The Korean Journal of Medicine

  • 제84권4호
  • /
  • Pages.522-530
  • /
  • 2013
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

이형 협심증 환자의 장기적 임상 예후에 영향을 미치는 인자

Predictive Factors for Long-term Clinical Outcomes in Patients with Variant Angina

  • 최명자 (전남대학교병원 심장센터) ;
  • 정명호 (전남대학교병원 심장센터) ;
  • 조재영 (전남대학교병원 심장센터) ;
  • 이영숙 (전남대학교 간호대학) ;
  • 이정애 (전남대학교 의과대학 예방의학교실) ;
  • 최진수 (전남대학교 의과대학 예방의학교실) ;
  • 심두선 (전남대학교병원 심장센터) ;
  • 박근호 (전남대학교병원 심장센터) ;
  • 홍영준 (전남대학교병원 심장센터) ;
  • 김주한 (전남대학교병원 심장센터) ;
  • 안영근 (전남대학교병원 심장센터) ;
  • 조정관 (전남대학교병원 심장센터) ;
  • 박종춘 (전남대학교병원 심장센터) ;
  • 강정채 (전남대학교병원 심장센터)
  • Choi, Myung Ja (The Heart Center of Chonnam National University Hospital) ;
  • Jeong, Myung Ho (The Heart Center of Chonnam National University Hospital) ;
  • Cho, Jae Yeong (The Heart Center of Chonnam National University Hospital) ;
  • Lee, Young-Sook (Chonnam National University College of Nursing) ;
  • Rhee, Jung Ae (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Choi, Jin Su (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Sim, Doo Sun (The Heart Center of Chonnam National University Hospital) ;
  • Park, Keun-Ho (The Heart Center of Chonnam National University Hospital) ;
  • Hong, Young Joon (The Heart Center of Chonnam National University Hospital) ;
  • Kim, Ju Han (The Heart Center of Chonnam National University Hospital) ;
  • Ahn, Young Keun (The Heart Center of Chonnam National University Hospital) ;
  • Cho, Jeong Gwan (The Heart Center of Chonnam National University Hospital) ;
  • Park, Jong Chun (The Heart Center of Chonnam National University Hospital) ;
  • Kang, Jung Chaee (The Heart Center of Chonnam National University Hospital)
  • 투고 : 2012.08.16
  • 심사 : 2012.10.23
  • 발행 : 2013.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 한국에서는 혈관 연축에 의하여 발생하는 변이형 협심증이 서양에 비하여 많으며, 이에 대한 국내 환자의 장기적 임상 예후에 관한 보고는 많지 않은 실정이다방법: 1996년부터 2011년까지 전남대학교 병원 심장센터 심도자실에서 ergonovine 유발검사를 시행하였던 1,162예 중 양성 결과를 보였던 686예를 대상으로 40.2 ${\pm}$ 38.0개월간 추적관찰 기간 중 반복적인 흉통, 재입원, 심근경색증, 심장사, 관상동맥 조영술이 필요하였던 경우를 심장사건으로 정의하고 이가 발생하였던 153예(I군: 52.4 ${\pm}$ 11.0 세, 남:여 = 103:50)와 발생하지 않았던 533예(II군: 51.6 ${\pm}$ 10.7 세, 남:여 = 350:183)로 분류하였다. 양 군 간에 임상적 소견, 검사실 소견, 관상동맥 조영술 등을 비교하였다. 결과:흡연력은 I군에서 II군보다 높았으며(45.8% vs. 36.3%, p = 0.037), 저밀도 지단백 콜레스테롤(119.4 ${\pm}$ 35.3 vs. 111.1 ${\pm}$ 32.2 mg/dL, p = 0.010) 수치도 I군에서 높았다. Cox 비례 위험 모형을 이용한 분석에서 유의한 심장사건 예측인자는 흡연이었다(HR 1.80, 95% CI 1.036-3.126, p = 0.037). 결론: 한국인 변이형 협심증 환자에서 흡연이 심장사건 발생의 유일한 예측인자이었다.

Background/Aims: The incidence of variant angina (VA) is relatively high in Korea compared with western countries, but its long-term clinical outcomes are not well defined. Methods: Patients who underwent ergonovine provocation tests at the cardiac catheterization laboratory of Chonnam National University Hospital between 1996 and 2011 were enrolled in this study (n = 1162). Of them, 686 patients with positive ergonovine provocation tests were divided into two groups: patients with cardiac events (Group I: 153 patients, 52.4 ${\pm}$ 11.0 years, M: F = 103: 50) and those without (Group II: 533 patients, 51.6 ${\pm}$ 10.7 years, M: F = 350: 183). The mean follow-up duration was 40.2 ${\pm}$ 38.0 months. Cardiac events were defined as cardiac death, recurrent ischemia, rehospitalization, myocardial infarction, and follow-up angiography. Clinical findings, laboratory and coronary angiographic characteristics were compared between the groups. Results: A history of smoking was more common in Group I than in Group II (45.8% vs. 36.3%, p = 0.037). The levels of low-density lipoprotein cholesterol (119.4 ${\pm}$ 35.3 vs. 111.1 ${\pm}$ 32.2 mg/dL, p = 0.010) were higher in Group I than in Group II. According to Cox proportional hazard regression analysis, the major predictive factor for cardiac events during clinical follow-up was smoking (HR 1.80, 95% CI 1.036-3.126, p = 0.037). Conclusions: A history of smoking was the only independent risk factor for cardiac events during a long-term clinical follow-up in Korean patients with variant angina.

키워드

참고문헌

  1. Shin WS, Lee MY, Park SW, et al. Coronary artery spasm provoked by intracoronary acetylcholine administration. Korean Circ J 1991;21:821-828. https://doi.org/10.4070/kcj.1991.21.5.821
  2. Han KI, Han KH, Park SW, et al. The vasomotor tone in vasospastic angina. Korean Circ J 1991;21:889-896. https://doi.org/10.4070/kcj.1991.21.5.889
  3. Jeong MH, Park JC, Rhew JY, et al. Successful management of intractable coronary spasm with a coronary stent. Jpn Circ J 2000;64:897-900. https://doi.org/10.1253/jcj.64.897
  4. Choi MJ, Lee SU, Choi JS, et al. The clinical significance of smoking in Korean patients with variant angina. J Korean Soc Hypertension 2004;10:8-14.
  5. Yoo SY, Shin DH, Jeong JI, et al. Long-term prognosis and clinical characteristics of patients with variant angina. Korean Circ J 2008;38:651-658. https://doi.org/10.4070/kcj.2008.38.12.651
  6. Jeong JY, Lim DS, Kang JA, et al. The study of coronary spasm by follow-up coronary angiography in variant angina. Korean Circ J 2002;32:791-797. https://doi.org/10.4070/kcj.2002.32.9.791
  7. Kang JA, Lee YS, Jeong SH, et al. Clinical characteristics of patients with variant angina. Korean J Med 2002;63:195-202.
  8. Doo YC, Kim JS, Chae KS, et al. Clinical and angiographic characteristics and long-term follow-up in patients with variant angina who presented as acute myocardial infarction. Korean Circ J 1999;29:276-284. https://doi.org/10.4070/kcj.1999.29.3.276
  9. Lee SC, Rha SW, Lim DS, et al. Pharmacologically inducible coronary vasospastic changes in patient with ischemic heart diseases with normal angiogram or insignificant coronary lesion and its relationships with risk factors. Korean Circ J 1996;26:1152-1162. https://doi.org/10.4070/kcj.1996.26.6.1152
  10. Park SJ, Park SW, Song JK, et al. Clinical, angiographic characteristics and long-term follow-up in patients with variant angina. Korean Circ J 1994;24:349-363. https://doi.org/10.4070/kcj.1994.24.3.349
  11. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. 18th Ed. New York: McGraw Hill, 2012:2012-2020.
  12. Kim W, Cho JS, Hong YJ, Ahn Y, Jeong MH. Clinical and laboratory characteristics in patients with acute myocardial infarction due to occlusive vasospasm. J Cardiol 2010;56: 320-325. https://doi.org/10.1016/j.jjcc.2010.07.008
  13. Ozaki Y, Takatsu F, Osugi J, et al. Long-term study of recurrent vasospastic angina using coronary angiograms during ergonovine provocation tests. Am Heart J 1992;123: 1191-1198. https://doi.org/10.1016/0002-8703(92)91022-S
  14. American Diabetes Association. Executive summary: standards of medical care in diabetes: 2012. Diabetes Care 2012;35(Suppl 1):S4-10. https://doi.org/10.2337/dc12-s004
  15. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003;289:2560-2572. https://doi.org/10.1001/jama.289.19.2560
  16. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-239. https://doi.org/10.1161/01.CIR.0000133317.49796.0E
  17. Pombo JF, Troy BL, Russell RO Jr. Left ventricular volumes and ejection fraction by echocardiography. Circulation 1971; 43:480-490. https://doi.org/10.1161/01.CIR.43.4.480
  18. JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2008): digest version. Circ J 2010; 74:1745-1762. https://doi.org/10.1253/circj.CJ-10-74-0802
  19. Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007;116:1081-1093. https://doi.org/10.1161/CIRCULATIONAHA.107.185649
  20. Cho SH, Jeong MH, Park IH, et al. Endothelial dysfunction, increased carotid artery intima-media thickness and pulse wave velocity, and increased level of inflammatory markers are associated with variant angina. J Cardiol 2009;54: 183-191. https://doi.org/10.1016/j.jjcc.2009.05.003
  21. Cho SH, Park IH, Jeong MH, et al. Increased inflammatory markers and endothelial dysfunction are associated with variant angina. Korean Circ J 2007;37:27-32. https://doi.org/10.4070/kcj.2007.37.1.27
  22. Hong YJ, Jeong MH, Choi YH, et al. Plaque components at coronary sites with focal spasm in patients with variant angina: virtual histology-intravascular ultrasound analysis. Int J Cardiol 2010;144:367-372. https://doi.org/10.1016/j.ijcard.2009.04.042
  23. Kim HS, Lee MM, Oh BH, et al. Variant angina is not associated with angiotensin I converting enzyme gene polymorphism but rather with smoking. Coron Artery Dis 1999;10:227-233. https://doi.org/10.1097/00019501-199906000-00004
  24. Cho SH. Effects of a smoking cessation education on smoking cessation, endothelial function, and serum carboxyhemoglobin in male patients with variant angina. J Korean Acad Nurs 2012;42:190-198. https://doi.org/10.4040/jkan.2012.42.2.190
  25. Figueras J, Domingo E, Ferreira I, Lidón RM, Garcia-Dorado D. Persistent angina pectoris, cardiac mortality and myocardial infarction during a 12 year follow-up in 273 variant angina patients without significant fixed coronary stenosis. Am J Cardiol 2012;110:1249-1255. https://doi.org/10.1016/j.amjcard.2012.06.026
  26. König D, Deibert P, Vogt S, et al. An unusual cause of recurrent chest pain in a highly trained recreational athlete. Herz 2007;32:665-668. https://doi.org/10.1007/s00059-008-2974-y
  27. Yilmaz A, Hill S, Schäufele T, Vöhringer M, Geissler A, Sechtem U. Exercise-induced spastic coronary artery occlusion at the site of a moderate stenosis: neither Prinzmetal's angina nor cardiac syndrome X but "Prinzmetal X". Circulation 2010;122:e570-574. https://doi.org/10.1161/CIRCULATIONAHA.110.937821
  28. Tani S, Nagao K, Anazawa T, et al. Treatment of coronary spastic angina with a statin in addition to a calcium channel blocker: a pilot study. J Cardiovasc Pharmacol 2008;52: 28-34. https://doi.org/10.1097/FJC.0b013e31817d4507
  29. Yasue H, Mizuno Y, Harada E, et al. Effects of a 3-hydroxy- 3-methylglutaryl coenzyme A reductase inhibitor, fluvastatin, on coronary spasm after withdrawal of calcium-channel blockers. J Am Coll Cardiol 2008;51:1742-1748. https://doi.org/10.1016/j.jacc.2007.12.049
  30. Cho JH, Jeong MH, Park WS, et al. The effects of oral nitric oxide donor (Molsidomine) in patients with variant angina unresponsive to conventional anti-anginal drugs. Korean Circ J 1998;28:1577-1582. https://doi.org/10.4070/kcj.1998.28.9.1577

피인용 문헌

  1. Impact of Smoking on Clinical Outcomes in Female Patients with Acute Myocardial Infarction vol.45, pp.1, 2013, https://doi.org/10.4070/kcj.2015.45.1.22