• Title/Summary/Keyword: percutaneous coronary

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Long-term Clinical Outcomes after Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction-on the basis of 65 Years (급성 심근경색증 환자에서 일차적 관상동맥 중재술 후 장기적 임상 경과-65세를 기준으로)

  • Lee, Han-Ol;Jang, Seong-Joo;Kim, In-Soo;Han, Jae-Bok;Park, Soo-Hwan;Kim, Jeong-Hun;Jang, Young-Ill
    • The Journal of the Korea Contents Association
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    • v.14 no.5
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    • pp.251-261
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    • 2014
  • Primary percutaneous coronary intervention (PCI) has been found to be superior, in terms of hospital mortality and long-term outcome, compared with thrombolytic therapy in patients with acute myocardial infarction (AMI). However, the clinical benefits of primary PCI have not been precisely evaluated in elderly patients.1,974 patients (Group I: n=1,018, $age{\geq}65years$, $73.8{\pm}5.99years$; Group II: n=956, age<65years, $52.8{\pm}7.96years$) who underwent primary PCI for AMI at Chonnam National University Hospital between 2006 and 2010 were analyzed according to their clinical, angiographic characteristics for hospital and one-year survival. Group I had a higher percentage of women, diabetes mellitus, hypertension, multi-vessel disease and lower prevalence of current smoking, hyperlipidemia, familial history than Group II. Culprit lesions were at the left anterior descending artery, left circumflex artery, right coronary artery and left main artery in 42.8% vs. 45.0%, 34.1% vs. 29.6%, 14.6% vs 14.6, 2.7% vs. 1.6%, respectively (p=0.007). Stent diameter was smaller in group I ($3.17{\pm}0.39$ vs. $3.29{\pm}0.42mm$, p=0.001). In-hospital mortality was higher in group I (8.4 vs. 1.9%, p<0.001). There were significant differences in the rates of major adverse cardiac events between the two groups during one-year clinical follow-up (20.1 vs.14.0%, p<0.001). On multiple logistic regression analysis, systolic blood pressure<100mmHg, serum $creatinine{\geq}1.3mg/dL$, Killip class> I, multivessel disease, left ventricular ejection fraction <40% and cerebro vascular disease were independent predictors of one-year motality in patients over 65 years after PCI.

Radiation Dose and Estimate of Lifetime Attributable Risk of Cancer from Coronary Angiography and Percutaneous Coronary Intervention (관상동맥조영술과 경피적관상동맥중재술에서 환자 선량과 암 발생 생애귀속위험 평가)

  • Kang, Yeong-Han;Kim, Bu-Sun;Park, Jong-Sam
    • Journal of radiological science and technology
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    • v.33 no.3
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    • pp.213-221
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    • 2010
  • The Purpose of this study was to determine the effective dose to an average patient from Coronary Angiography (CA) and Percutaneous Coronary Intervention (PCI). And to estimate the lifetime attributable risk (LAR) of cancer associated with radiation exposure from CA and PCI. The dose-area product (DAP) values to the patient were recorded from 60 CA and 58 PCI. A Monte Carlo based program PCXMC was used to calculate the effective dose from DAP values for each patient. Lifetime attributable risks were estimated with models developed in the National Academies' Biological Effects of Ionizing Radiation VII report. The mean DAP values was $53.76\;Gy{\cdot}cm^2$ for CA and $165.82\;Gy{\cdot}cm^2$ for PCI. Mean effective dose were 1.28 mSv in CA, 3.94 mSv in PCI. Results of Calculate organ dose, lung doses was 2.17 mSv in CA and 6.71 mSv in PCI. Female breast doses was 5.45 mSv in CA and 16.82 mSv in PCI. LAR estimates for CA varied from 1 in 1,508 for man to 1 in 1,357 for women. In PCI procedure varied from 1 in 553 for man to 1 in 482 for women. DAP can be used as the dose indicator to calculate the organ dose and effective dose of patient based on Monte Carlo simulation. These dose estimates derived from our simulation models suggest that CA and PCI are associated with a nonnegligible LAR of cancer. This risk varies markedly and is considerably greater for women, PCI than for man, CA.

