관상동맥 중재술 시술시 혈소판 당단백 Ⅱb/Ⅲa 수용체 차단제를 사용한 70세 이상 고령 급성 심근경색증 환자의 임상경과: 70세 미만 환자와 비교

심두선 ( Doo Sun Sim ),정명호 ( Myung Ho Jeong ),이민구 ( Min Goo Lee ),홍영준 ( Young Joon Hong ),박형욱 ( Hyung Wook Park ),김원 ( Weon Kim ),김주한 ( Ju Han Kim ),안영근 ( Young Keun Ahn ),조정관 ( Jeong Gwan Cho ),박종춘 ( Jo 대한내과학회 2004 대한내과학회지 Vol.67 No.6

배경 : 혈소판 당단백질 IIb/IIIa 수용체 차단제인 Abciximab (ReoPro(R))은 고위험 관상동맥 중재술의 결과를 향상시키고 주요 심장사건 감소에 효과적인 것으로서 관상동맥 중재술시 사용이 보편화 되어 있다. 급성 심근경색증을 동반한 70세 이상의 고령 환자에서 관상동맥 중재술시 ReoPro(R) 투여의 임상 효과를 70세 미만의 환자와 비교하고자 하였다. 방법 : 2000년 1월부터 2002년 1월까지 관상동맥 조영술상 혈전을 내재하거 Background : This study was designed to evaluate the safety and clinical benefits of a glycoprotein IIb/IIIa receptor inhibitor, ReoPro(R) in the elderly patients with acute myocardial infarction (AMI) (≥70 years of age) undergoing percutaneous coronary i

당뇨병 환자에서 고위험 관상동맥 중재술시 혈소판 당단백 IIb / IIIa 수용체 차단제 ( Abciximab : ReoPro ) 의 장기 임상 효과

심두선(Doo Sun Sim),정명호(Myung Ho Jeong),김원(Weon Kim),류제영(Jay Young Rhew),염주협(Ju Hyup Yum),김주한(Ju Han Kim),안영근(Young Keun Ahn),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),안병희(Byoung Hee Ahn),김상형(Sang Hyung Ki 대한내과학회 2002 대한내과학회지 Vol.62 No.2

N/A Background: High-risk percutaneous coronary interventions (PCI) are associated with high complication rate, low procedural success rate and high restenosis rate, especially in diabetics. We sought to observe whether diabetes affects long-term clinical outcomes after Abciximab (ReoPro) therapy in Korean patients undergoing high-risk PCI. Methods: One hundred nineteen patients with 152 lesion sites were administered ReoPro out of 2,231 patients who underwent PCI at Chonnam National University Hospital from Mar 1999 to Feb 2001. They were divided into two groups, 30 in diabetic group (Group I, 57.7±8.2 years, 22 male) and 89 in non-diabetic group (Group II, 59.6±10.8 years, 68 male). Early and long-term clinical outcomes after PCI were analyzed. Results: In clinical diagnosis the number of acute myocardial infarction was 25 in Group I (83.3%) and 76 in Group II (85.4%). As for risk factors and target lesion artery, ACC/AHA types, there were no differences between the two groups. The number of patients with total occlusion was 21 (55.3%) and 62 (53.9%) and thrombus-containing lesion 28 (93.3%) and 88 (98.9%) in Group I and II respectively. Procedure was successful in 27 (90.0%) in Group I and 80 (89.9%) in Group II and there were no differences in bleeding complications. No major adverse cardiac events (MACE), including myocardial infarction, repeat revascularization or cardiac death were observed in Group I, but there were 8 cases of MACE in Group II during hospitalization. Clinical follow-up was performed in 116 patients (97.5%) during 18.5±6.7 (5∼28) months. The number of overall MACEs were 10 (3.3%) in Group I and 14 (15.7%) in Group II (p=0.038). Conclusion: ReoPro used in high-risk PCI in diabetics was effective in early clinical outcome, but long-term clinical benefits were not warranted.(Korean J Med 62:171-181, 2002)

