http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
관상동맥 중재술 시술시 혈소판 당단백 IIb/IIIa 수용체 차단제를 사용한 70세 이상 고령 급성 심근경색증 환자의 임상경과 : 70세 미만 환자와 비교
심두선,정명호,이민구,홍영준,박형욱,김원,김주한,안영근,조정관,박종춘,류상완,안병희,김상형,강정채 대한내과학회 2004 대한내과학회지 Vol.67 No.6
Background : This study was designed to evaluate the safety and clinical benefits of a glycoprotein IIb/IIIa receptor inhibitor, ReoPro?? in the elderly patients with acute myocardial infarction (AMI) (≧70 years of age) undergoing percutaneous coronary intervention (PCI). Methods : AMI patients who underwent PCI with use of ReoPro?? at Chonnam National University Hospital from Jan 2000 to Jan 2002 were divided into two groups: Group I (≧70 years of age: 74±2.4 years, n=28) and Group II (<70 years of age: 56±8.0 years, n=122). Early and long-term clinical outcomes after PCI were analyzed in a retrospective fashion. Results : As for risk factors and angiographic profiles, there were no differences between the two groups. Stenting was performed in 18 patients (64%) in group I and in 78 patients (63%) in group II. The incidence of gastrointestinal bleeding was 3 patients in group I and no patient in group II (p=0.005). At one-month evaluation, three cardiac deaths developed in group I, but no cardiac death in group II (p=0.005). During a period of 25±10.4 months of clinical follow-up, three cardiac deaths (11%) occurred in group I and 3 (2%) in group II, four AMIs (3%) in group II, and one stroke (0.8%) in group II. Target lesion revascularization (TLR) was performed in two patients (7%) in group I and in 24 patients (19%) in group II. No differences were found in the incidences of these variables between the two groups. Conclusion : ReoPro?? in elderly patients with AMI undergoing PCI entailed higher bleeding complications and early mortality. However, it has comparable clinical effect in elderly patients to younger patients during long-term clinical follow-up. 배경 : 혈소판 당단백질 IIb/IIIa 수용체 차단제인 Abciximab (ReoPro??)은 고위험 관상동맥 중재술의 결과를 향상시키고 주요 심장사건 감소에 효과적인 것으로서 관상동맥 중재술시 사용이 보편화 되어 있다. 급성 심근경색증을 동반한 70세 이상의 고령 환자에서 관상동맥 중재술시 ReoPro?? 투여의 임상 효과를 70세 미만의 환자와 비교하고자 하였다. 방법 : 2000년 1월부터 2002년 1월까지 관상동맥 조영술상 혈전을 내재하거나 혈전에 의해 완전폐쇄를 동반하는 급성 심근경색증으로 ReoPro?潁? 투여하면서 관상동맥 중재술을 받은 환자를 대상으로 70세 이상을 I군[74±2.4세, 28예(남 16예)], 70세 미만을 II군[56±8.0세, 122예(남 102예)]으로 분류하고 25±10.4개월의 추적관찰 기간동안의 주요 심장사건의 발생을 비교하였다. 결과 : (1) 성별이나 관상동맥 질환의 주요 위험인자에 있어서 양군간 차이는 없었다. (2) 병변혈관 수는 I군에서 단일혈관 15예(53%), 두혈관 11예(39%) 세혈관 1예(3%), II군 단일혈관 79예(64%), 두혈관 31예(25%), 세혈관 12예(9%)이었으며, ACC/AHA 분류상 I군에서 B1형 12예(42%), B2형 9예(32%), C형 7예(25%)였고, II군에서 각각 39예(32%), 44예(36%), 39예(32%)로서 차이는 없었다. TIMI 혈류는 TIMI 0 I군 16예(57%) II군 78예(63%), TIMI 1 I군 1예(3%) II군 13예(10%), TIMI 2 I군 8예(28%) II군 18예(14%), TIMI 3 I군 3예(10%), II군 13예(10%)로서 차이는 없었다. (3) 스텐트 시술은 I군 18예(64%), II군 78예(63%)에서 시행하였으며, 스텐트 길이는 각각 17.0±4.1 mm, 18.3±4.8 mm로서 차이는 없었다. (4) ReoPro?纓叢㈎? 관련된 출혈성 합병증에 있어서 위장관 출혈의 빈도가 I군에서 유의하게 높았다(p=0.005). (5) 1개월 내 단기 주요 심장사건의 발생은 심장성 사망이 I군에서만 3예(11%)로 I군에서 유의하게 높았으며(p=0.005), 급성 심근경색증과 응급 재관류술 및 응급 관상동맥 우회술이 II군에서 각각 3예(2%), 2예(1%), 2예(1%) 발생하였으나 양군간에 차이는 없었다. (6) 25±10.4개월간의 추적관찰 기간동안 사망 I군 3예(11%), II군 3예(2%), 심근 경색증 II군 4예(3%), 목표혈관 재개통술 I군 2예(7%), II군 24예(19%), 뇌졸중 II군 1예(0.8%) 발생하였으나 양군간의 차이는 없었다. 결론 : 관상동맥 중재술을 시행 받은 70세 이상의 고령의 급성 심근경색증 환자에서 ReoPro?榮? 70세 미만의 환자군에 비하여 출혈성 합병증의 위험을 증가시켰으며 조기 사망률을 낮추지는 못하였으나, 장기 임상경과에 있어서 유의한 차이가 없어서 효과적으로 사용될 수 있었다.
