Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: The efficacy of xience/promus versus cypher to reduce late loss after stenting (EXCELLENT) randomized, multicenter study
Gwon H.-C.,Sungkyunkwan University |
Hahn J.-Y.,Sungkyunkwan University |
Park K.W.,Seoul National University |
Song Y.B.,Sungkyunkwan University |
And 22 more authors.
Circulation | Year: 2012
BACKGROUND-: The optimal duration of dual antiplatelet therapy (DAPT) after implantation of drug-eluting coronary stents remains undetermined. We aimed to test whether 6-month DAPT would be noninferior to 12-month DAPT after implantation of drug-eluting stents. METHODS AND RESULTS-: We randomly assigned 1443 patients undergoing implantation of drug-eluting stents to receive 6- or 12-month DAPT (in a 1:1 ratio). The primary end point was a target vessel failure, defined as the composite of cardiac death, myocardial infarction, or ischemia-driven target vessel revascularization at 12 months. Rates of target vessel failure at 12 months were 4.8% in the 6-month DAPT group and 4.3% in the 12-month DAPT group (the upper limit of 1-sided 95% confidence interval, 2.4%; P=0.001 for noninferiority with a predefined noninferiority margin of 4.0%). Although stent thrombosis tended to occur more frequently in the 6-month DAPT group than in the 12-month group (0.9% versus 0.1%; hazard ratio, 6.02; 95% confidence interval, 0.72-49.96; P=0.10), the risk of death or myocardial infarction did not differ in the 2 groups (2.4% versus 1.9%; hazard ratio, 1.21; 95% confidence interval, 0.60-2.47; P=0.58). In the prespecified subgroup analysis, target vessel failure occurred more frequently in the 6-month DAPT group than in the 12-month group (hazard ratio, 3.16; 95% confidence interval, 1.42-7.03; P=0.005) among diabetic patients. CONCLUSIONS-: Six-month DAPT did not increase the risk of target vessel failure at 12 months after implantation of drug-eluting stents compared with 12-month DAPT. However, the noninferiority margin was wide, and the study was underpowered for death or myocardial infarction. Our results need to be confirmed in larger trials. CLINICAL TRIAL REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00698607. © 2011 American Heart Association, Inc.
Jung J.-M.,Korea University |
Kang D.-W.,University of Ulsan |
Yu K.-H.,Hallym University |
Koo J.-S.,University of Ulsan |
And 6 more authors.
Stroke | Year: 2012
BACKGROUND AND PURPOSE-: Our goal was to investigate whether initial ischemic lesion pattern can predict stroke recurrence in patients with symptomatic intracranial arterial stenosis. METHODS-: Of the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS)-2 trial participants, we included patients who underwent diffusion-weighted imaging and fluid attenuation inversion recovery imaging at baseline with a follow-up fluid attenuation inversion recovery imaging at 7 months. Based on the diffusion-weighted imaging findings, we classified the initial ischemic lesion patterns according to location (subcortical versus cortical versus subcorticocortical) and multiplicity (single versus multiple). We also evaluated the occurrence of new ischemic lesions on follow-up fluid attenuation inversion recovery as well as clinical stroke in the symptomatic intracranial arterial stenosis territory. RESULTS-: Of 353 patients included in this study, 44 (12.5%) and 13 (3.7%) patients had new ischemic lesions and clinical recurrent stroke in the initial symptomatic intracranial arterial stenosis territory, respectively. On multivariable analysis, the initial lesion patterns of subcorticocortical and multiple lesions were independent predictors of new ischemic lesions in the symptomatic intracranial arterial stenosis territory (OR, 3.01; 95% CI, 1.33-7.01; P=0.03; OR, 2.81; 95% CI, 1.34-5.9; P=0.006). These patterns also predicted clinical recurrent stroke. CONCLUSION-: Subcorticocortical lesions and multiple lesions are radiological predictors of recurrent ischemic stroke in symptomatic patients with intracranial arterial stenosis. © 2012 American Heart Association, Inc.
