• Journal of Chest Surgery
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• 제33권10호
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• pp.834-838
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• 2000

Left ventricular free wall rupture following acute myocardial infarction (AMI) is the second most common cause of death and has been reported to be responsible for 4 to 24% of all infarction deaths. The rupture occurs anywhere from a few hours to several days after AMI. The common findings of ventricular rupture are persistent chest pain bradycardia and shock. This may be often mistaken for the ruptured dissection of the ascending aorta. The different points from dissection are 1) persistent chest pain 2)persistent ST segment elevation and 3) only intramural hematoma in ascending aorta. We have sucessfully managed two patients with postinfarction myocardial rupture. Surgical management consisted of infarctectomy repairi of the ventricular rupture and coronay artery bypass grafting. We conclude that successful surgical management of ventricular free wall rupture should require prompt diagnosis and emergency operation.

• 보건행정학회지
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• 제13권4호
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• pp.115-130
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• 2003

Reperfusion delay in patients with acute myocardial infarction leads to increased morbidity and mortality. We sought to measure the rates of reperfusion delay and to identify factors associated with reperfusion delay after arrival to hospitals. We included 360 patients who had acute myocardial infarction with ST-elevation or left bundle branch block on electrocardiogram and received reperfusion therapy from the three participating academic medical centers from 1997 to 2000. Through retrospective chart review, we collected data about time to reperfusion therapy, patient and hospital factors potentially associated with reperfusion delay. Factors independently associated with reperfusion delay were determined by logistic regression analysis. Median door­to­needle time was 60.0 minutes, and median door­to­balloon time was 102.5 minutes. According to recommendation of the American College of Cardiology/American Heart Association Guidelines, 226 out of 264(85.6％) of thrombolytic patients and 43 out of 96(44.8％) percutaneous transluminal coronary angioplasty(PTCA) patients experienced reperfusion delay. The significant factors associated with delay were type of reperfusion therapy, patient factors including hypertension and delayed symptom onset to presentation(>4 hours), and hospital factors including nocturnal presentation(6pm∼8am), weekend, and an individual hospital. A significant proportion of patients experienced reperfusion delay. The identified predictors of reperfusion delay may help design a hospital system to reduce the delay in reperfusion therapy

• 대한핵의학회지
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• 제30권1호
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• pp.104-111
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• 1996

저자들은 금성심근경색증으로 진단된 36명에서 응급실 도착후에 시행한 Tc-99m seataMIBl 심근 SPECT를 심전도검사와 비교하여 다음의 결과를 얻었다. 1) 좌전하행관동맥과 우관동맥의 폐쇄로 인한 심근 경색증환자 24명 모두가 안정기 Tc-99m sestamibi 심근 SPECT에서 관류결손을 나타냈고, 심전도상에서는 Q파 혹은 ST절의 상승이 관찰되었다. 2) 좌회선관동맥의 폐쇄로 인한 심근경색증환자 7명 모두 안정기 Tc-99m sestamibi 심근 SPECT에서 측벽에 관류결손이 나타났으나, 이상 Q파는 1명에서만 관찰되었고, 6명에서 ST절의 변화가 보였으며, 1명에서는 정상심전도소견을 보였다. 3) 심혈관촬영술을 시행하지 않은 3예중 2예에서는 심전도상 경색의 위치와 심근 SPECT에서의 관류결손부위가 일치하였으나, 나머지 1예에서는 심전도상 LBBB가 보였고 심근SPECT에서는 하벽에 관류결손이 관찰되 었다. 4) 극성지도를 이용하여 구한 손상된 심근의 면적을 전체심근에 대한 백분율로 표시하면 좌전하행관동맥 : $31.17{\pm}18.21%$, 우관동맥 : $31.17{\pm}13.24%$, 좌회선관동맥 : $24.71{\pm}5.94%$ 이었다. 5) 정성적인 분석에서 심근경색의 진단적 예민도는 100%였고, 관동맥 조영술을 시행하여 경색 관련 관동맥을 진단할 수 있었던 31명의 모든 예에서 심근관류 SPECT로 국소화가 가능하였다. 이상의 결과에서 응급으로 시행한 심근관류 SPECT가 심근경색의 진단에 유용하며, 특히 심전도에서 심근경색증의 판단이 어려운 측벽경색이나 좌각차단이 있는 경우에 유용한 방법으로 생각된다.