Patency Rate of Grafts after Coronary Artery Bypass Surgery (관상동맥 우회수술후 이식혈관의 개존)

  • 노환규
    • Journal of Chest Surgery
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    • v.25 no.1
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    • pp.42-48
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    • 1992
  • Clinical improvement after coronary artery bypass surgery depends on the complete revascularization and patency of graft vessels. Patency rate and the factors influencing the patency were studied by examining 134 grafts in 55 patients at a mean follow-up of 22.8$\pm$4.2 months, range 15 days and 108 months. Serial studies were performed on 7 patients with 18 grafts. The over-all patency rate was 80.6%, and the rate more than 5 years after surgery was 50.0% with mean interval of 81 months. Patency rate of patients who had taken both aspirin and dipyridamole was higher than of patients who had been treated with aspirin only[80.5% vs 56.5%]. The average serum triglyceride level of patients who had graft stenosis or occlusion in at least one site was significantly higher than that of patients in whom all grafts were patent[262.1mg% vs 174.8mg%]. Patency rate of grafts in patient who had angina was 73.2% and in patients without angina 79.2%. 6 patients underwent successful percutaneous transluminal angioplasty for narrowed or occluded grafts.

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A Study on the Effects of Percutaneous Transluminal Coronary Angioplasty and Pediatric Heart Surgery on the Differences of Risk-Adjusted Length of Stay and In-Hospital Death for Coronary Artery Bypass Graft Patients (관상동맥우회로술(CABG)환자의 재원일수와 병원 내 사망률 변이에 대한 경피적관상동맥성형술(PTCA)과 소아심장수술(PHS)의 영향분석)

  • Kim, Da-Yang;Lee, Kwang-Soo
    • The Korean Journal of Health Service Management
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    • v.8 no.4
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    • pp.47-55
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    • 2014
  • The purpose of this study was to analyze the differences in the outcome for CABG according to whether hospitals provided heart related surgeries. The 2011 National Inpatient Sample (NIS) and inpatient quality indicator principles from the Healthcare Research and Quality (AHRQ) were used for analysis. Hospitals were divided into three groups according to the surgeries they provided. The length of stay and in-hospital deaths were adjusted for the differences in risks. ANOVA was performed to examine the differences for the risk-adjusted in-hospital mortality rate and risk-adjusted length of stay among the three groups. The analysis results showed that hospitals providing CABG, PTCA, and PHS had lower risk-adjusted in-hospital mortality rates or similar risk-adjusted lengths of stay compared to those of hospitals providing only CABG. However, the three groups did not have statistically significant differences in outcome indicators. Another study will be needed with a larger sample.

Development and Evaluation of Motivational Enhancement Therapy for Patients with Coronary Artery Disease (관상동맥질환자를 위한 동기증진 교육·상담 프로그램이 건강행위변화에 미치는 효과)

  • Kang, Kyung Ja;Song, Mi Soon
    • Journal of Korean Clinical Nursing Research
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    • v.16 no.2
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    • pp.5-16
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    • 2010
  • Purpose: The purpose of this study was to develop a motivational enhancement therapy (MET) for coronary artery disease (CAD) patients in early stages of health behavior change and evaluate its effects on health motivation, the stages of change, health behaviors, and cardiovascular risk factors. Methods: Using a non-equivalent control pre-post design, the study was conducted on 42 CAD patients who underwent medical treatment or percutaneous coronary interventions in a hospital. The intervention group (n=21) received the MET (MET 1 during admission, MET 2 after discharge via telephone). The control group (n=21) received a standard care. Data were analyzed using descriptive statistics, ${\chi}^2-test$ and t-test with the SPSS 12.0 program. Results: Participants in the intervention group reported significantly increased scores of health motivation (t=-2.093, p=.043), the stages of change (t=-5.682, p<.001), and health behaviors (t=-3.069, p=.004) and significantly decreased scores of cardiovascular risk factors (t=2.131, p=.039) compared to those of the control group. Conclusion: The findings indicate that the MET is an effective intervention in improving health behaviors and decreasing cardiovascular risk factors for CAD patients.