관상동맥중재술을 시행받은 안정형 협심증 환자에서 고용량 Carvedilol의 정기적 임상 효과

심두선 ( Doo Sun Sim ),정명호 ( Myung Ho Jeong ),김원 ( Weon Kim ),홍영준 ( Young Joon Hong ),박형욱 ( Hyung Wook Park ),김주한 ( Ju Han Kim ),안영근 ( Young Keun Ahn ),조정관 ( Jeong Gwan Cho ),서순팔 ( Soon Pal Suh ),박종춘 ( J 한국지질동맥경화학회(구 한국지질학회) 2004 韓國脂質學會誌 Vol.14 No.2

작은 관상동맥질환자에 대한 BiodivYsio Phosphorylcholine - coated Coronary Stent 의 임상 효과

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),심두선(Doo Sun Shim),임상엽(Sang Yup Lim),양보라(Bo Ra Yang),이상현(Sang Hyun Lee),이승현(Seung Hyun Lee),박옥영(Ok Young Park),박우석(Woo Seok Park),김주한(Joo Han Kim),최명자(Myung Ja 대한내과학회 2002 대한내과학회지 Vol.63 No.3

배경 : BiodivYsio stent는 biocompatible molecule인 phosphorylcholine이 부착된 스텐트로서 관상동맥질환자에게 시술하였을 때 혈전 형성을 줄이고 재협착률을 감소시킨다고 알려져 있다. 목적 : 관상동맥 질환으로 내원하여 관상동맥 조영술을 시행한 환자 중 병변 내경이 2.0∼2.8 mm인 small vessel disease 환자를 대상으로 BiodivYsio stent와 경피적 풍선 확장술을 무작위 순서로 시행하여 BiodivYsio stent의 효용성에 대해 알아보기 위하여 본 연구를 시행하였다. 대상 및 방법 : 2001년 2월부터 2001년 10월까지 전남대학교병원 순환기내과에 관상동맥 질환으로 내원하여 관상동맥 조영술을 시행한 환자 중 혈관 내경이 2.0∼2.8 mm인 small vessel disease 환자 40예를 대상으로 BiodivYsio 스텐트를 시행했던 20예의 환자군을 I군(60.8±9.3세, 남: 12, 여: 8)으로, 경피적 풍선 확장술만을 시행했던 20예의 환자군을 II군(60.3±7.9세, 남: 9, 여: 11)으로 분류하고 양군 사이에 임상적 및 관상동맥 조영술상 특성과 주요 심장사고에 대하여 전향적으로 비교하였다. 결과 : 1) 임상 양상 및 검사실 소견에 있어서 양 군 사이에 유의한 차이는 없었다. 2) 병변 혈관의 수, 경색관련 혈관의 분포, ACC/AHA 형태, 혈전 내재 병변, TIMI 혈류 등 관상동맥 조영술상 양 군 간에 유의한 차이는 없었다. 3) 관상동맥 조영술상 참조 혈관 내경, 병변 최소 내경, 내경 협착률에 있어서 유의한 차이는 없었고, 양 군 모두에서 관상동맥 중재술 이후 병변 최소 내경 및 내경 협착률에 있어서 유의한 개선을 보였다. 6개월 추적 관상동맥 조영술상 II군에 비해 I군에서 병변 최소 내경의 감소 및 내경 협착률의 증가가 유의하게 적었다(1.64±0.17 mm vs 1.36±0.22 mm, 31.9±4.4% vs 43.4±9.7%, 각각 p=0.001, 0.005). 4) 재원 기간 중 급성 심근경색증, 표적 혈관 재개통술, 사망 등 주요 심장 사고에 있어서 양군간에 차이는 없었다. 5) 6개월 추적 관상동맥 조영술상 재협착률은 I군에서 유의하게 낮았고(I군 3/20명, 15.0% vs II군 9/20명, 45.0%, p=0.032), 표적 혈관 재개통술에 있어서 I군에서 유의하게 낮았으나(I군 3/20명, 15.0% vs II군 8/20명, 40.0%, p=0.041), 사망률에 있어서는 양군 사이에 유의한 차이는 없었다. 결론 : 관상동맥 조영술상 small vessel disease 환자에게 BiodivYsio stent 시술은 재협착률을 의미 있게 감소시켜 표적 혈관 재개통술의 빈도를 줄일 수 있었다. Background : The BiodivYsio stent is a balloon-expandable stent coated with phosphorylcholine designed to reduce the formation of thrombus and the risk of restenosis. Methods : We prospectively studied 20 patients who underwent implantation of BiodivYsio stent (group I; 60.8±9.3 years, male 60.0%) and compared to 20 patients who underwent balloon angioplasty alone (group II; 60.3±7.9 years, male 45.0%) for small coronary arterial lesions (target arterial diameter was between 2.0 mm and 2.8 mm) between February 2001 and October 2001. Major adverse cardiac events such as acute myocardial infarction, target vessel revascularization and death were evaluated during hospital admission and at 6-months after percutaneous coronary intervention (PCI). Results : During hospitalization, the incidence of acute myocardial infarction, target vessel revascularization and death was not different between the two groups. At follow-up coronary angiography 6 months after PCI, the incidence of restenosis was lower in group I than in group II (Group I; 3/20, 15.0% vs Group II; 9/20, 45.0%, p=0.032) and the incidence of target vessel revascularization (TLR) was lower in group I than in group II (Group I; 3/20, 15.0% vs Group II; 8/20, 40.0%, p=0.041). Conclusion : Coronary BiodivYsio stenting in small coronary artery leads to excellent short- and mid-term clinical outcomes.(Korean J Med 63:251-260, 2002)

