Original Articles Korean Circulation J 1999;293:276-284 급성심근경색증으로발현한변이형협심증환자의 임상적, 관동맥조영검사상특성및장기추적관찰 두영철 김재삼 채경수 송관욱 홍경순 박대균 한규록오동진 유규형 임종윤 고영박 이광학 이영 Clinical and Angiographic Characteristics and Long-term Follow-up in Patients with Variant Angina Who Presented as Acute Myocardial Infarction Young-Cheoul Doo, MD, Jae-Sam Kim, MD, Kyung-Soo Chae, MD, Kwan-Wook Song, MD, Kyung-Soon Hong, MD, Dae-Gyun Park, MD, Kyoo-Rok Han, MD, Dong-Jin Oh, MD, Kyu-Hyung Ryu, MD, Chong-Yun Rim, MD, Young-Bahk Koh, MD, Kwang-Hwahk Lee, MD and Yung Lee, MD Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea ABSTRACT Background and ObjectivesThere were numerous reports for clinical characteristics and prognosis of patients with variant angina VA but little information is available for patients with VA who presented as acute myocardial infarction AMI. The purpose of this study is to determine the clinical and angiographic predictors for initial development of AMI in patients with VA and prognosis of patients with VA who presented as AMI. Materials and MethodsThe study group comprised 166 patients with VAforty one 25% of whom presented as AMI Group AMale 32, mean age 50 years and 125 presented as typical VA or unstable angina Group BMale 73, mean age 54 years. The diagnosis of VA was made by spontaneous spasm and ergonovine or acetylcholine only Group B provocation. Results1 Male gender 78% vs. 58%, p0.05, smoking 74% vs. 53%, p0.05, and disease duration 185 vs. 71 month, p0.0001, and ST-segment elevation during chest pain 71% vs. 23%, p0.05 were significantly higher in group A than in Group B. 2 Prevalence of fixed stenosis of 50% or greater was higher in Group A than in group B 12% vs. 2%, p0.05 and the percent stenosis after nitroglycerin injection was also greater in group A than in group B 435% vs. 282, p0.01, but the disease activity such as frequency of resting angina, spontaneous spasm, and multivessel spasm were not different between two groups. 3 During clinical follow-up at a mean duration of 2.7 years, three patient 2% in group B died of a cardiac cause. Non-fatal MI occurred 1 2% and 3 patients 2% in group A and B, respectively. ConclusionsOur data show that male gender, smoking, duration of disease, ST-segment elevation during chest pain, and a fixed stenosis of 50% or greater are predictors for initial development of AMI in patients with VA. The prognosis in group A is excellent and this may be associated with less severe atherosclerotic disease and a high rate 276
of medication with calcium channel blocker or nitrate compared with those in previous studies. Korean Circulation J 1999;293:276-284 KEY WORDSVariant angina Acute myocardial infarction Clinical and angiographic characteristics Prognosis. 서론 재료및방법 대상환자 방법 277
결과 임상적특성 278 Table 1. Clinical characteristics of subjects Group A Group B n41 patients n125 patients Sex MF* 329 7352 Age year 501 541 Clinical manifestaton Variant anginaua 60 48%54 43% Rest pain 35 85% 114 91% Effort pain 6 15% 34 27% Pain related to alcohol 10 31% 39 32% Frequency of pain 5wk 5 12% 32 26% Risk factors Hypertension 6 15% 35 28% Diabetes mellitus 7 17% 34 27% Hyperlipidemia 7 17% 34 27% Smoking* 30 74% 66 53% Angina before admission 32 78% 121 97% Duration of disease month 185 71 LV function EF, % 572 591 EF40% 37 90% 122 98% AMI acute myocardial infarction LV Left ventricleefejection fractionuaunstable angina *p0.0 p0.01 p0.001 심전도및운동부하검사 Korean Circulation J 1999;293:276-284
