SCI 발표논문
2026년 74편
- 142026
제1저자 한정규 · 교신저자 한정규
, ,
Aspirin in Patients Receiving Oral Anticoagulation.N Engl J Med. 2026;394(5):516.
- 132026
제1저자 오승석 · 교신저자 김원, 강건욱
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Inhibition of NOD-like receptor pyrin domain-containing protein 3 inflammasome activation by MK-571, a multidrug resistance protein inhibitor.Chem Biol Interact. 2026;424:111867.
PubMed IF 5.2 소화기내과Abstract
Proinflammatory cytokines such as interleukin (IL)-1β and IL-18 are known to be activated through the NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome, a multi-protein intracellular complex. MK-571 has been identified as an efflux inhibitor of multidrug resistance protein (MRP) transporters. In this study, we have revealed that MK-571 effectively suppresses the activation of the NLRP3 inflammasome in bone marrow-derived macrophages (BMDMs) by elevating intracellular cAMP levels. The accumulation of cAMP mediated by MK-571 inhibited the ATP-driven secretion of IL-1β through the ubiquitination of the NLRP3 protein. Additionally, MK-571 suppressed the nuclear factor-κB (NF-κB)-dependent priming signaling of the NLRP3 inflammasome, as evidenced by the reduction in proinflammatory cytokines and proteins as well as NF-κB-driven transcriptional activity. When administered orally, MK-571 significantly lowered mRNA levels of IL-6 and IL-1β, along with serum levels of IL-1β, in mice subjected to lipopolysaccharide/d-galactosamine treatment. These findings underline the crucial role of energy-dependent transporters MRP4 and 5 in regulating the priming and activation signals of the NLRP3 inflammasome in macrophages. Furthermore, MK-571 emerges as a promising therapeutic candidate for managing NLRP3 inflammasome-related diseases.
- 122026
제1저자 박지석, 김지연 · 교신저자 윤연이, 박재형
, , , , , , , , ,
Longitudinal Validation of a Deep Learning Index for Aortic Stenosis Progression.J Am Heart Assoc. 2026;15(2):e045179.
PubMed IF 6 순환기내과Abstract
BACKGROUND Aortic stenosis (AS) is a progressive disease requiring timely monitoring and intervention. While transthoracic echocardiography remains the diagnostic standard, deep learning-based approaches offer the potential for improved disease tracking. This study examined the longitudinal changes in a previously developed deep learning-derived index for AS continuum (DLi-ASc) and assessed its prognostic association with progression to severe AS.
METHODS We retrospectively analyzed 2373 patients (7371 transthoracic echocardiographies) from 2 tertiary hospitals. DLi-ASc (scaled 0-100), derived from parasternal long-axis and short-axis views, was tracked longitudinally. The median follow-up duration was 42.8 (interquartile range, 22.2-75.7) months.
RESULTS DLi-ASc increased in parallel with worsening AS stages (P for trend<0.001) and showed strong correlations with aortic valve maximal velocity (Pearson correlation coefficient, 0.69; P<0.001) and mean pressure gradient (Pearson correlation coefficient, 0.66; P<0.001). Higher baseline DLi-ASc was associated with a faster AS progression rate (P for trend<0.001). Additionally, the annualized change in DLi-ASc, estimated using linear mixed-effect models, correlated strongly with the annualized progression of aortic valve maximal velocity (Pearson correlation coefficient, 0.71, P<0.001) and mean pressure gradient (Pearson correlation coefficient, =0.68; P<0.001). In Fine-Gray competing risk models, baseline DLi-ASc was independently associated with progression to severe AS, even after adjustment for aortic valve maximal velocity or mean pressure gradient (hazard ratios per 10-point increase, 2.38 and 2.80, respectively).
CONCLUSIONS DLi-ASc increased in parallel with AS progression and was independently associated with severe AS progression. These findings support its role as a noninvasive imaging-based digital marker for longitudinal AS monitoring and risk stratification.