급성 흉통의 평가 및 감별 진단

이승헌 ( Seung Hun Lee ),김민철 ( Min Chul Kim ),심두선 ( Doo Sun Sim ),홍영준 ( Young Joon Hong ),김주한 ( Ju Han Kim ),안영근 ( Youngkeun Ahn ),정명호 ( Myung Ho Jeong ) 대한내과학회 2023 대한내과학회지 Vol.98 No.3

관상동맥 스텐트 재협착 병변에 대한 Cutting Balloon Angioplasty의 장기적 임상효과

이승현 ( Seung Hyun Lee ),정명호 ( Myung Ho Jeong ),심두선 ( Doo Sun Sim ),임상엽 ( Sang Yeob Lim ),배은희 ( Eun Hee Bae ),홍영준 ( Young Joon Hong ),박옥영 ( Ok Young Park ),박우석 ( Woo Seok Park ),김주한 ( Ju Han Kim ),김인수 ( 대한내과학회 2003 대한내과학회지 Vol.64 No.5

목적 : 관상동맥 스텐트는 풍선 확장술에 비해 재협착을 줄였지만 여전히 재협착이 문제되고 있으며, 이를 해결하고자 하는 연구가 활발히 진행 중이다. 그 방법 중의 하나가 cutting balloon angioplasty (CBA)이라고 알려져 있으며, 본 연구에서는 CBA와 plain old balloon angioplasty (POBA)의 장기 임상효과를 전향적으로 비교하고자 하였다. 방법 : 2001년 1월부터 12월까지 스텐트 내 협착이 진단되었던 Background : Coronary stent implantation reduced the restenosis rate after percutaneous coronary intervention (PCI) but, still coronary in-stent restenosis (ISR) remains the major problem after PCI. Cutting balloon angioplasty is one of the method for ISR

인공 심박동기 환자에서 심실동기이상의 관련인자

김성수 ( Sung Soo Kim ),조정관 ( Jeong Gwan Cho ),김현국 ( Hyun Kuk Kim ),장수영 ( Soo Young Jang ),심두선 ( Doo Sun Sim ),윤남식 ( Nam Sik Yoon ),윤현주 ( Hyun Ju Yoon ),홍영준 ( Young Joon Hong ),박형욱 ( Hyung Wook Park ),김주 대한내과학회 2010 대한내과학회지 Vol.78 No.1

