고중성지방혈증과 복부비만이 관상동맥 중재술을 시술받은 급성심근경색증 환자의 임상경과에 미치는 영향
Clinical Impact of High Triglycerides and Central Obesity in Patients with Acute Myocardial Infarction who Underwent Percutaneous Coronary Intervention
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목적: 인구의 고령화 및 생활 습관의 변화로 심근경색증,협심증 등의 관상동맥 질환은 주요 사망원인이 되고 있다. 관상동맥 질환의 위험인자로는 흡연, 고혈압, 당뇨병, 이상지혈증, 비만 등이 잘 알려져 있으며 이러한 위험인자를 조절하는 것이 관상동맥 질환의 예방과 치료에 필수적이다. 또한 관상동맥 질환의 치료로서 경피적 관상동맥 중재술(percutaneous coronary intervention, PCI)이 많이 시행되고 있다. 이 연구에서는 급성 심근경색증 환자에서 PCI 후 중성지방의 수치와 복부비만의 유무에 따른 임상적 경과를 파악하고자 하였다. 방법: 2006년 1월부터 2010년 12월까지 전남대학교병원에내원한 급성 심근경색증 환자 중에서 PCI 시행 후 1년간 추적관찰하였던 환자 2,751예(평균나이 63.7 ± 12.1세)를 대상으로 하였다. 이 환자들을 중성지방의 수치와 복부비만의 유무에 따라 중성지방이 200 mg/dL 미만이며 복부비만이 없는군을 Ia군 1,217명(63.9 ± 11.9세, 남자: 87.6%), 중성지방이200 mg/dL 미만이며 복부비만이 있는 군을 Ib군 1,203명(65.4± 11.6세, 남자: 55.5%), 중성지방이 200 mg/dL 이상이며 복부비만이 없는 군을 IIa군 132명(56.3 ± 12.0세, 남자: 97.0%), 중성지방이 200 mg/dL 이상이며 복부비만이 있는 군을 IIb군199명(57.3 ± 12.7세, 남자: 66.3%)으로 분류하여 각 군 간의임상경과와 주요 심장사건 발생을 분석하였다. 결과: 대상 환자를 1년간 추적관찰한 결과 주요 심장사건은 502명(18.2%)에서 발생하였으며 사망은 303명(11.0%)에서 발생하였다. 복부비만이 있는 환자군에서 고혈압과 당뇨병이 더 많았으며 총 콜레스테롤과 저밀도 지단백 콜레스테롤 수치 역시 복부비만이 있는 군에서 더 높았다. 병원 내합병증이나 사망률은 네 그룹 간에 차이가 없었고 1년간의심장사건 발생 비율도 각 군 간에 유의한 차이를 보이지 않았으며 연령 및 성별을 보정한 후와 다변량 보정 후에도 유의한 차이가 없었다. 결론: PCI를 받은 급성 심근경색증 환자에서 중성지방의수치나 복부비만의 유무에 따라 병원 내 합병증 발생이나1년간의 주요 심장사건 발생 등의 임상적 경과에 있어 차이를 보이지 않았다.
Abstract
Background/Aims: Dyslipidemia and obesity are risk factors for the development of acute myocardial infarction (AMI) that affectthe clinical outcomes in patients. Methods: We analyzed 2,751 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) (mean age, 63.7± 12.1 years). The patients were divided into four groups based on serum triglyceride levels and central obesity [Group Ia:triglycerides < 200 mg/dL and (-) central obesity; Group Ib: triglyceride < 200 mg/dL and (+) central obesity; Group IIa:triglyceride ≥ 200 mg/dL and (-) central obesity; Group IIb: triglyceride ≥ 200 mg/dL and (+) central obesity]. In-hospital outcomewas defined as in-hospital mortality and complications. One-year clinical outcome was compared and defined as the composite of1-year major adverse cardiac events (MACE), including death, recurrent MI, and target vessel revascularization. Results: Total MACE developed in 502 patients (18.2%), while 303 patients (11.0%) died prior to the 1-year follow-up visit. In-hospital complications and in-hospital mortality were not different among the four groups. One-year clinical outcomes based ontriglyceride levels (Group I vs. Group II) were not different. In addition, there were no differences in clinical outcomes in patientswith a triglyceride level < 200 mg/dL, regardless of central obesity. One-year MACE rates were not significantly different amongthe four groups.Conclusions: There was no significant difference in the 1-year MACE rate based on the triglyceride level and presence of centralobesity in patients with AMI who underwent PCI.
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