• The Korean Journal of Nuclear Medicine
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• v.34 no.3
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• pp.228-233
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• 2000

Purpose: The aim of this study is to better understand the pattern and nature of reverse redistribution (RR) in myocardial perfusion imaging. Materials and Methods: In consecutive 20 acute myocardial infarction (MI) patients, frequency of RR was correlated with that of subendocardial MI that was detected by myocardial contrast echocardiography (MCE). RR was judged to be present when there was more than one grade of worsening in perfusion at 24 hr delayed images compared with the initial rest images. MCE evaluated the significant lack of opacification in the subendocardial myocardium relative to the subepicardial myocardium to suggest the subendocardial MI. Kendall's nonparametric correlation coefficiency was calculated. Results: Concordant cases were 15 of 20 (75%) and correlation was statistically significant (p=0.0285). Conclusion: Our results suggested that RR was correlated with MCE-detected nontransmural MI.

• The Korean Journal of Emergency Medical Services
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• v.20 no.2
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• pp.7-19
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• 2016

Purpose: To investigate the effect of early hypothermia on post-resuscitation myocardial recovery and survival time after cardiac arrest and resuscitation in a rat model of myocardial infarction(MI). Methods: Thoracotomies were performed in 10 male Sprague Dawley rats weighing 450-455g. Myocardial infarction was induced by ligation of the left anterior descending coronary artery. Ninety minutes after arterial ligation, ventricular fibrillation was induced, cardiopulmonary resuscitation was subsequently performed before defibrillation was attempted. Animals were randomized to control group and experimental group(acute MI-normothermia)($32^{\circ}C$ for 4 hours). Duration of survival was recorded. Myocardial functions, including cardiac output, left ventricular ejection fraction, and myocardial performance index were measured using echocardiography. Results: Myocardial function was significantly better in hypothermia group than the control group during the first 4 hours post-resuscitation. The survival time of the experimental group was greater than that of the control group(p<.050). Conclusion: This study suggests that early hypothermia can attenuate post-resuscitation myocardial dysfunction after acute myocardial function, and may be a useful strategy in post-resuscitation care.

• Korean Journal of Adult Nursing
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• v.20 no.1
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• pp.126-134
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• 2008

Purpose: This study was to explore gender differences on presenting patients with acute myocardial infarction in the emergency department. Methods: The survey was done with 143 emergency medical charts presented to the emergency department and diagnosed with acute myocardial infarction between January 2005 and December 2006. The collected data were analyzed with frequency, chi-square, and t-test. Results: Significant gender differences were apparent in age, route to the emergency department, elapsed time from onset of symptoms to arrival, and initial heart rate. Women were significantly more likely to report hypertension, diabetes, and congestive heart failure than men, but men were significantly more likely to report smoking. Chest pain was the most common initial symptom in both men and women. Women were significantly more likely to report dyspnea and nausea/vomiting than men. Conclusion: Although similarities exist in the associated symptoms of acute myocardial infarction, women might experience different symptoms, compared to men. These findings have implication that patients and health care providers should consider gender difference in presenting symptoms.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.329-334
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• 2008

