추적 관상동맥조영술을 받은 급성관동맥증후군 환자의 재협착 유무와 자가관리 이행
Restenosis and Compliance with Self-Care Among Acute Coronary Syndrome Patients Undergoing Follow-up Angiograms
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연구배경: 추후관리 또는 증상발현으로 추적 관상동맥조영술을 시행하기 위해 입원한 ACS 환자를 대상으로 재협착 유무에 따른 증상관련 만족도와 자가관리 이행 정도를 파악하고, 재협착 및 낮은 자가관리 이행을 예측하는 인자를 확인하고자 하였다. 방법: 일 지역 소재 3차 의료기관인 C대학병원에서 과거 ACS로 진단 받고 2010년 1월부터 7월까지 순환기 내과 병동에 입원하여 추적 관상동맥조영술을 시행 받은 환자들을 편의 표집하여 자가보고형 설문지를 이용하였다. 결과: 본 연구에서 재협착률은 40.4% 이었으며, 재협착과 자가관리 이행과의 통계적 유의성은 보이지 않았다. 재협착의 예측인자로는 일상생활에서 증상관련 만족도가 낮은 경우와 첫 PCI 후 경과기간이 긴 경우로 나타났고, 낮은 자가관리 이행에는 흡연의 지속과 낮은 증상관련 만족도, 그리고 첫 PCI 후 경과기간이 짧은 경우가 독립적 예측인자인 것으로 밝혀졌다. 결론: 본 연구에서 재협착과 자가관리 이행 정도와의 상관성은 규명하지 못하였으나 초발 ACS 환자를 대상으로 추후관리 기간 동안 금연 교육과 증상관련 일상생활 만족도 정도를 사정하는 지지가 필요함을 확인하였다. 향후 대상자의 입원 시 증상 유무를 고려하고 첫 추적 관상동맥조영술 환자만을 대상으로 더 많은 표본을 확보한 반복 연구를 제언한다.
Abstract
Background: Compliance with self-care and lifestyle modification is recommended for all patients with acute coronary syndrome to prevent a secondary attack. Data is limited regarding the association between compliance with self-care and restenosis. This study was conducted to examine the association between compliance with self-care and restenosis and to determine the predicting factors for restenosis and low compliance with self-care. Methods: A total of 166 acute coronary syndrome patients (64.2±10.8 years) hospitalized for an angiogram during routine follow-up or symptom management were conveniently recruited from a university hospital cardiovascular care unit. Self-administered questionnaires were used to evaluate the level of compliance with self-care and symptom-related satisfaction. Results: In-stent restenosis was found in 40.4% of the subjects and 36.1% were persistently smoking. There was no significant relationship between low compliance with self-care and restensosis. A lower symptom-related satisfaction significantly predicted restenosis and low compliance with self-care. A longer period after initial diagnosis predicted restenosis and a shorter period after initial diagnosis predicted low compliance with self-care. Persistent smoking was independently associated with low compliance with self-care. Conclusions: Patients who continued to smoke and had lower symptom-related satisfaction with daily living showed a stronger tendency for lower compliance with self-care and lifestyle modification. Effective educational strategy focusing on smoking cessation is needed to increase compliance with self-care in patients with ACS, especially during admission with a first heart attack.
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