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Seungwoon Rha - One of the best experts on this subject based on the ideXlab platform.
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comparison of two year outcomes of acute myocardial infarction caused by Coronary Artery Spasm versus that caused by Coronary atherosclerosis
American Journal of Cardiology, 2019Co-Authors: Ju Yeol Baek, Seungwoon Rha, Hong Seog Seo, Cheol Ung Choi, Byoung Geol Choi, Chang Gyu Park, Tae Hoon Ahn, Kiyuk Chang, Shung Chull Chae, Seung Ho HurAbstract:The study compared the 2-year outcomes of patients diagnosed with acute myocardial infarction (AMI) triggered by Coronary Artery atherosclerosis and AMI caused by Coronary Artery Spasm. A total of 36,797 patients in the Korea AMI Registry were grouped into 2 categories—(1) AMI due to Coronary Artery Spasm without stenotic lesion (CAS-AMI, n = 484); and (2) AMI induced by Coronary Artery atherosclerosis (CAA-AMI, n = 36,313). The major clinical outcomes of the 2 groups were compared over a 2-year clinical follow-up period. Major adverse cardiac events (MACE) were defined as the composite of total death, nonfatal myocardial infarction, and repeat revascularization. The incidence of MACE (7.1% vs 11.1%; p = 0.007) and repeat revascularization (0.4% vs 4.2%; p
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clinical outcome according to Spasm type of single Coronary Artery provoked by intraCoronary ergonovine tests in patients without significant organic stenosis
International Journal of Cardiology, 2018Co-Authors: Daewon Kim, Sung Ho Her, Youngkeun Ahn, Dong Il Shin, Seung Hwan Han, Dongsoo Kim, Dong Ju Choi, Hyuck Moon Kwon, Hyeon Cheol Gwon, Seungwoon RhaAbstract:Abstract Background This study aimed to evaluate clinical implications of single vessel Coronary Spasm provoked by intraCoronary ergonovine provocation test in Korean population. Method A total of 1248 patients who presented with single vessel Coronary Artery Spasm induced by intraCoronary ergonovine provocation test, excluding 1712 with negative Spasms, multiple and mixed Coronary Artery Spasms and missing data among 2960 patients in the VA-KOREA (Vasospastic Angina in Korea) registry, were classified into diffuse ( n =705) and focal ( n =543) groups. Results The 24-month incidences of a composite primary endpoints (cardiac death, new-onset arrhythmia, and acute Coronary syndrome) were determined. Over a median follow-up of 30months, the composite primary end point occurred more frequently in the focal type patients than in the diffuse type patients (primary endpoint: adjusted hazard ratio [aHR], 1.658; 95% confidence interval [CI] 1.272 to 2.162, P P =0.028). Conclusion Focal type of single vessel Coronary Artery Spasm in vasospastic angina (VSA) patients is found to be associated with worse clinical outcomes. It is thought that the effect is stemmed from unstable angina among ACS rather than the other components of primary endpoint. Therefore, focal type of single vessel Coronary Artery Spasm in patients with VSA should be more carefully assessed and managed with appropriate medication.
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tct 489 impact of left ventricular hypertrophy on Coronary Artery Spasm as assessed by acetylcholine provocation test
Journal of the American College of Cardiology, 2016Co-Authors: Woohyeun Kim, Seungwoon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Jun Hyuk Kang, Ja Yeon Choi, James A Hall, Sung Hun Park, Sunki LeeAbstract:In our previous study, hypertensive patients with uncontrolled blood pressure had a significantly lower incidence of Coronary Artery Spasm (CAS) than those with controlled blood pressure. However, it is unknown whether hypertensive patients with target-organ damage have a lower incidence of CAS than
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five year clinical outcomes in patients with significant Coronary Artery Spasm a propensity score matched analysis
International Journal of Cardiology, 2015Co-Authors: Byoung Geol Choi, Seungwoon Rha, Se Yeon Choi, Yoonjee Park, Sangho Park, Ji Bak Kim, Ji Young Park, Harris Abdullah Ngow, Jabar Ali, Sunki LeeAbstract:Abstract Background Coronary Artery Spasm (CAS) is known to be a risk factor of acute Coronary syndrome and angina pectoris. However, there is no currently available data with larger study population regarding long-term clinical outcomes of CAS in real world clinical practice. Objectives We evaluated the prevalence of CAS and the impact of CAS on 5-year clinical outcomes in a series of Asian CAS patients documented by intraCoronary acetylcholine (Ach) provocation test. Methods A total of 1413 consecutive patients without significant Coronary Artery disease (CAD) who underwent Ach provocation test between Nov. 2004 and Oct. 2008 were enrolled. Significant CAS was defined as >70% of narrowing by incremental intraCoronary injection of 20, 50 and 100μg. Patients were divided into two groups based on the presence of significant CAS (the non-CAS group: n=640, the CAS group; n=773). To adjust potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model. Results A total of 54.7% (773/1413) patients were diagnosed as CAS documented by Ach provocation test. After PSM analysis, 2 propensity-matched groups (451 pairs, n=902, C-statistic=0.677) were generated. Despite of similar incidence of individual hard endpoints including mortality, myocardial infarction and revascularization, the CAS group showed the higher trend of recurrent angina requiring follow up angiography than the non-CAS group up to 5years (HR; 1.56, 95% C.I.; 0.99–2.46, p=0.054). Conclusions The prevalence of CAS was 54.7%. Although the cumulative incidence of recurrent angina requiring follow up Coronary angiography seems to be increased up to 5years in CAS patients, CAS patients was not associated with major individual and composite clinical outcomes such as mortality, MI, PCI, CVA with optimal medical therapy as compared with patients without CAS.
