Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry and reflects the current therapeutic approaches and management for acute myocardial infarction (AMI) in Korea. The results of KAMIR demonstrated different risk factors and different responses to medical and interventional therapies. The prevalence of hypertension, diabetes mellitus and dyslipidemia has increased, but smoking has decreased remarkably. Different pattern of dyslipidemia was demonstrated. The KAMIR score was better than TIMI and GRACE scores in the prediction of long-term mortality in AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel and cilostazol, was effective in preventing adverse clinical outcomes after percutaneous coronary intervention (PCI). Prasugrel and ticagrelor could not reduce ischemic events, but increased bleeding risk in Korean patients. Therefore, we may recommend low dose prasugrel and ticagrelor compared with Western patients. Statin therapy was effective in Korean AMI patients, including those with very low levels of low density cholesterol and spasm-induced AMI. Statin and ezetimibe was effective in high-risk AMI patients, such as diabetes, old age and systolic heart failure. PCI and its success rates of ST-elevation myocardial infarction (STEMI) are 96.7% and 99.4%, and those of non-ST-elevation myocardial infarction (NSTEMI) 82.7% and 99.5%, respectively. Drug-eluting stents were effective and safe in AMI patients with no increased risk of stent thrombosis in Korean patients. KAMIR will provide new therapeutic strategies and effective methods for secondary prevention of AMI and new guidelines for Asian patients.

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Objective: Guidelines are suggesting Heart Team is crucial to manage patients with multi vessel coronary disease. We have created the ideal Heart Team by creating a facility and having interactive conferences every day since 2011. Here we introduce our strategies and achievable outcomes. Materials and Methods: Numbers of CABG and PCI cases are collected retrospectively. Results: The number of isolated CABG also increased from 22 in 2011 to 61 in 2014. The ratio of PCI/isolated CABG dramatically decreased from 19.3 in 2011 to 5.0 in 2014. Conclusions: Number of CABG increased and the reduction in PCI/CABG ratio was observed between before and after establishment of new Heart Team.

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Objective: Sequential grafting using an arterial graft is essential for achieving complete revascularization and long-term patency with complex multivessel diseases; however, technical difficulties still exist. Side-to-side anastomosis using 4 interrupted sutures for sequential grafting is effective for implementing complete revascularization for such complex coronary lesions. In this study, we evaluated the effectiveness of this technique for small coronary arteries using arterial grafts. Materials and methods: Between March 2010 and March 2017, the side-to-side technique with 4 interrupted sutures and arterial grafts for targeting small coronary arteries, smaller than 1.0 mm in diameter, was performed for 72 sequential anastomoses (69 for proximal touchdown site of sequential graft and 3 for distal) in 68 patients (57 men and 11 women; mean age, 64.4 ± 9.0 years). Results: This technique was frequently used for the proximal portion of the left internal thoracic artery (LITA)-diagonal branch(D)-left anterior descending coronary artery (35 anastomoses; 49%), LITA-D/circumflex coronary artery (Cx)-Cx (19 anastomoses; 26%) sequential grafting. Postoperative coronary angiography was performed for 65 of 72 anastomoses (90%). Fitz-Gibbon grade A was found for 64 of 65 (98%), grade B was found for 1 of 65 (2%), and grade O was not observed. Conclusion: The side-to-side anastomosis technique with 4 interrupted sutures and arterial grafts for small coronary arteries is versatile, safe, and associated with excellent short-term outcomes.

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Objective: We evaluated the relationship of coronary plaque characteristics including the plaque color with the long-term clinical outcomes in patients with acute coronary syndrome (ACS). Methods: Consecutive 339 ACS patients treated with percutaneous coronary intervention (PCI) were enrolled in the present study. The culprit lesions were examined by coronary angioscopy and were divided into three groups: thick yellow plaque: TYP, yellow plaque: YP, white plaque: WP. Major adverse cardiac event (MACE) was defined as the composite of cardiovascular death, nonfatal acute myocardial infarction (AMI), unstable angina (UAP), heart failure admission, and the need for PCI or coronary artery bypass grafting. Results: TYP and ruptured plaque were observed in AMI more frequently than in UAP. Among the three groups of plaque color, baseline clinical characteristics was similar except lower body mass index and LDL-cholesterol level in WP group. In contrast to YP group, TYP group showed more ruptured plaques, and WP group showed less ruptured or eroded plaques. During the median follow-up of 3.5 years, the incidence of MACE was reduced in TYP group and similar between WP and YP groups by Kaplan-Meier analysis. An increased incidence of UAP and a trend of increased target vessel revascularization were observed in WP group. Conclusions: In ACS patients with PCI, the TYP in culprit lesions was independently associated with the long-term favorable prognosis and the WP independently predicted with high incidence of UAP. These relationships might provide new insights for prevention of the secondary cardiac events after ACS.

