• Health Policy and Management
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• v.28 no.2
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• pp.168-177
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• 2018

Background: This study investigates the potential volume and outcome association of coronary heart disease (CHD) patients who have undergone percutaneous coronary intervention (PCI) using a large and representative sample. Methods: We used a National Health Insurance Service-Cohort Sample Database from 2002 to 2013 released by the Korean National Health Insurance Service. A total of 8,908 subjects were analyzed. The primary analysis was based on Cox proportional hazards models to examine our hypothesis. Results: After adjusting for confounders, the hazard ratio of thirty-day and 1-year mortality in hospitals with a low volume of CHD patients with PCI was 2.8 and 2.2 times higher (p=0.00) compared to hospitals with a high volume of CHD patients with PCI, respectively. Thirty-day and 1-year mortality of CHD patients with PCI in low-volume hospitals admitted through the emergency room were 3.101 (p=0.00) and 2.8 times higher (p=0.01) than those in high-volume hospitals, respectively. Only 30-day mortality in low-volume hospitals of angina pectoris and myocardial infarction patients with PCI was 5.3 and 2.4 times those in high-volume hospitals with PCI, respectively. Conclusion: Mortality was significantly lower when PCI was performed in a high-volume hospital than in a low-volume hospital. Among patients admitted through the emergency room and diagnosed with angina pectoris, total PCI volume (low vs. high) was associated with significantly greater cardiac mortality risk of CHD patients. Thus, There is a need for better strategic approaches from both clinical and health policy standpoints for treatment of CHD patients.

• Korean Circulation Journal
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• v.52 no.1
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• pp.47-59
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• 2022

Background and Objectives: The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR. Methods: A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years. Results: The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15-2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in post-PCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Conclusions: Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR.

• Annals of Laboratory Medicine
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• v.38 no.6
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• pp.538-544
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• 2018

Background: Serum copeptin has been demonstrated to be useful in early risk stratification and prognostication of patients with acute myocardial infarction (AMI). However, the prognostic value of copeptin after percutaneous coronary intervention (PCI) for clinical outcomes remains uncertain. We investigated the prognostic role of serum copeptin levels immediately after successful PCI as a prognostic marker for major adverse cardiac events (MACE; comprising death, repeat PCI, recurrent MI, or coronary artery bypass grafting) in patients with AMI. Methods: A retrospective study was performed in 149 patients with AMI who successfully received PCI. Serum copeptin levels were analyzed in blood samples collected immediately after PCI. The association between copeptin levels and MACE during the follow-up period was evaluated. Results: MACE occurred in 34 (22.8%) patients during a median follow-up of 30.1 months. MACE patients had higher copeptin levels than non-MACE patients did. Multiple logistic regression analysis showed that the increase in serum copeptin levels was associated with increased MACE incidence (odds ratio=1.6, P =0.005). Conclusions: A high level of serum copeptin measured immediately after PCI was associated with MACE in patients with AMI during long-term follow-up. Serum copeptin levels can serve as a prognostic marker in patients with AMI after successful PCI.

• Journal of Medicine and Life Science
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• v.19 no.2
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• pp.46-56
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• 2022

The incidence of fever complicating percutaneous coronary intervention (PCI) is rare. However, little is known regarding the cause of fever after PCI. Therefore, this study aimed to determine the clinical characteristics of patients with acute myocardial infarction (AMI), with or without fever, after PCI. We enrolled a total of 926 AMI patients who underwent PCI. Body temperature (BT) was measured every 4 hours or 8 hours for 5 days after PCI. Patients were divided into two groups according to BT as follows: BT<37.7℃ (no-fever group) and BT ≥37.7℃ (fever group). The 2 years clinical outcomes were compared subsequently. Fever after PCI was associated with higher incidence of major adverse cardiac events (MACE) (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.07-2.28; P=0.021), all-cause death (HR, 2.32; 95% CI, 1.18-4.45; P=0.014), cardiac death (CD) (HR, 2.57; 95% CI, 1.02-6.76; P=0.049), and any revascularization (HR, 1.69; 95% CI, 1.02-2.81; P=0.044) than without fever. In women, prior chronic kidney disease, lower left ventricular (LV) ejection fraction, higher LV wall motion score index, white blood cell count, peak creatine kinase-myocardial band level, and longer PCI duration were associated with fever after PCI. Procedures such as an intra-aortic balloon pump, extracorporeal membrane oxygenation, continuous renal replacement therapy, central and arterial line insertion, and cardiopulmonary resuscitation were related to fever after PCI. Fever after PCI in patients with AMI was associated with a higher incidence of MACE, all-cause death, CD, and any revascularization at the 2 years mark than in those without fever.

• Korean Circulation Journal
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• v.52 no.1
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• pp.34-46
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• 2022

Percutaneous coronary intervention (PCI) is used to treat obstructive coronary artery disease (CAD). The role of PCI is well defined in acute coronary syndrome, but that for stable CAD remains debatable. Although PCI generally relieves angina in patients with stable CAD, it may not change its prognosis. The extent and severity of CAD are major determinants of prognosis, and complete revascularization (CR) of all ischemia-causing lesions might improve outcomes. Several studies have shown better outcomes with CR than with incomplete revascularization, emphasizing the importance of functional angioplasty. However, different definitions of inducible myocardial ischemia have been used across studies, making their comparison difficult. Various diagnostic tools have been used to estimate the presence, extent, and severity of inducible myocardial ischemia. However, to date, there are no agreed reference standards of inducible myocardial ischemia. The hallmarks of inducible myocardial ischemia such as electrocardiographic changes and regional wall motion abnormalities may be more clinically relevant as the reference standard to define ischemia-causing lesions. In this review, we summarize studies regarding myocardial ischemia, PCI guidance, and possible explanations for similar findings across studies. Also, we provide some insights into the ideal definition of inducible myocardial ischemia and highlight the appropriate PCI strategy.

