ST분절 상승 심근경색증 환자에서 시간 지연이 사망률에 미치는 영향
Clinical Impact of Time Delay on 1-Year Mortality in Patients with ST-Segment Elevation Myocardial Infarction
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목적: ST분절 상승 심근경색증 환자에서 증상 발생 후 일차적 관동맥 중재술까지의 시간지연은 중요한 예후인자로 알려져 있다. 본 연구는 ST분절 상승 심근경색증 환자에서 시간지연을 분석하고 증상 발생 후 일차적 관동맥 중재술까지의 시간이 임상 성적에 미치는 영향을 알아보고자 하였다. 방법: 한국인 급성 심근경색증 등록 연구사업(Korea Acute Myocardial Infarction Registry, KAMIR)에 등록된 환자 중 증상 발생 후 12시간 내에 일차적 관동맥 중재술을 시행 받은 ST상승 급성심근경색증 환자 3,399명을 대상으로 하였다. 증상 발생 후 일차적 관동맥 중재술 까지의 시간이 3시간 이내를 I군(n = 955), 3시간 이상을 II군(n = 2,444)으로 분류하여 병원 내 사망률, 1년 사망률과 주요 심혈관계 합병증 발생률을 비교하였다. 결과: 증상 발생 후 병원 도착까지의 평균 시간은 188.0 ± 133.6분(중앙값: 152), 병원 도착 후 일차적 관동맥 중재술까지의 시간은 평균 97.8 ± 67.9분(중앙값: 80), 증상 발생 후 일차적 관동맥 중재술까지의 시간은 285.8 ± 146.2분(중앙값: 250)이었다. 병원 내 사망률은 I군(3.6%)에서 II군(5.2%, p = 0.044)보다 유의하게 낮았으며, 1년 사망률도 I군(4.7%)에서 II군(7.2%, p = 0.012)보다 유의하게 낮았다. 1년 주요 심혈관계 합병증 발생률은 양 군 간에 유의한 차이는 없었다(I군 17.9%, II군 20.4%, p = 0.179). 결론: ST분절 상승 심근경색증 환자에서 병원 도착 전 많은 시간이 지연되며 이러한 시간 지연이 1년 사망률과 연관성이 있음을 알 수 있었다.
Abstract
Background/Aims:The delay between the onset of myocardial infarction symptoms and primary percutaneous coronary intervention (PCI) is an important prognostic factor in patients with ST-segment elevation acute myocardial infarction (STEMI). We reviewed this delay in patients with STEMI and analyzed clinical outcomes. Methods:The study enrolled 3,399 patients (age, 61.4 ± 12.8 years; 25.6% women) with STEMI who underwent primary PCI within 12 hours of symptom onset between October 2005 and February 2008 from the Korea Acute Myocardial Infarction Registry. The patients were divided into two groups according to the symptom-to-balloon time: group I (≤ 3 hours, n = 955) and group II (> 3 hours, n = 2444). The in-hospital mortality rates and 1-year mortality and major adverse cardiac event (MACE) rates were compared between the two groups. Results:The mean time interval from the onset of symptoms to arrival at the emergency room (ER) was 188.0 ± 133.6 minutes (median, 152 minutes). The mean time interval from the ER to reperfusion (door-to-balloon time) was 97.8 ± 67.9 minutes (median, 80 minutes). The mean time interval from the onset of symptoms to reperfusion (symptom-to-balloon time) was 285.8 ± 146.2 minutes (median 250 minutes). The in-hospital mortality rate was significantly lower in group I as compared with group II (3.6% versus 5.2%, p = 0.044). The 1-year mortality rate was also significantly lower in group I (4.7% versus 7.2%, p = 0.012), while the 1-year MACE rate was not significantly different between groups (17.9% versus 20.4%, p = 0.179). Conclusions:This study demonstrates that there is a significant pre-hospital time delay in patients with STEMI in Korea and this time delay is associated with increased 1-year mortality. (Korean J Med 2011;81:199-207)
참고문헌 (17)
- 홍재석, "Long-Term Trend in the Incidence of Acute Myocardial Infarction in Korea: 1997-2007", Korean Circulation Journal, 39(11), pp.467~476 (2009), 대한심장학회
- De Luca G, "Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty", Eur Heart J, 25, pp.1009~1013 (2004)
- Keeley EC, "Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials", Lancet, 361, pp.13~20 (2003)
- Antoniucci D, "Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty", Am J Cardiol, 89, pp.1248~1252 (2002)
- De Luca G, "Symptom-onsetto- balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty", J Am Coll Cardiol, 42, pp.991~997 (2003)
- Brodie BR, "Impact of treatment delays on outcomes of primary percutaneous coronary intervention for acute myocardial infarction: analysis from the cadillac trial", Am Heart J, 151, pp.1231~1238 (2006)
- Young Bin Song, "The Impact of Initial Treatment Delay Using Primary Angioplasty on Mortality among Patients with Acute Myocardial Infarction: from the Korea Acute Myocardial Infarction Registry", Journal of Korean Medical Science, 23(3), pp.357~364 (2008), 대한의학회
- 김정애, "ST분절 상승 심근경색 환자의 일차적 관동맥중재술까지 시간 지연 인자", 대한내과학회지, 78(5), pp.586~594 (2010), 대한내과학회
- 이선옥, "ST분절 비상승 심근경색증 환자에서 증상발생 후 병원 도착 시간이 일년 후 사망률에 미치는 임상적 영향", 대한내과학회지, 78(6), pp.717~724 (2010), 대한내과학회
- Thygesen K, "Universal definition of myocardial infarction", Eur Heart J, 28, pp.2525~2538 (2007)
- Ryan TJ, "Guidelines for percutaneous transluminal coronary angioplasty: a report of the American Heart Association", American College of Cardiology Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (committee on percutaneous transluminal coronary angioplasty), 1993, pp.88, 2987~3007
- Scanlon PJ, "ACC", AHA guidelines for coronary angiography: a report of the American College of Cardiology, J Am Coll Cardiol, pp.1999, 33[DOI]
- Antman EM, "2007 focused update of the ACC", AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology, AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction, writing on Behalf of the 2004 Writing Committee, pp.Circulation, 2008[DOI]
- Saczynski JS, "Trends in prehospital delay in patients with acute myocardial infarction (from the Worcester Heart Attack Study)", Am J Cardiol, 102, pp.1589~1594 (2008)
- De Luca G, "Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts", Circulation, 109, pp.1223~1225 (2004)
- Brodie BR, "Door-to-balloon time with primary percutaneous coronary intervention for acute myocardial infarction impacts late cardiac mortality in high-risk patients and patients presenting early after the onset of symptoms", J Am Coll Cardiol, 47, pp.289~295 (2006)
- McNamara RL, "Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction", J Am Coll Cardiol, 47, pp.2180~2186 (2006)