Original Articles Korean Circulation J 1999;296:550-559 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 A56.69.9 year, MF448 who had SR, and the other 49 patients Group B53.88.5 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 p0.05. 3 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;296:550-559 KEY WORDSSecond restenosis Coronary intervention. 550
서론 대상및방법 대상환자 관상동맥조영술소견 551
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 56.69.9 53.88.5 NS Sex MF 448 445 NS Diagnosis Stable angina 7 13.5% 4 8.2% NS Unstable angina 18 34.6% 18 36.7% NS Acute MI 20 38.5% 23 46.9% NS Old MI 7 13.5% 4 8.2% NS Risk factors Family history 2 3.8% 5 10.2% NS Diabetes 14 26.9% 7 14.3% NS Hypertension 26 50% 26 53.1% NS Smoking 38 73.1% 36 73.5% NS Hyperlipidemia 30 57.7% 28 57.1% NS *MImyocardial infarction Korean Circulation J 1999;296:550-559
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 1732.7% 3061.2% Two vessel disease 2243.2% 1326.5% Three vessel disease 1325% 612.2% Target lesion NS Proximal 917.3% 1224.5% LAD Middle 1936.5% 1530.6% 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% 16 30.8% 17 32.7%* 17 32.7%* n52 Second restenosis 2 3.8% 13 25% 20 38.5% 17 32.7% Group B First restenosis 7 14.3% 29 59.2% 5 10.2% 8 16.3% n49 Second restenosis 2 5.1% 17 43.6% 11 28.2% 9 23.1% *p0.05 553
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 6 11.5% 2 4.1% Bifurcation 6 11.5% 2 4.1% Calcification 2 3.8% 0 0% Diffuse* 17 32.7% 6 12.2% Eccentric 11 21.2% 11 22.4% Irregular* 13 25% 4 8.2% Ostial 2 3.8% 1 2% Thrombus 7 13.5% 2 4.1% Total occlusion 9 17.3% 7 14.3% *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 3.0 0.7 2.9 0.5 MLD mm 0.75 0.4 0.74 0.3 Length mm* 15 8.7 10 5.8 DS % 75.1 11.7 74.7 11.8 Acute gain mm 1.8 0.6 1.8 0.5 Residual stenosis % 14.8 13.8 9.8 12.3 Late loss mm 1.7 0.5 1.23 0.9 Loss index 0.98 0.2 0.66 0.5 Restenotic lesion RD mm 3.0 0.7 3.0 0.6 MLD mm 0.84 0.4 1.37 0.9 Length mm 15.9 9.4 12.3 5.4 DS % 72.0 12 56.0 25 Acute gain mm 1.77 0.6 1.81 0.5 Residual stenosis % 13.1 17.4 8.7 20.8 Late loss mm 1.8 0.8 0.17 1.0 RDreference diameter, MLDminimal luminal diameter, DSpercent stenosis of lesion site, *p0.05 OR 1.11, 95% CI 1.031.19 관상동맥중재술소견의분석결과 Korean Circulation J 1999;296:550-559
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 42 80.8% 19 38.2% angiography Elective 10 19.2% 30 61.2% Lesion Type B1 18 34.6% 36 73.5% B2 34 65.4% 13 26.5% 8.17 2.8623.3 0.01 5.75 2.0116.4 0.05 추적관상동맥조영술 고찰 555
556 Korean Circulation J 1999;296:550-559
본연구의제한점 요약 연구배경 : 대상및방법 : 결과 : 557
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