• Journal of Korean Critical Care Nursing
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• v.9 no.2
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• pp.24-35
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• 2016

Purpose: This study investigated the degree of stress, depression, mindfulness and life satisfaction of elderly patients who had undergone percutaneous coronary intervention (PCI) and identified factors influencing life satisfaction. Methods: Participants were 106 patients over 60 years who had undergone PCI in a university hospital. Results: The mean scores for stress, depression, mindfulness, and life satisfaction were $9.10{\pm}2.53$, $7.77{\pm}3.32$, $88.57{\pm}8.47$, and $17.40{\pm}5.38$ respectively. There were statistically significant differences in life satisfaction by main source of income (F = 4.74, p = .004) and perceived health status as compared with peer (F = 4.80, p = .010). Depression (p < .001) explained 38 % of the total variance of life satisfaction, and the explanatory power increased to 42 % when mindfulness (p = .035) was added. There were significant correlations among stress, depression, mindfulness and life satisfaction of the patients. Conclusions: Depression and mindfulness were significant influencing factors on subjects' satisfaction in life. To enhance the life satisfaction of the elderly patients after PCI, it is necessary to reduce depression and to develop mindfulness-based interventions.

• Korean Circulation Journal
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• v.52 no.7
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• pp.485-495
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• 2022

Coronary artery disease is highly prevalent in chronic kidney disease (CKD) and is a risk factor for contrast-associated acute kidney injury (CA-AKI), a complication of cardiovascular procedures that require contrast administration (e.g., coronary angiography, percutaneous coronary intervention [PCI]). CA-AKI has a major impact on morbidity, mortality, and healthcare resource utilization. The incidence of CA-AKI is particularly high in patients with pre-existing CKD, advanced age and comorbidities that increase the likelihood of CKD. The focus of the present review is to provide a brief overview on the assessment of the risk for and prevention of CA-AKI in patients undergoing angiography and PCI, including recognition of the important patient- and procedure-related factors that may contribute to CA-AKI. Preventive and treatment strategies, the mainstay of which is volume repletion by normal saline, are briefly discussed. The main focus of the review is placed on technical details of contrast minimization techniques, including ultra-low contrast angiography and zerocontrast PCI. Operator competence in such techniques is important to ensure that procedural challenges in patients with CKD, like vessel calcification, multivessel disease and complex anatomical subsets, are effectively addressed by PCI while minimizing the risk of CA-AKI.

• Journal of agricultural medicine and community health
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• v.41 no.3
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• pp.140-151
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• 2016

Objectives: The purpose of this study was to investigate health behaviors of patients before and after percutaneous coronary intervention (PCI). Methods: The subjects of this study were 120 men and women whose age ranged from 40 years to 69 years among the patients who received percutaneous coronary intervention in Y university hospital that was located in Daegu city and who had diagnosed for 3 months or more and less than 2 years. Structured questionnaire was used to conduct self-administered survey from May 15 to October 12 in 2012. Results: Patients's health behavior score was ranged from 46 to 94 points after the PCI intervention. The score was $65.42{\pm}12.99$ points before and significantly increased up to $72.53{\pm}10.18$ points after the PCI intervention (p<.001). According to subcategory of health behavior, significant differences were found in scores of health responsibility (increased interest in health, watching of lecture on health and behavior to be punctual on counseling or medical treatment), diet, smoking, and drinking (p<.001, p=.039, p=<.001). However, no significant change was found in practice efforts such as exercise, eating habits and relaxation for stress management. Conclusions: In conclusion, it is necessary to provide education and counseling that enabling patients to improve smoking, drinking, practicing exercise and healthy eating habits.

• Journal of Yeungnam Medical Science
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• v.33 no.1
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• pp.52-55
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• 2016

Guide wire fracture during percutaneous coronary intervention (PCI) is rare. It can cause fatal complications such as thrombus formation, embolization, and perforation. Guide wire fracture could occur during intervention for severely calcified stenotic lesions, and rarely from distal small branches of stenotic lesions. There are several methods for its management depending on the material character, position, length of the remnant, and the patient's condition. If percutaneous retrieval was not achieved, the surgical procedure should be considered for prevention of potential risks, although the remnant guide wire does not usually cause complications. We experienced a patient with a guide wire fracture during PCI, and managed to prevent its complications through surgical removal of the remnant wire. We report this case here.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.640-642
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• 2006

Entrapment and fracture of coronary angioplasty hardware are rare complications of percutaneous coronary intervention (PCI). Retained guidewire should be removed either percutaneously or surgically, because it could serve as a nidus for thrombus formation. We report on a successful surgical retrieval of entrapped PCI guidewire and subsequent bypass grafting of the affected coronary vessel.