개흉술을 받는 한국 성인 판막 환자의 유의한 관상동맥 질환의 유병률
Prevalence of Significant Coronary Arterial Disease in Adult Patients who Underwent Valvular Surgery in Korea
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목적: 판막 질환으로 수술적 치료를 시행받는 환자들에서 유의한 관상동맥 질환의 유무를 확인하는 것은 동시에 관상동맥우회술을 시행함으로써 향후의 재개흉술 및 이로 인한 합병증의 예방에 중요하다. 국내의 허혈성 심질환의 빈도는 서구에 비해 낮으나 어떤 환자군에서 관상동맥 조영술을 시행하여야 하는지에 대한 기초 통계자료는 없는 실정이다. 이에 저자들은 국내에서 판막 질환으로 개흉술을 시행받는 환자들을 대상으로 하여 관상동맥 조영술의 시행유무 및 유의한 관상동맥 질환의 유병률에 대해 연구하였다. 방법: 2005년 1월부터 2011년 6월까지 충남대학교 병원 및 전북대학교 병원 심장내과와 흉부외과에서 유의한 판막 질환으로 개흉술을 시행받은 성인 환자들을 대상으로 후향적 분석을 하였다. 급성 대동맥 박리증이나 외상으로 인해 응급수술을 시행받은 경우 및 관상동맥 협착증으로 관상동맥 우회로술을 시행받으면서 동시에 판막 질환을 수술한 경우는 제외하였다. 결과: 연구 기간 동안 총 431명의 환자(평균나이 58 ± 13세, 남자 204명)가 연구에 등록되었다. 질환별로 보면 승모판막 질환은 241명에서 관찰되었고, 대동맥판 질환은 230명에서 관찰되었다. 관상동맥 조영술을 시행받은 환자는 297명(68.9%)으로 이 중 36명(12.1%)에서 유의한 협착증이 관찰되었고, 32명에서 관상동맥 우회로술이 판막 수술과 동시에 시행되었다. 다변량 분석결과 관상동맥의 유의한 협착은 65세 이상의 고령 [Odd ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372- 6.921, p = 0.006], 심혈관계 위험인자가 많은 경우(≥3) (OR = 3.002, 95% CI = 1.386-6.503, p = 0.005) 및 대동맥협착증(OR = 2.763, 95% CI = 1.269-6.013, p = 0.010)과 유의하게 연관되었다. 결론: 한국에서 판막 질환으로 수술적 치료를 시행받는 성인 환자에서 유의한 관상동맥 질환의 빈도는 12.1%로 주로 고령, 대동맥판막 협착증 및 많은 수의 심혈관계 위험인자를 가진 환자에서 높게 나타났다.
Abstract
Background/Aims:The identification of significant coronary arterial disease (CAD) is important to reduce perioperative ischemic insult and the possibility of repeated open-chest surgery in patients scheduled to undergo valvular surgery. However, there are no published data on the incidence of significant CAD in these patients. Thus, we examined the prevalence of significant CAD in patients scheduled to undergo valvular surgery. Methods:From January 2005 to June 2011, all consecutive adult patients diagnosed with significant valvular disease and scheduled for an elective open valvular operation were retrospectively investigated at Chungnam National University Hospital and Chonbuk National University Hospital. Patients who underwent emergent valvular operations due to acute aortic dissection or trauma and concomitant valvular operations at the time of coronary artery bypass graft (CABG) surgery were excluded. Results:During the study period, a total of 431 patients (58 ± 13 years old, 204 males) were included. The distributions of mitral (241 patients) and aortic valvular disease (230 patients) were similar. Coronary angiography was performed in 297 patients (68.9%). Of these, 36 (12.1%) showed significant CAD and 32 underwent concomitant CABG operations. Based on a multivariate analysis, the presence of CAD was significantly associated with old age (≥ 65 years old) [odds ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], more cardiovascular risk factors (≥ 3) (OR = 3.002, 95% CI = 1.386-6.503, p = 0.005), and the presence of aortic stenosis (OR = 2.763, 95% CI = 1.269-6.013, p = 0.010). Conclusions:The incidence of significant CAD was 12.1% in adult patients who underwent valvular operations in Korea. CAD was more common in patients with old age, aortic stenosis, and multiple cardiovascular risk factors. (Korean J Med 2012;83:75-82)
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