Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

Previous studies have evaluated the effects of antithrombotic agents on the performance of fecal immunochemical tests (FITs) for the detection of colorectal cancer (CRC), but the results were inconsistent and based on small sample sizes. We studied this topic using a large-scale population-based database. Using the Korean National Cancer Screening Program Database, we compared the performance of FITs for CRC detection between users and non-users of antiplatelet agents and warfarin. Non-users were matched according to age and sex. Among 5,426,469 eligible participants, 768,733 used antiplatelet agents (mono/dual/triple therapy, n = 701,683/63,211/3839), and 19,569 used warfarin, while 4,638,167 were non-users. Among antiplatelet agents, aspirin, clopidogrel, and cilostazol ranked first, second, and third, respectively, in terms of prescription rates. Users of antiplatelet agents (3.62% vs. 4.45%; relative risk (RR): 0.83; 95% confidence interval (CI): 0.78-0.88), aspirin (3.66% vs. 4.13%; RR: 0.90; 95% CI: 0.83-0.97), and clopidogrel (3.48% vs. 4.88%; RR: 0.72; 95% CI: 0.61-0.86) had lower positive predictive values (PPVs) for CRC detection than non-users. However, there were no significant differences in PPV between cilostazol vs. non-users and warfarin users vs. non-users. For PPV, the RR (users vs. non-users) for antiplatelet monotherapy was 0.86, while the RRs for dual and triple antiplatelet therapies (excluding cilostazol) were 0.67 and 0.22, respectively. For all antithrombotic agents, the sensitivity for CRC detection was not different between users and non-users. Use of antiplatelet agents, except cilostazol, may increase the false positives without improving the sensitivity of FITs for CRC detection.ope

Relationship between sleep duration and Framingham cardiovascular risk score and prevalence of cardiovascular disease in Koreans

Studies have shown sleep duration to be related to the prevalence of metabolic syndrome and hypertension. However, whether sleep duration is associated with cardiovascular disease (CVD) risk and the prevalence of CVD irrespective of conventional CV-risk factor, such as diabetes mellitus, obesity, and metabolic syndrome, has not been well established for the Korean population.A total of 23,878 individuals aged 18 years or older from the 2007-2010 Korean National Health and Nutrition Examination Survey were analyzed. We evaluated the relationship between sleep duration and CV-event risk using the Framingham Cardiovascular Risk Score (FRS; ≥10% or ≥20%) and the prevalence of CVD.After adjusting for traditional risk factors of CVD, a short sleep duration (≤5 hours) yielded odds ratios (OR) of 1.344 (95% confidence interval [CI] 1.200-1.505) for intermediate to high risk and 1.357 (95% CI, 1.140-1.614) for high risk. A long sleep duration (≥9 hours) was also associated with both intermediate to high (OR 1.142, 95% CI 1.011-1.322) and high cardiovascular FRS (OR 1.276, 95% CI 1.118-1.457).Both short and long sleep durations were related with high CVD risk, irrespective of established CVD risk, and a short sleep duration was associated with a higher prevalence of CVD than an optimal or long sleep duration.ope

Association of physical activity on body composition, cardiometabolic risk factors, and prevalence of cardiovascular disease in the Korean population (from the fifth Korea national health and nutrition examination survey, 2008-2011)

Background: Data regarding associations among physical activity (PA) level, body composition, and prevalence of cardiovascular diseases in Asian populations are rare. Methods: The International Physical Activity Questionnaire (IPAQ) was utilized to estimate PA levels and analyze the association of PA level with various body composition parameters and the prevalence of cardiovascular diseases by using data from the Korean National Health and Nutrition Examination Survey from 2008 to 2011. Results: Moderate and high PA levels were associated with lower prevalence of hypertension and diabetes mellitus, and lower concentrations of serum ferritin, parathyroid hormone, and alkaline phosphatase. Sarcopenia (low vs. moderate vs. high PA group: 14.3% vs. 10.5% vs. 7.3%, p = 0.001), underweight (5.7% vs. 4.9% vs. 3.5%, p = 0.001), and central obesity (7.8% vs. 6.9% vs. 6.3%, p = 0.002) were more often observed in the low PA group. The prevalence rates of cardiovascular diseases were lower in the moderate (odds ratio [OR], 0.822; 95% confidence interval [CI], 0.737-0.916; p = 0.001) and high activity groups (OR, 0.663; 95% CI, 0.589-0.748; p = 0.001) than in the low activity group, even after adjusting for age, sex, smoking, underlying disease, and general or abdominal obesity and muscle mass. Conclusion: Regular physical activity was associated with a low prevalence of cardiovascular diseases (stroke, myocardial infarction, stable angina, and chronic renal disease), which was independent of body composition and conventional risk factors in the Korean population, with a positive dose-response relationship.ope

Bowel Preparation and Subsequent Colonoscopy Is Associated with the Risk of Atrial Fibrillation: A Population-Based Case-Crossover Study

This study aimed to clarify the association of the risk of atrial fibrillation (AF) with bowel preparation and subsequent colonoscopy through population-based case-crossover analysis. Patients who developed new-onset AF after undergoing colonoscopy following bowel preparation were included. For each patient, one hazard period and four control periods were matched at specified time windows. Among 189,613 patients with AF, 84 patients (mean age: 72.4 years) finally met the inclusion criteria. Most patients used polyethylene glycol (PEG)-based solutions (2 L PEG + ascorbic acid (n = 56), 4 L PEG (n = 21)) as purgatives and had hypertension (n = 75). A significant association of bowel preparation and colonoscopy with AF occurrence was found in all time windows. The proportion of patients with bowel preparation and colonoscopy was higher during the hazard period than during the control periods. In the 1-, 2-, 4-, 8-, and 12-week time windows, the proportions were 11.9% vs. 4.2%, 13.1% vs. 4.8%, 16.7% vs. 6.3%, 28.6% vs. 11.9%, and 29.8% vs. 14.0%, and the odd ratios (ORs) were 3.11, 3.01, 3.00, 2.96, and 2.61, respectively. Bowel preparation and undergoing colonoscopy was associated with the risk of AF and this examination need to be performed with caution especially in elderly patients with hypertension.ope

Intravascular ultrasound as an adjunct tool for angiographically intermediate lesions and complex coronary interventions: patient selection and perspectives

Intravascular ultrasound (IVUS) provides valuable anatomic information about the coronary arterial lumen, wall, and plaques that cannot be assessed by coronary angiography alone. For over 2 decades, IVUS has been shown to be a helpful tool for identifying significant ischemia in angiographically intermediate left main (LM) or non-LM lesions by measuring the minimum luminal area. It can also guide percutaneous coronary intervention (PCI) in complex coronary lesions such as LM, bifurcation, chronic total occlusion, in-stent restenosis, and long or calcified lesions. In these complex lesions, IVUS can reduce stent thrombosis or restenosis by accurate lesion assessment and detection of stent underexpansion, malapposition, or edge dissections. Through further intervention based on these IVUS findings, optimal stent deployment can be achieved. IVUS can also identify the culprit lesion with plaque rupture, and vulnerable lesions with a large plaque burden or thin-cap fibroatheroma. Although other new imaging modalities with improved resolution and technologies are attracting increased clinical attention, IVUS remains the most reliable intracoronary imaging modality to guide PCI until other new imaging devices are proven to be useful and improve clinical outcomes. However, current data on clinical utility are conflicting and the guidelines do not recommend routine use of IVUS when performing angiography or PCI. In this review, we focus on issues related to the selection of patients who might benefit from IVUS guidance and discuss future perspectives on intracoronary imaging.ope

Successful Primary Percutaneous Coronary Intervention without Stenting: Insight from Optimal Coherence Tomography

