https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/450 2025-12-25T01:39:03Z 2025-12-25T01:39:03Z Park, Soohyung Rha, Seung-Woon Ahn, Woo Jin Choi, Byoung Geol Choi, Se Yeon Byun, Jae Kyeong Lee, Youjin Chesario, Manda Satria Susanti, Melly Choi, Cheol Ung Jeong, Myung Ho https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/78819 2025-12-17T01:00:17Z 2025-11-10T00:00:00Z

Title: Impact of β-Blocker Nebivolol versus Bisoprolol Prescription at Discharge on Long-term Clinical Outcomes in ST elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction (<40%) treated with Drug-eluting Stents Authors: Park, Soohyung; Rha, Seung-Woon; Ahn, Woo Jin; Choi, Byoung Geol; Choi, Se Yeon; Byun, Jae Kyeong; Lee, Youjin; Chesario, Manda Satria; Susanti, Melly; Choi, Cheol Ung; Jeong, Myung Ho Abstract: Background: The comparative long-term outcomes of Nebivolol and Bisoprolol in ST-segment elevation myocardial infarction (STEMI) patients with reduced left ventricular ejection fraction (LVEF <40%) treated with drug-eluting stents (DESs) are not well understood. This study evaluated the efficacy and safety of these β-blockers in this population. Methods: We analyzed data from the Korea Acute Myocardial Infarction Registry (KAMIR) involving STEMI patients with reduced LVEF treated with DESs. Patients were grouped based on Nebivolol or Bisoprolol prescription at discharge and followed for up to 3 years. The primary endpoint was all-cause death, while the secondary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction (MI), and revascularization. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline confounders. Results: After IPTW adjustment, baseline characteristics were well balanced between the Nebivolol group (n=654) and the Bisoprolol group (n=663). At 1 year, the incidence of total death was similar between the two groups (3.2% vs. 4.4%, HR: 0.724, 95% CI: 0.408–1.283, P=0.313), whereas the incidence of MACE was significantly lower in the Nebivolol group (5.2% vs. 10.0%, HR: 0.495, 95% CI: 0.322–0.760, P=0.001). Over the 3-year follow-up, the incidence of total death (5.5% vs. 7.1%, HR: 0.762, 95% CI: 0.486–1.193, P=0.257) remained comparable, but the incidence of MACE continued to be significantly lower in the Nebivolol group (9.9% vs. 15.8%, HR: 0.586, 95% CI: 0.421–0.815, P=0.002). Conclusions: In STEMI patients with reduced LVEF treated with DESs, discharge prescription of Nebivolol was associated with a significantly lower incidence of MACE compared to Bisoprolol, while total death remained similar between the two groups after IPTW adjustment. These findings suggest that Nebivolol may offer additional benefits in reducing MACE in this population.

2025-11-10T00:00:00Z Ahn, Woo Jin Rha, Seung-Woon Choi, Byoung Geol Choi, Se Yeon Byun, Jae Kyeong Lee, Youjin Chesario, Manda Satria Susanti, Melly Park, Soohyung Choi, Cheol Ung https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/78822 2025-12-17T01:00:33Z 2025-11-09T00:00:00Z

Title: Clinical Implications of Elevated Lipoprotein(a) in the Absence of Significant Coronary Artery Stenosis Authors: Ahn, Woo Jin; Rha, Seung-Woon; Choi, Byoung Geol; Choi, Se Yeon; Byun, Jae Kyeong; Lee, Youjin; Chesario, Manda Satria; Susanti, Melly; Park, Soohyung; Choi, Cheol Ung Abstract: Background: Lipoprotein(a) [Lp(a)] has recently re-emerged as a biomarker of growing interest in the prognostic assessment of cardiovascular disease. However, prognostic evidence remains limited in patients without significant coronary artery stenosis confirmed by coronary angiography (CAG), and who therefore did not undergo percutaneous coronary intervention (PCI). Methods: A total of 2,342 patients with chest pain who underwent CAG and acetylcholine provocation test and were confirmed to have no significant coronary artery stenosis, were analyzed and categorized into two groups based on Lp(a) levels: the high Lp(a) group (≥50 mg/dL) and the low Lp(a) group (<50 mg/dL). The primary endpoint was major adverse cardiovascular events (MACE); secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE1) and MACCE1 with recurrent angina (MACCE2). Multiple imputation was followed by inverse probability of treatment weighting (IPTW), and Cox regression analysis was used to analyze 10-year clinical outcomes. Results: Atherosclerotic plaque burden appeared to be higher in the high Lp(a) group. However, there was no difference in the incidence of coronary artery spasm between the two groups. In addition, there was no significant difference in MACE, MACCE1, or MACCE2. Before IPTW adjustment, the high Lp(a) group showed a higher incidence of revascularization (2.5% vs. 1.0%; p = 0.033), but this difference was no longer statistically significant after adjustment (p = 0.085). Conclusion: Although Lp(a) is an established independent risk factor, it did not show prognostic significance in patients with the absence of significant coronary artery stenosis and PCI.

