The Clinical Impact of Intravascular Imaging-Guided Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients with High Thrombus Burden.

Despite the established clinical efficacy following intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) than angiography-guided PCI, evidence regarding prognostic benefits of IVI-guided PCI in acute myocardial infarction (AMI) patients with high thrombus burden remains limited. Using the nationwide registries of KAMIR-NIH and KAMIR-V, we evaluated the prognostic impact of IVI-guided PCI in AMI patients with high thrombus burden. A total of 4,074 patients with AMI and TIMI thrombus grades 4 or 5 who underwent aspiration thrombectomy were selected, of whom 892 patients (21.

Optimal Maintenance Strategy for Patients with Improved Left Ventricular Function Following Sacubitril/Valsartan Therapy.

: Optimal pharmacological treatment following left ventricular ejection fraction (LVEF) improvement remains largely unknown. This study compared the clinical outcomes of patients with heart failure (HF) with improved EF (HFimpEF) based on the maintenance of sacubitril/valsartan (S/V) or transition to a renin-angiotensin system blocker (RASB). : A total of 354 patients with recovered LVEF of at least 40% after S/V treatment from a single center were retrospectively analyzed.

Clinical Relevance of Fractional Flow Reserve-Guided Percutaneous Coronary Interevention According to Left Ventricular Ejection Fraction in Patients With Acute Myocardial Infarction and Multivessel Disease.

Background: Fractional flow reserve (FFR)-guided or angiography-guided complete revascularization has not been evaluated in patients with acute myocardial infarction (AMI) with multivessel disease and reduced left ventricular ejection fraction (LVEF). This study sought to evaluate the impact of FFR-guided percutaneous coronary intervention (PCI) for patients with AMI with multivessel disease according to left ventricular systolic function.

Methods: We performed a prespecified analysis of the FRAME-AMI (Fractional Flow Reserve Versus Angiography-Guided Strategy in Acute Myocardial Infarction With Multivessel Disease) trial, which randomly allocated 562 patients to undergo either FFR-guided PCI (FFR ≤0.

Intravascular Imaging-Guided PCI vs Coronary Artery Bypass Grafting for Left Main or 3-Vessel Disease.

Background: Previous trials have shown that coronary artery bypass graft (CABG) has better clinical outcomes compared with percutaneous coronary intervention (PCI) for patients with left main coronary artery or 3-vessel disease. However, it is unclear whether intravascular imaging (IVI)-guided PCI would reduce the difference in clinical events compared to CABG.

Objectives: The present study sought to compare the clinical outcomes of patients with left main or 3-vessel disease who underwent IVI-guided PCI with those who underwent CABG.

The Association of Early or Late Combined Infection with Clinical Outcomes in Cardiogenic Shock Patients.

Background: Infections are common predisposing factors for mixed cardiogenic shock (CS) due to their contribution to systemic vasodilation. However, data on the prognosis of mixed CS complicated by infection remain limited. This study compared the clinical picture and outcomes of isolated CS and mixed CS, stratified by the timing of infection.

Exploring Strategies to Improve Outcomes in Patients With Giant Cell Myocarditis: A Case Series of Five Biopsy-Proven Cases.

Giant cell myocarditis (GCM) is a rare but severe disease with high morbidity and mortality, often requiring heart transplantation (HT). While immunosuppressive therapy has improved outcomes, recurrence after HT remains high, and long-term survival without transplantation is also limited. This case series presents five biopsy-confirmed GCM cases, highlighting clinical characteristics and strategies to improve prognosis.

Post-Transplant Lymphoproliferative Disorder Presenting as Biventricular Failure After Heart Transplantation.

Background: The diagnosis of post-transplant lymphoproliferative disorder (PTLD) is challenging because of its diverse clinical presentations.

Case Summary: A 65-year-old man, previously stable 61 months after heart transplantation for dilated cardiomyopathy, presented with biventricular failure and worsening dyspnea. Given the acute decline in graft function, acute rejection was suspected, and rejection therapy was initiated.

Association Between Vasoactive Inotropic Score and Clinical Outcomes in Patients With Fulminant Myocarditis.

Background And Objectives: This study aimed to evaluate the prognostic value of the vasoactive inotropic score (VIS) in patients with fulminant myocarditis according to the application of venoarterial-extracorporeal membrane oxygenation (VA-ECMO).

