The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Early Experience of Busan-Ulsan Regional Cardiocerebrovascular Center Project in the Treatment of ST Elevation Myocardial Infarction

부산.울산 권역심뇌혈관질환센터 사업의 초기 경험

  • Lee, Dong Hyun (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Seo, Jeong-Min (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Choi, Jae-Hyuk (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Cho, Young-Rak (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Park, Kyungil (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Park, Tae-Ho (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Kim, Moo Hyun (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Kim, Young-Dae (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Maeng, Su Youn (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Kim, Doo Yeong (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Ko, Eun Yeong (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Park, Jong Sung (Department of Internal Medicine, Dong-A University College of Medicine)
  • 이동현 (동아대학교 의과대학 내과학교실) ;
  • 서정민 (동아대학교 의과대학 내과학교실) ;
  • 최재혁 (동아대학교 의과대학 내과학교실) ;
  • 조용락 (동아대학교 의과대학 내과학교실) ;
  • 박경일 (동아대학교 의과대학 내과학교실) ;
  • 박태호 (동아대학교 의과대학 내과학교실) ;
  • 김무현 (동아대학교 의과대학 내과학교실) ;
  • 김영대 (동아대학교 의과대학 내과학교실) ;
  • 맹수연 (동아대학교 의과대학 내과학교실) ;
  • 김두영 (동아대학교 의과대학 내과학교실) ;
  • 고은영 (동아대학교 의과대학 내과학교실) ;
  • 박종성 (동아대학교 의과대학 내과학교실)
  • Received : 2012.11.12
  • Accepted : 2013.03.04
  • Published : 2013.09.01
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Abstract

Background/Aims: The purpose of this study was to compare changes in primary percutaneous coronary artery intervention (PCI) outcomes after starting the government-directed Busan-Ulsan Regional Cardiocerebrovascular Center Project. Methods: Patients with ST segment elevation myocardial infarction (STEMI) who visited the Busan-Ulsan Regional Cardiocerebrovascular Center from 1 June 2009 to 30 May 2011 were selected. Their medical records were retrospectively reviewed. Clinical and survival outcomes before and after starting the project were compared. Results: A total of 122 patients (mean age, $63{\pm}13$ years; male, 74%) with STEMI were selected for analysis. There were no significant differences in patients' baseline characteristics. After starting the Busan-Ulsan Regional Cardiocerebrovascular Center Project, the door-to-balloon time decreased from $72{\pm}30$ to $59{\pm}22$ minutes (p = 0.011). The door-to-balloon time when the PCI team did not stay in the hospital also decreased from 80{\pm}30 to $62{\pm}12$ minutes (p = 0.005). However, there was no significant change in the total ischemic time ($339{\pm}293$ vs. $304{\pm}287$ minutes, p = 0.514), survival discharge rate (94% vs. 93%, p = 1.000), or 1-year survival rate (89% vs. 91%, p = 0.996). Conclusions: After starting the government-directed Busan-Ulsan Regional Cardiocerebrovascular Center Project, the door-to-balloon time was significantly reduced. However, the total ischemic time and short-term survival remained unchanged.

목적: 정부주도하 권역심뇌혈관질환센터 사업을 시작하면서 관상동맥 중재시술 성적을 향상하는 것으로 알려진 여러 전략을 적용한 주요 임상경로를 개발하여 운영하였다. 권역심뇌혈관질환센터 사업 시작 전후 1년간의 ST분절 상승 급성심근경색증 치료성적을 비교하여 주요 임상경로 운영의 효율성을 평가한다. 방법: 권역심뇌혈관질환센터 사업을 시작한 2010년 6월 1일을 기준으로 전후 1년씩인 2009년 6월 1일부터 2011년 6월 30일까지 응급실을 내원한 ST분절 상승 급성심근경색증 환자들의 의무기록을 후향적으로 분석하여 중재시술과 관련된 시간지표와 생존지표의 변화를 비교하였다. 결과: 2009년 6월 1일부터 2011년 6월 30일까지 총 169명의 ST분절 상승 급성심근경색증 환자가 응급실 방문하였고 122명의 환자가 관상동맥 중재시술 성적 평가대상으로 선정되었다. 평균연령은 $63{\pm}13$세였고 나이, 성별, 동반질환 등의 임상적 특성은 두 군 간에 큰 차이가 없었다. 사업 시작 후 평균 응급실도착-재관류 시간은 $72{\pm}30$분에서 $59{\pm}22$분으로 평균 $13{\pm}5$분 단축되었으며(p = 0.011), 응급실도착-재관류 시간이 70분 및 90분 미만인 환자의 비율 역시 의미있게 증가하였다. 중재시술팀이 병원에서 대기하지 않는 취약시간대의 응급실도착-재관류 시간도 평균 $18{\pm}5$분 단축되었다(p = 0.005). 그러나 증상발생-응급실도착 및 재관류까지의 시간($339{\pm}293$ vs. $304{\pm}287$분, p = 0.514)은 권역심 뇌혈관질환센터 사업 시작 전후에 차이가 없었으며 생존 퇴원율(94 vs. 93%, p = 1.000)과 1년 생존율(89 vs. 91%, p = 0.996) 역시 차이가 없었다. 결론: 정부주도하 권역심뇌혈관센터 사업 시작 후 관상동맥 중재시술 성적을 향상하는 것으로 알려진 여러 전략을 적용한 주요 임상경로를 적극 운용함으로써 응급실도착-재관류 시간을 의미 있게 단축할 수 있었다. 그러나 총 허혈 시간 및 단기 생존율의 변화는 없었다.

Keywords

Acknowledgement

Supported by : Dong-A university

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