• Korean Circulation Journal
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• 제53권9호
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• pp.635-644
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• 2023

Background and Objectives: The History, Electrocardiography, Age, Risk factors, and Troponin (HEART) pathway was developed to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department. Methods: We modified the HEART pathway by replacing the Korean cut-off of 25 kg/m² with the conventional threshold of 30 kg/m² in the definition of obesity among risk factors. The primary outcome was a MACE within 30 days, which included acute myocardial infarction, primary coronary intervention, coronary artery bypass grafting, and all-cause death. Results: Of the 1,304 patients prospectively enrolled, MACE occurred in 320 (24.5%). The modified HEART pathway identified 37.3% of patients as low-risk compared with 38.3% using the HEART pathway. Of the 500 patients classified as low-risk with HEART pathway, 8 (1.6%) experienced MACE, and of the 486 low-risk patients with modified HEART pathway, 4 (0.8%) experienced MACE. The modified HEART pathway had a sensitivity of 98.8%, a negative predictive value (NPV) of 99.2%, a specificity of 49.0%, and a positive predictive value (PPV) of 38.6%, compared with the original HEART pathway, with a sensitivity of 97.5%, a NPV of 98.4%, a specificity of 50.0%, and a PPV of 38.8%. Conclusions: When applied to Korean population, modified HEART pathway could identify patients safe for early discharge more accurately by using body mass index cut-off levels suggested for Koreans.

• 성인간호학회지
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• 제22권5호
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• pp.499-508
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• 2010

Purpose: Cardiovascular risk factor modification is important for patients with coronary artery disease to prevent poor progression of the disease. Without an understanding and an awareness of risk factors, patients with coronary artery disease are not able to reduce their risk by the lifestyle modification. The aims of this study were to assess patient's awareness of risk factors and to identify predictors of awareness of risk factors. Methods: A descriptive correlational study using a cross-sectional survey method was performed. The sites of the study were three hospitals in Seoul, Korea. The sample consisted of 214 subjects. The awareness of risk factors and other subjects' characteristics were measured by a questionnaire developed for this study. Results: A range of subjects (gender: 72.0%; hyperlipidemia: 51.9%; hypertension: 40.7%; obese: 37.4%; age: 35.5%; smoking: 22.4%; diabetes: 19.2%; family history: 18.2%) were not able to accurately identify the risk factors. Among predictors, gender (${\beta}$=-.17) and diabetics (${\beta}$=-.25) had statistically significant influences on awareness of risk factors. Conclusion: Our findings highlight the lack of awareness of risk factors for coronary artery disease. The findings have important implications for nursing practice in terms of guiding educational strategies for the modification of risk factors for coronary heart disease.

• 재활간호학회지
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• 제16권1호
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• pp.27-36
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• 2013

Purpose: This study was performed to analyse the trends of risk factor management programs for patients with coronary artery disease. Methods: Using PubMed, 35 intervention studies related to risk factor management programs among randomized controlled trials searched with the key words of coronary artery disease and coronary heart disease. Collected studies were analysed according to the characteristics of studies and participants, method and content of intervention, and outcome indicator and its effects. Results: The mean period of intervention was $28.7{\pm}26.8$ weeks, the mean frequency was $3.0{\pm}2.0$ times per week, and the duration of one session was below 60 minuets in 65.8% of the reviewed studies. The interventions were counselling, exercise, education, and cognitive behavior therapy. Counselling was applied most frequently in previous studies. The outcomes of intervention had been measured with anthropometric, physical, physiological, psychological, behavioral, and cognitive aspects, but the effect of the intervention was inconsistent among the studies. Conclusion: Based on the results of this study, systematic and comprehensive cardiac rehabilitation program consisted of counselling, exercise, and education should be developed and performed for health management and relapse prevention of patients with coronary artery disease.