Background: Percutaneous cardiopulmonary support. (PCPS) has the potential to rescue patients in cardiogenic shock who might otherwise die. PCPS has been a therapeutic option in a variety of the clinical settings such as for patients with myocardial Infarction, high-risk coronary intervention and postcardiotomy cardiogenic shock, and the PCPS device is easy to install. We report our early experience with PCPS as a life saving procedure in cardiogenic shock patients due to acute myocardial infarction. Material and Method: From January 2005 to December 2006, eight patients in cardiogenic shock with acute myocardial infarction underwent PCPS using the CAPIOX emergency bypass system($EBS^{(R)}$, Terumo, Tokyo, Japan). Uptake cannulae were inserted deep into the femoral vein up to the right atrium and return cannulae were inserted into the femoral artery with Seldinger techniques using 20 and 16-French cannulae, respectively. Simultaneously, autopriming was performed at the $EBS^{(R)}$ circuit. The $EBS^{(R)}$ flow rate was maintained between $2.5{\sim}3.0L/min/m^2$ and anticoagulation was performed using intravenous heparin with an ACT level above 200 seconds. Result: The mean age of patients was $61.1{\pm}14.2$ years (range, 39 to 77 years). Three patients were under control of the $EBS^{(R)}$ before percutaneous coronary intervention (PCI), three patients were under control of the $EBS^{(R)}$ during PCI, one patient was under control of the $EBS^{(R)}$ after PCI, and one patient was under control of the $EBS^{(R)}$ after coronary bypass surgery. The mean support time was $47.5{\pm}27.9$ hours (range, 8 to 76 hours). Five patients (62.5%) could be weaned from the $EBS^{(R)}$ after $53.6{\pm}27.2$ hours. (range, 12 to 68 hours) of support. All of the patients who could successfully be weaned from support were discharged from the hospital. There were three complications: one case of gastrointestinal bleeding and two cases of acute renal failure. Two of the three mortality cases were under cardiac arrest before $EBS^{(R)}$ support, and one patient had an intractable ventricular arrhythmia during the support. All of the discharged patients are still surviving at $16.8{\pm}3.1$ months (range, 12 to 20 months) of follow-up. Conclusion: The use of $EBS^{(R)}$ for cardiogenic shock caused by an acute myocardial infarction could rescue patients who might otherwise have died. Successfully recovered patients after $EBS^{(R)}$ treatment have survived without severe complications. More experience and additional clinical investigations are necessary to elucidate the proper installation timing and management protocol of the $EBS^{(R)}$ in the future.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.576-587
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• 2009

Background: The up-regulation of the nitric oxide (NO)-cGMP pathway might be involved in the change of vascular reactivity in rats 3 days after they suffer acute myocardial infarction. However, the underlying mechanism for this has not been clarified. Material and Method: Acute myocardial infarction (AMI) was induced by occluding the left anterior descending coronary artery (LAD) for 30 min (Group AMI), whereas the sham-operated control rats were treated similarly without LAD occlusion (Group SHAM), The concentration-response relationships for phenylephrine (PE), KCl, acetylcholine (Ach) and sodium nitroprusside (SNP) were determined in the endothelium intact E(+) and endothelium denuded E(-) thoracic aortic rings from the rats 3 days after AMI or a SHAM operation. The concentration-response relationships of PE in the E(+) rings from the AMI rats were compared with those relationships in the rings pretreated with nitric oxide synthase (NOS) inhibitor $N{\omega}$-nitro-L-arginine methyl ester (L-NAME) or the cyclooxygenase inhibitor indomethacin. The plasma nitrite/nitrate concentrations were checked via a Griess reaction. The cyclic GMP content in the thoracic aortic rings was measured by radioimmunoassay and the endothelial nitric oxide synthase (eNOS) mRNA expression was assessed by real time PCR. Result: The mean infarct size (%) in the rats with AMI was $21.3{\pm}0.62%$. The heart rate and the systolic and diastolic blood pressure were not significantly changed in the AMI rats. The sensitivity of the contractile response to PE and KCl was significantly decreased in both the E(+) and E(-) aortic rings of the AMI group (p<0.05). L-NAME completely reversed these contractile responses whereas indomethacin did not (p<0.05). Moreover, the sensitivity of the relaxation response to Ach was also significantly decreased in the AMI group (p<0.05). The plasma nitrite and nitrate content (p<0.05), the basal cGMP content (p<0.05) and the eNOS mRNA expression (p=0.056) in the AMI rats were increased as compared with the SHAM group. Conclusion: Our findings indicate that the increased eNOS activity and the up-regulation of the NO-cGMP pathway can be attributed to the decreased contractile or relaxation response in the rat thoracic aorta 3 days after AMI.