Methods: This study retrospectively analyzed 417 patients with biopsy-proven or clinically suspected fulminant myocarditis from 7 hospitals in Korea. The primary outcome was a composite of all-cause death, heart transplantation, or the use of left ventricular assist device (LVAD) at 1 year.

Association Between Initial Left Ventricular Systolic Dysfunction and Clinical Outcome in Sepsis: A Multicenter Cohort Study.

Objectives: To investigate the association between the severities of left ventricular (LV) systolic dysfunction and clinical outcomes in patients with sepsis, with a particular focus on in-hospital mortality.

Design: Multicenter cohort study.

Setting: Nineteen tertiary or university-affiliated hospitals in South Korea.

The effects of extracorporeal blood purification (oXiris®) in patients with cardiogenic shock who require VA-ECMO (CLEAN ECMO): a prospective, open-label, randomized controlled pilot study.

Background: A systemic inflammatory response can contribute to poor outcomes in an advanced stage of cardiogenic shock (CS). We investigated the efficacy of extracorporeal endotoxin and cytokine adsorption using oXiris in patients with CS undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO).

Methods: In this prospective, single-center, randomized, open-label pilot trial, 40 patients with CS who were undergoing VA-ECMO were randomly assigned to receive either oXiris for 24 h (n = 20) or usual care (n = 20).

Effect of Operator Experience Performing Rotational Atherectomy on Clinical Outcomes After Percutaneous Coronary Intervention.

Background And Objectives: Rotational atherectomy (RA) is a technique used to ablate calcified plaques. There is speculation that operators' experience with RA could play a role in the outcomes.

Methods: From December 2015 to April 2020, patients with calcified coronary lesions requiring percutaneous coronary intervention (PCI) with RA were enrolled in a prospective, multicenter, observational registry.

Sex-Specific Differences in Management and Outcomes of Cardiogenic Shock Patients With and Without Ischemic Cardiomyopathy.

Background And Objectives: Comprehensive data on sex-based differences in the management and outcomes of patients with and without ischemic cardiomyopathy (ICMP) presenting with cardiogenic shock (CS) remain limited. This study aimed to investigate whether clinical management and outcomes differ by sex among CS patients, stratified by underlying etiology.

Methods: We analyzed 1,247 CS patients from the RESCUE registry, a multicenter observational cohort, stratified by sex and CS etiology: ICMP (females: 276, males: 730) and non-ICMP (females: 111, males: 130).

Clinical significance of low-density lipoprotein cholesterol percentage reduction and attained levels after percutaneous coronary intervention.

Background: Differences exist between European and American guideline recommendations regarding targets for low-density lipoprotein cholesterol (LDL-C) levels after percutaneous coronary intervention (PCI), with European guidance advocating for more aggressive reduction to less than 1.4 mmol/L compared with the American guideline, which recommends an LDL-C level of 1.8 mmol/L or greater as the threshold for treatment intensification.

Impact of Elevated Troponin Level at the Time of Sepsis Recognition on the Clinical Outcomes: A Propensity Score-Matched Cohort Study.

Background: Sepsis-induced cardiac dysfunction, known as septic cardiomyopathy, is a common complication associated with increased mortality. Cardiac troponins serve as markers for myocardial injury and are frequently elevated in patients with sepsis. However, the role of troponin elevation at sepsis recognition in risk stratification remains controversial.

Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial.

Background: The optimal strategy for long-term antiplatelet maintenance for patients who underwent percutaneous coronary intervention (PCI) remains uncertain. This study aimed to compare the efficacy and safety of clopidogrel versus aspirin monotherapy in patients who completed a standard duration of dual antiplatelet therapy (DAPT) following PCI with drug-eluting stents.

Methods: In this multicentre, randomised, open-label trial, patients aged 19 years or older at high risk of recurrent ischaemic events (previous myocardial infarction at any time before enrolment, medication-treated diabetes, or complex coronary lesions) who completed a standard duration of DAPT after PCI were randomly assigned (1:1) to receive clopidogrel (75 mg once a day) or aspirin (100 mg once a day) oral monotherapy at 26 sites in South Korea.

Intravascular Imaging-Guided Versus Angiography-Guided Complex PCI in Patients With High Bleeding Risk: A Secondary Analysis of the RENOVATE-COMPLEX PCI Trial.

Background: Although patients with high bleeding risk (HBR) often have complex coronary artery lesions, it is not known whether intravascular imaging-guided percutaneous coronary intervention (PCI) improves their prognosis. We sought to investigate the benefit of intravascular imaging-guided PCI for complex coronary artery lesions in patients with HBR.

Methods: This was a secondary analysis of the RENOVATE-COMPLEX-PCI trial (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) in which patients with complex coronary artery lesions undergoing PCI were enrolled at 20 sites in Korea from May 2018 through May 2021.

Sex Differences in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation.

Background And Objectives: Limited data are available on sex differences in clinical outcomes of patients with profound cardiogenic shock (CS) receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO). Therefore, our study sought to compare clinical pictures and outcomes between male and female patients treated with VA-ECMO.

Methods: A total of 1,328 patients receiving VA-ECMO were selected from either the Samsung Medical Center or a multicenter CS registry named the SMART RESCUE study.

Recent Advances in Chronic Thromboembolic Pulmonary Hypertension: Expanding the Disease Concept and Treatment Options.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive form of pulmonary hypertension characterized by unresolved thromboembolic occlusion of pulmonary arteries, leading to increased pulmonary arterial pressure and right heart failure. This review examines recent advances in the pathophysiology, diagnosis, and management of CTEPH, focusing on expanding disease concepts and evolving therapeutic approaches. The incidence of CTEPH has been revised upward with improved diagnostic techniques revealing a higher prevalence than previously recognized.

Continuous Renal Replacement Therapy and Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock: Results from the Rescue Registry.

Cardiogenic shock (CS) frequently leads to multiorgan failure, often necessitating continuous renal replacement therapy (CRRT) or extracorporeal membrane oxygenation (ECMO). We evaluated the association between CRRT, ECMO, and its prognostic implication in patients with CS. A total of 1247 patients with CS were enrolled from the RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients with Cardiogenic Shock) registry between January 2014 and December 2018.

Efficacy and safety of SGLT2 inhibitors in patients with heart failure according to kidney function: a systematic review and meta-analysis.

Introduction And Objectives: This study aimed to evaluate the efficacy and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors throughout the spectrum of kidney function in patients with heart failure (HF).

Methods: This meta-analysis included randomized controlled trials comparing SGLT2 inhibitors with placebo in patients with HF stratified by renal function. Literature from inception to June 8, 2024 was searched.

Impact of coronary artery calcium on progression of diastolic dysfunction: a cohort study.

Background: The relationship between coronary artery calcium (CAC) and progression of diastolic dysfunction (DD) during longitudinal follow-up is uncertain. This study aimed to investigate the prevalence and progression of DD according to severity of CAC and understand their synergistic effect on mortality.

Methods: This was a population-based cohort study.

Microvascular Resistance Reserve and Prognosis After Heart Transplantation.

Background: Impaired microcirculatory function after heart transplantation is associated with increased risk for acute cellular rejection. Microvascular resistance reserve (MRR) is a novel index for assessing microcirculatory function, irrespective of epicardial coronary artery stenosis, but it has not been validated in transplanted hearts.

Objectives: The aim of this study was to investigate the prognostic impact of MRR in heart transplantation.

Assessing the clinical impact of cardiac intensivists in cardiac intensivecare units: results from the RESCUE registry.

Background: The presence of dedicated intensive care unit (ICU) physicians is associated with reduced ICU mortality. However, the information available on the role of cardiac intensivists in cardiac ICUs (CICUs) is limited. Therefore, we investigated the association of cardiac intensivist-directed care with clinical outcomes in adult patients admitted to the CICU.

Simulating the effects of reducing transfer latency from the intensive care unit on intensive care unit bed utilization in a Korean Tertiary Hospital.

Background: Latency in transferring patients from intensive care units (ICUs) to general wards impedes the optimal allocation of ICU resources, underscoring the urgency of initiatives to reduce it. This study evaluates the extent of ICU transfer latency and assesses the potential benefits of minimizing it.

Methods: Transfer latency was measured as the time between the first transfer request and the actual ICU discharge at a single-center tertiary hospital in 2021.