In patients with ST-elevation myocardial infarction (STEMI) with a high risk of ischemic events, the safety and efficacy of drug-eluting stent (DES) are unclear.
Based on the nationwide, multicenter, ...prospective registry, we selected 1,592 patients who underwent primary percutaneous coronary intervention (PCI) with everolimus-(EES) and zotarolimus-eluting stent (ZES) for STEMI with a high risk of an ischemic event. The occurrence of target lesion failure (TLF) for 3 years, defined as the composite of cardiac death, target vessel myocardial infarction (TV-MI), and ischemia-driven target lesion revascularization (ID-TLR), was evaluated.
The prevalence of high ischemic risk features was observed in 43.4% (2,744/6,325) of overall patients with STEMI. Among them, a total of 1,078 and 514 patients were treated with EES and ZES, respectively. At 3 years, the risk of TLF was not significantly different between the two groups (
= 0.93). In addition, the incidence of cardiac death, TV-MI, ID-TLR, and definite/probable stent thrombosis (ST) were also not different between the two groups. Moreover, elderly patients (age > 75 years) and PCI for the left main disease were identified as independent predictors of TLF.
Implantation of EES or ZES provided comparable clinical outcomes in STEMI patients and high ischemic risks.
There is ongoing debate regarding the optimal antiplatelet strategy beyond 12 months in patients with acute myocardial infarction (AMI) who undergo successful percutaneous coronary intervention ...(PCI). This study therefore aimed to investigate the clinical outcomes of single (SAPT) vs. dual antiplatelet therapy (DAPT) beyond 12 months in patients with stable AMI and second-generation drug-eluting stent (DES) implantation.
Of 13,104 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health database, we selected 4,604 patients who underwent PCI with second-generation DES and exhibited no adverse clinical events within 12 months; they were classified into SAPT (aspirin or clopidogrel) or DAPT (aspirin and clopidogrel) groups. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE), including the composite of all-cause death, myocardial infarction (MI), and stroke between 12 and 36 months.
The SAPT group (
= 1,862) was associated with a significantly lower risk of MACCE between 12 and 36 months 4.2 vs. 8.5%, hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.37-0.61;
< 0.001 than the DAPT group (
= 2,742). The results were consistent after adjusting for confounders through multivariable and propensity score matching analysis. Moreover, in patients with complex features (defined as an unprotected left main PCI, implanted stent length of ≥38 mm, multivessel PCI, or ≥3 stents per patients), the SAPT group (
= 678) also demonstrated a significantly lower risk of MACCE between 12 and 36 months (4.9 vs. 9.9%, HR: 0.46, CI: 0.31-0.68,
< 0.001) than the DAPT group (
= 1,167).
In patients with AMI who underwent successful PCI with second-generation DES and exhibited no adverse clinical events within 12 months, the use of SAPT was associated with a significantly lower MACCE between 12 and 36 months compared with the use of DAPT.
Background and Aim
Recent genomic studies have identified genetic variants in the IL12B gene, which encodes the p40 subunit shared by interleukin 12 and interleukin 23, as susceptibility loci for ...inflammatory bowel disease (IBD). The study aimed to identify additional novel genetic variants in IL12B and investigated whether variants confer susceptibility to the development of Crohn's disease (CD) or ulcerative colitis (UC) in the Korean population.
Methods
To detect single nucleotide polymorphisms (SNPs) in IL12B, direct sequencing of all coding exons, exon‐intron boundaries, promoter region, and 5′ untranslated region was performed in 24 randomly selected samples. Selected haplotype‐tagging SNPs were subsequently genotyped in 493 IBD patients (245 patients with CD and 248 with UC) and 504 healthy controls.
Results
Two haplotype‐tagging SNPs (rs2288831 and rs919766) were selected through direct sequencing and were genotyped. Of them, SNP rs2288831 in the IL12B gene was significantly associated with CD susceptibility in allelic association analysis (odds ratio = 1.30; 95% confidence interval 1.04–1.62; P = 0.019). This significant association with CD was also observed for a haplotype consisting of SNP rs919766 and rs2288831 (odds ratio = 1.29; 95% confidence interval 1.03–1.60; P = 0.025). However, none of IL12B SNPs were associated with UC susceptibility. Finally, no specific associations between genetic variants and disease phenotype of CD were identified.
Conclusions
This study is first to identify SNP rs2288831 in the IL12B gene as a susceptible variation for CD. Further studies in other ethnic groups are warranted to validate the association of this genetic variant with IBD.