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Background: Only a few nationwide studies have focused on the post-discharge treatment and outcomes of acute coronary syndrome (ACS) by general practitioners. Methods and Results: This prospective cohort study was conducted between February 2007 and March 2011. In total, 178 facilities across the country participated in this study, which included 545 patients with ACS who received acute care in cardiovascular centers and were then referred to general practitioners for further care. Clinical follow-up data, of up to 5 years, were obtained. As for patient characteristics, 403 of the 545 patients (73.9%) were men. The mean age of all subjects was 66 ± 11 years. Approximately two-thirds of patients had hypertension and dyslipidemia, and one-third had diabetes mellitus. Only 3.5% of patients had renal dysfunction. In the cardiovascular centers, reperfusion therapy was administered as acute care to 516 of the 545 patients (94.7%). Frequent use of guideline-directed medical therapy was indicated during the in-hospital and post-discharge periods. During the 5-year follow-up period, the cumulative incidence of clinical events was 24.0%, and all-cause mortality was 5.3%. The number of affected vessels was the strongest independent predictor of cardiovascular events. Conclusions: The MIC-K study identified an incidence of clinical events of 24.0%, and that of mortality of 5.3% in patients with ACS who were managed by general practitioners following their discharge from cardiovascular centers. The high rate of reperfusion therapy administered in cardiovascular centers and a low complication rate may have contributed to the favorable outcomes in these patients.

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We report a simple technique, which we term “wakka technique”, for management of the intracoronary shunt tube during beating-heart coronary artery bypass grafting. The shunt tube itself aids in maintaining a clear surgical view, as the shunt tube tag tends to wander and interfere with the anastomosis. Our technique is simply to pass the shunt tube tab through a loop of string, and to hold in appropriate position. This simple technique provides a comfortable anastomosis by locating the interfering tag away from the operative view, without any risk at no extra cost.

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We report on the successful surgical treatment of a blow-out type left ventricular free wall rupture (LVFWR), which had been diagnosed as an oozing type LVFWR. After full sternotomy, cardiac rupture suddenly occurred, and the pericardial cavity filled within blood in a few seconds. Because we could not secure a field of vision, it was difficult to apply a cardio-pulmonary bypass (CPB) by direct cannulation via the ascending aorta. Based on this experience, we recommend that given a diagnosis of oozing type LVFWR: access to the femoral artery and vein are prepared before full sternotomy in case a CPB becomes necessary for maintaining hemodynamics.

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Coronary malperfusion associated with aortic dissection is fatal when it occurs. Although there are some case reports of coronary malperfusion involving a single coronary artery, the involvement of bilateral coronary arteries is extremely rare. The appropriate management of this fatal phenomenon remains controversial because of the difficulty in its accurate diagnosis and prompt treatment. We report 2 cases of type A aortic dissection with malperfusion involving bilateral coronary arteries.
In the first case, because aortography revealed acute type A aortic dissection (AAD) and coronary artery angiography (CAG) showed obvious bilateral coronary malperfusion the patient was transferred to the operation room without undergoing computed tomography (CT) scan after palliative revascularization at a catheter laboratory. The patient died of nonocclusive mesenteric ischemia in spite of postoperative medical treatment.
In the second case, bilateral coronary artery malperfusion was not detected at the initial CT scan. Although detachment of the right coronary artery was detected during the operation, the left main coronary artery (LMCA) dissection was not detected until 1 week after the operation.
When assessing the aortic root in a case of aortic dissection with coronary artery malperfusion, CT scan is not always satisfactory. Preoperative and postoperative catheter intervention is effective in aortic dissection with coronary malperfusion.

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