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급성 심근경색증 환자에서 조기에 적절한 재관류 요법을 시행받지못한 요인
유병수(Byung Su Yoo),윤정한(Jung Han Yoon),박금수(Keum Soo Park),여경구(Kyung Koo Yoh),조윤경(Yun Kyung Cho),안승찬(Seung Chan Ahn),이용규(Yong Kyu Lee),송광선(Kwang Seon Song),최경훈(Kyung Hoon Choe),이부수(Boo Soo Lee),황성오(Sung 대한내과학회 1995 대한내과학회지 Vol.48 No.6
Objectives: Early application of reperfusion therapy such as thrombolytic agent or direct PTCA is utmost important to amximize the efficacy of reperfusion therapy in patients with aute myocardial infarction. However, early adequate reperfusion thearpy was given only in 15% to 36% pf patients with acute myocardial infarction and substantial patients were not benefited from reperfusion therapy, Therefore, we performed these study to evaluate the reasons for which patients with acute myocardial infarction cannot receive an adequate reperfusion therapy. Methods: We analyzed the initial electrocardiogram and various time delays from chest pain onset time, first hospital arrival time, transfer time, ER arrival time, and door to reperfusion time in 138 patients with acute myocardial infarction from Jan. 1991 to Oct. 1993 admitted to Wonju Christian Hospital. Patients were grouped as reperfusion group(n=55) who had reperfusion therapy such as thrombolytic trial or direct PTCA and conservative grou who had not received reperfusion therapy(n= 83). Results: 1) Eighty-three cases(60.1%) did not received an adequate reperfusion therapy. 2) Hospital arrival time of patients was 237±162min and 786±615min in reperfusion and conservative group(p<0.05) respectively. Patient time delay was 103±98min and 439±511min, first hospital time delay, 93±78min and 333±482min, and transfer time, 81±59min and 105±64min in reperfusion and conservative group respectively(p<0.05). Only 4.8% of patients was transferred from first hospital after reperfusion therapy. 3) Patient time delay was the most common reason of not receiving reperfusion therapy, and time delay and lack of adequate reperfusion therapy at the first hospital inspite of early arrival were the second place. Other reasons were contraindication to lytic therapy(4 cases), definite Q wave MI(11 cases), inconclusive EKG(4 cases), and delay in therapy(4 cases). Conclusion: The most common reason of not receiving reperfusion therapy was patient delay in seeking medical care(45.8%) and time delay at first hospital in 22 cases(26.5%). To maximize the effectiveness of reperfusion therapy, it is important to shorten hospital arrival time delay and widespread use of reperfusion therapy at first hospital is recommeded.