• 대한물리의학회지
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• 제12권2호
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• pp.9-20
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• 2017

PURPOSE: The purpose of this study is to understand the difference in the risk factors of coronary artery disease (CAD) between Korean and American CAD patients to determine the discriminant factor for each group, as well as to provide useful information to be reflected in the national concern of health. METHODS: Data were collected from 248 Korean and 107 American CAD patients who underwent either percutaneous coronary intervention or coronary artery bypass grafting. By using t-test and $X^2$-test, risk factors were compared between the Koreans and Americans. To elucidate which risk factor was the most discriminant for each group, logistic regression analysis was performed. RESULTS: All risk factors, except diastolic blood pressure, showed a significant difference between the two groups. $X^2$-test showed statistical significance with respect to the smoking rate between the female groups. Moreover, there was a statistically significant difference between the two groups regarding blood total cholesterol (TC) and triglyceride, and between the male groups, here was a statistically significant difference with respect to blood high-density lipoprotein cholesterol (HDL). Diabetes mellitus (DM) was the most discriminant factor for Korean patients while TC/HDL is the most discriminant for the Americans. CONCLUSION: The characteristics of CAD risk factors were determined to be different between Koreans and Americans in this study. TC/HDL was a discriminant factor for Americans while DM was a discriminant factor for Koreans. This result implies that DM should primarily be given attention to prevent CAD in Korean adults.

• Korean Journal of Radiology
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• 제24권9호
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• pp.827-837
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• 2023

Objective: To investigate the predictive value of radiomics features based on cardiac magnetic resonance (CMR) cine images for left ventricular adverse remodeling (LVAR) after acute ST-segment elevation myocardial infarction (STEMI). Materials and Methods: We conducted a retrospective, single-center, cohort study involving 244 patients (random-split into 170 and 74 for training and testing, respectively) having an acute STEMI (88.5% males, 57.0 ± 10.3 years of age) who underwent CMR examination at one week and six months after percutaneous coronary intervention. LVAR was defined as a 20% increase in left ventricular end-diastolic volume 6 months after acute STEMI. Radiomics features were extracted from the oneweek CMR cine images using the least absolute shrinkage and selection operator regression (LASSO) analysis. The predictive performance of the selected features was evaluated using receiver operating characteristic curve analysis and the area under the curve (AUC). Results: Nine radiomics features with non-zero coefficients were included in the LASSO regression of the radiomics score (RAD score). Infarct size (odds ratio [OR]: 1.04 (1.00-1.07); P = 0.031) and RAD score (OR: 3.43 (2.34-5.28); P < 0.001) were independent predictors of LVAR. The RAD score predicted LVAR, with an AUC (95% confidence interval [CI]) of 0.82 (0.75-0.89) in the training set and 0.75 (0.62-0.89) in the testing set. Combining the RAD score with infarct size yielded favorable performance in predicting LVAR, with an AUC of 0.84 (0.72-0.95). Moreover, the addition of the RAD score to the left ventricular ejection fraction (LVEF) significantly increased the AUC from 0.68 (0.52-0.84) to 0.82 (0.70-0.93) (P = 0.018), which was also comparable to the prediction provided by the combined microvascular obstruction, infarct size, and LVEF with an AUC of 0.79 (0.65-0.94) (P = 0.727). Conclusion: Radiomics analysis using non-contrast cine CMR can predict LVAR after STEMI independently and incrementally to LVEF and may provide an alternative to traditional CMR parameters.

• The Korean Journal of Physiology and Pharmacology
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• 제27권2호
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• pp.143-155
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• 2023

Percutaneous coronary intervention and acute coronary syndrome are both closely tied to the frequently occurring complication of coronary microembolization (CME). Resveratrol (RES) has been shown to have a substantial cardioprotective influence in a variety of cardiac diseases, though its function and potential mechanistic involvement in CME are still unclear. The forty Sprague-Dawley rats were divided into four groups randomly: CME, CME + RES (25 mg/kg), CME + RES (50 mg/kg), and sham (10 rats per group). The CME model was developed. Echocardiography, levels of myocardial injury markers in the serum, and histopathology of the myocardium were used to assess the function of the cardiac muscle. For the detection of the signaling of TLR4/MyD88/NF-κB along with the expression of pyroptosis-related molecules, ELISA, qRT-PCR, immunofluorescence, and Western blotting were used, among other techniques. The findings revealed that myocardial injury and pyroptosis occurred in the myocardium following CME, with a decreased function of cardiac, increased levels of serum myocardial injury markers, increased area of microinfarct, as well as a rise in the expression levels of pyroptosis-related molecules. In addition to this, pretreatment with resveratrol reduced the severity of myocardial injury after CME by improving cardiac dysfunction, decreasing serum myocardial injury markers, decreasing microinfarct area, and decreasing cardiomyocyte pyroptosis, primarily by blocking the signaling of TLR4/MyD88/NF-κB and also reducing the NLRP3 inflammasome activation. Resveratrol may be able to alleviate CME-induced myocardial pyroptosis and cardiac dysfunction by impeding the activation of NLRP3 inflammasome and the signaling pathway of TLR4/MyD88/NF-κB.

