• 대한한방내과학회지
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• 제44권3호
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• pp.387-401
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• 2023

Objective: This study was conducted to investigate the preventive effect of herbal medicines on restenosis after percutaneous coronary intervention (PCI) by reviewing randomized controlled trials (RCTs). Methods: RCTs were searched for herbal medicine treatment after PCI using eight online databases (PubMed, CNKI, Wanfang, J-STAGE, OASIS, ScienceON, KTKP, and KISS). Studies that confirmed restenosis through coronary angiography at follow-up were selected according to the inclusion and exclusion criteria. The primary outcome was the restenosis rate, and the secondary outcome was the angina recurrence rate. Data were extracted from the final selected studies according to the research methodology and then analyzed with Review Manager 5.4.1. Study quality was assessed using Cochrane's risk-of-bias (RoB) tool. Results: Of the 252 papers obtained through the primary search, nine studies that met the selection criteria were finally selected. In these nine studies, herbal medicine combined with western medicine was used for the experimental group, and western medicine treatment was used alone for the control group. The meta-analysis result revealed that the restenosis rate and angina recurrence rate were significantly lower in the experimental group than in the control group (RR=0.34, 95% CI: 0.22-0.53, p<0.00001, I²=0% and RR=0.47, 95% CI: 0.29-0.78, p=0.004, I²=0%, respectively). Furthermore, the quality of studies assessed by Cochrane's RoB was low. Conclusions: This study showed that the combined treatment of herbal medicine and western medicine was effective in preventing restenosis and angina after PCI. As the number of papers included in this study was small, a large number of high-quality clinical studies should be considered in the future.

• 한국콘텐츠학회논문지
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• 제14권5호
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• pp.251-261
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• 2014

본 연구는 일차적인 경피적 관상동맥 중재술(percutaneous coronary intervention, PCI)를 시술 받은 65세 이상의 고령 환자들에서 임상적 특성, 관상동맥 병변 및 중재술의 특성, 병원 내 및 1년 사망률과 주요심장사건(major adverse cardiac events, MACE)의 발생에 대해 알아보고자 하였다. 2006년 1월 1일부터 2010년 12월 30일까지 모 대학병원 심혈관센터에서 급성 심근경색증으로 진단받고 흉통 발생 12시간 이내 관상동맥 조영술 및 일차적 PCI를 시행 받은 환자 1,974예를 대상으로 하였고, 65세 이상의 I군(1,018예, 연령 $73.8{\pm}5.99$세, 남자 : 여자 = 574 : 821)과 65세 이하의 II군(956예, 연령 $52.8{\pm}7.96$세, 남자 : 여자 = 444 : 135)으로 나누어 분석하였다. 심혈관질환의 위험인자는 I군에서 더 높았고, 흡연력, 고지혈증, 가족력은 II군에서 높았다. PCI 표적 병변은 I군에서 좌주관지(2.7 vs. 1.6%, p=0.007)가 유의하게 많았으며, 다혈관병변(54.5 vs. 41.0%, p<0.001)도 I군에서 많았다. 병원 내 사망(8.4 vs. 1.9%)과 MACE(20.1 vs. 14.0%)는 I군에서 많이 관찰되었다(p<0.001). 로지스틱 다중회귀분석 결과 65세 이상 고령 환자에서 1년 사망률에 영향을 미치는 독립적인 인자는 내원 시 혈중 creatinine 1.3 mg/dL 이상, 뇌혈관 질환, 수축기 혈압<100 mmHg, Killip class II 이상, 다혈관 질환, 그리고 좌심실 구혈률 <40%로 나타났다.

• Korean Circulation Journal
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• 제48권11호
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• pp.989-999
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• 2018

Background and Objectives: We aimed to compare outcomes of complete revascularization (CR) versus culprit-only revascularization for ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) in the $2^{nd}$ generation drug-eluting stent (DES) era. Methods: From 2009 to 2014, patients with STEMI and MVD, who underwent primary percutaneous coronary intervention (PCI) using a $2^{nd}$ generation DES for culprit lesions were enrolled. CR was defined as PCI for a non-infarct-related artery during the index admission. Major adverse cardiovascular event (MACE) was defined as cardiovascular (CV) death, non-fatal myocardial infarction, target lesion revascularization, or heart failure during the follow-up year. Results: In total, 705 MVD patients were suitable for the analysis, of whom 286 (41%) underwent culprit-only PCI and 419 (59%) underwent CR during the index admission. The incidence of MACE was 11.5% in the CR group versus 18.5% in the culprit-only group (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.37-0.86; p<0.01; adjusted HR, 0.64; 95% CI, 0.40-0.99; p=0.04). The CR group revealed a significantly lower incidence of CV death (7.2% vs. 12.9%; HR, 0.51; 95% CI, 0.31-0.86; p=0.01 and adjusted HR, 0.57; 95% CI; 0.32-0.97; p=0.03, respectively). Conclusions: CR was associated with better outcomes including reductions in MACE and CV death at 1 year of follow-up compared with culprit-only PCI in the $2^{nd}$ generation DES era.

