The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Predictors of One-Year Mortality in Smokers with Acute Myocardial Infarction

흡연을 하는 급성 심근경색증 환자에서 일년 후 사망 예측인자

  • Seol, Soo Young (The Heart Center, Chonnam National University Hospital) ;
  • Jeong, Myung Ho (The Heart Center, Chonnam National University Hospital) ;
  • Lee, Seung Hun (The Heart Center, Chonnam National University Hospital) ;
  • Sohn, Seok-Joon (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Kim, Min Chul (The Heart Center, Chonnam National University Hospital) ;
  • Sim, Doo Sun (The Heart Center, Chonnam National University Hospital) ;
  • Hong, Young Joon (The Heart Center, Chonnam National University Hospital) ;
  • Kim, Ju Han (The Heart Center, Chonnam National University Hospital) ;
  • Ahn, Youngkeun (The Heart Center, Chonnam National University Hospital) ;
  • Cho, Myeong Chan (Department of Cardiology, Chungbuk National University Hospital) ;
  • Kim, Chong Jin (Department of Cardiology, Kyunghee University Hospital) ;
  • Kim, Young Jo (Department of Cardiology, Yeungnam University Hospital)
  • 설수영 (전남대학교병원 심장센터) ;
  • 정명호 (전남대학교병원 심장센터) ;
  • 이승헌 (전남대학교병원 심장센터) ;
  • 손석준 (전남대학교 의과대학 예방의학교실) ;
  • 김민철 (전남대학교병원 심장센터) ;
  • 심두선 (전남대학교병원 심장센터) ;
  • 홍영준 (전남대학교병원 심장센터) ;
  • 김주한 (전남대학교병원 심장센터) ;
  • 안영근 (전남대학교병원 심장센터) ;
  • 조명찬 (충북대학교병원 심장내과) ;
  • 김종진 (경희대학교병원 심장내과) ;
  • 김영조 (영남대학교병원 심장내과)
  • Received : 2017.08.20
  • Accepted : 2017.10.26
  • Published : 2018.08.01
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Abstract

Background/Aims: It is well known that smoking is associated with clinical outcomes in patients with acute myocardial infarction (AMI). In this study, we aimed to predict the one-year mortality in AMI patients that smoked. Methods: Of the AMI patients who were enrolled in the Korean Acute Myocardial Infarction Registry-National Institutes of Health study, 5,110 were current smokers ($57.1{\pm}11.6$ years, male 95%), and these patients were included in the present study. Patients were divided into two groups; group I (survival group, n = 4,844, $56.5{\pm}11.3$ years, male 95%) and group II (deceased group, n = 266, male 88%). Clinical characteristics, coronary angiographic findings, procedural characteristics, and independent factors related to one-year mortality were analyzed. Results: In group II, the incidence of hypertension and diabetes were significantly higher than in group I, and the patients were significantly older. Patients with history of angina pectoris, myocardial infarction, and heart failure were significantly more common in group II than in group I. Smoking duration and pack-years of smoking were also significantly longer in group II than in group I. Multivariate analysis revealed that creatine > 2 mg/dL, left ventricular ejection fraction < 40%, Killip class ${\geq}II$, age ${\geq}65$ years, and post-percutaneous coronary intervention thrombolysis in myocardial infarction (post-PCI TIMI) flow ${\leq}II$ were independent factors of mortality during the one-year follow-up. Conclusions: The predictors of one-year mortality in AMI patients with smoking were renal and left ventricular dysfunction, high Killip class, old age, and low post-PCI TIMI flow.

목적: 흡연은 관상동맥 질환의 위험인자로 잘 알려져 있으며, 흡연을 하는 급성 심근경색증 환자에서 임상적 특성을 파악하고 일년 후 사망 예측인자를 파악하고자 하였다. 방법: 2011년 11월부터 2015년 12월까지 KAMIR-NIH에 등록된 13,104예 중 흡연을 하는 5,110예($57.1{\pm}11.6$세, 남성 95%)를 대상으로 하였다. 그중 흡연자 중에서 생존한 급성 심근경색증 환자를 I군 4,844예($56.5{\pm}11.3$세, 남자 95.3%), 사망한 급성 심근경색증 환자를 II군 266예($68.9{\pm}12.5$세, 남자 88.3%)로 분류하여, 각 군 간의 임상적 특징과 관상동맥 조영술 소견 및 1년 사망률과 관련된 사망 예측인자를 분석하였다. 결과: 사망한 흡연자 그룹은 65세 이상의 고령자가 많았으며, 고혈압, 당뇨병의 유병률이 유의하게 높았다. II군은 흡연 기간과 흡연 갑년에서 I군에 비하여 유의하게 많았다. 다변량 분석 결과 1년 추적 관찰 기간 중 사망사건 발생의 독립적인 인자는 creatine 2 mg/dL 이상, 좌심실구혈률 40% 미만, Killip class II 이상의 높은 Killip class, 65세 이상 고령, 관상동맥중재술 후 TIMI flow II 이하의 낮은 TIMI flow였다. 결론: 흡연을 하는 급성 심근경색증 환자에서 1년 후 유의한 사망 예측인자는 65세 이상의 고령, 신장 기능 장애, 좌심 실구혈률 저하, 높은 Killip class, 관상동맥중재술 후 TIMI flow 2 이하였다.

Keywords

Acknowledgement

Supported by : Ministry of Health & Welfare, Korea Centers for Disease Control and Prevention

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