The Journal of the Korea Contents Association (한국콘텐츠학회논문지)

The Korea Contents Association (한국콘텐츠학회)
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Long-term Clinical Outcomes after Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction-on the basis of 65 Years

급성 심근경색증 환자에서 일차적 관상동맥 중재술 후 장기적 임상 경과-65세를 기준으로

  • 이한올 (동신대학교 방사선학과) ;
  • 장성주 (동신대학교 방사선학과) ;
  • 김인수 (동신대학교 방사선학과) ;
  • 한재복 (동신대학교 방사선학과) ;
  • 박수환 (전남대학교병원 심혈관센터) ;
  • 김정훈 (전남대학교병원 심혈관센터) ;
  • 장영일 (광양보건대학교 방사선과)
  • Received : 2014.02.11
  • Accepted : 2014.03.18
  • Published : 2014.05.28
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Abstract

Primary percutaneous coronary intervention (PCI) has been found to be superior, in terms of hospital mortality and long-term outcome, compared with thrombolytic therapy in patients with acute myocardial infarction (AMI). However, the clinical benefits of primary PCI have not been precisely evaluated in elderly patients.1,974 patients (Group I: n=1,018, $age{\geq}65years$, $73.8{\pm}5.99years$; Group II: n=956, age<65years, $52.8{\pm}7.96years$) who underwent primary PCI for AMI at Chonnam National University Hospital between 2006 and 2010 were analyzed according to their clinical, angiographic characteristics for hospital and one-year survival. Group I had a higher percentage of women, diabetes mellitus, hypertension, multi-vessel disease and lower prevalence of current smoking, hyperlipidemia, familial history than Group II. Culprit lesions were at the left anterior descending artery, left circumflex artery, right coronary artery and left main artery in 42.8% vs. 45.0%, 34.1% vs. 29.6%, 14.6% vs 14.6, 2.7% vs. 1.6%, respectively (p=0.007). Stent diameter was smaller in group I ($3.17{\pm}0.39$ vs. $3.29{\pm}0.42mm$, p=0.001). In-hospital mortality was higher in group I (8.4 vs. 1.9%, p<0.001). There were significant differences in the rates of major adverse cardiac events between the two groups during one-year clinical follow-up (20.1 vs.14.0%, p<0.001). On multiple logistic regression analysis, systolic blood pressure<100mmHg, serum $creatinine{\geq}1.3mg/dL$, Killip class> I, multivessel disease, left ventricular ejection fraction <40% and cerebro vascular disease were independent predictors of one-year motality in patients over 65 years after PCI.

본 연구는 일차적인 경피적 관상동맥 중재술(percutaneous coronary intervention, PCI)를 시술 받은 65세 이상의 고령 환자들에서 임상적 특성, 관상동맥 병변 및 중재술의 특성, 병원 내 및 1년 사망률과 주요심장사건(major adverse cardiac events, MACE)의 발생에 대해 알아보고자 하였다. 2006년 1월 1일부터 2010년 12월 30일까지 모 대학병원 심혈관센터에서 급성 심근경색증으로 진단받고 흉통 발생 12시간 이내 관상동맥 조영술 및 일차적 PCI를 시행 받은 환자 1,974예를 대상으로 하였고, 65세 이상의 I군(1,018예, 연령 $73.8{\pm}5.99$세, 남자 : 여자 = 574 : 821)과 65세 이하의 II군(956예, 연령 $52.8{\pm}7.96$세, 남자 : 여자 = 444 : 135)으로 나누어 분석하였다. 심혈관질환의 위험인자는 I군에서 더 높았고, 흡연력, 고지혈증, 가족력은 II군에서 높았다. PCI 표적 병변은 I군에서 좌주관지(2.7 vs. 1.6%, p=0.007)가 유의하게 많았으며, 다혈관병변(54.5 vs. 41.0%, p<0.001)도 I군에서 많았다. 병원 내 사망(8.4 vs. 1.9%)과 MACE(20.1 vs. 14.0%)는 I군에서 많이 관찰되었다(p<0.001). 로지스틱 다중회귀분석 결과 65세 이상 고령 환자에서 1년 사망률에 영향을 미치는 독립적인 인자는 내원 시 혈중 creatinine 1.3 mg/dL 이상, 뇌혈관 질환, 수축기 혈압<100 mmHg, Killip class II 이상, 다혈관 질환, 그리고 좌심실 구혈률 <40%로 나타났다.