Background/Aims: Chronic right ventricular pacing (RVP) can lead to increased risks of ventricular dyssynchrony (VD), heart failure, and mortality. This study examined the factors influencing VD in patients treated with a permanent pacemaker (PPM). Methods: The study enrolled 139 patients (M:F=1:1.35, 66.8±1.0 years) who had permanent pacemaker implanted [AAI (R): 11, VVI (R): 39, VDD (R): 50, DDD: 39]. Their clinical characteristics, 12-lead electrocardiogram (ECG), echocardiography, and laboratory parameters were evaluated. The patients were divided into two groups according to the presence of VD. Results: VD was seen in 71.9% of the patients with a PPM. No significant difference was observed in the clinical characteristics, except for the indications and current action mode of the PPM. VD was more frequently associated with patients with AV block and ventricular pacing. The QRS duration and QTc interval were significantly wider in patients with VD (159.9±3.2 vs. 129.4±6.3 ms, p<0.001; 487.7±4.0 vs. 470.9±8.0 ms, p<0.05, respectively). On echocardiography, tricuspid regurgitation was more common in patients with VD. The N-terminal B-type natriuretic peptide (NT-proBNP) level was higher in the dyssynchrony group (431.4±66.1 vs. 202.8±40.8, p<0.05). Conclusions: Patients with AV block and ventricular pacing developed VD more frequently. A higher serum NT-proBNP level and prolonged QRS duration, QTc, and tricuspid regurgitation might be associated with VD. (Korean J Med 78:59-67, 2010)

대동맥 탄성도와 동맥경화증의 혈액학적 인자의 관계

김현국 ( Hyun Kuk Kim ),박종춘 ( Jong Chun Park ),김성수 ( Sung Soo Kim ),최홍상 ( Hong Sang Choi ),심두선 ( Doo Sun Sim ),윤남식 ( Nam Sik Yoon ),윤현주 ( Hyun Ju Yoon ),홍영준 ( Young Joon Hong ),박형욱 ( Hyung Wook Park ),김주 대한내과학회 2009 대한내과학회지 Vol.77 No.1

Background/Aims: The elasticity of the aorta modulates the entire cardiovascular system. Increasing arterial stiffness with the loss of aortic elasticity is not only a surrogate marker for early atherosclerosis, but also a predictor of cardiovascular events. Methods: This study included 203 patients (57.6±14.7 years, 117 male) who underwent diagnostic transesophageal echocardiography. We investigated the correlation between the arterial stiffness index (β stiffness index), which is calculated from the distensibility of the descending thoracic aorta and blood pressure, and known serologic markers of atherosclerosis and cardiovascular events. Results: The β stiffness index correlated significantly with the brachial-ankle pulse wave velocity (R2=0.243, p<0.001) and in-tima-media thickness of the descending thoracic aorta (R2=0.470, p<0.001). It also correlated with age (r=0.465, p<0.001) and the presence of diabetes mellitus (r=0.250, p<0.001). The β stiffness index was significantly positively correlated with the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), glucose, HbA1c, apolipoprotein (Apo) A-I, and erythrocyte sediment rate. A multivariate regression analysis demonstrated that the β stiffness index was associated with the levels of NT-proBNP, hsCRP, HbA1c, and Apo A-I. Conclusions: The β stiffness index for the distensibility of the descending thoracic aorta significantly correlates with other parameters of arterial stiffness and serologic markers for atherosclerosis. Therefore, the β stiffness index can be used as a parameter of cardiovascular events in diseases requiring transesophageal echocardiography, such as atrial fibrillation and mitral stenosis. (Korean J Med 77:68-75, 2009)

급성 심근경색증 환자의 입원 중 합병증과 1년간 임상경과의 예측인자

윤현주 ( Hyun Ju Yoon ),정명호 ( Myung Ho Jeong ),김계훈 ( Kye Hun Kim ),박근호 ( Keun Ho Park ),심두선 ( Doo Sun Sim ),박형욱 ( Hyun Wook Park ),윤남식 ( Nam Sik Yoon ),홍영준 ( Young Joon Hong ),김주한 ( Ju Han Kim ),안영근 ( Yo 대한내과학회 2009 대한내과학회지 Vol.77 No.6