Safety and efficacy of second-generation everolimus-eluting Xience v Stents versus zotarolimus-eluting resolute stents in real-world practice: Patient-related and stent-related outcomes from the multicenter prospective EXCELLENT and RESOLUTE-Korea registries
Park K.W.,Seoul National University |
Lee J.M.,Seoul National University |
Kang S.-H.,Seoul National University |
Ahn H.-S.,Seoul National University |
And 13 more authors.
Journal of the American College of Cardiology | Year: 2013
Objectives: This study sought to compare the safety and efficacy of the Xience V/Promus everolimus-eluting stent (EES) (Abbott Vascular, Temecula, California) with the Endeavor Resolute zotarolimus-eluting stent (ZES-R) (Medtronic Cardiovascular, Santa Rosa, California) in "all-comer" cohorts. Background: Only 2 randomized controlled trials have compared these stents. Methods: The EXCELLENT (Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting) and RESOLUTE-Korea registries prospectively enrolled 3,056 patients treated with the EES and 1,998 patients treated with the ZES-R, respectively, without exclusions. Stent-related composite outcomes (target lesion failure [TLF]) and patient-related composite outcomes were compared in crude and propensity score-matched analyses. Results: Of 5,054 patients, 3,830 (75.8%) had off-label indication (2,217 treated with EES and 1,613 treated with ZES-R). The stent-related outcome (82 [2.7%] vs. 58 [2.9%], p = 0.662) and the patient-related outcome (225 [7.4%] vs. 153 [7.7%], p = 0.702) did not differ between EES and ZES-R, respectively, at 1 year, which was corroborated by similar results from the propensity score-matched cohort. The rate of definite or probable stent thrombosis (18 [0.6%] vs. 7 [0.4%], p = 0.306) also was similar. In multivariate analysis, off-label indication was the strongest predictor of TLF (adjusted hazard ratio: 2.882; 95% confidence interval: 1.226 to 6.779; p = 0.015). Conclusions: In this robust real-world registry with unrestricted use of EES and ZES-R, both stents showed comparable safety and efficacy at 1-year follow-up. Overall incidences of TLF and definite stent thrombosis were low, even in the patients with off-label indication, suggesting excellent safety and efficacy of both types of second-generation drug-eluting stents. © 2013 American College of Cardiology Foundation.
Oh S.J.,Hallym University |
Chung C.H.,Kangdong Sacred Heart Hospital
Journal of Craniofacial Surgery | Year: 2011
The combined dorsalis pedis cutaneous, extensor hallucis and digitorum brevis muscle conjoined free flap is useful for a moderate or subtotal defect of the full-thickness lip when local or regional flaps are not applicable. This method can restore good oral competence, adequate oral aperture allowing dental hygiene, and an ability to purse the lips and create a seal. Copyright © 2011 by Mutaz B. Habal, MD.
Jeong K.W.,Kangdong Sacred Heart Hospital |
Jang H.J.,Hallym University
International Journal of Bio-Science and Bio-Technology | Year: 2016
This study investigated the correlation between knowledge and performance of radia-tion protection among operating room nurses. The research design was a descriptive survey. Data were collected by using a questionnaire from August 24 to September 7, 2015. The participants were 184 operating room nurses. The average score for radiation protection knowledge was 8.68(SD=2.65). The average score for the performance of radiation protection behaviors was 3.16(SD=0.67). There were no significant differences in knowledge of radiation protection according to general and occupational characteris-tics. However, there were significant differences in performance of radiation protection according to gender, age, education, and special health screening. Knowledge and per-formance of radiation protection had a significant positive correlation (r=.23, p<.01). This study concluded that educational programs are needed to improve performance of radiation protection among operating room nurses. © 2016 SERSC.
