관상동맥 중재술을 받은 급성 심근경색증 환자에서 흡연 유무에 따른 임상경과
Clinical Outcomes of Persistent Smoking in Patients with Acute Myocardial Infarction Who Underwent Percutaneous Coronary Intervention
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목적: 흡연은 관상동맥 질환의 위험인자로 잘 알려져 있으나, 급성 심근경색증의 발생 후에도 여전히 흡연을 지속하는 경우가 있다. 관상동맥 중재술을 받은 급성 심근경색증 환자에서 흡연유무에 따른 임상적 특성을 파악하고, 흡연 지속유무에 따른 임상경과의 차이를 파악하고자 하였다. 방법: 2007년 1월부터 2007년 12월까지 전남대학교병원에 내원한 급성 심근경색증 환자 498명 중에서 관상동맥 중재술을 시행하고 1년 동안 추적관찰이 완료되어 분석 가능한 407명(63.9 ± 11.9세, 남자; 70%)을 대상으로 하였다. 그 중 흡연을 하는 급성 심근경색증 환자는 I군 164명(57.9 ± 11.2세, 남자 93%), 비흡연 급성 심근경색증 환자는 II군 243명(68.0 ± 10.6세, 남자; 55%)으로 분류하였고, 흡연가 중에서 지속적인 흡연 환자는 IΑ군 95명(56.8 ± 10.5세, 남자; 92%), 금연한 환자는IΒ군 69명(59.4 ± 12.0세, 남자; 96% )으로 분류하여 각 군 간의 임상적 특징과 관상동맥 조영술 소견 및 1년 간 주요 심장사건 및 사망률에 대해서 분석하였다. 결과: 전체 환자를 1년간 추적관찰하였을 때, 주요 심장 사건은 112예(27.6%) 였으며 사망은 42예(10.3%)에서 관찰되었다. 전체 환자 중 내원 시 흡연여부에 따른 임상경과를 비교한 결과, 흡연환자(I군)는 비흡연환자(II군)에 비해 1년간 주요 심장 사건은 유의한 차이를 보이지 않았으며, 사망률은 유의하게 낮았으나(I군: 6% vs. II군: 13%, p = 0.021), 다변량 분석 결과 내원 당시 흡연유무는 1년 사망률에 영향을 미치는 독립적인 인자는 아니었다. 흡연환자 중에서 관상동맥 중재술 시술 후 흡연지속여부에 따른 임상적 특징과 관상동맥 조영술 소견 및 1년간 임상경과를 비교한 결과, 흡연을 지속한 군(IΑ)에서 지속하지 않은 군(IΒ)에 비해 주요 심장사건은 유의한 차이를 보이지 않았으나 사망률은 유의하게 높았다[IΑ: 11% (n = 10) vs. IB: 0% (n = 0)]. 결론: 급성 심근경색증으로 관상동맥 중재술을 받은 환자에서 시술 후에도 지속적인 흡연을 하는 환자는 금연한 환자에 비하여 일 년 후 사망율이 높았다.
Abstract
Background/Aims:To analyze the clinical effects of continuing to smoke in patients with acute myocardial infarction (AMI), clinical outcomes of those continuing or ceasing smoking were compared. Methods:In total, 498 patients with AMI who underwent percutaneous coronary intervention (PCI) from January to December 2007 were enrolled. Of these patients, 407 (63.9 ± 11.9 years, males 70%) with 1-year follow-ups were analyzed. Based on risk factors for smoking, patients were divided into two groups: Group I (smokers, n = 164, 57.9 ± 11.2 years) and Group II (nonsmokers, n = 243, 68.0 ± 10.6 years). Additionally, Group I patients were subdivided by cessation of smoking after discharge: Group IA (current smokers, n = 95, 56.8 ± 10.5 years) and IB (past smokers, n = 69, 59.4 ± 12.0 years). Clinical characteristics, coronary angiographic and procedural findings, and 1year major adverse cardiac events (MACE) were analyzed. Results:During the 1-year follow-up period, MACE developed in 112 patients (27.6%) and death in 42 patients (10.3%). In terms of smoking habits at admission, there was no significant difference in the 1-year MACE between current smokers (Group I) and nonsmokers (Group II). In the subgroup analysis, there were no significant difference in clinical characteristics between Groups IΑ and IΒ. Mortality was significantly higher in Group IA than in Group IB during the 1-year clinical follow-up (11% vs. 0%; p = 0.005). Conclusions:Of the AMI patients who underwent PCI, mortality was significantly higher in current smokers than in past smokers after PCI. (Korean J Med 2011;80:562-570)
참고문헌 (27)
- 이기홍, "한국인 급성 심근경색증 등록 연구에서 성별에 따른 임상적 특징과 초기 치료의 차이", Korean Circulation Journal, 37(3), pp.64~71 (2007), 대한심장학회
- Jeong MH, "Korean registry of acute myocardial infarction", Korean Circ J, 38, pp.13~18 (2008)
- Yoon YE, "National cholesterol education panel III guidelines performance role in preventing myocardial infarction in a large cohort without a history of coronary artery disease: Korea Acute Myocardial Infarction Registry Study", Prev Cardiol, 12, pp.109~113 (2009)
- 정명호, "급성 심근경색증 환자에서 치료 시간 지연을 줄일 수 있는가? - 한국인 급성 심근경색증 등록 연구의 경험", 대한내과학회지, 78(5), pp.582~585 (2010), 대한내과학회