• 대한핵의학회지
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• 제39권2호
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• pp.87-93
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• 2005

Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary Intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCI. In the management of patients with 57 segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but mote complete. Recently published evidences in the pharmacologic therapy including antiplatelet and stalin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed.

• Journal of Chest Surgery
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• 제43권2호
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• pp.172-175
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• 2010

61세 남자 환자가 급성 흉통을 주소로 전원 되었으며, 심전도상 ST분절 상승 소견 및 흉통으로 급성 심근 경색 진단 하에 심혈관 조영술을 시행하였다. 좌회선동맥 둔각변연분지의 완전 폐색 소견 보여 대동맥 내 풍선장치 삽입 하에 혈관 중재술을 시행하였으나, 성공적인 혈관 중재술 후에도, 쇼크 지속되어 체외막 산소화 장치를 삽입하였다. 그러나, 이후에도 상태는 호전되지 않았고, 청진 및 심초음파상 심한 급성 승모판 폐쇄 부전 발견되어 승모판막 치환술을 시행하였다. 술 후 이틀째 체외막 산소화 장치 및 대동맥 내 풍선장치를 제거할 수 있었고, 수술 후 48일째 자가 보행 가능한 상태로 퇴원하였다.

• Journal of Yeungnam Medical Science
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• 제29권2호
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• pp.129-131
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• 2012

A 70-year-old male came to the emergency room of the authors' hospital because of sudden cardiac arrest due to inferior wall ST elevation myocardial infarction. His coronary angiography revealed multiple severe coronary spasms in his very long left anterior descending artery. After an injection of intracoronary nitroglycerine, his stenosis improved. The cardiac arrest relapsed, however, accompanied by ST elevation of the inferior leads, while the patient was on diltiazem and nitrate medication to prevent coronary spasm. Recovery was not achieved even with cardiac massage, intravenous injection of epinephrine and atropine, and intravenous infusion of nitroglycerine. The patient eventually recovered through high-dose nicorandil intravenous infusion without ST elevation of his inferior leads. Therefore, intravenous infusion of a high dose of nicorandil must be considered a treatment option for cardiac arrest caused by refractory coronary vasospasm.

• Korean Journal of Radiology
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• 제24권9호
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• pp.827-837
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• 2023

Objective: To investigate the predictive value of radiomics features based on cardiac magnetic resonance (CMR) cine images for left ventricular adverse remodeling (LVAR) after acute ST-segment elevation myocardial infarction (STEMI). Materials and Methods: We conducted a retrospective, single-center, cohort study involving 244 patients (random-split into 170 and 74 for training and testing, respectively) having an acute STEMI (88.5% males, 57.0 ± 10.3 years of age) who underwent CMR examination at one week and six months after percutaneous coronary intervention. LVAR was defined as a 20% increase in left ventricular end-diastolic volume 6 months after acute STEMI. Radiomics features were extracted from the oneweek CMR cine images using the least absolute shrinkage and selection operator regression (LASSO) analysis. The predictive performance of the selected features was evaluated using receiver operating characteristic curve analysis and the area under the curve (AUC). Results: Nine radiomics features with non-zero coefficients were included in the LASSO regression of the radiomics score (RAD score). Infarct size (odds ratio [OR]: 1.04 (1.00-1.07); P = 0.031) and RAD score (OR: 3.43 (2.34-5.28); P < 0.001) were independent predictors of LVAR. The RAD score predicted LVAR, with an AUC (95% confidence interval [CI]) of 0.82 (0.75-0.89) in the training set and 0.75 (0.62-0.89) in the testing set. Combining the RAD score with infarct size yielded favorable performance in predicting LVAR, with an AUC of 0.84 (0.72-0.95). Moreover, the addition of the RAD score to the left ventricular ejection fraction (LVEF) significantly increased the AUC from 0.68 (0.52-0.84) to 0.82 (0.70-0.93) (P = 0.018), which was also comparable to the prediction provided by the combined microvascular obstruction, infarct size, and LVEF with an AUC of 0.79 (0.65-0.94) (P = 0.727). Conclusion: Radiomics analysis using non-contrast cine CMR can predict LVAR after STEMI independently and incrementally to LVEF and may provide an alternative to traditional CMR parameters.

