약물방출 스텐트 시술을 받은 급성 심근경색증 환자에서 항인지질 항체의 존재가 주요 심혈관 사건에 미치는 영향
Relationship between Antiphospholipid Antibodies and Major Adverse Cardiovascular Events after Drug-Eluting Stent Implantation in Patients with Acute Myocardial Infarction
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 항인지질항체는 급성 심근경색증의 발병과 연관이 있는 것으로 알려져 있다. 하지만 약물방출 스텐트를 삽입한 급성 심근경색증 환자에게서 항인지질항체와 주요 심혈관 사건의 발생과의 연관성은 잘 알려져 있지 않다. 이 연구의 목적은 약물방출 스텐트를 시술한 급성 심근경색증 환자에서 항인지질항체와 주요 심혈관 사건 발생과의 연관성을 알아보는 것이다. 방법: 본 연구는 성공적으로 약물방출 스텐트를 삽입한 급성 심근경색증 생존자를 대상으로 항인지질항체 양성군과 음성군으로 나누어 주요 심혈관 사건과의 연관성에 대해 후향적으로 연구하였다. 결과: 항인지질항체 양성군에서 더 고령이었으며, 뇌졸중의 과거력이 더 많았고, 급성 심근경색증으로 내원 당시 Killip class는 더 높았다. 관상동맥 조영술상에서 다혈관 질환의 빈도가 양성군에서 더 잦았다. 그러나 주요 심혈관 사건에 있어 항인지질항체 양성군과 음성군 사이에 통계적인 차이가 없었다(p = 0.099). 결론: 항인지질항체의 존재는 급성 심근경색증으로 약물방출 스텐트를 삽입한 환자에게서 주요 심혈관 사건과 의미 있는 연관성이 없었다.
Abstract
Background/Aims: Several studies have reported an association between antiphospholipid antibodies (APA) and major adverse cardiovascular events (MACE) following acute myocardial infarction (AMI). However, the relationship between APA and the prognosis after drug-eluting stent (DES) implantation in patients with AMI is not known. Methods: Thus, we investigated the relationship between the incidence of MACE and APA levels in patients with AMI who underwent successful DES implantation. Results: Of 182 patients, 78 (42.9%) tested positive for APA. Lupus anticoagulant was positive in 37.6% (68 of 181) patients, anticardiolipin antibody IgM was positive in 8.3% (15 of 180), and anticardiolipin antibody IgG was positive in 1.7% (3 of 180) patients. At follow up, a MACE had occurred in 11 (14.1%) patients in the APA-positive group and in seven (6.7%) patients in the APA-negative group (p = 0.099). Conclusions: No significant association was found between the incidence of MACE and the presence of APA in patients with AMI who underwent successful DES implantation.
참고문헌 (26)
- Brar SS, "Use of drug-eluting stents in acute myocardial infarction : a systematic review and meta-analysis", J Am Coll Cardiol, 53, pp.1677~1689 (2009)
- Kalesan B, "Comparison of drug-eluting stents with bare metal stents in patients with ST-segment elevation myocardial infarction", Eur Heart J, 33, pp.977~987 (2012)
- Iakovou I, "and outcome of thrombosis after successful implantation of drug-eluting stents", JAMA, 293, pp.2126~2130 (2005)
- Acar G, "Recurrent acute stent thrombosis associated with protein C and S deficiencies", Int J Cardiovasc Imaging, 22, pp.333~337 (2006)
- Turgut T, "Acute coronary occlusion and in-stent thrombosis in a patient with essential thrombocythemia", Cathet Cardiovasc Diagn, 45, pp.428~433 (1998)
- Vaarala O, "Anti-cardiolipin antibodies and risk of myocardial infarction in a prospective cohort of middle-aged men", Circulation, 91, pp.23~27 (1995)
- Urbanus RT, "Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study : a case-control study", Lancet Neurol, 8, pp.998~1005 (2009)
- Sletnes KE, "Antiphospholipid antibodies after myocardial infarction and their relation to mortality, reinfarction, and non-haemorrhagic stroke", Lancet, 339, pp.451~453 (1992)
- Greco TP, "Newer antiphospholipid antibodies predict adverse outcomes in patients with acute coronary syndrome", Am J Clin Pathol, 132, pp.613~620 (2009)
- Killip T 3rd, "Treatment of myocardial infarction in a coronary care unit : a two year experience with 250 patients", Am J Cardiol, 20, pp.457~464 (1967)
- Cutlip DE, "Clinical end points in coronary stent trials : a case for standardized definitions", Circulation, 115, pp.2344~2351 (2007)
- Long BR, "The role of antiphospholipid syndrome in cardiovascular disease", Hematol Oncol Clin North Am, 22, pp.79~94 (2008)
- Petri M, "Epidemiology of the antiphospholipid antibody syndrome", J Autoimmun, 15, pp.145~151 (2000)
- Petri M, "The lupus anticoagulant is a risk factor for myocardial infarction(but not atherosclerosis) : Hopkins Lupus Cohort", Thromb Res, 114, pp.593~595 (2004)
- Vaarala O, "Anti-cardiolipin antibodies and risk of myocardial infarction in a prospective cohort of middle-aged men", Circulation, 91, pp.23~27 (1995)
- Bili A, "Anticardiolipin antibodies and recurrent coronary events: a prospective study of 1150 patients: Thrombogenic Factors, and Recurrent Coronary Events Investigators", Circulation, 102, pp.1258~1263 (2000)
- Su HM, "Acute thrombosis after elective direct intracoronary stenting in primary antiphospholipid syndrome : a case report", Kaohsiung J Med Sci, 19, pp.177~182 (2003)
- Weissman A, "Antiphospholipid antibody syndrome and acute stent thrombosis", Rev Cardiovasc Med, 7, pp.244~246 (2006)
- Niessner A, "qPre-existing anticardiolipin antibodies and development of restenosis after coronary balloon angioplasty: predictive value for a complicated course?", Blood Coagul Fibrinolysis, 15, pp.311~316 (2004)
- Gürlek A, "Association between anticardiolipin antibodies and recurrent cardiac events in patients with acute coronary syndrome", Int Heart J, 46, pp.631~638 (2005)
- Sharma S, "Association of anticardiolipin antibodies levels with instent restenosis in patients with coronary artery disease", Indian J Physiol Pharmacol, 52, pp.288~292 (2008)
- Chiarugi L, "Lipoprotein (a) and anticardiolipin antibodies are risk factors for clinically relevant restenosis after elective balloon percutaneous transluminal coronary angioplasty", Atherosclerosis, 154, pp.129~135 (2001)
- Eber B, "Anticardiolipin antibodies are no marker for survived myocardial infarction", Klin Wochenschr, 68, pp.594~596 (1990)
- Vuilleumier N, "Head-to-head comparison of auto-antibodies for cardiovascular outcome prediction after myocardial infarction: a prospective study", J Clinic Experiment Cardiol, 2, pp.169~ (2011)[DOI]
- Zuckerman E, "Anticardiolipin antibodies and acute myocardial infarction in non-systemic lupus erythmatosus patients: a controlled prospective study", Am J Med, 104, pp.381~386 (1996)
- Vianna JL, "Comparison of the primary and secondary antiphospholipid syndrome : a European Multicenter Study of 114 patients", Am J Med, 96, pp.3~9 (1994)