QMI7.1 vs. 2 %, p0.05. ConclusionNQMI is associated with similar complication rates with QMI and higher re-infarction rates than QMI, and thus NQMI sh

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1 Original Articles 비 Q 파급성심근경색증환자의임상적특징 Abstract 김성희 김준우 김주한 안영근 배열 박종철 차광수박주형 정명호 * 조정관 * 박종춘 * 강정채 * Clinical Features of Non-Q Wave Acute Myocardial Infarction Sung Hee Kim, M.D., Joon Woo Kim, M.D., Ju Han Kim, M.D., Young Keun Ahn, M.D., Yul Bae, M.D., Jong Cheol Park, M.D., Kwang Soo Cha, M.D., Joo Hyung Park, M.D., Myung Ho Jeong, M.D.,* Jeong Gwan Cho, M.D.,* Jong Chun Park, M.D.,* Jung Chaee Kang, M.D.* Department of Internal Medicine, Chonnam University Medical School, Chonnam, Korea Research Institute of Medical Sciences,* Chonnam National University, Chonnam, Korea BackgroundNon-Q wave myocardial infarctionnqmi is known to have smaller infarct size and less degree of ventricular dysfunction than Q wave myocardial infarctionqmi. However, clinical characteristics of NQMI compared to QMI are not known exactly. To evaluate the clinical outcome of NQMI, retrospective analysis of NQMI was performed. MethodSubjects were male, 32 female yearspatients with acute myocardial infarction who visited the emergency room of Chonnam University Hospital between January 1995 and July Inclusion criteria were prolonged30 min angina, persistent EKG changes consistent with QMI or NQMI, an increasetwice than normalin serum CKnormal30170 U/L with CK- MBnormal016 U/L enzyme. Thirty four28 male, 6 female years) patients were diagnosed as NQMI and male, 26 female yrs patients as QMI. Results 1 Percentage of patients who received thrombolytic therapy was not different between NQMI50 % and QMI51 %. 2 There was no differences in the atherosclerosis risk factors between NQMI and QMI. 3 Peak cardiac enzyme was not different between NQMI and QMI. 4 Lateral wall infarction by EKG was more frequent in NQMI than QMI8.8 vs. 0.8 %, p According to coronary angiogram, LCX involvement was more frequent in NQMI than in QMI17.8 vs. 1 %, p Percentage of coronary revascularizations, including PTCA and CABG, was not different between two groups. 7 There were no differences in the incidences of in-hospital mortality and arrhythmia between two groups. 8 During months follow-up, reinfarction rate was more frequent in NQMI than in 875

2 QMI7.1 vs. 2 %, p0.05. ConclusionNQMI is associated with similar complication rates with QMI and higher re-infarction rates than QMI, and thus NQMI should be treated rigorously at early and follow-up time periods. KEY WORDSNon-Q wave myocardial infarction Q wave myocardial infarction Complication rate Re-infarction rate. 서론 대상및방법 876

3 결과 1. 관찰대상환자의임상적차이 2. 응급실내원시간 3. 혈전용해제투여 4. 심전도소견 Table 1. Clinical characteristics of QMI and NQMI QMI NQMI Age SexMF Risk factors Family history 8 6.6% 1 2.9% Smoking % % Hypertension % 926.4% Diabetes % 720.5% Hyperlipidemia % 514.7% QMIQ wave myocardial infarction NQMINon-Q wave myocardial infarction 877

4 5. 심근효소및혈청지질소견 6. 관상동맥및좌심실조영술소견 Table 2. Coronary angiographic findings QMI n=99 NQMI n=28 p value Number No stenosis 4 3.9% 2 6.6% NS of 1 vessel 4039% 1343% NS involved 2 vessels 3736% 1137% NS vessels 3 vessels 2222% 413% 0.05 Involved LAD % 612% NS vessels LCX 1 1% 517.8% 0.05 RCA 5 5% 27.2% NS LAD+LCX 9 9% 310.7% NS LAD+RCA % 621.4% NS LCX+RCA 9 9% 2 7.2% NS LADleft anterior descending artery LCXleft circumflex artery RCAright coronary artery 7. 합병증 8. 관상동맥재관류요법 9. 추적관찰 Table 3. Comparison of Killip class and left ventricular EF between QMI and NQMI QMI NQMI Killip class 6151% 2050% 3629% 823.5% 2117% 3 8.8% 3 2.4% 3 8.8% EF% EFejection fraction Table 4. Complications during admission QMIn=121 NQMIn=34 Bleeding 5 4.1% 0 0% Arrhythmia 3630% 1029% CHF 2117% 3 9% Shock 3 2.4% 3 9% Death 1215% 3 9% Total 7763% 1955% CHFcongestive heart failure 878

5 Table 5. Causes of death during admission and follow-up QMI NQMI p value In hospital NS Sudden death 3 0 CHF or Shock 9 3 After discharge NS Sudden death 5 1 Total % 412.9% NS Table 6. Clinical course after discharge QMIn=97 NQMIn=28 Event free 7275% 2175% Reccurent pain 1010% 2 7.1% CHF 8 8.2% 2 7.1% Reinfarction 2 2% 2 7.l%* Death 5 5.1% 1 3.5% *p0.05 고 안 879

