tent implantation is an effective treatment for coronary artery stenosis and is a commonly used strategy in percutaneous coronary intervention (PCI). At the present time, 2 drug-eluting stents (DES: sirolimus and paclitaxel) have made it into large clinical trials and seem to have fundamentally changed the treatment of coronary artery disease. DES are successful in most patients in preventing restenosis as compared with bare metal stents (BMS). [1][2][3][4][5] There are reports of the superiority of the sirolimuseluting stent (SES) over the paclitaxel-eluting stent (PES) in certain clinical groups such as those with diabetes or small vessels. [6][7][8] However, in truly head-to-head comparisons, such as the REALITY trial, there were no differences in the rate of binary restenosis and major adverse cardiac events (MACE) between the 2 types. 9 The importance of the angiographic endpoint of lower in-stent late luminal loss as representative of clinical events has been doubted and there are only a few published studies on the patterns of DES use in clinical practice. 10,11 Recent trials of DES in acute myocardial infarction However, there are growing questions about the actual usefulness of DES, because of the increased incidence of thrombosis and death in DES cases compared with BMS during follow-up. [15][16][17] Moreover, because there is more chance of a thrombotic condition in AMI, many clinicians have questioned the incidence of MACE and stent thrombosis in DES-implanted AMI patients during real-life clinical Circ J 2008; 72: 392 -398

Although the long-term survival of patients suffering from coronary spasm is usually excellent, serious complications can develop, such as disabling pain, myocardial infarction, ventricular tachyarrhythmias, atrioventricular block and sudden cardiac death. A 40-year-old man who had intractable chest pain from coronary artery spasm suffered ventricular fibrillation and an acute anterior myocardial infarction upon first admission. The patient underwent a coronary angiogram, which revealed a spontaneous focal spasm at the proximal left anterior descending coronary artery (LAD). He was treated by the combination of nitrate and calcium channel blocker, but continued to complain of severe chest pain despite intensive medical therapy and he had to be treated in the emergency room 5 times during an 8-month follow-up period. An ergonovine coronary angiogram was performed and an intracoronary ultrasound examination, which revealed a focal spasm at the same site of the proximal LAD with a small amount of localized eccentric atheromatous plaque. A coronary artery stent was placed in the proximal LAD and his symptoms resolved. A follow-up coronary angiogram was performed 3 years after stenting and the stent remained patent without any in-stent restenosis or spasm.

Background:The characteristics of the periodic variation in acute myocardial infarction (AMI) and the subsequent effect on management and prognosis have not been fully investigated in a large number of Asian populations. Methods and Results:From a prospective, observational multicenter online registry, 4,573 patients diagnosed as AMI in Korea from January to December 2006 were included. The highest incidence of AMI was between 8 a.m. and noon. The number of cases was highest in the winter and lowest in the autumn (13.6 vs 11.4 patients per day, P<0.001). Patients with symptom onset during working hours had a shorter time to first medical contact (203±288 min) compared with out-of-hours onset (230±288 min, P=0.003). In patients who underwent primary angioplasty, out-of hours symptom onset was associated with a greater time delay in both the patient's and the medical facility's response (door-to-balloon time out-of hours vs working hours: 101±54 min vs 84±44 min, P<0.001). In patients with ST-segment elevation myocardial infarction, symptoms to first medical contact showed a significant relationship to in-hospital mortality (for every 10 min of symptoms to first medical contact, odds ratio 1.006, 95% confidence interval 1.001-1.012, P=0.018) Conclusions: Circadian and periodic variation in AMI exists in Korean patients, which resulted in different patient behavior, hospital management and outcomes. (Circ J 2010; 74: 970 - 976)

In latecomers with STEMI, RAS inhibition improved long-term clinical outcomes after a successful PCI, even in patients with low risk who had relatively preserved LVEF.

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