Keywords

References

  1. E. C. Keeley, J. A. Boura, and C. L. Grines, "Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials, "Lancet, Vol.361, pp.13-20, 2003. https://doi.org/10.1016/S0140-6736(03)12113-7
  2. H. R. Andersen, T. T. Nielsen, and K. Rasmussen, "A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction, "N Engl J Med, Vol.349, pp.733-742, 2003. https://doi.org/10.1056/NEJMoa025142
  3. E. M. Antman and F. van de Werf, "Pharmacoinvasive therapy the future of treatment for ST-elevation myocardial infarction, "Circulation, Vol.109, pp.2480-2486, 2004. https://doi.org/10.1161/01.CIR.0000128736.57259.48
  4. S. Y. Lim, M. H. Jeong, and E. H. Bae, "Predictive factors of major adverse cardiac events in acute myocardial infarction patients complicated by cardiogenic shock undergoing primary percutaneous coronary intervention, "J. Circ, Vol.69, pp.154-158, 2005. https://doi.org/10.1253/circj.69.154
  5. E. M. Antman, D. T. Anbe, and P. W. Armstrong, "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)," Circulation, Vol.110, pp.588-636, 2004. https://doi.org/10.1161/01.CIR.0000134791.68010.FA
  6. E. M. Antman, P. P. DT. Anbe, and P. W. Armstrong, "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction)," J. Am Coll Cardiol, Vol.44, pp.671-719, 2004. https://doi.org/10.1016/j.jacc.2004.07.002
  7. F. Zijlstra, J. C. Hoorntje, and M. J. de Boer, "Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction, "N Engl J Med, Vol.341, pp.1413-1419, 1999. https://doi.org/10.1056/NEJM199911043411901
  8. C. M. Nunn, W. W. O'eill, and D. Rothbaum, "Long-term outcome after primary angioplasty," J. Am Coll Cardiol, Vol.33, pp.640-646, 1999. https://doi.org/10.1016/S0735-1097(98)00622-6
  9. C. T. Tran, A. Laupacis, M. M. Mamdani, and J. V. Tu, "Effect of age on the use of evidence-based therapies for acute myocardial infarction, "Am Heart J, Vol.148, pp.834-841, 2004. https://doi.org/10.1016/j.ahj.2003.11.028
  10. V. S. DeGeare, G. W. Stone, and L. Grines, "Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials), "Am J Cardiol, Vol.86, pp.30-34, 2000.
  11. S. H. Lee, M. H. Jeong, and O. Y. Park, "Early outcome and restenosis rate after coronary artery stenting in the elderly, "Korean Circ J, Vol.31, pp.31-38, 2001. https://doi.org/10.4070/kcj.2001.31.1.31
  12. J. C. Park, M. H. Jeong, and J. H. Kim, "Clinical characteristics of coronary interventions in old aged patients, " Korean Circ J, Vol.28, pp.256-261, 1998. https://doi.org/10.4070/kcj.1998.28.2.256
  13. Y. A. Kim, M. H. Jeong, and S. B. Joo, "The percutaneous coronary intervention in elderly women over 70 years of age, "Korean J Med, Vol.60, pp.456-462, 2001.
  14. S. Y. Lim, M. H. Jeong, and B. R. Yang, "Long-term clinical outcomes after primary percutaneous coronary intervention in patients with acute myocardial infarction older than 75 yea. Korean Circulation J, Vol.35, pp.613-619, 2005. https://doi.org/10.4070/kcj.2005.35.8.613
  15. B. R. Yang, M. J. Choi, and M. H. Jeong, "The effect of gender on short- and long-term clinical outcomes of percutaneous coronary intervention in Koreano ctogenarians, "Korean Circ J, Vol.32, pp.864-871, 2002. https://doi.org/10.4070/kcj.2002.32.10.864