- 112026
제1저자 이근욱 · 교신저자 이근욱
, , , , , , , , , , , , ,
Phase Ib/II Study of Zanidatamab in Combination with Tislelizumab and Chemotherapy in First-Line HER2-Positive Gastric/Gastroesophageal Junction Adenocarcinoma.Clin Cancer Res. 2026;32(2):312-323.
PubMed IF 10.9 혈액종양내과Abstract
PURPOSE This phase Ib/II trial (NCT04276493) assessed the antitumor activity, safety, and pharmacokinetics (PK) of zanidatamab in combination with tislelizumab and chemotherapy in patients with advanced HER2-positive (HER2+) gastric cancer/gastroesophageal junction cancer (GEJC).
PATIENTS AND METHODS Adult patients with previously untreated, unresectable, locally advanced/metastatic HER2+ gastric cancer/GEJC received zanidatamab 30 mg/kg i.v. (cohort A) or zanidatamab 1800 mg i.v. (weight <70 kg)/2,400 mg i.v. (weight ≥70 kg; cohort B) once every 3 weeks (Q3W). Both cohorts received tislelizumab 200 mg i.v. once every 3 weeks and standard chemotherapy [capecitabine and oxaliplatin (CAPOX)] once every 3 weeks. Primary endpoints were investigator-assessed confirmed objective response rate (cORR) per RECIST v1.1, in addition to the frequency and severity of adverse events (AE) and serious AEs. Secondary endpoints included investigator-assessed progression-free survival (PFS), duration of response (DoR), overall survival (OS), PK, and immunogenicity of zanidatamab.
RESULTS As of December 7, 2023, 33 patients (cohort A, n = 19; cohort B, n = 14) received treatment. The confirmed objective response rate was 75.8%; the median duration of response, progression-free survival, and overall survival were 23.3, 16.7, and 32.4 months, respectively. The most common treatment-related AEs (TRAEs) were diarrhea (100%), nausea (63.6%), and decreased appetite (48.5%). Treatment-related AEs of grade ≥3 were reported in 22 (66.7%) patients; diarrhea was the most common (27.3%).
CONCLUSIONS Zanidatamab, in combination with tislelizumab and CAPOX, demonstrated clinically meaningful antitumor activity with a manageable safety profile as first-line therapy for patients with HER2+ gastric cancer/GEJC. These results support a further development of zanidatamab and tislelizumab with chemotherapy in this patient population in the ongoing phase III HERIZON-GEA-01 trial (NCT05152147).
- 102026
제1저자 이현주,문송미 · 교신저자 김홍빈
, , , , , , , , , , , , ,
National Pilot Program for Antimicrobial Stewardship in the Republic of Korea.JAMA Netw Open. 2026;9(1):e2555843.
PubMed IF 11.7 감염내과Abstract
IMPORTANCE Antimicrobial resistance (AMR) poses an urgent global health challenge, undermining treatment efficacy and threatening patient safety. Antimicrobial stewardship (AMS) programs are recognized as essential interventions to optimize antibiotic use, but implementation has often been fragmented and underresourced. The Republic of Korea (ROK), facing high antibiotic consumption and increasing multidrug resistance, launched a national pilot program for AMS as part of its Second National Action Plan on AMR (2021-2025). This program represents the first government-coordinated effort to establish a standardized framework for hospital-based stewardship nationwide.
OBSERVATIONS The pilot program, initiated in November 2024, was developed by the Korea Disease Control and Prevention Agency with academic and clinical partners. It set explicit eligibility criteria, requiring hospitals with at least 300 beds to form multidisciplinary AMS teams with minimum physician and pharmacist staffing. Core program components include leadership commitment, workforce development, guideline implementation, real-time audit and feedback, surveillance, reporting, and education. Institutions undergo annual evaluation based on both foundational and advanced criteria, with operational funding linked to performance grades. Depending on size and evaluation outcomes, hospitals may receive financial support from the government annually. Early implementation highlights both progress and challenges. The program has enabled the establishment of dedicated AMS teams, integration of stewardship into hospital governance, and initiation of national monitoring systems. However, persistent workforce shortages, uneven institutional readiness, limited awareness of AMS among clinicians and the public, and disparities between tertiary and smaller hospitals pose significant barriers. Sustained progress will require workforce expansion, awareness-building, stable long-term financing, and integration of stewardship into broader quality and safety frameworks.
CONCLUSIONS AND RELEVANCE The ROK's national AMS pilot illustrates how government-led policy, financing, and accountability mechanisms can motivate large-scale stewardship implementation. The initiative provides a replicable model for embedding stewardship into health systems while aligning public health priorities with clinical practice. Lessons from the Korean experience are relevant for countries seeking to strengthen national AMR strategies, particularly in resource-limited settings. By institutionalizing stewardship at the policy level, the program offers critical insights for sustaining progress against AMR and advancing global health security.
- 92026
제1저자 박영수,조유리,김승업,김아영 · 교신저자 김윤준
, , , , , , , , , , , , , , , , , , , , ,
Transarterial radioembolization versus atezolizumab-bevacizumab for the treatment of hepatocellular carcinoma with portal vein tumor thrombosis.Diagn Interv Imaging. 2026;107(1):25-37.
PubMed IF 11.1 소화기내과Abstract
PURPOSE The purpose of this study was to compare transarterial radioembolization (TARE) and atezolizumab plus bevacizumab (Atezo/Bev) in treatment-naïve patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without extrahepatic metastasis.
MATERIAL AND METHODS This multicenter retrospective study evaluated 213 patients initially treated with TARE or Atezo/Bev between 2016 and 2023. The primary outcome was overall survival, and the secondary outcomes were progression-free survival, objective response rate, and safety. Baseline characteristics were adjusted using inverse probability treatment weighting or propensity score matching.
RESULTS Deaths occurred in 36 out of 125 patients (28.8 %) in the TARE group and 57 out of 88 patients (64.8 %) in the Atezo/Bev group. The median overall survival was significantly longer in the TARE group (27.5 months) than in the Atezo/Bev group (8.6 months) (P < 0.01), consistent across analyses before matching (hazard ratio [HR], 0.38; 95% confidence interval [CI]: 0.25-0.58; P < 0.01), after inverse probability treatment weighting (HR, 0.49; 95 % CI: 0.28-0.85; P = 0.01), and after propensity score matching (HR, 0.40; 95% CI: 0.22-0.74; P < 0.01). In the PVTT subgroup involving segmental to lobar branches (Vp1-3), TARE demonstrated prolonged overall survival (HR, 0.36; 95 % CI: 0.20-0.63; P < 0.01), with no significant difference in patients with Vp4. The TARE and Atezo/Bev groups exhibited similar progression-free survival. No significant differences in objective response rate were found between TARE group (22.2-30.9 %) and Atezo/Bev group (30.6-30.9 %). Adverse events were less frequent in the TARE group than in the Atezo/Bev group. The incidence of grade ≥ 2 ascites and variceal bleeding were significantly lower in the TARE group (12.0 % and 1.7 %, respectively) than in the Atezo/Bev group (20.5 % and 8 %, respectively) (both P < 0.05). No significant differences in Child-Pugh score aggravation of ≥ 2 were observed between the TARE group (14.4 %) and the Atezo/Bev group (25 %) (P = 0.08).
CONCLUSION For patients with preserved liver function and locally advanced HCC involving segmental or lobar PVTT, TARE may be preferable to Atezo/Bev.
- 82026
제1저자 윤준필 · 교신저자 한정규
, , , , , , , ,
Comparative outcomes of moderate-intensity statin with ezetimibe vs high-intensity statin therapy: A retrospective observational cohort study.J Clin Lipidol. 2026;20(1):87-95.
PubMed IF 6.9 순환기내과Abstract
BACKGROUND Evidence supports that more aggressive low-density lipoprotein cholesterol (LDL-C) lowering improves outcomes in patients at high cardiovascular risk, but whether one therapeutic strategy is superior to another remains unclear.
OBJECTIVE This study compared the effectiveness of moderate-intensity statin therapy combined with ezetimibe vs high-intensity statin monotherapy.