Recent European ancestry genome-wide association studies have identified genetic variants of IRGM as significant susceptibility loci for Crohn's disease (CD). Therefore, we investigated whether ...genetic variants of IRGM confer genetic susceptibility to CD or ulcerative colitis (UC) and evaluated the genotype-phenotype associations in the Korean population.
This study included 510 inflammatory bowel disease (IBD) patients (253 patients with CD and 257 with UC) and 520 healthy controls in Koreans. Initially, we performed direct sequencing analysis to identify unique IRGM single nucleotide polymorphisms (SNPs). Three selected haplotype-tagging SNPs and one risk locus (rs72553867, rs10065172, rs4958847, and rs12654043) within the IRGM were then geno-typed in patients and controls.
IRGM SNP rs10065172 was significantly associated with CD susceptibility in terms of allelic frequency (P = 0.004; odds ratio OR = 1.42) and genotype frequency (dominant model, P = 0.008; OR = 1.62). We also found a relationship between SNP rs72553867 and CD susceptibility in the analysis of allelic frequency (P = 0.0117; OR = 0.67) and genotype frequency (dominant model, P = 0.002; OR = 0.55). In addition, we observed that the association of CD with rs10065172 became stronger in patients with younger age at diagnosis (≤ 20 years) or male gender. However, there was no significant association between the four SNPs and UC susceptibility.
This is the first study to identify SNP rs10065172 and rs72553867 in IRGM as principal CD susceptibility loci in an Asian population.
Abstract Background Recent studies suggest that adiposity is associated with arterial stiffness. However, it is unclear which adipokine or what adiposity related parameters are related with the ...progression of arterial stiffness. We hypothesized that in hypertensive patients, initial levels of adipokines such as adiponectin and resistin are related to the progression of arterial stiffness, which has been proven to be associated with increased risk of cardiovascular events. Methods One hundred forty one consecutive patients with treated essential hypertension (81 men, 57.7 ± 8.2 years) were enrolled. Pulse wave velocity (PWV) was measured at baseline, and after 24 months. Clinical variables and laboratory findings at the time of initial enrollment were analyzed to reveal the determinants of arterial stiffening. Results Mean heart to femoral PWV (hfPWV) was 992 ± 202 cm/s at baseline, and 1021 ± 263 cm/s at 24 months follow up. hfPWV progressed in seventy two patients (51.1%) during follow up period. In patients with hfPWV progression, mean plasma adiponectin level was significantly lower than patients with nonprogression (progressor: 5.18 ± 3.21 μg/ml, non-progressor: 7.02 ± 5.19 μg/ml, p = 0.013). Multivariate regression analysis revealed plasma adiponectin level to being an independent predictor of hfPWV changes (ß = − 0.018, p = 0.032) when controlled for age, gender, SBP changes, BP control and HOMA. Conclusions Plasma adiponectin levels are associated with progression of arterial stiffness in hypertensive patients. These findings may be one explanation for the high association between adiposity and arterial stiffness in hypertensive patients.
Background
Augmentation pressure has emerged as a surrogate marker for cardiovascular disease, and endothelial dysfunction has been proposed as related factor. However, the relationship between ...augmentation pressure and digital endothelial function has not yet been well defined. We investigated the relationship between augmentation pressure and digital reactive hyperemia (RH) in patients with hypertension using peripheral arterial tonometry (PAT), which is regarded as being representative of endothelial function.
Methods
One hundred hypertensive patients (64 males; mean age, 49 ± 12 years) without a history of taking antihypertensive medication were enrolled in this study.
Results
The mean augmentation pressure and augmentation index (AIx) normalized for a heart rate of 75 beats/min (AIx75) were 15 ± 8 mm Hg and 26 ± 11%, respectively. The mean RH-PAT index and log transformed PAT ratio were 2.24 ± 0.55 and 0.62 ± 0.30. There was an inverse relationship between the RH-PAT index and age, male sex, and body mass index. The log transformed PAT ratio also showed inverse relationship with age and male sex. The RH-PAT index and the log transformed PAT ratio showed no relationship with augmentation pressure or AIx75. In a multiple linear regression analysis, age, height, and central systolic BP demonstrated an independent association with augmentation pressure and AIx75.
Conclusion
In patients with hypertension, the RH-PAT index determined using PAT was not associated with augmentation pressure or AIx75. Digital vascular function may be a less important factor for pressure augmentation in patients with hypertension.
American Journal of Hypertension, advance online publication 8 September 2011; doi:10.1038/ajh.2011.132
Triggering receptor expressed on myeloid cells-1 (TREM-1) has been shown to play a crucial role in the propagation of inflammatory responses. Recent studies have reported that TREM-1 expression is ...up-regulated in patients with inflammatory bowel disease (IBD). Therefore, we investigated the associations between
TREM-
1 genetic polymorphisms and IBD development and its phenotypes in the Korean population.
