서론 대상및방법 대상환자 관상동맥조영술소견 551

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1 Original Articles Korean Circulation J 1999;296: 관상동맥중재술후제 2 차재협착에관여하는인자 김성희 1 정명호 1,2 김준우 1 조장현 1 김남호 1 박우석 1 최명자 1 김인수 1 안영근 1,2 조정관 1,2 박종춘 1,2 강정채 1,2 Risk Factors for the Second Restenosis after Coronary Interventions Sung Hee Kim, MD 1, Myung Ho Jeong, MD 1,2, Joon Woo Kim, MD 1, Jang Hyun Cho, MD 1, Nam Ho Kim, MD 1, Woo Suck Park, MD 1, Myung Ja Choi, RN 1, In Soo Kim, MS 1, Young Keun Ahn, MD 1,2, Jeong Gwan Cho, MD 1,2, Jong Chun Park, MD 1,2 and Jung Chaee Kang, MD 1,2 1 The Heart Center of Chonnam University Hospital, 2 The Research Institute of Medical Sciences, Chonnam National University, Kwangju, Korea ABSTRACT Background and ObjectivesOne of the major limitations in coronary intervention is restenosis. This study was aimed to identify clinical, angiographic and procedural factors, which may be related to the second restenosis SR. Materials and MethodWe studied 101 patients who underwent more than two follow-up coronary angiograms after two coronary interventions between Jan 1996 and Dec 1998 in Chonnam University Hospital out of 4092 total coronary interventions in 3030 patients during the same period. The patients were divided into two groups according to the evidence of second restenosis SR. Fifty two patients Group A year, MF448 who had SR, and the other 49 patients Group B year, MF445 were analyzed. Clinical features, angiographic characteristics, coronary interventional procedures, and other risk factors were compared between two groups by univariate analysis and multivariate stepwise logistic regression analysis for the predictive factors of second restenosis. Results1 The clinical variables of age, sex, clinical diagnosis, and risk factors were not different between two groups. 2 The lesion types severer than B 2 by AHAACC classification were associated with SR p Recurrent angina as an indication for follow up angiography was associated with SR p0.01. ConclusionThe predictive factors associated with SR were patient s subjective symptom and lesion severer than type B 2 according to AHAACC classification. Korean Circulation J 1999;296: KEY WORDSSecond restenosis Coronary intervention. 550

2 서론 대상및방법 대상환자 관상동맥조영술소견 551

3 관상동맥중재술시술 추적관상동맥조영술 자료의분석및통계처리 552 임상적인특징 결 Table 1. Clinical characteristics of the patients with second restenosis Group A and without second restenosis Group B Group A n52 과 Group B n49 p value Age NS Sex MF NS Diagnosis Stable angina % 4 8.2% NS Unstable angina % % NS Acute MI % % NS Old MI % 4 8.2% NS Risk factors Family history 2 3.8% % NS Diabetes % % NS Hypertension 26 50% % NS Smoking % % NS Hyperlipidemia % % NS *MImyocardial infarction Korean Circulation J 1999;296:

4 Table 2. Anigographic characteristics in patients with second restenosis Group Aand without second restenosis Group B Group A n52 Group B n49 p value Vessel number 0.05 One vessel disease % % Two vessel disease % % Three vessel disease 1325% 612.2% Target lesion NS Proximal 917.3% % LAD Middle % % Distal 1 1.9% 4 8.2% LCX Proximal 5 9.6% 816.3% Distal 2 3.8% 2 2% Obtuse marginal 1 1.9% 0 0% Intermediate 3 5.8% 0 0% Proximal 4 7.7% 1 2% RCA Middle 3 5.8% 612.2% Distal 5 9.6% 1 2% *LADleft anterior descending artery, LCXleft circumflex artery, RCAright coronary artery 관상동맥조영술소견 Table 3. Angiographic morphology by AHAACC classification in patients with second restenosis Group A and without second restenosis Group B Type A B1 B2 C Group A First restenosis 2 3.8% % %* %* n52 Second restenosis 2 3.8% 13 25% % % Group B First restenosis % % % % n49 Second restenosis 2 5.1% % % % *p

