성공적 관상동맥 중재술 후 심질환 재발과 시술 전 hs-CRP 및 대사증후군 간의 관계: 후향적 조사
Pre-procedural hs-CRP and Metabolic Syndrome in Recurrent Cardiac Events After Successful Percutaneous Coronary Intervention: A Retrospective Study
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연구배경: 고감도 C반응성 단백질 및 대사증후군은 관상동맥 질환 발병과정의 강력한 예측인자로 널리 알려져 있으나 성공적 관상동맥 중재술 후 심질환 재발관련 위험요인으로서는 그 인과관계가 명확히 밝혀져 있지 않다. 본 연구는 관상동맥 중재술 후 심질환 재발과 시술 전 hs-CRP 및 대사증후군간의 연관성을 파악하기 위해 시도된 후향적 조사연구이다. 방법: 본 연구는 충청남도 C시 소재 S대학 종합병원 순환기 내과에서 성공적인 관상동맥 중재술 후 6개월이 경과된 환자 중 심질환 재발로 응급실 또는 외래를 경유하여 입원한 재발군 35명과 비재발군 65명을 대상으로 하였다. 결과: 1. 심질환 재발군과 비재발군의 시술 전 hs-CRP 수치의 경우 심질환 재발군은 평균 7.18±9.55 mg/L, 비재발군은 1.44±10.79 mg/L로 심질환 재발군에서의 수치가 통계적으로 유의하게 훨씬 높았으며, 3 mg/L를 전후로 나누어 비교한 결과에서도, 3 mg/L 이상의 수치에 해당하는 사람들이 심질환 재발군에서는 54.3%로 비재발군 23.1%에 비해 훨씬 많아 통계적으로 유의한 차이를 보였다(P=0.002). 심질환 재발군과 비재발군의 시술 전 대사증후군 유병률 차이에서는 두 군간에 통계적으로 유의한 차이가 없었다. 2. 관상동맥 중재술 후 심질환 재발에 영향을 미치는 요인을 분석한 결과, 시술 전 hs-CRP (P=0.002)만이 통계적으로 유의한 변수로 확인되었는데, 즉 시술 전 hs-CRP 수치가 ‘3 mg/L 이상’인 사람이 ‘3 mg/L 미만’인 사람에 비해 심질환 재발 위험이 9.27배로 훨씬 높게 나타났다. 결론: 본 연구결과, 관상동맥 중재술 후 심질환 재발의 위험요인으로서 시술 전 hs-CRP 수치가 중요한 생리적 표지자임을 확인할 수 있었다. 본 연구는 후향적 연구로서 한계가 있으므로 추후 심질환 재발여부의 조사기간을 시술 후 1년 이내로 확대하고 대상자를 충분히 확보하여 전향적 코호트 연구를 통해 인과성을 검증해 볼 것을 제언하는 바이다.
Abstract
Background: Elevated high sensitivity C-reactive protein (hs-CRP) and metabolic syndrome are well-known predictors of coronary atherosclerosis. However, few data are available on the roles of hs-CRP and metabolic syndrome on recurrent cardiac events in patients having undergone percutaneous coronary intervention (PCI). This retrospective study examined the effects of pre-procedural hs-CRP and metabolic syndrome on recurrent cardiac events in patients who underwent successful PCI. Methods: This study included one hundred patients (with recurrence group=35, without recurrence group=65) in their twenties to eighties admitted to a university hospital. Data were collected by a questionnaire and medical records using convenience sampling. Results: Pre-procedural hs-CRP levels were higher in the ‘with recurrence’ group than in the ‘without recurrence’ group (P=0.002). Prevalence of metabolic syndrome was not significant in the recurrence of cardiac events. Logistic regression analysis was performed to delineate the factors affecting recurrent cardiac events and showed that pre-procedural hs-CRP (P=0.002) was the only statistically significant parameter for the recurrence of cardiac events. In terms of risk for recurrent cardiac events, pre-procedural hs-CRP level of ‘above 3 mg/L’ was higher than that of ‘below 3 mg/L’ by 9.27 fold. Conclusion: Our study showed that pre-procedural hs-CRP may predict recurrent cardiac events after successful PCI. Prospective studies conducted on larger populations would be needed to strengthen our findings.
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