Table 2. ECG changes during chest pain and treadmill test of subjects Group A Group B n41 patients n125 patients ECG changes during chest pain ST-segment elevation* 29 71% 29 23% ST-segment depression 5 12% 13 10% T wave inversion 1 19 15% AV block 0 1 Ventricular tachycardia 1 1 No change 4 10% 13 10% Treadmill test premedication 23 73 Positive on treadmill test 9 39% 22 30% ST-sement elevation 3 33% 0 ST-segment depression 6 67% 22 100% ECG electrocardiogram AMI acute myocardial infarctionavatrioventricular*p0.05 p0.001 관동맥조영검사및연축유발검사 추적관찰 : 심혈관계사건및자연관해율 Table 3. Angiographic characteristics and spasm provocation test of subjects Extents of CAD Group A Group B n41 patients n125 patients Normal 18 44% 74 59% Near normal 18 44% 48 38% Mild stenosis 50% & 70%* 5 12% 3 2% 1-vessel disease 6 15% 9 7% 2-vessel disease 0 1 Diameter stenosis of lesion % Before NTG injection 802 801 After NTG 435 282 Documentation of spasm Spontaneous coronary spasm 23 56% 56 45% Provocation test Ergonovine 18 44% 27 21% Acetylcholine 42 34% E1 or ach1 7 39% 36 52% Multivessel spasm 11 2% 24 19% Artery involved in spasm LADRCA 2818 6076 Proximal 25 60 AMIacute myocardial infarctioncadcoronary artery disease NTG nitroglycerin E1 or Ach1 ergonovine 50 ug or acetylcholine 20 ugladleft anterior descending artery RCA right coronary artery*p0.05 p0.01 279
Table 4. Clinical follow-up of subjects Group A:Q파및비Q파심근경색증 280 Group A Group B n41 patients n125 patients Follow-up period year* 3.60.4 2.30.2 Cardiac complications Death cardiac cause 0 3 2% Myocardial infarction 1 2% 3 2% Syncope 0 3 2% Medication Calcium channel blocker 36 88% 114 91% Nitrate 35 85% 109 87% Potassium channel 5 12% 26 21% ACE-inhibitor* 10 29% 9 7% Response to medication No sx without medication 3 7% 11 9% No sx with medication 25 61% 54 43% Sx without medication 2 5% 9 7% Sx with medication 11 27% 51 41% AMIacute myocardial infarctionsxsymptom No Sx without medicationspontaneous remission Sx with medicationrecurrent anginaaceangiotensin converting enzyme*p0.01 고 안 임상적특성 Korean Circulation J 1999;293:276-284
Table 5. Clinical and angiographic characteristics and cardiac events of patients with variant angina who were presented with AMI by Q-wave infarction QMI n27 Group A non-qmi n14 Group B n125 Age year 49 2 52 2 54 1 Sex Male 24 89%* 8 57% 73 58% Angina before admission 21 78% 12 86% 121 97% Frequency of pain 5wk 4 15% 1 7% 32 26% Duration of disease month 21 6 1321 7 1 Smoking 23 85% 7 50% 66 53% ECG changes during pain ST-segment elevation 24 89%* 5 36% 29 23% Extents of CAD Normal 12 44% 6 43% 74 59% Mild 50% & <70% 3 11% 2 14% 3 2% Diameter stenosis % After NTG injection 20 4 18 5 11 1 ACE-inhibitor 9 33%* 1 7% 9 7% Cardiac complications Death cardiac cause 0 0 3 2% Myocardial infarction 0 1 7% 3 2% Remission 2 7% 1 7% 11 9% AMIacute myocardial infarctionqmiq wave myocardial infarctioncadcoronary artery disease ECGelectrocardiogramNTGnitroglycerinACEangiotensin converting enzyme*p0.01 vs. Group B p0.05 vs. non-qmi patients p0.05 vs. Group B p0.01 vs. non-qmi patients 관동맥조영검사및연축유발검사 281
추적관찰 282 Korean Circulation J 1999;293:276-284
연구의제한점 요약 연구배경 : 방법 : 결과 : 283
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