급성 대동맥 증후군의 발병 시기 변동에 관한 연구：급성 심근경색증과의 비교 = Chronobiological Patterns of Acute Aortic Syndrome：Comparison with Those of Acute Myocardial Infarction

다국어 초록 (Multilingual Abstract)

Background and Objectives：Chronobiological rhythms have been shown to influence the occurrence of a variety of cardiovascular disorders, including acute myocardial infarction (AMI). The present study investigated whether the onset of acute aortic syndrome (AAS) has unique chronobiological rhythms in Korean populations. Subjects and Methods：The clinical data of 371 consecutive AAS patients, admitted between 1993 and 2003, were retrospectively analyzed; 310 AMI patients, who underwent primary percutaneous angioplasty in the hyperacute phase between 1998 and 2001, were also selected. Results：In the AAS group, the final diagnoses were aortic dissection (AD) and aortic intramural hematoma (AIH) in 212 and 159 patients, respectively. Similar to AMI, AAS showed a significantly higher occurrence from 6 AM to noon compared with other time periods (p=0.0013). AAS showed a second peak occurrence from 6 PM to midnight, which was not observed in the AMI group. A subgroup analysis revealed that younger patients (age<60 years) and those with a past medical history of hypertension had the highest occurrence from 6 PM to midnight, which was quite different compared to the AAS patients. No significant variation was found for the day of the week in either group. Although no significant seasonal variation was observed in the frequency of AMI, the frequency of AAS was significantly higher during winter (p<0.001). The circadian and seasonal variations in the frequency of AIH were similar to those of AD. Conclusion：AAS shows unique circadian and seasonal variations in Korean populations. Our findings may have implications for the prevention of AAS by tailoring treatment strategies to ensure maximal benefits during the vulnerable periods.

국문 초록 (Abstract)

배경 및 목적：
저자들은 내과적 응급상황으로 임상 발현하는 급성대동맥증후군(acute aortic syndrome, AAS)의 chronobiological pattern이 발병시기의 주기성이 잘 알려진 급성 심근경색증(acute myocardial infarction, AMI)과 어떠한 차이점을 갖는지 알아보고자 하였다.
방 법：
1998년 1월부터 2001년 12월까지 AMI로 즉각적 경피적 관동맥 성형술을 시행 받은 310명과 1993년 4월부터 2003년 4월까지 AAS로 입원한 371명의 임상자료를 후향적으로 분석하였다.
결 과：
AAS군에서 전형적인 급성대동맥박리(aortic dissection, AD)는 212명이며 대동맥 벽내혈종(aortic intramural hematoma, AIH)는 159명이었다. AMI와 마찬가지로 AAS군에서도 오전 6시부터 정오 사이에 가장 높은 발생빈도를 보였고(p=0.0013) 오후 6시부터 자정까지의 시간대에 두번째 정점을 보였는데 AMI에 비하여 AAS의 발생이 유의하게 높았다(p=0.0018). 또한 60세 미만의 연령군과 고혈압의 과거력이 있었던 환자군은 오후 6시부터 자정까지의 시간대에 가장 높은 발생빈도를 보여 전체 환자군과 구별되었다. 두 질환 모두 요일별 발생 빈도의 차이는 없었다. AMI는 계절에 따른 발생 빈도의 차이는 없었지만 AAS는 겨울에 가장 높았고(p<0.001) 여름에 AAS의 발생이 AMI군에 비하여 유의하게 낮았다(p<0.05). AD과 AIH간 비교에서 일간, 주간, 계절간 발생 빈도의 의미 있는 차이는 없었다.
결 론：
한국인에서 AAS의 발병은 독특한 chronobiological pattern을 갖고 있으며, 이를 바탕으로 한 고위험군에 대한 약물 처방이나 교육이 질병예방에 이용될 수 있으리라 기대된다.

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