Three
TREM-
1 single nucleotide polymorphisms (SNPs, rs2234237, rs3789205, and rs9471535) were genotyped by Taqman technology on 202 Crohn's disease (CD), 265 ulcerative colitis (UC), 138 with intestinal Behcet's disease (BD), and 234 healthy controls and the relationships between these SNPs and IBD development and phenotypes were evaluated.
We found that
TREM-
1 SNPs are significantly associated with the development of intestinal Behcet's disease (rs9471535: odds ratio OR
=
1.637,
P
=
0.025; rs3789205: OR
=
1.668,
P
=
0.019; rs2234237: OR
=
1.691,
P
=
0.016), and in particular with skin involvement (rs9471535: OR
=
2.723,
P
=
0.009; rs3789205: OR
=
2.477,
P
=
0.017; rs2234237: OR
=
2.278,
P
=
0.030) and the risk of azathioprine use (rs9471535: OR
=
2.722,
P
=
0.021; rs3789205: OR
=
2.493,
P
=
0.032; rs2234237: OR
=
2.638,
P
=
0.026). However,
TREM-
1 SNPs were not significantly associated with the development of Crohn's disease or ulcerative colitis.
The results of our study suggest that
TREM-
1 SNPs may play a significant role in the development of intestinal Behcet's disease and may have modest effects on disease severity.
To identify the genetic risk factors that influence the development of electrocardiographic (ECG) left ventricular hypertrophy (LVH), a major risk factor for cardiovascular (CV) morbidity and ...mortality.
We performed a genomewide association study (GWAS) of ECG-LVH, in which the community-based Korea Association REsource (KARE) study (8432 controls and 398 cases) was analysed by Affymetrix SNP array 5.0. The GWAS results were validated in hospital-based samples (597 controls and 207 cases). Fourteen single-nucleotide polymorphisms (SNPs) in eight genetic loci (5q35.1, 6p22.3-22.1, 8q24.2, 11p15, 11q21-22.1, 14q12, 17q11.2, and 19q13.1) were associated with ECG-LVH in the original GWAS study (P < 1 × 10(-5)). Of these SNPs, 12 were genotyped in the hospital sample. There was consistent association with the 19q13.1 region which contains RYR1 gene. The most significant SNP in the region was rs10500279, which had genomewide significance in the combined GWAS/replication sample odds ratio = 1.58 (confidence interval: 1.35-1.85), P = 1.0 × 10(-8). Mutations in RYR1, which encodes a major Ca(2+) channel in the skeletal muscle, have been reported to correlate with CV diseases.
We performed the first GWAS for ECG-LVH, implicating the skeletal muscle Ca(2+) channel protein RYR1 as a genetic risk factor. These results might increase our understanding of the development of ECG-LVH.
Arterial stiffness is a known independent predictor of cardiovascular mortality. The Colins system is an easy device and has gained widespread use, but the cutoff value for high-risk central arterial ...stiffness is not well established. We investigated the correlation between arterial stiffness measured by the Colins system with conventional measurements from the SphygmoCor system. Arterial pulse wave velocity (PWV) and augmentation indices (AIs) were measured on a single visit using two different devices in 948 patients with hypertension or coronary artery disease. Strong positive correlations were observed for PWV values measured by the SphygmoCor and Colins systems. The Colins system measurements accurately predicted high-risk central arterial stiffness, defined as carotid-femoral PWV≥12 m s(-1), with an area under the receiver-operating characteristic curve (AUC) of 0.884 (heart-femoral PWV, hfPWV) and 0.830 (brachial-ankle PWV, baPWV) in the training set (N=664). The cutoff values, 11.18 (hfPWV) and 16.17 m s(-1) (baPWV), showed good discrimination in the validation set (N=284), with sensitivity of 83.3 (hfPWV) and 76.0% (baPWV), and specificity of 74.9 (hfPWV) and 82.6% (baPWV). The SphygmoCor and Colins AI systems also showed moderate positive correlation. The Colins AI system better predicted high-risk central pulse pressure as defined by pulse pressure≥50 mm Hg (AUC: Colins, 0.765; SphygmoCor, 0.692; P=0.011). Arterial stiffness measured by the Colins system showed strong positive correlation and agreement with the SphygmoCor system measurement. Cutoff values for high-risk central arterial stiffness in the Colins system need further validation in a prospective study.
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