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1 Vol.11 No ISSN
2 1. Elmfeldt D et al. Blood Press 2002;11: Bönner, Fuchs. Curr Med Res Opin 2004; 20: McMurray et al. Lancet 2003; 362: Mcmurray J et al. Am Heart J 2006; 151: Ogihara T. CASE-J study. Presented at the ISH, Oct Mogensen CE, BMJ 2000;321: Rossing K et al. Diabetes Care 2003; 26: Susan C Fagan et al. J Hypertens 2006; 24: Papademetrious V et al. JACC 2004;44: P [ ]-V2.1
3 쉽고 편한 콜레스테롤 관리 % Achievemen4t LDL-C goal % H A CYP Increase in HDL-C % LDL-C Reduction1 Anytime2 References 1. Jones PH et al., Am J Cardiol 2003;92: Davison MH et al., Expert Opin Investig Drugs. 2002;11(1): Cziraky M et al., Am J Cardiol 2006;97(s):61C-68C. 4. Schuster H et al., Am Heart J 2004; 147: 크레스토 정 CRESTOR Tab (전문의약품/218) 한국아스트라제네카 AstraZeneca Korea 조성 : Rosuvastatin calcium 5.2mg 10.4mg 20.8mg 효능/효과 : 고콜레스테롤혈증, 고콜레스테롤혈증 환자에서 죽상동맥경화증의 진행지연 용법/용량 : 초회용량은 1일1회 5mg, 필요시 유지용량 10mg으로 투여할 수 있음, 유지용량은 10mg이며 필요시 4주후 20mg 증량. 식사와 상관없이 하루 중 아무때나 복용 금기 : 본제 과민증 기왕력자, 불명의 지속적인 혈장 트랜스아미네이즈 상승이나 정상 상한치의 3배를 초과하는 혈장 트랜스아미네이즈 상승을 포함하는 활동성 간질환, 근병증, 사이크로스포린 병용. 서울시 강남구 대치 3동 해성 2빌딩 12층 TEL: (02) FAX: (02) 보다 자세한 정보는 아스트라제네카 마케팅부 ( )로 문의하시기 바랍니다. P [ ]
4 Copyright 2009 Cardiovascular Update Editorial Board. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without permission in written form from the copyright holder. This publication is published by MMK Co., Ltd. under continuing medical educational grant from AstraZeneca Ltd. and Novartis Korea. AP-CVUP-09-03
5 Continuing Medical Education inquiry@mmkgroup.co.kr
6
7 TOPIC 1. 8 TOPIC TOPIC TOPIC TOPIC 5. 33
8 SECTION TOPIC 1 8 Cardiovascular Update
9 Cardiovascular Update 9
10 SECTION TOPIC 1 1. Braunwald s Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Chapter Kern MJ. Coronary Physiology Revisited: Practical Insights From the Cardiac Catheterization Laboratory. Circulation 2000; 101: Spaan JAE, Piek JJ, Hoffman JIE, Siebes M. Physiological Basis of Clinically Used Coronary Hemodynamic Indices. Circulation 2006;113: Cokkinos DV, Manginas A, Voudris V. Coronary flow: clinical considerations. Heart 2003;89: Cardiovascular Update
11 SECTION TOPIC 2 Cardiovascular Update 11
12 SECTION TOPIC 2 12 Cardiovascular Update
13 CCS class I CCS class II CCS class III CCS class IV CCS: Canadian Cardiac Society Cardiovascular Update 13
14 SECTION TOPIC 2 14 Cardiovascular Update
15 Cardiovascular Update 15
16 SECTION TOPIC 2 A B C 16 Cardiovascular Update
17 A B Cardiovascular Update 17
18 SECTION TOPIC 2 18 Cardiovascular Update
19 1. Braunwald s Heart Disease. 8th ed. Saunders Harrison s Internal Medicine. 17th ed. Mc Graw Hill 2008 Cardiovascular Update 19
20 SECTION TOPIC 3 20 Cardiovascular Update
21 Cardiovascular Update 21
22 SECTION TOPIC 3 22 Cardiovascular Update
23 propranolol metoprolol atenolol nadolol timolol acebutolol betaxolol bisoprolol esmolol labetalol pindolol Cardiovascular Update 23
24 SECTION TOPIC 3 24 Cardiovascular Update
25 1. Fraker TD Jr, Fihn SD; 2002 Chronic Stable Angina Writing Committee; American College of Cardiology; American Heart Association, Gibbons RJ, et al Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to Develop the Focused Update of the 2002 Guidelines for the Management of Patients With Chronic Stable Angina. J Am Coll Cardiol 2007;50: Antithrombotic Trialists Collaboration. Collaboratery meta-analysis of randomized of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high risk patients. BMJ 2002;324: Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-convertingenzyme