• 한국식품영양학회지
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• 제27권3호
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• pp.484-494
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• 2014

The purpose of this study was to evaluate dietary intake according to the risk of coronary heart disease (less than 10% = low-risk group; 10~20% = middle-risk group) based on Framingham risk score (FRS), on 122 male adult subjects. The body weight and body mass index were not significantly different between the groups, while height of the low-risk group was shown to be significantly high compared to that of the middle-risk group. The daily energy intake was shown to be significantly high in the low-risk group with 1,910.88 kcal, compared to 1,606.63 kcal of the middle-risk group. As a result of analyzing nutrient intake per 1,000 kcal of energy, while the low-risk group had significantly high intake of animal protein, fat, and animal fat compared to the middle-risk group, the intake of plant protein, carbohydrate, and plant iron was found to be significantly low. The daily food intake was shown to be significantly high in the low-risk group (1,445.16 g), compared to the middle-risk group (1,075.12 g). The low-risk group was found to have significantly high intake of sugars, eggs, and beverages compared to the middle-risk group, while mushrooms intake was significantly high in the middle-risk group. Dietary variety score (DVS) was significantly high in the low-risk group with 26.42, compared to 22.66 of the middle-risk group. Dietary diversity score (DDS) was indicated to be significantly high in the low-risk group with 3.70, compared to 3.27 of the middle-risk group. The low-risk group was indicated to have significantly high score in DDS of dairy products and fruit group, compared to the middle-risk group. In the correlation between diversity index of food intake (DVS and DDS) and FRS, DDS was shown to have significantly negatively correlation with FRS after adjusting for confounding factors. To sum up these results, the adult males with low-risk of coronary heart disease had more various consumptions of fruits and milk, compared to the subjects with the middle-risk. The proportion of consuming major food groups such as cereals, meat group, milk, fruits, and vegetables more than a fixed quantity was indicated to be high. Accordingly, dietary habit for intake of various food seems to be necessary, to prevent coronary heart disease.

• Journal of Preventive Medicine and Public Health
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• 제34권2호
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• pp.149-156
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• 2001

Objective : To elucidate risk factors for coronary heart diseases among Korean males. Methods : A nested case control study was conducted among a Korea Medical Insurance Cooperation(KMIC) cohort composed of 108,802 males. The eases included 246 male patients who were admitted to hospital due to coronary heart diseases from 1993 to 1997 (120-25 by ICD) and whose diagnosis was confirmed by the protocol by WHO MONICA Project(1994). The control group was composed of 483 patients selected by frequency matching considering age and resident area from an inpatient care group without coronary heart disease during the same period. For study cases and the controls, the results of a health check-up in 1990 and a questionnaire on life style in 1992 were received through the KMIC. Some additional information was collected by telephone interviews during October 1999. Results : Multiple logistic regression analysis showed that the odds ratio(OR) of coronary heart diseases among past smokers and current smokers as compared to non-smokers were 1.94(95% CI : 1.14-3.31) and 2.20(55% CI : 1.35-3.59), respectively. The OR among persons who drank 4 cups or more of caffeinated beverages such as coffee or tea daily as compared to persons who drank one cup for 2-3 days was 2.50(95% CI : 1.07-6.12). The OR among persons with high normal BP and stage 3 hypertension against normotension were 2.51 (95% CI : 1.44-4.37) and 5.08(95% CI : 2.38-10.84). The OR among persons whose blood cholesterol were 240 mg/dL or mere against lower than 200mg/dL was 2.24(95% CI : 1.43-3.49). Conclusion : Smoking, drinking of excessive caffeinated beverages, hypertension and high blood cholesterol were proven to be significant risk factors for coronary heart diseases among Korean males.

• Nuclear Medicine and Molecular Imaging
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• 제43권3호
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• pp.196-202
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• 2009

Myocardial perfusion scintigraphy is currently by far the most commonly performed cardiac nuclear study, constituting approximately one third of all nuclear medicine procedure. It plays an important role in the diagnosis, prognosis, risk assessment and management of heart disease. Aim of this review is to describe recent evolution of myocardial perfusion imaging on the focus of diagnosis of coronary artery disease. In addition, current status of other imaging modalities will be reviewed.

