좌심실 수축 기능부전을 가진 급성 심근경색 환자에서 ST 분절 변화가 미치는 영향 = Impact of ST segment deviation in patients with acute myocardial infarction and Left ventricular systolic dysfunction

국문 초록 (Abstract)

목적: 급성 심근경색 환자에서 ST 분절 상승의 영향에 대해서는 많은 연구가 이루어졌으나 좌심실 수축 기능부전을 동반한 심근경색 환자에서는 연구되지 않았다. 방법: 2004년 1월부터 2006년 6월까지 좌심실 구혈률이 40% 이하의 수축 기능부전을 가진 급성 심근경색 환자 117명을 대상으로 하였다. ST 분절 상승 심근경색 77명과 비 ST 분절 상승 심근경색 환자 40명을 임상적 특징과 관상동맥조영술 결과 및 입원기간 및 1년 주요 심장사건(심장사망, 새로운 비치명적 심근경색, 목표혈관 재관류술, 심부전)을 후향적으로 분석하였다. 결과: ST 분절 상승에 따른 양 군의 기본적인 임상특징의 차이는 없었다. 관상동맥조영술의 TIMI flow 0 grade는 STEMI군에서 많았고(49.4% vs. 15.0%, p<0.01), 다혈관 질환은 NSTEMI군이 많았다(39.0% vs. 65.0%, p=0.01). 하지만 입원 중 심장 사망률과 주요 심장사건은 비슷했다(cardiac death 6.5% vs. 2.5%, p=0.66, MACE 19.5% vs. 22.5%, p=0.81). 1년 심장 사망률과 주요 심장사건에서도 의미있는 차이를 보이지 않았다(cardiac death 14.4% vs. 7.5%, p=0.37, MACE 33.8% vs. 30.0%, p=0.68). 결론: 좌심실 수축기능이 저하된 급성 심근경색 환자에서 ST 분절의 상승은 입원기간과 장기적인 예후에 영향을 미치지 않았다.

다국어 초록 (Multilingual Abstract)

Background/Aims: Although the impact of ST segment elevation in patients with acute myocardial infarction (MI) has been studied, little information is available on the impact of ST segment elevation in the patients with acute MI and left ventricular systolic dysfunction. Methods: We retrospectively analyzed the baseline clinical and angiographic characteristics and the in-hospital and 1-year clinical outcomes of 117 consecutive patients who were diagnosed with acute MI and who had a left ventricular ejection fraction of less than 40%, and these patients were treated from January 2004 to June 2006 at Busan Paik Hospital. Coronary angiography at the index hospitalization and the major adverse cardiac events (MACEs), including cardiac death, non-fatal reinfarction, target vessel revascularization (TVR), and heart failure, were compared between the 77 patients with ST segment elevation myocardial infarction (STEMI) and the 40 patients with non-ST segment elevation myocardial infarction (NSTEMI). Results: Overall, the baseline clinical characteristics were similar between the two groups. On the coronary angiography, thrombolysis in myocardial infarction 0 flow was more common in the STEMI group as compared to the NSTEMI group (p<0.01) and the NSTEMI group had more frequent multivessel disease compared to the STEMI group (p=0.01). However, the in-hospital cardiac deaths and MACEs were not different on comparison between the two groups (p=0.66, p=0.81, respectively). The one-year cardiac deaths and MACEs were not significantly different on comparison between the two groups (p=0.37, p=0.68, respectively). Conclusions: This study demonstrated that ST segment elevation had no influence on in-hospital and the long term outcomes of patients with acute MI and left ventricular systolic dysfunction.(Korean J Med 74:632-639, 2008)

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