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관상동맥 중재술을 시행 받은 40세 이하의 ST 분절 상승과
박종춘 ( Jong Chun Park ),조정관 ( Jeong Gwan Cho ),김주한 ( Ju Han Kim ),홍영준 ( Young Joon Hong ),안영근 ( Youngkeun Ahn ),강정채 ( Jung Chaee Kang ),김남윤 ( Nam Yoon Kim ),박인혜 ( In Hyae Park ),정명호 ( Myung Ho Jeong ) 대한내과학회 2012 대한내과학회지 Vol.82 No.2
Background/Aims: The prevalence of coronary artery disease has increased in young adults. We evaluated the differences in clinical characteristics and clinical outcomes in young patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Methods: A total of 164 patients with acute myocardial infarction who underwent percutaneous coronary intervention were divided into two groups: the STEMI group (120 patients; mean age, 35.7±3.8 years; 118 males) and the NSTEMII group (44 patients; mean age, 35.7±4.3 years; 43 males). We analyzed clinical and angiographic characteristics and major adverse cardiac events (MACE), including death from any cause, non-fatal myocardial infarction, target lesion revascularization, and coronary artery bypass graft surgery, during a 1-year clinical follow-up of the two groups. Results: During hospitalization, Killip class II acute myocardial infarction (5.8% vs. 15.9%, p=0.041) was observed more frequently in the NSTEMI group. The levels of troponin-I (66.9±103.6 vs. 26.6±38.5 ng/mL, p=0.014) and N-terminal pro-brain natriuretic peptide (733.0±1,018.1 vs. 476.2±374.5 pg/mL, p=0.012) were significantly higher in the STEMI group. One-year MACE did not differ between the two groups. By multiple logistic regression analysis, bare metal stents (odds ratio, 3.360; 95% confidence interval, 1.105-10.217; p=0.033) and high lipoprotein (a) levels (odds ratio, 1.047; 95% confidence interval, 1.020-1.075; p=0.001) were independent predictors of 1-year MACE. Conclusions: Young patients with STEMI and NSTEMI have similar clinical outcomes. Bare metal stents and high serum lipoprotein (a) levels are independent predictors of MACE during 1-year clinical follow-ups in young patients with acute myocardial infarction. (Korean J Med 2012;82:175-184)
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흡연을 하는 급성 심근경색증 환자에서 일년 후 사망 예측인자
설수영 ( Soo Young Seol ),정명호 ( Myung Ho Jeong ),이승헌 ( Seung Hun Lee ),손석준 ( Seok-joon Sohn ),김민철 ( Min Chul Kim ),심두선 ( Doo Sun Sim ),홍영준 ( Young Joon Hong ),김주한 ( Ju Han Kim ),안영근 ( Youngkeun Ahn ),조명찬 대한내과학회 2018 대한내과학회지 Vol.93 No.4
목적: 흡연은 관상동맥 질환의 위험인자로 잘 알려져 있으며, 흡연을 하는 급성 심근경색증 환자에서 임상적 특성을 파악하고 일년 후 사망 예측인자를 파악하고자 하였다. 방법: 2011년 11월부터 2015년 12월까지 KAMIR-NIH에 등록된 13,104예 중 흡연을 하는 5,110예(57.1 ± 11.6세, 남성95%)를 대상으로 하였다. 그중 흡연자 중에서 생존한 급성심근경색증 환자를 I군 4,844예(56.5 ± 11.3세, 남자 95.3%), 사망한 급성 심근경색증 환자를 II군 266예(68.9 ± 12.5세, 남자 88.3%)로 분류하여, 각 군 간의 임상적 특징과 관상동맥 조영술 소견 및 1년 사망률과 관련된 사망 예측인자를 분석하였다. 결과: 사망한 흡연자 그룹은 65세 이상의 고령자가 많았으며, 고혈압, 당뇨병의 유병률이 유의하게 높았다. II군은 흡연기간과 흡연 갑년에서 I군에 비하여 유의하게 많았다. 다변량분석 결과 1년 추적 관찰 기간 중 사망사건 발생의 독립적인 인자는 creatine 2 mg/dL 이상, 좌심실구혈률 40% 미만, Killip class II 이상의 높은 Killip class, 65세 이상 고령, 관상동맥중재술 후 TIMI flow II 이하의 낮은 TIMI flow였다. 결론: 흡연을 하는 급성 심근경색증 환자에서 1년 후 유의한 사망 예측인자는 65세 이상의 고령, 신장 기능 장애, 좌심실구혈률 저하, 높은 Killip class, 관상동맥중재술 후 TIMI flow 2 이하였다. Background/Aims: It is well known that smoking is associated with clinical outcomes in patients with acute myocardial infarction (AMI). In this study, we aimed to predict the one-year mortality in AMI patients that smoked. Methods: Of the AMI patients who were enrolled in the Korean Acute Myocardial Infarction Registry-National Institutes of Health study, 5,110 were current smokers (57.1 ± 11.6 years, male 95%), and these patients were included in the present study. Patients were divided into two groups; group I (survival group, n = 4,844, 56.5 ± 11.3 years, male 95%) and group II (deceased group, n = 266, male 88%). Clinical characteristics, coronary angiographic findings, procedural characteristics, and independent factors related to one-year mortality were analyzed. Results: In group II, the incidence of hypertension and diabetes were significantly higher than in group I, and the patients were significantly older. Patients with history of angina pectoris, myocardial infarction, and heart failure were significantly more common in group II than in group I. Smoking duration and pack-years of smoking were also significantly longer in group II than in group I. Multivariate analysis revealed that creatine > 2 mg/dL, left ventricular ejection fraction < 40%, Killip class ≥ II, age ≥ 65 years, and post-percutaneous coronary intervention thrombolysis in myocardial infarction (post-PCI TIMI) flow ≤ II were independent factors of mortality during the one-year follow-up. Conclusions: The predictors of one-year mortality in AMI patients with smoking were renal and left ventricular dysfunction, high Killip class, old age, and low post-PCI TIMI flow. (Korean J Med 2018;93:369-378)
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