심두선,현대용,홍영준,김주한,안영근,정명호,이상록,채제건,박근호,고영엽,윤경호,오석규,주승재,Sun Ho Hwang,박종필,류재영,김수현,조장현,Seung Uk Lee,Dong Goo Kang 전남대학교 의과학연구소 2024 전남의대학술지 Vol.60 No.1
There are limited data on outcomes after implantation of everolimus-eluting stents (EES) in East Asian patients with small vessel coronary lesions. A total of 1,600 patients treated with XIENCE EES (Abbott Vascular, CA, USA) were divided into the small vessel group treated with one ≤2.5 mm stent (n=119) and the non-small vessel group treated with one ≥2.75 mm stent (n=933). The primary end point was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction (MI), and any repeat revascularization at 12 months. The key secondary end point was a device-oriented composite outcome (DOCO), a composite of cardiovascular death, target-vessel MI, and target lesion revascularization at 12 months. The small vessel group was more often female, hypertensive, less likely to present with ST-elevation MI, and more often treated for the left circumflex artery, whereas the non-small vessel group more often had type B2/C lesions, underwent intravascular ultrasound, and received unfractionated heparin. In the propensity matched cohort, the mean stent diameter was 2.5±0.0 mm and 3.1±0.4 mm in the small and non-small vessel groups, respectively. Propensity-adjusted POCO at 12 months was 6.0% in the small vessel group and 4.3% in the non-small vessel group (p=0.558). There was no significant difference in DOCO at 12 months (small vessel group: 4.3% and non-small vessel group: 1.7%, p=0.270). Outcomes of XIENCE EES for small vessel disease were comparable to those for non-small vessel disease at 12-month clinical follow-up in real-world Korean patients.
심두선,정명호,홍영준,김주한,안영근,박근호,황선호,강동구,이승욱,김준우,박종필,류재영,이상록,채제건,윤경호,오석규,Won You Kang,김수현,조장현 전남대학교 의과학연구소 2018 전남의대학술지 Vol.54 No.1
The Endeavor ResoluteⓇ (ER) is a zotarolimus-eluting stent (ZES) with a biocompatibleBioLinx polymer. This study prospectively compared the clinical outcomes of 2 versionsof ZES, ER and Endeavor SprintⓇ (ES), in patients with multivessel disease. A totalof 488 patients who underwent multivessel percutaneous coronary intervention (PCI)were divided into 2 groups the ER group (n=288) and the ES group (n=200). The primaryendpoint was a composite of major adverse cardiac events (MACE) consisting of death,myocardial infarction, and target vessel revascularization after 12 months. In all patients,the prevalence of diabetes was higher in the ER group (42.7% vs. 31.0%, p=0.009). The rate of post-PCI Thrombolysis in Myocardial Infarction flow grade 3 was higherin the ER group (100.0% vs. 98.0%, p=0.028). There were no between-group differencesin the in-hospital, 1-month and 12-month clinical outcomes. In the propensity scorematched cohort (n=200 in each group), no differences were observed in the baseline andprocedural characteristics. There were no statistical differences in the rates of in-hospital,1-month and 12-month events (12-month MACE in the ER and ES groups: 6.0%vs. 3.5%, p=0.240, respectively). The safety and efficacy of both versions of ZES werecomparable in patients with multivessel disease during a 12-month clinical follow-up.
