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불안정형 관동맥질환 환자에서 주요 심혈관 사건의 예측 인자로서의 심근 Troponin 1 및 Myoglobin 에 관한 연구
허재웅(Jae Woong Hur),김경현(Kyung Hyun Kim),하영준(Young Jun Ha),박찬수(Chan Su Park),서우종(Woo Jong Seo),조영재(Yeong Jae Cho),차경우(Keung Woo Cha),남시현(Si Hyun Nam),김종연(Jong Yeon Kim) 대한내과학회 2001 대한내과학회지 Vol.61 No.5
N/A Background: Patients with unstable angina or non Q wave myocardial infarction still have an elevated risk for subsequent cardiac events. Therefore early assessment of the risk of future cardiac events is important. In this study, prognostic value of troponin I and myoglobin was evaluated and compared with other known early available risk indicators. Methods: Serum troponin I and myoglobin were measured at presentation and 8 hours, 16 hours, and 24 hours thereafter in 126 patients with unstable angina (n=70) or non Q myocardial infarction (n=56) from Jan 1998, through Feb 2000. Echocardiography was performed with calculation of wall motion score index. The incidence of cardiac death or myocardial infarction was compared between patients with normal troponin I, myoglobin and abnormal ones, respectively. Results: (1) At 6 months, 1 death (2.2%) and 1 myocardial infarction (2.2%) occurred in the 45 unstable angina patient s with normal troponin I compared with 3 deaths (12.0%) and 8 myocardial infarctions (32.0%) in the 25 unstable angina patient s with elevated troponin I. (2) At 6 months, 1 death (1.7%) and 3 myocardial infarctions (5.2%) occurred in the 58 unstable angina patients with normal myoglobin compared with 3 deaths (25.0%) and 6 myocardial infarctions (50.0%) in the 12 unstable angina patient s with elevated myoglobin. (3) When the analysis was limited to patients with normal baseline troponin I (≤0.4 ng/ dl: n=45), increased myoglobin level remained significantly associated with increased incidence of cardiac deaths or myocardial infarction compared with normal myoglobin level (16.7% vs 0%). (4) Together with age, diabetes, wall motion score index, troponin I and myoglobin levels were identified as independent prognostic variables for myocardial infarction or cardiac death in a multivariate logistic regression analysis. (5) The maximal troponin I and myoglobin value obtained during the first 24 hours provides independent and import ant prognostic information regardless of whether the patient is classified as having unstable angina or non Q wave myocardial infarction. Conclusion: The maximum troponin I and myoglobin obtained during the first 24 hours provides independent and important prognostic information in patients with unstable angina or non Q wave myocardial infarction. (Korean J Med 61:496- 505, 2001)
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