center from January 1990 to May 1997. The subjects were devided into two groups. Group I was dead patients during the in-hospital period (85 patients, 15.3%), and Group II was living patients (470 patients, 84.7%) wen they discharged from hospital. We compared clinical and laboratory results in both groups and analysed the cause of death according to the time of death during hospitalization. Results:The results were as follows;1) The mean age and female percentage of Group I (65.4 years, 43%) were higher than Group II (60.5 years, 28%). The mean of systolic/diastolic blood pressure and percentage of smoker of Group I (108/65 mmHg, 48%) were lower than Group II (125/76 mmHg, 65%), significantly. 2) The degree of Killip classification was higher in Group I (class 1:29.4%, II:18.8%, III:21.2%, IV:30.6%) than in Group II patients (class 1:73.4%, II:13.6%, III: 8.7%, IV:4.3%), significantly. 3) 47 patients were died first day of hospitalization and the most common cause of death was cardiogenic shock (27 patients, 31%). The most common cause of death within 1 week was cardiogenic shock, afterthen congestive heart failure. 4) The most common cause of death in Killip class I patients was ventricular tachycardia or ventricular fibrillation and in Killip class II-IV patients was cardiogenic shock. Conclusion:The risk of in-hospital death was higher in elderly, female sex, and patients with higher Killip classification. Cardiogenic shock was most common cause of death within 1 week, and was congestive heart failure after 1 week. (Korean Circulation J 1998; 28(9):1518-1526)