• Journal of Preventive Medicine and Public Health
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• 제55권4호
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• pp.351-359
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• 2022

Objectives: The Regional CardioCerebroVascular Center (RCCVC) project was initiated to improve clinical outcomes for patients with acute myocardial infarction or stroke in non-capital areas of Korea. The purpose of this study was to evaluate the outcomes and issues identified by the Busan RCCVC project in the treatment of ST-segment elevation myocardial infarction (STEMI). Methods: Among the patients who were registered in the Korean Registry of Acute Myocardial Infarction for the RCCVC project between 2007 and 2019, those who underwent percutaneous coronary intervention (PCI) for STEMI at the Busan RCCVC were selected, and their medical data were compared with a historical cohort. Results: In total, 1161 patients were selected for the analysis. Ten years after the implementation of the Busan RCCVC project, the median door-to-balloon time was reduced from 86 (interquartile range [IQR], 64-116) to 54 (IQR, 44-61) minutes, and the median symptom-to-balloon time was reduced from 256 (IQR, 180-407) to 189 (IQR, 118-305) minutes (p<0.001). Inversely, the false-positive PCI team activation rate increased from 0.6% to 21.4% (p<0.001). However, the 1-year cardiovascular death and major adverse cardiac event rates did not change. Even after 10 years, approximately 75% of the patients had a symptom-to-balloon time over 120 minutes, and approximately 50% of the patients underwent inter-hospital transfer for primary PCI. Conclusions: A decade after the implementation of the Busan RCCVC project, although time parameters for early reperfusion therapy for STEMI improved, at the cost of an increased false-positive PCI team activation rate, survival outcomes were unchanged.

• Journal of Preventive Medicine and Public Health
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• 제57권3호
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• pp.260-268
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• 2024

Objectives: Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival. Methods: A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed. Results: The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions: Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.

• 디지털융복합연구
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• 제19권12호
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• pp.661-673
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• 2021

본 연구는 관상동맥중재술을 받은 남성의 건강행위 이행에 미치는 영향을 경과기간을 중심으로 파악하기 위한 서술적 상관관계 연구이다. 연구 대상자는 일개 대학병원에서 관상동맥중재술을 받은 남성 249명이며, 2017년 9월 1일부터 2018년 4월 30일까지 자료수집이 이루어졌다. 자료는 Stepwise multiple regression을 사용하여 분석하였다. 연구결과 건강행위 이행에 영향을 미치는 요인은 자기조절 중 자율적 동기(β=.35, p<.001), 교육요구도 중 위험요소(β=-.26, p<.001), 질병의 경과기간(β=.19, p<.001), 결혼 여부(β=.15, p=.001), 최종 학력(β=-.12, p=.035)이며, 총 설명력은 29.1%였다. 관상동맥 중재술을 받은 남성 환자의 건강행위 이행을 높이기 위해서는 중증도가 높고 경과시간이 1년 미만인 대상자의 자율적 동기를 강화할 수 있는 프로그램 개발이 필요하다.

• 약학회지
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• 제51권3호
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• pp.186-193
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• 2007

This study was performed to analyse the economic value of abciximab which is used in PCI to prevent high-risk patients with ischemic complications. The effectiveness of abciximab was extracted from published clinical trials by search-ing CCIS, and the direct medical costs relevant to using abciximab were estimated from the NHI claims database. The results in terms of cost per life-year gained (LYG) and cost per QALY gained showed that abciximab was cost-effective enough to deserve its cost. Social net benefit resulting from abciximab in PCI was estimated to be 60-70 billion Won per year.

• Journal of Chest Surgery
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• 제39권5호
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• pp.399-402
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• 2006

스텐트 혈전증은 경피적 관상동맥 중재술의 드문 합병증으로 치명적인 결과를 일으킬 수 있다. 저자들은 스텐트 혈전에 의한 심인성 쇼크와 심실성 빈맥이 동반된 급성 심근경색 환자 1예를 경피적 심폐 순환 보조 요법으로 성공적으로 치료하였기에 보고하고자 한다.