• 대한간호학회지
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• 제39권6호
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• pp.788-795
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• 2009

Purpose: The purpose of this study was to define and clarify the concept of 'resilience' in patients with cardiovascular diseases. Methods: A hybrid model was used to develop the concept of resilience. The model included a field study carried out in Cheonan, Korea. The participants in this study were 9 patients with cardiovascular diseases who underwent a percutaneous coronary intervention. Results: The concept of resilience was found to be a complex phenomenon having meanings in two dimensions: the personal-dispositional and interpersonal dimensions. Four attributes and seven indicators were defined. Conclusion: A resilient person was defined as one who has a positive attitude toward restoration, the power to reconstruct and control his/her disease (personal dimension), and support from a supportive system with supportive persons (interpersonal dimension). In the clinical setting, resilience plays an important role in managing the care plans of cardiovascular patients. Therefore, nurses who work closely with patients suffering from cardiovascular diseases should be aware of the attributes and indicators of resilience to enhance the resilience of their patients.

• 한국보건간호학회지
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• 제28권3호
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• pp.565-573
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• 2014

Purpose: Health Insurance Review & Assessment Service (HIRA) launched an Acute Myocardial Infarction(AMI) assessment for the Payment For Performance(Quality Incentives) Pilot Project from July 2007. Assessment measures of AMI were composed of five process measures and one outcome measure, and each measure was incorporated into one composite quality score to Pay for Performance. Method: For calculation of composite quality score, we considered weighting for the measures using the Delphi method. The questionnaire was composed of three measure groups, 'Reperfusion rate'(Fibrolytic therapy received within 60 minutes of hospital arrival, Primary Percutaneous Coronary Intervention within 120 minutes of hospital arrival), 'Medication prescription rate'(Aspirin at arrival, Aspirin prescribed at discharge, Beta-blocker prescribed at discharge) and 'Survival Index'(30-day mortality rate). Result: A panel composed of 18 and completed a questionnaire by allocation of 10 scores to the three above mentioned measure groups. The Delphi was carried out until three rounds of surveys. In conclusion, each measure group was weighted differently and the 10 scores were allocated as 4.5 to 'Reperfusion rate', 2.5 to 'Medication prescription rate', and 3.0 to 'Survival Index'. Conclusion: The results of this study proposed the calculation method for weighting of Acute Myocardial Infarction quality indicators.

• 기본간호학회지
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• 제13권1호
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• pp.42-49
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• 2006

Purpose: This study was done to evaluate the effectiveness of cardiac rehabilitation education individualized to PCI patients in order to improve their knowledge of these diseases and to lessen their anxiety. Method: A Quasi experimental design with non-equivalent control group non-synchronized design was used. The experimental group had the PCI operation for ischemic heart disease and individualized cardiac rehabilitation education and counseling twice for 25 minutes each time using an educational booklet developed by the authors. The effects of the education were analyzed using a knowledge assessment tool, state anxiety inventory and anxiety visual analogue scale. Results: The experimental group who received the individualized cardiac rehabilitation education showed a high level of knowledge about diseases compared to the control group and particularly showed a significant difference in knowledge about the drugs used for treatment. However, no significant difference was observed between the two groups in the level of state anxiety and anxiety visual analogue scale. Conclusion: Individualized cardiac rehabilitation education did not reduce anxiety but it was effective in enhancing the participants' knowledge about the diseases. Thus, it can be utilized effectively in addressing risk factors in ischemic heart diseases by providing education individualized according to patients' demands and knowledge levels.

• Bulletin of the Korean Chemical Society
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• 제28권3호
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• pp.397-402
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• 2007

Restenosis after percutaneous coronary intervention (PCI) continues to be a serious problem in clinical cardiology. To solve this problem, drug eluting stents (DES) with antiproliferative agents have been developed. Variable local drug delivery systems in the context of stenting require the development of stent manufacture, drug pharmacology and coating technology. We have worked on a system that integrates electrophoretic deposition (EPD) technology with the polymeric nanoparticles in DES for local drug delivery and a controlled release system. The surface morphology and drug loading amount of DES by EPD have been investigated under different operational conditions, such as operation time, voltage and the composition of media. We prepared poly-D,L-lactide-co-glycolic acid (PLGA) nanoparticles embedded with curcumin, which was done by a modified spontaneous emulsification method and used polyacrylic acid (PAA) as a surfactant because its carboxylic group contribute negative charge to the surface of CPNPs (?53.5 ± 5.8 mV). In the process of ‘trial and error' endeavors, we found that it is easy to control the drug loading amount deposited onto the stent while keeping uniform surface morphology. Accordingly, stent coating by EPD has a wide application to the modification of DES using various kinds of nanoparticles and drugs.