2025-11-09T00:00:00Z Susanti, Melly Rha, Seung-Woon Choi, Byoung Geol Choi, Se Yeon Lee, You Jin Chesario, Manda Satria Ahn, Woo Jin Chu, Wonsang Park, Eun Jin Kang, Dong Oh https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/78814 2025-12-16T08:30:36Z 2025-10-28T00:00:00Z

Title: Lipoprotein(a) and Long-Term Cardiovascular Events in Patients With Coronary Vasospasm Authors: Susanti, Melly; Rha, Seung-Woon; Choi, Byoung Geol; Choi, Se Yeon; Lee, You Jin; Chesario, Manda Satria; Ahn, Woo Jin; Chu, Wonsang; Park, Eun Jin; Kang, Dong Oh Abstract: BACKGROUND Lipoprotein(a) [Lp(a)] is a genetically determined lipoprotein associated with atherosclerotic cardiovascular disease, but its prognostic relevance in coronary vasospasm remains unclear. We evaluated the relationship between Lp(a) levels and cardiovascular outcomes in patients undergoing spasm provocation testing. METHODS We retrospectively analyzed 2,977 patients who underwent coronary angiography with spasm provocation testing between 2004 and 2021. Patients were stratified by Lp(a) level (<30 mg/dL vs. >30 mg/dL), and a continuous analysis per 10 mg/dL increment was also performed. The primary endpoint was major adverse cardiovascular events (MACE). A secondary outcome was recurrent angina. Associations were assessed using Kaplan-Meier survival analysis, Cox proportional hazards, and logistic regression, adjusting for age, sex, hypertension, diabetes, smoking, statin use, and angiographic spasm (>70%). RESULTS Among 2,977 patients (mean age 56.9 ± 12.5 years, 52.8% female), 20.6% had Lp(a) >30 mg/dL. Coronary spasm was present in 58.7% with low Lp(a) and 57.6% with high Lp(a) (p=0.637). Over a median follow-up of 6,365 days (~17.4 years), MACE occurred in 96 (4.1%) and 27 (4.4%) patients with low and high Lp(a), respectively. Kaplan-Meier analysis showed no difference in MACE-free survival (log-rank p=0.619). In Cox regression, Lp(a) >30 mg/dL was not associated with MACE (adjusted HR 1.11, 95% CI 0.73–1.71, p=0.622); neither was Lp(a) per 10 mg/dL (HR 1.01, 95% CI 0.93–1.09, p=0.910). In logistic regression for recurrent angina, Lp(a) >30 mg/dL was not significant (OR 1.18, 95% CI 0.94–1.49, p=0.160); nor was Lp(a) per 10 mg/dL (OR 1.02, 95% CI 0.96–1.08, p=0.328). CONCLUSION In this large, long-term spasm registry, Lp(a) was not independently associated with MACE or recurrent angina, whether analyzed as a dichotomous or continuous variable. These findings suggest Lp(a) may have limited prognostic utility in vasospastic angina populations.

2025-10-28T00:00:00Z Susanti, Melly Rha, Seung-Woon Choi, Byoung Geol Choi, Se Yeon Lee, You Jin Chesario, Manda Satria Ahn, Woo Jin Chu, Wonsang Kang, Dong Oh Park, Eun Jin https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/78815 2025-12-17T00:30:12Z 2025-10-28T00:00:00Z

Title: Lipoprotein(a) as a Predictor of Lesion Complexity in Patients undergoing Elective Percutaneous Coronary Intervention: Insights from an Asian single center cohort Authors: Susanti, Melly; Rha, Seung-Woon; Choi, Byoung Geol; Choi, Se Yeon; Lee, You Jin; Chesario, Manda Satria; Ahn, Woo Jin; Chu, Wonsang; Kang, Dong Oh; Park, Eun Jin Abstract: BACKGROUND Lipoprotein(a) [Lp(a)] is a recognized independent risk factor for cardiovascular disease. However, its association with coronary lesion complexity, particularly among Asian populations, remains under-investigated. METHODS We conducted a retrospective study involving 573 Asian patients who underwent elective PCI (2004–2021). Participants were stratified by Lp(a) levels into two groups: < 50 mg/dL and > 50 mg/dL. A lesion complexity score (range 0–5) was assigned based on five angiographic features: chronic total occlusion (CTO), use of > 2 stents, total stent length > 60 mm, bifurcation PCI, and multivessel disease. Multivariable linear regression was used to identify independent predictors of lesion complexity. RESULTS Among 573 patients, 142 (24.8%) had Lp(a) > 50 mg/dL. Patients with elevated Lp(a) were more often female, had elevated LDL-cholesterol, and a greater prevalence of diabetes. Lesion complexity was significantly higher in patients with elevated Lp(a) (mean score 4.201.49 vs. 2.88 ± 1.75, p < 0.001). In multivariable analysis, Lp(a) > 50 mg/dL remained an independent predictor of lesion complexity (B - 1.24, 95% CI: 0.88–1.61, p < 0.001), along with diabetes and LDL-cholesterol. CONCLUSION Elevated Lp(a) (> 50 mg/dL) was independently associated with greater lesion complexity in Asian patients undergoing elective PCI. These findings support the value of Lp(a) not only as a cardiovascular risk marker, but also as a predictor of procedural challenge and complexity.

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