서론 대상및방법 대상환자 스텐트시술방법 관동맥조영술상분석 추적검사및정의 997

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1 Original Articles Korean Circulation J 2001;3110: 세이상고령환자의관동맥스텐트시술의특징 정욱성 김종진 승기배 조은주 문건웅 이종민 오용석윤호중 채장성 박인수 김재형 최규보 홍순조 Characteristics of Coronary Artery Stenting in the Elderly over 70 Years Old Short-Term Outcome and Long-Term Angiographic and Clinical Follow-up Wook Sung Chung, MD, Chong Jin Kim, MD, Ki Bae Seung, MD, Eun Joo Cho, MD, Keon Woong Moon, MD, Jong Min Lee, MD, Young Suk Oh, MD, Ho Joong Youn, MD, Jang Seong Chae, MD, Ihn Soo Park, MD, Jae Hyung Kim, MD, Kyu Bo Choi, MD and Soon Jo Hong, MD Department of Internal Medicine, Medical College, The Catholic University of Korea, Seoul, Korea ABSTRACT Background and ObjectivesThe average population in Korea is gradually becoming older. Elderly patients undergoing coronary revascularization are considered to be a high-risk group. There is a paucity of data that relates the results of stenting in treating coronary artery disease in the elderly population. This study compared the short- and long-term outcomes of elderly patients undergoing coronary artery stenting with those of younger patients. Materials and MethodThe elddrly patients 70 years of age who underwent coronary artery stenting between January 1997 and July 1999 n106 at our centers were compared with patients 70 years of age who also underwent coronary artery stenting during the same time period n597. ResultsElderly patients presented with a lower ejection fraction 52.9% vs. 57.4%, p0.001, more unstable angina 47% vs. 31%, p0.003, and a greater incidence of multivessel disease 67% vs. 51%, p0.005 than the younger patients. There were no differences in major in-hospital complications including death 0.9% vs. 0.5%, p NS, procedural acute Q-wave myocardial infarction 0.9% vs. 0.3%, pns, and emergency CABG 0% vs. 0.3%, pns between two groups. Furthermore, the vascular complication rate was similar between the two groups 1.9% vs. 1.0%, pns. An angiographic follow-up, obtained in both groups, demonstrated similar restenosis rates 26.5% vs. 24.9%, pns. Long-term clinical follow-up at 12 months showed that major adverse cardiac events including death, acute myocardial infarction, and repeat revascularization were significantly higher in elderly patients than in younger patients 18.3% vs. 12.6%, p0.04. ConclusionElderly patients with higher risk factors who underwent coronary artery stenting had similar rates of in-hospital procedural complications and similar rates of angiographic restenosis after 6 months follow-up, compared to younger patients. The overall rates of major adverse cardiac events in the elderly population at 12 months postcoronary artery stenting were significantly higher than those of younger patients. Korean Circulation J 2001; 3110: KEY WORDSAgedStentsFollow-up studies. 996

2 서론 대상및방법 대상환자 스텐트시술방법 관동맥조영술상분석 추적검사및정의 997

3 통계분석 결과 대상환자의임상적특징 관동맥조영술소견과스텐트시술에관련된특징 Table 1. Clinical characteristics of 703 patients Age70 n106 Age70 n597 Mean age years Male, n % Risk factors, n % Hypercholesterolemia 220 mg/dl NS Hypertension NS Current smoker Diabetes Renal insufficiency creatinine2.0 mg/dl, n % LVEF % Prior myocardial infarction, n % NS Clinical diagnosis, n % Stable angina Unstable angina Acute myocardial infarction NS Number of diseased vessels, n % NS Multivessel disease, n % NSnot significant, LVEFleft ventricular ejection fraction p 998 Korean Circulation J 2001;3110:

4 Table 2. Angiographic and procedural characteristics of 819 lesions Artery stented, n % Age70 n134 Age70 n685 p Left main NS Left anterior descending NS Left circumflex NS Right coronary artery NS Saphenous vein graft NS Modified AHA/ACC lesion type, n % A NS B B C NS B2 or C Total occlusion, n % NS Mean reference diameter mm NS Lesion % stenosis NS Final stent MLD mm NS Lesion length mm NS Maximal inflation pressure atm NS Number of stent per patient Use of IABP, n % NS AHA/ACCAmerican heart association/american college of cardiology, MLDminimal luminal diameter, IABPintraaortic balloon counterpulsation, NSnot significant Table 3. In-hospital clinical data Age70 n106 Age70 n597 p All major cardiac event NS Death NS Q-wave myocardial infarction NS Emergency CABG NS Non-Q wave myocardial infarction Vascular complication NS CABGcoronary artery bypass graft surgery, NSnot significant 병원내주요임상사건의비교 추적관동맥조영술소견 999

5 Table 4. Angiographic data at follow-up Age70 n131 Age70 n681 p Follow-up % Follow-up duration days Mean reference diameter mm NS Stent MLD mm NS Stent % stenosis NS Angiographic restenosis rate % NS Type of restenosis % Focal NS Diffuse NS Proliferative NS MLDminimal luminal diameter, NSnot significant Table 5. Clinical data at follow-up Age70 n104 Age70 n594 p Follow-up % Follow-up duration days MACE % Cardiac death NS Acute myocardial infarction NS Revascularization NS PCI NS CABG NS MACEmajor adverse cardiac event, PCIpercutaneous coronary intervention, CABGcoronary artery bypass graft surgery, NSnot significant 장기주요임상사건의비교 고찰 1000 Korean Circulation J 2001;3110:

6 요약 배경및목적 : 1001

7 방법 : 결과 : 결론 : 1002 중심단어 REFERENCES 1) Peterson ED, Jollis JG, Bebchuck JD, DeLong ER, Muhlbaier LH, Mark DB, Pryor DB. Changes in mortality after myocardial revascularization in the elderly. Ann Intern Med ) Little T, Milner MR, Lee K, Constantine J, Pichard AD, Lindsay J Jr. Late outcome and quality of life following percutaneous transluminal coronary angioplasty in octogenarians. Cathet Cardiovasc Diagn ) O Keefe JH, Sutton MB, McCallister BD, Vacek JL, Piehler JM, Ligon RW, Hartzler GC. Coronary angioplasty versus bypass surgery in patients 70 years old matched for ventricular function. J Am Coll Cardiol ) Morrison DA, Bies RD, Sacks J. Coronary angioplasty for elderly patients with high risk unstable angina shortterm outcomes and long-term survival. J Am Coll Cardiol ) Thompson RC, Holmes DR, Grill DE, Mock MB, Bailey KR. Changing outcome of angioplasty in the elderly. J Am Coll Cardiol ) Santana JO, Haft JI, LaMarche NS, Goldstein JE. Coronary angioplasty in patients eighty years of age or older. Am Heart J ) Thompson RC, Holmes DR, Gersh BJ, Mock MB, Bailey KR. Percutaneous transluminal coronary angioplasty in the elderly early and long term results. J Am Coll Cardiol ) Lindsay J, Reddy VM, Pinnow EE, Little T, Pichard AD. Morbidity and mortality rates in elderly patients undergoing percutaneous coronary transluminal angioplasty. Am Heart J ) Tan KH, Sulke N, Taub N, Karani S, Sowton E. Percutaneous transluminal coronary angioplasty in patients 70 years of age or older 12 years experience. Br Heart J ) Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C. Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med ) Hannan EL, Burke J. Effect of age on mortality in coronary artery bypass surgery in New York, Am Heart J ) Fishman RF, Kuntz RE, Carozza JP, Friedrich SP, Gordon PC, Senerchia CC, Baim DS. Acute and long term results of coronary stents and atherectomy in women and the elderly. Coron Artery Dis ) Ten Berg JM, Voors AA, Suttorp MJ, Ernst SM, Mast EG, Bal E, Plokker HW. Long term results after successful percutaneous transluminal coronary angioplasty in patients over 75 years of age. Am J Cardiol ) Paul SD, O Gara PT, Mahjoub ZA, DiSalvo TG, O Do- Korean Circulation J 2001;3110:

