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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)
원 저급성 심근경색증 환자에서 Everolimus-eluting Stent와 Biolimus-eluting Stent 시술 후 임상 경과
박인철 ( In Cheol Park ),정명호 ( Myung Ho Jeong ),김인수 ( In Soo Kim ),이정애 ( Jung Ae Rhee ),최진수 ( Jin Su Choi ),박인혜 ( In Hyae Park ),채임순 ( Leem Soon Chai ),정윤아 ( Yun Ah Jeong ),현대용 ( Dae Yong Hyun ),정해창 ( Ha 대한내과학회 2015 대한내과학회지 Vol.89 No.4
Background/Aims: We compared the efficacy and safety of the second-generation everolimus-eluting stent (EES) and the third generation biolimus-eluting stent (BES) in patients with acute myocardial infarction (AMI). Methods: We analyzed 629 consecutive patients (mean age 65.1 ± 11.2 years, 426 males) with AMI undergoing percutaneous coronary intervention from February 2008 to April 2012. They were divided into two groups according to stent type (EES group, n = 426; BES group, n = 203). The primary end-point was 2-year major adverse cardiac events (MACEs), defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, non-target vessel revascularization and target lesion revascularization. The secondary end-point was 2-year target lesion failure (TLF). Results: There were no significant differences in baseline characteristics, except that the patients with EES had a significantly higher prevalence of diabetes mellitus (34.7 vs. 22.7%, p = 0.002) and were older (67.1 ± 11.3 vs. 64 ± 12.9 years, p = 0.039) com-pared with the patients with BES. After propensity score matching, 2-year clinical outcomes showed no differences in composite MACEs or TLF between the two groups. Multivariate Cox regression analysis showed that stent type was not a predictor of 2-year mortality or MACEs. However, older age (hazard ratio [HR] 1.037, 95% confidence interval [CI] 1.014-1.060, p = 0.001), diabetes mellitus (HR 2.247, 95% CI 1.426-3.539, p = 0.001) and a left ventricular ejection fraction ≤ 45% (HR 3.007, 95% CI 1.978-4.573, p = 0.001) were independent predictors for 2-year MACEs in patients undergoing EES or BES. Conclusions: Patients with BES had similar clinical 2-year outcomes compared with EES patients with AMI. (Korean J Med 2015;89:418-427)