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abstract 19697 impact of baseline Spasm on 3 year clinical outcomes in patient with significant Coronary Artery Spasm as assessed by acetylcholine provocation test
Circulation, 2014Co-Authors: Seungwoon Rha, Byoung Geol Choi, Se Yeon Choi, Sunki Lee, Sangho Park, Sewhan Lee, Wonyong Shin, Seung Jin Lee, Dongkyu Jin, Ji Bak KimAbstract:Background: It has been not known whether the presence of baseline Coronary Artery Spasm (CAS) can impact on long-term clinical outcomes in patients with significant CAS. Methods: The baseline Coronary Spasm was defined that the diameter of epicardial Coronary Artery after nitroglycerin administration can be increased greater than 30% compared to the reference vessel diameter at baseline angiography. The definition of positive Ach provocation test was defined as transient significant Coronary vasoconstriction more than 70% following incremental Ach injection into left Coronary Artery. A total of 1,546 patients (baseline Spasm, n=402; control, n=1144) were finally enrolled and compared the cumulative clinical outcomes up to 3 years. Results: Baseline clinical characteristics were balanced between the two groups except current alcoholics. In multivariate binary logistic regression analysis adjusted by multiple co-variates, the presence of baseline Spasm was associated with the increased incidence of recurre...
Hiroaki Shimokawa - One of the best experts on this subject based on the ideXlab platform.
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Coronary Artery Spasm and perivascular adipose tissue inflammation insights from translational imaging research
European Cardiology Review, 2019Co-Authors: Kazuma Ohyama, Yasuharu Matsumoto, Hiroaki ShimokawaAbstract:Perivascular adipose tissue, which constitutes perivascular components along with the adventitial vasa vasorum, plays an important role as a source of various inflammatory mediators in cardiovascular disease. Inflammatory changes in the Coronary adventitia are thought to be involved in the pathogenesis of Coronary Artery Spasm and vasospastic angina. Recent advances in translational research using non-invasive imaging modalities, including 18F-fluorodeoxyglucose PET and cardiac CT, have enabled us to visualise perivascular inflammation in the pathogenesis of Coronary Artery Spasm. These modality approaches appear to be clinically useful as a non-invasive tool for examining the presence and severity of vasospastic angina.
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inhibition of myosin phosphatase by upregulated rho kinase plays a key role for Coronary Artery Spasm in a porcine model with interleukin 1β
Circulation, 2000Co-Authors: Tadashi Kandabashi, Hiroaki Shimokawa, Kensuke Egashira, Kenji Miyata, Ikuko Kunihiro, Yoji Kawano, Yuko Fukata, Taiki Higo, Shosuke Takahashi, Kozo KaibuchiAbstract:Background—We recently demonstrated that the Rho-kinase–mediated pathway plays an important role for Coronary Artery Spasm in our porcine model with interleukin-1β (IL-1β). In this study, we examined whether or not Rho-kinase is upregulated at the spastic site and if so, how it induces vascular smooth muscle hypercontraction. Methods and Results—Segments of the left porcine Coronary Artery were chronically treated from the adventitia with IL-1β–bound microbeads. Two weeks after the operation, as reported previously, intraCoronary serotonin repeatedly induced Coronary hypercontractions at the IL-1β–treated site both in vivo and in vitro, which were markedly inhibited by Y-27632, one of the specific inhibitors of Rho-kinase. Reverse transcription–polymerase chain reaction analysis demonstrated that the expression of Rho-kinase mRNA was significantly increased in the spastic compared with the control segment. Western blot analysis showed that during the serotonin-induced contractions, the extent of phosphory...