5 Table 4. Morphologic characteristics by angiography in patients with second restenosis Group A and without second restenosis Group B Fig. 1. Coronary interventions in patients with second restenosis Group A and without second restenosis Group B. PTCApercutaneous transluminal coronary angioplasty, CABGcoronary artery bypass graft. 관상동맥중재술의시술 554 Group A n52 Group B n49 Angulated % 2 4.1% Bifurcation % 2 4.1% Calcification 2 3.8% 0 0% Diffuse* % % Eccentric % % Irregular* 13 25% 4 8.2% Ostial 2 3.8% 1 2% Thrombus % 2 4.1% Total occlusion % % *p0.05univariate analysis Table 5. Lesion characteristics in patients with second restenosis Group A and without second restenosis Group B Primary lesion Group A n52 Group B n49 RD mm MLD mm Length mm* DS % Acute gain mm Residual stenosis % Late loss mm Loss index Restenotic lesion RD mm MLD mm Length mm DS % Acute gain mm Residual stenosis % Late loss mm RDreference diameter, MLDminimal luminal diameter, DSpercent stenosis of lesion site, *p0.05 OR 1.11, 95% CI 관상동맥중재술소견의분석결과 Korean Circulation J 1999;296:

6 Table 6. Predictors for second restenosis by multivariate analysis in patients with second restenosis Group A and without second restenosis Group B Indications for follow-up Symptomatic or positive stress test Group A Group B OR 95%CI p value % % angiography Elective % % Lesion Type B % % B % % 추적관상동맥조영술 고찰 555

7 556 Korean Circulation J 1999;296:

8 본연구의제한점 요약 연구배경 : 대상및방법 : 결과 : 557

9 결론 : 중심단어 REFERENCES 1) Frishman WH, Chiu R, Landzberg BR, Weiss M. Medical therapies for the prevention of restenosis after percutaneous coronary interventions. Curr Problems in Cardiol ) Grentzig A. Transluminal dilatation of coronary artery stenosis. Lancet ) Rim SJ, Chung IM, Cho SY, Jang YS, Chung NS, Shim WH, et al. Progression of coronary artery disease after percutaneous transluminal coronary angioplasty. Korean Circulation J ) Jeong MH, Cho IJ, Seo JP, Ryu MH, Lee MG, Park JS, et al. Predictive factors of restenosis after percutaneous transluminal coronary angioplasty. Korean Circulation J ) Seok JH, Kim SM, Bae SH, Kim BJ, Lee HJ, Yoon JS, et al. Predictive factors of restenosis after successful percutaneous transluminal coronary angioplasty. Kor Int Med J ) Freed M, Grines C, Safian RD. The new manual of interventional cardiology Physicians press1996. p ) Nobuyoshi MN, Kimura T, Ohishi H, Horiuchi H, Nosaka H, Hamasaki N, et al. Restenosis after percutaneous transluminal coronary angioplasty Pathologic observations in 20 patients. J Am Coll Cardiol ) Nobuyoshi M, Kimura T, Noksaka H, et al. Restenosis after successful coronary agnioplasty Serial angiographic follow-up of 229 patients. J Am Coll Cardiol ) Jeong MH. Local drug delivery in prevention of restenosis. 558 Korean Circulation J ) Jeong MH. Biologic and genetic therapy for restenosis. Chonnam J Med Sci ) Jeong MH, JC Park, Cha KS, Bae Y, Ahn YK, Park JH, et al. The effects of local nitric oxide doner delivery in stented Patients. Korean Circulation J ) Kim JW, Lee CW, Cheong SS, Kang DH, Hong MK, Song JK, et al. A Prospective, randomized, comparative clinical investigation of the effects of Sulodexide on restenosis after percutaneous transluminal coronary balloon angioplasty. Korean Circulation J ) Schwartz RS, Huber KC, Murphy JG, Edwards WD, Camrud AR, Vlietstra RE, et al. Retenosis and the proportional neointimal response to coronary artery injury. J Am Coll Cardiol ) Schwartz RS, Holmes DR, Topol E. The restenosis paradigm revisited An alternative proposal for cellular mechanism. J Am Coll Cardiol ) Chung WS, Hong SJ. New concept of restenosis and new targeted therapy. Korean Circulation J ) Serruys PW, Luijten HE, Beatt KJ, Geuskens R, Feyter PJ, van den Brand M, et al. Incidence of restenosis after successful coronary angioplasty A time-related phenomenon A quantitative angiographic study in 342 consecutive patients at 1, 2, 3, and 4 months. Circulation ) Ellis SG, Roubin GS, King SB, Douglas JS, Cox WR. Importance of stenosis morphology in the estimation of restenosis risk after elective percutaneous transluminal coronary angioplasty. Am J Cardiol ) Forrester JS, Fishbein M, Helfant R, Fagin J. A Paradigm for restenosis based on cell biology Clues for the development of new preventive therapies. J Am Coll Cardiol ) Serruys PW, de Jaegere P, Kimeneij F, et al BENESTENT Study Group. A comparison of balloon-expandable stent implantation with balloon angioplasty in patient with coronary artery disease. N Eng J Med ) Fischman DL, Leon MB, Baim DS, et al STRESS Investigators. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Eng J Med ) Jeong MH, Kang JC, Holmes DR, Schwartz RS. Combination of aspirin and ticlopidine is effective in the prevention of the acute stent thrombosis. Chonnam J Med Sci ) Bauters C, Banos JL, Belle EV, Mc Fadden EP, Lablanche JM, Bertrand ME. Six-month angiographic outcome after successful repeat percutaneous intervention for in-stent restenosis. Circulation ) Joo SB, Jeong MH, Bae Y, Ahn YK, Park JC, Cha KS, et al. The ealry results of clinical and angiographic followup after coronary interventions for restenotic lesions. Korean Circulation J ) Glazier JJ, Varrichione TR, Ryan TJ, Ruocco NA, Jacobs AK, Faxon DP. Outcome in patients with recurrent restenosis after precutaneous transluminal balloon angioplasty. Br Heart J ) Califf RM, Fortin DF, Frid DJ, Harlan WR, Ohman EM, Bengtson JR, et al. Restenosis after coronary angioplasty An overview. J Am Coll Cardiol B-13B. 26) Belle EV, Bauters C, Hubert E, Bodart JC, Abolmaali Korean Circulation J 1999;296:

10 KA, Meurice T, et al. Restenosis rates in diabetic patients A comparison of coronary stenting and balloon angioplasty in native coronary vessels. Circulation ) Johanbsson SR, Wiklund O, Karlsson T, Hjalmarson A, Emaunelsson H. Serum lipids and lipoproteins in relation to restenosis after coronary angioplasty. Eur Heart J ) Muller DWM, Ellis SG, Topol EJ. Experimental models of coronary artery restenosis. J Am Coll Cardiol ) Bauters C, Mc Fadden EP, Lablanche JM, Quandalle P, Bertrand ME. Restenosis rate after multiple percutaneous transluminal coronary angioplasty procedures at the same site A quantitative angiographic study in consecutive patients undergoing a third angioplasty procedure for a second restenosis. Circulation ) Teirstein PS, Hoover CA, Ligon RW, Giorgi LV, Rutherford BD, McConahay DR, et al. Repeat coronary angioplasty Efficacy of a third angioplasty for a second restenosis. J Am Coll Cardiol ) Dangas G, Fuster V. Management of restenosis after coronary intervention. Am Heart J ) Dimas AP, Grigera F, Arora RR, Simpfendorfer CC, Hollman JL, Frierson JH, et al. Repeat coronary angioplasty as treatment for restenosis. J Am Coll Cardiol ) Desmarais RL, Sarembock IJ, Ayers CR, Vernon SM, Powers ER, Gimple LW. Elevated serum lipoprotein a is a risk factor for clinical recurrence after coronary balloon angioplasty. Circulation ) Hirshfeld JW, Schwartz JS, Jugo R, Macdonald RG, Glodberg S, Savage MP, et al. and the M-Heart Investigators. Restenosis after coronary angioplasty A multivariate statistical model to relate lesion and procedure variables to restenosis. J Am Coll Cardiol ) Foley DP, Melkert R, Serruys PW, on behalf of the CARPORT, MERCATOR, MARCATOR, and PARK Investigators. Influence of coronary vessel size on renarrowing process and late angiographic outcome after successful balloon angioplasty. Circulation

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386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon