급성 심근경색증 환자의 입원 중 합병증과 1년간 임상경과의 예측인자
Predictors of in-hospital complications and one-year clinical events in patients with acute myocardial infarction
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목적: 이 연구의 목적은 입원 초기 병원 내 합병증을 경험한 급성 심근경색증 환자의 임상적 특징을 조사하고 초기 합병증과 관련된 인자들을 찾아서 이들의 관계를 분석하고자 하였다. 방법: 전남대학교병원에 입원한 급성 심근경색증 환자 1,000명(63.4±12세, 남성 705명)을 대상으로 하였다. 이들을 병원 내 초기 합병증을 경험했던 환자군(총 175명, 65.6±12세, 남성 115명)과 그렇지 않은 군(총 825명, 62.8±12세, 남성 590명)으로 나누어 각 군의 특성을 비교 분석하였다. 입원 초기 합병증으로는 사망, 재경색증, 심인성 쇼크, 인공 심박동기가 필요할 정도의 서맥이나 방실 전도 장애, 악성 심실 부정맥 및 인공호흡기 치료가 필요했던 호흡부전을 포함하였다. 1년간 다양한 임상상과 혈액학적 검사, 심장 초음파 및 관상동맥 조영술 소견을 각 군 간에 비교하였다. 결과: 혈중 glucose, creatinine, 최대 creatinine kinase (CK), troponin-I, troponin-T, high sensitivity C-reactive peptide (hs- CRP)와 N-terminal pro B-type natriuretic peptide (NT-pro BNP) 농도가 I군에 비하여 II군에서 의미있게 증가되어 있었다(p<0.001). 좌심실 이완기와 수축기 직경, 구혈률, 승모판 역류증, 이완기능 부전 및 벽운동 지수가 두 군 사이에 유의한 차이를 보였다(p<0.001). 다변량 분석에서 초기 Killip 분류, ST-분절 상승 심근경색증, 혈중 glucose, creatinine, CK-MB, troponin I, hs-CRP, NT-pro BNP 농도와 승모판 역류증이 있는 경우 병원 내 초기 합병증과 관련된 독립적인 인자로 밝혀졌다. 일년간 추적관찰하였을 때 주요 심장 사건 발생률은 I군에서 II군에 비해 더 높았다(25.4% vs. 12.9%, p<0.001). 병원 내 초기 합병증, 그 중에서도 심폐소생술을 행했던 경우 대동 맥내 펌프를 삽입하였던 심인성 쇼크 및 인공 호흡기 치료를 하였던 경우는 일년간 주요심장 사건의 독립적인 인자였다. 결론: 고농도의 혈중 glucose, creatinine, CK-MB, troponin I, hs-CRP, NT-pro BNP와 승모판 역류증이 급성 심근경색증 환자에서 입원 초기 합병증과 관련된 의미있는 인자이다. 병원 내 합병증을 경험하였던 환자에서 1년 내 장기 추적 시 주요 심장 사건이 더 많이 발생했음을 알 수 있었다.
Abstract
Background/Aims: This study evaluated the predictors of in-hospital early complications and 1-year clinical events in patients with acute myocardial infarction (AMI). Methods: A total of 1,000 consecutive patients (63.4±12 years, 705 males) with AMI were divided into two groups according to the presence of in-hospital events (IHE): group I had IHEs (n=175, 65.6±12 years, 115 males), and group II had no events (n=825, 62.8±12 years, 590 males). IHE included death, cardiogenic shock, pacemaker implantation, ventricular arrhythmia, and mechanical ventilation. Results: The levels of glucose, creatinine, maximal creatine kinase (CK), troponin-I, hs-CRP, and NT-proBNP were higher in group I than in group II. Increased left ventricular dimension, a low ejection fraction, mitral regurgitation (MR), diastolic dysfunction, and a high wall motion score index were more common in group I compared with group II. The initial Killip class, ST-elevation AMI, and high levels of glucose, creatinine, CK-MB, troponin I, hs-CRP, NT-proBNP, and MR were significant independent predictors of IHE on multivariate analysis. During the 1-year follow-up, the major adverse cardiac event (MACE) rate was higher in group I than in group II. IHE, especially cardiopulmonary resuscitation, cardiogenic shock, and respiratory failure, were independent predictors of MACE during the 1-year clinical follow-up. Conclusions: High levels of glucose, creatinine, CK-MB, troponin I, hs-CRP, NT-proBNP, and MR were predictors of IHE, and the 1-year MACE-free survival was lower in AMI patients with IHE.
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