Background/Aims: This study evaluated the predictors of in-hospital early complications and 1-year clinical events in patients with acute myocardial infarction (AMI). Methods: A total of 1,000 consecutive patients (63.4±12 years, 705 males) with AMI were divided into two groups according to the presence of in-hospital events (IHE): group I had IHEs (n=175, 65.6±12 years, 115 males), and group II had no events (n=825, 62.8±12 years, 590 males). IHE included death, cardiogenic shock, pacemaker implantation, ventricular arrhythmia, and mechanical ventilation. Results: The levels of glucose, creatinine, maximal creatine kinase (CK), troponin-I, hs-CRP, and NT-proBNP were higher in group I than in group II. Increased left ventricular dimension, a low ejection fraction, mitral regurgitation (MR), diastolic dysfunction, and a high wall motion score index were more common in group I compared with group II. The initial Killip class, ST-elevation AMI, and high levels of glucose, creatinine, CK-MB, troponin I, hs-CRP, NT-proBNP, and MR were significant independent predictors of IHE on multivariate analysis. During the 1-year follow-up, the major adverse cardiac event (MACE) rate was higher in group I than in group II. IHE, especially cardiopulmonary resuscitation, cardiogenic shock, and respiratory failure, were independent predictors of MACE during the 1-year clinical follow-up. Conclusions: High levels of glucose, creatinine, CK-MB, troponin I, hs-CRP, NT-proBNP, and MR were predictors of IHE, and the 1-year MACE-free survival was lower in AMI patients with IHE. (Korean J Med 77:723-733, 2009)

급성 심근경색증 환자에서 관상동맥 중재술 후 허혈성 심근병증 예측인자

김혜숙 ( Hye Sook Kim ),정명호 ( Myung Ho Jeong ),윤현주 ( Hyun Ju Yoon ),김용철 ( Yongcheol Kim ),손석준 ( Seok-joon Sohn ),김민철 ( Min Chul Kim ),심두선 ( Doo Sun Sim ),홍영준 ( Young Joon Hong ),김주한 ( Ju Han Kim ),안영근 ( 대한내과학회 2020 대한내과학회지 Vol.95 No.3

