Background: Owing to the differential propensity for bleeding and ischemic events with response to antiplatelet therapy, the safety and effectiveness of potent P2Y12 inhibitor ticagrelor in East Asian populations remain uncertain. Methods: In this multicenter trial, 800 Korean patients hospitalized for acute coronary syndromes with or without ST elevation and intended for invasive management were randomly assigned to receive, in a 1:1 ratio, ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) or clopidogrel (600 mg loading dose, 75 mg daily thereafter). The primary safety outcome was clinically significant bleeding (a composite of major bleeding or minor bleeding according to PLATO (Platelet Inhibition and Patient Outcomes) criteria at 12 months. Results: At 12 months, the incidence of clinically significant bleeding was significantly higher in the ticagrelor group than in the clopidogrel group (11.7% [45/400] vs 5.3% [21/400]; hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.34 to 3.79; P =0.002). The incidences of major bleeding (7.5% [29/400] vs 4.1% [16/400], P =0.04) and fatal bleeding (1% [4/400] vs 0%, P =0.04) were also higher in the ticagrelor group. The incidence of death from cardiovascular causes, myocardial infarction, or stroke was not significantly different between the ticagrelor group and the clopidogrel group (9.2% [36/400] vs 5.8% [23/400]; HR, 1.62; 95% CI, 0.96 to 2.74; P =0.07). Overall safety and effectiveness findings were similar with the use of several different analytic methods and in multiple subgroups. Conclusions: In Korean acute coronary syndrome patients intended to receive early invasive management, standard-dose ticagrelor as compared with clopidogrel was associated with a higher incidence of clinically significant bleeding. The numerically higher incidence of ischemic events should be interpreted with caution, given the present trial was underpowered to draw any conclusion regarding efficacy. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02094963.

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The purpose of this study is to investigate the frequency of the subclinical synovitis in hand or wrist joints of the SLE patients using ultrasonography (US) and to correlate them with clinical parameters. Forty-eight systemic lupus erythematosus (SLE) patients without musculoskeletal (MS) involvement were enrolled and underwent clinical and laboratory examinations. Gray-scale and power Doppler (PD) US was performed for imaging the wrist, second and third metacarpophalangeal (MCP) joints, and flexor tendons on non-dominant sides of the individuals. US synovitis index (USSI) and PD index were calculated as sum of the synovitis and PD semiquantitative scores, respectively, obtained from each joint. Subclinical synovitis was found by US in 28 (58.3%) out of 48 patients. US revealed synovitis of the wrist in 16 (33.3%) patients, of the second MCP joint in 14 (29.2%) and of the third MCP joint in 15 (31.3%). PD signals in three (6.3%) patients and tenosynovitis in two (4.2%) were also detected. USSI scores showed significant positive correlation with erythrocyte sedimentation rate (ESR) levels (r = 0.30, p < 0.05) or anti-dsDNA Ab titers (r = 0.34, p < 0.05). Within 6 months after US examination, new MS symptoms were developed in 11 (22.9%) patients. Older age at diagnosis (OR 1.283, 95% CI 1.029-1.601, p = 0.027) or higher USSI scores (OR 12.93, 95% CI 1.023-163.503, p = 0.048) were independently associated with development of new MS symptoms. Subclinical synovitis is common in SLE patients who do not suffer from MS symptoms. US is useful to detect joint abnormalities before symptoms appear in SLE patients.

Recent studies have suggested a favorable effect of cardiac rehabilitation (CR) on patients with cardiovascular disease. This study aimed to evaluate the impact of home-based exercise training with wireless monitoring on acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). A total of 55 ACS patients undergoing PCI were randomly divided into home based exercise training with wireless monitoring cardiac rehabilitation (CR, n = 26) and usual care (UC, n = 29). Exercise capacity and quality of life (QOL) were evaluated at baseline and after 12 weeks. Change of metabolic equivalent of the tasks, maximal exercise time and QOL were significantly increased (+2.47 vs +1.43, P = 0.021; +169.68 vs +88.31 sec, P = 0.012; and +4.81 vs +0.89, P = 0.022, respectively), and the change of submaximal rate pressure product, and of submaximal rate of perceived exertion were significantly decreased (-28.24 vs -16.21, P = 0.013; and -1.92 vs -1.62, P = 0.018, respectively) in the CR group compared to the UC group after 12 weeks. CR using home-based exercise training with wireless monitoring led to improvement of exercise capacity and QOL relative to conventional care in ACS patients undergoing PCI. Our findings suggest that early scheduled CR may be considered in ACS patients undergoing PCI.

BackgroundChemerin is a novel adipokine that is associated with inflammation and adipogenesis. However, it remains unclear whether chemerin is involved in patients with cardiovascular disease. We investigated whether the serum chemerin levels of Korean patients with coronary artery disease correlated with specific cardiometabolic parameters.MethodsIn total, 131 patients, all of whom had coronary artery stenosis exceeding 50%, participated in this study. Their serum chemerin levels and cardiometabolic parameters were measured. The serum chemerin levels of two groups of patients were compared; those with one stenotic vessel (n=68) and those with multiple stenotic vessels, including left main coronary artery disease (n=63).ResultsSerum chemerin levels correlated positively with the degree of coronary artery stenosis and fasting glucose, triglyceride, total cholesterol, low density lipoprotein cholesterol, and high sensitive C-reactive protein levels. The group with multiple stenotic vessels, including left main disease, had higher chemerin levels than the group with one stenotic vessel (t=-2.129, P=0.035). Multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease (odds ratio, 1.018; confidence interval, 0.997 to 1.040; P=0.091).ConclusionSerum chemerin levels have a significant correlation with several cardiometabolic risk factors and the degree of coronary artery stenosis in Korean patients with coronary artery disease. However, multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease. Additional investigations are necessary to fully elucidate the role of chemerin in cardiovascular disease.

Background: In heart failure with preserved ejection fraction (HFPEF), physiological abnormalities are not solely restricted to diastolic function. Because the tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) offers the advantage of recording systolic and diastolic tissue velocity simultaneously in the same cardiac cycle, this study aimed to determine whether TDI-MPI is an informative index for assessing HFPEF, compared with conventional echo parameters. Hypothesis: In patients with HFPEF, TDI-MPI would be an independent predictor for adverse cardiac events. Methods: Among 408 patients who had diastolic dysfunction without heart failure (HF) or HFPEF, cardiac function was evaluated by mitral flow (MF) or TDI-MPI. During the median follow-up of 32 months, clinical outcomes, which were defined as the composite of cardiovascular death and admission for HF, were assessed. Results: Mean MF and TDI-MPI were significantly greater in the HFPEF group. TDI-MPI rather than MF had a significant correlation with N-terminal pro-brain natriuretic peptide level. The area under the receiver operating characteristic curve of TDI-MPI for the detection of HFPEF was 0.86. With regard to clinical outcomes, 31 events were identified during follow-up periods. On a multivariate analysis, TDI-MPI >0.66 was the best prognostic predictor of events and provided incremental predictive value. Conclusions: Compared to MF-MPI, TDI-MPI may be a more useful parameter for the evaluation of patients with HFPEF.

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