Original Articles Korean Circulation J 2001;3110:996-1003 70 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; 3110:996-1003 KEY WORDSAgedStentsFollow-up studies. 996
서론 대상및방법 대상환자 스텐트시술방법 관동맥조영술상분석 추적검사및정의 997
통계분석 결과 대상환자의임상적특징 관동맥조영술소견과스텐트시술에관련된특징 Table 1. Clinical characteristics of 703 patients Age70 n106 Age70 n597 Mean age years 74 4 56 8 Male, n % 54 51 437 73 0.001 Risk factors, n % Hypercholesterolemia 220 mg/dl 24 23 143 24 NS Hypertension 48 45 263 44 NS Current smoker 28 26 233 39 0.006 Diabetes 15 14 148 25 0.008 Renal insufficiency creatinine2.0 mg/dl, n % 8 7.5 22 3.7 0.04 LVEF % 52.911.9 57.413.1 0.001 Prior myocardial infarction, n % 16 15 72 12 NS Clinical diagnosis, n % Stable angina 42 40 340 57 0.004 Unstable angina 50 47 185 31 0.003 Acute myocardial infarction 14 13 72 12 NS Number of diseased vessels, n % 1 35 33 293 49 0.003 2 34 32 185 31 NS 3 37 35 119 20 0.005 Multivessel disease, n % 71 67 304 51 0.005 NSnot significant, LVEFleft ventricular ejection fraction p 998 Korean Circulation J 2001;3110:996-1003
Table 2. Angiographic and procedural characteristics of 819 lesions Artery stented, n % Age70 n134 Age70 n685 p Left main 2 1.5 10 1.5 NS Left anterior descending 74 55.1 369 53.8 NS Left circumflex 25 18.9 117 17.1 NS Right coronary artery 33 24.5 187 27.3 NS Saphenous vein graft 0 2 0.3 NS Modified AHA/ACC lesion type, n % A 12 9 68 10 NS B1 36 27 233 34 0.02 B2 67 50 295 43 0.03 C 19 14 89 13 NS B2 or C 86 64 384 56 0.02 Total occlusion, n % 12 9 89 13 NS Mean reference diameter mm 2.90 0.66 3.09 1.17 NS Lesion % stenosis 81.1 17.3 81.3 16.8 NS Final stent MLD mm 2.87 0.75 3.06 1.17 NS Lesion length mm 10.9 6.0 11.3 6.1 NS Maximal inflation pressure atm 12.9 6.0 13.3 6.1 NS Number of stent per patient 1.26 0.51 1.15 0.39 0.04 Use of IABP, n % 2 1.9 8 1.3 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 2 1.8 7 1.2 NS Death 1 0.9 3 0.5 NS Q-wave myocardial infarction 1 0.9 2 0.3 NS Emergency CABG 0 2 0.3 NS Non-Q wave myocardial infarction 10 9.4 31 5.2 0.01 Vascular complication 2 1.9 6 1.0 NS CABGcoronary artery bypass graft surgery, NSnot significant 병원내주요임상사건의비교 추적관동맥조영술소견 999
Table 4. Angiographic data at follow-up Age70 n131 Age70 n681 p Follow-up % 83 63 469 69 Follow-up duration days 224113 206114 Mean reference diameter mm 2.940.59 3.09 1.17 NS Stent MLD mm 1.801.14 1.88 1.03 NS Stent % stenosis 38.7 9.0 39.1 11.7 NS Angiographic restenosis rate % 26.5 24.9 NS Type of restenosis % Focal 9 45 54 46 NS Diffuse 8 37 39 33 NS Proliferative 4 18 24 21 NS MLDminimal luminal diameter, NSnot significant Table 5. Clinical data at follow-up Age70 n104 Age70 n594 p Follow-up % 97 93 558 94 Follow-up duration days 357265 376270 MACE % 19 18.3 75 12.6 0.04 Cardiac death 2 1.9 2 0.5 NS Acute myocardial infarction 2 1.9 3 0.5 NS Revascularization 15 14.4 70 11.8 NS PCI 14 13.5 68 11.4 NS CABG 1 1.0 2 0.5 NS MACEmajor adverse cardiac event, PCIpercutaneous coronary intervention, CABGcoronary artery bypass graft surgery, NSnot significant 장기주요임상사건의비교 고찰 1000 Korean Circulation J 2001;3110:996-1003
요약 배경및목적 : 1001
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