• 한국정보과학회:학술대회논문집
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• 한국정보과학회 2012년도 한국컴퓨터종합학술대회논문집 Vol.39 No.1(C)
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• pp.139-141
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• 2012

이 논문에서는 한국인 급성심근경색증 환자에 대한 KAMIR 데이터를 기반으로 ST분절상승 심근경색이 처음 발병한 환자의 사망에 영향을 미치는 위험요소들을 찾고, 이를 기반으로 ST분절상승 급성심근경색환자의 1년 이내 사망을 예측하는 모델을 제시한다. 총 22개의 속성 중에서 속성 선택 알고리즘을 적용한 결과 나이, 심장박출계수, 크레아티닌, 고감도 C-반응성 단백질 등 4개의 속성이 선택되었고, 이 속성들을 이용하여 더욱 정확한 예측 모델을 구축할 수 있었다. 제시된 모델을 통해서 고위험군 환자의 위험성을 평가하고 예후를 추정할 수 있을 것으로 기대한다.

• 한국임상약학회지
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• 제28권3호
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• pp.250-253
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• 2018

When stenting is applied to treat myocardial infarction, antiplatelet agents are administered to prevent thrombosis, which increases the risk of bleeding. Patients with myocardial infarction are also more likely to have osteoarthritis simultaneously, because both diseases occur frequently in elderly patients. Patients with osteoarthritis often use analgesics, especially nonsteroidal anti-inflammatory drugs (NSAIDs); hence, patients with both diseases use analgesics and antiplatelet agents simultaneously. The risk of bleeding increases with the use of antiplatelet agents and this is further increased when NSAIDs are added. We would like to report a case that reflects this situation. A 60-year-old man underwent stenting after ST-elevation myocardial infarction, and was treated with aspirin and clopidogrel. This patient also received a pelubiprofen prescription from another physician to treat osteoarthritis. After the patient took pelubiprofen twice, he found a bruise on his wrist and reported it to the pharmacist. It is unlikely that this is rare in community pharmacies, so pharmacists should pay careful attention to the concomitant administration of analgesics to patients receiving antiplatelet agents and should provide appropriate education to patients.

• 한국방사선학회논문지
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• 제6권1호
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• pp.5-10
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• 2012

AMI로 SES 혹은 PES 시술을 시행받은 모든 환자에서 4년 이상의 임상추적 기간이 지난 환자를 대상으로 데이터를 분석하여 두 스텐트의 안전성과 유용성을 비교해 보고자 하였다. 2004년 1월 1일부터 2006년 8월 31일까지 본원에서 ST분절 상승 혹은 ST 분절 비상승 급성심근경색증 (STEMI or NSTEMI)로 진단되어 입원 기간 중 관동맥중재술을 시행받은 환자 중 SES 혹은 PES 삽입술이 시행된 환자를 대상으로 후향적 분석을 시행하였다. 그리고 사망, 심장사. 심근경색증, 표적 혈관재관류술, 스텐트 혈전증 발생에 대해 분석하였다. 연구 기간 동안 총 668명의 급성심근경색증 환자가 중 522명만 연구 대상에 포함 사망 ($18.3{\pm}3.0%$ vs. $14.6{\pm}2.2%$, p=0.26), 심장사($11.2{\pm}2.6%$ vs. $6.8{\pm}1.52%$, p=0.39), 심근경색증 ($6.4{\pm}1.8%$ vs. $3.3{\pm}1.1%$, p=0.31), and 스텐트 혈전증 ($5.4{\pm}1.7%$ vs. $3.2{\pm}1.1%$, p=0.53) 표적 혈관재관류술(TVR) ($10.0{\pm}3.0%$ vs. $4.0{\pm}1.2%$, p=0.008) and 심혈관계 임상사건(MACE) ($29.4{\pm}3.5%$ vs. $19.4{\pm}2.5%$, p=0.003) 급성심근경색증의 초기 치료에 약물방출스텐트인 SES와 PES의 4년 장기 임상 성적을 조사한 본 연구를 통해 전체환자를 대상으로 분석하였을 때 두 스텐트의 장기 사망률, 심장사. 심근경색증, 표적 혈관재관류술, 스텐트 혈전증의 발생은 차이가 없었으나 TVR 및 MACE의 발생은 PES 삽입 환자가 SES삽입 환자보다 유의하게 높았다.