급성 ST 분절 비상승 심근경색증의 경색 관련 동맥 완전 폐색 예측인자
Predictors of total occlusion of the infarct-related artery in patients with acute Non-ST elevation myocardial infarction
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Background/Aims : Some patients with non-ST elevation myocardial infarction (NSTEMI) have total occlusion of the infarct related artery (IRA) and may benefit from early invasive treatments. The aim of this study was to investigate the predictors of total occlusion of the IRA in patients with NSTEMI before coronary angiography. Methods : A total of 205 consecutive patients with NSTEMI (63.3±10.5 years, 123 males) who were admitted and underwent coronary angiogram from April 2005 to December 2006 at Chonnam National University Hospital were divided into two groups: group I (total occlusion of IRA: n=62, 61.1±13.3 years, 42 males) and group II (patent IRA: n=143, 64.2±11.3 years, 81 males). Clinical, biochemical and echocardiographic parameters on admission were compared between the groups. Results : A total occlusion of the IRA in patients with NSTEMI was observed in 62 (30.2%) patients most frequently in the left circumflex coronary artery. The predictive factors for total occlusion, according to the multivariate analysis, were prolonged duration of continuous chest pain (OR:9.67, 95% CI:1.59～80.6, p=0.03), a higher level of the creatine kinase-MB fraction (CK-MB) (OR:5.35, 95% CI:1.31～90.0, p=0.035) and fibrinogen (OR:6.73, 95% CI:1.48～50.2, p=0.043), and multiple leads with ST depression on the ECG (OR:4.78, 95% CI:1.22～41.9, p=0.048). Conclusions : Total occlusion of the IRA in patients with acute NSEMI is associated with a long duration of chest pain, high levels of CK-MB and fibrinogen, and ST changes in multiple ECG leads. (Korean J Med 74:271-280, 2008)
Abstract
Background/Aims : Some patients with non-ST elevation myocardial infarction (NSTEMI) have total occlusion of the infarct related artery (IRA) and may benefit from early invasive treatments. The aim of this study was to investigate the predictors of total occlusion of the IRA in patients with NSTEMI before coronary angiography. Methods : A total of 205 consecutive patients with NSTEMI (63.3±10.5 years, 123 males) who were admitted and underwent coronary angiogram from April 2005 to December 2006 at Chonnam National University Hospital were divided into two groups: group I (total occlusion of IRA: n=62, 61.1±13.3 years, 42 males) and group II (patent IRA: n=143, 64.2±11.3 years, 81 males). Clinical, biochemical and echocardiographic parameters on admission were compared between the groups. Results : A total occlusion of the IRA in patients with NSTEMI was observed in 62 (30.2%) patients most frequently in the left circumflex coronary artery. The predictive factors for total occlusion, according to the multivariate analysis, were prolonged duration of continuous chest pain (OR:9.67, 95% CI:1.59～80.6, p=0.03), a higher level of the creatine kinase-MB fraction (CK-MB) (OR:5.35, 95% CI:1.31～90.0, p=0.035) and fibrinogen (OR:6.73, 95% CI:1.48～50.2, p=0.043), and multiple leads with ST depression on the ECG (OR:4.78, 95% CI:1.22～41.9, p=0.048). Conclusions : Total occlusion of the IRA in patients with acute NSEMI is associated with a long duration of chest pain, high levels of CK-MB and fibrinogen, and ST changes in multiple ECG leads. (Korean J Med 74:271-280, 2008)
참고문헌 (30)
- Antman EM, "ACC", AHA guidelines for the management of patients with ST-elevation myocardial infarction, 2004, pp.110, 588~636
- DeWood MA, "Coronary arteriographic findings soon after non-Q-wave myocardial infarction", N Engl J Med, 315, pp.417~423 (1986)
- Keen WD, "Comparison of coronary angiographic findings during the first six hours of non-Q-wave and Q-wave myocardial infarction", Am J Cardiol, 74, pp.324~328 (1994)