For patients with acute myocardial infarction, current management guidelines recommend implantation of a drug-eluting stent, dual antiplatelet therapy (including potent P2Y12 inhibitors) for at least 1 year, and maintenance of life-long antiplatelet therapy. However, a pilot study showed favorable results with antithrombotic therapy without stent implantation when plaque erosion, not definite plaque rupture, was confirmed using optical coherence tomography (OCT), despite the patients having acute myocardial infarction. Here, we present a case where successful primary percutaneous coronary intervention was performed without stenting with the aid of OCT in a patient with ST-elevation myocardial infarction who developed thrombotic total occlusion of the right coronary artery.ope

Feasibility and Safety of the Left Distal Radial Approach in Percutaneous Coronary Intervention for Bifurcation Lesions

Recently, the left distal radial approach (DRA) for percutaneous coronary intervention (PCI) has been shown to be a feasible option, but there are limited data regarding the feasibility of performing bifurcation PCI via the left DRA. Therefore, this study aimed to describe our experience with the contemporary left DRA to perform PCI of bifurcation lesions. Between December 2017 and December 2019, we identified 106 patients treated with bifurcation PCI via the left DRA. We evaluated the success rate of PCI, access-site complications including major bleeding requiring surgery or transfusion, hematoma, distal and forearm radial artery occlusion, and 30-day mortality. Eleven patients (10.4%) treated with left main bifurcation and true bifurcations accounted for 39.6% of cases, with the left anterior descending artery/diagonal branch being the most frequent bifurcation site (57.5%, 61/106). PCI was performed using a 6-French guiding catheter in 101 (95.3%) cases. Successful PCI for bifurcation lesions via the left DRA was achieved in all 106 patients without access-site cross-over. There was no major bleeding, distal and forearm radial artery occlusion, forearm hematoma, or mortality at 30 days. The left DRA is a safe and feasible alternative access site for bifurcation PCI in selected patients.ope

Comparison of spasmolytic regimen for prevention of radial artery spasm during the distal radial approach: A single-center, randomized study

Background: The distal radial approach (DRA) for coronary catheterization is increasingly being used worldwide yet the optimal medication regimen to prevent radial artery spasm (RAS), an important factor for the success of the procedure, remains unclear. The aim of this study is to examine the effectiveness of medication for preventing RAS via the DRA. Methods: This was a prospective, comparative randomized study including 400 patients who underwent coronary catheterization via DRA in single center by three experienced DRA operators. Patients were randomized to either nitroglycerin (NTG) injection (N = 200) or NTG plus verapamil (N = 200) to compare the effectiveness and safety of these regimens. Results: There were no differences between the groups in the changes in radial artery diameter at most spastic area (0.34 ± 0.20 in the NTG group, 0.35 ± 0.20 in the NTG plus verapamil group; P = 0.73). There was no difference between the groups in the ratio of patients without arm pain during the procedure (95.0% in the NTG group, 93.5% in the NTG plus verapamil group; P = 0.67). However, there was a greater reduction in diastolic blood pressure in the NTG plus verapamil group (-8.3 ± 7.9 mmHg) than in the NTG group (-6.6 ± 7.6 mmHg) (P = 0.03). Conclusion: Intra-arterial injection of NTG as a single agent is effective and safe in the prevention of RAS during coronary catheterization via the DRA compared with a cocktail regimen of NTG plus verapamil. cocktail regimen of NTG plus verapamil.ope

Transthoracic Echocardiographic Detection, Differential Diagnosis, and Follow-Up of Esophageal Hematoma

Esophageal hematoma is a rare form of esophageal injury. It may occur spontaneously, or in association with direct esophageal damage or a bleeding diathesis. Endoscopy and computed tomography are generally necessary for the establishment of a diagnosis. In this report, we present a case of esophageal hematoma that was discovered via a bedside transthoracic echocardiography. The echocardiography was conducted to evaluate an unexplained shock in a critically ill-patient. After conservative treatment, complete resolution of the esophageal hematoma was documented by a 7-day short-term follow-up of bedside transthoracic echocardiography. To the best of our knowledge, this is the first case report regarding transthoracic echocardiographic detection, differential diagnosis, and follow-up for esophageal hematomaope

Successful optical coherence tomography-guided stent ablation with rotational atherectomy for an underexpanded stent

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