• The Journal of the Korean life insurance medical association
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• v.19
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• pp.109-117
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• 2000

연구배경 : 3대 특정질병 진단보험금지급의 양상과 경향을 평가하고자 하였다. 방법 : 1997년 7월${\sim}$1999년 3월까지 당사의 한 건강보험가입자 중 1998년 1월${\sim}$1999년 9월 기간동안 당사 약관상의 정의에 의한 악성종양, 급성심근경색증, 뇌졸중으로 진단보험금이 지불된 총 411건에 대해 조사하였다. 결과 : 3대 특정질병 진단보험금 지급건 총 411건의 구성을 보면 악성종양이 290건(70.6%), 급성심근경색이 25건(6.1%) 그리고 뇌졸중이 96건(23.3%)이었다. 남녀비율은 남자 280건(68.1%), 여자 131건(31.9%)이었다. 3대 특정질병 진단급여금 지급건의 평균연령은 $3.88{\pm}5.9$이었다. 3대 특정질병 진단보험금 지불건은 $30{\sim}39$세 연령대에서 187건(45.4%)으로 가장 많았고, 그 다음으로 $40{\sim}49$세 연령대 178건(43.2%)의 순이었다. 계약시점에서 3대 특정질병 진단보험금 지급 시까지 평균진단확정 기간은 325.2일${\pm}$184.9일 이었다. 계약 후 12개월 내에 진단지급보험금 발생건은 총 193건(55.3%)이었고, 12개월 이후에 지급된 건은 156건(44.7%)이었다. 계약 후 12개월 내에 진단지금보험금 발생건 193건을 분석하여 보면 3개월 이상${\sim}$4개월 미만이 40건(20.7%)로 가장 많았다. 악성종양의 신체계통별로 보면 소화기관>유방>여자생식기>호흡기계 순이었다. 악성종양을 장기별로 보면 위암>유방암>간암 및 담도계암>결장암과 직장암, 자궁경부암의 순이었다. 남자의 경우 위암>간암 및 담도계암>결장암과 직장암의 순이었고 여자의 경우 유방암>자궁경부암(상피내암 제외)>결장암, 직장암의 순이었다. 뇌졸중의 종류별 빈도를 보면 뇌경색증(47.9%)>뇌내출혈(34.4%)>거미막하출혈(9.4%)의 순이었다. 결론 : 3대 특정질병 중 악성종양이 다수를 차지하고 있었고, 남자가 여자보다 훨씬 많았고 주로 $30{\sim}39$세 연령대, $40{\sim}49$세 연령대였다. 계약 후 12개월 내에 진단지급보험금 발생건을 분석하여 보면 3개월 이상${\sim}$4개월 미만이 40건(20.7%)으로 가장 많았다는 것은 역선택의 가능성 그리고 제척기간 중 발생한 3대 특정질환이 3개월 이후 특히 3개월 이상${\sim}$4개월 미만 사이에 지급청구되었을 가능성을 시사하는 것으로 사료된다.

• Korea Journal of Hospital Management
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• v.23 no.1
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• pp.87-106
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• 2018

Objective: The objective of this study is to examine the association between process quality of inpatient care and risk-adjusted, thirty-day potentially preventable hospital readmission (PPR) rates. Data Sources/Study Setting: This was an observational cross-sectional study of nonfederal acute-care hospitals located in two states California and Florida, discharging Medicare patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia January through December 31, 2007. Data were obtained from the Healthcare Cost and Utilization Project State Inpatient Database of the Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services Hospital Compare database, and the American Hospital Association Annual Survey of Hospitals. Study Design: The dependent variable of this study is condition-specific, risk-adjusted, thirty-day potentially preventable hospital readmission (PPR). 3M's PPR software was utilized to determine whether a readmission was potentially preventable. The independent variable of this study is hospital performance for process quality of inpatient care, measured by hospital adherence to recommended processes of care. We used multivariate hierarchical logistic models, clustered by hospitals, to examine the relationship between condition-specific, risk-adjusted, thirty-day PPR rates and process quality of inpatient care, after taking clinical and socio-demographic characteristics of patients and structural and operational characteristics of hospitals into account. Findings: Better performance on the process quality metrics was associated with better patient outcome (i.e., low thirty-day PPR rates) in pneumonia, but not generally in two cardiovascular conditions (i.e., heart failure and acute myocardial infarction). Practical Implication: Adherence to the process quality metrics currently in use by CMS is associated with risk-adjusted, thirty-day PPR rates for patients with pneumonia, but not with cardiovascular conditions. More evidence-based process quality metrics closely linked to 30-day PPR rates, particularly for cardiovascular conditions, need to be developed to serve as a guideline to reduce potentially preventable readmissions.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.525-531
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• 1999

