Predictive Factors for Long-term Clinical Outcomes in Patients with Variant Angina

이형 협심증 환자의 장기적 임상 예후에 영향을 미치는 인자

Background/Aims: The incidence of variant angina (VA) is relatively high in Korea compared with western countries, but its long-term clinical outcomes are not well defined. Methods: Patients who underwent ergonovine provocation tests at the cardiac catheterization laboratory of Chonnam National University Hospital between 1996 and 2011 were enrolled in this study (n = 1162). Of them, 686 patients with positive ergonovine provocation tests were divided into two groups: patients with cardiac events (Group I: 153 patients, 52.4 ${\pm}$ 11.0 years, M: F = 103: 50) and those without (Group II: 533 patients, 51.6 ${\pm}$ 10.7 years, M: F = 350: 183). The mean follow-up duration was 40.2 ${\pm}$ 38.0 months. Cardiac events were defined as cardiac death, recurrent ischemia, rehospitalization, myocardial infarction, and follow-up angiography. Clinical findings, laboratory and coronary angiographic characteristics were compared between the groups. Results: A history of smoking was more common in Group I than in Group II (45.8% vs. 36.3%, p = 0.037). The levels of low-density lipoprotein cholesterol (119.4 ${\pm}$ 35.3 vs. 111.1 ${\pm}$ 32.2 mg/dL, p = 0.010) were higher in Group I than in Group II. According to Cox proportional hazard regression analysis, the major predictive factor for cardiac events during clinical follow-up was smoking (HR 1.80, 95% CI 1.036-3.126, p = 0.037). Conclusions: A history of smoking was the only independent risk factor for cardiac events during a long-term clinical follow-up in Korean patients with variant angina.

목적: 한국에서는 혈관 연축에 의하여 발생하는 변이형 협심증이 서양에 비하여 많으며, 이에 대한 국내 환자의 장기적 임상 예후에 관한 보고는 많지 않은 실정이다방법: 1996년부터 2011년까지 전남대학교 병원 심장센터 심도자실에서 ergonovine 유발검사를 시행하였던 1,162예 중 양성 결과를 보였던 686예를 대상으로 40.2 ${\pm}$ 38.0개월간 추적관찰 기간 중 반복적인 흉통, 재입원, 심근경색증, 심장사, 관상동맥 조영술이 필요하였던 경우를 심장사건으로 정의하고 이가 발생하였던 153예(I군: 52.4 ${\pm}$ 11.0 세, 남:여 = 103:50)와 발생하지 않았던 533예(II군: 51.6 ${\pm}$ 10.7 세, 남:여 = 350:183)로 분류하였다. 양 군 간에 임상적 소견, 검사실 소견, 관상동맥 조영술 등을 비교하였다. 결과:흡연력은 I군에서 II군보다 높았으며(45.8% vs. 36.3%, p = 0.037), 저밀도 지단백 콜레스테롤(119.4 ${\pm}$ 35.3 vs. 111.1 ${\pm}$ 32.2 mg/dL, p = 0.010) 수치도 I군에서 높았다. Cox 비례 위험 모형을 이용한 분석에서 유의한 심장사건 예측인자는 흡연이었다(HR 1.80, 95% CI 1.036-3.126, p = 0.037). 결론: 한국인 변이형 협심증 환자에서 흡연이 심장사건 발생의 유일한 예측인자이었다.