The Effects of Beta-blocker and Aerobic Exercise on Heart Rate Recovery and Exercise Capacity after Maximal Exercise in Acute Coronary Syndrome Patients

  • Cha, Kyung-Hwa;Oh, Jae-Keun;Kim, Young-Joo
    • Biomedical Science Letters
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    • v.19 no.1
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    • pp.70-78
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    • 2013
  • This study was conducted to identify the effects of intake of beta-blocker and aerobic exercise on heart rate recovery (HRR) and exercise capacity after maximal exercise in acute coronary syndrome patients (ACS). Subjects were divided into 4 groups; Beta-blocker-Exercise group (n=10), Beta-blocker group (n=10), Exercise group (n=10), Control group (n=10). Symptom-limited grade exercise test were conducted on subjects pre- and post- 6 week study, to measure maximal heart rate, heart rate at 1 minute and 2 minutes at the recovery stage, maximal oxygen uptake and maximal exercise time. Study resulted in significant improvements in heart rate recovery for BB-Ex group ($17.40{\pm}5.58$ bpm to $26.10{\pm}6.66$ bpm), maximal oxygen uptake for BB-Ex group ($30.46{\pm}8.63$ to $36.33{\pm}8.10$) and Ex group ($29.04{\pm}4.93$ to $34.31{\pm}5.19$), and total exercise time for BB-Ex group ($906.30{\pm}158.57$ to $1018.50{\pm}151.21$), BB group ($805.70{\pm}182.94$ to $897.50{\pm}160.16$) and Ex group ($870.00{\pm}145.63$ to $961.90{\pm}107.29$). Therefore it showed the biggest improvement for heart rate recovery and exercise capacity in acute coronary syndrome patients when both Beta-blocker and aerobic exercise were in effect.

Edge Extraction using Fuzzy Techniques in Coronary Artery Image (Fuzzy 기법을 이용한 관상동맥영상의 에지추출)

  • Kim, Seong-Hu;Lee, Ju-Won;Kim, Joo-Ho;Lee, Han-Wook;Jung, Won-Geun;Lee, Gun-Ki
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.16 no.3
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    • pp.585-590
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    • 2012
  • Coronary Intervention treatment has become the core that is the test of cardiac catheterization to conduct treatment with Coronary Arteriography. Operators must be careful in Coronary Intervention treatment because the stent is inserted into the point of narrowing of blood vessel. So, the operator must correctly recognize the path of blood vessel to deal with the problems which are damages and ruptures of blood vessel, and there would be some errors of finding the path of blood vessel by bad qualify of the image. Therefore in this paper, median filtering is conducted by preprocessing to evaluate the performance of the effect of noise of the image that affects quality of the image and Fuzzy Edge Extraction Techniques is tested by using Soble Edge Extraction Techniques to compare the performance with The Fuzzy Edge Extraction Techniques. In result, the performance, removing the noise and extracting the signal of Fuzzy Edge Extraction Techniques using median filtering, demonstrates the superiority.

Aortocoronary bypass after PTCA (관상동맥 풍선확장술 후의 개심술)

  • 송명근
    • Journal of Chest Surgery
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    • v.26 no.1
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    • pp.32-35
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    • 1993
  • During the period from September 1989 through December 1992, 118 cases of coronary arterial bypass graft were performed at Department of Cardiothoracic Surgery, Asan Medical Center. Twenty-one of these had history of recent or remote percutaneous transluminal coronary angioplasty. They consisted of 13 males[age,58.7 + 5.4 years] and 8 females[age, 63.6 + 2.8years] with the mean age of 60.6. History of old myocardial infarction was noted in 24%[5/21] of the patients and congestive heart failure in 2 cases. The angina by type of presentation is unstable in all of the patients. The patterns of involvement of coronary arterial disease were left main disease[1], single vessel disease[5], double vessel involvement[10], and triple vessel involvement[5]. We performed 4 cases of single bypasses, 7 cases of double, 8 cases of triple, and 2 cases of quadruple bypasses. Total of 51 grafts[LIMA:12, RSVG:39] were inserted in 21 cases with average of 2.4 grafts per patient. The methods of myocardial protection were cold blood cardioplegia[8 cases], intermittent aortic occlusion[11], and continuous coronary perfusion with local coronary sharing[2]. There were no operative or late death. The only cardiac complication was 1 case of low cardiac output required IABP. The other complications were 1 case of sternal wound infection and 1 case of postoperative bleeding required reoperation. And there was no case of perioperative myocardial infarction. Postoperatively, 3 cases of recurrent angina were detected at 5, 7, and 18months after surgery. One of them was managed successfully with repeat PTCA[who was recurred 18 months postoperatively], and the other two with medication. I conclude that we can approach the patients more aggressively with PTCA, because of our acceptable operative risks.