- Watanabe N, "Noninvasive detection of total occlusion of the left anterior descending coronary artery with transthoracic Doppler echocardiography", J Am Coll Cardiol, 38, pp.1328~1332 (2001)
- Hochman JS, "Coronary intervention for persistent occlusion after myocardial infarction", N Engl J Med, 355, pp.2395~2407 (2006)
- Puma JA, "The natural history of single-vessel chronic coronary occlusion: a 25-year experience", Am Heart J, 133, pp.393~399 (1997)
- Trappe HJ, "Natural history of single vessel disease: risk of sudden coronary death in relation to coronary anatomy and arrhythmia profile", Eur Heart J, 10, pp.514~524 (1989)
- Antman EM, "The TIMI risk score for unstable angina", non- ST elevation MI: a method for prognostication and therapeutic decision making, 2000, pp.284, 835~842
- Braunwald E, "ACC", AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction, 2002, pp.106, 1893~1900
- Hirsch A, "Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study", Lancet, 369, pp.827~835 (2007)
- Bavry AA, "Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials", J Am Coll Cardiol, 48, pp.1319~1325 (2006)
- Mehta SR, "Routine vs. selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials", JAMA, 293, pp.2908~2917 (2005)
- Lagerqvist B, "A long-term perspective effects of an early invasive strategy in unstable coronary artery disease: two-year follow-up of the FRISC-II invasive study", J Am Coll Cardiol, 40, pp.1902~1914 (2002)
- Fox KA, "5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial", Lancet, 366, pp.914~920 (2005)
- Eagle KA, "A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry", JAMA, 291, pp.2727~2733 (2004)
- Bodi V, "Risk stratification in non-ST elevation acute coronary syndromes: predictive power of troponin I, C-reactive protein, fibrinogen and homocysteine", Int J Cardiol, 98, pp.277~283 (2005)
- Kalil Filho R, "Role of circumflex coronary artery involvement in non-Q wave myocardial infarction", Arq Bras Cardiol, 65, pp.125~128 (1995)
- Matetzky S, "Significance of ST segment elevations in posterior chest leads (V7 to V9) in patients with acute inferior myocardial infarction: application for thrombolytic therapy", J Am Coll Cardiol, 31, pp.506~511 (1998)
- Menown LB, "Early diagnosis of right ventricular or posterior infarction associated with inferior wall left ventricular acute myocardial infarction", Am J Cardiol, 85, pp.934~938 (2000)
- 김계훈, "심근경색증 환자에서 후흉부 유도의 임상적 가치", Korean Circulation Journal, 35(3), pp.258~263 (2005), 대한심장학회
- Lindahl B, "Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease", Circulation, 93, pp.1651~1657 (1996)
- Antman EM, "Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes", N Engl J Med, 335, pp.1342~1349 (1996)
- Luscher MS, "Applicability of cardiac troponin T and I for early risk stratification in unstable coronary artery disease", Circulation, 96, pp.2578~2585 (1997)
- Toss H, "Prognostic influence of increased fibrinogen and C-reactive protein levels in unstable coronary artery disease", Circulation, 96, pp.4204~4210 (1997)
- Danesh J, "Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease", JAMA, 279, pp.1477~1482 (1998)
- Wang TJ, "Multiple biomarkers for the prediction of first major cardiovascular events and death", N Engl J Med, 355, pp.2631~2639 (2006)
- Magalhaes CK, "Correlation between biochemical markers and coronary angiography in patients with non-ST elevation acute coronary syndromes", Arq Bras Cardiol, 86, pp.223~231 (2006)
- Ledwich JR, "Chest pain duration in myocardial infarction", JAMA, 244, pp.2172~2174 (1980)
- Leong-Poi H, "Perfusion versus function: the ischemic cascade in demand ischemia: implications of single-vessel versus multivessel stenosis", Circulation, 105, pp.987~992 (2002)
- Nesto RW, "The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia", Am J Cardiol, 59, pp.23~30 (1987)