8 nnell CJ, Newell JB, Villarreal-Levy G, Smith AJ, Kondo NI, Cararach M, Ferrer L, Eagle KA. Geriatric patients with acute myocardial infarction Cardiac risk factor profiles, presentation, thrombolysis, coronary interventions and prognosis. Am Heart J ) Maiello L, Colombo A, Gianrossi R, Thomas J, Finci L. Results of coronary angioplasty in patients aged 75 years and older. Chest ) Elliot JM, MacIsaac AI, Lefkovits J, Horrigan MC, Franco I, Whitlow PL. New coronary devices in the elderly comparison with angioplasty. Circulation suppl II ) Schomig A, Neumann FJ, Kastrati A, Schuhlen H, Blasini R, Hadamitzky M, Walter H, Zitzmann-Roth EM, Richardt G, Alt E, Schmitt C, Ulm K. A randomized comparison of antiplatelet and anticoagulation therapy after the placement of coronary artery stents. N Engl J Med ) Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G, Gaglione A, Goldberg SL, Tobis JM. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation ) Moussa I, Di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A. Subacute stent thrombosis in the era of intravascular ultrasound guided coronary stenting without anticoagulation frequency, predictors and clinical outcome. J Am Coll Cardiol ) Ryan TJ, Bauman WB, Kennedy JW, Kereiakes DJ, King III SB, McCallister BD, Smith SC, Ullyot DJ. Guidelines for percutaneous transluminal angioplasty a report of the American College of Cardiology/American Heart Association task force on assessment of diagnostic and therapeutic cardiovascular procedures. J Am Coll Cardiol ) Reimers B, Moussa I, Akiyama T, Tucci G, Ferraro M, Martini G, Blengino S, Di Mario C, Colombo A. Longterm clinical follow-up after successful repeat percutaneous intervention for stent restenosis. J Am Coll Cardiol ) Yokoi H, Kimura T, Nakagawa Y, Nosaka H, Nobuyoshi M. Long-term clinical and quantitative angiographic follow-up after the Palmaz-Schatz stent restenosis. J Am Coll Cardiol suppl A224A. 23) Carrozza JP, Kuntz RE, Levine MJ, Pomerantz RM, Fishman RF, Mansour M, Gibson CM, Senerchia CC, Diver DJ, Safian RD. Angiographic and clinical outcome of intracoronary stenting immediate and long-term results from a large singlecenter experience. J Am Coll Cardiol ) De Gregorio J, Kobayashi Y, Albiero R, Reimers B, Di Mario C, Finci L, Colombo A. Coronary artery stenting in the elderly short-term outcome and long-term angiographic and clinical follow-up. J Am Coll Cardiol ) Abizaid AS, Mintz GS, Abizaid A, Saucedo JF, Mehran R, Pichard AD, Kent KM, Satler LF, Leon MB. Influence of patient age on acute and late clinical outcomes following Palmaz-Schatz coronary stent implatation. Am J Cardiol

Original Articles Korean Circulation J 1998;28 6 : 항혈소판요법을이용한관동맥내 Stent 삽입술의조기결과 손지원 김영준 손민수 오세진 안태훈 최인석 신익균 Initial Results after Implantation

Original Articles Korean Circulation J 1998;286:939-946 항혈소판요법을이용한관동맥내 Stent 삽입술의조기결과 손지원 김영준 손민수 오세진 안태훈 최인석 신익균 Initial Results after Implantation of Coronary Artery Stents with Antiplatelet Agents Ji-Won