서론 대상및방법 대상환자 방법 - 757

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1 Original Artices Korean Circulation J 2002;329: 급성심근경색증에서중재시술후관동맥혈류예비력과 예후와의관계 윤명호 탁승제 최소연 염철훈 최태영장혁재 황교승 신준한 김한수 최병일 Coronary Flow Reserve as a Predictor of Long-Term Clinical Outcome after Acute Myocardial Infarction Myeong-Ho Yoon, MD, Seung-Jea Tahk, MD, So-Yeon Choi, MD, Zhe-Xun Lian, MD, Tae-Young Choi, MD, Hyuk-Jae Jang, MD, Gyo-Seung Hwang, MD, Joon-Han Shin, MD, Han-Soo Kim, MD and Byung-Il W. Choi, MD Department of Cardiology, College of Medicine, Ajou University, Suwon, Korea ABSTRACT Background and ObjectivesIt has been shown that the coronary flow reserve CFR of an infarct related artery can predict left ventricular functional recovery following acute myocardial infarction AMI. However, the prognostic value of CFR on the long-term clinical outcome of patients with an AMI has not been studied. Subjects and MethodsUsing a Doppler guide wire, we measured the CFR in 130 patients with an AMI following successful intervention 63 days after onset of the AMI. Two-year follow-up was conducted with regard to end points, includingcardiac death, non-fatal AMI, and severe congestive heart failure CHF NYHA III. ResultsDuring the follow-ups, occurred in 17 patients 5 deaths, 3 non-fatal AMIs and 9 severe CHFs. After analysis of the receiver operating characteristic curves, the best cut-off value for CFR in predicting was 1.4 sensitivity 76.5%, specificity 73.5%, accuracy 82.0%. With as an end point, a 2-year Kaplan-Meier event survival analysis revealed that the patients with a CFR1.4 had a worse prognosis than those with a CFR1.4 Event free survival rates were 69.8% vs. 95.4%, respectively, p0.001). Using Cox proportional hazard analyses, as an independent predictor, age, heart rate, CFR and left ventricular end systolic volume index, were also found to be significantly associated with cardiac events hazard ratios , , , and , respectively. ConclusionThe coronary flow reserve, of infarct related arteries, measured during the early recovery phase can be used as an independent predictor for the prognosis of patients with an acute myocardial infarction following successful intervention. Korean Circulation J 2002;329: KEY WORDSCoronary circulationmyocardial infarction. 756

2 서론 대상및방법 대상환자 방법 - 757

3 - - - 결과 대상환자의임상적특성 추적기간중심장관련주요사건의발생 심장관련주요사건발생의예측인자 Korean Circulation J 2002;329:

4 Table 1. Comparison of patients characteristics between group with major and group without major Group without major n113 Group with major cardiac events n17 Age year Gender MF Heart rate beatmin Risk factor Hypertension, n % DM, n % Dyslipidemia, n % Smoking, n % Lipid profile T.Chol mgdl TG mgdl LDL mgdl HDL mgdl CK IUL CK-MB ngml Killip class, n % I II III IV TPA, n % blocker, n % Calcium blockers, n % ACE inhibitors, n % DMdiabetes mellitus, T.Choltotal cholesterol, TGtriglyceride, LDLlow density lipoprotein cholesterol, HDL high density lipoprotein cholesterol, CKcreatine kinase, CK-MBcreatine kinase-myocardial band, tpatissue type plasminogen inhibitor, ACEangiotensin converting enzyme p - 관동맥혈류예비력과심장관련주요사건의발생과의관계 - 759

5 Table 2. Comparison of angiographic findings between group with major and group without major Group without major Group with major Intervention, n % Stent 68 60% 10 59% Balloom 28 28% 5 29% No need intervention 17 15% 2 12% Infarct related artery, n % LAD LCx RCA Vessel disease severity, n % Nomal-minimal VD VD VD Major side branch, n % Lesion length mm Diffuse 20mm, n % Pre-intervention MLD mm DS % Post-intervention MLD mm DS % RVD mm LADleft anterior descending artery, LCxleft circumflex artery, RCAright coronary artery, VDvessel disease, MLDminimal lumen diameter, DSdiameter stenosis, RVDreference vessel diameter p Table 3. Comparison of echocardiographic findings between group without major and group with major Group without major Group with major P LVEDVImLm LVESVImLm EF% WMSI LVEDVIleft ventricular end diastolic volume index, LVESVIleft ventricular end systolic volume index, EFejection fraction, WMSIwall motion score index 고찰 760 Korean Circulation J 2002;329:

6 Table 4. Comparison of coronary flow velocity index in group without major and group with major Baseline Group without Group with major Major cardiac cardiacevents events APVcm/sec DSVR Hyperemic APVcm/sec DSVR CFR APVaveraged peak velocity, DSVRdiastolic systolic velocity ratio, CFRcoronary flow reserve p Fig. 1. Comparison of coronary flow reserve between group without major and group with major. Fig. 2. Receiver operating characteristic curve analysis of CFR for major. CFRcoronary flow reserve, AUCarea under the curve. Table 5. Comparison of predictors of major cardiac event between group without major and group with major Group without major Group with major Univariate Cox proportional hazard analysis p Hazard ratio P Age HR HAPV cmsec >0.044 NS CFR LVEDVImLm >0.016 NS LVESVImLm EF % NS WMSI >0.110 NS DM >0.071 NS HRheart rate, hapvhyperemic average peak velocity, CFRcoronary flow reserve, LVEDVIleft ventricular end diastolic volume index, LVESVIleft ventricular end diastolic volume index, EFejection fraction, WMSIwall motion score index, DMdiabetes mellitus 761

7 Fig. 3. Kaplan-Meier survival curve of major cardiac events between CFR1.4 group and CFR1.4 group p CFRcoronary flow reserve. Table 6. Comparison of major between CFR1.4 group and CFR1.4 group 762 CFR1.4 n43 CFR1.4 n87 Total major event,n % % 404.6% Death, n % % 101.1% Re-MI, n % % 101.1% CHF, n % % 202.3% Angina, n % % 809.2% CFRcoronary flow reserve, Re-MIrecurred non fatal myocardial infarction, CHFcongestive heart failure p Korean Circulation J 2002;329:

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Original Articles Korean Circulation J 1998;28 10 : 급성심근경색증에서경색심근의관류정도와 12 유도 심전도상 R 파, ST 절, QRS 평점과의관계 안정천 김수미 황교승 이은미 송우혁 임도선박창규 김영훈 서홍석 심

Original Articles Korean Circulation J 1998;2810:1707-1716 급성심근경색증에서경색심근의관류정도와 12 유도 심전도상 R 파, ST 절, QRS 평점과의관계 안정천 김수미 황교승 이은미 송우혁 임도선박창규 김영훈 서홍석 심완주 오동주 노영무 Significance of ST Segment, R Wave, Q Wave