inhibitor, ramipril, on cardiovascular events in high risk patients. The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. N Engl J Med 2000;342: McMurray JJB, Otergren J, Swedberg K et al. Effects of candersartan in patients with chronic heart failure and reduced left ventricular systolic function treated with ACE inhibitor: the CHARM- Added trial. Lancet 2003;362: Pitt B, Remme WJ, Zannad F et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348: Pepine CJ, Handberg EM, Cooper-DeHoff RM et al. A calcium antagonist vs.a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandopril Study (INVEST): a randomized controlled trial. JAMA 2003;290: Nissen SE, Tuzcu EM, Liby P et al. Effect of antihypertensive agent on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA 2004;292: Cardiovascular Update 25
26 SECTION TOPIC 4 26 Cardiovascular Update
27 SECTION TOPIC 4 A B C D CI: confidence interval, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome Cardiovascular Update 27
28 SECTION TOPIC 4 Outcome RE Risk ratio (95% CI) p Q (I 2 ) FE Risk ratio (95% CI) p Death 0.94 ( ) (0%) 0.95 ( ) 0.68 Cardiac death or MI 1.17 ( ) (13%) 1.16 ( ) 0.24 Nonfatal MI 1.28 ( ) (0%) 1.32 ( ) CABG 1.03 ( ) (0%) 1.04 ( ) 0.76 PCI 1.23 ( ) (74%) 0.91 ( ) 0.25 CABG: coronary artery bypass graft, FE: fixed effects, MI: myocardiac infarction, PCI: percutaneous coronary intervention, RE: random effects 28 Cardiovascular Update
29 Study MT/PCI Follow-up MT Death PCI Death MT Cardiac Death PCI Cardiac Death n (yrs) n n n n ACME (1 vessel), Hartigan et al. (29) ACME (2 vessel), Folland et al. (30) 107/ ND ND 50/ ND ND Dakik et al. (31) 22/ Hambreche et al. (32) 51/ COURAGE Boden et al. (1) 1.138/ SWISS II, Kastrati (7) 105/ ACME: Angioplasty Compared to Medicinel, COURAGE: Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation, MT: medical therapy, PCI: percutaneous coronary intervention, SWISS II: Interventional Study in Silent Ischemia Type II Spontaneous CK-MB Elevation (n=5583) PCI-related CK-MB Elevation (n=8838) Peak CK-MB Category n Deaths (%) OR (95% CI) n Deaths (%) OR (95% CI) Breslow-Day (p) CK-MB 0-1 X ULN (4.1) (1.3) - - CK-MB 1-3 X ULN (8.6) 2.2 ( ) (2.0) 1.5 ( ) CK-MB 3-5 X ULN (9.0) 2.3( ) (2.3) 1.8 ( ) CK-MB 5-10 X ULN (14.3) 3.9 ( ) (4.3) 3.4 ( ) CK-MB 10 X ULN (15.5) 4.3 ( ) (7.4) 6.1 ( ) Odds ratios (OR) with 95% confidence intervals (CI) for risk of death at 6 months in each peak creatine kinase (CK)-MB category relative to risk in category without CK-MB elevation (CK-MB 0-1 X upper limit of normal [ULN]). Breslow-Day indicates Breslow-Day test for heterogeneity of the odds ratio of PCI-related CK-MB elevation vs the odds ratio of spontaneous DK-MB elevation within each peak CK-MB enzyme category (p). CK-MB: creatine kinase-muscle brain, OR: odds ratios, PCI: percutaneous coronary intervention Cardiovascular Update 29
30 SECTION TOPIC 4 CABG PCI No diabetes and normal LVEF Diabetes Depressed LVEF No diabetes and normal LVEF Diabetes Depressed LVEF Two vessel coronary artery disease with proximal LAD stenosis A A A A A A Three vessel coronary artery disease A A A U U U Isolated left main stenosis A A A I I I Left main stenosis and additional coronary artery disease A A A I I I A: appropriate, CABG: coronary artery bypass grafting, I:inappropriate, LAD: left anterior descending, LVEF: left ventricular ejection fraction, PCI: percutaneous coronary intervention, U:uncertain 30 Cardiovascular Update
31 Cardiovascular Update 31
