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Coronary artery diseases in Korea--based upon experiences of the Seoul National University Hospital.

Lee YW - Korean J. Intern. Med. (1993)

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Korea.

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With recent economic growth and changing life style, the incidence of coronary artery diseases in Korea has increased remarkably... However, there have been no systematic investigations whether or not the incidence is really increasing rapidly, what the pattern of coronary artery diseases in this country is and whether there is any difference in the prevalence and patterns compared to those in western countries... Since little data are available, I would like to discuss the general features of coronary artery diseases in this country, especially in respect to the indicence, patterns including risk factors, clinical spectrum, changing diagnostic and therapeutic modalities and different aspects from those of western counries, based upon experiences of the Seoul National University Hospital during the past 10 years... Fortunately, however, there has been a growing public interest in the serum choleterol levels and its association with atherosclerotic cardiovascular diseases... During the relatively short period of time between August 1991 and August 1992, our Department found 52 cases of familial hypercholesterolemia among 25 families, which had been considered extremely rare in Korea... Although intravenous injection of ergonovine has been widely used for the provocation of coronary artery spasm, intracoronary acetylcholine, which is known to release EDRF (endothelial-derived relaxing factor) from the vascular endothelium, has also been introduced recently for the induction of the spasm during coronary arteriography... Provocation of spasm with acetylcholine can are safely performed in patients with moderate to severe hypertension in whom hypertensive effect of intravenous ergonovine may be harmful, and short duration of action enables tests of multiple vessels... Moreover, because the morphologic pattern of induced coronary artery spasm was rather diffuse than focal, and was significantly different from those of spontaneous or intravenous ergonovine induced coronary artery spasm (Table 3), acetylcholin induced spasm might not be the clinically relevent spasm... Thus, in order to resolve such problems related to acetylcholine provocation test and to reduce the risk associated with intravenous ergonovine test, we have recently developed a new method using intracoronary ergonovine injection to provoke coronary artery spasm... During the period between 1985 and 1992, a total of 297 patients who had valvular heart diseases and were older than 40 years of age, had coronary arteriography prospectively while performing cardiac catheterization... Since only 16 cases (5.4%) were found to have significant coronary artery stenosis and most (14 cases) of them had single vessel disease, it does not appear to be necessary to perform the coronary arteriography routinely in valvular heart disease patients without symptoms of coronary artery disease... The implantable stent, initially thought to reduce the incidence of restenosis, also demonstrates a comparable rate of restenosis to that of balloon angioplasty... Coronary artery bypass graft surgery has been proved not to improve long-term suvival in patients with multi-vessel disease and depressed left ventricular function, compared to that of medical treatments, but to improve quality of life in patients whose anginal pain cannot be effectively controlled with medical or interventional teatment... Within the scope of our limited experiences first, the incidence of coronary artery disease is rapidly increasing; second, the frequency of correctible risk factors like smoking or hypertension are relatively high; third, several aspects or features of coronary artery diseases, distinct from those in western countries exist in Korea such as coronary artery spasm and coronary arterial involvement in Takayasu’s arteritis... Taken together, we should have a special interest and fervour not only in the diagnosis and management of patients but also in the clinical and experimental researches to resolve the problems peculiar to coronary artery diseases of our country.

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A. Extent of significant coronary arterial lesion, more than 50% luminal narrowing, in 1869 patients with angina pectoris.B. Extent of significant coronary arterial lesion, more than 50% luminal narrowing, in 636 patients with myocardial infarction.
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f3-kjim-8-2-57-1: A. Extent of significant coronary arterial lesion, more than 50% luminal narrowing, in 1869 patients with angina pectoris.B. Extent of significant coronary arterial lesion, more than 50% luminal narrowing, in 636 patients with myocardial infarction.

Mentions: The extent of coronary arterial lesions in patients with angina pectoris was one vessel disease in 47% followed by two vessel disease (27%), three vessel disease (20%) and left main disease (6%)(Fig. 3A). Patients with myocardial infarction demonstrated a similar pattern of arterial involvement: one vessel disease (54%), two vessel disease (27%), three vessel disease (17%) and left main disease (2%)(Fig. 3B). Although these results were generally similar to the reports from other countries. However, compared to those in western countries, there seems to be a tendency toward somewhat higher prevalence of patients with isolated atherosclerotic left coronary ostial stenosis without apparent secondary causes (11 cases; 0.44% of all the patients who undertook coronary arteriography18)) and acute myocardial infarction patients with normal coronary arteriography or insignificant coronary arterial narrowing (17% of all the infarction patients)19,20).