심두선,김주한,정명호 대한심장학회 2009 Korean Circulation Journal Vol.39 No.8
In Korea, the incidence of acute myocardial infarction has been increasing rapidly. Twelve-month clinical outcomes for 13,133 patients with acute myocardial infarction enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry study were analyzed according to the presence or absence of ST-segment elevation. Patients with ST-segment elevation myocardial infarction (STEMI) were younger, more likely to be men and smokers, and had poorer left ventricular function with a higher incidence of cardiac death compared to patients with non-ST-segment elevation myocardial infarction (NSTEMI). NSTEMI patients had a higher prevalence of 3-vessel and left main coronary artery disease with complex lesions, and were more likely to have co-morbidities. The in-hospital and 1-month survival rates were higher in NSTEMI patients than in STEMI patients. However, 12-month survival rates was not different between the two groups. In conclusion, NSTEMI patients have worse clinical outcomes than STEMI patients, and therefore should be treated more intensively during clinical follow-up. In Korea, the incidence of acute myocardial infarction has been increasing rapidly. Twelve-month clinical outcomes for 13,133 patients with acute myocardial infarction enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry study were analyzed according to the presence or absence of ST-segment elevation. Patients with ST-segment elevation myocardial infarction (STEMI) were younger, more likely to be men and smokers, and had poorer left ventricular function with a higher incidence of cardiac death compared to patients with non-ST-segment elevation myocardial infarction (NSTEMI). NSTEMI patients had a higher prevalence of 3-vessel and left main coronary artery disease with complex lesions, and were more likely to have co-morbidities. The in-hospital and 1-month survival rates were higher in NSTEMI patients than in STEMI patients. However, 12-month survival rates was not different between the two groups. In conclusion, NSTEMI patients have worse clinical outcomes than STEMI patients, and therefore should be treated more intensively during clinical follow-up.
심두선,정명호,안영근,김영조,채성철,홍택종,성인환,채제건,김종진,조명찬,승기배,박승정,나승운,오석규,허승호,조진만,김수중 대한의학회 2011 Journal of Korean medical science Vol.26 No.4
This study compared clinical outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in large coronary arteries in patients with acute myocardial infarction (MI). A total of 985 patients who underwent single-vessel percutaneous coronary intervention (PCI)in large coronary arteries (≥ 3.5 mm) in lesions < 25 mm were divided into DES group (n = 841) and BMS group (n = 144). Clinical outcomes during 12 months were compared. In-hospital outcome was similar between the groups. At six months, death/MI rate was not different. However, DES group had significantly lower rates of target-lesion revascularization (TLR) (1.7% vs 5.6%, P = 0.021), target-vessel revascularization (TVR)(2.2% vs 5.6%, P = 0.032), and total major adverse cardiac events (MACE) (3.4% vs 11.9%, P = 0.025). At 12 months, the rates of TLR and TVR remained lower in the DES group (2.5% vs 5.9%, P = 0.032 and 5.9% vs 3.1%, P = 0.041), but the rates of death/MI and total MACE were not statistically different. The use of DES in large vessels in the setting of acute MI is associated with lower need for repeat revascularization compared to BMS without compromising the overall safety over the course of one-year follow-up.
심두선,정명호,김효수,권현철,승기배,나승운,채성철,김종진,차광수,박종선,윤정한,채제건,주승재,최동주,허승호,성인환,조명찬,김두일,오석규,안태훈,황진용 한국지질동맥경화학회 2019 지질·동맥경화학회지 Vol.8 No.2
Objective: Data on the intensity of statin therapy for patients with acute myocardial infarction (MI) and very low baseline low-density lipoprotein (LDL) cholesterol level are lacking. We sought to assess the impact of statin intensity in patients with acute MI and LDL cholesterol <70 mg/dL. Methods: A total of 1,086 patients with acute MI and baseline LDL cholesterol <70 mg/dL from the Korea Acute Myocardial Infarction Registry-National Institute of Health database were divided into less intensive statin (expected LDL reduction <40%, n=302) and more intensive statin (expected LDL reduction ≥40%, n=784) groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, MI, revascularization occurring at least 30 days after admission, and stroke, at 12 months. Results: After 1:2 propensity matching, differences were not observed between less intensive (n=302) and more intensive statin (n=604) groups in incidence of cardiac death (0.3% vs. 0.3%) and hemorrhagic stroke (0.3% vs. 0.5%, p=0.727) at 12 months. Compared with the less intensive statin group, the more intensive statin group showed lower target-vessel revascularization (4.6% vs. 1.8%, p=0.027) and MACCE (11.6% vs. 7.0%, p=0.021). Major bleeding was not different between less intensive and more intensive statin groups (1.0% vs. 2.6%, p=0.118). Conclusion: More intensive statin therapy was associated with significantly lower major adverse cardiovascular events in patients with acute MI and very low LDL cholesterol compared with less intensive statin therapy.