Original Articles 27 9 1997 비 Q 파급성심근경색증환자의임상적특징 Abstract 김성희 김준우 김주한 안영근 배열 박종철 차광수박주형 정명호 * 조정관 * 박종춘 * 강정채 * Clinical Features of Non-Q Wave Acute Myocardial Infarction Sung Hee Kim, M.D., Joon Woo Kim, M.D., Ju Han Kim, M.D., Young Keun Ahn, M.D., Yul Bae, M.D., Jong Cheol Park, M.D., Kwang Soo Cha, M.D., Joo Hyung Park, M.D., Myung Ho Jeong, M.D.,* Jeong Gwan Cho, M.D.,* Jong Chun Park, M.D.,* Jung Chaee Kang, M.D.* Department of Internal Medicine, Chonnam University Medical School, Chonnam, Korea Research Institute of Medical Sciences,* Chonnam National University, Chonnam, Korea BackgroundNon-Q wave myocardial infarctionnqmi is known to have smaller infarct size and less degree of ventricular dysfunction than Q wave myocardial infarctionqmi. However, clinical characteristics of NQMI compared to QMI are not known exactly. To evaluate the clinical outcome of NQMI, retrospective analysis of NQMI was performed. MethodSubjects were 155123 male, 32 female61.111.4 yearspatients with acute myocardial infarction who visited the emergency room of Chonnam University Hospital between January 1995 and July 1996. Inclusion criteria were prolonged30 min angina, persistent EKG changes consistent with QMI or NQMI, an increasetwice than normalin serum CKnormal30170 U/L with CK- MBnormal016 U/L enzyme. Thirty four28 male, 6 female62.711.2 years) patients were diagnosed as NQMI and 12195 male, 26 female60.611.5 yrs patients as QMI. Results 1 Percentage of patients who received thrombolytic therapy was not different between NQMI50 % and QMI51 %. 2 There was no differences in the atherosclerosis risk factors between NQMI and QMI. 3 Peak cardiac enzyme was not different between NQMI and QMI. 4 Lateral wall infarction by EKG was more frequent in NQMI than QMI8.8 vs. 0.8 %, p0.05. 5 According to coronary angiogram, LCX involvement was more frequent in NQMI than in QMI17.8 vs. 1 %, p0.05. 6 Percentage of coronary revascularizations, including PTCA and CABG, was not different between two groups. 7 There were no differences in the incidences of in-hospital mortality and arrhythmia between two groups. 8 During 10.911 months follow-up, reinfarction rate was more frequent in NQMI than in 875
QMI7.1 vs. 2 %, p0.05. ConclusionNQMI is associated with similar complication rates with QMI and higher re-infarction rates than QMI, and thus NQMI should be treated rigorously at early and follow-up time periods. KEY WORDSNon-Q wave myocardial infarction Q wave myocardial infarction Complication rate Re-infarction rate. 서론 대상및방법 876
결과 1. 관찰대상환자의임상적차이 2. 응급실내원시간 3. 혈전용해제투여 4. 심전도소견 Table 1. Clinical characteristics of QMI and NQMI QMI NQMI Age 60.611.5 62.711.2 SexMF 9526 286 Risk factors Family history 8 6.6% 1 2.9% Smoking 8166.9% 2470.5% Hypertension 4133.8% 926.4% Diabetes 2218.1% 720.5% Hyperlipidemia 1814.8% 514.7% QMIQ wave myocardial infarction NQMINon-Q wave myocardial infarction 877
5. 심근효소및혈청지질소견 6. 관상동맥및좌심실조영술소견 Table 2. Coronary angiographic findings QMI n=99 NQMI n=28 p value Number No stenosis 4 3.9% 2 6.6% NS of 1 vessel 4039% 1343% NS involved 2 vessels 3736% 1137% NS vessels 3 vessels 2222% 413% 0.05 Involved LAD 3434.4% 612% NS vessels LCX 1 1% 517.8% 0.05 RCA 5 5% 27.2% NS LAD+LCX 9 9% 310.7% NS LAD+RCA 1919.2% 621.4% NS LCX+RCA 9 9% 2 7.2% NS LADleft anterior descending artery LCXleft circumflex artery RCAright coronary artery 7. 합병증 8. 관상동맥재관류요법 9. 추적관찰 Table 3. Comparison of Killip class and left ventricular EF between QMI and NQMI QMI NQMI Killip class 6151% 2050% 3629% 823.5% 2117% 3 8.8% 3 2.4% 3 8.8% EF% 5419 5917 EFejection fraction Table 4. Complications during admission QMIn=121 NQMIn=34 Bleeding 5 4.1% 0 0% Arrhythmia 3630% 1029% CHF 2117% 3 9% Shock 3 2.4% 3 9% Death 1215% 3 9% Total 7763% 1955% CHFcongestive heart failure 878
Table 5. Causes of death during admission and follow-up QMI NQMI p value In hospital NS Sudden death 3 0 CHF or Shock 9 3 After discharge NS Sudden death 5 1 Total 1715.5% 412.9% NS Table 6. Clinical course after discharge QMIn=97 NQMIn=28 Event free 7275% 2175% Reccurent pain 1010% 2 7.1% CHF 8 8.2% 2 7.1% Reinfarction 2 2% 2 7.l%* Death 5 5.1% 1 3.5% *p0.05 고 안 879
880
요약 연구배경 : 연구대상및방법 : 결과 : 881
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