METHODS We conducted a retrospective observational cohort study at a large tertiary university hospital. The study included patients prescribed either moderate-intensity statin with ezetimibe or high-intensity statin between January 1, 2018, and December 31, 2020. Propensity score matching was performed to balance clinical characteristics between the groups. The primary endpoint was an ischemic outcome, defined as a composite of cardiovascular death, non-fatal myocardial infarction, and ischemic stroke. Secondary outcomes included cardiovascular death, myocardial infarction, ischemic stroke, revascularization, and all-cause mortality.
RESULTS Before matching, 1380 patients were prescribed moderate-intensity statin-ezetimibe combination therapy, and 1105 patients were prescribed high-intensity statin therapy. After matching, 971 patients were included in each group. Over a median follow-up of 3.8 years, the primary endpoint occurred in 1.7% of patients in the moderate-intensity statin with ezetimibe group and in 2.1% of patients in the high-intensity statin group. The incidence of major adverse cardiovascular events did not differ significantly between the 2 groups (hazard ratio 0.82, 95% CI: 0.41-1.61, P = .558). No statistically significant differences were observed in secondary outcomes, including cardiovascular death, myocardial infarction, ischemic stroke, revascularization, and all-cause mortality.
CONCLUSION In this retrospective cohort study, moderate-intensity statin combined with ezetimibe was as effective as high-intensity statin monotherapy in preventing cardiovascular events.
- 72026
제1저자 김연욱, 정세영 · 교신저자 김연욱
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Trajectories of Synchronous Subsolid Nodules in Patients With Resected Subsolid Lung Adenocarcinoma: A Multicenter Cohort Study.J Thorac Oncol. 2026;21(1):174-185.
PubMed IF 23.3 호흡기내과Abstract
INTRODUCTION Multifocal subsolid nodules (SSNs), representing a spectrum of multifocal lung adenocarcinomas (LUADs), are increasingly detected with widespread lung cancer screening and advanced thoracic imaging. When synchronous SSNs coexist with a surgically confirmed subsolid LUAD, their trajectories remain poorly understood, contributing to uncertainty regarding optimal management strategies. This study aimed to evaluate the clinical course and impact of synchronous SSNs in such patients and to identify features associated with their progression.
METHODS The clinical course of synchronous SSNs in individuals who underwent surgical resection for subsolid LUAD between January 2009 and December 2019 at four referral centers in South Korea, with follow-up to June 2024, was analyzed. Longitudinal outcomes, including growth patterns and subsequent lung cancer diagnosis, were evaluated using comprehensive nodule-level assessments. Multivariable Cox regression models were used to identify risk factors associated with SSN trajectories and patient-level mortality outcomes.
RESULTS Overall, 1791 synchronous SSNs in 409 patients with surgically resected subsolid LUAD as the index lesion were included. During the initial surgery for the 409 index LUADs, 380 synchronous SSNs were resected concurrently, whereas 1002 SSNs were followed up in a mean duration of 80.6 months. Among the 1002 SSNs, 16.9% exhibited growth and 7.9% were subsequently diagnosed as lung cancer-all of which were stage 0 to I adenocarcinomas. Factors associated with SSN growth and lung cancer diagnosis included part-solid type, larger nodule size, the presence of bubble lucency, and pleural retraction. Notably, the number of synchronous SSNs was not associated with an increased risk of growth. At the individual patient level, neither the absolute number nor the mere growth of synchronous SSNs significantly affected lung cancer-related mortality or overall survival.
CONCLUSIONS Synchronous SSNs in patients with subsolid LUAD exhibited growth in 16.9% of cases, with varying trajectories and clinical impact. Identified risk factors were primarily related to the characteristics of each SSN. Our findings highlight the need for nodule-based, individualized management strategies, along with a more clinically relevant growth threshold to guide balanced intervention decisions.
- 62026
제1저자 안주희, 허문행, 신현재, 박민경 · 교신저자 김윤준
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Aspirin and hepatocellular carcinoma risk in metabolic dysfunction-associated steatotic liver disease: nationwide cohort study with genetic risk analysis.Clin Mol Hepatol. 2026;32(1):339-352.
PubMed IF 21.7 소화기내과Abstract
BACKGROUND/AIMS The association between aspirin use and hepatocellular carcinoma (HCC) risk in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. This study evaluated the effect of aspirin on HCC development in MASLD patients using Korean National Health Insurance Service (NHIS) and UK Biobank (UKB) databases.
METHODS A retrospective cohort analysis was conducted using the NHIS database with a 3-year landmark design. Baseline characteristics were balanced using inverse probability of treatment weighting (IPTW) and 1:3 propensity score matching (PSM). Additionally, Mendelian randomization analysis was performed in the UKB cohort using a genomic risk score (GRS) for salicylic acid, based on genetic variants related to aspirin metabolism, as a proxy for aspirin use.
RESULTS In the NHIS cohort, 6,584,155 eligible patients were included, of whom 1,723,435 had MASLD. After PSM, aspirin use was associated with a significantly lower risk of HCC compared to no aspirin use, in both the overall population (adjusted subdistribution hazard ratio [ASHR]=0.86; 95% confidence interval [CI] 0.78-0.95; P=0.002) and MASLD group (ASHR=0.86; 95% CI 0.75-0.99; P=0.036). Similar results were reproduced in the IPTW population and several sensitivity and subgroup analyses. In the UKB cohort, individuals in the top 95% of GRS had a significantly lower risk of HCC compared to those in the bottom 5%, in both the overall population (ASHR=0.61; 95% CI 0.39-0.95; P=0.028) and MASLD group (ASHR=0.47; 95% CI 0.29-0.76; P=0.002).
CONCLUSIONS Findings from both population-based and genetic analyses suggest a possible protective association between aspirin use and HCC in patients with MASLD, which warrants further validation.
- 52026
제1저자 이현승 · 교신저자 박흥우
,
Ginsenoside Rg1 attenuates asthma features in mice co-exposed to house dust mite allergen and diesel exhaust particle by modulating epithelial ILC2 interactions.J Ginseng Res. 2026;50(1):100919.
PubMed IF 7.5 알레르기내과Abstract
BACKGROUND Airway epithelial cells initiate asthma-related inflammation, making them key therapeutic targets. While some ginsenosides, the principal active constituents of Panax ginseng, are known to modulate epithelial inflammation, the role of ginsenoside Rg1 in this context remains underexplored. This study investigated the therapeutic effects of ginsenoside Rg1 on airway inflammation and airway hyperresponsiveness (AHR) in a murine asthma model induced by co-exposure to Dermatophagoides pteronyssinus (Dp) and diesel exhaust particles (DEP).
METHODS BALB/c mice were exposed intranasally to Dp and DEP with or without ginsenoside Rg1 treatment. AHR, inflammatory cell counts in bronchoalveolar lavage fluid, serum IgG1 levels, lung histopathology, and cytokine levels were assessed. Lung Th2/Th17 cells and ILC2/ILC3 populations were analyzed by flow cytometry. Mechanistic studies were conducted using MLE-12 lung epithelial cells and ILC2 co-cultures.
RESULTS Co-exposure to Dp and DEP significantly increased AHR, eosinophilic inflammation, Th2/Th17 responses, and ILC2/ILC3 populations. Ginsenoside Rg1 treatment markedly attenuated AHR, reduced eosinophils and serum Dp-specific IgG1, and decreased frequencies of IL-13+ ILC2s and IL-17+ ILC3s. IL-33 and IL-1β levels in lung tissue were also significantly reduced by Rg1. In MLE-12 cells, Rg1 suppressed IL-33 and phosphorylated STAT6 expression, mirroring the effects of a STAT6 inhibitor. Furthermore, Rg1 reduced IL-13 and IL-5 secretion from ILC2s co-cultured with MLE-12 cells.
CONCLUSION Ginsenoside Rg1 mitigates Dp/DEP-induced airway inflammation by downregulating Th2/Th17 and ILC2/ILC3 responses, potentially via the IL-33-STAT6 axis in airway epithelial cells.
- 42026
제1저자 최용훈 · 교신저자 김나영
, , , , , , , , , , , , , , , , , , , , , , ,
Survival Rates of Patients with Gastric Cancer According to Age and Sex: A Large-Scale Study Using Data from 14,739 Patients.Cancer Res Treat. 2026;58(1):252-263.