32 SECTION TOPIC 4 1. Katritsis DG, Ioannidis JP. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a meta-analysis. Circulation 2005;111: Boden WE, O Rourke RA, Teo KK et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356: Stone GW. Non-ST-elevation acute coronary syndromes. Lancet 2007;369: Fox KA, Poole-Wilson P, Clayton TC, et al. 5- year outcome of an interventional strategy in non- ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial. Lancet 2005;366: Boden WE, O Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356: Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT. Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 2006;48: Akkerhuis KM, Alexander JH, Tardiff BE, et al. Minor myocardial damage and prognosis: are spontaneous and percutaneous coronary intervention-related events different? Circulation 2002;105: Antman EM, Morrow DA, McCabe CH, et al. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med 2006;354: Vanzetto G, Ormezzano O, Fagret D, Comet M, Denis B, Machecourt J. Long-term additive prognostic value of thallium-201 myocardial perfusion imaging over clinical and exercise stress test in low to intermediate risk patients : study in 1137 patients with 6-year follow-up. Circulation 1999;100: Min JK, Shaw LJ, Devereux RB, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 2007;50: Pan M, de Lezo JS, Medina A, et al. Rapamycineluting stents for the treatment of bifurcated coronary lesions: a randomized comparison of a simple versus complex strategy. Am Heart J 2004;148: Colombo A, Moses JW, Morice MC, et al. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation 2004;109: Steigen TK, Maeng M, Wiseth R, et al. Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation 2006;114: Cardiovascular Update
33 SECTION TOPIC 5 Cardiovascular Update 33
34 SECTION TOPIC 5 34 Cardiovascular Update
35 Cardiovascular Update 35
36 SECTION TOPIC 5 1. Smith SC, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National 36 Cardiovascular Update
37 Heart, Lung, and Blood Institute [published correction appears in Circulation. 2006;113:e- 847]. Circulation 2006;113: Balady GJ, Williams MA, Ades PA, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2007;115: Cardiovascular Update 37
38 THE MOST ADVANCED CONTINUING MEDICAL EDUCATION SERVICE VOL 1 NO VOL 1 NO VOL 2 NO VOL 2 NO VOL 2 NO VOL 2 NO VOL 3 NO VOL 3 NO VOL 4 NO VOL 4 NO VOL 4 NO VOL 4 NO VOL 5 NO VOL 5 NO VOL 5 NO VOL 5 NO VOL 6 NO VOL 6 NO VOL 6 NO VOL 6 NO VOL 6 NO VOL 7 NO VOL 7 NO VOL 7 NO VOL 7 NO VOL 7 NO VOL 7 NO VOL 8 NO VOL 8 NO VOL 8 NO VOL 8 NO VOL 8 NO VOL 8 NO VOL 9 NO VOL 9 NO VOL 9 NO VOL 9 NO VOL 9 NO VOL 9 NO VOL 10 NO VOL 10 NO VOL 10 NO VOL 10 NO VOL 10 NO VOL 10 NO VOL 11 NO VOL 11 NO VOL 11 NO VOL 11 NO
39 Cardiovascular Update
40 Cardiovascular Update
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Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ
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Original Articles Korean Circulation J 2000;30 8 : 경요골동맥중재술에서심좌법의유용성에관한연구 최해종 김무현 양창호 차광수 김혜진김성근 이수훈 김상곤 김영대 김종성 Usefulness of Deep Seating Tec
Original Articles Korean Circulation J 2000;308:921-926 경요골동맥중재술에서심좌법의유용성에관한연구 최해종 김무현 양창호 차광수 김혜진김성근 이수훈 김상곤 김영대 김종성 Usefulness of Deep Seating Technique for Transradial Coronary Intervention Hae Jong
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Review Article Korean Circulation J 2000;30 8 : 심부전증의최신개념과치료 김재중 New Concepts and Treatment of Heart Failure Modulation of Neurohormonal Syst
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