The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Clinical impact of symptom-to-door time on 1-year mortality in patients with non-ST segment elevation acute myocardial infarction

ST분절 비상승 심근경색증 환자에서 증상발생 후 병원 도착 시간이 일년 후 사망률에 미치는 임상적 영향

Lee, Sun-Ok;Oh, Sang-Eun;Jeong, Myung-Ho;Kim, Hyun-Kuk;Jeon, Hae-Jung;Choi, Young-Ja;Kim, Sung-Soo;Ko, Jum-Suk;Lee, Min-Goo;Sim, Doo-Sun;Park, Keun-Ho;Yoon, Nam-Sik;Yoon, Hyun-Ju;Park, Hyung-Wook;Kim, Kye-Hun;Hong, Young-Joon;Kim, Ju-Han;Ahn, Young-Keun;Cho, Jeong-Gwan;Park, Jong-Chun;Kang, Jung-Chaee
이선옥;오상은;정명호;김현국;전해정;최영자;김성수;고점석;이민구;심두선;박근호;윤남식;윤현주;박형욱;김계훈;홍영준;김주한;안영근;조정관;박종춘;강정채

  • Published : 20100600
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Abstract

Symptom-to-door time is associated with the prognosis for ST-segment elevation myocardial infarction. However, this value has not been a concern in patients with non-ST segment elevation myocardial infarction (NSTEMI). The aim of this study was to assess the relationship between symptom-to-door time and clinical outcomes in patients with NSTEMI. Methods: In total, 1,971 patients with NSTEMI (64.8${\pm}$12.1 years, 23.6% women) were enrolled between Nov. 2005 and Jan. 2008. The patients were divided into two groups according to the time difference between the presentation of symptoms and first medical contact: group I (<12 hours, n=1433) and group II (>12 hours, n=538). One-year mortality rates were compared between the groups. Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores were calculated in all study patients. Results: The mean age was 64.4${\pm}$12.2 years in group I and 65.6${\pm}$12.0 years in group II (p=0.046). No significant differences existed between the two groups, except for the prevalence of hypertension, diabetes mellitus, initial systolic blood pressure, and initial serum creatinine levels. One-year mortality rates decreased significantly in group I patients [hazard ratio (HR)=1.35, 95% CI (confidential interval): 1.03~1.75, p=0.028] based on a multivariate Cox proportional analysis, which was adjusted by GRACE score, baseline characteristic variables, and predictors of a 1-year mortality in a univariate analysis. In intermediate-to high-risk patients (n=1,184, defined as having a TIMI risk score above 3 points), significant differences were observed in mortality rates between the two groups (HR=1.35, 95% CI: 1.02~1.80, p=0.037); the low-risk patients (n=787, HR=1.57, 95% CI: 0.80~3.05, p=0.188), however, showed no such differences. Conclusions: Symptom-to-door time was an independent long-term clinical predictor in patients with NSTEMI, especially in intermediate-to high-risk groups.

목적: 증상발생 후 병원도착 시간(symptom-to-door time)은 ST분절 상승 심근경색증(STEMI) 환자에서 질병의 예후에 관련이 있다고 알려져 있으나, ST분절 비상승 심근경색증(NSTEMI) 환자에서는 확실한 관계가 아직까지 입증되지 않고 있다. 본 연구에서는 NSTEMI 환자에서 증상 발생 후 병원도착 시간이 일년 후 사망률에 미치는 영향에 대하여 알아보고자 하였다. 방법: 2005년 11월부터 2008년 1월까지 응급의료센터에 내원한 STEMI 1,971예(64.8${\pm}$12.1세, 여성 23.6%)를 대상으로 하였다. 증상발생부터 내원 시간이 12시간 이내를 I군(n=1,433), 12시간 이상을 II군(n=538)으로 분류하여 GRACE score 및 TIMI risk score를 평가하였고, TIMI risk score와 1년 후 사망률과 관계를 분석 비교하였다. 결과: 위험인자에서 고혈압(I군 51.8%, II군 58.7%, p=0.006)과 당뇨병(I군 29.8%, II군 34.8%, p=0.032)이 II군에서 많았으며, GRACE score 및 위험인자를 보정한 Cox proportional analysis에서 I군에서 II군에 비하여 1년 사망률이 유의하게 낮았다[hazard ratio (HR)=1.35, 95% CI (confidential interval)=1.03~1.75, p=0.0028]. 특히, TIMI risk score 3점 이상의 증등도 고위험 환자(n=1184)에서 증상발생 후 내원 시간이 짧은군에서 사망률이 유의하게 낮았으며(HR 1.35, 95% CI 1.02~1.80, p=0.037), 3점 이하의 저위험 환자(n=787)에서는 사망률은 유의한 차이는 없었다(n=787, HR 1.57, 95% CI 0.85~3.05, p=0.188). 결론: NSTEMI 환자 중에서 고위험군에서 증상발생 후 병원 도착 시간이 12시간 이내인 환자에서 사망률이 낮았다.

Keywords

References

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