PubMed IF 4.2 소화기내과Abstract
PURPOSE The male predominance in the incidence of gastric cancer (GC) is established; however, sex differences in the prognosis of GC remain controversial. As such, this study analyzed the prognosis of patients with GC based on age and sex.
MATERIALS AND METHODS Data from 14,739 patients diagnosed with GC at Seoul National University Bundang Hospital between 2003 and 2023 were analyzed. Baseline characteristics, histological types of GC, overall and GC-specific survival rates (age and stage stratification), and associated risk factors were analyzed.
RESULTS Females were significantly younger (p < 0.001) and exhibited more gastric body cancers (p < 0.001) and tumors with diffuse-type or poorly differentiated histology (p < 0.001) than males. Females exhibited an advantage over males in terms of overall survival (p=0.004), but not in GC-specific survival. However, age stratification revealed significant sex differences, that females < 50 years of age exhibited survival disadvantages (p < 0.001); however, this trend was reversed with age, and females > 60 years exhibited survival advantages (p < 0.001) for both overall and GC-specific survival. This may be explained by the lower ratio of diffuse-type GC as females age. Furthermore, in the analysis according to stage, females with stage IV disease exhibited significant survival disadvantages, with significantly younger age and a higher proportion of diffuse-type GC which exhibits aggressive features, resulting in poorer survival than in males.
CONCLUSION Age and stage stratification revealed significant differences in survival between the sexes, which can be helpful for public health strategies.
- 32026
제1저자 최용훈, 장지은 · 교신저자 김나영
, , ,
The Effect of Alcohol Consumption Behavior Changes on Gastric Cancer Risks Stratified by Sex in South Korea.Cancer Res Treat. 2026;58(1):232-241.
PubMed IF 4.2 소화기내과Abstract
PURPOSE The effect of behavior changes in alcohol drinking on gastric cancer (GC) development, and the sex differences in those effects have not yet been fully elucidated. This study investigated the effect of behavior changes in alcohol drinking on the GC risk by sex.
MATERIALS AND METHODS The cohort consisted of 310,192 Koreans (≥ 40 years) from the National Health Insurance Service-Health Screening Cohort with a median follow-up period of 12 years. Subjects were classified according to alcohol consumption behavior changes (non-drinker, quitter, reducer, sustainer, and increaser). The independent effect of changes in alcohol drinking patterns or concurrent effect of alcohol on GC risk were evaluated using the Cox proportional hazard regression.
RESULTS In males, non-drinkers showed a lower risk of developing GC (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.84 to 0.98), whereas increasers showed a higher risk of GC than sustainers (HR, 1.11; 95% CI, 1.02 to 1.20). Starting to drink alcohol, even at a mild level, was associated with an increased GC risk, while a decreased GC risk was induced when alcohol consumption dose decreases to a mild from a moderate level among males. However, in females, only substantial change of alcohol consumption dose from non- to heavy-drinking was associated with increased GC risk (HR, 1.97; 95% CI, 0.98 to 3.96).
CONCLUSION These results suggest that alcohol abstinence can reduce the risk of developing GC, particularly among males.
- 22026
제1저자 한정규, 황도연 · 교신저자 김효수, 이남호
, , , , , , , , , , , , , , , , , , , ,
Abbreviated dual antiplatelet therapy after percutaneous coronary intervention with ultrathin-strut drug-eluting stents in South Korea: 3-year outcomes of the multicentre, randomised HOST-IDEA trial.EClinicalMedicine. 2026;91:103698.
PubMed IF 12.8 순환기내과Abstract
BACKGROUND The HOST-IDEA trial demonstrated non-inferiority of 3-to-6-month dual antiplatelet therapy (DAPT) to 12-month DAPT for net adverse clinical event (NACE) at 1 year in patients undergoing percutaneous coronary intervention (PCI) with third-generation drug-eluting stents (DES). We evaluated the long-term outcomes of abbreviated antiplatelet therapy following PCI with third-generation DES.
