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Calcium channel blocker monotherapy versus combination with reninangiotensin system inhibitors on the development of new-onset diabetes mellitus in hypertensive Korean patients

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Journal of Geriatric Cardiology 2019年第6期16卷 439-447页

作者： Yong Hoon Kim Ae-Young Her Seung-Woon Rha Byoung Geol Choi Se Yeon Choi Jae Kyeong Byun Yoonjee Park Dong Oh Kang Won Young Jang Woohyeun Kim Woong Gil Choi Tae Soo Kang jihun ahn Sang-Ho Park Ji Young Park Min-Ho Lee Cheol Ung Choi Chang Gyu Park Hong Seog Seo Division of Cardiology Department of Internal Medicine Kangwon National University School of Medicine Chuncheon South Korea Cardiovascular Center Korea University Guro Hospital Seoul South Korea Department of Medicine Korea University Graduate School Seoul South Korea Cardiology Department Konkuk University Chungju Hospital Chungju South Korea Department of Internal Medicine Cardiovascular Division Dankook University Hospital Cheonan South Korea Department of Cardiology Soonchunhyang University Gumi Hospital Gumi South Korea Cardiology Department Soonchunhyang University Cheonan Hospital Cheonan South Korea Division of Cardiology Department of Internal Medicine Cardiovascular Center Nowon Eulji Medical Center Eulji University Seoul South Korea Department of Cardiology Soonchunhyang University College of Medicine Seoul South Korea

Background In real practice, two or more antihypertensive drugs are needed to achieve target blood pressure. We investigated the comparative beneficial actions of combination therapy of renin-angiotensin system inhibitors (RASI), with calcium channel blockers (CCB) over CCB monotherapy on the development of new-onset diabetes mellitus (NODM) in Korean patients during four-year follow-up periods. Methods A total of 3208 consecutive hypertensive patients without a history of diabetes mellitus who had been prescribed CCB were retrospectively enrolled from January 2004 to December 2012. These patients were divided into the two groups according to the additional use of RASI (the RASI group, n = 1221 and the no RASI group, n = 1987). Primary endpoint was NODM, defined as a fasting blood glucose ≥ 126 mg/dL or hemoglobin A1c ≥ 6.5%. Secondary endpoint was major adverse cardiac events (MACE) defined as total death, myocardial infarction (MI) and percutaneous coronary intervention (PCI). Results After propensity score-matched (PSM) analysis, two propensity- matched groups (939 pairs, n = 1878, C-statistic = 0.743) were generated. The incidences of NODM (HR = 1.009, 95% CI: 0.700–1.452, P = 0.962), MACE (HR = 0.877, 95% CI: 0.544–1.413, P = 0.589), total death, MI, PCI were similar between the two groups after PSM during four years. Conclusions The use of RASI in addition to CCB showed comparable incidences of NODM and MACE compared to CCB monotherapy in non-diabetic hypertensive Korean patients during four-year follow-up period. However, large-scaled randomized controlled clinical trials will be required for a more definitive conclusion.

关键词： Calcium channel blocker Diabetes mellitus Renin-angiotensin system inhibitors

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Five-year clinical outcomes of first-generation versus second-generation drug-eluting stents following coronary chronic total occlusion intervention

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Journal of Geriatric Cardiology 2019年第8期16卷 639-647页

作者： Yong Hoon Kim Ae-Young Her Seung-Woon Rha Byoung Geol Choi Se Yeon Choi Jae Kyeong Byun Yoonjee Park Dong Oh Kang Won Young Jang Woohyeun Kim Ju Yeol Baek Woong Gil Choi Tae Soo Kang jihun ahn Sang-Ho Park Ji Young Park Min-Ho Lee Cheol Ung Choi Chang Gyu Park Hong Seog Seo Division of Cardiology Department of Internal MedicineKangwon National University School of MedicineChuncheonSouth Korea Department of Cardiology Soonchunhyang University College of MedicineSeoulSouth Korea Cardiovascular Center Korea University Guro HospitalSeoulSouth Korea Department of Medicine Korea University Graduate SchoolSeoulSouth Korea Cardiovascular Center Seoul St. Mary’s Hospitalthe Catholic University of KoreaSeoulSouth Korea Cardiology Department Konkuk University Chungju HospitalChungjuSouth Korea Department of Internal Medicine Cardiovascular DivisionDankook University HospitalCheonanSouth Korea Department of Cardiology Soonchunhyang University Gumi HospitalGumiSouth Korea Cardiology Department Soonchunhyang University Cheonan HospitalCheonanSouth Korea Division of Cardiology Department of Internal MedicineCardiovascular CenterNowon Eulji Medical CenterEulji UniversitySeoulSouth Korea

Background There are limited data comparing long-term clinical outcomes between first-generation (1G) and second-generation (2G) drug-eluting stents (DESs) in patients who underwent successful percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) lesion. Methods A total of 840 consecutive patients who underwent PCI with DESs for CTO lesion from January 2004 to November 2015 were enrolled. Finally, a total of 324 eligible CTO patients received 1G-DES (Paclitaxel-eluting stent or Sirolimus-eluting stent, n = 157) or 2G-DES (Zotarolimus-eluting stent or Everolimus-eluting stent, n = 167) were enrolled. The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total repeat revascularization [target lesion revascularization (TLR), target vessel revascularization (TVR), and non-TVR]. We investigated the 5-year major clinical outcomes between 1G-DES and 2G-DES in patient who underwent successful CTO PCI. Results After propensity score matched (PSM) analysis, two well-balanced groups (111 pairs, n = 222, C-statistic = 0.718) were generated. Up to the 5-year follow-up period, the cumulative incidence of all-cause death, re-MI, TLR, TVR and non-TVR were not significantly different between the two groups. Finally, MACE was also similar between the two groups (HR = 1.557, 95% CI: 0.820–2.959, P = 0.176) after PSM. Conclusions In this study, 2G-DES was not associated with reduced long-term MACE compared with 1G-DES following successful CTO revascularization up to five years.

关键词： Chronic total occlusion Drug-eluting stent Outcomes

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