  16. S. H. Lee and J. K. Chae, "Long-term clinical outcomes of percutaneous coronary intervention using drug-eluting stents in octogenarians and older, "Korean Circ J, Vol.37, pp.647-655, 2007. https://doi.org/10.4070/kcj.2007.37.12.647
  17. W. G. Austen, J. E. Edwards, and R. L. Frye, "A reporting system on patients evaluated for coronary artery disease. " Circulation, Vol.51, pp.5-40, 1975. https://doi.org/10.1161/01.CIR.51.4.5
  18. C. M. Gibson, C. P. Cannon, and W. L. Daley, "TIMI frame count: a quantitative method of assessing coronary artery flow, " Circulation, Vol.93, pp.879-88, 1996. https://doi.org/10.1161/01.CIR.93.5.879
  19. M. J. de Boer, M. J. Ottervangerx, H. Suryapranata, J. C. Hoorntje, J. H. Dambrink, A. T. Gosselink, A. W. van't Hof, and F. Zijlstra, "Old age and outcome after primary angioplasty for acute myocardial infarction, "J Am Geriatr Soc, Vol.58, pp.867-872, 2010. https://doi.org/10.1111/j.1532-5415.2010.02821.x
  20. R. J. Goldberg, J. M. Gore, and J. H. Gurwitz, "The impactofage on the incidence and prognosis of initial acute myocardial infarction, " Am HeartJ, Vol.117, pp.543-549, 1989. https://doi.org/10.1016/0002-8703(89)90727-8
  21. C. D. Naylor and E. Chen, "Population-wide mortality trendsamong patients hospitalized for acute myocardial infarction: the Ontario experience, 1981-1991, " J Am Coll Cardiol, Vol.24, pp.1431-1438, 1994. https://doi.org/10.1016/0735-1097(94)90136-8
  22. D. R. Thiemann, J. Coresh, S. P. Schulman, G Gerstenblith, W. J. Oetgen, and N. R Powe, "Lack of benefit for intravenous thrombolysisin patients with myocardial infarction who are older than 75 years, " Circulation, Vol.101, pp.2239-46, 2000. https://doi.org/10.1161/01.CIR.101.19.2239
  23. H. D. White, G. I. Barbash, and R. M. Califf, "Age and outcome with contemporary thrombolytic therapy: results from the GUSTO-1 trial, " Circulation, Vol.94, pp.1826-1833, 1996. https://doi.org/10.1161/01.CIR.94.8.1826
  24. A. K. Berger, "Thrombolysis in elderly patients with acute myocard ialinfarction, "Am J Geriatr Cardiol, Vol.12, pp.251-256, 2003. https://doi.org/10.1111/j.1076-7460.2003.02011.x
  25. W. B. Batchelor, K. J. Anstrom, and L. H. Muhlbaier, Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7, 472 octogenarians," J Am CollCardiol, Vol.36, pp.723-730, 2000. https://doi.org/10.1016/S0735-1097(00)00777-4
  26. D. Antoniucci, R. Valenti, and A. Migliorini, "Comparison of impact of emergency percutaneous revascularization on outcome of patients ${\geq}$75 to those <75 years of age with acute myocardial infarction complicated by cardiogenic shock. " Am J Cardiol, Vol.91, pp.1458-1461, 2003. https://doi.org/10.1016/S0002-9149(03)00397-7
  27. K. A. Skelding, L. S. Mehta, and B. Finta, "Primary percutaneous interventions for acute myocardial infarction in octogenarians: a single-centerexperience, "Clin Cardiol, Vol.25, pp.363-366, 2002. https://doi.org/10.1002/clc.4950250804
  28. K. Sakai, Y. Nakagawa, and T. Kimura, "Comparison of results of coronary angioplasty for acute myocardial infarction in patients ${\geq}$75 years of age versus patients <75 years of age, " Am J Cardiol, Vol.89, pp.797-800, 2002. https://doi.org/10.1016/S0002-9149(02)02187-2