METHODS In the open-label, adjudicator-blinded, multicentre, randomised HOST-IDEA trial, 2013 patients from 37 hospitals in South Korea were randomly allocated to 3-to-6-month (n = 1002) or 12-month (n = 1011) DAPT between January 2016 and May 2021. The primary outcome was NACE at 3 years, comprising cardiac death, target vessel myocardial infarction (TVMI), clinically driven target lesion revascularisation (CD-TLR), stent thrombosis, and major bleeding (Bleeding Academic Research Consortium type 3 or 5). Major secondary outcomes were target lesion failure (TLF)-comprising cardiac death, TVMI, and CD-TLR-and major bleeding at 3 years. To evaluate the efficacy and safety of >1-year DAPT, patients event-free at 1 year were classified into >1-year and ≤1-year DAPT groups and matched using a propensity score. These 3-year clinical outcomes were prespecified in the published protocol as mandatory clinical follow-up. HOST-IDEA is registered with ClinicalTrials.gov, NCT02601157.
FINDINGS At 3 years, clinical follow-up was completed in 955 patients (95.3%) and 966 patients (95.5%) in the 3-to-6-month and 12-month DAPT groups, respectively. The median follow-up duration was 1095 days (IQR 1095-1095). The primary outcome occurred in 7.7% and 8.2% of patients in the 3-to-6-month and 12-month DAPT groups, respectively (HR 0.94; 95% CI 0.69-1.29; P = 0.71). The risks of TLF (HR 0.92; 95% CI 0.62-1.36; P = 0.66) and major bleeding (HR 0.96; 95% CI 0.59-1.56; P = 0.88) were comparable between the two groups. Among patients who were event-free at 1 year, 583 remained on DAPT, while 1259 switched to single antiplatelet therapy within the 1 year. In the matched cohort, there was some evidence of a higher risk of TLF in the >1-year DAPT group (HR 2.56; 95% CI 0.99-6.60; P = 0.05), whereas major bleeding risk was significantly higher with >1-year DAPT (HR 4.44; 95% CI 1.26-15.57; P = 0.02).
INTERPRETATION 3-to-6-month and 12-month DAPT showed comparable 3-year clinical outcomes in patients undergoing PCI with third-generation DES. However, extending DAPT beyond 1 year was associated with increased major bleeding without additional ischemic benefits. Further studies are warranted to validate these findings and identify patient subsets who may benefit from extended DAPT.
FUNDING Biotronik Korea (Seongnam si, Gyeonggi-do, South Korea) and B. Braun Korea (Seoul, South Korea).
- 12026
제1저자 최홍재 · 교신저자 김학령
, , , ,
Development of a long-term survival prediction model for patients undergoing invasive coronary angiography using ensemble-based machine learning in time-to-event analysis.Heart Lung. 2026;77:102697.
PubMed IF 2.5 순환기내과Abstract
BACKGROUND Prognosis prediction for high-risk patients undergoing invasive coronary angiography (ICA) is crucial for clinical decision-making. Despite machine learning (ML) advancements, time-to-event survival prediction remains limited.
OBJECTIVES This study developed an ensemble ML model based on survival analysis to predict long-term outcomes in ICA patients.
METHODS A total of 9517 ICA patients (2008-2020) were retrospectively analyzed. The primary outcome was all-cause mortality, with follow-up until December 31, 2021. Using 8 ML algorithms, we developed a model comprising 80 variables. Model performance was assessed using time-dependent C-index and Brier score, with variable importance analyzed using permutation-based and partial dependent plots.
RESULTS Survival Quilts model achieved the highest time-dependent C-index (0.920 at 30 days, 0.897 at 365 days), outperforming other ML algorithms. Time-dependent Brier scores generally increased, which remained stable. ICA-related characteristics had the greatest impact on mortality, while laboratory results, comorbidities, and patient characteristics gained influence over time. By day 365, patient characteristics and laboratory results became more prominent predictors. Among the domains, key variables included catheterization status, C-reactive protein, smoking, and chronic kidney disease.
CONCLUSION Survival analysis-based ensemble ML models, such as Survival Quilts, improve survival prediction by capturing time-varying influences of key predictors, offering a foundation for more precise cardiovascular care.
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