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관동맥 연축환자의 약물투여기간 및 질병의 활성도에 대한 장기 추적 관찰
김철홍(Cheol Hong Kim),유규형(Kyu Hyung Ryu),한성우(Seong Woo Han),박규용(Kyu Yong Park),한윤창(Yun Chang Han),홍경순(Kyung Soon Hong),두영철(Young Cheoul Doo),한규록(Kyu Rok Han),오동진(Dong Jin Oh),임종윤(Chong Yun Rim),고영박(Youn 대한내과학회 1998 대한내과학회지 Vol.54 No.1
N/A Objectives: Clinical course of vasospastic angina is variable : spontaneous remission, persistent angina and progression of disease or death. Several studies from western institutes have been performed on the clinical characteristics and long-term prognosis of patient with coronary vasospasm. In these reports, 53-82% of patients had spontaneous remission. These results may be assumed differ from that of Korean patients with vasospastic angina, but no detailed studies have been reported in Korea. Currently, in patients with vasospastic angina, treatment with calcium antagonists and/or nitrates are effective in reducing the frequency of anginal attacks. And, clinical course and outcome of vasospastic angina may be different from previous western reports thereafter. The purpose of this study is to describe the disease activities and the factors influencing the clinical course of vasospastic angina in relation to medication-period; age, sex, risk factors, extents of coronary vasospasm, initial ischemic events and significance of fixed lesion. Also we tried to determine if clinical or angiographic variables might be useful in predicting the possibility of spontaneous remission for an each patient. Methods: Eighty-seven patients with vasospastic angina(M/F;58/29, mean age;53±9 years) were included and all documented coronary vasospasm on the coronary angiogram, spontaneous spasm in 35, positive ergonovine or acetylchoine provocation in 52. Coronary artery spasm was defined as more than 75% reduction in coronary luminal diameter and ST segment changes on electrocardiogram, or typical anginal symptoms together and then narrowed coronary arteries were recovered after intracoronary nitroglycerin. The patients were treated with calcium antagonists(nifedipine, diltiazem, amlodipine and felodipine) and nitrates single or both and were divided into 3 groups according to angina activity: group I, which anginal attacks less than one time monthly, group II, which anginal symptoms occurred in 24- 48 hours after withdrawal of medication, group III, which symptoms recurred frequently with the incidence of over one time weekly, After discharge, each patient returned to a medical out-patient department at every 1-2 months. Results: Age, gender, other coronary risk factors, disease activity of vasospastic angina, initial clinical presentation at admission, coronary angiographic findings, fixed lesion and alcohol-induced anginal attacks were not statistically different among the 3 groups. But admission frequency of group II and III, which had a high anginal activities, were more than that of group I significantly. Conclusion: In the present study, it is concluded that medical treatment in patients with vasospastic angina in Korea may be taken long duration during follow-up period if the patient of group II and III considered to persistent angina group. To assess the prevalence of spontaneous remission, we consider that systematic attempts to taper medication may be done for patient of group I(angina free-on treatment) after absence of anginal attacks for at least one year medication-period.
안정형 및 불안정형 협심증 환자에서 관동맥 조영술상 병변형태와 관동맥내 혈전에 대한 비교
이록윤(Rok Yun Lee),한윤창(Yun Chang Han),지재환(Jae Hwan Jee),조병동(Byung Dong Cho),채경수(Gyeoung Soo Chae),장명국(Myoung Kuk Jang),서유미(Yu Mi Seo),김재삼(Jai Sam Kim),경태영(Tae Young Kyong),임종윤(Chong Yun Rim),고영박(Young B 대한내과학회 1996 대한내과학회지 Vol.51 No.6
N/A Objectives: Unlike stable angina, unstable angina is a common syndrome associated with significant morbidity and frequent progression to acute myocardial infarction. Several investigators have suggested that corronary artery thrombus formation, most likely secondary to plaque rupture in complex morphology of stenotic coronary artery, may preci- pitate unstable angina. But the frequency of coronary artery thrombus by coronary angiography is diverse. Methods: In 108 patients with either stable(27 patients) or unstable angina(81 patients), the morphology of coronary artery lesions was qualitatively assessed by angiography. Each obstruction reducing the luminal diameter of the vessel by 50% or greater was categorized into one of Ambrose morphologic classification. Results: Type II eccentric lesion was more frequent in patients with unstable angina pectoris (38.9%) than in patients with stable angina pectoris (6.1%) (p<0.01). Frequency of intraluminal ulcer was 31.9% in unstable angina, and 8.6% in stable angina(p<0.05). Intraluminal thrombus was observed more frequently in unstable angina pectoris(18.6%) than in stable angina pectoris(6.1%)(p<0,05). Conclusions: The high prevalence of type II eccentric lesion morphology, ulcer, and intraluminal thrombus observed in patients with unstable angina emphasizes the important role of intimal disruption and of subsequent thrombogenesis in the pathogenesis of myocardial ischemic in those unstable syndromes of ischemic heart disease.