Kwon J.H.,Kangdong Sacred Heart Hospital |
Kwon J.H.,University of Houston |
Tanco K.,University of Houston |
Hui D.,University of Houston |
And 2 more authors.
Palliative and Supportive Care | Year: 2014
Objective: The purpose of this case series was to describe patients with aberrant drug-related behaviors and similar patterns of dose escalation in whom interdisciplinary assessment revealed different bases for their dose increases. Method: During the period from December 26 to December 30, 2011, the medical records of two patients with opioid-related aberrant behaviors were reviewed. Results: We described two patients with a significant cancer history and different comorbidities who presented with different aberrant drug-related behaviors and opioid requirements. Significance of Results: Opioid-related aberrant behaviors can be interpreted in different ways, and two of the more common syndromes in cancer patients are chemical coping and pseudoaddiction. In advanced cancer patients, the boundaries between these conditions are not as clear, and diagnosis is often made retrospectively. Furthermore, there have been relatively limited studies describing these two syndromes. Thus, they continue to pose a diagnostic and treatment challenge that requires different approaches for effective management of symptoms. The key characteristic between the two syndromes is that the behaviors displayed in chemical coping are motivated by obtaining opioids to relieve psychosocial distress, while in pseudoaddiction these behaviors are motivated by uncontrolled nociceptive input. Close monitoring of the pain syndromes, aberrant behaviors, and opioid requirements over several visits is usually necessary to distinguish the two syndromes. Copyright © Cambridge University Press 2014.
Lee M.,Kangdong Sacred Heart Hospital |
Kim Y.T.,Yonsei University |
Kim S.W.,Yonsei University |
Kim S.,Yonsei University |
And 2 more authors.
International Journal of Gynecological Cancer | Year: 2013
This study aimed to evaluate the influence of intrauterine manipulation on the surgical outcome in patients with early-stage endometrial cancer treated with 2 different laparoscopic approaches. Methods: In a randomized parallel trial, 110 patients with clinical stage I endometrial cancer were randomly assigned for laparoscopic staging surgery with (group A, 55) or without (groupB, 55) the use of a uterine manipulator (RUMI), between June 2009 and June 2011. Two sets of peritoneal washings were obtained, 1 before and 1 after the insertion of the uterine manipulator. Primary end points were the rates of positive cytology and lymphovascular space invasion. Results: No difference was detected in patient characteristics between the groups. Mean operative time, estimated blood loss, and postoperative complications were similar between the groups. Group A had a similar incidence of lymphovascular space invasion compared with group B (12.7% vs 9.1%, respectively; P = 0.761). Four patients (7.3%) in group A had positive peritoneal cytology in the initial washing. One of these patients was classified as stage IIIA. One patient in group B was positive in the second washing. The agreement rate between the 2 sets of washings for both groupswas 98.2%. During the median follow-up of 19 months, 6 patients had tumor recurrence without significant difference between the groups. Conclusions: Despite concerns that the use of uterine manipulators may predispose the spread of early-stage disease, insertion of such uterine-manipulating systems did not increase rate of positive peritoneal cytology or lymphovascular space invasion in this study. © 2013 by IGCS and ESGO.