Background: We analyzed five hundred patients who underwent either isolated or concomitant coronary artery bypass grafting(CABG) between November 1981 and June 1997. Material and Method: There were 330 males and 170 females with a mean age of 57.4$\pm$8.9 years. To evaluate the preoperative status, we performed electrocardiograghy, echocardiography, MIBI scan, Duplex sonogram, common blood test including CK and LDH and coronary angiography. Result: Preoperative clinical diagnoses were unstable angina in 282 (56.4%), stable angina in 141 (28.2%), postinfarction angina in 58 (11.6%), acute myocardial infarction in 8 (1.6%), variant angina in 7 (1.4%) and failed percutaneous transluminal coronary angioplasty in 4 (0.8%) patients. Preoperative angiographic diagnoses were three-vessel disease in 263 (52.6%), two-vessel disease in 93 (18.6%), one-vessel disease in 71 (14.2%), left main disease in 68 (13.6%), and others in 5 (1.0%) patients. Patients had various risk factors for coronary disease, and the frequency of the risk factors such as hypertension, diabetes and smoking showed increasing tendency year by year. We used saphenous vein grafts in 1143, internal thoracic artery grafts in 442, radial artery graft in 17, and gastroepiploic artery graft in 1 anastomosis. The mean number of grafts was 3.2$\pm$1.2 per patient. Concomitant operations were prosthetic valve replacement or valvuloplasty in 31, coronary endarterectomy and angioplasty in 27, left main coronary angioplasty in 13, carotid endarterectomy in 5, and neurologic problems, bleeding, and perioperative myocardial infarction. The mean follow-up period was 25$\pm$23 months and there were 5 cases of reoperation. Conclusion: We hope that the surgical results would improve with the accumulation of experience, application of new myocardial protection technique, and timely intervention of mechanical assisted devices.

• The Korean Journal of Nuclear Medicine
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• v.32 no.4
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• pp.325-331
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• 1998

Purpose: We evaluated the importance of redistribution and 24 hour reinjection images in T1-201 SPECT assessment of myocardial viability after acute myocardial infarction (AMI). Materials and Methods: We performed dipyridamole stress-4 hour redistribution-24 hour reinjection T1-201 SPECT in 43 patients with recent AMI (4-16 days). The myocardium was divided into 16 segments and perfusion grade was measured visually with 4 point score from 0 to 3 (absent uptake to normal uptake). A perfusion defect with stress score 2 was considered moderate. A defect was considered severe if the stress score was 0 or 1 (absent uptake or severe perfusion decrease). Moderate defect on stress image were considered viable and segments with severe defect were considered viable if they showed improvement of 1 score or more on redistribution or reinjection images. We compared the results of viability assessment in stress-redistribution and stress-reinjection images. Results: On visual analysis, 344 of 688 segments (50%) had abnormal perfusion. Fifty two (15%) had moderate perfusion defects and 292 (85%) had severe perfusion defects on stress image. Of 292 severe stress defects, 53 were irreversible on redistribution and reversible on reinjection images, and 15 were reversible on redistribution and irreversible on reinjection images. Two hundred twenty four of 292 segments (76.7%) showed concordant results on stress-redistribution and stress-reinjection images. Therefore 24 hour reinjection image changed viability status from necrotic to viable in 53 segments of 292 severe stress defect (18%). However, myocardial viability was underestimated in only 5% (15/292) of severe defects by 24 hour reinjection. Conclusion: The 24 hour reinjection imaging is useful in the assessment of myocardial viability. It is more sensitive than 4 hour redistribution imaging. However, both redistribution and reinjection images are needed since they complement each other.

• 대한예방의학회:학술대회논문집
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• 2001.10a
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• pp.197-198
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• 2001