Original Articles Korean Circulation J 1999;291:14-21 급성심근경색증환자의장기생존율및예후인자 김석연 한주용 김용진 성지동 채인호 김효수손대원 오병희 이명묵 박영배 최윤식 이영우 Long Term Survival Rate and Prognositc Factors of Acute Myocardial Infarction Seok-Yeon Kim, MD, Joo-Yong Han, MD, Yong-Jin Kim, MD, Ji-Dong Sung, MD, In-Ho Chae, MD, Hyo-Soo Kim, MD, Dae-Won Shon, MD, Byung-Hee Oh, MD, Myoung-Mook Lee, MD, Young-Bae Park, MD, Yun-Shik Choi, MD and Young-Woo Lee, MD Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea ABSTRACT Background and MethodsTo identify the long term survival rate and prognostic factors of acute myocardial infarction AMI in Korea, total 1139 patients who presented between Jan. 1980 and Dec. 1997 at Seoul National University Hospital were followed for an average of 115 months. 321 patients died during follow up periods, 238 patients were lost and 580 patients are alive till the end point of the study. ResultsOverall survival rates standard error were 88.21, 86.81, 85.31.1, 82.11.2, 79.61.3, 75.61.5, 73.11.6, 56.32.5 at 1, 6, 12, 24, 36, 48, 60, 120 months. In univariate analysis, older, history of diabetes, higher degree of Killip class, higher peak creatine kinase level, residual ischemia on treadmill test or MIBI scan, lower ejection fraction on echocardiography or gated blood pool scan, more severe extent of coronary artery disease, lower HDL-cholesterol level at least 3 months after AMI proved as poor long term prognostic factors of AMI with statistical significance p0.05. Sex, body mass index, history of hypertension, hsitory of angina, history of infarction, infarct site on electrocardiography, existence of Q-wave, patency of infarct related arteries, total cholesterol level, HDL- and LDL-cholesterol at the time of AMI, total cholesterol and LDL-cholesterol at least 3 months after AMI did not show statistical significance p0.05. In multivariate analysis, old age and Killip class III versus I proved as independent poor long term prognostic factors of AMI with statistical significance p0.05 at combinations of age, sex, Killip class, existence of Q-wave, history of diabetes, ejection fraction on gated blood pool scan. ConclusionThe morthality of AMI is composed of two components. At acute phase, within 1 month, the mortality reaches to about 12, and at chronic phase, after 1 month from AMI, mortality increases by 3 a year for 10 years. The other conclusion is old patients who have poor left ventricular functions show poor prognosis. Korean Circulation J 1999;291:14-21 KEY WORDSAMISurvival rate Prognostic factor. 14
서론 방법및대상 결과 Fig. 1. Survival rate of AMI. Fig. 2. Distribution of age and sex in patients with AMI. 15
Fig. 3. Comparison of survival rates between sex. 16 Table 1. Clinical features of AMI Body mass index BMI 18.4 N20 3% 18.524.9 25.029.9 518 66% 228 29% 30.039.9 14 2% Killip class I N820 72% II 161 14% III 84 7% IV 75 7% Infarct site on ECG Anterior N646 57% Inferior 391 34% AntInf 46 4% Lateral 47 4% Others 10 1% Infarct-Related artery LAD N408 56% Previous DM Previous HT Previous angina LCx RCA 90 11% 223 33% N237 21% N455 40% N423 37% Previous MI N73 6% Q wave infarct N151 13% Extent of CAD on CAG Normal N36 5% 1VD 2VD 3VD 367 49% 186 25% 159 21% Table 2. Significant prognostic factors for AMI on acute phase Age per year increase 1.05 1.042 1.064 DM present vs absent 1.91 1.493 2.435 Previous MI present vs absent 1.55 1.062 2.257 Killip class III vs I 2.18 1.975 2.411 Treadmill test positive vs negative 3.23 1.326 7.872 Sex male vs female 0.53 0.417 0.680 EF by scan per % increase 0.97 0.953 0.984 EF by echo per % increase 0.95 0.938 0.970 Post-MI within 7 day cholesterol* 0.99 0.994 1.000 Post-MI after 1 month HDL-chol* 0.97 0.947 0.996 * per 1 mg/dl increase p0.05 univariate analysis Korean Circulation J 1999;291:14-21
Table 3. Risk factors without prognostic significance on acute phase Body mass index 0.99 0.929 1.058 Hypertension present vs absent 1.02 0.814 1.287 Previous MI present vs absent 1.24 0.991 1.559 Peak CK level 1.00 1.000 1.000 Q vs non-q infarct 0.82 0.559 1.127 No. of involved vessels 1.69 1.373 2.079 Patency on CAG present vs absent 0.92 0.647 1.309 Post-MI within 7 day HDL-Chol* 1.01 0.998 1.028 Post-MI within 7 day LDL-Chol* 0.99 0.995 1.004 Post-MI after 1 month Cholesterol* 0.99 0.994 1.002 Post-MI after 1 month LDL-Chol* 1.01 0.999 1.012 * per 1 mg/dl increase p0.05 univariate analysis Table 4. Independent prognostic factors for AMI on acute phase Age per year increase* 1.04 1.005 1.007 Sexmale vs female 1.96 0.664 5.804 Killip class II vs I* 2.32 1.187 4.514 Killip class III vs I* 4.99 1.659 15.01 Killip class IV vs I 4.47 0.575 34.78 Q vs non-q infarct 1.41 0.497 4.031 Chol within 7 day 1.01 0.997 1.001 HDL-Chol after 1 month 0.97 0.945 1.011 n439 *p0.05 multivariate Cox proportional hazard model * Table 5. Significant prognostic factors for AMI after recovery Age per year increase 1.06 1.049 1.079 DM present vs absent 1.93 1.389 2.675 Peak CK level 1.00 1.000 1.000 Killip class 1.66 1.393 1.983 Treadmill test positive vs negative 3.81 1.486 9.749 EF by scan per % increase 0.97 0.958 0.990 EF by echo per % increase 0.97 0.954 0.993 HDL-Chol after 1 month 0.97 0.947 0.946 No. of involved vessels 1.68 1.341 2.112 p0.05 univariate analysis Table 6. Independent prognostic factors for AMI after recovery Age per year increase* 1.05 1.018 1.087 Sex male vs female 1.28 0.522 3.119 Killip class II vs I 1.74 0.889 3.412 Killip class III vs I* 5.37 2.280 12.63 Killip class IV vs I 4.73 0.530 42.20 Q vs non-q infarct 1.21 0.396 3.685 DM present vs absent 1.21 0.889 3.263 EF by scan per % increase 0.99 0.965 1.014 n350 *p0.05 multivariate Cox proportional hazard model 17
18 고안 Korean Circulation J 1999;291:14-21
요약 연구배경 : 방법 : 결과 : 19
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