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sarpogrelate a selective 5 ht2a serotonergic receptor antagonist inhibits serotonin induced Coronary Artery Spasm in a porcine model
Journal of Cardiovascular Pharmacology, 2000Co-Authors: Kenji Miyata, Hiroaki Shimokawa, Naoki Katsumata, Tohru Yamawaki, Tadashi Kandabashi, Taiki Higo, Eriko Tanaka, Yoshiaki Takamura, Kenji Yogo, Kensuke EgashiraAbstract:Serotonin is one of the most important vasoactive substances and has been implicated in the pathogenesis of Coronary Artery Spasm and of acute Coronary syndrome. We have recently demonstrated that local and long-term treatment with interleukin-1 β (IL-1β) causes Coronary arteriosclerotic changes and hyperconstrictive responses to serotonin in pigs in vivo. However, it remains to be examined which serotonergic (5-HT) receptor subtype mediates Coronary Spasm and whether alterations in serotonergic receptors are involved in the abnormality. In this study, we examined the inhibitory effect of sarpogrelate, a selective 5-HT 2A serotonergic receptor antagonist, on the serotonin-induced Coronary Spasm as well as the possible alterations of serotonergic receptors in out porcine model. A segment of the porcine Coronary Artery was carefully dissected and aseptically wrapped with cotton mesh absorbing IL-1β-bound microbeads from the adventitia. Two weeks after the procedure, angiographic study was performed, followed by binding assay for 5-HT 1B and 5-HT 2A serotonergic receptors and reverse transcription-polymerase chain reaction (RT-PCR) analysis for mRNA of those receptors. Angiographic study showed Coronary vasospastic responses to serotonin at the IL-1β-treated site. Sarpogrelate dose-dependently inhibited the serotonin-induced Coronary Spasm, but it did not affect the prostaglandin F 2α -induced vasoconstriction. Radiolabeled receptor-binding assay showed that receptor affinity or receptor number of the 5-HT 1B or 5-HT 2A receptors did not differ significantly between the spastic and the control sites. Furthermore, RT-PCR analysis showed that the expression of neither 5-HT 2A nor 5-HT 1B receptor mRNA was significantly altered at the spastic site. These results indicate that serotonin-induced Coronary Spasm is mediated primarily by 5-HT 2A receptor in out porcine model, although the 5-HT 2A receptor was not up-regulated, suggesting that alteration in the signal-transduction pathway for vascular smooth muscle contraction beyond the 5-HT 2A receptor plays a primary role in the pathogenesis of Coronary Spasm in out porcine model.
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cellular and molecular mechanisms of Coronary Artery Spasm lessons from animal models
Japanese Circulation Journal-english Edition, 2000Co-Authors: Hiroaki ShimokawaAbstract:Coronary Artery Spasm plays an important role in the pathogenesis of a wide variety of ischemic heart diseases, especially in the Japanese population. Because Coronary Artery Spasm can be induced by a variety of stimuli with different mechanisms of action, the occurrence of the Spasm appears to be due to the local hyperreactivity of the Coronary Artery rather than to an enhanced stimulation with a single mechanism of action. Several lines of evidence indicate that Coronary Artery Spasm is caused primarily by smooth muscle hypercontraction whereas the contribution of endothelial dysfunction may be minimal. In order to elucidate the cellular and molecular mechanisms of the Spasm, porcine models of the Spasm were developed. In the first model with balloon injury and high-cholesterol feeding, a close topological correlation between the early atherosclerotic lesions and the spastic sites was noted, whereas in the second model with an inflammatory cytokine the potential importance of Coronary inflammatory changes, especially at the adventitia, was noted. Subsequent studies in vivo and in vitro demonstrated that protein kinase C (PKC) and Rho-kinase are substantially involved in the intracellular mechanism of the Spasm, resulting in increases in the mono- and diphosphorylations of myosin light chain (MLC). Furthermore, molecular biological analyses demonstrated that Rho-kinase is upregulated at the spastic site (at all levels, including mRNA, protein, and activity), resulting in the inhibition of MLC phosphatase through the phosphorylation of its myosin binding subunit and thereby causing the increase in MLC phosphorylations. Preliminary results also suggest that the long-term inhibition of Rho-kinase is effective in inhibiting the development of arteriosclerotic vascular lesions in several porcine models. Thus, Rho-kinase could be regarded as a novel therapeutic target for Coronary arteriosclerosis in general and Coronary Artery Spasm in particular.