Coronary artery diseases in Korea--based upon experiences of the Seoul National University Hospital.

Lee YW - Korean J. Intern. Med. (1993)

A. Extent of significant coronary arterial lesion, more than 50% luminal narrowing, in 1869 patients with angina pectoris.B. Extent of significant coronary arterial lesion, more than 50% luminal narrowing, in 636 patients with myocardial infarction.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4532086&req=5

f3-kjim-8-2-57-1: A. Extent of significant coronary arterial lesion, more than 50% luminal narrowing, in 1869 patients with angina pectoris.B. Extent of significant coronary arterial lesion, more than 50% luminal narrowing, in 636 patients with myocardial infarction.
Mentions: The extent of coronary arterial lesions in patients with angina pectoris was one vessel disease in 47% followed by two vessel disease (27%), three vessel disease (20%) and left main disease (6%)(Fig. 3A). Patients with myocardial infarction demonstrated a similar pattern of arterial involvement: one vessel disease (54%), two vessel disease (27%), three vessel disease (17%) and left main disease (2%)(Fig. 3B). Although these results were generally similar to the reports from other countries. However, compared to those in western countries, there seems to be a tendency toward somewhat higher prevalence of patients with isolated atherosclerotic left coronary ostial stenosis without apparent secondary causes (11 cases; 0.44% of all the patients who undertook coronary arteriography18)) and acute myocardial infarction patients with normal coronary arteriography or insignificant coronary arterial narrowing (17% of all the infarction patients)19,20).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

With recent economic growth and changing life style, the incidence of coronary artery diseases in Korea has increased remarkably... However, there have been no systematic investigations whether or not the incidence is really increasing rapidly, what the pattern of coronary artery diseases in this country is and whether there is any difference in the prevalence and patterns compared to those in western countries... Since little data are available, I would like to discuss the general features of coronary artery diseases in this country, especially in respect to the indicence, patterns including risk factors, clinical spectrum, changing diagnostic and therapeutic modalities and different aspects from those of western counries, based upon experiences of the Seoul National University Hospital during the past 10 years... Fortunately, however, there has been a growing public interest in the serum choleterol levels and its association with atherosclerotic cardiovascular diseases... During the relatively short period of time between August 1991 and August 1992, our Department found 52 cases of familial hypercholesterolemia among 25 families, which had been considered extremely rare in Korea... Although intravenous injection of ergonovine has been widely used for the provocation of coronary artery spasm, intracoronary acetylcholine, which is known to release EDRF (endothelial-derived relaxing factor) from the vascular endothelium, has also been introduced recently for the induction of the spasm during coronary arteriography... Provocation of spasm with acetylcholine can are safely performed in patients with moderate to severe hypertension in whom hypertensive effect of intravenous ergonovine may be harmful, and short duration of action enables tests of multiple vessels... Moreover, because the morphologic pattern of induced coronary artery spasm was rather diffuse than focal, and was significantly different from those of spontaneous or intravenous ergonovine induced coronary artery spasm (Table 3), acetylcholin induced spasm might not be the clinically relevent spasm... Thus, in order to resolve such problems related to acetylcholine provocation test and to reduce the risk associated with intravenous ergonovine test, we have recently developed a new method using intracoronary ergonovine injection to provoke coronary artery spasm... During the period between 1985 and 1992, a total of 297 patients who had valvular heart diseases and were older than 40 years of age, had coronary arteriography prospectively while performing cardiac catheterization... Since only 16 cases (5.4%) were found to have significant coronary artery stenosis and most (14 cases) of them had single vessel disease, it does not appear to be necessary to perform the coronary arteriography routinely in valvular heart disease patients without symptoms of coronary artery disease... The implantable stent, initially thought to reduce the incidence of restenosis, also demonstrates a comparable rate of restenosis to that of balloon angioplasty... Coronary artery bypass graft surgery has been proved not to improve long-term suvival in patients with multi-vessel disease and depressed left ventricular function, compared to that of medical treatments, but to improve quality of life in patients whose anginal pain cannot be effectively controlled with medical or interventional teatment... Within the scope of our limited experiences first, the incidence of coronary artery disease is rapidly increasing; second, the frequency of correctible risk factors like smoking or hypertension are relatively high; third, several aspects or features of coronary artery diseases, distinct from those in western countries exist in Korea such as coronary artery spasm and coronary arterial involvement in Takayasu’s arteritis... Taken together, we should have a special interest and fervour not only in the diagnosis and management of patients but also in the clinical and experimental researches to resolve the problems peculiar to coronary artery diseases of our country.

Show MeSH
Related in: MedlinePlus