- Sukiennik A, "Smokers versus non-smokers undergoing percutaneous transluminal coronary angioplasty: the impact of clinical and procedural characteristics on in-hospital mortality", Cardiol J, 14, pp.482~492 (2007)
- Koyanagi R, "Primary percutaneous coronary intervention vs conservative treatment for acute ST elevation myocardial infarction: short-and long-term follow up according to disease severity", Circ J, 72, pp.1391~1396 (2008)
- Madan P, "Predicting major adverse cardiac events after percutaneous coronary intervention: the Texas heart institute risk score", Am Heart J, 155, pp.1068~1074 (2008)
- Epstein LH, "Smoking, stress, and coronary heart disease", J Consult Clin Psychol, 56, pp.342~349 (1988)
- Greenwood DC, "Stress, social support, and stopping smoking after myocardial infarction in England", J Epidemiol Community Health, 49, pp.583~587 (1995)
- Kini AS, "Coronary angiography, lesion classification and severity assessment", Cardiol Clin, 24, pp.153~162 (2006)
- Scanlon PJ, "ACC", AHA guidelines for coronary angiography: a report of the American College of Cardiology, J Am Coll Cardiol, pp.1999, 33[DOI]
- Thygesen K, "Universal definition of myocardial infarction", Eur Heart J, 28, pp.2525~2538 (2007)
- Castelli WP, "Cardiovascular disease and multifactorial risk: challenge of the 1980s", Am Heart J, 106, pp.1191~1200 (1983)
- Ambrose JA, "The pathophysiology of cigarette smoking and cardiovascular disease: an update", J Am Coll Cardiol, 43, pp.1731~1737 (2004)
- Bullen C, "Impact of tobacco smoking and smoking cessation on cardiovascular risk and disease", Expert Rev Cardiovasc Ther, 6, pp.883~895 (2008)
- 임상엽, "75세 이상 고령 급성 심근경색증 환자에서 일차적관상동맥 중재술 후 장기적 임상 경과", Korean Circulation Journal, 35(8), pp.613~619 (2005), 대한심장학회
- Park JC, "Clinical characteristics of coronary interventions in old aged patients", Korean Circ J, 28, pp.256~261 (1998)
- DeGeare VS, "Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials)", Am J Cardiol, 86, pp.30~34 (2000)
- Batchelor WB, "Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians. National Cardiovascular Network Collaboration", J Am Coll Cardiol, 36, pp.723~730 (2000)
- Won YI, "Baseline factors associated with smoking cessation", J Korean Acad Fam Med, 13, pp.862~868 (1992)
- 이군자, "6개월 금연 성공의 영향 요인 연구 - 인천광역시 보건소 금연클리닉을 방문한 흡연자를 중심으로", Journal of Korean Academy of Nursing, 36(5), pp.742~750 (2006), 한국호과학회
- 심재윤, "금연클리닉에서 금연성공과 관련된 요인", Korean Journal of Family Medicine, 23(3), pp.325~333 (2002), 대한가정의학회
- Anderson JL, "ACC", AHA 2007 guidelines for the management of patients with unstable angina, American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 guidelines for the management of patients with unstable Angina, pp.non-ST-elevation myocardial infarction) developed in collaboration with the American college of emergency physicians, the society for cardiovascular angiography and interventions, and the society of thoracic surgeons endorsed by the American association of cardiovascular and pulmonary rehabilitation and the society for academic emergency medicine, J Am Coll Cardiol[DOI]
- Hasdai D, "Effect of smoking status on the long-term outcome after successful percutaneous coronary revascularization", N Engl J Med, 336, pp.755~761 (1997)
- Weisz G, "Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction: the smoker's paradox revisited", Am Heart J, 150, pp.358~364 (2005)
- Mohiuddin SM, "Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease", Chest, 131, pp.446~452 (2007)
- Rea TD, "Smoking status and risk for recurrent coronary events after myocardial infarction", Ann Intern Med, 137, pp.494~500 (2002)