  29. A. Bakhai, R. H. Stables, S. Prasad, and U. Sigwart, "Trials comparing coronary artery bypass grafting with percu taneoustransluminal coronary angiography and primary stent implantation in patients with multivessel coronary artery disease, "Curr Opin Cardiol, Vol.15, pp.388-394, 2000. https://doi.org/10.1097/00001573-200011000-00003
  30. R. H. Mehta, I. Sadiq, and R. J. Goldberg, "Effectiveness of primary percutaneous coronary intervention compared with that of thrombolytic therapy in elderly patients with acute myocardial infarction," Am Heart J, Vol.147, pp.253-259, 2004. https://doi.org/10.1016/j.ahj.2003.08.007
  31. Y. L. Chen, A. Bhasin, A. AYoussef, C. J. Wu, C. H. Yang, Y. K. Hsieh, C. Y. Fang, C. L. Hang, and H. K. Yip, "Prognostic factors and outcomes in young chinese patients with acute myocardial infarction undergoing primary coronary angioplasty, " Int Heart J, Vol.50, pp.1-11, 2009. https://doi.org/10.1536/ihj.50.1
  32. D. E. Wennberg, D. J. Makenka, and A. Sengupta, "Percutaneous transluminal coronary angioplasty in the elderly: epidemiology, clinical risk factors, and in-hospitaloutcomes, "Am Heart J, Vol.137, pp.639-45, 1999. https://doi.org/10.1016/S0002-8703(99)70216-4
  33. A. R Assali, A. Moustapha, and S. Sdringola, "The dilemma of success: percutaneous coronary interventions in patients > or=75 years ofage-successful but associated with higher vascular complications and cardiac mortality, "Catheter Cardiovasc Interv, Vol.59, pp.195-199, 2003. https://doi.org/10.1002/ccd.10532
  34. S. B. Laster, B. D. Rutherford, and L. V. Giorgi, "Results of direct percutaneous transluminal coronary angioplasty in octogenarians, "Am J Cardiol, Vol.77, pp.10-13. 1996. https://doi.org/10.1016/S0002-9149(97)89126-6
  35. M. Ishihara, I. Inoue, T. Kawagoe, Y. Shimatani, F. Miura, Y. Nakama, K. Dai, T. Ootani, K. Ooi, H. Ikenaga, T. Miki, M. Nakamura, S. Kishimoto, and Y. Sumimoto, "Comparison of gender-specific mortality in patients <70 years versus ${\geq}$ 70 years old with acute myocardial infarction, " Am J Cardiol, Vol.108, No. 6, pp.772-775, 2011. https://doi.org/10.1016/j.amjcard.2011.04.030
  36. J. S. Park, Y. J. Kim, D. G. Shin, M. H. Jeong, Y. K. Ahn, W. S. Chung, K. B. Seung, C. J. Kim, M. C. Cho, Y. S. Jang, S. J. Park, I. W. Seong, S. C. Chae, S. H. Hur, D. H. Choi, and T. J. Hong, "Korean Acute Myocardial Infarction Registry (KAMIR)Group. Gender differences in clinical features and in-hospital outcomes in ST-segment elevation acute myocardial infarction: from the Korean Acute Myocardial Infarction Registry (KAMIR) study, "Clin Cardiol, Vol.33, No. 8, pp.E1-6, 2010.
  37. A. C. Martin and J. Monsegu, "ST-elevation myocardial infarction in octogerians, " Ann Cardiol Angeiol, Vol.59, No. 6, pp.349-55, 2010. https://doi.org/10.1016/j.ancard.2010.10.005
  38. I. S. Kim, N. G. Choi, S. J. Jang, J. B. Han, and Y. I. Jang, "Occurrence and Prognosis for the Thrombosis in the Drug-Eluting Stents and Bare-Metal Stents," Journal of the korea contents association, Vol.12, No. 7, pp.273-283, 2012.
  39. I. S. Kim, S. J. Jang, M. H. Jeong, J. B. Han, and Y. I. Jang, "Clinical Outcomes of Stent Thrombosis after Drug-Eluting Coronary Stent Implantation, "Journal of the korea contents association, Vol.13, No. 12, pp.880-892, 2013. https://doi.org/10.5392/JKCA.2013.13.12.880

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