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rho kinase mediated pathway induces enhanced myosin light chain phosphorylations in a swine model of Coronary Artery Spasm
Cardiovascular Research, 1999Co-Authors: Hiroaki Shimokawa, Naoki Katsumata, Minoru Seto, Toshiyuki Kozai, Tohru Yamawaki, Kouichi Kuwata, Kensuke Egashira, Mutsuki Amano, Tadashi Kandabashi, Ichiro IkegakiAbstract:Objective: We recently demonstrated in our swine model of Coronary Artery Spasm that enhanced myosin light chain (MLC) phosphorylations (both MLC mono- and diphosphorylations) play a central role in the pathogenesis of the Spasm. However, the molecular mechanism for and the phosphorylation sites for the enhanced MLC phosphorylations were unknown. In the present study, we addressed these points using hydroxyfasudil, a novel inhibitor of protein kinases, which we found preferentially inhibits Rho-kinase. Methods: The specificity of the inhibitory effects of hydroxyfasudil on Rho-kinase, MLCK, MRCKβ and PKC were examined by kinase assay in vitro. The left porcine Coronary Artery was chronically treated with interleukin-1β (IL-1β, 2.5 μg). Two weeks after the operation, Coronary Artery vasomotion was examined both in vivo and in vitro. MLC phosphorylations were examined by Western blot analysis and the sites for the phosphorylations by anti-phosphorylated MLC antibodies that identified the monophosphorylation site as Ser19 and diphophorylation sites as Ser19/Thr18 of MLC. Results: Inhibitory effects of hydroxyfasudil was at least 100 times more potent for Rho-kinase as compared with other protein kinases tested. IntraCoronary serotonin (10 μg/kg) caused Coronary hyperconstriction at the IL-1β-treated site in vivo, which was dose-dependently inhibited by hydroxyfasudil ( p <0.01). The Coronary segment taken from the spastic site also showed hypercontractions to serotonin in vitro, which were again dose-dependently inhibited by hydroxyfasudil ( p <0.01). Western blot analysis showed that MLC monophosphorylation was significantly greater in the spastic segment than in the control segment, while MLC diphosphorylation was noted only at the spastic segment ( p <0.01). The sites for the mono- and diphosphorylated MLC were identified as the monophosphorylated site Ser19 and diphosphorylated sites Ser19/Thr18 of MLC, respectively. Both types of MLC phosphorylations at the spastic segment were markedly inhibited by hydroxyfasudil ( p <0.01). Conclusion: These results indicate that hydroxyfasudil-sensitive Rho-kinase-mediated pathway appears to mediate the enhanced MLC phosphorylations (on Ser19 and Ser19/Thr18 residues) and plays a central role in the pathogenesis of Coronary Artery Spasm.
Kensuke Egashira - One of the best experts on this subject based on the ideXlab platform.
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inhibition of myosin phosphatase by upregulated rho kinase plays a key role for Coronary Artery Spasm in a porcine model with interleukin 1β
Circulation, 2000Co-Authors: Tadashi Kandabashi, Hiroaki Shimokawa, Kensuke Egashira, Kenji Miyata, Ikuko Kunihiro, Yoji Kawano, Yuko Fukata, Taiki Higo, Shosuke Takahashi, Kozo KaibuchiAbstract:Background—We recently demonstrated that the Rho-kinase–mediated pathway plays an important role for Coronary Artery Spasm in our porcine model with interleukin-1β (IL-1β). In this study, we examined whether or not Rho-kinase is upregulated at the spastic site and if so, how it induces vascular smooth muscle hypercontraction. Methods and Results—Segments of the left porcine Coronary Artery were chronically treated from the adventitia with IL-1β–bound microbeads. Two weeks after the operation, as reported previously, intraCoronary serotonin repeatedly induced Coronary hypercontractions at the IL-1β–treated site both in vivo and in vitro, which were markedly inhibited by Y-27632, one of the specific inhibitors of Rho-kinase. Reverse transcription–polymerase chain reaction analysis demonstrated that the expression of Rho-kinase mRNA was significantly increased in the spastic compared with the control segment. Western blot analysis showed that during the serotonin-induced contractions, the extent of phosphory...
