The Korean Association of Internal Medicine
290 32nd World Congress of Internal Medicine (October 24-28, 2014)
PS 1178 Cardiology
Comparison of Endothelial Dysfunction between Acute Coronary Syndrome SND Stable Angina Pectoris Pa- tients
Bo ram Youn1, Kyung Hwan Kim2, Wan Kim1, Hyun gee Moon1, Won Yu Kang1, Sang Cheol Cho1, Sun Ho Hwang1, Weon Kim3, Eun Kyung Cho1
Department of Internal Medicine, Gwangju Veterans Hospital, Korea1, Department of Internal Medicine, Chonnam Natural University Hospital, Korea2, Department of Internal Medicine, Kyung Hee University Medical Center, Korea3
Background: Endothelial dysfunction (ED) is well known to be associated with coro- nary artery disease (CAD). However, the effect of ED on clinical manifestation of CAD is not well established. This study is designed to assess the difference of endothelial dysfunction between acute coronary syndrome and stable angina pectoris (SAP).
Method: Our study has enrolled 224 patients (182 SAP group and 42 ACS group) with chest pain consecutively and coronary angiography was performed for all patients. We used fl ow-medicated dilation (FMD) as detecting tool for endothelial dysfunction.
Result: The average FMD value of was 9.64±4.10 for SAP group and 8.17 ± 3.96 for ACS group. The prevalence of some other medical conditions that are known to be associated with ED was similar between two groups. Although the difference of FMD value was meaningful when compared by t-test (p=0.040), there was no signifi cant difference after adjusting other variables such as age, diabetes, hypertension, med- ications (p=0.454). Age was only important contributing factor for ED in this study (p=0.035).
Conclusion: The severity of endothelial dysfunction was not different between ACS patients and SAP patients. From this result, we can propose that endothelial dysfunc- tion cause coronary artery disease mainly by chronic pathological course such as ath- erosclerosis. The impact of endothelial dysfunction on plaque rupture or erosion may not be important in development of acute coronary syndrome.
PS 1179 Cardiology
The Impact of Colchicine Use on Prevalence of Myocar- dial Infarction in Patients with Gout
Hyun Gee Moon1, Sun Ho Hwang1, Chung Kang1, Dong In Nam1, Il Hyung Jung1, Boram Youn1, Sang Cheol Cho1, Won Yu Kang1, Wan Kim1
Gwangju Veterans Hospital, Korea1
Background: Gout patients have an increased risk of myocardial infarction (MI). Since atherosclerosis and plaque rupture are inflammatory processes, anti-inflammatory gout medications might also reduce MI. Colchicine is an antiinfl ammatory agent that affects macrophages, neutrophils, and endothelial cells, all of which are implicated in the pathogenesis of cardiovascular disease. Some prior study suggests that colchicine might reduce MI in gout patients. We examined whether colchicine use was associat- ed with a reduced risk of MI in patients with gout.
Methods: We conducted a retrospective study of all patients with an International Classifi cation of Diseases, 9th ed, code for gout in the electronic medical record (EMR) of Gwangju Veterans Hospital Between January 2005 and 2012 December. Data were used to identify patients who had fi lled at least 1 colchicine prescription (n=99) versus those who had not (n=97). The primary outcome was MI during the study period. Sec- ondary outcomes included all-cause mortality and C-reactive protein (CRP) level Results: Total 196 patients were enrolled. MI has a trends toward lower prevalence in colchcine group (2.02% vs 7.22%, p=0.757). Two groups had no signifi cant difference in all cause mortality (Colchicine vs No colchicines ; 2.02% vs 6.02%, p=0.1421) and in C-reactive protein level (Colchicine vs No colchicines ; 11.14 mg/dl vs 12.51mg/dl, p=0.772).
Conclusions: In this hypothesis-generating study active colchicine users demonstrated trends toward a reduced incidence of MI in the fi rst 2 years of observation vs controls.
But all-cause-mortality and CRP does not show a meaningful result. Overall, additional studies are needed to clarify the potential cardioprotective effect of colchicine.
