Publications by authors named "Yongwhan Lim"

Background: The optimal timing of complete revascularisation for patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear. We aimed to assess whether immediate complete revascularisation was non-inferior to staged complete revascularisation during the index admission.

Methods: We conducted an open-label, randomised, non-inferiority trial at 14 hospitals in South Korea.

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Aims: Rapid myocardial revascularization in patients with acute myocardial infarction (AMI) is essential to improve clinical outcomes. There is still room for improvement in the timely diagnosis of AMI. This study aimed to develop an artificial intelligence (AI) model using electrocardiograms (ECGs) for detecting AMI needing revascularization.

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Aims: The long-term effects of early left ventricular (LV) unloading after venoarterial extracorporeal membrane oxygenation (VA-ECMO) remain unclear.

Methods And Results: The EARLY-UNLOAD trial was a single-centre, investigator-initiated, open-label, randomized clinical trial involving 116 patients with cardiogenic shock (CS) undergoing VA-ECMO. The patients were randomly assigned to undergo either early routine LV unloading by transseptal left atrial cannulation within 12 h after randomization or the conventional approach, which permitted rescue transseptal cannulation in case of an increased LV afterload.

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Background And Objectives: The optimal timing for complete revascularization (CR) in patients with acute myocardial infarction (AMI) and multivessel disease (MVD) remain uncertain.

Methods: This post-hoc analysis of the FRAME-AMI trial included AMI patients with MVD ( = 549). They were classified into immediate ( = 329) and staged CR ( = 220) groups.

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Article Synopsis
  • * While VA-ECMO is beneficial, it can cause issues like left ventricular (LV) overload due to increased retrograde arterial flow, leading to complications like pulmonary edema and arrhythmias.
  • * Effective management of VA-ECMO requires LV unloading to mitigate these risks; the article discusses the timing, indications, and methods for achieving this unloading.
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Article Synopsis
  • * Results showed that during the first week, STEMI patients had a significantly higher mortality rate (4.62%) compared to NSTEMI patients (1.79%), but this trend reversed after the second week for men and the tenth week for women.
  • * The research highlights the need for further studies to develop advanced risk prediction models based on time-point mortality outcomes, as different baseline variables influenced mortality rates over time.
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Introduction: Elevated low-density lipoprotein cholesterol (LDL-C) is a major residual risk factor among patients with acute coronary syndrome (ACS). In the absence of sufficient real-world evidence, this observational (noninterventional) study investigated the effectiveness and safety of evolocumab in patients with hyperlipidemia treated with evolocumab for ACS in a real-world clinical setting in Korea.

Methods: Between January 2022 and February 2023, patients from 10 hospitals in Korea who initiated evolocumab within 24 weeks of an ACS event were enrolled.

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Objectives: This study investigated the optimal timing for percutaneous coronary intervention (PCI) in patients with NSTEMI complicated by heart failure (HF).

Methods: In total, 762 patients with NSTEMI and HF in a multicenter, prospective registry in South Korea were classified according to the Killip classification (Killip class 2, n = 414 and Killip class 3, n = 348) and underwent early (within 24 h) and delayed (after 24 h) PCI. The primary outcome was all-cause mortality which was further analyzed with landmark analysis with two months as a cut-off.

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Article Synopsis
  • Current guidelines suggest complete revascularization (CR) for stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), but the best timing for the procedure is still unclear.
  • The OPTION-STEMI trial investigates whether immediate CR during a primary angioplasty is as effective as in-hospital staged CR, using fractional flow reserve (FFR) assessments for certain lesions.
  • The trial enrolled patients with significant non-infarct-related artery lesions, aiming to measure outcomes like death and myocardial infarction one year post-randomization, with results expected in mid-2025.
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Article Synopsis
  • The study examines the effects of early left ventricular unloading versus a conventional approach on 30-day mortality in patients with cardiogenic shock undergoing VA-ECMO.
  • Conducted from March 2021 to September 2022, it involved 116 patients randomly assigned to either early unloading or the conventional approach, with no significant difference in mortality rates observed between the two groups.
  • However, the early unloading group experienced a shorter time to disappearance of pulmonary congestion compared to the conventional group.
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Background: Thin-cap fibroatheroma is a rupture-prone vulnerable plaque that leads to acute coronary syndrome (ACS). However, its underlying mechanisms are not fully understood. Several studies have investigated the clinical association between angiopoietin-like protein 4 (ANGPTL4) and coronary artery disease.

