Original Articles Korean Circulation J 1998;289:1518-1526 재원기간중사망한급성심근경색증환자의임상적특징 현대우 김기식 신이철 박소영 배장호 한창엽 김윤년 김권배 Clinical Characteristics of Acute Myocardial Infarction Died during Hospitalization Dae-Woo Hyun, MD, Kee-Sik Kim, MD, Yi-Chul Synn, MD, So-Young Park, MD, Jang-Ho Bae, MD, Chang-Yeob Han, MD, Yoon-Nyun Kim, MD and Kwon-Bae Kim, MD Division of Cardiology, Department of Internal Medicine, School of Medicine, Keimyung University, Taegu, Korea ABSTRACT BackgroundRecently, the incidence of acute myocardial infarction AMI rapidly increased with prolongation of life spans, improvements of food and life styles in Korea. The mortality rate of AMI is higher than other disease. The purpose of this study is to evaluate which factors can affect the early outcome of AMI in Korean. MethodsA retrospective clinical study was done on 555 consecutive patientsmalefemale387 69.7 168 30.3, mean age 61.3 years with AMI who had been admitted to Dong-San Medical Center from January 1990 to May 1997. The subjects were devided into two groups. was dead patients during the in-hospital period 85 patients, 15.3, and I was living patients 470 patients, 84.7 wen they discharged from hospital. We compared clinical and laboratory results in both groups and analysed the cause of death according to the time of death during hospitalization. ResultsThe results were as follows1 The mean age and female percentage of 65.4 years, 43 were higher than I 60.5 years, 28. The mean of systolic/diastolic blood pressure and percentage of smoker of 108/65 mmhg, 48 were lower than I 125/76 mmhg, 65, significantly. 2 The degree of Killip classification was higher in class 129.4, II18.8, III21.2, IV30.6 than in I patients class 173.4, II13.6, III 8.7, IV4.3, significantly. 3 47 patients were died first day of hospitalization and the most common cause of death was cardiogenic shock 27 patients, 31. The most common cause of death within 1 week was cardiogenic shock, afterthen congestive heart failure. 4 The most common cause of death in Killip class I patients was ventricular tachycardia or ventricular fibrillation and in Killip class II-IV patients was cardiogenic shock. ConclusionThe risk of in-hospital death was higher in elderly, female sex, and patients with higher Killip classification. Cardiogenic shock was most common cause of death within 1 week, and was congestive heart failure after 1 week. Korean Circulation J 1998; 289:1518-1526 KEY WORDSAcute myocardial infarction Cause of death. 서 론 1518
대상및방법 대상 방법 결과 사망군과생존군의특성과위험인자 1519
Table 1. Comparison of clinical characteristics in myocardial infarction between in-hospital death and survivor groups 1520 n85 15.3% I n470 84.7% P value Age 65.4 60.5 0.05 Sex MF 4837 339131 0.05 Q-wave infarction 61 72% 285 61% NS Mean delay between onset 18 24 NS of symptom and arrival at our hospital hr SBP mmhg 108 125 0.05 DBP mmhg 65 76 0.05 PR BPM 79 77 NS Risk factor Smoking 41 48% 303 65% 0.05 Diabetes 15 18% 62 13% NS Hypertension 25 29% 119 25% NS Hypercholesterolemia 7/45 16% 99/396 25% NS NSnot significant, SBPsystolic blood pressure, DBPdiastolic blood pressure, PRpulse rate 주증상및 Killip 분류 심전도상기본리듬과경색부위 Table 2. Comparison of chief complaints in myocardial infarction between in-hospital death and survivor groups N85 15.3% I N470 84.7% P value Chest pain 56 65.9% 406 86.5% 0.05 Dyspnea 8 9.4% 19 4.0% 0.05 Epigastric pain 4 4.7% 11 2.3% NS Mental change 16 18.8% 15 3.2% 0.05 Others 1 1.2% 19 4.0% NS NSnot significant Fig. 1. Killip classification of in-hospital death and survivor groups. NSnot significant Korean Circulation J 1998;289:1518-1526
심근효소치와혈청지질검사 심근경색의초기치료 사망원인 Table 3. Comparison of basic rhythm in myocardial infarction in-hospital death and survivor groups N85 15.3% I N470 84.7% P value Sinus 74 87.0% 427 90.9% NS AF 3 3.5% 11 2.3% NS VT or VF 2 2.4% 8 1.7% NS Heart block 6 7.1% 24 5.1% NS NSnot significant, AFatrial fibrillation VTventricular tachycardia, VFventricular fibrillation Fig. 2. Peak cardiac enzyme level of in-hospital death and survivor groups. NSnot significant Table 4. Location of myocardial infarction in-hospital death and survivor groups N85 15.3% I N470 84.7% P value Anterior 42 49.4% 206 43.8% NS Inferior 24 28.2% 166 35.3% NS Anteroseptal 5 5.9% 37 7.9% NS Anterolateral 5 5.9% 11 2.3% NS Ant.Inf. 5 5.9% 20 4.3% NS Lateral 4 4.7% 18 3.8% NS Unclassifiable 0 0% 12 2.6% NS NSnot significant Fig. 3. Lipid profile of in-hospital death and survivor groups. NSnot significant 1521
Table 5. Management of myocardial infarction in-hospital death and survivor groups PO medication N85 15.3% I N470 84.7% P value Aspirin 66 77.6% 410 87.2% 0.05 Nitrate 72 84.7% 407 86.6% NS Calcium channel blocker 33 38.8% 319 67.9% 0.05 -blocker 5 5.9% 73 15.5% 0.05 ACE inhibitor 21 24.7% 158 33.6% NS Ticlopidine 4 4.7% 62 13.2% 0.05 Lipid lowering agent 1 1.2% 60 12.8% 0.05 Cardiotonics 30 35.3% 42 8.9% 0.05 Diuretics 24 28.2% 52 11.1% 0.05 Heparinization 64 75.3% 323 68.7% NS Thrombolytic therapy 32 37.6% 184 39.1% NS Mean delay between onset of symptom and 14.1 6.8 0.05 thrombolytic therapy hr NSnot significant Table 6. Causes of death of in-hospital death group Cardiac 68 80% cardiogenic shock 27 31% chronic congestive HF 8 9% VT or VF 22 26% heart block 3 4% reinfarction 3 4% cardiac rupture 5 6% Non-cardiac 9 11% stroke 6 7% infection 3 4% Others 8 9% Fig. 4. Percentage of dead patients according to the time of death. 1522 고안 Korean Circulation J 1998;289:1518-1526
Fig. 5. Cause of death in myocardial infarction during hospitalization. Fig. 6. Cause of death in myocardial infarction according to killip classification. 1523
1524 요약 연구배경 : 방법 : Korean Circulation J 1998;289:1518-1526
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