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sarpogrelate a selective 5 ht2a serotonergic receptor antagonist inhibits serotonin induced Coronary Artery Spasm in a porcine model
Journal of Cardiovascular Pharmacology, 2000Co-Authors: Kenji Miyata, Hiroaki Shimokawa, Naoki Katsumata, Tohru Yamawaki, Tadashi Kandabashi, Taiki Higo, Eriko Tanaka, Yoshiaki Takamura, Kenji Yogo, Kensuke EgashiraAbstract:Serotonin is one of the most important vasoactive substances and has been implicated in the pathogenesis of Coronary Artery Spasm and of acute Coronary syndrome. We have recently demonstrated that local and long-term treatment with interleukin-1 β (IL-1β) causes Coronary arteriosclerotic changes and hyperconstrictive responses to serotonin in pigs in vivo. However, it remains to be examined which serotonergic (5-HT) receptor subtype mediates Coronary Spasm and whether alterations in serotonergic receptors are involved in the abnormality. In this study, we examined the inhibitory effect of sarpogrelate, a selective 5-HT 2A serotonergic receptor antagonist, on the serotonin-induced Coronary Spasm as well as the possible alterations of serotonergic receptors in out porcine model. A segment of the porcine Coronary Artery was carefully dissected and aseptically wrapped with cotton mesh absorbing IL-1β-bound microbeads from the adventitia. Two weeks after the procedure, angiographic study was performed, followed by binding assay for 5-HT 1B and 5-HT 2A serotonergic receptors and reverse transcription-polymerase chain reaction (RT-PCR) analysis for mRNA of those receptors. Angiographic study showed Coronary vasospastic responses to serotonin at the IL-1β-treated site. Sarpogrelate dose-dependently inhibited the serotonin-induced Coronary Spasm, but it did not affect the prostaglandin F 2α -induced vasoconstriction. Radiolabeled receptor-binding assay showed that receptor affinity or receptor number of the 5-HT 1B or 5-HT 2A receptors did not differ significantly between the spastic and the control sites. Furthermore, RT-PCR analysis showed that the expression of neither 5-HT 2A nor 5-HT 1B receptor mRNA was significantly altered at the spastic site. These results indicate that serotonin-induced Coronary Spasm is mediated primarily by 5-HT 2A receptor in out porcine model, although the 5-HT 2A receptor was not up-regulated, suggesting that alteration in the signal-transduction pathway for vascular smooth muscle contraction beyond the 5-HT 2A receptor plays a primary role in the pathogenesis of Coronary Spasm in out porcine model.
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rho kinase mediated pathway induces enhanced myosin light chain phosphorylations in a swine model of Coronary Artery Spasm
Cardiovascular Research, 1999Co-Authors: Hiroaki Shimokawa, Naoki Katsumata, Minoru Seto, Toshiyuki Kozai, Tohru Yamawaki, Kouichi Kuwata, Kensuke Egashira, Mutsuki Amano, Tadashi Kandabashi, Ichiro IkegakiAbstract:Objective: We recently demonstrated in our swine model of Coronary Artery Spasm that enhanced myosin light chain (MLC) phosphorylations (both MLC mono- and diphosphorylations) play a central role in the pathogenesis of the Spasm. However, the molecular mechanism for and the phosphorylation sites for the enhanced MLC phosphorylations were unknown. In the present study, we addressed these points using hydroxyfasudil, a novel inhibitor of protein kinases, which we found preferentially inhibits Rho-kinase. Methods: The specificity of the inhibitory effects of hydroxyfasudil on Rho-kinase, MLCK, MRCKβ and PKC were examined by kinase assay in vitro. The left porcine Coronary Artery was chronically treated with interleukin-1β (IL-1β, 2.5 μg). Two weeks after the operation, Coronary Artery vasomotion was examined both in vivo and in vitro. MLC phosphorylations were examined by Western blot analysis and the sites for the phosphorylations by anti-phosphorylated MLC antibodies that identified the monophosphorylation site as Ser19 and diphophorylation sites as Ser19/Thr18 of MLC. Results: Inhibitory effects of hydroxyfasudil was at least 100 times more potent for Rho-kinase as compared with other protein kinases tested. IntraCoronary serotonin (10 μg/kg) caused Coronary hyperconstriction at the IL-1β-treated site in vivo, which was dose-dependently inhibited by hydroxyfasudil ( p <0.01). The Coronary segment taken from the spastic site also showed hypercontractions to serotonin in vitro, which were again dose-dependently inhibited by hydroxyfasudil ( p <0.01). Western blot analysis showed that MLC monophosphorylation was significantly greater in the spastic segment than in the control segment, while MLC diphosphorylation was noted only at the spastic segment ( p <0.01). The sites for the mono- and diphosphorylated MLC were identified as the monophosphorylated site Ser19 and diphosphorylated sites Ser19/Thr18 of MLC, respectively. Both types of MLC phosphorylations at the spastic segment were markedly inhibited by hydroxyfasudil ( p <0.01). Conclusion: These results indicate that hydroxyfasudil-sensitive Rho-kinase-mediated pathway appears to mediate the enhanced MLC phosphorylations (on Ser19 and Ser19/Thr18 residues) and plays a central role in the pathogenesis of Coronary Artery Spasm.
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enhanced myosin light chain phosphorylations as a central mechanism for Coronary Artery Spasm in a swine model with interleukin 1β
Circulation, 1997Co-Authors: Naoki Katsumata, Hiroaki Shimokawa, Minoru Seto, Toshiyuki Kozai, Tohru Yamawaki, Kouichi Kuwata, Kensuke Egashira, Ichiro Ikegaki, Toshio Asano, Yasuharu SasakiAbstract:Background Although Coronary Artery Spasm plays an important role in a wide variety of ischemic heart diseases, the intracellular mechanism for the Spasm remains to be clarified. We examined the role of myosin light chain (MLC) phosphorylations, a key mechanism for contraction of vascular smooth muscle, in our swine model with interleukin-1β (IL-1β). Methods and Results IL-1β was applied chronically to the porcine Coronary arteries from the adventitia to induce an inflammatory/proliferative lesion. Two weeks after the operation, intraCoronary serotonin repeatedly induced Coronary hyperconstrictions at the IL-1β-treated site both in vivo and in vitro, which were markedly inhibited by fasudil, an inhibitor of protein kinases, including protein kinase C and MLC kinase. Western blot analysis showed that during serotonin-induced contractions, MLC monophosphorylation was significantly increased and sustained in the spastic segment compared with the control segment, whereas MLC diphosphorylation was noted only i...
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Coronary Artery Spasm does not depend on the intracellular calcium store but is substantially mediated by the protein kinase c mediated pathway in a swine model with interleukin 1β in vivo
Circulation, 1996Co-Authors: Toshiaki Kadokami, Hiroaki Shimokawa, Kensuke Egashira, Yoshihiro Fukumoto, Tsuneo Takayanagi, Akira TakeshitaAbstract:Background The intracellular mechanism for Coronary Artery Spasm is still unknown. Since the protein kinase C (PKC)–mediated pathway and Ca2+ release from sarcoplasmic reticulum (SR) are important intracellular mechanisms of vascular smooth muscle contraction, we examined the possible role of these two mechanisms in the pathogenesis of Coronary Spasm in our swine model in vivo. Methods and Results In 25 pigs, interleukin-1β (IL-1β) was applied chronically to the Coronary arteries from the adventitia to induce an inflammatory/proliferative lesion. Two weeks after the operation, either intraCoronary serotonin or histamine repeatedly induced Coronary Spasm at the IL-1β–treated site. At those spastic sites, phorbol-12,13-dibutyrate, a PKC-activating phorbol ester, also induced Coronary Spasm, which was blocked by pretreatment with the PKC inhibitors staurosporine and sphingosine. Serotonin- and histamine-induced Coronary Spasm was also significantly inhibited by pretreatment with staurosporine, sphingosine, o...
Byoung Geol Choi - One of the best experts on this subject based on the ideXlab platform.
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comparison of two year outcomes of acute myocardial infarction caused by Coronary Artery Spasm versus that caused by Coronary atherosclerosis
American Journal of Cardiology, 2019Co-Authors: Ju Yeol Baek, Seungwoon Rha, Hong Seog Seo, Cheol Ung Choi, Byoung Geol Choi, Chang Gyu Park, Tae Hoon Ahn, Kiyuk Chang, Shung Chull Chae, Seung Ho HurAbstract:The study compared the 2-year outcomes of patients diagnosed with acute myocardial infarction (AMI) triggered by Coronary Artery atherosclerosis and AMI caused by Coronary Artery Spasm. A total of 36,797 patients in the Korea AMI Registry were grouped into 2 categories—(1) AMI due to Coronary Artery Spasm without stenotic lesion (CAS-AMI, n = 484); and (2) AMI induced by Coronary Artery atherosclerosis (CAA-AMI, n = 36,313). The major clinical outcomes of the 2 groups were compared over a 2-year clinical follow-up period. Major adverse cardiac events (MACE) were defined as the composite of total death, nonfatal myocardial infarction, and repeat revascularization. The incidence of MACE (7.1% vs 11.1%; p = 0.007) and repeat revascularization (0.4% vs 4.2%; p
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the impact of myocardial bridge on Coronary Artery Spasm and long term clinical outcomes in patients without significant atherosclerotic stenosis
Atherosclerosis, 2018Co-Authors: Purumeh Nam, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Ahmed Mashaly, Yoonjee Park, Won Young Jang, Woohyeun Kim, Jah Yeon Choi, Eun Jin ParkAbstract:Abstract Background and aims Myocardial bridge (MB) and Coronary Artery Spasm (CAS) can induce a sustained chest pain, acute Coronary syndrome (ACS) and even sudden cardiac death. The aim of this study is to evaluate the relationship between MB and CAS and its impact on long-term clinical outcomes. Methods A total of 812 patients with MB without significant Coronary Artery disease (CAD), who underwent acetylcholine (ACH) provocation test, were enrolled. Significant CAS was defined as ≥70% temporary narrowing by ACH test, and MB was defined as the characteristic phasic systolic compression of the Coronary Artery with a decrease of more than 30% in diameter on the angiogram after intraCoronary nitroglycerin infusion. To adjust baseline confounders, logistic regression analysis was performed. The primary endpoint was incidence of CAS, and secondary endpoints were major adverse cardiac events (MACE) and recurrent angina requiring repeat Coronary angiography (CAG) at 5 years. Results MB is closely implicated in a high incidence of CAS, spontaneous Spasm, ischemic ECG change and chest pain during ACH provocation test. In addition, MB of various severity and reference vessel size was substantially implicated in CAS incidence, and severe MB was a strong risk factor of CAS. MB patients with CAS were shown to have a higher rate of recurrent angina compared with MB patients without CAS, up to a 5-year follow-up. However, there were no differences regarding the incidence of MACE. Conclusions Severe MB was associated with high incidence of CAS, and MB patients with CAS were likely to have a higher incidence of recurrent angina. Intensive medical therapy and close clinical follow-up are needed for better clinical outcomes in MB patients with CAS.
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tct 489 impact of left ventricular hypertrophy on Coronary Artery Spasm as assessed by acetylcholine provocation test
Journal of the American College of Cardiology, 2016Co-Authors: Woohyeun Kim, Seungwoon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Jun Hyuk Kang, Ja Yeon Choi, James A Hall, Sung Hun Park, Sunki LeeAbstract:In our previous study, hypertensive patients with uncontrolled blood pressure had a significantly lower incidence of Coronary Artery Spasm (CAS) than those with controlled blood pressure. However, it is unknown whether hypertensive patients with target-organ damage have a lower incidence of CAS than
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five year clinical outcomes in patients with significant Coronary Artery Spasm a propensity score matched analysis
International Journal of Cardiology, 2015Co-Authors: Byoung Geol Choi, Seungwoon Rha, Se Yeon Choi, Yoonjee Park, Sangho Park, Ji Bak Kim, Ji Young Park, Harris Abdullah Ngow, Jabar Ali, Sunki LeeAbstract:Abstract Background Coronary Artery Spasm (CAS) is known to be a risk factor of acute Coronary syndrome and angina pectoris. However, there is no currently available data with larger study population regarding long-term clinical outcomes of CAS in real world clinical practice. Objectives We evaluated the prevalence of CAS and the impact of CAS on 5-year clinical outcomes in a series of Asian CAS patients documented by intraCoronary acetylcholine (Ach) provocation test. Methods A total of 1413 consecutive patients without significant Coronary Artery disease (CAD) who underwent Ach provocation test between Nov. 2004 and Oct. 2008 were enrolled. Significant CAS was defined as >70% of narrowing by incremental intraCoronary injection of 20, 50 and 100μg. Patients were divided into two groups based on the presence of significant CAS (the non-CAS group: n=640, the CAS group; n=773). To adjust potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model. Results A total of 54.7% (773/1413) patients were diagnosed as CAS documented by Ach provocation test. After PSM analysis, 2 propensity-matched groups (451 pairs, n=902, C-statistic=0.677) were generated. Despite of similar incidence of individual hard endpoints including mortality, myocardial infarction and revascularization, the CAS group showed the higher trend of recurrent angina requiring follow up angiography than the non-CAS group up to 5years (HR; 1.56, 95% C.I.; 0.99–2.46, p=0.054). Conclusions The prevalence of CAS was 54.7%. Although the cumulative incidence of recurrent angina requiring follow up Coronary angiography seems to be increased up to 5years in CAS patients, CAS patients was not associated with major individual and composite clinical outcomes such as mortality, MI, PCI, CVA with optimal medical therapy as compared with patients without CAS.
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abstract 19697 impact of baseline Spasm on 3 year clinical outcomes in patient with significant Coronary Artery Spasm as assessed by acetylcholine provocation test
Circulation, 2014Co-Authors: Seungwoon Rha, Byoung Geol Choi, Se Yeon Choi, Sunki Lee, Sangho Park, Sewhan Lee, Wonyong Shin, Seung Jin Lee, Dongkyu Jin, Ji Bak KimAbstract:Background: It has been not known whether the presence of baseline Coronary Artery Spasm (CAS) can impact on long-term clinical outcomes in patients with significant CAS. Methods: The baseline Coronary Spasm was defined that the diameter of epicardial Coronary Artery after nitroglycerin administration can be increased greater than 30% compared to the reference vessel diameter at baseline angiography. The definition of positive Ach provocation test was defined as transient significant Coronary vasoconstriction more than 70% following incremental Ach injection into left Coronary Artery. A total of 1,546 patients (baseline Spasm, n=402; control, n=1144) were finally enrolled and compared the cumulative clinical outcomes up to 3 years. Results: Baseline clinical characteristics were balanced between the two groups except current alcoholics. In multivariate binary logistic regression analysis adjusted by multiple co-variates, the presence of baseline Spasm was associated with the increased incidence of recurre...
Sunki Lee - One of the best experts on this subject based on the ideXlab platform.
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tct 489 impact of left ventricular hypertrophy on Coronary Artery Spasm as assessed by acetylcholine provocation test
Journal of the American College of Cardiology, 2016Co-Authors: Woohyeun Kim, Seungwoon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Jun Hyuk Kang, Ja Yeon Choi, James A Hall, Sung Hun Park, Sunki LeeAbstract:In our previous study, hypertensive patients with uncontrolled blood pressure had a significantly lower incidence of Coronary Artery Spasm (CAS) than those with controlled blood pressure. However, it is unknown whether hypertensive patients with target-organ damage have a lower incidence of CAS than
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five year clinical outcomes in patients with significant Coronary Artery Spasm a propensity score matched analysis
International Journal of Cardiology, 2015Co-Authors: Byoung Geol Choi, Seungwoon Rha, Se Yeon Choi, Yoonjee Park, Sangho Park, Ji Bak Kim, Ji Young Park, Harris Abdullah Ngow, Jabar Ali, Sunki LeeAbstract:Abstract Background Coronary Artery Spasm (CAS) is known to be a risk factor of acute Coronary syndrome and angina pectoris. However, there is no currently available data with larger study population regarding long-term clinical outcomes of CAS in real world clinical practice. Objectives We evaluated the prevalence of CAS and the impact of CAS on 5-year clinical outcomes in a series of Asian CAS patients documented by intraCoronary acetylcholine (Ach) provocation test. Methods A total of 1413 consecutive patients without significant Coronary Artery disease (CAD) who underwent Ach provocation test between Nov. 2004 and Oct. 2008 were enrolled. Significant CAS was defined as >70% of narrowing by incremental intraCoronary injection of 20, 50 and 100μg. Patients were divided into two groups based on the presence of significant CAS (the non-CAS group: n=640, the CAS group; n=773). To adjust potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model. Results A total of 54.7% (773/1413) patients were diagnosed as CAS documented by Ach provocation test. After PSM analysis, 2 propensity-matched groups (451 pairs, n=902, C-statistic=0.677) were generated. Despite of similar incidence of individual hard endpoints including mortality, myocardial infarction and revascularization, the CAS group showed the higher trend of recurrent angina requiring follow up angiography than the non-CAS group up to 5years (HR; 1.56, 95% C.I.; 0.99–2.46, p=0.054). Conclusions The prevalence of CAS was 54.7%. Although the cumulative incidence of recurrent angina requiring follow up Coronary angiography seems to be increased up to 5years in CAS patients, CAS patients was not associated with major individual and composite clinical outcomes such as mortality, MI, PCI, CVA with optimal medical therapy as compared with patients without CAS.
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abstract 19697 impact of baseline Spasm on 3 year clinical outcomes in patient with significant Coronary Artery Spasm as assessed by acetylcholine provocation test
Circulation, 2014Co-Authors: Seungwoon Rha, Byoung Geol Choi, Se Yeon Choi, Sunki Lee, Sangho Park, Sewhan Lee, Wonyong Shin, Seung Jin Lee, Dongkyu Jin, Ji Bak KimAbstract:Background: It has been not known whether the presence of baseline Coronary Artery Spasm (CAS) can impact on long-term clinical outcomes in patients with significant CAS. Methods: The baseline Coronary Spasm was defined that the diameter of epicardial Coronary Artery after nitroglycerin administration can be increased greater than 30% compared to the reference vessel diameter at baseline angiography. The definition of positive Ach provocation test was defined as transient significant Coronary vasoconstriction more than 70% following incremental Ach injection into left Coronary Artery. A total of 1,546 patients (baseline Spasm, n=402; control, n=1144) were finally enrolled and compared the cumulative clinical outcomes up to 3 years. Results: Baseline clinical characteristics were balanced between the two groups except current alcoholics. In multivariate binary logistic regression analysis adjusted by multiple co-variates, the presence of baseline Spasm was associated with the increased incidence of recurre...