목적: 급성 심근경색증 환자에서 적극적인 치료에도 불구하고 허혈성 심근병증으로 진행한 환자는 많은 육체적, 사회경제적인 어려움을 겪게 된다. 이 연구의 목적은 급성 심근경색증 환자에서 성공적인 관상동맥 중재술 후에 허혈성 심근병증이 발생하는 예측인자에 대하여 알아보고자 하였다. 방법: 2011년 11월부터 2015년 10월까지 Korea Acute Myocardial Infarction Registry-National Institute of Health(KAMIR-NIH)에 등록된 환자 중 급성 심근경색증으로 전남대학교병원에 내원 후 성공적인 관상동맥 중재술을 시행 받고, 퇴원 전 심장초음파를 시행한 후 추적 심장초음파 검사가 시행된 환자 547명(63.1 ± 12.3세, 남자 71.1%)을 대상으로 하였다. 추적 심장초음파 검사에서 허혈성 심근병증이 발생한 환자군 66명(Ⅰ군: 67.1 ± 11.9세, 남자 78.8%)과 발생하지 않은 환자군 481명(Ⅱ군: 62.5 ± 12.2세, 남자 70.1%)으로 분류하여, 양군 간의 임상적 특성, 혈액 검사 특성, 심장초음파 및 관상동맥 조영술 소견 및 주요심장사건을 비교·분석하였다. 허혈성 심근병증은 심장초음파 검사에서 좌심실 이완기말 직경(left ventricular end-diastolic dimension, LVEDD) > 55 mm이고, 좌심실 구혈률(left ventricular ejection fraction, LVEF) < 50%로 저하되어 있는 경우로 정의하였다. 결과: Ⅰ군에서 평균연령(67.1 ± 11.9세 vs. 62.5 ± 12.2세, p = 0.004)이 높았으며, ST-분절 상승 심근경색증(65.2% vs. 46.2%, p = 0.004), Killip class (p = 0.008), 병원 내 심장사건(48.5% vs. 22.7%, p < 0.001)에서 유의한 차이를 보였다. 백혈구(12,340 ± 4,235 mm3 vs. 10,560 ± 4,057 mm³, p = 0.001)와 혈당(201.7 ± 104.4 mg/dL vs. 164.7 ± 75.7 mg/dL, p = 0.007), CK-MB (163.9 ± 124.6 U/L vs. 87.8 ± 102.9 U/L p < 0.001), troponine-I (124.2 ± 113.5 ng vs. 44.5 ± 113.5 ng, p < 0.001)는 Ⅰ군에 비하여 Ⅱ군에서 의미있게 높았다. LVEF (41.7 ± 10.5 vs. 55.4 ± 10.3%, p < 0.001), LVEDD (54.1 ± 7.2 vs. 49.3 ± 5.3 mm, p < 0.001), E/A 비(1.19 ± 0.67 vs. 0.95 ± 0.45, p =0.017), E/e’ ratio (16.7 ± 7.8 vs. 12.7 ± 6.1, p = 0.001)가 유의한 차이가 있었으나, 관상동맥 조영술 및 중재술 소견은 두군 간에 유의한 차이는 없었다. 다변량 회귀분석 결과 LVEF < 50% (OR 8.722, CI 2.986-25.478, p < 0.001), LVEDD > 55 mm (OR 4.511, CI 1.561-13.038, p = 0.005), E/e' ratio ≥ 15 (OR 3.270, CI 1.168-9.155, p = 0.024)이 허혈성 심근병증 발생의 독립적 예측인자였다. 결론: 급성 심근경색증 환자에서 허혈성 심근병증 발생의 독립적인 예측인자는 LVEF < 50%, LVEDD > 55 mm, E/e' ratio ≥ 15였다. 따라서, 내원 시 예측인자를 갖고 있는 환자에 대해서는 급성 심근경색증 발생초기부터 보다 적극적인 치료가 필요할 것으로 사료된다. Background/Aims: Many patients with acute myocardial infarction (AMI) suffer from heart failure due to progressive ischemic left ventricular (LV) remodeling. This study investigated the predictors of ischemic cardiomyopathy (ICMP) in patients with AMI who underwent successful percutaneous intervention. Methods: A total of 547 patients with AMI were divided into two groups: ICMP (n = 66, 67.1 ± 11.9 years, 78.8% males) and non-ICMP (n = 481, 62.5 ± 12.2 years, 70.1% males). Results: On echocardiography, the LVEF was significantly decreased (41.7 ± 10.5 vs. 55.4 ± 10.3%, p < 0.001) but the LV end-diastolic (54.1 ± 7.2 vs. 49.3 ± 5.3 mm, p < 0.001) and systolic (42.1 ± 8.0 vs. 33.5 ± 6.0 mm, p < 0.001) dimensions significantly increased in the ICMP group compared with the non-ICMP group. According to multivariate logistic regression analysis, LVEF < 50% (odds ratio [OR] 8.722, 95% confidence interval [CI] 2.986-25.478, p < 0.001), LV end-diastolic dimension > 55 mm (OR 4.511, 95% CI 1.561-13.038, p = 0.005), and ratio of early mitral inflow velocity to mitral annular early diastolic velocity (E/e’) ≥ 15 (OR 3.270, 95% CI 1.168-9.155, p = 0.024) were independent predictors of ICMP development. Conclusions: The present study demonstrates that a larger LV size, lower LV function, and increased E/e’ (≥ 15) were independent predictors of ICMP. Therefore, the development of ICMP should be carefully monitored in AMI patients with these features. (Korean J Med 2020;95:188-200)