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Article Synopsis
  • * Conducted with 116 patients, participants were randomly assigned to either receive routine unloading within 12 hours of VA-ECMO or the conventional method based on later monitored signs of increased afterload.
  • * The trial aims to assess the effects on 30-day mortality and other clinical outcomes, potentially influencing future practices in managing complications linked to VA-ECMO.
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Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality in patients with cardiogenic shock (CS) who underwent venoarterial (VA) ECMO.

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Article Synopsis
  • * LVR was defined as an LV end-diastolic diameter greater than 55 mm and was found in 9.9% of the 262 patients who were monitored through echocardiography over a year.
  • * Results showed that LVR is linked to poorer outcomes, particularly in patients who had incomplete revascularization, with significantly higher risks of major adverse cardiovascular events and heart failure compared to those who had complete revascularization.
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The clinical concept of coronary artery disease (CAD) has seen a paradigm shift over the last decade. CAD is mostly a progressive disease, and patients with CAD can develop acute coronary syndromes at any point in disease progression. In this clinical context, a new term, "chronic coronary syndrome," was published in the 2019 European Society of Cardiology guidelines, reflecting the importance of early diagnosis and active management.

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Previous studies have not compared outcomes between different percutaneous coronary intervention (PCI) strategies and lesion locations in non-left main (LM) bifurcation lesions. We enrolled 2044 patients from a multicenter registry with an LAD bifurcation lesion (n = 1551) or non-LAD bifurcation lesion (n = 493). The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR).

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Background Chronic vasodilator therapy with long-acting nitrate is frequently used to treat vasospastic angina. However, the clinical benefits of this approach are controversial. We investigated the prognostic impact of vasodilator therapy in patients with vasospastic angina from the multicenter, prospective VA-KOREA (Vasospastic Angina in KOREA) registry.

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Scrub typhus is an acute zoonotic febrile illness caused by having a specific geographic endemic area. This infection could be complicated with multi-organ involvement including myocarditis with variable severity. Here, we report a rare case of scrub typhus with biopsy-proven acute fulminant myocarditis which progressed very rapidly to cardiac arrest and was treated successfully with extracorporeal cardiopulmonary resuscitation.

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Recently, myocarditis following messenger RNA (mRNA) coronavirus disease 2019 (COVID-19) vaccination has become an important social issue worldwide. According to the reports so far, myocarditis related to mRNA COVID-19 vaccination is rare and usually associated with a benign clinical course without intensive care or any sequelae of fulminant myocarditis. Here, we report a case of acute fulminant myocarditis and cardiogenic shock after the mRNA COVID-19 vaccination, requiring extracorporeal cardiopulmonary resuscitation.

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Air embolism is a rare, fatal complication of computed tomography (CT)-guided transthoracic needle biopsy (TTNB) of the lung. Here, we report a patient who developed an air embolism after CT-guided TTNB, which led to ST-elevation myocardial infarction and acute cerebral ischemia. The patient recovered completely without critical sequelae and was diagnosed with adenocarcinoma harboring activating epidermal growth factor receptor (EGFR) mutation.

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Glycogen synthase kinase-3beta (GSK3beta) is recognized as one of major kinases to phosphorylate tau in Alzheimer's disease (AD), thus lots of AD drug discoveries target GSK3beta. However, the inactive form of GSK3beta which is phosphorylated at serine-9 is increased in AD brains. This is also inconsistent with phosphorylation status of other GSK3beta substrates, such as beta-catenin and collapsin response mediator protein-2 (CRMP2) since their phosphorylation is all increased in AD brains.

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