• 지질동맥경화학회지
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• 제7권2호
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• pp.110-121
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• 2018

Objective: We developed a new equation for predicting coronary heart disease (CHD) risk in Korean diabetic patients using a hospital-based cohort and compared it with a UK Prospective Diabetes Study (UKPDS) risk engine. Methods: By considering patients with type 2 diabetes aged ${\geq}30years$ visiting the diabetic center in Boramae hospital in 2006, we developed a multivariable equation for predicting CHD events using the Cox proportional hazard model. Those with CHD were excluded. The predictability of CHD events over 6 years was evaluated using area under the receiver operating characteristic (AUROC) curves, which were compared using the DeLong test. Results: A total of 732 participants (304 males and 428 females; mean age, $60{\pm}10years$; mean duration of diabetes, $10{\pm}7years$) were followed up for 76 months (range, 1-99 month). During the study period, 48 patients (6.6%) experienced CHD events. The AUROC of the proposed equation for predicting 6-year CHD events was 0.721 (95% confidence interval [CI], 0.641-0.800), which is significantly larger than that of the UKPDS risk engine (0.578; 95% CI, 0.482-0.675; p from DeLong test=0.001). Among the subjects with <5% of risk based on the proposed equation, 30.6% (121 out of 396) were classified as ${\geq}10%$ of risk based on the UKPDS risk engine, and their event rate was only 3.3% over 6 years. Conclusion: The UKPDS risk engine overestimated CHD risk in type 2 diabetic patients in this cohort, and the proposed equation has superior predictability for CHD risk compared to the UKPDS risk engine.

• Journal of Cardiovascular Imaging
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• 제31권1호
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• pp.1-17
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• 2023

The Coronary Artery Calcium Data and Reporting System (CAC-DRS) is a standardized reporting method for calcium scoring on computed tomography. CAC-DRS is applied on a per-patient basis and represents the total calcium score with the number of vessels involved. There are 4 risk categories ranging from CAC-DRS 0 to CAC-DRS 3. CAC-DRS also provides risk prediction and treatment recommendations for each category. The main strengths of CAC-DRS include a detailed and meaningful representation of CAC, improved communication between physicians, risk stratification, appropriate treatment recommendations, and uniform data collection, which provides a framework for education and research. The major limitations of CAC-DRS include a few missing components, an overly simple visual approach without any standard reference, and treatment recommendations lacking a basis in clinical trials. This consistent yet straightforward method has the potential to systemize CAC scoring in both gated and non-gated scans.

• Journal of Nutrition and Health
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• 제41권3호
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• pp.232-241
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• 2008

Moderate alcohol consumption has been known to be associated with reduced risk for coronary heart disease (CHD). We assessed the association between alcohol consumption and CHD-related risk factors [hypertension, diabetes mellitus (DM) , high total cholesterol, high triglyceride (TG), low HDL-cholesterol (HDL-C), and high LDL-cholesterol (LDL-C)] in Korean. After excluding those with extreme intake values, the number of final subjects included in the analysis was 4,662 Korean adults aged over 20 years (1,961 men, 2,701 women) who participate in the 2005 Korean National Health and Nutrition Examination Survey. The subjects were divided into four or five groups; none-alcohol consumption group, moderate alcohol consumption group (<15 or 15.0-29.9 g/d), heavy alcohol consumption group (30-69.9 g/d or ${\geq}$ 70 g/d in men, ${\geq}$ 30 g/d in women). Odds ratios (ORs) were estimated from logistic regression adjusting for potential covariates. Alcohol consumption was inversely associated with low HDL-C in both men and women. However, heavy alcohol intake (${\geq}$ 70 g/d) significantly increased risk for hypertension, DM, and hypertriglyceridemia in men. The frequency of alcohol intake was also associated with CHD risk. The risk for low HDLC was decreased with alcohol consumption (${\geq}$ 1 times/wk), but frequent alcohol intake (${\geq}$ 4 times/wk) increased the risk for hypertension. This study revealed that moderate alcohol consumption has protective effect on CHD-related risk factors in Korean population.

• Journal of Chest Surgery
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• 제49권6호
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• pp.427-434
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• 2016

Background: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD. Methods: From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group. Results: The risk of acute kidney injury was about ${\times}3$ higher in the CKD group than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases. Conclusion: Off-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.