PS 1180 Cardiology
Relevance of Index of Microcirculatory Resistance on Fractional Flow Reserve in Intermediate Coronary Ar- tery Stenosis
Seong Huan Choi1, Sang-Don Park1
Division of Cardiology/Department of Internal Medicine , Korea1
Background: Coronary angiography is primarily used to assess the severity of coro- nary artery disease. However visual estimation dose not exactly predict the functional severity of coronary artery disease. We investigated the relevance of the index of microcirculatory resistance (IMR) and fractional flow reserve (FFR) of intermediate coronary lesion.
Methods: We enrolled patients who met the following criteria: stable angina with de novo coronary stenotic lesions of intermediate epicardial coronary stenosis (approxi- mately 50–70% diameter stenosis) in the left anterior descending coronary artery. An intracoronary combined pressure-temperature sensor-tipped guidewire was used to measure the thermodilution-derived IMR and FFR.
Results: Sixty-seven intermediate coronary lesions (approximately 50–70% diameter stenosis) of the left anterior descending artery were analyzed in 67 patients. The IMR showed a modest correlation with FFR (r = 0.31, p = 0.01). However, no correlation be- tween percent diameter stenosis and IMR was observed (r = 0.12, p = 0.35). Patients were divided into three groups, Low-IMR (n = 22, IMR 14 ± 3), Mid-IMR (n = 23, IMR 21 ± 2) and High IMR (n = 22, IMR 36 ± 10) according to the IMR value. In analysis of covariance, High-IMR group showed the signifi cantly higher FFR value (0.87 ± 0.07) than that in the Low-IMR group (0.81 ± 0.08) (p = 0.03). The IMR value was an inde- pendent determinant of visual-functional mismatch (odd = 1.1, p = 0.03, CI 1.01~ 1.20).
). Lesions with FFR =0.8 were 36% in the Low-IMR group, 22% in the Mid-IMR and 9%
in the High-IMR group (p = 0.02).
Conclusions: Despite similar percent diameter stenosis and lesion length, intermediate coronary lesion with High IMR may reveal the signifi cantly higher FFR compared with Mid and Low-IMR.
PS 1181 Cardiology
Long-Term Impact of Preinfarction Angina on Infarct Size and Left Ventricular Function after Percutane- ous Coronary Intervention in Patients with First Acute Myocardial Infarction
Kyu Yeun Kim1, Young Ae Yang1, Jae Hee Kim1, Sun Hee Park1, Se Yong Jang1, Myung Hwan Bae1, Jang Hoon Lee1, Dong Heon Yang1, Hun Sik Park1, Yongkeun Cho1, Shung Chull Chae1
Kyungpook National University Hospital, Korea1
Background: Preinfarction angina (PA) has benefi cial effects on early phase of left ventricular (LV) remodeling in patients who underwent thrombolysis for acute myo- cardial infarction (AMI). However, long-term impact of PA on subsequent changes in infarct size and LV functionin the current era of percutaneous coronary intervention (PCI) is unclear. Methods: Between November 2005 and November 2011, 506 post- MI survivors who underwent follow-up 2D-echocardiogram more than 1-year after baseline echocardiogram were analyzed. The clinical outcome was composite of reverse remodeling (RR) and wall motion score index (WMSI) recovery (WR). RR was defi ned as recovery of LV ejection fraction (EF) more than 5% and WR as improve- ment of WMSI grade compared to those of index admission. Results: PA was present in 312 (61.7%). During the follow-up, changes in LVEF (4.1±26.9% versus -3.7±20.7%, p=0.001) and WMSI (-7.4±21.3% versus -0.6±22.5%, p=0.001) were significantly greater in patients with versus without PA. WMSI signifi cantly decreased compared to WMSI at baseline in patients with PA (1.50±0.41 versus 1.36±0.41, p
Conclusions: PA has a long-term favorable effect on infarct expansion and LV func- tion in late phase of post-MI survivors who underwent PCI.