• 성인간호학회지
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• 제26권2호
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• pp.203-213
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• 2014

Purpose: The purpose of this study was to understand and describe the every day life experience of patients with acute myocardial infarction (AMI) during the recovery period after Percutaneous Coronary Intervention (PCI) using a qualitative approach. Methods: Twelve patients with AMI participated in this study. Their age ranged from 42 to 75. The data were collected by individual in-depth interviews and all interviews were audio-taped and transcribed verbatim. The transcribed data were analyzed using traditional qualitative content analysis. Results: Six sub-themes emerged from the data as follows: Getting to know about illness, getting motivated for health behavior, putting an effort into health behavioral change, having difficulties maintaining health behavior, setting up coping strategies for health behavior and having a need for a tailored education. The results of this study showed how the health behaviors of patients with AMI are related to their every day life experiences. Conclusion: The results of this study could help health professionals to better understand patients with AMI and design effective educational interventions to improve their health behaviors.

• Communications for Statistical Applications and Methods
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• 제29권2호
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• pp.177-191
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• 2022

This paper addresses the use of machine learning methods for causal estimation of treatment effects from observational data. Even though conducting randomized experimental trials is a gold standard to reveal potential causal relationships, observational study is another rich source for investigation of exposure effects, for example, in the research of comparative effectiveness and safety of treatments, where the causal effect can be identified if covariates contain all confounding variables. In this context, statistical regression models for the expected outcome and the probability of treatment are often imposed, which can be combined in a clever way to yield more efficient and robust causal estimators. Recently, targeted maximum likelihood estimation and causal random forest is proposed and extensively studied for the use of data-adaptive regression in estimation of causal inference parameters. Machine learning methods are a natural choice in these settings to improve the quality of the final estimate of the treatment effect. We explore how we can adapt the design and training of several machine learning algorithms for causal inference and study their finite-sample performance through simulation experiments under various scenarios. Application to the percutaneous coronary intervention (PCI) data shows that these adaptations can improve simple linear regression-based methods.

• 대한방사선기술학회지:방사선기술과학
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• 제33권1호
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• pp.37-44
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• 2010

본 연구에서는 약물용출성 스텐트 삽입 후 재협착에 관한 독립적 인자를 확인하고 MDCT로 측정된 calcium score가 재협착 발생의 예측인자로써 가능성을 알아보고자 하였다. 2006년 5월부터 2009년 5월까지 전남대학교병원에서 MDCT상 관상동맥 협착이 발견되어 약물 용출 스텐트를 삽입 받은 환자 1,131명 중 추적검사로 관상동맥조영술을 시행되었던 178명(남자 159명, 여자 19명, 평균 연령 61.7, 연령분포 51~71세), 190개소 병변을 대상으로 하였으며 재협착 여부에 따라 두 군(비협착군 133병변, 재협착군 57병변)으로 나누어 비교 분석하였다. 그 결과 임상진단명은 진구성 심근경색이 비협착군 3예(2.3%), 재협착군 5예(8.8%)로 유의한 차이가 있었으며(p = 0.040), 급성 심근경색증, 불안정 협심증, 안정 협심증의 유병률은 차이가 없었다. 관상동맥 조영술 소견에서 병변 혈관의 위치는 재협착군에서 좌주간지 병변이 더 많았다(0.8% vs. 5.3%, p = 0.047). 스텐트 직경은 재협착군에서 유의하게 작았으며($3.3{\pm}0.4\;mm$ vs. $3.1{\pm}0.3\;mm$, p = 0.004), 스텐트 길이는 양군 간에 차이가 없었다. 관상동맥 조영술 상 혈관의 초기 협착 정도는 재협착군에서 더 심했으며($86.1{\pm}11.4%$ vs. $91.5{\pm}9.2%$, p = 0.001), 복잡 병변(B2/C형)은 양 군간에 차이가 없었다. 연령은 재협착군에서 더 높았고($60.2{\pm}9.9$세 vs. $65.8{\pm}9.0$세, p = 0.0001), 흡연력과 고지혈증은 비협착군에서(42.1% vs. 19.3%, p = 0.003, 23.3% vs. 8.8%, p = 0.019), 그리고 당뇨병은 재협착군에서 많았다(21.8% vs. 52.6%, p = 0.0001). 심초음파로 측정한 좌심실 구혈률은 양 군 간에 유의한 차이는 없었다. 전체 MDCT coronary artery calcium scoring는 비협착군 $371.2{\pm}500.8$, 재협착군 $389.3{\pm}458.3$로 차이가 없었고, 목표혈관과 좌주간지, 좌전하행지, 좌회선지 및 우관상동맥 각각의 calcium score 역시 양군 간 차이가 없었다. 다 변량 로지스틱 회귀분석에서 좌주간지 병변(OR = 168.0, 95% CI = 7.83-3,604.3, p = 0.001), 남성(OR = 36.5, 95% CI = 5.89-2,226.9, p = 0.0001), 당뇨병의 존재(OR = 2.62, 95% CI = 1.071~6.450, p = 0.035)가 약물용출성 스텐트 삽입 후 재협착 발생에 대한 독립적인 예측인자이었다. 따라서 관상동맥 협착에 대해 약물용출 스텐트를 삽입 받은 환자에서 스텐트 내 재협착의 발생은 좌주간지 병변, 남성, 당뇨병의 존재와 관련이 있었으나, MDCT로 측정된 calcium score는 재협착 발생에 대한 독립적인 예측인자로써 기능은 없었다.