The traditional cut-off for the cardiothoracic ratio (CTR) by chest X-ray was not originally proposed as a prognostic variable. We investigated an optimal CTR cut-off that could predict clinical outcomes in patients with acute myocardial infarction (AMI). A total of 3,083 AMI patients (65.2 ± 12.0 years, 2,091 males) who underwent successful percutaneous coronary intervention were divided into two groups by use of a CTR of 0.42 as determined by receiver-operating characteristic curve analysis (group I: CTR ≤ 0.42, group II: CTR > 0.42). We compared the incidences of in-hospital death and major adverse cardiac events (MACEs), including cardiac death, reinfarction, coronary artery bypass grafting, and target lesion revascularization, during 12 months between the groups. The patients in group II were older than those in group I and included more women. The patients in group II were more likely to have hypertension and multivessel disease and had a higher Killip class, higher troponin, higher N-terminal pro-brain natriuretic peptide, and lower ejection fraction than did those in group I. The in-hospital death rate was higher in group II (1.9 vs. 4.8%, p < 0.001). The incidences of cardiac death and composite of MACEs during 12 months of follow-up were significantly higher in group II than in group I (2.4 vs. 5.7%, p < 0.001, and 16.0 vs. 19.8%, p = 0.007, respectively). Multivariable logistic regression analysis revealed that CTR greater than 0.42 was an independent predictor of MACEs (relative risk: 1.361, 95% CI 1.014-1.827, p = 0.040). A CTR greater than 0.42, although within the traditional normal range, was associated with worse in-hospital and long-term clinical outcome in AMI patients.

Background/AimsCoronary vasospasms are one of the important causes of sudden cardiac death (SCD). Provocation of coronary vasospasms can be useful, though some results may lead to false positives, with patients potentially experiencing recurrent SCD despite appropriate medical treatments. We hypothesized that it is not coronary vasospasms but inherited primary arrhythmia syndromes (IPAS) that underlie the development of SCD.MethodsWe analyzed 74 consecutive patients (3.8%) who survived out-of-hospital cardiac arrest among 1,986 patients who had angiographically proven coronary vasospasms. Electrical abnormalities were evaluated in serial follow-up electrocardiograms (ECGs) during and after the index event for a 3.9 years median follow-up. Major clinical events were defined as the composite of death and recurrent SCD events.ResultsForty five patients (60.8%) displayed electrocardiographic abnormalities suggesting IPAS: Brugada type patterns in six (8.2%), arrhythmogenic right ventricular dysplasia patterns in three (4.1%), long QT syndrome pattern in one (2.2%), and early repolarization in 38 (51.4%). Patients having major clinical events showed more frequent Brugada type patterns, early repolarization, and more diffuse multivessel coronary vasospasms. Brugada type pattern ECGs (adjusted hazard ratio [HR], 4.22; 95% confidence interval [CI], 1.16 to 15.99; p = 0.034), and early repolarization (HR, 2.97; 95% CI, 1.09 to 8.10; p = 0.034) were ultimately associated with an increased risk of mortality.ConclusionsEven though a number of aborted SCD survivors have coronary vasospasms, some also have IPAS, which has the potential to cause SCD. Therefore, meticulous evaluations and follow-ups for IPAS are required in those patients.

Acute pancreatitis is an uncommon side effect of pegylated interferon (PEG-IFN) α-2b and ribavirin (RBV) combination therapy. In South Korea, There is a no report of acute pancreatitis associated PEG-IFN α-2b plus RBV combination therapy. Here, acute pancreatitis associated with PEG-IFN α-2b plus RBV treatment is described in two patients with chronic hepatitis C. We started on weekly subcutaneous injection of PEG-IFN α-2b plus daily RBV. During this therapy, acute pancreatitis occurred in these patients without other causes of acute pancreatitis. We thought that the cause of acute pancreatitis in these patients was PEG-IFN α-2b and RBV. We stopped the treatment of PEG-IFN α-2b and RBV, and patients were improved.

Kommerell diverticulum is a rare congenital anomaly of the aortic arch characterized by dilation at the proximal descending aorta, which gives rise to an aberrant subclavian artery. Kommerell diverticulum is usually asymptomatic, but can also be associated with symptoms due to compression of the esophagus or trachea, and can rarely be fatal due to dissection or rupture of the diverticulum. Here, we report a rare case of dysphagia caused by compression of the esophagus by Kommerell diverticulum originating from the right-sided aortic arch.