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급성 ST분절 비상승 환자의 1년 사망률 예측을 위한 새로운 위험 도구
박진희 ( Jin Hee Park ),박인혜 ( In Hyae Park ),정명호 ( Myung Ho Jeong ),이숙자 ( Sook Ja Lee ),장수영 ( Soo Yong Jang ),조재영 ( Jae Young Cho ),정해창 ( Hae Chang Jeong ),이기홍 ( Ki Hong Lee ),박근호 ( Keun Ho Park ),심두선 ( 대한내과학회 2015 대한내과학회지 Vol.88 No.2
Background/Aims: Accurate risk stratification is important in the management of patients with acute myocardial infarction (AMI). This study aimed to develop a new assessment tool for the prediction of 1-year mortality in patients with AMI, including biochemical markers. The author developed a new assessment tool (new risk score) that takes biochemical markers into account for 1-year mortality in patients with non-ST elevation myocardial infarction (NSTEMI) and identifies the risk factors related to 1-year mortality. Methods: A total of 1,427 patients (65 ± 11.8 years of age, 985 males) who were admitted to the Chonnam National University Hospital with NSTEMI from November 2005 to March 2012 were retrospectively analyzed for score derivation. Multivariable Cox-regression analysis was used to select correlates of 1-year mortality that were subsequently weighted and integrated into an integer scoring system.Results: Seven variables selected from the initial multivariate model were weighted proportionally to their respective hazard ratiofor 1-year mortality; age ≥ 65 years (2 points), N-terminal pro-brain natriuretic peptide (NT pro-BNP) > 991 pg/mL (1 point), baseline left ventricular ejection fraction < 40% (1 point), high sensitivity C-reactive protein (hs-CRP) > 3 mg/dL (1 point), glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 (1 point), heart rate > 82 beats/min (2 points), and final thrombolysis In myocardial infarction flow < 3 (2 points). Conclusions: In NSTEMI patients, our new score that incorporates seven risk factors accurately predicts the 1-year mortality. Additionally, the biochemical markers hs-CRP, NT pro-BNP, and GFR are reliable predictors of 1-year mortality. (Korean J Med 2015;88:168-176)
ST분절 상승 심근경색증 환자에서 증상 발생 후 응급센터 도착 시간 지연에 영향을 주는 요인
이재훈 ( Jae Hoon Lee ),정명호 ( Myung Ho Jeong ),이정애 ( Jung Ae Rhee ),최진수 ( Jin Su Choi ),박인혜 ( In Hyae Park ),채임순 ( Leem Soon Chai ),장수영 ( Soo Yong Jang ),조재영 ( Jae Young Cho ),정해창 ( Hae Chang Jeong ),이기홍 대한내과학회 2014 대한내과학회지 Vol.87 No.4
Background/Aims: Delay in symptom-to-door time (SDT) in patients with acute ST-segment elevation myocardial infarction (STEMI) is the most important factor in the prediction of short and long-term mortality. The purpose of this study was to investigate the social and clinical factors affecting SDT in patients with STEMI. Methods: We analyzed 784 patients (61.0 ± 13.2 years, 603 male) diagnosed with STEMI from November 2005 to February 2012. The patients were divided into four groups according to SDT: Group I (n = 163, ≤ 1 h), Group II (n = 183, 1-2 h), Group III (n = 142, 2-3 h) and Group IV (n = 296, > 3 h). Results: Delay in SDT increased with age (Group I, 58.4 ± 12.0; Group II, 59.4 ± 13.3; Group III, 62.0 ± 12.8; Group IV, 63.0 ± 13.8 years, p = 0.001). In 119 patients, transportation was less frequently used as the delay in SDT (41.7% vs. 29.0% vs. 26.1% vs. 9.8%, p < 0.001). By multiple logistic regression analysis, family history [OR, 0.488; CI, 0.248-0.959; p = 0.037], previous ischemic heart disease [OR, 0.572; CI, 0.331-0.989; p = 0.045], no occupation [OR, 1.600; CI, 1.076-2.380; p = 0.020] and method of transportation [OR, 0.353; CI, 0.239-0.520; p < 0.001] were independent predictors of delay in SDT. Conclusions: Our study shows that general education about cardiovascular symptoms and a prompt emergency call could be important to reduce SDT in STEMI. (Korean J Med 2014;87:429-438)