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Determinants of Successful Percutaneous Transluminal Coronary Angioplasty (경피적 관상동맥 성형술의 성공율에 영향을 미치는 인자에 대한 고찰)

  • Choi, Kyo-Won;Kweon, Jun-Young;Kim, Young-Jin;Lee, Tae-Il;Shin, Dong-Gu;Kim, Young-Jo;Shim, Bong-Seup;Lee, Hyun-Woo;Lee, Sam-Beom
    • Journal of Yeungnam Medical Science
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    • v.11 no.2
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    • pp.230-239
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    • 1994
  • In Order to evaluate determinants of successful percutaneous transluminal coronary angioplasty (PTCA), PTCA was performed for 172 coronary arterial lesions in 120 patients (89 male, 31 female) at Yeungnam university hospital from Sep. 1992 to Aug. 1993. The corinary artery luminal diameter at the site of the original stenosis was eveluated from end-diastolic frames of identical projections of the preangioplasty and immediate post angioplasty. The coronary luminal and balloon diameters were measured with using of computer measuring system. Overall success rate of 172 attempted lesions was 87.2%. Success rate of female patients was 93.5% and higher than those of male patients. According to the clinical diagnosis, success rate in stable angina was 93.7% and higher than those of post myocardial infarction angina, unstable angina and acute myocardial infarcrion. Success rate of American Heart Association type C lesion was 65.5% and lower those of type A (95.7%), type B (89.5%). There was signfifcantly difference in preangioplasty luminal stenosis, elastic recoil and length of lesion between successful PTCA group and failed PTCA group. Success rate of lesion location at a bend > $45^{\circ}$ and presence of intracoronary thrombus were lower than than those of other angiographic findings. In coclusion, primary angioplasty success was affected by specific angiographic factors. Stenosis severity, thrombus, lesion location at a bend > $45^{\circ}$, elastic recoil, and length of lesion were the principle of determinants of coronary angioplasty success rate.

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Analysis of Medical Expenses Structure for Patients on Percutaneous Coronary Intervention by Medical Security Type (의료보장형태에 따른 관상동맥중재술 환자의 진료비 구조분석)

  • Son, Mi-Kyung;Lee, Sok-Goo
    • Journal of agricultural medicine and community health
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    • v.44 no.4
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    • pp.195-208
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    • 2019
  • Objectives: The purpose of this study was to analyze whether there are differences in medical expenses according to medical security type in the use of medical services with high disease burden such as coronary intervention. Methods: Chi-square test and covariance analysis(ANCOVA) were conducted to identify the differences in the characteristics and costs according to medical security type of 1,904 patients who underwent coronary intervention in a university hospital from 2011 to 2012. Hierarchical regression analysis was conducted to determine whether the cost affects medical expenses. Results: In the medical aid group, the proportion of women, those without a job, those without a spouse, and those who received hemodialysis was high, length of stay was high, patients using the emergency room and those who died was high. The medical aid patients were significantly higher in the non-benefit medical expenses, optional medical expenses, physician and admission, meals, medications and injections. National health insurance patients were significantly higher in procedure. The medical security type was found to be significant as a variable affecting the medical expenses. Conclusions: Provision of medical expenses should be managed in advance by providing prevention and education services for the vulnerable, and care services in the region should be provided to suppress the occurrence of medical expenses due to the increase in the number of days spent. In addition, it is necessary to support medical expenses to prevent unsatisfactory medical services from occurring for non-benefit and optional care.