• Journal of Chest Surgery
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• 제38권11호
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• pp.733-738
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• 2005

배경: 경피적 관상동맥중재술과 최소침습성 관상동맥우회술을 병합하여 시행하는 하이브리드 관상동맥우회술(hybrid coronary artery bypass surgery; hybrid CABG)는 고위험군 환자에서 심근의 불완전한 재관류가 예상되는 경우에 수술관련 유병률을 낮추고 완전 재관류화를 이루기 위하여 적용할 수 있다. 대상 및 방법: 1998년 1월부터 2004년 7월 사이에 심폐바이패스를 사용하지 않고 관상동맥우회술을 시행한 782명의 환자 중에서 수술 전, 후에 경피적 관상동맥중재술을 같이 시행한 25명$(3.2\%)$의 환자들(M : F=17:8)을 대상으로 임상적 결과 및 심혈관 조영술을 통한 개존율을 비교하였다. 결과: 수술 전에 중재술을 시행한 8예 중 7예는 최소절개 관상동맥우회술을 시행하기에 부적합한 병변에 대해서 경피적 관상동맥중재술을 시행하였고, 다른 1예는 급성심근경색증에서 culprit병변에 대한 응급 중재술후 관상동맥우회술이 필요했던 경우였다. 수술 후 중재술을 시행한 17예는 관상동맥의 중등도 병변($70\~90\%$ 협착)으로 수술 후 이식도관과의 경쟁혈류가 예상되었던 경우 8예, 관상동맥병변이 혈관 전체에 광범위하여 혈관문합이 불가능했던 경우 5예, 상행대동맥 석회화를 동반하면서 이용 가능한 동맥 우회도관의 부족 3예, 그리고 심근내 관상동맥의 주행 1예 등에서 관상동맥우회술 후에 대상혈관에 대한 경피적 중재술을 시행하였다. 관상동맥우회술시 평균 원위부 문합수는 평균 $2.3\pm1.0$ 개소였으며, 중재술로 치료된 병변의 수는 평균 $1.2\pm0.4$개소였다. 중재술 및 수술관련사망은 없었다. 중재술관련 합병증으로 심근경색이 발생한 경우 1예가 있었으며 수술관련 합병증으로는 일시적인 심방세동 5예, 수술전후 심근경색 1예, 일시적 신기능저하 1예가 있었다. 전례에서 수술 후 평균 $1.8\pm1.6$일째에 관상동맥조영술을 시행하여 모든 도관의 개존율$(100\%=57/57)$을 확인하였다 수술 전 중재 술을 시행한 1개소에서는 중재술 부위의 재협착소견이 보여 수술 후 조영술시 재풍선확장술로 치료하였다. 수술 후 추적관찰(평균 $25\pm26$개월)동안 1예에서 심부전으로 사망하였다. 생존한 환자 24예에서 술 후 평균 $9.6\pm3$개월째에 관상동맥조영술을 시행하였고 이식도관이 string 징후를 보인 1예를 제외하고 모두 개존(56/57)되어 있었으며, 약물용출형 스탠트를 시행하기 이전의 12예의 중재술 중 2예에서 $50\%$ 이상의 스텐트 협착이 있었으나 흉통의 재발은 없었다. 결론: 하이브리드 관상동맥 우회 술은 수술위험도를 낮추기 위하여 최소절개 관상동맥우회술과 병합하여 시도될 수 있을 뿐 아니라, 선택적 환자들에서는 정중 흉골절개 관상동맥우회술과 병합하여 수술관련 유병률을 낮추고 심근의 완전 재관류화를 도모할 수 있었다.

• Korean Circulation Journal
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• 제53권12호
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• pp.843-854
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• 2023

Background and Objectives: We evaluated the effect of diabetes on the relationship between body mass index (BMI) and clinical outcomes in patients following percutaneous coronary intervention (PCI) with drug-eluting stent implantation. Methods: A total of 6,688 patients who underwent PCI were selected from five different registries led by Korean Multicenter Angioplasty Team. They were categorized according to their BMI into the following groups: underweight (<18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight to obese (≥25.0 kg/m²). Major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, nonfatal myocardial infarction, stroke, and target-vessel revascularization, were compared according to the BMI categories (underweight, normal and overweight to obese group) and diabetic status. All subjects completed 1-year follow-up. Results: Among the 6,688 patients, 2,561 (38%) had diabetes. The underweight group compared to normal weight group had higher 1-year MACCE rate in both non-diabetic (adjusted hazard ratio [HR], 2.24; 95% confidence interval [CI], 1.04-4.84; p=0.039) and diabetic patients (adjusted HR, 2.86; 95% CI, 1.61-5.07; p<0.001). The overweight to obese group had a lower MACCE rate than the normal weight group in diabetic patients (adjusted HR, 0.67 [0.49-0.93]) but not in non-diabetic patients (adjusted HR, 1.06 [0.77-1.46]), with a significant interaction (p-interaction=0.025). Conclusions: Between the underweight and normal weight groups, the association between the BMI and clinical outcomes was consistent regardless of the presence of diabetes. However, better outcomes in overweight to obese over normal weight were observed only in diabetic patients. These results suggest that the association between BMI and clinical outcomes may differ according to the diabetic status.