Kim S.Y.,Kangdong Sacred Heart Hospital
The Cochrane database of systematic reviews | Year: 2013
Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used for the treatment of pain and fever associated with the common cold. However, there is no systematic review to assess the effects of NSAIDs in treating the common cold. To determine the effects of NSAIDs versus placebo (and other treatments) on signs and symptoms of the common cold, and to determine any adverse effects of NSAIDs in people with the common cold. We searched CENTRAL (The Cochrane Library 2013, Issue 1), MEDLINE (January 1966 to April week 4, 2013), EMBASE (January 1980 to April 2013), CINAHL (January 1982 to April 2013) and ProQuest Digital Dissertations (January 1938 to April 2013). Randomised controlled trials (RCTs) of NSAIDS in adults or children with the common cold. Four review authors extracted data. We subdivided trials into placebo-controlled RCTs and head-to-head comparisons of NSAIDs. We extracted and summarised data on global efficacies of analgesic effects (such as reduction of headache and myalgia), non-analgesic effects (such as reduction of nasal symptoms, cough, sputum and sneezing) and side effects. We expressed dichotomous outcomes as risk ratios (RR) with 95% confidence intervals (CI) and continuous data as mean differences (MD) or standardised mean differences (SMD). We pooled data using the fixed- and random-effects models. We included nine RCTs with 1069 participants, describing 37 comparisons: six were NSAIDs versus placebo and three were NSAIDs versus NSAIDs. The overall risk of bias in the included studies was mixed. In a pooled analysis, NSAIDs did not significantly reduce the total symptom score (SMD -0.40, 95% CI -1.03 to 0.24, three studies, random-effects model), or duration of colds (MD -0.23, 95% CI -1.75 to 1.29, two studies, random-effects model). For respiratory symptoms, cough did not improve (SMD -0.05, 95% CI -0.66 to 0.56, two studies, random-effects model) but the sneezing score significantly improved (SMD -0.44, 95% CI -0.75 to -0.12, two studies, random-effects model). For outcomes related to the analgesic effects of NSAIDs (headache, ear pain, and muscle and joint pain) the treatment produced significant benefits. The risk of adverse effects was not high with NSAIDs (RR 2.94, 95% CI 0.51 to 17.03, two studies, random-effects model) and it is difficult to conclude that such drugs are not different from placebo. NSAIDs are somewhat effective in relieving discomfort caused by a cold but there is no clear evidence of their effect in easing respiratory symptoms. The balance of benefit and harms needs to be considered when using NSAIDs for colds.
Ahn S.M.,Kangdong Sacred Heart Hospital
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi | Year: 2012
Although the adrenal gland is a common site of metastasis from hepatocellular carcinoma (HCC), adrenal metastases are rarely seen in clinical practice because of its lower metastatic potential compared to the other malignancies. Adrenal metastases usually were detected at the time of diagnosis of primary HCC or simultaneously with intrahepatic recurrence after curative management of HCC. It is very rare that only metastatic HCC is detected without evidence of intrahepatic recurrence. Hereby, we report two cases of adrenal metastasis from HCC without intrahepatic recurrence after hepatic resection.
Park J.H.,Kangdong Sacred Heart Hospital |
Kim C.W.,Kangdong Sacred Heart Hospital |
Kim S.S.,Kangdong Sacred Heart Hospital
Annals of Dermatology | Year: 2012
Background: Scabies is a contagious skin infestation characterized clinically by nocturnal pruritus, visible burrows and contagiousness. Dermoscopy has been suggested as an alternative for diagnosing scabies. But, there have been few well-designed studies evaluating the diagnostic accuracy of dermoscopy. Objective: We tried to confirm the diagnostic accuracy of dermoscopy for diagnosing scabies. We also tried to demonstrate specific circumstances in which dermoscopic identification of mites ("with dermoscopy") is more useful in diagnosing scabies, and to identify the specific clinical findings that could be used as a possible marker in diagnosing scabies. Methods: We compared the scraping procedure "with dermoscopy" and "without it" in 49 patients, measuring the duration and outcome of each procedure. Also, we tried to find the specific clinical factors associated with our objects. Results: The skin scraping "with dermoscopy" was superior to "without it" with respect to the duration and accuracy of the procedure. A history of previous steroid treatment was associated with the superiority of dermoscopy. The correlation between the presence of visible burrows and the positive outcomes of "with dermoscopy" was statistically significant. Conclusion: Skin scraping with dermoscopy is implicated as the diagnostic method of choice for scabies at the present time. Dermoscopy is especially useful in diagnosis of incognito scabies. In addition, the presence of visible burrows could be a reliable positive marker of scabies in the absence of dermoscopy or microscopy data.