6 880

7 요약 연구배경 : 연구대상및방법 : 결과 : 881

8 결론 : References 1) Antman EM, Braunwald E:Acute myocardial infarction. Heart disease;a text book of cardiovascular medicine. 5th Ed. p1184, Philadelphia, W.B. Saunders Co, ) 강정채 : 급성심근경색증의임상. 순환기 23 : , ) 김범수 조승연 심원흠 정남식 장양수 안중배 조재용 김성순 : 급성심근경색증환자의임상적고찰. 순환기 22: , ) Horan LG, Flowers NC, Johnson JC:Significance of the diagnostic Q wave of myocardical infarction. Circulation 43: , ) Pruitt RD, Klakeg CH, Chapin LE:Certain clinical states and pathologic changes associated with deeply inverted T waves in the precordial electrocar-diogram. Circulation 11: , ) Zema MJ:Q wave, S-T segment and T wave myocardial infarction. Am J Med 78: , ) Levine HD:Subendocardial infarction in retrospect: pathologic, cardiographic and ancillary features. Circulation 72: , ) Spodick DH:Q-wave infarction versus S-T infarction. Am J Cardiol 51: , ) 최윤식 : 임상심전도학. p52-60, 서울대학교출판부, ) Madigan NP, Rutherford BD, Frye RL:The clinical course, early prognosis and coronary anatomy of subendocardial infarction. Am J Med 60: , ) 이만영 승기배 김종진 노태호 채장성 김종상 홍순조 최규보 :Q 파심근경색증과 non-q 파심근경색증. 대한내과학회잡지 39: , ) 한세환 황산 김성구 권영주 김계혁 라성찬 전동하 어중건 : Q 파및비 -Q 파심근경색증의임상적소견및관동맥조영술소견의비교관찰. 순환기 25: , ) 이재련 석준호 박종선 신동구 김영조 심봉섭 : 비 Q 파급성심근경색증의임상적특징및심전도와경색관련동맥과의관계. 순환기 26:52-61, ) Edlavitch SA, Crow R, Burke GL, Baxter J:Secular trends in Q wave and non-q wave acute myocardial infarction. Circulation 83: , ) Ogawa H, Hiramori K, Haze K, Saito M, Sumiyoshi T, Fukami K, Goto Y, Ikeda M:Comparison of clinical 1 Heart J 111: , ) Coll S, Castaner A, Sanz G, Roig E, Nagrina J, Mavarro- Lopez F, Betriu A:Prevalence and prognosis after a first nontransmural myocardial infarction. Am J Cardiol 51: , ) Madias JE, Chahine RA, Gorlin R, Blacklow DJ:A comparison of transmural and nontransmural acute myocardial infarction. Circulation XLIX: , ) Maisel AS, Ahnve S, Gilpin E, Henning H, Goldberger AL, Collins D, LeWinter M, Ross J:Prognosis after extension of myocardial infarct:the role of Q wave or non-q wave infarction. Circulation 71: , ) Cannom DS, Levy W, Cohen LS:The short- and longterm prognosis of patients with transmural and nontransmural myocardial infarction. Am J Med 61: , ) Nicod P, Gilpin E, Dittrich H, Polikar R, Hjalmarson A, Blacky AR, Henning H, Ross J:Short-and long-term clinical outcome after Q wave and non-q wave muocardial infarction in a large patient population. Circulation 79: , ) Gibson RS, Beller GA, Gheorghiade M, Nygaard TW, Watson DD, Huey BL, Sayre SL, Kaiser DL:The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-q wave infarction:a prospective natural history study. Circulation 73: , ) Isselbacher EM, Siu SC, Weyman AE, Picard MH:Absence of Q waves after thrombolysis predicts more rapid improvement of regional left ventricular dysfunction. Am Heart J 131:649-54, ) Suryapranata H, Serruys PW, Beatt K, Feyter PD, Brand MVD, Roelandt J:Recovery of regional myocardial dysfunction after successful coronary angioplasty early after a non-q wave myocardial infarction. Am Heart J 120: , ) Irimpen AM, Tenaglia AN, Shin DJ, Buda AJ:Lack of ventricular remodeling in non-q wave myocardial infarction. Am Heart J 131: , ) Aguirre FV, Younis LT, Chaitmen BR, Ross AM, McMahon RP, Kern MJ, Berger PB, Sopko G, Rogers WJ, Shaw L, Knatterud G, Braunwald E:Early and 1-year clinical outcome of patients evolving non-q wave versus Q-wave myocardial infarction after thrombolysis. Result from the TIMI Ⅱ study. Circulation 91: ,

9 26) Ogawa H, Misumi I, Sakamoto T, Masuda T, Okubo H, Miyao Y, Yasue H:Difference in plasminogen activator inhibitor activity between non-q wave infarction and Q- wave infarction. Int J Cardiol 41: , ) Gheorghiade M, Schultz L, Tilley B, Kao W, Goldstein S:Natural history of the first non-q wave myocardial infarction in the placebo arm of the betablocker heart attack trial. Am Heart J 122: , ) Dewood MA, Stifter WF, Simpson CS, Spores J, Eugster GS, Judge TP, Hinnen ML:Coronary arteriographic findings soon after non-q wave myocardial infarction. N Engl J Med 315: , ) Langer A, Goodman SG, Topol EJ, Charlesworth A, Skene AM, Wilcox RG, Armstrong PW:Late assessment of thrombolytic efficacy(late) study:prognosis in patients with non-q wave myocardial infarction. J Am Coll Cardiol 27: ,

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar