Background and ObjectivesContrast-induced nephropathy (CIN) is associated with increased morbidity and mortality. This observational, non-randomized study evaluated the effect of rosuvastatin loading before percutaneous coronary intervention (PCI) on the incidence of CIN in patients with acute coronary syndrome (ACS).Subjects and MethodsA total of 824 patients who underwent PCI for ACS were studied (408 patients in the statin group=40 mg rosuvastatin loading before PCI; 416 patients of control group=no statin pretreatment). Serum creatinine concentrations were measured before and 24 and 48 hours after PCI. The primary endpoint was development of CIN defined as an increase in serum creatinine concentration of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after PCI.ResultsThe incidence of CIN was significantly lower in the statin group than that in the control group (18.8% vs. 13.5%, p=0.040). The maximum percent changes in serum creatinine and estimated glomerular filtration rate in the statin group within 48 hours were significantly lower than those in the control group (5.84±22.59% vs. 2.43±24.49%, p=0.038; -11.44±14.00 vs. -9.51±13.89, p=0.048, respectively). The effect of rosuvastatin on preventing CIN was greater in the subgroups of patients with diabetes, high-dose contrast medium, multivessel stents, high baseline C-reactive protein, and myocardial infarction. A multivariate analysis revealed that rosuvastatin loading was independently associated with a decreased risk for CIN (odds ratio, 0.64; 95% confidence interval, 0.43-0.95, p=0.026).ConclusionHigh-dose rosuvastatin loading before PCI was associated with a significantly lower incidence of CIN in patients with ACS.

No abstract

IntroductionThe measurement of flow-mediated dilatation (FMD) via ultrasound has been established as a reliable non-invasive measurement of endothelial function. However, the guidelines mention nothing regarding diurnal variation of FMD. Thus, we investigated the FMD in healthy people and diurnal variation of FMD.MethodsTwenty-five apparently healthy persons participated in this study. All participants had no history of cardiovascular diseases, hypertension, or diabetes and used any medication. For each volunteer, the measurements were repeated in the morning and afternoon on two different days. We checked capillary blood glucose, total cholesterol, triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL)-cholesterol.ResultsThe average of FMD measurements was 8.45% ± 2.39%. The mean values of systolic and diastolic blood pressure, heart rate, lipid profiles, and glucose levels were similar between the morning and afternoon measurements after 9-h fasting. There was no significant difference of FMD measurements between the morning and afternoon (8.32% ± 2.27% and 8.58% ± 2.56%, p = 0.329). Moreover, there was significant correlation between FMD in the morning and afternoon (r = 0.856, p < 0.001).ConclusionsOur study shows measurement of FMD was 8.45% in healthy Koreans. Also, there was no significant difference of FMD measurements between the morning and afternoon.

Most esophageal lipomas are discovered incidentally and are small and asymptomatic. However, large (>4 cm) lipomas may cause various symptoms, including dysphagia, regurgitation, or epigastric discomfort. We present a 45-year-old woman with intermittent sudden choking and globus pharyngeus. Upper gastrointestinal endoscopy and endoscopic ultrasound revealed an approximately 10.0×1.5 cm pedunculated subepithelial tumor in the upper esophagus, identified as the cause of her symptoms. A thoracic computed tomography scan revealed a fat attenuated longitudinal mass along the upper esophagus, suggestive of a lipoma. Endoscopic resection of the lesion was performed with a detachable snare to relieve her symptoms, and the pathologic findings were consistent with a lipoma.

Objective: Despite successful efforts to shorten the door-to-balloon time in patients with ST-segment elevation myocardial infarction (STEMI), pre-hospital delayremains a problem. We evaluated the factors related to pre-hospital delay using the Jeonbuk regional cardiovascular center database. Methods: From 2010 to 2013, a total of 384 STEMI patients were enrolled. We analyzed the onset time, door time, and balloon time, and the patients were grouped according to pre-hospital delay (120 minutes). Clinical and socio-demographic variables were compared. Results: 53.2% of patients had prolonged onset-to-door time (median 130, interquartile range [IQR] 66~242 minutes), and 68.5% of patients did not achieve <120 minute of total ischemic time (median 175, IQR 110~304 minutes). Pre-hospital delay was more frequent in patients with old age, female, no local residence, low education level, transfer via other hospital and no use of emergency squad (119). Only 20% of patients used 119, and 119 team responded in a prompt manner (call to scene time 6 min), but 41.6% of patients was transported to non-PCI-capable hospitals. Multivariate analysis revealed that transfer via other hospital [Odds ratio (OR) 2.5, 95% confidence interval (CI) 1.6-4.1, p<0.001), use of 119 (OR 0.4, 95% CI 0.2-0.6, p<0.001), age >60 years (OR 1.8, 95% CI 1.1-3.0, p=0.031) and hypertension (OR 1.9, 95% CI 1.2-2.9, p=0.047) were independent predictors of pre-hospital delay.